IPO: Ackman Fund Postponed

By Staff Reporters

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Bill Ackman’s fund postpones IPO

The billionaire hedge fund boss and frequent main character on X has delayed the stock market debut of the closed-end fund Pershing Square USA, which was scheduled for early next week, a notice on the New York Stock Exchange’s website said.

The decision to wait came days after Ackman said in a letter to investors that the firm was downsizing its expectations for the share sale from a target of about $25 billion (which would have made it the largest-ever IPO of its kind) to something between $2.5 billion and $4 billion.

Ackman has a similar fund already trading shares in Europe and has hinted he might take his larger firm, Pershing Square, public as soon as next year.

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PODCAST: About the Mathematical WOLFRAM ALPHA Computational Knowledge Engine

What it is – How it works

SMART CONTRACTS

[By Staff Reporters]

Wolfram Alpha is an online mathematical search engine launched in March 2009 and developed by Stephen Wolfram. It seeks to answer factual queries directly by computing the answer from structured data, rather than providing a list of web pages that might contain the answer.

In this way, WA differs from traditional semantic search engines, which index a large number of answers and then try to match the question to one. Wolfram Alpha has many parallels with Cyc, a project aimed since the 1980s at developing a common-sense inference engine. Wolfram Alpha is built on Wolfram’s earlier flagship product, Mathematica, which encompasses computer algebra, symbolic and numerical computation, visualization, and statistics capabilities.

With Mathematica running in the background, WA is suited to answer mathematical questions. The answer usually presents a human-readable solution.

Link: http://www.wolframalpha.com/

Technology

Wolfram Alpha is written in about 5 million lines of Mathematica (using webMathematica and gridMathematica) code and runs on 10,000 CPUs. As well as being a web site, Wolfram Alpha provides an API (for a fee) that delivers computational answers to other applications. One such application is the Bing search engine.

Capabilities

As an example, one can input the name of a website, and it will return relevant information about the site, including its location, site rank, number of visitors and more. The database currently includes hundreds of datasets, including current and historical weather, drug data, star charts, currency conversion, and many others. The datasets have been accumulated over approximately two years, and are expected to continue to grow. The range of questions that can be answered is also expected to grow with the expansion of the datasets.

Audio: http://www.wolframalpha.com/screencast/introducingwolframalpha.html

Utility and Usefulness

Wolfram Alpha is ideal for use by all readers and subscribers of the ME-P. It may be used by doctors, nurses, financial advisors and insurance agents, economists, mathematicians, editors, and publishers, teachers and students of all academic levels. The graphical nature of output is particularly helpful.

Assessment

Wolfram Alpha has received mixed reviews, to date. Advocates point to its potential, some even stating that how it determines output result is more important than current usefulness.

Note: Info courtesy wikipedia.org

PODCAST: https://www.bing.com/videos/search?q=stephen+wolfram&docid=608027542444182789&mid=7432EA16AEF1CDF4FCDD7432EA16AEF1CDF4FCDD&view=detail&FORM=VIRE

Conclusion

And so, your thoughts and comments on this ME-P are appreciated. Give Wolfram Alpha a click, listen to the audio-cast, and tell us what you think. Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

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Daniel Vande Lune MD on How HCQIA provided immunity is misused by hospitals for sham peer-review

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Originally posted on Disrupted Physician

PUBLISHER’S NOTE: From time-to-time the ME-P might re-post an essay or opinion of vital interest to our readers and industrial ecosystem. This article is one of those times from an Award Winning Blogger and physician colleague from the Disrupted Physician. Feel free to visit his website directly and support his work as you deem fit.

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Langan MD

 The Ability for Hospitals to Hide behind the Immunity of HCQIA and the Abuse and Coercion by the PHP: my story and caveats.

I have been asked to write a guest blog and whole heartedly agreed. I am not afraid to tell my story ……

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Guest Post: Dr. Daniel Vande Lune, MD discusses how HCQIA provided immunity is misused by hospitals for sham peer-review — Disrupted Physician

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Conclusion

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DAILY UPDATE: Healthcare Costs, Lobbyists and Private Equity as Technology Drowns

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In the second quarter, 14 healthcare organizations spent more than a million dollars lobbying the federal government for healthcare policy change, led by the American Hospital Association and AARP.

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

Sen. Ed Markey (D-Massachusetts) and Rep. Pramila Jayapal (D-Washington) introduced strengthened legislation to rein in the actions of private equity firms that invest in healthcare facilities. The Health Over Wealth Act would require PE firms to put out reports on the facilities’ pay of executives, set up escrow accounts and receive a license from the Department of Health & Human Services prior to investing in healthcare facilities.

CITE: https://tinyurl.com/2h47urt5

The Federal Open Market Committee (FOMC) meeting ending tomorrow is widely expected to conclude with no interest rate move. Instead, it could serve as a platform to help prepare market participants for a possible cut at the September meeting.

Here’s where the major benchmarks ended:

  • The S&P 500® (SPX) index lost 27.1 points (–0.5%) to 5,436.44; the Dow Jones Industrial Average® ($DJI) climbed 203.4 points (0.5%) to 40,743.33; the NASDAQ Composite®($COMP) fell 222.78 points (–1.3%) to 17,147.42. 
  • The 10-year Treasury note yield (TNX) dropped about two basis points to 4.14%.
  • The CBOE Volatility Index® (VIX) jumped to 17.77, not far below last week’s highs.

What’s up

  • Paypal popped 8.59% after announcing impressive earnings and proving it’s got nothing to fear from Apple’s moves into the online payment world.
  • JetBlue Airways soared 12.31% thanks to a surprise profit last quarter rather than the loss analysts expected.
  • Affirm Holdings rose 2.31% due to an upgrade from “neutral” to “buy” from Bank of America analysts.
  • Tenable Holdings surged 9.30% after the cybersecurity company made it clear it’s willing to take acquisition offers.
  • F5 jumped 12.99% thanks to a beat-and-raise earnings report.

What’s down

CITE: https://tinyurl.com/tj8smmes

Visualize: A key measure of employer healthcare costs is poised for its biggest annual increase in more than a decade as more people use mental health care and get prescriptions for new, expensive drugs—yes, including Ozempic—according to a new PwC report.

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MICROSOFT DOWN: Online Outage Hit Again After Global IT Meltdown

BREAKING NEWS

Story by Andrew Griffin • 4h ago

By Staff Reporters

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Microsoft’s online service have been hit by another outage, days after an IT meltdown that brought much of the world to a halt. The company said it was investigating reports of user problems accessing its services, with some reporting being unable to access email and other functions.

An alert on the technology giant’s service status website said it was looking into a “network infrastructure” issue that was impacting access to Microsoft services.

The incident comes less than two weeks after a major global IT outage knocked global infrastructure including transportation and healthcare services offline because of a flawed software update from cybersecurity firm CrowdStrike affected Microsoft devices.

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DAILY UPDATE: Bank Debt and Flat Stock Markets

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Here’s where the major benchmarks ended:

  • The S&P 500® (SPX) index rose 4.44 points (0.1%) to 5,463.54; the Dow Jones Industrial Average® ($DJI) slipped 49.41 points (–0.1%) to 40,539.93; the NASDAQ Composite®($COMP) gained 12.32 points (0.1%) to close at 17,370.20. 
  • The 10-year Treasury note yield (TNX) fell roughly five basis points to just under 4.18%.
  • The CBOE Volatility Index® (VIX) finished nearly steady but still elevated at 16.59.

CITE: https://tinyurl.com/2h47urt5

What’s up

What’s down

  • Abbott Laboratories sank 0.45% after it was ordered to pay $495 million in damages for failing to warn of the risks to premature infants drinking its formula, a far higher number than analysts expected. Shares of its peer Reckitt Benckiser fell 8.65% in sympathy.
  • Arm Holdings slipped 5.07% after an HSBC analyst downgraded the company due to its sky-high valuation.
  • Heineken fell 8.18% thanks to slower beer sales in key markets, as well as the poor performance of its investment in Chinese brewer CR Beer.
  • Loews slid 1.47% due to an announcement that CEO James Tisch will step down after 25 years at the helm.
  • 3M dropped 1.56%, falling back to Earth after the stock enjoyed its best day of trading ever last Friday.

CITE: https://tinyurl.com/tj8smmes

Visualize: How private equity tangled banks in a web of debt, from the Financial Times.

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Three BOTS of Artificial Intelligence

A.I. and Computers

By Staff Reporters

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  • Google revealed its answer to ChatGPT: an “experimental conversational AI service” called Bard that’s currently in testing mode.
  • Microsoft (which invested in ChatGPT) announced its own surprise event scheduled for later today in order to “share some progress on a few exciting projects.”
  • Chinese tech giant Baidu confirmed it’s on track to introduce its AI chatbot, known as “Ernie Bot” in English, in March.

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LAUGH -or- CRY?

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IAN BEAN MD

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The “Magnificent 7” and the Dangers of Stock Market Hype

By Vitaliy Katsenelson CFA

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The Magnificent 7 and the Dangers of Market Hype
You can also listen to a professional narration of this article on iTunes & online.
Despite the S&P 500 showing gains in the mid-teens, the average stock on the market is either up slightly or flat for the year. Most of the gains in the index came from the Magnificent 7 stocks, which constitute 35% of the index! The equal-weighted index, where the Magnicent 7 have only a 1.4% weight, is up only about 4% this year (as of this writing). 

The Magnificent 7 are starting to look like the Nifty Fifty stocks from the 1970s (Kodak, Polaroid, Avon, Xerox, and others) – stocks you “had to own” or you were left behind – until all your gains were taken away or you faced a decade or two of no returns. Forty years later, it’s easy to dismiss these companies as has-beens. They’ve all either gone bankrupt or become irrelevant.

But back then, they were the stars of corporate America, just like the Magnificent 7 are today.
As an investor, it’s crucial to know which games you play and which ones you don’t.

Let me explain: The Magnificent 7 and the Dangers of Market Hype

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DAILY UPDATE: Technology Stocks

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A magnificent earnings week is on tap: Four of the Magnificent Seven—Microsoft, Meta, Amazon, and Apple—will drop their reports throughout this week.

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

Technology stocks were down last week but investors are encouraged by signs that 2024’s rally—which had been underpinned by a handful of Big Tech companies—is spreading to a broader swath of the market. For instance, the industrial focused Dow Jones Industrial Average has gained for four straight weeks, and the small-cap Russell 3000 is now up 14% this year. All eyes will be on the upcoming Federal Reserve meeting and the busiest earnings week of the season.

CITE: https://tinyurl.com/2h47urt5

Donald Trump pledges to make the US “the crypto capital of the planet.” The former president pitched himself as the pro-crypto candidate in a keynote speech at the Bitcoin 2024 conference in Nashville. He told the audience that, if elected, he’d fire SEC Chair Gary Gensler (whom the crypto community accuses of waging a war on crypto) and install regulators friendly to digital tokens. He also said he’d create a strategic national crypto stockpile as part of a plan to make the US the “bitcoin superpower of the world.”

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Consider two numbers: $568.34 and $60.09. The first is Zoom’s highest closing stock price, from October 2020; the second is its stock price today. That’s an 89% decline, caused by more workers heading back into the office (even Zoom employees) and competition from rival products by Microsoft and Google.

Visualize: How private equity tangled banks in a web of debt, from the Financial Times.

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SURVEY: Primary Care Doctors Deliver Most Medical Care

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By MCOL

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25% of Primary Care Doctors Delivered 86% of Medical Care

 •  25% of primary care doctors delivered 86% of medical care.
 •  25% of specialists on average provided 75% of medical care.
 •  16.3% of physicians listed in Medicaid managed care plan provider network directors in a year qualified as ghost physicians (seeing zero Medicaid beneficiaries over the course of the year in an outpatient setting).
 •  The share of ghost physicians ranged from 13.4% to 24.9% across states.

Source: Health Affairs via Fierce Healthcare, May 5, 2022

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PODCAST: Scaling Primary Care

By Eric Bricker MD

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SCOTUS: Rejects Chevron Deference [Healthcare Industry Implications]

By Health Capital Consultants, LLC

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On June 28, 2024, the U.S. Supreme Court issued a seismic decision explicitly overruling the Chevron doctrine,” which will limit the ability of federal agencies to rely on their own interpretation of the laws they administer.

Under the Chevron doctrine, more commonly referred to as Chevron deference, courts were mandated to uphold a federal agency’s interpretation of a statute as long as it was reasonable.

This Health Capital Topics article discusses the Chevron doctrine, the Supreme Court’s decision, and the impact of this ruling on the healthcare industry. (Read more…)

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STOCK MARKET “FRONT RUNNING”

By Staff Reporters

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According to Wikipedia, front running, also known as tailgating, is the practice of entering into an equity (stock) trade, option, futures contract, derivative, or security-based swap to capitalize on advance, nonpublic knowledge of a large (“block”) pending transaction that will influence the price of the underlying security. In essence, it means the practice of engaging in a personal or proprietary securities transaction in advance of a transaction in the same security for a client’s account.

Front running is considered a form of market manipulation in many markets. Cases typically involve individual brokers or brokerage firms trading stock in and out of undisclosed, unmonitored accounts of relatives or confederates. Institutional and individual investors may also commit a front running violation when they are privy to inside information.

A front running firm either buys for its own account before filling customer buy orders that drive up the price, or sells for its own account before filling customer sell orders that drive down the price. Front running is prohibited since the front-runner profits come from nonpublic information, at the expense of its own customers, the block trade, or the public market.

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

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High-profile short seller accused of fraud.

Citron Research founder Andrew Left is used to being the one calling out fraud, but federal prosecutors and the SEC claimed he’s the one pulling a financial fast one. The government alleges that Left committed securities fraud by using his appearances on television and his social media accounts to make misleading statements that manipulated the market—and reaped $16 million in profit for doing so.

Left declined to comment to news outlets, but his lawyer told the Wall Street Journal that the government’s cases were “based on a defective theory” and targeted Left for sharing his opinions.

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What is the “Endowment” Effect?

The “Endowment” Effect

[By staff reporters]

In psychology and behavioral economics, the endowment effect (also known as divestiture aversion and related to the mere ownership effect in social psychology) is the hypothesis that people ascribe more value to things merely because they own them.

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MORE: https://www.interaction-design.org/literature/topics/endowment-effect

MORE: What is the “Butterfly” Effect?

Assessment: Your thoughts are appreciated.

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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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DAILY UPDATE: Hacking Hospitals and Urinary Catheter Scam as Broad Stock Markets Gain

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According to a recent report in the Washington Post, a $3 billion scam involving urinary catheters has brought to light serious flaws in Medicare, prompting strong calls for reform.

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

Here’s where the major benchmarks ended:

  • The S&P 500 rose about 60 points (1.1%) to 5,459.10; the Dow Jones Industrial Average was up 654 points (1.6%) at 40,589.34; the NASDAQ Composite ended 176 points higher (1.0%) at 17,357.88.
  • The 10-year Treasury note yield (TNX) fell five basis points to 4.197%.
  • The CBOE Volatility Index® (VIX) slipped 10% to 16.56.

What’s up

What’s down

  • Dexcom plummeted 40.66% after management cut the diabetes monitoring company’s full-year revenue guidance.
  • Biogen sank 7.15% after European regulators denied marketing authorization for the pharma company’s new Alzheimer’s drug.
  • Weight Watchers fell 12.50% after Morgan Stanley analysts downgraded the company from overweight to equal weight based on the long-term headwinds it faces from obesity drugs.

CITE: https://tinyurl.com/2h47urt5

The US is raising alarm bells about a North Korean hacking group that broke into NASA, two US Air Force bases, and several defense companies.  The FBI, NSA and State Department just called out the North Korean hacking group “Andariel” for committing cyber espionage and using ransomware attacks on US hospitals to fund its operations. 

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Stat: 524. That’s how many employees Optum is laying off in California. (Becker’s Health IT)

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SPAC v. Direct Listing v. IPO?

What’s the difference between an IPO, a special purpose acquisition company (SPAC), and a direct listing?

[By staff reporters]

IPOs are a 6–12 month journey where a company works with investment banks and underwriters, who buy a bunch of shares and then sell them to investors in the public market during the actual IPO. Early investors are able to liquidate their shares, and the company raises new funds.

Direct listings skip the underwriting hullabaloo. But without that stability guarantee, direct listings can result in a more volatile opening. Some companies, like Coinbase, find that it’s worth it to keep their hard-earned money out of bankers’ hands.

SPACs, aka “blank-check companies,” offer yet another alternative path to public markets. A SPAC is a shell company that raises money through the traditional IPO process, then merges with a private company and takes it public. 

MORE: https://medicalexecutivepost.com/2019/06/24/what-is-a-direct-listing-process-on-wall-street/

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DOW JONES INDUSTRIAL AVERAGE: 30 “Blue Chip” Stock Index Update

By Staff Reporters

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The Dow Jones Industrial Average is a collection of 30 “blue-chip” U.S. stocks. Blue chip = big, established, and influential companies like Microsoft, JPMorgan, Disney, and McDonald’s. The Dow recently updated its roster, swapping ExxonMobil, Pfizer, and Raytheon for Salesforce, biotech Amgen, and manufacturing heavyweight Honeywell.

The Dow is weighted by share price, so higher-priced stocks have more influence on the index’s total value. Price-weighting also means that if the price of any stock in the Dow changes by $1, it has the same impact on the index, even though a $1 increase to a stock worth $20 is more significant (relatively) than a $1 change to a stock worth, say, $40.

  • During stock splits—when a company increases its number of outstanding shares and chops prices by the same factor—a company’s influence in the Dow can fall even if their market value doesn’t change. The Dow has some mechanisms to account for stock splits, but they can still lead to a shakeup in the index (like what happened last summer).

At 124 years old, the Dow has had plenty of time to cement its reputation as a leading indicator of the stock market. But with only 30 stocks representing a smattering of U.S. corporate titans, it’s not exactly representative.

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At one point the Dow Jones Industrial Average was up 585 points before it sold off later yesterday afternoon, though it wrapped the trading session with a small win. The S&P 500 fought its way into positive territory but struggled to stay there, eventually sinking into negative territory at the end of the day.

As for the NASDAQ, the tech selloff continued to punish the index for most of yesterday afternoon. Treasury yields fell a bit on positive GDP news, though the big PCE [personal consumption expenditures] announcement is the one investors have been waiting for.

Oil popped on a stronger than expected GDP reading, with traders banking on future economic growth and stronger oil demand.

Bitcoin sank a bit yesterday ahead of a major conference that could set the tone for the entire digital asset industry for years to come.

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DAILY UPDATE: The US Economy of KH and Medicare [Part C] with Mixed Stock Markets

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The Wall Street Journal explores what Kamala Harris as president would mean for the economy. (the Wall Street Journal)

  • Q2 GDP was shockingly strong, with today’s reading of 2.8% growth outpacing the 2.1% economists expected.
  • The Japanese yen is rising while US tech stocks are falling.
  • You’re in my seat: Southwest Airlines is getting rid of its open seating arrangement and shifting to assigned seats.
  • 32 charts that tell you everything you need to know about markets midway through 2024 at a glance.
  • The Fed should cut interest rates at next week’s meeting, according to the former president of the Federal Reserve Bank of New York.
  • Bill Ackman is trying to turn social media stardom into profit.

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

Here’s where the major stock market benchmarks ended:

  • The S&P 500® index (SPX) fell about 28 points (0.5%) to 5,399.22; the Dow Jones Industrial Average® ($DJI) rose 81 points (0.2%) to 39,935.07; the NASDAQ Composite ended 161 points lower (0.9%) at 17,181.72.
  • The 10-year Treasury note yield (TNX) dropped four basis points to 4.255%.
  • The CBOE Volatility Index® (VIX)declined 0.6% to 17.94.

What’s up

What’s down

  • Universal Music Group tumbled 23.54% after subscription and streaming revenues fell well short of analyst expectations.
  • Ford plummeted 18.40% for the automaker’s worst day of trading since 2009 after it missed profit expectations and provided no positive forecast for the quarters ahead.
  • Lululemon slid 9.09% thanks to a downgrade from Citi analysts from “buy” to “neutral” predicated on a sales slowdown.
  • Royal Caribbean sank 7.61% after the company indicated that it’s facing a slowdown in demand.
  • Edwards Lifesciences crashed 31.27% thanks to a mixed earnings report, as well as management’s guidance that sales for its key heart valve replacement therapy will sink next quarter.

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Thousands of seniors are losing coverage at local hospitals as problems plague Medicare Advantage. Lower payout rates for Medicare and Medicaid are sparking insurance companies to leave certain areas and change coverage options across the country.

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On Medical Debt

In the USA

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DAILY UPDATE: Digital Therapeutics, FSEDs, Medical Costs and the NASDAQ Collapse

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You’ve heard of an emergency department and an urgent care center, but have you heard of a freestanding emergency department (FSED)? While only 1% of FSEDs were freestanding in 2001, that figure jumped to 11% in 2016, totaling 566 facilities nationwide. The concept of FSEDs dates back to the 1970s, when these facilities provided emergency care to people in rural areas who didn’t have convenient access to hospitals. In 2001, there were only 50 FSEDs in the US—now there are about 745, according to 2018 research by the Emergency Medicine Network, which Herscovici worked on.

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Here’s where the major benchmarks ended:

  • The S&P 500 fell about 129 points (2.3%) to 5,427.13; the Dow Jones Industrial Average shed 504 points (1.3%) to 39,853.87; the NASDAQ Composite ended 655 points lower (3.6%) at 17,342.41.
  • The 10-year Treasury note yield (TNX) rose four basis points to 4.291%.
  • The CBOE Volatility Index® (VIX) surged 23% to 18.13.

What’s up

  • Enphase Energy gained 12.80% despite missing earnings estimates as investors cheered management’s very positive forecast for the solar company’s future.
  • AT&T phoned in a 5.22% pop after reporting a stronger than expected increase in its number of wireless subscribers, a key metric its competitor Verizon recently missed on.
  • Mattel rose yet another 9.80% as takeover rumors continue to swirl, with reports that rival toy maker Hasbro could place a competing bid.
  • Seagate Technology jumped 4.02% thanks to a strong earnings report from the hardware maker.

What’s down

  • Visa slid 4.01% after missing analyst estimates for revenue thanks to slower consumer spending.
  • AMC Entertainment Holdings fell 7.68% after the company tried to get ahead of bad news and released preliminary earnings that impressed nobody.
  • Vertiv Holdings sank 13.64% despite beating earnings estimates, with investors seemingly worried about the AI play’s sky-high valuation.
  • General Dynamics stumbled 3.32% thanks to fewer deliveries of its high-end jets last quarter.
  • Lamb Weston dropped like a hot potato, plunging 28.24% after the frozen food supplier announced earnings well below expectations and forecast a terrible second half of the year.

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The Centers for Medicare and Medicaid Services (CMS) proposed CPT payment codes for some digital therapeutics products for the first time, potentially paving a pathway toward widespread reimbursement for the nascent industry.

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In 2025, medical costs are projected to increase 8% in the group market and 7.5% in the individual market—the highest levels seen in 13 years—according to an analysis from consulting firm PwC’s Health Research Institute. The anticipated rise is mainly pinned on inflationary pressure, expensive pharmaceuticals, and an increasing number of patients seeking mental health care, analysts found.

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HEALTH EXPENDITURES: Projected to Approach $8 Trillion by 2032

By Health Capital Consultants LLC

***

On June 12, 2024, the Centers for Medicare & Medicaid Services (CMS) released their health insurance enrollment and national health expenditure (NHE) projections for 2023 through 2032. The annually-updated NHE is the official U.S. estimate of insurance enrollment and health spending. CMS projects that, between 2023 and 2032, the NHE’s annual growth rate of 5.6% will surpass the U.S. gross domestic product (GDP) annual growth rate of 4.3%. As a result, health spending as a share of the U.S. GDP is expected to jump from 17.3% in 2022 to 19.7% in 2032.

This Health Capital Topics article reviews the notable findings from CMS’s projections. (Read more…) 

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What is “Risk Adjusted” Stock Market Performance?

Update on Some Interesting and Important Financial Calculations

By Timothy J. McIntosh MBA CFP® MPH

By Dr. David Edward Marcinko MBA MEd CMP™

By Jeffrey S. Coons PhD CFA

TMDr. Jeff Coons

dr-david-marcinko9

-INTRODUCTION-

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

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

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

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

[a] The Treynor Ratio

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

[b] The Sharpe Ratio

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

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

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[c] The Jensen Alpha Measure

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

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

[d] Database Ratings

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

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

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

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Assessment

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

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

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

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ABOUT

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

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

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DAILY UPDATE: Ardent Health IPO, Davita Settles, Amex Reports with Choppy Stock Markets

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Stat: 13%. That’s how much millennial and Gen Z spending increased year over year, according to American Express earnings released last week. Amex reported slower growth in travel and entertainment compared to the previous quarter, but restaurant spending “remained strong.” (PYMNTS)

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Here’s where the major stock market benchmarks ended:

  • The S&P 500 fell about 9 points (0.16%) to 5,555.69; the Dow Jones Industrial Average shed 57 points (0.14%) to 40,358.09; the NASDAQ Composite ($COMP) ended 10 points lower (0.06%) at 17,997.35.
  • The 10-year Treasury note yield (TNX) was unchanged at 4.255%.
  • The CBOE Volatility Index® (VIX) decreased about 2% to 14.62.

What’s up

What’s down

  • UPS delivered a 12.05% dip, falling to new all-time lows after missing analyst earnings expectations, as well as cutting its revenue forecast.
  • NXP Semiconductors plunged 7.58% on management’s poor revenue forecast for the coming quarter, despite meeting expectations this quarter.
  • Comcast sank 2.58% on a mixed earnings announcement that saw the company beat on earnings but miss revenue thanks to a slow theme parks segment.
  • GM stalled 6.43% despite announcing solid earnings—investors didn’t like to hear management note that the second half of the year will be a lot tougher.

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Kidney care giant DaVita has agreed to pay nearly $34.5 million to settle allegations that it paid kickbacks for referrals to its former DavitaRx subsidary.


And … Ardent Health was targeting a $300 million IPO but raised just $192 million.

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DAILY UPDATE: UnitedHealth Group and PBMs as Technology Stocks Soar

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Here’s where the major stock market benchmarks ended:

The Cboe Volatility Index® (VIX) fell sharply to 14.91.

The S&P 500® index (SPX) rose 59.41 points (1.1%) to 5,564.41; the Dow Jones Industrial Average® ($DJI) climbed 127.91 points (0.3%) to 40,415.44; the NASDAQ Composite® ($COMP)jumped 280.63 points (1.6%) to 18,007.57. 

The 10-year Treasury note yield (TNX) added two basis points to 4.26%.

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What’s up

What’s down

  • Crowdstrike withered another 13.46% as the fallout from what’s being hailed as the largest IT outage in history continues to punish the stock.
  • Trump Media & Technology Group dipped 0.83% during the trading session after President Biden’s announcement that he’s dropping out of the presidential race.
  • Verizon sank 6.04% after whiffing on its earnings report, missing on revenue thanks to customers holding on to their old phones for longer.
  • Ryanair crumbled 15.41% following an earnings report that revealed the company’s earnings after taxes sank an eye-watering 46% last quarter.
  • Starbucks dropped 3.43% on a report by the Wall Street Journal late last week that activist investor Elliott Investment Management has taken a stake in the coffee chain.

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The US House of Representatives Committee on Oversight and Accountability is holding a hearing tomorrow, bringing in PBMs from around the US to testify on “their role in rising healthcare costs.” The hearing comes soon after an FTC report found PBMs to have an “outsized influence” on drug pricing.

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The February cyberattack on a UnitedHealth Group subsidiary may have exposed the health data of one in three Americans, but the nation’s largest health insurance company by market cap and revenue returned to profitability in the second quarter, beating Wall Street expectations and reporting net income of $4.2 billion.

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CORPORATE EARNINGS REPORT: Week

By Staff Reporters

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Earnings announcements are a public statement of a company’s profitability for a specific period of time, such as a quarter (90 days) or a year. Equities research analysts will issue estimates of the company’s earnings numbers prior to its announcement date, which is generally set weeks or months in advance. If a company releases better results than analysts predict, its share price will generally rise after the announcement. Below you will find a list of public companies announcing their earnings results this week.

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Earnings reports to feast on them this week. About one-quarter of S&P 500 companies will release their Quarter 2nd financials, including Alphabet, Coca-Cola, Tesla, UPS, Visa, Chipotle, Comcast, GM, and Southwest Airlines.

And if you have room for more economic data, the government will release its first estimate of Q2 GDP on Thursday and an important inflation gauge on Friday.

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DAILY UPDATE: Starbucks, Crowdstrike, US Banks and Charles Schwab

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Shares of Charles Schwab (NYSE: SCHW) fell over 15% last week, according to data from S&P Global Market Intelligence. One of the largest brokerages posted slow growth and poor earnings as the company deals with low-yielding assets on its balance sheet. As of 1:31 p.m. ET on Friday, July 19th, Charles Schwab stock was down 17.5% this week.

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Activist investor Elliott Investment Management has reportedly built up a substantial stake in Starbucks and has been pushing the coffee chain to improve its stock price.

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Markets: The S&P 500 logged its worst week since April as investors pulled back from Big Tech stocks. CrowdStrike fell because causing a global IT outage is not good (more on that in a sec).

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In a recent video, finance YouTuber Lena Petrova highlighted the troubling financial state of U.S. banks as they report significant losses and increase their reserves to cover a surge in loan delinquencies. With the second quarter results rolling in, it’s evident that the banking sector is under considerable strain.

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ECONOMIC LANDSCAPE: Understanding Today

By Vitaliy Katsenelson CFA

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Interest rates that stay low and actually keep declining for almost a quarter of a century slowly propagate deep into the fabric of the economy.

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Interest rates went up and refused to decline. They are high in relation to where they came from, but they look reasonable in relation to inflation, which is running about 3%.

Bulls argue that current interest rates only appear to be high in relation to the last 20 years, and they are actually low if you look at the 30 years before the turn of the century. This argument is historically accurate, but it is missing a very important point – interest rates that stay low and actually keep declining for almost a quarter of a century slowly propagate deep into the fabric of the economy.

Let me try this analogy.

HERE: Understanding Today’s Economic Landscape

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BIDEN: Bows Out of 2024 Presidential Race!

KAMALA HARRIS IN

BREAKING NEWS!

By Staff Reporters

WASHINGTON − President Joe Biden said he is ending his bid for reelection amid intense pressure from Democratic leaders sounding the alarm that his path to beat former President Donald Trump in November has vanished.

The president’s historic withdrawal throws the 2024 race − already roiled by a shocking attempt on Trump’s life − into uncertain territory, with Vice President Kamala Harris seen as the Democrat best placed to take Biden’s place atop the party’s ticket. Biden did not immediately endorse a successor but did so later.

Biden just made the announcement Sunday from his home in Rehoboth Beach, Del., where he’s self-isolated since testing positive for COVID-19 Thursday night.

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MEDICARE DOCTOR SALARY RATES: Would Cut Pay 3%

By Staff Reporters

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***

Orthopedic doctors and surgeons earn on average 558 thousand U.S. dollars annually. This makes Orthopedic doctors and surgeons the most well-compensated physicians in the United States as of 2024, followed by plastic surgeons. Plastic surgeons were, by far, the highest earning physicians in the U.S. in 2023. An orthopedic physician specializes in injuries and diseases involving bones, muscles, joints, nerves and other parts of the musculoskeletal system.

Although orthopedic doctors and surgeons have the highest average annual salary, from 2023 to 2024 their compensation actually decreased by 3 percent. In comparison, compensation for physicians specialized in physical medicine and rehabilitation increased 11 percent during this time, while plastic surgeons saw the largest decrease of 13 percent. The region with the highest annual compensation for physicians was West North Central in 2024, with physicians earning some 404 thousand U.S. dollars in this region.

There are currently around 29.2 active physicians per 10,000 people in the U.S. Around 29 percent of physicians in the U.S. are aged between 56 and 65 years, while only 11 percent are 35 years or younger. The vast majority of physicians are employed by hospitals or groups and work an average of 51 hours per week.

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Medicare Rates in 2025 Would Cut Pay For Docs by About 3%

And so, Federal officials on July 11th proposed Medicare rates that effectively would cut physician pay by about 3% in 2025, touching off a fresh round of protests from medical associations. The 2025 draft base rate, or conversion factor, is slated to drop to $32.36 from the current level of $33.29, the Centers for Medicare & Medicaid Services said.

This proposed cut is mostly due to the 5-year freeze in the physician schedule base rate mandated by the 2015 Medicare Access and CHIP Reauthorization Act (MACRA). Congress designed MACRA with an aim of shifting clinicians toward programs that would peg pay increases to quality measures.

Source: Kerry Dooley Young, MD Edge [7/11/25]

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ECONOMICS: What is the “Golden Rule” Savings Rate?

And … the Solow capital motion growth model?

[By staff reporters]

In economics, the Golden Rule savings rate is the rate of savings which maximizes steady state level or growth of consumption, as for example in the Solow growth model.

Although the concept can be found earlier in John von Neumann and Maurice Allais‘s works, the term is generally attributed to Edmund Phelps who wrote in 1961 that the golden rule “do unto others as you would have them do unto you” could be applied inter-generationally inside the model to arrive at some form of “optimum“, or put simply “do unto future generations as we hope previous generations did unto us.”

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The Solow growth model

In the Solow growth model, a steady state savings rate of 100% implies that all income is going to investment capital for future production, implying a steady state consumption level of zero. A savings rate of 0% implies that no new investment capital is being created, so that the capital stock depreciates without replacement. This makes a steady state unsustainable except at zero output, which again implies a consumption level of zero.

Somewhere in between is the “Golden Rule” level of savings, where the savings propensity is such that per-capita consumption is at its maximum possible constant value.

Assessment

Put another way, the golden-rule capital stock relates to the highest level of permanent consumption which can be sustained.

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DAILY UPDATE: Crowdstrike Price, Banks and Healthcare

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CrowdStrike saw its share price plummet Friday, although it is still up ~24% YTD. At $74.2 billion, CrowdStrike has the second-largest market cap in the IT security industry, behind only Palo Alto Networks ($107.1 billion), and reported $900 million in revenue for the quarter ending in April, per Reuters. It’s got ~29,000 customers, which is part of why the outage caused so much havoc.

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Crowdstrike Banks: Some traders at JPMorgan Chase, UBS, Bloomberg, and other financial institutions couldn’t execute orders yesterday morning, with one unnamed senior trader telling the Financial Times that it was “the biggest upset in years.”

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Crowdstrike Healthcare: Many hospitals—including some of the largest in Europe and the US—were forced to cancel all elective operations, routine appointments, and walk-ins, and online portals for most UK general practitioners went down.

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DENTAL CARE: Unattainable for Many Patients

“Crisis”

By Staff Reporters

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A lack of insurance and high out-of-pocket costs make dental care unattainable for 69 million people in the US. (USA Today)

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DAILY UPDATE: Public Companies and the Stock Market Software Snafu Wraps Up Worst Week Since April

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42,500. That’s how many people died in car accidents in 2022, which experts believe was exacerbated during the Covid-19 pandemic, as reckless driving worsened and traffic enforcement decreased. (KFF)

“These attacks and breaches of data can literally mean the difference between life and death for patients, significantly impact hospital operations, and—with the average hack costing millions to address—increase healthcare prices across the board.”—Sen. Angus King about a bill he co-sponsored to improve cybersecurity in healthcare (Healthcare Dive)

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

Here’s where the major benchmarks ended:

  • The S&P 500® index (SPX) dropped 39.59 points (–0.7%) to 5,505.00 and ended down 1.97% for the week, its worst weekly performance in three months; the Dow Jones Industrial Average® ($DJI) slipped 377.49 points (–0.9%) to 40,287.53 on Friday and finished up less than 1% for the week; the NASDAQ Composite® ($COMP)fell 144.28 points (–0.81%) on Friday to 17,726.94 and lost 3.65% for the week.
  • The 10-year Treasury note yield (TNX) rose four basis points to nearly 4.24% and finished up for the week, partly on worries about possible U.S. tariffs and their potential impact on inflation.
  • The CBOE Volatility Index closed at 16.47 after climbing above 17 intraday for the first time since late April.
  • Markets sagged under the weight of a massive IT outage, accentuating a selloff that was already in motion. All three indexes spent the day in the red, with the S&P 500 capping off its worst week since April and the NASDAQ snapping its six-week win streak.
  • The CBOE Volatility Index, a gauge of investor fear, rose to its highest level since April. The VIX is up over 25% in the last five days alone, as the small-cap rotation rally sputtered to a halt.
  • Oil took a big blow today as US Secretary of State Anthony Blinken said a cease-fire between Israel and Hamas is nearly complete.
  • Gold sold off as well as investors not only took profits after the commodity hit a new all-time high this week, but also began to rotate into riskier assets in light of a likely Fed rate cut.

What’s up

What’s down

  • SunPower transformed into a stock submarine, sinking 55.01% after the company made it clear it’s about to go out of business.
  • American Express fell faster than a greased pig on skates, sliding 2.68% after beating bottom line expectations but missing on revenue.
  • Plug Power turned into a lead balloon, descending 13.87% after management declared a $200 million stock offering.
  • Halliburton crumbled like a cookie, dropping 5.63% following a mixed earnings report that saw the fracking giant fall short of revenue expectations.
  • Travelers journeyed to the center of the Earth, burrowing 7.73% after beating earnings expectations, missing on revenue, and revealing that catastrophe losses came in higher than hoped.
  • Comerica sank like a stone, plummeting 10.50% due to lower net interest income last quarter and forecasts of lower interest income in the quarters ahead.

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It’s common for patients to delay or skip medical care due to high costs in the US—but data shows that fewer adults have done so in recent years.

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PODCAST: Early Retirement and Health Insurance

By Staff Reporters

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DAILY UPDATE: Public Companies and the Stock Market Technology Sell-Off

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The S&P 500 and NASDAQ both continued to sink under the weight of a tech selloff today, with semiconductors leading the way down. But even the Dow and Russell 2000, which have been the clear winners of the recent rally, took a beating today as investors assessed what a market rotation really means for them. 10-year Treasury yields bounced from recent lows as investors try to read between the lines of a full week of Fedspeak. Gold and oil both sold off a bit more today, though both remain near recent highs.

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

What’s up

What’s down

  • Domino’s Pizza sank 13.42% after it missed earnings expectations last quarter and warned it will open fewer stores for the rest of 2024.
  • Beyond Meat tanked 10.32% on a report from the Wall Street Journal that management is in talks to restructure the company’s debt.
  • Eli Lilly slid another 6.24% as its selloff continues thanks to news that rival Roche Holdings is on its way to developing a weight-loss pill.
  • Nokia dropped 7.05% after posting its worst quarterly sales since 2015. Seems like nobody is buying phones with the shape and durability of a brick any more.

CITE: https://tinyurl.com/2h47urt5

Here’s where the major benchmarks ended:

  • The S&P 500 index fell 43.68 points (–0.78%) to 5,544.59; the Dow Jones Industrial Average® ($DJI) lost 533.06 points (–1.29%) to 40,665.02; the NASDAQ Composite gave up 125.70 points (–0.7%) to 17,871.22.
  • The 10-year Treasury note yield (TNX) rose about four basis points to 4.18%.
  • The CBOE Volatility Index climbed sharply to 15.9, its highest close since late April.

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JOHNS HOPKINS: Medical School Free!

By Dr. David Edward Marcinko MBA MEd CMP

I grew up in SE inner city Baltimore, Maryland and played stick ball in the parking lot of JHU medical school. And so, I was gratified to learn that it is about to get a lot cheaper—for many students at Johns Hopkins University, at least.

Thanks Mike Bloomberg. Be like Mike!

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The former New York mayor, entrepreneur, and 1964 John Hopkins alum Michael Bloomberg donated $1 billion to the university, according to Bloomberg Philanthropies and the university in a recent announcement. Starting this fall, tuition will be free for students coming from households that earn less than $300,000 annually, and the gift will also cover living expenses and other fees for students from families with less than $175,000 in annual income.

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Financial access to medical school is a challenge for many students: The median debt for the class of 2023 is $200,000, according to the Association of American Medical Colleges. This cost can discourage students from attending medical school at a time when the US needs more physicians; the association predicted that there will be a physician shortage of up to 86,000 doctors nationwide by 2036.

READ: https://tinyurl.com/bd6sbmvj

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PODCAST: Physician Entrepreneurial Tips on Opening Your Own Medical Practice

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By MEDICAL ECONOMICS

James Underberg, MD, discusses how he left a large health system to open his own practice, and provides tips for physicians considering the same move.

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Private Healthcare Equity: https://www.youtube.com/watch?v=tBwHu1uigoA

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DAILY UPDATE: UnitedHealth, Aetna, Long Covid and Physician Burnout as NASDAQ Collapses

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The Dow surged another 240 points as the cyclical rotation continues, sending the index to its 22nd record closing high of the year. The S&P 500 had its worst day since late April, while the NASDAQ slumped to its worst finish since December 2022. The last time the Dow rose on the same day the S&P 500 fell by more than 1% was all the way back in 1999. Gold hit a record high yesterday on hopes of a rate cut, not a hike. Oil bubbled up thanks to an Energy Information Administration report highlighting higher demand and lower crude inventories. Bond yields stayed steady throughout the trading session before sinking slightly 20-year Treasury bond auction.

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

Here’s where the major benchmarks ended:

  • The S&P 500® index (SPX) fell 78.93 points (–1.39%) to 5,588.27; the Dow Jones Industrial Average added 243.6 points (0.59%) to 41,198.08; the NASDAQ Composite plunged 512.41 points (–2.77%) to 17,996.92.
  • The 10-year Treasury note yield (TNX) dropped just below 4.15%.
  • The CBOE Volatility Index jumped sharply to 14.48.

What’s up

  • VF Corp. rose 13.64% on the news that it is selling its Supreme brand to EssilorLuxottica for $1.5 billion.
  • Roche soared 7.55% after the Swiss pharmaceutical company announced it has made strides in developing a weight-loss and diabetes treatment that uses a pill rather than an injection. Competitors sank on the news, with Eli Lilly declining 3.78% and Novo Nordisk falling 3.87%.
  • GitLab popped 9.34% on a report that the software developer is exploring a sale, potentially to cloud company Datadog, whose shares fell 7.35%.
  • Johnson & Johnson rose a tepid 3.67% thanks to a mixed earnings announcement that included beating expectations this quarter but warning of lower profits ahead.

What’s down

  • Spirit Airlines descended 10.76% to a new all-time low after warning that both earnings and revenue will come in lower than expected this coming quarter.
  • Five Below plummeted 25.05% after its CEO, who has helmed the company for over a decade, announced his departure smack in the middle of a very difficult year.
  • J.B. Hunt tanked 6.88% thanks to a poor second-quarter earnings report in which earnings and revenue came in well below analyst expectations.
  • Charles Schwab fell yet another 5.34% as the hits keep coming. Today, the culprit was a price target downgrade from Bank of America analysts.
  • Elevance Health slipped 5.96% despite beating analyst expectations this quarter, but warning that Medicaid membership declined.

CITE: https://tinyurl.com/2h47urt5

UnitedHealth Group has bounced back in the second quarter, reaffirming its guidance for the year as it posts a profit of $4.2 billion


An audit of Aetna Health of Texas found significant errors in how the health plan calculated the qualifying payment amount for air ambulance services, raising more questions over broader noncompliance in the industry for the No Surprises Act.


And … clinical decision software company Regard pocketed $61 million in series B funding to scale its reach in healthcare as investors have a growing appetite for AI-powered startups.

CITE: https://tinyurl.com/tj8smmes

A study published in JAMA this month found that nearly 7% of the US population (or roughly 18 million people) have had long Covid. Symptoms of the condition vary widely, but often include fatigue, brain fog, and post-exertional malaise (meaning symptoms worsen after minimal exertion), according to the CDC. Booster shots may help protect against long Covid, the JAMA study suggested.

And, President Joe Biden tested positive for COVID-19 while campaigning in Las Vegas with ‘mild symptoms’.

Physician burnout is on the decline after spiking to unprecedented levels during the Covid-19 pandemic, according to a survey from professional group the American Medical Association (AMA).

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Surgeon to Pay $5 Million for Restriction of Negative Reviews

By Staff Reporters

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A Non-Disclosure Agreement (or “NDA”) is an agreement under which a party (the “Recipient”) agrees not to disclose proprietary and confidential information (“Confidential Information”) that it receives from another party (the “Owner”).

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Surgeon to Pay $5 Million for Restriction of Negative Reviews, Directing Fake Reviews

A Seattle plastic surgeon who illegally restricted patients from posting negative reviews about his practice and directed his staff to post fake positive reviews will pay $5 million for violating Washington state’s consumer protection law. According to a July 1 consent decree, Javad Sajan, MD, and his practice Allure Esthetic must pay $1.5 million in restitution to 21,000 patients and $3.5 million to the state for manipulation of patient ratings.

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FTC: https://consumer.ftc.gov/consumer-alerts/2022/09/should-we-trust-online-reviews

The settlement resolves a federal lawsuit brought by Washington State Attorney General Bob Ferguson that accused the doctor of illegally suppressing patients’ negative reviews by “forcing” them to sign nondisclosure agreements (NDAs) before they received care. In an April decision, US District Judge Ricardo S. Martinez sided with the state, ruling that Allure Esthetic’s actions violated the federal Consumer Review Fairness Act (CRFA).

Source: Alicia Gallegos,MD Edge [7/10/24]

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ESTATE Planning Basics

Rick Kahler MS CFP

By Rick Kahler MS CFP®

Supposedly, the most frightening words one spouse can hear from the other are, “Honey, we need to talk.” Even more frightening, however, is, “Honey, we need to talk about estate planning.”

What can you do if you want to get serious about estate planning, but your spouse doesn’t?

Here are a few suggestions:

  1. Consider ways to persuade a reluctant spouse to participate

First, give up nagging. In my years of financial planning, I’ve seen how ineffective it is from either an advisor or a spouse.

Instead, it might be worthwhile to do some research and show your spouse some of the specific consequences of not planning. Depending on the complexity of your circumstances, you may find it worthwhile to consult an attorney, accountant, or financial advisor. You can also find a great deal of helpful information, such as state probate and intestacy laws, online.

If you have no wills, find out how your state laws distribute assets when someone dies without a will. Show your spouse how that distribution would affect your family. In many cases, intestacy laws are still designed around a traditional one-marriage-with-children family structure. They may fail to provide for members of families that don’t fit that mold—for example, by disregarding stepchildren and step grandchildren.

If you have wills but made them years ago, take a close look at their provisions. Show your spouse—with numbers, if you can—exactly who would benefit and who would not. Your spouse may be persuaded to take action if he or she sees the specific ways that yesterday’s wills don’t provide for today’s family. Even if this accomplishes nothing beyond convincing your spouse to destroy an outdated will, it may be worthwhile. An outdated will, in some cases, can be worse than none at all.

It’s quite likely that neither of these approaches will succeed. This leaves you with the next-best option.

  1. Do what you can on your own

With your own separate property, you can do any estate planning you want, including executing a will and setting up a living trust. I would also strongly encourage you to execute powers of attorney for financial and health decisions.

However, you might be surprised at the limits on estate planning for assets you consider yours. One important provision is that married people cannot name anyone except each other as beneficiaries on retirement plans without the spouse’s permission. Suppose, for example, you would like to name your children from a previous marriage as beneficiaries on a retirement account as a way of providing fairly for them if your spouse died intestate. You would need your spouse’s consent to do so.

Also, a will executed by one spouse does not affect assets held jointly or in trust, annuities, retirement plans, or individually held bank or brokerage accounts that have a TOD (transfer on death) provision.

Assuming you cannot persuade your spouse to participate in estate planning, and assuming you have done whatever individual planning you can, there’s one more step you can take.

  1. Educate yourself.

Do your best to create and maintain a complete inventory of assets you and your spouse hold jointly, as well as your separate retirement accounts, insurance policies, and other individual assets. Include account locations, approximate balances, and access information. Having this information will be invaluable if you end up as the administrator of your spouse’s estate.

Ironically, the person who benefits most from your separate estate planning may be your non-planning spouse. Yet doing whatever you can-will also help you be prepared, just in case you need to deal with the consequences of your spouse’s lack of planning.

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Assessment

Some basic; but important thoughts.

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

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

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

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

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DAILY UPDATE: Apple, Macy’s, Goldman, Banks, Companies and the Roaring DJIA

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  • The Dow jumped 700 points at one point today, its biggest single-day surge this year. The S&P 500 spent the entire trading session in positive territory, ending the afternoon at another record close, while the NASDAQ was flat most of the day as tech stocks sat out the rally.
  • Bitcoin continued to surge, rising as high as $65,191 as predictions of a second Trump presidency helped erase the cryptocurrency’s recent losses.
  • Gold hit a new record as hopes of a rate hike continue to rise, while oil sank on the news of slower economic growth in China translating to lower demand for crude.
  • The Russell 2000 enjoyed its 5th straight gain of 1% or more for the first time since 1979 as small caps make their comeback (more on that below).

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Apple released public beta versions of the newest software for iPhone, Mac, iPad, and Apple Watch. Macy’s ended talks of a buyout with investment firms Arkhouse Management and Brigade Capital Management after months of wrangling. Goldman Sachs was the latest big bank to benefit from rebounding investment banking fees as deals start making a comeback.

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

Despite such challenges as high interest rates, a sluggish M&A market, and increased regulatory scrutiny, bank executives are feeling optimistic about the road ahead. That’s according to KPMG’s 2024 US Banking Industry Outlook Survey, published last month, which polled 200 senior executives at US banks of varying sizes in March 2024.

CITE: https://tinyurl.com/2h47urt5

Here’s where the major benchmarks ended:

  • The S&P 500® index (SPX) rose 35.98 points (0.64%) to 5,667.20; the Dow Jones Industrial Average® ($DJI) climbed 742.76 points (1.85%) to 40,954.48; the NASDAQ Composite® ($COMP) added 36.77 points (0.2%) to 18,509.34.
  • The 10-year Treasury note yield (TNX) fell slightly to just under 4.17%.
  • The CBOE Volatility Index® (VIX) ticked up to 13.19, still near three-week highs.

What’s up

  • Match Group climbed 7.46% after activist investor Starboard Value revealed it has taken a 6.6% stake in the matchmaking company.
  • Bank of America rose 5.35% on strong earnings, and management’s expectation that the bank’s net interest income will rise this year.
  • UnitedHealth Group popped 6.49% after beating analyst earnings estimates, missing revenue expectations, and most importantly, avoided higher costs after a recent cyberattack.
  • Shopify surged 8.57% thanks to an analyst upgrade from “neutral” to “buy” on the company’s turnaround efforts. Shares of Etsy rose 6.33% in sympathy.
  • GRAIL boomed 24.76% on the news that it is kicking off the clinical trials of its new cancer detection test.
  • Home builders’ hot streak continues: Hopes of a rate cut are fueling a rally for home builder stocks, with D.R. Horton up 6.64%, Lennar rising 6.55%, KB Home gaining 7.17%, and Builders FirstSource popping 8.11%.

What’s down

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INFLATION: Update FOMC

By Staff Reporters

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Jerome Powell said the Fed won’t wait for 2% inflation to cut rates

The central bank won’t wait to hit its inflation target before bringing interest rates down but wants to have “greater confidence” that inflation will get there in order to make cuts, Powell said at the Economic Club of Washington, DC, in his first public event since June’s cooling inflation numbers came out.

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MEDICAL INFLATION: https://medicalexecutivepost.com/2023/03/30/medical-economics-healthcare-inflation/

However, the FOMC chair wasn’t willing to get into specifics about when rate cuts might be coming.

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DAILY UPDATE: PBMs Scrutinized as Companies Report and Stock Markets Rotate

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Though the accountant shortage is still a concern, a shortage of AI and tech skills might be a more pressing issue right now. That’s according to a pulse survey by consulting firm RGP and YouGov, which polled 213 US financial professionals at the director level and above this June.

Read: What do you do when you hit your insurance deductible? Some people throw parties. (the New York Times)

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

Here’s where the major benchmarks ended:

  • The S&P 500® index (SPX) rose 15.87 points (0.28%) to 5,631.22; the Dow Jones Industrial Average® ($DJI) climbed 210.82 points (0.53%) to 40,211.72, a new record-high close; the NASDAQ Composite® ($COMP) added 74.12 points (0.4%) to 18,472.57. 
  • The 10-year Treasury note yield (TNX) gained four basis points to just below 4.23%.
  • The CBOE Volatility Index® (VIX) increased to 13.14, its highest close since June 24.

What’s up

  • Bitcoin-related stocks rose alongside the crypto rally today, with Coinbase up 11.39% and Microstrategy climbing 15.36%.
  • Gun manufacturers always rise after a major shooting incident, and the assassination attempt on Donald Trump certainly meets that criteria. Sturm, Ruger & Company jumped 5.44%, and Smith & Wesson rose 11.38%.
  • Stelco Holdings rocketed 73.98% higher on the news that the Canadian steelmaker will be acquired by Cleveland Cliffs for $2.8 billion.
  • AutoNation popped 2.01% on the news that it’s cutting $1.50 off of its EPS for the latest quarter due to the CDK cyberattack. Apparently getting ahead of the bad news is actually good news?

What’s down

  • Macy’s sank 11.76% after the department store’s board voted to end acquisition negotiations with activist investors Arkhouse and Brigade.
  • Burberry fell 16.08% after a poor quarterly report, a profit warning, and the ousting of its CEO.
  • AES plummeted 10.01% thanks to a storm cutting power to thousands of the utility company’s customers throughout Ohio.
  • SolarEdge Technologies dropped 15.36% after the company announced it will lay off 400 employees to improve profitability. Shares of solar competitors slumped in sympathy: First Solar fell 8.50%, Sunrun sank 8.95%, and Sunnova Energy fell 9.96%.

CITE: https://tinyurl.com/2h47urt5

The Federal Trade Commission (FTC) frequently sets its sights on healthcare, which has previously included efforts to crack down on data privacy and ban noncompetes in contracts. Lately, the agency has turned its attention to pharmacy benefit managers (PBMs)—the groups that negotiate drug prices between insurers and pharmaceutical manufacturers—to shed light on how they impact the healthcare industry.

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Stat: 23.5%. That’s how much Covid-related emergency room visits increased in a week at the beginning of this month. (CDC)

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EDUCATIONAL TEXTBOOKS: https://tinyurl.com/4zdxuuwf

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HUMAN TOUCH: Needed in Medicine

By Staff Reporters

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According to Fierce Healthcare, 60% of patients say they are willing to switch doctors for a better communications experience, according to a survey. Patients want more of a “human touch” when texting their providers, like conversational message exchanges. 

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PODCAST: Shortages in Healthcare

By Eric Bricker MD

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

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62% of Nurses Would Consider a Change in Career Paths

By Staff Reporters

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A recent survey by StaffHealth of 250 RNs, LPNS, and CNAs found the following:

 •  86% of respondents say their workload/job responsibility has increased in the last year.
 •  54% of the above respondents say that the increase in workload has negatively impacted their mental health.
 •  83% of those surveyed agree that an increase in compensation/incentives would alleviate nurse burn out and shortages.
 •  62% of nursing professionals would currently consider a change in career paths.
 •  66% of respondents say access to mental health resources at work would be beneficial.

Source: StaffHealth via PRNewswire, February 8, 2022

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