Why Physicians Need to Deal with Debt

Understanding the Impending Retirement-Planning Crisis

[By Somnath Basu PhD, MBA]

A serious retirement-planning crisis is looming in the US with many Baby Boomer physicians, and others, having already spent a portion of their nest egg and undermining any hope for a comfortable lifestyle unless they continue to work. Notwithstanding medical professionals, look no further than an annual “retirement confidence” survey conducted by the Employee Benefit Research Institute and Mathew Greenwald & Associates in each of the past 17 years. Nearly two in five of working Americans responding to the latest survey indicated that they have taken no action in the face of reductions in their employer-provided retirement benefits.

Consumption Equals Happiness?

The population is constantly told that consumption equals happiness. At the same time they are not being asked to understand about the implications of borrowing to fund for such consumption. Before we can expect to effect a change in the ensuing pattern of a vicious cycle, the population mass must have a clear understanding of the difference between needs (e.g., retiring with peace of mind) and desires (e.g., cruises or living the high life).

Negative Savings Rate

When savings first dipped into negative territory during the Great Depression in 1932 and 1933, people didn’t have enough to eat, whereas there has been no such urgency to raid nest eggs since the repeat of this performance in 2005 when the rate fell to minus 0.5 percent. Our grandparents were shining stars in the way they worked hard to build this country’s infrastructure and manufacturing sector, saved every red cent they could get their hands on and created affluence on a mass scale. Today we’re able to enjoy the fruit of their labor. But, somehow their values were lost on future generations.

Changing American Culture

Many of the nation’s top engineers and scientists now hail from China, India and other Asian countries as American culture has undergone a dramatic change to the point where jocks and cheerleaders are more valued than computer geeks and science nerds in our schools. We inherited so much affluence that it made us lazy as a society. The seeds of our destruction have been sown, but it’s up to our politicians, educators and other leaders, including financial advisors, to help reverse this disturbing pattern before it’s too late.

Many people fall into the trap of rushing through dinner and unwinding in front of the TV where a big part of the problem lies in slick and subtle, and hard to resist, primetime advertising and marketing messages (prime time for subtle messages) that seduce viewers into purchasing luxury cars or flying to far-flung resorts where they can sip umbrella-clad cocktails alongside affluent vacationers.

Americans in Debt

A recent wave of foreclosures has put Americans deeper in debt, with the sub-prime crisis exposing despicable predatory lending practices. But, research has shown the wreckage also could be found strewn across in the mid-prime and prime markets as middle-class borrowers struggled to pay adjustable rate mortgages. High hopes have been pinned on the stock market helping people crawl out from this crisis just like when the real estate market had softened the blow when the tech-bubble burst at the turn of this century. So far, this has happened, to an extent. But, if the stock market starts reeling again, then it will spell even bigger trouble. Add to this the international trade imbalance, which implies foreign governmental funding of our conspicuous consumption, and which comes with high interest rates that need to be paid to the lenders, again to such countries as China, India and other emerging economies, and a bigger, worse picture emerges.

Personal Bankruptcies

Personal bankruptcies have an even more devastating effect on an individual’s ability to plan for the future, particularly since the laws pertaining to this area were toughened to a point where reckless spenders will need to muster fiscal and financial discipline as never before. The doomsday scenario is that children now run the risk of inheriting debt instead of wealth, and it’s unconscionable to think future generations would have a standard of living that’s worse than their parents or grandparents.

Assessment

The true grit associated with being an American is to rise up in the face of adversity – a frontier spirit that drew me this remarkable country. We’ve weathered numerous storms and can do it again. But, it requires a serious commitment to stopping mindless consumption of goods and services, as well as understanding there’s a difference between basic needs and pie-in-the-sky desires.

NOTE: Dr. Somnath Basu is a Professor of Finance at California Lutheran University and the Director of its California Institute of Finance. He is also the creator of the innovative AgeBander technology www.agebander.com for planning retirement needs.

Conclusion

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DAILY UPDATE: Delta Airlines with Stock Market Recap

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Americans are traveling in record numbers this summer, but Delta Air Lines said Thursday that it saw second-quarter profit drop 29% due to higher costs and discounting of base-level fares across the industry. The airline is also predicting a lower profit than Wall Street expects for the third quarter.

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Dramatic photos from the aftermath of the Trump shooting.

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  • Markets: Stocks swung upward finishing the week strong. The Dow closed above 40,000 for the second time ever. And, investors expect the stock market to get a jolt of volatility this week following the assassination attempt on former President Trump, and trades linked to his victory in November (such as a rising US dollar) could see an uptick. For example, Trump has fashioned himself into a pro-crypto candidate, and bitcoin spiked above $62,000 after the shooting.
  • Finance: Big banks kicked off the Q2 earnings season, with JPMorgan, Citigroup, and Wells Fargo reporting. Investment banking revenue was up as deals have started coming back, even as continued high interest rates took a toll on their loan and deposit businesses. Wells Fargo, which relies most on the businesses hit by inflation, saw its profit drop year over year. Investors are wary: All three banks’ stock fell.

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Alphabet is close to acquiring cybersecurity startup Wiz, according to the Wall Street Journal. The $23 billion purchase price would be the largest in the company’s history.

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Hospitals Transferring Patient Medical Debt

To RIP Medical Debt

By Anonymous

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CREDIT CARDS: Medical Debt?

By Staff Reporters

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What is a medical credit card?

Medical credit cards are typically offered through healthcare providers such as physicians, veterinarians, dentists, and even hospitals. Unlike major credit cards, you can’t use them for cash advances or to purchase items like groceries, gasoline, or airline tickets.

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The cards are only accepted by participating medical providers for certain medical services or procedures. 

READ: https://www.experian.com/blogs/ask-experian/should-you-use-medical-credit-card/

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MEDICAL DEBT: Remains a Household Strain

Report underscores ongoing concerns about accuracy of collections data, particularly with respect to medical debt

By Staff Reporters

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According to Gabriella Cruz-Martinez, tens of millions of debt collections disappeared from Americans’ credit reports during the pandemic, a new government watchdog report found, but overdue medical bills remain a big strain on many households nationwide. The total number of debt collections on credit reports dropped by 33% from 261 million in 2018 to 175 million in 2022, according to the Consumer Financial Protection Bureau, while the share of consumers with a debt collection on their credit report shrunk by 20%.

Medical debt collections also dropped by 17.9% during that time, but still made up 57% of all collection accounts on credit reports, far more than other types of debt combined — including credit cards, utilities, and rent accounts. Despite the reduction in collections, the CFPB noted that the results underscore ongoing concerns that current medical billing and collection practices can lack transparency, often hurting the credit scores and financial health of those most vulnerable.

“Our analysis of credit reports provides yet another indicator that, due to a strong labor market and emergency programs during the pandemic, household financial distress reduced over the last two years,” Rohit Chopra, CFPB director said in a statement. “However, false and inaccurate medical debt on credit reports continues to drag on household financial health.”

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JUNE: Men’s Mental Health Month

By Staff Reporters

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Mental Health America is proud to recognize June as Men’s Health Month. So, if you think you or a loved-one may be experiencing signs of a mental illness, visit www.mhascreening.org to take a free, quick and confidential screen for depression, bipolar disorder, anxiety, PTSD, and/or Alcohol or Substance Use problems.  

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Mental Health Entrepreneurial Start-Up Companies

Top Ten [10] Venture Capital Backed

By Dr. David Edward Marcinko MBA MEd CMP

By Carol Miller RN MBA

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Mental Health White Paper:

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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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DAILY UPDATE: Assassination Attempt on the President

MEDICAL EXECUTIVE-POST TODAY’S NEWSLETTER BRIEFING

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Good Sunday Morning

A brief note on yesterday’s shocking events at the Donald J. Trump Rally.

A shooting at a Pennsylvania rally in Butler County for former President Trump has officially been deemed an assassination attempt, the FBI confirmed. Trump said he was shot in the ear but is “fine,” according to a spokesperson, while the alleged gunman and one rally attendee are dead.

Moreover, Texas Rep. Ronny Jackson, who was former President Donald Trump‘s White House doctor, revealed that his nephew was ‘grazed in the neck’ by a bullet at the Butler, Pennsylvania rally. 

Authorities identified the gunman as a 20-year-old man from Bethel Park, a town about an hour’s drive from the site of the shooting. Leaders in the US and around the world offered their support to Trump and condemned political violence as the Secret Service faces questions about the security failure.

Therefore, we will re-post related articles on workplace violence, prisons, mental health and psychological turmoil etc; addressing our core but non-political topics. Unite and stay strong. Thank You!

David Edward Marcinko [Editor-in-Chief]

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SURVEY: Medical Work-Place Violence 2022

Global Healthcare Exchange

By Staff Reporters

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5 Key Findings

 •  58% of Americans are worried about nurses and other clinicians being harmed while on hospital property.
 •  66% of Americans agree nurses and other front-line healthcare workers are more likely than those in other professions to be victims of workplace violence.
 •  57% say burn out from the past few years plays a role in contributing to healthcare labor shortages.
 •  88% believe that keeping track of every hospital visitor is essential to safety.
 •  82% of Americans believe that more state/federal action should be taken to keep healthcare workers safe.

Source: GHX, “82% of Americans believe that more state/federal action should be taken to keep healthcare workers safe,” April 7, 2022

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PRACTICE RISKS IN CORRECTIONAL CARE MEDICINE

Some Thoughts and Some Statistics

dr-david-e-marcinko-mba-msl[By Dr. David Edward Marcinko MBA MEd CMP]

Most primary care doctors, psychologists and psychiatrists who work in corrections long enough will end up being named in a lawsuit or having a complaint filed against them with their licensing board.

And, it is a fact that physicians who treat inmates are at greater risk of litigation.

Bureau of Justice Statistics

According to the 2011-12 National Inmate Survey conducted by the Bureau of Justice Statistics:

  • Half of state and federal prisoners and jail inmates reported a history of a chronic medical condition.
  • About 2/3 of females in prisons (63%) and jails (67%) reported ever having a chronic condition
  • An estimated 40% of prisoners and inmates reported having a current chronic medical condition.
  • About 1 in 5 (21%) of prisoners and 14% of jail inmates reported ever having an infectious disease.
  • Approximately 1% of prisoners and jail inmates reported being HIV positive.
  • High blood pressure was the most common condition reported by prisoners (30%) and inmates (26%).
  • Nearly a quarter (24%) of prisoners and jail inmates reported ever having at least 2 chronic conditions.
  • 66% of prisoners and 40% of jail inmates with a chronic condition reported taking prescription medication.And, although specific figures are not available, malpractice carriers are quite aware of this risk.

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gavel stethoscope

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Risks Not a Work Deterrent

Yet, according to colleague Eric A. Dover MD and Jeffrey Knuppel MD, a psychiatrist who blogs at The Positive Medical Blog, the risk of litigation should not be a deterrent to working as a health care professional in correction facilities if:

1. You truly like working in the correctional setting. This work is not for everyone. If you don’t really like it anyway, then the thought of getting sued is just likely to decrease your career satisfaction further.

2. You have ability to be assertive yet get along well with most people. If you frequently find yourself in power struggles with people or cannot politely set limits, then do not work in corrections. If you let your ego get involved in you interpersonal interactions very often, then you’re likely to irritate many inmates, and you probably will become a target for lawsuits and complaints [personal communication]. 

Conclusion

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

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Medical Workplace Violence Prevention Guidelines

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Earliest Guidelines in California Program

By Eugene Schmuckler; PhD MBA MEd CTS

By Dr. David E. Marcinko MBA MEd CMP

UPDATE

Assassination attempt on Donald J.Trump

At least 5 people are dead and multiple people are injured following a shooting at the Natalie Building at St. Francis Hospital in Tulsa, Oklahoma.

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The impact of medical workplace violence became widely exposed on November 6, 2009 when 39 year old Army psychiatrist Maj. Nidal M. Hasan MD, a 1997 graduate of Virginia Tech University who received a medical doctorate in psychiatry from the Uniformed Services University of the Health Sciences in Bethesda, Maryland, and served as an intern, resident and fellow at the Walter Reed Army Medical Center in the District of Columbia, went on a savage 100 round shooting spree and rampage that killed 13 people and injured 32 others. In April 2010 he was transferred to Bell County Jail in Belton, Texas awaiting trial.

Federal Government Guidelines

The federal government and some states have developed guidelines to assist employers with workplace violence prevention. For instance, one of the earliest sets of guidelines for a comprehensive workplace violence prevention program was published in 1993 by California OSHA. This resulted from the murder of a state employee. In 1996, Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers was published by OSHA.

OSHA Guidelines

In its guidelines, OSHA sets forth the following essential elements for developing a violence prevention program:

  • Management commitment — as seen by high-level management involvement and support for a written workplace violence prevention policy and its implementation.
  • Meaningful employee involvement — in policy development, joint management-worker violence prevention committees, post-assault counseling and debriefing, and follow-up are all critical program components.
  • Worksite analysis — includes regular walk-through surveys of all patient care areas and the collection and review of all reports of worker assault. A successful job hazard analysis must include strategies and policies for encouraging the reporting of all incidents of workplace violence, including verbal threats that do not result in physical injury.
  • Hazard prevention and control — includes the installation and maintenance of alarm systems in high-risk areas. It may also include the training and posting of security personnel in emergency departments. Adequate staffing is an essential hazard prevention measure, as is adequate lighting and control of access to staff offices and secluded work areas.
  • Pre-placement and periodic training and education — must include educationally appropriate information regarding the risk factors for violence in the healthcare environment and control measures available to prevent violent incidents. Training should include skills in aggressive behavior identification and management, especially for staff working in the mental health and emergency departments.

On May 17, 1999, Governor Gary Locke signed the New Workplace Violence Prevention Act for the state of Washington. This act mandates that each healthcare setting in the state implement a plan to reasonably prevent and protect employees from violence.

New Washington Workplace Violence Prevention Act

According to this act, prevention plans need to address security considerations related to:

  • physical attributes of the healthcare setting;
  • staffing, including security staffing;
  • personnel policies;
  • first aid and emergency procedures;
  • reporting of violent acts; and
  • employee education and training.

Prior to the development of an actual plan, a security and safety assessment needs to be conducted to identify existing or potential hazards. The training component of the plan must include the following topics:

  • general safety procedures;
  • personal safety procedures;
  • the violence escalation cycle;
  • violence-predicting factors;
  • means of obtaining a patient history form from a patient with violent behavior;
  • strategies to avoid physical harm;
  • restraining techniques;
  • appropriate use of medications as chemical restraints;
  • documenting and reporting incidents;
  • the process whereby employees affected by a violent act may debrief;
  •  any resources available to employee for coping with violence; and
  • the healthcare setting’s workplace violence prevention plan.

Assessment

The act further mandates that any hospital operated and maintained by the State of Washington for the care of the mentally ill is required to provide violence prevention training to affected employees identified in the plan on a regular basis and prior.

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.

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GAP BETWEEN A.I. AND BEDSIDE: Participatory Workshop on the Barriers to the Integration, Translation, and Adoption of Digital Health Care and AI Startup Technology Into Clinical Practice

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The study examines the challenges of integrating new technologies in clinical practice, identified four primary barriers: insufficient knowledge of health system technology procurement protocols, which can vary across facilities; strict regulations and clinical trial requirements; obstacles in the health system technology procurement process; and competitive disadvantages for smaller startups.

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DAILY UPDATE: Corporate Earnings, Oxendine Guilty as Stock Markets Rotate

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Here’s where the major stock market benchmarks ended:

  • The S&P 500® index (SPX) rose 30.81 points (0.5%) to 5,615.35, up 0.9% for the week; the Dow Jones Industrial Average® ($DJI) rose 247.15 points (0.6%) to 40,000.90, up 1.6% for the week; the NASDAQ Composite® ($COMP) added 115.04 points (0.6%) to 18,398.44, up 0.3% for the week. Both the SPX and $DJI set intraday record highs today.
  • The 10-year Treasury note yield closed basically unchanged just below 4.19%.
  • The CBOE Volatility Index® (VIX) fell slightly to 12.49.

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What’s up

  • Trump Media & Technology Group climbed 3.40% as President Biden’s recent stumbles seem to be breathing new life into the stock.
  • Tesla rose 2.99%, nearly recovering from yesterday’s drop over robotaxi delays, despite a UBS analyst downgrading the company to “sell.”
  • Deckers Outdoor recovered 1.14% when the board announced a 6-for-1 stock split just a few days after M Science analysts warned investors away from the company.
  • Array Technologies popped 8.69% thanks to an upgrade from Citi analysts from “neutral” to “buy” citing the company’s strong long-term prospects. Competitor Enphase Energy jumped 6.85% in sympathy.
  • Carvana soared 4.80% after BTIG analysts initiated coverage of the company with a “buy” rating and a price target 7% higher than where shares trade today.
  • Home builder stocks continued their climb today on higher hopes of rate cuts. D.R. Horton rose 2.68%, Builders FirstSource jumped 3.99%, and even Home Depot got in on the action and rose 1.70%.

What’s down

  • AT&T slid 0.21% after Ma Bell announced that hackers had stolen information about virtually every single one of the cell carrier’s customers. Shares of cybersecurity company Snowflake sank 1.74% on the news as well.
  • Delta Air Lines fell another 3.06% as turbulence throughout the airline industry continued to weigh the stock down.
  • Arbor Realty Trust plummeted 17.03% after the Justice Department announced a probe of the company due to improper lending practices.
  • Vita Coco dropped 9.07% thanks to a downgrade to “neutral” from Piper Sandler analysts. Are you telling me that a company that just sells coconut water isn’t actually worth $1.58 billion? Now that’s just vita loco!

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Here’s a list of some corporate earnings announcements next week:

  • Monday: Goldman Sachs, BlackRock.
  • Tuesday: Bank of America, Morgan Stanley, PNC Financial Services, and Charles Schwab. We’ll also hear from UnitedHealth Group, Progressive, and J.B. Hunt.
  • Wednesday: ASML, Citizens Bank, Ally Financial, Synchrony Financial, and U.S. Bancorp will wrap up the big financial names. Plus Johnson & Johnson, Kinder Morgan, United Airlines, and Alcoa.
  • Thursday: The busiest day of the week includesNetflix, Domino’s Pizza, Abbott Laboratories, Nokia, D.R. Horton, Intuitive Surgical, and much more.
  • Friday: The week wraps up with American Express, Schlumberger, and Halliburton.

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A federal judge on Friday sentenced former Georgia Insurance Commissioner John Oxendine to serve three and a half years in prison after Oxendine pleaded guilty to healthcare fraud. U.S. District Judge Steve Jones, at a hearing in Atlanta, also ordered Oxendine to pay a $25,000 fine and to share in $760,000 in restitution with Dr. Jeffrey Gallups.

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MDs RETIRING: 23,000 Physicians Will Retire by 2026

By Staff Reporters

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Thousands of doctors are expected to reach retirement age in the next three years, and their replacements won’t be physicians.

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Instead, physician assistants (PAs) and nurse practitioners (NPs) will increasingly provide primary care services, according to a report from consulting firm Mercer.

MORE: https://www.healthcare-brew.com/stories/2023/03/16/non-mds-will-provide-primary-care?cid=31157347.24865&mid=349b552221c994e2540a304649746d7c&utm_campaign=hcb&utm_medium=newsletter&utm_source=morning_brew

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RELATED: https://www.kevinmd.com/2023/04/rural-americas-health-care-crisis-unmasking-the-physician-shortage-epidemic.html

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CONSUMER PRICE INDEX: Down Mid-Year 2024

INFLATION EASING

By Staff Reporters

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For the first time since May 2020, the average cost of goods and services in the US made like a remote worker with wanderlust and dipped last month, the Labor Department just reported in July 2024, bolstering confidence that inflation is easing.

Carried by softening gas and rent prices, the consumer price index (CPI) decreased 0.1% in June, beating economists’ forecasts of a 0.1% monthly increase.

  • That dip brought down the annual CPI, which also beat expectations, to record a 3% year over year gain in June—a one-year price growth low and a rate last seen in early 2021.
  • Average gas prices fell 3.8% in June, after dropping 3.6% in May.
  • Shelter prices, which account for about one-third of the CPI, only rose 0.2% in June as rents cooled. It was the category’s smallest monthly rise in three years.

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CONSUMER PRICE INDEX: What is the Elderly CPI?

The CPI-E

[By staff reporters]

We’ve written about the CPI and Chained CPI before on this ME-P.
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Q = So, what is the Elderly CPI?
A = It is experimental CPI for the elderly called the CPI-E.
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According to the Bureau of Labor Statistics, or BLS, the CPI-E includes households whose reference person or spouse is 62 years of age or older.
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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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What is the PRODUCER PRICE INDEX?

By Dr. David E. Marcinko MBA MEd CMP®

CMP logo

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DEFINITION: The PPI is a group of indexes that measure the change, over time, in the prices received by domestic producers of goods and services. It measures price changes from the perspective of the seller rather than the consumer, as with the CPI. The CPI would include imported goods, while the PPI is relevant to U.S. producers, and therefore would not include imports.

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

The PPI measures over 10,000 products and services. It reports the price changes prior to the retail level. This information is useful to the government in formulating fiscal and monetary policies. The data gathered from the PPI is often used in escalating purchase and sales contracts. That is the dollar amount to be paid at some time in the future.

NOTE: Long-term managed medical care contracts of the future will seek escalation clauses for increases in prices.

BLS: https://www.bls.gov/pPI/

full report: https://www.bls.gov/news.release/pdf/ppi.pdf

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DAILY UPDATE: Pfizer, MSFT and the NASDAQ Collapse

MEDICAL EXECUTIVE-POST TODAY’S NEWSLETTER BRIEFING

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As drugs like Wegovy and Zepbound that help people slim down have enlarged its competitors’ bottom lines, Pfizer has struggled to keep up. But now it’s moving forward with the development of a once-daily version.

Here’s where the major benchmarks ended:

  • The S&P 500 index fell 49.37 points (0.8%) to 5,584.54; the Dow Jones Industrial Average® ($DJI) rose 32.39 points (0.1%) to 39,753.75; the NASDAQ Composite® ($COMP) collapsed and lost 364.04 points (1.95%) to 18,283.41 but remains up 22% year to date. The SPX is still up 17% this year.
  • The 10-year Treasury note yield dropped eight basis points to 4.19%.
  • The CBOE Volatility Index® (VIX) climbed to 12.99.

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

  • More specifically, the S&P 500 and NASDAQ broke their winning streaks today, closing in the red for the first time in over a week—though both did hit intraday highs at one point. The Dow finished the afternoon in the green, just barely.
  • Gold breached $2,400, and is closing in on a record high of $2,449.89 set back in May.
  • Oil rose on today’s CPI news, with the idea being that if inflation slows and the Fed cuts rates then economic activity will pick up, as will demand for crude.
  • Bond yields sank on CPI data while prices rose.

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According to the Wall Street Journal, Microsoft abandoned its post as an observer on the board after realizing it was bothering antitrust officials who were looking into the relationship between the two companies. Apple, which was expected to take a similar seat on the OpenAI board, will reportedly no longer do s

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PODCAST: How to be a DEBT FREE Direct Primary Care Physician?

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DEFINITION: The DPC model was created to allow for a singular focus upon the Primary Care Physician-2-Patient relationship. To achieve this, DPC removes the hassles and overhead expenses created by insurance and replaces it with a fixed monthly membership fee. This simplified approach frees the physician from meaningless paperwork and allows them to only see 8-10 patients a day. This level of personalized engagement allows them to develop a meaningful and enduring relationship with each patient.

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

By James Hawkes MD

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Dr. James Hawkes grew up in a large family. His father was a U.S. diplomat, which exposed him to different models of healthcare. In addition to exposure, his grandmother encouraged him to become a doctor. He followed her recommendation but to his surprise, the definition of a good doctor wasn’t about improving patients’ quality of life it was about hierarchies, documentation, administrative requirements, and quality measures. 

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Shortly after saying goodbye to the traditional healthcare model, he launched his own direct care practice. Fast forward to today, he is a 100% debt-free direct care physician. He shares his story of how it’s possible to achieve this goal.

PODCAST: https://healthcareamericana.com/episode/how-to-become-a-debt-free-direct-care-physician/

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Doctors, Sole Proprietors and Taxes

On the Self-Employment Tax

By Perry D’Alessio CPA

perry-dalessio-cpaA sole proprietor is an individual business owner [medical practice] physician-executive whose business [practice] is accounted for on a separate schedule of the owner’s individual income tax return.

Typically, owners filing their business returns via the use of Schedule C of Form 1040 have the lowest level of reporting requirements and also (in general) do the poorest job of keeping good records of business activity.

There is only one level of tax for the sole proprietor. The net profit (or loss) from the Schedule C business is reported on page one of Form 1040 and is combined with all of the other income items reported to arrive at gross income.

Different from interest and dividend income, or investment income that is typically considered passive in nature, self-employment income is income considered to be generated by ones’ own actions.

Self Employment Tax

There is “Self Employment” tax to be paid on virtually all self-employment income reported in the tax return.  Many sole proprietors get into trouble because they neglect to take this tax into account when estimating their tax liability for the year and this tax is significant as noted below.

How SET Works

Self-employment tax is paid on 92.35 percent of all self-employment net profits.  This tax is the equivalent of the combination of the employer’s and employee’s Social Security tax and Medicare tax.  Social Security tax is 12.4 percent of the first $117,000 (in 2014) in net income and Medicare tax is paid 2.90 percent of net income without any upper income limit. There is also no maximum for the .9% additional Medicare tax under the PP-ACA [Obamacare] that applies when adjusted gross income exceeds $250,000 for joint filers, $200,000 for single filers, or $125,000 on married-filing-separate returns.

2024

The most you will have to pay in Social Security taxes for 2024 will be $10,453. That’s what you will pay if you earn $168,600 or more. As its name suggests, the Social Security tax goes to the Social Security program. For 2024, it amounts to 6.2% for employees on all income up to $168,600. Employers deduct the tax from paychecks and match it, so that 12.4% goes to the program for each employee. If you’re self-employed, you’ll pay the full 12.4%, though you can deduct half on your tax return.

solo

Social Security Limit

The Social Security income limit is indexed and adjusted (upward) annually.  The sole proprietor is allowed to deduct one half of the self-employment tax against income; however, this deduction is worth far less than the actual tax.

More: Changes   in The Health Care Marketplace and Their Likelihood Over The Next   Five Years

Conclusion

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PODCAST: Independent Physicians Will Win!

By Eric Bricker MD

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PODCAST: “Real ACOs Haven’t Been Tried Yet!”

What is an Accountable Care Organization?

DEFINITION: ACOs are groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high-quality care to their patients. The goal of coordinated care is to ensure that patients get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors. When an ACO succeeds both in delivering high-quality care and spending health care dollars more wisely, the ACO will share in the savings.

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

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QUESTION: What happens when you’re a healthcare policy wonk and the pilot study for your pet program has failed miserably? 

ANSWER: You declare “Success!” in the editorial pages of the New England Journal of Medicine and demand that the program become nationwide and mandatory. I kid you not.  This is exactly what happens.

Thankfully, Anish Koka is vigilant and explains the blatant obfuscations and manipulations that the central planners engage in to have their way.

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And so, In this video, Anish and colleague Michel Accad, MD, will reveal the machinations, take the culprits to task, and discuss pertinent questions regarding health care organization: 

  • Does “capitation” reduce costs? 
  • Do employed physicians necessarily utilize fewer resources? 
  • What happens when a HMO and a traditional fee-for-service health system operate side-by-side in a community?
BMC and Accountable Care - Boston Medical Center

Enjoy!

PODCAST: http://alertandoriented.com/real-acos-havent-been-tried-yet/

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77% of Surveyed ACOs Use 6 or More EHR Systems

By Staff Reporters

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77% of Surveyed ACOs Use 6 or More EHR Systems

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All roads lead to the EHR - MedCity News

According to a recent AJMC survey of 163 MSSP ACOs

 •  Just 9% of surveyed ACOs use a single EHR system throughout their entire organization.
 •  77% of surveyed ACOs use 6 or more EHR systems.
 •  Among the 37% of Medicare Shared Savings Program ACOs with 16 or more EHR systems, concerns about EHR-based quality measures include access to data, standardization of data elements, and cost of integrating across systems.

Source: AJMC, “Use of Electronic Health Record Systems in Accountable Care Organizations”, January 18th 2022

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ACOs: Regulatory Environment Scrutiny

By Health Capital Consultants, LLC

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Because of the federal government’s preference for, and reliance on the success of, accountable care organizations (ACOs), some ACOs assume their legal status shields the organization from legal scrutiny on all issues.

However, since the 2010 advent of ACOs, the law has adapted uniquely to these organizations. This fourth installment of a five-part series on the valuation of ACOs will discuss this unique regulatory environment in which ACOs operate. (Read more…) 

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ACOs: A Brief History of Accountable Care Organizations

ACOs to the Rescue – Not Yet!

DEM white shirt

By Dr. David E. Marcinko MBA CMP®

SPONSOR: http://www.CertifiedMedicalPlanner.org

According to the Health Dictionary Series of administrative terms; valuation expert and colleague Robert James Cimasi MHA, ASA, AVA CMP of www.HealthCapital.com; an ACO is a healthcare organization in which a set of providers, usually large physician groups and hospitals, are held accountable for the cost and quality of care delivered to a specific local population. ACOs aim to affect provider’s patient expenditures and outcomes by integrating clinical and administrative departments to coordinate care and share financial risk [personal communication]

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Enter the PP-ACA

Since their four-page introduction in the PP-ACA of 2010, ACOs have been implemented in both the Federal and commercial healthcare markets, with 32 Pioneer ACOs selected (on December 19, 2011), 116 Federal applications accepted (on April 10, 2012 and July 9, 2012), and at least 160 or more Commercial ACOs in existence today.

Federal Contracts

More recently, Donna Marbury writing in Medical Economics, revealed that Federal ACO contracts are established between an ACO and CMS, and are regulated under the CMS Medicare Shared Savings Program (MSSP) Final Rule, published November 2, 2011.  ACOs participating in the MSSP are accountable for the health outcomes, represented by 33 quality metrics, and Medicare beneficiary expenditures of a prospectively assigned population of Medicare beneficiaries. If a Federal ACO achieves Medicare beneficiary expenditures below a CMS established benchmark (and meets quality targets), they are eligible to receive a portion of the achieved Medicare beneficiary expenditure savings, in the form of a shared savings payment.

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Commercial Contracts

Commercial ACO contracts are not limited by any specific legislation, only by the contract between the ACO and a commercial payer. In addition to shared savings models which may not be in effect for another 3-5 years, Commercial ACOs may incentivize lower costs and improved patient outcomes through reimbursement models that share risk between the payer and the providers, i.e., pay for performance compensation arrangements and/or partial to full capitation.

Although commercial ACOs experience a greater degree of flexibility in their structure and reimbursement, the principals for success for both Federal ACOs and Commercial ACOs are similar. And, nearly any healthcare enterprise can integrate and become an ACO, larger enterprises, may be best suited for ACO status.

Medicare Contracts

Assessment

Larger organizations are more able to accommodate the significant capital requirements of ACO development, implementation, and operation (e.g., healthcare information technology), and sustain the sufficient number of beneficiaries to have a significant impact on quality and cost metrics.

More:

Conclusion

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Medical Franchises, MLM and In-Office Dispensation

BY Dr. DAVID EDWARD MARCINKO MBA MEd CMP

http://www.MARCINKOASSOCIATES.com

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Healthcare Business and Medical Franchises

The International Franchise Association (IFA) estimates that that about $1 trillion in sales, or 40% of all retail sales, were made through franchised establishment last decade. On the positive side, franchises offer a branded practice concept with management training and access to proprietary methods, marketing and advertising campaigns and a host of support. Moreover, there are franchises available for virtually every healthcare product or service, including: diet, weight loss and fitness; vein care and laser surgery; vitamins, nutriceuticals and pharmaceuticals; plastic and cosmetic surgery; dermatology, tanning and skin care; home healthcare and extended, etc.

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

Some well know established healthcare and medical franchises are: Doctors Express, Being There Senior Care, Home Care Assistance, Personal Training Institute, Inches-A-Weigh, Remedy Intelligent Staffing, Visiting Angels, Unlimited MedSearch, prnYourHealth and Any Lab Test Now.

On the downside, franchises incur high start-up costs, rules and obligations, payment of franchise percentages and many contractual obligations.

Questions to consider when contemplating this business entity include:

 Franchise stability, track record, licensing and costs.
 Training, support and proximity of other franchises.
 Independence, ownership laws, contracts and dispute resolutions,
 Screening methods, market size and potential market share.
 Replacement cost and transferability?

For more information on Uniform Franchise Offerings Circulars (UFOCs) contact:

Frandata
1130 Connecticut Avenue, NW
Washington DC 20036
202.659.8640

International Franchise Association7
1350 New York Avenue, NW
Washington, DC 20005
202.628.800

Multi-Level Marketing and In-Office Dispensation


A multi-level marketing (MLM) business delivers products or services through a chain of independent distributors rather than traditional retail business outlets. Existing medical practices not only pursue income ancillary, but it is not unusual for beginning practitioners to plan for and include it in their start-up models and business plans.

The first layer is usually the distributor who must sell products/services and recruit additional members to produce a hierarchical organization with many employees. Each distributor profits from direct sales, and from a varying commission stream down-line. It may be best to investigate before you leap into these situations since some may be fraudulent pyramid schemes that sell no useful product or service, and requires only recruiting others into the scheme. Be sure to obtain a Dunn & Bradstreet or TRW credit
report about any MLM company and inquire about current litigation. Most authorities agree that it take 3-5 years before serious money is made in the MLM business.

Moreover, care must be taken with this model. According to colleague Stephen Barrett MD, writing on the Mirage of Multilevel Marketing: “Many any physicians are selling health-related multi-level products to patients in their offices. The companies most involved have included Amway (now doing business as Quixtar), Body Wise, Nu Skin (Interior Design), Rexall, and Juice Plus+. Doctors are typically recruited with promises that the extra income will replace income lost to managed-care.

Back, in December 1997, the AMA Council on Ethical and Judicial Affairs (CEJA) advised against profiting from the sale of “non- health-related products” to their patients. Although CEJA’s policy statement does
not mention products sold through multilevel marketing, CEJA’s chairman said the statement was triggered by the growing number of physicians who had added an Amway distributorship to their practice.”

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DAILY UPDATE: Tesla, PBMs, Medicare Part C and the Hot Stock Markets

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A day before the June CPI report, major indexes extended their rally amid growing demand for semiconductors and rate cut hopes.

  • The S&P 500 rose above 5,600 for the first time ever, only a few short days after breaking above 5,500, with the index hitting a new record for the last seven straight trading sessions. The NASDAQ also enjoyed a solid day as well thanks to strong performances by tech stocks, while even the Dow got in on the action and ended the session in the green.
  • Bond yields stayed almost right where they’ve been all week as investors hold their breath ahead of tomorrow’s key CPI reading.
  • Gold rose as investors hope for a strong CPI report to point the Fed toward more rate cuts, while oil rose as well thanks to a stronger-than-expected outlook on global demand from OPEC.

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The Centers for Medicare & Medicaid Services (CMS) announced in June it would recalculate 2024 Medicare Advantage (MA) star ratings for all plans after two court rulings called into question the agency’s method for determining this year’s ratings. The decision is estimated to cost the federal agency roughly $1 billion in additional bonus payments for insurers, according to healthcare analytics firm Cotiviti. The move comes after several large insurers laid off employees in late 2023 after their star ratings decreased.

HIPAA: Some groups are disputing a proposed federal rule that would require hospitals to report cybersecurity incidents, saying they want it to also include insurers and third-party vendors. (Healthcare Dive)

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

What’s up

  • Taiwan Semiconductor rose 3.54% after it reported that its June revenue fell 10% month over month, but its sales rose roughly 33% year over year.
  • Advanced Micro Devices popped 3.87% on the news it is acquiring Silo AI, the largest private artificial intelligence lab in Europe, for $665 million.
  • Carvana drove 4.21% higher after Needham analysts upgraded the stock from “hold” to “buy” due in part to new features at checkout highlighting EVs. Competitor CarMax jumped 6.42% in sympathy.
  • Aehr Test Systems rocketed 24.01% after the semiconductor testing equipment maker raised earnings guidance thanks to strong AI demand.
  • Smart Global Holdings rose 26.27% thanks to earnings that beat Wall Street expectations in the third quarter and a strong outlook for the rest of the year.

What’s down

  • LegalZoom plummeted 25.35% to a new all-time low after the company cut its outlook and its CEO stepped down.
  • HubSpot sank 12.24% on a report that Alphabet is no longer interested in acquiring the company.
  • Intuit dropped 2.57% on the news that the tax prep company is cutting 10% of its workforce.
  • Deckers Outdoor fell 4.86% after M Science analysts published a note cautioning that sales for key brands UGG and HOKA fell in June.
  • Ziff Davis fell 10.32% after the digital media company tried to get ahead of the bad news and pre-announced that second-quarter earnings will fall below analyst expectations.
  • Fast-casual restaurant stocks continued to sink today as investors grow more concerned about lower consumer spending and higher valuations. CAVA Group fell 5.47%, Sweetgreen dropped 1.72%, and Dutch Bros fell 4.34%.

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Tesla’s US electric car market share fell below 50% in Q2 for the first time, according to estimates by the research firm Cox Automotive.

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In a scathing report, the Federal Trade Commission accused [PBMs] pharmacy benefit managers—the companies that act as go-betweens for drug makers and consumers—of jacking up drug prices

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Why a Physician’s Charitable Contribution was Denied

Setty Gundanna Viralam et ux. v. Commissioner

[A Case Model]

By Children’s Home Society of Florida Foundation

In Setty Gundanna Viralam et ux. v. Commissioner; 136 T.C. No. 8; No. 21355-03 (13 Feb 2011), the Tax Court denied a deduction for a charitable gift to an organization maintaining donor advised funds for doctors. In addition to not receiving the charitable deduction, the doctor was subject to capital gains tax on sale of the stock and an accuracy-related penalty.

Physician Example

Dr. Viralam is a medical practitioner. In 1998, Dr. Viralam sold his 50% interest in a medical practice for $2,262,500, producing a taxable gain of $2,261,750. Dr. Viralam had joined a membership organization of doctors named Xelan. He paid a $975 membership fee for the “Xelan tax reduction plan.”

Xelan Foundation

Based upon promotional materials that promised “a tax reduction” program, Dr. Viralam transferred appreciated stock to the Xelan Foundation (“Foundation”) in 1998. The Foundation indicated that Dr. Viralam could create an account described variously as a “donor advised fund” or “family public charity.” The fund was available for “charitable giving, income tax reduction planning, estate tax reduction, educational funding and future retirement planning.”

The Xelan Foundation had been recognized by the IRS as a public charity and was included in IRS Publication 78. In addition, the Foundation had obtained an opinion letter from the Conner & Winters law firm on deductibility of gifts. In their opinion letter, Conner & Winters suggested that gifts to the Foundation were more likely than not to be deductible. However, the opinion letter declined to issue an opinion on the specific grants or educational programs of the Foundation donor advised funds.

The Gifting Mechanism

Following Dr. Viralam’s gift of stock with fair market value of $262,433 and cost basis of $131,360, the Foundation sold the gifted stock and provided him with a receipt. The receipt included the Sec. 170(f)(8) statement that “no goods or services” were transferred in exchange for the gift.

At the recommendation of Dr. Viralam, the Foundation accountant distributed $15,500 to religious organizations for the next two years. However, his Foundation account also made distributions to the University of Pennsylvania of $70,299. Dr. Viralam’s son Vinay was at that time a student at that university. The IRS audited Dr. Viralam and issued a notice of deficiency for 1998. The IRS denied the charitable deduction, assessed a tax on the sale of the appreciated stock by Xelan Corporation and also accessed an accuracy-related penalty under Sec. 6662.

The Court and IRS Opines

The court noted that under Sec. 170(c)(2), a charitable contribution is permitted if it is given to “a foundation organized and operated exclusively for charitable or educational purposes.”

The IRS claimed that the supposed “student loan” to Vinay showed that Dr. Viralam had “never surrendered dominion and control” over the fund. When Dr. Viralam created the fund in 1998, he anticipated that his three children would receive most of the fund for their college expenses. The initial distributions for the benefit of Vinay were made and “the Foundation’s approval of petitioner’s son as a student loan beneficiary was perfunctory.”
While it was true that the Foundation had been granted exempt status and was listed in Publication 78, the issue of the operation exclusively for the benefit of charitable purposes remained. Even though the purported donor advised fund was supposedly for charitable purposes, the facts indicated that Dr. Viralam had retained dominion and control.

The Sec. 170(f)(8)(A) receipt issued by Xelan Foundation indicated that there were no “goods or services” provided in consideration of the gift. However, the “student loans” were clearly within the regulatory definition of “cash, property, services, benefits and privileges.” Because the student loans were contemplated as part of the fund benefits, the gift failed the “no goods or services” test. Under Sec. 170(f)(8), there is “no deduction” if that test is failed.

Assessment

Because there was no charitable deduction, Dr. Viralam is also taxable on the long-term capital gain produced by sale of the stock in 1998. In addition, the penalty under Sec. 6662 applied. Dr. Viralam pointed to the legal opinion by the law firm Connor & Winters. However, that legal opinion explicitly excepted a potential student loan program. In the view of the court, the arrangement fails the “too good to be true” test. In the view of a reasonable person, a taxpayer should realize that this gift to provide university-level educations for children would not be deductible.

Conclusion

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On Donor Advised Funds

More on DAFs

By Rick Kahler CFP®

In A Christmas Carol, Charles Dickens has a scene where two charity workers raising funds for the poor approach Ebenezer Scrooge on Christmas Eve.

” What shall I put you down for?”
   “Nothing!” Scrooge replied.
   “You wish to be anonymous?”
   “I wish to be left alone,” said Scrooge.

Scrooge may not be alone in his desire to be left alone. With 60% of Americans supporting presidential candidates’ proposals for wealth taxes, financial transaction taxes, higher capital gains tax rates, and increases in income taxes, many of our affluent neighbors are just not feeling the love this Christmas.

Nevertheless, there are still millions more who want to give. Charitable giving, though, can be more complicated than it was in Scrooge’s time. For example:

  • Are you bunching your itemized deductions into every other year and would like to give a substantial amount to charities this year, but you haven’t had time to research which charity you want to support or you want to spread the giving out over time as opposed to giving it all this month?
  • Do you support a number of charities and would like to support even more, but find the IRS requirements for documenting your gifts to be burdensome?
  • Would you like to set aside a sum of money for your favorite charities that could generate an annual income forever, but forming a foundation or charitable trust is beyond your reach?

All the above are possible with a donor-advised fund.

Let’s say you wanted to give small amounts to fifty different charities. Rather than write fifty checks and obtain fifty receipts, you can make one gift to the fund, which distributes the money to the fifty charities. You only have to provide one receipt to the IRS.

You can also make a charitable gift to the donor-advised fund that qualifies as a deduction on your 2019 tax return, but you can delay the distribution of the funds until sometime in the future. This gives you time to explore the various causes you may want to support.

What really sets a donor-advised fund apart from other types of charitable giving is that you can decide how your donations are used, much as you would if you set up your own foundation. You can even create either an endowed or a non-permanent fund for a particular purpose, such as a specifically-designated scholarship fund in memory of a loved one.

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Case Example:

One example of a donor-advised fund is the Black Hills Area Community Foundation. The BHACF supports scores of local charities and special projects. However, almost all financial institutions like Fidelity, TD Ameritrade, and Schwab have relationships with donor-advised funds.

While DAFs create an easy-to-establish, low-cost, flexible vehicle for charitable giving as an alternative to an expensive and complex private foundation, they are not hassle-free or without costs. Many charge a combination of fixed quarterly fees and an annual percentage of the undistributed funds. There is also a reasonable amount of administrative work involved. One DAF that I use assesses a penalty of $500 if the account is closed in under a year. They work best when a person anticipates significant contributions and a long-term giving plan.

Every donor-advised fund has different charities, minimums, processes, and costs, so it’s important to do your homework. Research whether the fund approves of the charities you want to support, as well as the costs involved.

Assessment

A donor advised fund may be a good way to take a large deduction this year, reduce the administrative hassles and costs of setting up a foundation, and still give to causes you choose to support.

Your thoughts are appreciated.

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DAILY UPDATE: Mike Bloomberg, Arianna Huffington and Andreessen Horowitz as Stock Markets Tread Lightly

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Most medical students at Johns Hopkins University won’t have to pay tuition anymore thanks to a $1 billion gift from Michael Bloomberg.

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Here’s where the major benchmarks ended:

  • The S&P 500 index®(SPX) rose 4.13 points (0.1%) to 5,576.98; the Dow Jones Industrial Average® ($DJI) fell 52.82 points (0.1%) to 39,291.97; the NASDAQ Composite® ($COMP) climbed 25.55 points (0.1%) to 18,429.9.
  • The 10-year Treasury note yield increased two basis points to 4.29%.
  • The CBOE Volatility Index® (VIX) inched up to 12.49, still near recent lows.

What’s up

  • Tesla rose 3.71%, putting the company squarely in the green year to date as investors continue to celebrate the automaker’s strong delivery numbers.
  • Corning rose yet another 3.76%, extending the glassmaker’s gains as it quickly becomes the new hot AI stock du jour.
  • Kymera Therapeutics shot 23.40% higher after its partner Sanofi gave the go-ahead for further studies of its experimental skin disease treatment.
  • Jumia Technologies soared 29.79% after Benchmark analysts initiated coverage of the African e-commerce company with a “buy” rating.
  • Sony rose 4.46% on the news that it has nothing to do with the merger of Paramount and Skydance as shareholders celebrate dodging a Paramount-shaped bullet.

What’s down

  • Albemarle dropped 8.76% after Baird analysts warned that lower lithium demand will translate to lower profits for the miner in its upcoming second quarter.
  • BP sank 4.80% after management warned of lower-than-expected profits and a writedown of its German refining facility to the tune of up to $2 billion.
  • Helios Technologies fell 10.94% on the news that the CEO of the industrial manufacturer had been placed on paid leave for potentially violating the company’s code of ethics.
  • Helen of Troy plummeted 27.73% after the Hydro Flask maker announced terrible earnings and lowered its fiscal year outlook.
  • UiPath fell 6.90% on the announcement that the software company will cut 10% of its workforce.

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

OpenAI’s venture fund and Arianna Huffington’s Thrive Global are jointly funding a new startup that aims to build an AI health coach to promote healthier lifestyles.


Function Health, a health tech company focused on preventive medicine, recently closed a series A round led by Andreessen Horowitz (a16z) Bio + Health along with a slew of celebrity investors.


And … made possible by the American Rescue Plan, the Biden administration is putting $27.5 million toward women’s behavioral health.

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Selecting Money Managers?

TRUST BUT VERIFY – CAVEAT EMPTOR

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By Clifton McIntire; CIMA, CFP® and Lisa McIntire; CIMA, CFP® 

Most physicians and healthcare executives do not manage their own portfolios, or those of their office or medical foundations. Most are more comfortable using outside money managers to make their investment decisions. Just as the general public does not have the facilities, equipment, staff, or training to make medical decisions, physicians generally do not have the time, education, infrastructure or temperament, to make their own investment decisions.

The Style Search 

The search for the right manager(s) begins with creating a “want” list. What kind of a manager do you want? Let’s say you want to find a large cap growth manager. That narrows the field considerably from the start. You are looking for a manger that does research in and understands the field of large growth companies like Microsoft, Walmart, Pfizer, Google, and AOL-Time Warner.   Jim Cowperthwait, Managing Partner of NewBridge Partners, LLC in New York City, is a “growth” manager.  Cowperthwait sums up this philosophy with the statement, “Earnings growth drives stock prices over the long-term. Therefore, we invest our clients’ money in companies whose earnings are expected to grow at 20 percent per year.  Over the long term, this should result in portfolio growth of 15 percent per year.” The other main investment “style” is “value.” 

Value managers buy stocks at a discount to some perceived value.  Generally these stocks pay above market dividend yield, are selling below market price/earnings ratios, and have a low price to cash flow ratio.  Examples of value stocks would be Exxon, Philip Morris, Dupont, and Texas Utilities.  Jim Landau of Berkeley Capital Management in San Francisco, California is a value manager. Landau says, “We look for quality companies with a consistent record of dividend increases and a stock price that is undervalued.” Other styles include the following:

  • Contrarian—invest in stocks that are out of favor or have little market interest
  • Small Cap Growth—small growing companies with high capital appreciation potential
  • Small Cap Value—companies that sell at a discount to some perceived value
  • Market timers
  • Asset Allocators
  • Sector Rotators

Fixed Income Managers 

Managers in the field of fixed income also have a variety of styles. Some are managers of municipal bond portfolios such as John Mousseau of Cumberland Advisors of Vineland, New Jersey.  George Shaffrey of Morgan Keegan & Company of Memphis, Tennessee manages a portfolio of high yielding (average rating “B”) corporate bonds.  Madison Investment Advisors of Madison, Wisconsin offers management of U.S. Government Bonds.  To limit the field even more let us establish some minimum requirements.  To begin with, the performance numbers must be in conformance with AIMR (Association for Investment Management and Research); now CFA Institute, standards.  After that, limit your search to firms with the following characteristics: 

  • Assets under management of at least $1 billion
  • Organization with at least four principals
  • Some independent research
  • Length of time in business  (at least 2 market cycles)
  • Consistent return performance
  • Control of risk well defined
  • Minimum account size within our reach

Software programs are available to screen the world of investment management and come up with a list of potential candidates. CheckFree Investment Services of Research Triangle Park, North Carolina has one of the best. Many others are available. Whether the Bank Trust Department, Private Money Manager or Personal Investment Consultant is being interviewed, here are a few of the questions that should be asked: 

  • Can I get a sample of that report?
  • What kind of performance measurement reporting do I get from you?
  • What due diligence work is done by your organization?
  • What investment/portfolio choices do I have?
  • Who is/are the portfolio manager(s)?
  • How experienced is the portfolio manager?
  • How is he/she compensated?
  • Are you showing me audited performance?
  • How has the performance been? (1, 3, 5 and 7 years)
  • Whose performance is it?  The same portfolio manager as five years ago?
  • Have other key personnel changes been made?
  • Will my account be a separate or commingled account?
  • What are the total costs?  Does that include the following:  ü       [Custody of assets?   Management fee?  Trustee fees?  Transaction fees?  Transaction costs?  Distribution fees?  Termination fees?, etc] 
  • Can I get the costs in writing with a statement that there are no additional costs?

stock-exchange

Decision Matrix 

Now decide what’s important to you in a money-manger and weight each matrix or category. Here are four useful qualities to assess each potential money-manager on the same criteria to be as objective as possible.  These areas are organization, philosophy, performance and fit with your overall plan.  Decide how much weight to assign each of these areas and then rank each manager on a scale of 1 (lowest) to 4 (highest) for each manager. 

1. Performance: 

Like some medical P4P initiatives, after installing your manager(s) you must monitor the performance to assure strict and complete conformance with your investment policy statement. You need to compare your returns with standard indexes, your return objectives, consumer price index, and Treasury Bills. It is also important to compare your results with other investment managers with similar investment style. Let’s not forget the very important capital market line analysis, which depicts the risk we experienced for the return we received; or manager expenses and portfolio size.                   

2. Capital Market Line Analysis:

Quarterly in depth analysis of the portfolio is a must. Most institutions require a formal presentation from the consultant quarterly. Your money is certainly as important to you as the fiduciary responsibility is to them. Some consultants let the report always reflect the account from the beginning. The theory is that the more data that we put in, the more accurate the statistics become, but this begins to distort the performance after the fifth year, and data going back to 1940 is not relative to current market environments. Many reports exclude numbers more than five to seven years old. 

3. Expenses:

Expenses can play an important role in performance. You don’t hear much about expense ratios in an up market. If your account was up +28 percent, whether the expense was 3 percent or 1 percent doesn’t seem to make much difference.  But let the market decline and the portfolio with it for a year and we change our perspective. A 10 percent portfolio decline plus charges of 3 percent equals a 13 percent decline.  Now we need a 15 percent increase net of fees just to get even.  Basically you have four cost areas: 

  • Custody—someone must hold the stocks and bonds, collect dividends and interest, prepare tax information for the government, issue monthly statements, and send checks.
  • Commissions—orders must be executed, transfer securities into and out of your account, trades settled.
  • Investment Decisions—the money manager must be paid.
  • Monitoring Performance and Advice—usually an investment management analyst is engaged to provide this service as well as write the investment policy statement and prepare the asset allocation study.

4. Size:

Naturally, size makes a difference. For a stock account with a $200,000 total value, all of the above can be accomplished for annual fees between 2.00 and 3.00 percent.  An account with $1,500,000 in total assets part bonds and part stocks would pay annual fees between 1.25 and 1.75 percent depending on the ratio of stocks and bonds.  These are annual fees and are all-inclusive. Commissions, portfolio management fees, and statements check charges are all included.  One quarter of the annual fee is charged every three months.  Family related accounts are generally grouped for a quantity fee discount. Most all fee structures are negotiable. Some consultants prefer to use mutual funds with smaller accounts.  A charge of 1 percent per year for their service with a stated minimal fee is common practice. This does not include fees deducted from the account by the mutual fund (anywhere from .50 to 2.50 percent) or commissions paid by the fund managers for trade executions.   

Assessment 

Remember, when considering money management, be sure to understand the ultimate fiscal consequences and your own personal liability? Always be sure to use a fiduciary consultant and let the competition for your business begin. 

Conclusion

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CYBERSECURITY: Healthcare Podcast

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“Victims of cyber extortion and ransomware increase in 2024”

By Dan Raywood for SC Magazine, July 8, 2024.
https://www.scmagazine.com/news/victims-of-cyber-extortion-and-ransomware-increase-in-2024

“…small businesses with fewer than 1,000 employees are four times more likely to be impacted by attackers than medium and large businesses.” That’s us, Doc. (You might not get this kind of news from the American Dental Association).

DARRELL PRUITT DDS

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Protecting Healthcare: Unveiling the Cybersecurity Imperative

Podcast: A Conversation with Dan Dotson

RICH HELPPIE The Common Bridge

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

-Dr. David E. Marcinko MBA MEd CMP®

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SECOND OPINIONS: Secure Investment Advisory -OR- Medical Practice Management Advice

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FINANCIAL PLANNING

CAREER DEVELOPMENT

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INVESTMENT ANALYSIS

PORTFOLIO MANAGEMENT

MERGERS AND ACQUISITIONS

PRACTICE APPRAISALS AND VALUATIONS

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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: Health Insurers & Hospital Mergers with Light Stock Market Trading

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Here’s where the major benchmarks ended:

The CBOE Volatility Index® (VIX) climbed slightly to 12.37.

The S&P 500 index®(SPX) rose 5.66points (0.1%) to 5,572.85; the Dow Jones Industrial Average® ($DJI) dropped 31.08 points (0.1%) to 39,344.79; the NASDAQ Composite® ($COMP) gained 50.98 points (0.3%) to 18,403.74.

The 10-year Treasury note yield (TNX) was roughly flat at 4.27%.

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What’s up

  • Intel popped 6.15% after an analyst at Melius Research declared the company could be one of the big AI winners in the second half of this year.
  • Morphic Holding skyrocketed 75.06% on the news that Eli Lilly will acquire the drugmaker for $3.2 billion in cash.
  • SolarEdge climbed 9.26% thanks to an upgrade from “underperform” to “neutral” by Bank of America analysts, who see big upside and few downside risks ahead.
  • Corning rose 11.98% after management raised earnings guidance for the coming quarter thanks to higher demand due to the AI boom.
  • Lucid rose 7.85% on the news that its deliveries rose 70% in the second quarter.

What’s down

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Stat: 27. That’s a tally of some of the hospital mergers, acquisitions, joint ventures, affiliations, and partnerships that have been canceled since January 2022. (Becker’s Hospital Review)

Read: Health insurers received $50 billion from Medicare for diseases that doctors did not treat over three years, according to a recent analysis. (Wall Street Journal)

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HEDGE FUNDS: Understanding Fees and Costs

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DEFINITION: A Hedge fund is an investment partnership with freer rein to invest aggressively in a wider variety of financial products than most mutual funds. A hedge fund’s purpose is to pool funds, maximize investor returns, and eliminate risk with hedging strategies. Hedge funds are generally considered more aggressive, risky, and exclusive than mutual funds. The hedge fund industry has grown tremendously since its inception. There are trillions of dollars of assets under management, more than 8,800 hedge fund managers, and over 27,000 funds globally

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

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Many physicians and other investors — even those that meet net worth guidelines — are surprised to learn that there exists a $500 – 999 billion, or more, alternative investment industry that is not generally marketed to the public. Such alternative investments have also been known as hedge funds or private investment funds.

Unlike mutual funds, these alternative investments can be structured in a wide variety of ways. Because of the very same regulations discussed above, these funds cannot be advertised, but they are far from illegal or illicit.

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Novant/CHS Deal Scrapped after FTC Intervenes

By Health Capital Consultants LLC

In February 2023, Novant Health, a 19-hospital, non-profit health system operating throughout the Carolinas, agreed to acquire two North Carolina hospitals – Davis Regional Medical Center and Lake Norman Regional Medical Center – from Community Health System (CHS), a publicly-traded mega-system operating in 15 states.

After the $320 million deal was announced, the Federal Trade Commission (FTC) began an extensive review of the acquisition, and concluded that: (1) the transaction may substantially reduce competition; (2) create a monopoly; and (3) constitute an unfair method of competition. (Read more…)

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How to Monitor Hedge Funds

Four Ways to Monitor after Purchase

By Dr. David Edward Marcinko MBA, MEd, CMP™

SPONSOR: www.CertifiedMedicalPlanner.org

[Publisher-in-Chief]

Hedge funds (broadly defined as private investment vehicles that trade a variety of long and short equities, derivatives, futures contracts, and options in a variety of capital markets) have grown in size and importance in client portfolios because of superior performance, until late [2008-09 and 2022], and readily available investor capital.

Risk Factors

Physicians and clients often ask us to assess certain risk factors and a variety of investment entity structural characteristics associated with hedge funds. Accordingly, we must often be involved in discussing clients’ specific risk/return desires and expectations as they consider such investments.

Four Key Post-Investment Issues:

  1. A change in core investment strategies or risk postures from those which are documented in the investment policy statement—Among these are the specific markets to be traded, the degree of financial leverage to be employed or allowable, the underlying instruments or contracts to be used, and the investment strategies to be pursued under various conditions. Hence, there is no substitute for careful and regular assessment by the planner of changes in how and what an investment manager is trading and communication of such to the client.
  2. Use of financial leverage can dramatically increase returns just as poor performance can be accentuated—The key issue for the planner is whether a given investment manager’s use of leverage changes over the life of the hedge-fund investment, thereby possibly affecting the client’s initial desired risk/return profile.
  3. The composition of the performance return, particularly with respect to the long-term capital gain component.
  4. Asset growth—Regularly monitor and evaluate whether it is detrimental to performance and capable of causing an erosion of performance over a long-term horizon.

Assessment

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Often, after a hedge-fund investment has been made, if performance over time is good (or even adequate), both the doctor client and the financial advisors or planner may assume that there has been no material changes in investment strategy or structural characteristics that warrant attention or concern. Such changes often occur subtly over time and, if performance erodes, and the client may feel that the planner did not adequately monitor the investment. Hence the necessity for the above warning post

Note: “Post investment Issues Regarding Hedge Funds,” by Richard L. Fisher, Personal Financial Planning, November/December 1996, pp. 14–19, Warren, Gorham & Lamont, 1-800-950-1205.)

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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DAILY UPDATE: Earnings Season, the FOMC, Threads and Boeing

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Wall Street is counting down the hours until Friday, which is when Q2 earnings season kicks off. Investors are hoping anyone besides Big Tech will post impressive results to keep the rally going. Although the stock market has set record after record this year, it’s mostly been the work of tech giants. As of Tuesday, about 40% of S&P 500 companies were in the red for 2024.

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Federal Reserve Chair Jerome Powell will give updates on the economy to Congress on Tuesday and Wednesday, where he’ll likely be asked about the prospect of interest rate cuts. Those plans could become clearer on Thursday, when the consumer price index inflation report drops.

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Meta’s Twitter clone, Threads, has 175 million monthly users one year after its launch, CEO Mark Zuckerberg said.

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Boeing will plead guilty to a criminal fraud charge stemming from two fatal crashes of 737 Max planes and pay an additional $243.6 million fine, allowing it to avoid a criminal trial sought by victims’ families. More here.

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OUR TAKE: Private Equity and Venture Capital

By Lon Jefferies MBA CMP™ CFP®

By Dr. David Edward Marcinko MBA CMP®

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Private equity and venture capital investments typically involve ownership of shares in a company and represent title to a portion of the company’s future earnings. However, private equity is an equity interest in a company or venture whose stock is not yet traded on a stock exchange.

Venture capital is typically a special case of private equity in which the investment is in a company or venture that has little financial history or is embarking on a high risk/high potential reward business strategy.

Like real estate, private equity and venture capital investments generally share a general lack of liquidity and a lack of comparability across different individual investments. The lack of liquidity comes from the fact that private equity and venture capital investments are typically not tradable on a stock exchange until the company has an IPO.

The lack of comparability is due to the fact that most private equity and venture capital investments are the result of direct negotiation between the investor/venture capitalist and the existing owners of the company  /venture.

With widely divergent terms and provisions across different investments, it is difficult to make general claims regarding the characteristics of private equity and venture capital investments.

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HEALTH INFORMATION TECHNOLOGY: Ransomware and Bankruptcy!

Bad things can happen in paperless practices, Doc

By Darrell Pruitt DDS

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“Illinois Hospital First To Shut Down Completely After Ransomware Attack”

-By Karl Bode for Techdirt, Jun 16th 2023.

“Such attacks can have a chain reaction on already broken hospitals and health care systems. Health care workers are sometimes forced to resort to pen and paper for patient charts and prescriptions, increasing the risk of potentially fatal error. Delays in care can also prove fatal. And ransomware is only one of the problems that plague dated medical IT systems whose repair is being made increasingly costly and difficult by medical health care system manufacturers keen on monopolizing repair.”

Remember the MCNA (Managed Care of North America) data breach that was reported by Bill Toulas in Bleeping Computer on May 29th? There have been new developments.

LINK: https://www.bleepingcomputer.com/news/security/mcna-dental-data-breach-impacts-89-million-people-after-ransomware-attack/?fbclid=IwAR29pojexxoxDrrjIbcQqAAgnw17L5xqMXGxCnnDk_ZL0-kIv2PCniVaG0Y

“Patients of a Florida-based dental insurance provider brought a proposed class action lawsuit alleging negligence over a ransomware data breach that leaked the private information of more than 8.9 million people on the dark web, saying they face a lifetime risk of having their identities stolen.”

David Minsky for Law 360

[June 16th, 2023]

If you are still using paper records, don’t change now.

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META: Violating the DMA?

Europe can’t stop penalizing US tech firms.

The European Union or EU has charged Meta with violating its Digital Markets Act (DMA), a new law regulating digital platforms, through its “pay or consent” model. That model, which Meta introduced in November to comply with the DMA, allowed European users of Instagram and Facebook to pay for a subscription instead of seeing ads. The EU now says these options prevent users from consenting to the use of their personal data.

Meta is the second US-based Big Tech company to be charged for violating the DMA, after Apple got nailed last week.

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What is ADVERSE SELECTION in Health Insurance?

ADVERSE SELECTION

By staff reporters

The tendency of people who are less than standard health insurance risks to seek or continue insurance to a greater extent than other individuals.  This so called “selection against the insurer”, or “anti-selection”, is a form of stacking the deck and is also found in the tendency of policy owners to take advantage of favorable options in health insurance or managed care contracts.

Or, a particular health plan, whether indemnity or managed care, is selected against by the enrollee, and thus an inequitable proportion of enrollees requiring more medical services are found in that plan.

Example:   Low enrollee out-of-pocket costs might lure those individuals requiring more health services into an HMO rather than an indemnity-plan because the former does not have a deductible.

Therefore, the HMO would have a greater proportion of less-healthy enrollees, thereby driving up costs and increasing financial risks. Also occurs with one of the following:

  1. When a premium doesn’t cover costs. Some populations, perhaps due to age or health status, have a great potential for high utilization.
  2. Some population parameter such as age (e.g., a much greater number of 65-year-olds or older to young population) that increases the potential for higher utilization and often increases costs above those covered by a payer’s capitation rate.

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On Nursing Capitation Reimbursement?

Partial-Risk Medicare Nursing Capitation Economics is Still Not Working!

By Dr. David E. Marcinko MBA MEd CMP®

SPONSOR: http://www.CertifiedMedicalPlanner.org

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Capitated reimbursement is predominantly, but not exclusively, within the realm of physician providers. But, a decade ago Community Nursing Organization project examined an innovative approach to community nursing and ambulatory care services for Medicare beneficiaries. The hypothesis was that provision of such services would promote the timely and appropriate use of health care and to reduce the use of costly acute care services.

Organizations participating in the CNO demonstration were paid a fixed per-member-per-month capitated rate for covered services. But, the participating CNOs were only at risk under capitation for a subset of Medicare benefits [partial-capitation or carve-out]. The financial incentive was to minimize utilization covered under the capitated payment, but not necessarily to minimize utilization of services not covered because traditional Medicare, not the CNO, would be at risk.

Assessment

Final results indicated that the CNO model under partial capitation led to increased Medicare costs based on findings consistent across several analytic approaches. The cost differences between treatment and control or reference groups persisted after the application of increasingly complex risk-adjustment methods.

Moreover, the differences increased over time and were robust to changes in the way CNO participation was defined.

Lastly, there was no statistically significant evidence of increase in physical or social functioning of the treatment group, as compared with the control group. CNOs cost more without providing any health benefits along dimensions measured

[Source: Voluntary Partial Capitation: The CNO Medicare Demonstration Project, Austin Frakt, Steve Pizer, Robert Schmitz, and Soeren Mattke – Health Care Financing Review 2005).

Your thoughts are appreciated.

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How MCOs Intensify Accounting IBNRs

Understanding the Uncertainty of Loss

By Dr. David E. Marcinko MBA MEd CMP

Because of the high degree of uncertainty inherent in the estimates of ultimate losses underlying the liability for unpaid claims, the IRS will not allow a Managed Care Organization to deduct an IBNR because the financial statements are based on an estimate (IRS, 134-155).

Loss Based Deductions

Unless the taxpayer healthcare entity qualifies for the insurance company exclusion, the IRS does not allow any taxpayer entity to deduct losses based on estimates. However, the precedent has been set that the IRS will accept an amount for IBNR claims if the amount is supported by actuarial projections and/or valid receipts of claims that the company has in-house prior to the filing of the tax return.

Time Line Controversy

There has been some controversy as to how long a reporting time period the IRS will allow to include those estimates. The time period ranges from three to six months to file a claim (IRS, 137). The process by which these reserves are established requires reliance upon estimates based on known facts and on interpretations of circumstances, including the business’s experience with similar cases and historical trends involving claim payment patterns, claim payments, pending levels of unpaid claims, and product mix, as well as other factors such as court decisions, economic conditions, and public attitudes.

Assessment

There has been no clear indication from the IRS that it will accept an accrual for these losses and entities. Therefore, healthcare organizations deducting such losses may eventually find themselves in a position where the IRS may challenge the relating deductibility of those losses.

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, be sure to 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 Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

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What Is an IBNR Medical Claim?

Significance Often Under Appreciated

By Dr. David Edward Marcinko; MBA, MEd, CMP™

[Publisher-in-Chiefdem2]

As some Medical Executive-Post readers and subscribers are aware, hospitals that filed bankruptcy a decade ago include: a two-hospital system in Honolulu; one in Pontiac, MI; Trinity Hospital in Erin, Tennessee; Century City Doctors Hospital in Beverly Hills, and four hospital system Hospital Partners of America, in Charlotte. Today,

one can only wonder about the impact of Incurred But Not Reported claims on their plight?  

IBNR Definition

According to the www.CertifiedMedicalPlanner.org, an IBNR claim is a concept that signifies healthcare services have been rendered but not invoiced or recorded by the healthcare provider, clinic, hospital, or organization.

Cause and Affect

IBNRs are usually the result of a commercial prospective payment risk contract between managed care organizations and healthcare providers, an IBNR claim refers to the estimated cost of medical services for which a claim has not been filed, or monitored by an IBNR collection systems or control sheet.

IBNR Types

More formally, IBNRs are a financial accounting of all services that have been performed but, as a result of a short period of time or “lag,” have not been invoiced or recorded. The medical services that will not be collected should be accounted for using the following accrued but not recorded (ABNR) entry:

Debit — accrued payments to medical providers or healthcare entity

Credit — IBNR accrual account

Example:

An example of an IBNR is hospital Coronary Artery Bypass Graft [CABG] surgery for a managed care plan member. Out of the capitated or prospective payment funds, the surgeon and/or healthcare organization has to pay for all related physical and respirator therapy, and rehabilitation services, as well as ancillary providers, drugs, and durable medical equipment [DME], as contractually obligated. This may also include complication diagnosis and extensive follow-up treatment.

Accordingly, the health plan will not be completely billed until several weeks, months, or quarters later or even further downstream in the reporting year after the patient is discharged. In order to accurately project the health plan’s financial liability, however, the health plan and hospital must estimate the cost of care based on past expenses.

Accounting Cost Controls

Since the identification and control of costs are paramount in financial healthcare management, an IBNR reserve fund (an interest bearing account) must be set up for claims that reflect services already delivered but, for whatever reason, not yet reimbursed.

From the accounting perspective, IBNR is accrued as an expense and is related as a short-term liability each fiscal month or accounting period.

Otherwise, the organization may not be able to pay the claim, if the associated revenue has already been spent. The proper handling of these “bills in the pipeline” is crucial for proactive providers and health organizations that are exploring arrangements that put them in the role of adjudicating claims or operating in a sub-capitated system.

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Stetho-Claim

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Assessment

IBNRs are especially important with newer patients who may be sicker than prior norms.

Recoverables that hospitals post as part of their large reserve charges are also, in many cases, IBNR losses. They may be recorded as IBNR claims on their balance sheets. Once these losses start becoming actual losses, the hospital may look to the insurer to pay a part of the claim. This causes disputes between the payor, provider, and/or healthcare organization.

Conclusion

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

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

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PHYSICIAN APPRAISAL ENGAGEMENTS: Investment Banking, FMV and Venture Capital

By Staff Reporters

SPONSOR: http://www.MARCINKOASSOCIATES.com

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There are a myriad of reasons for obtaining a Fair Market Value [FMV], Venture Capital [VC} and/or Investment Banking [IB] funding appraisal engagement:

  • Outright Selling-Buying
  • Partnership and Associate buy-in / buy-out
  • Mergers and Acquisitions
  • Organic growth tracking
  • Hospital integrations
  • Private and public reporting
  • Financing and Venture Capital
  • Estate and Tax Planning

And, there are many cautions, too. On July 19, 2023, the Federal Trade Commission (FTC) and the Department of Justice (DOJ) released a draft update of its Merger Guidelines, which guides the regulatory agencies in their review of both mergers and acquisitions in evaluating compliance with federal antitrust laws.

The new Guidelines replace, amend, and consolidate the Vertical Merger Guidelines and Horizontal Merger Guidelines, which were published in 2020 and 2010, respectively.

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DAILY UPDATE: Home Health and Nurse Vacancies as Stock Markets Reach New Highs

MEDICAL EXECUTIVE-POST TODAY’S NEWSLETTER BRIEFING

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Essays, Opinions and Curated News in Health Economics, Investing, Business, Management and Financial Planning for Physician Entrepreneurs and their Savvy Advisors and Consultants

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As home hospital programs continue to grow—employment in the home health industry is projected to increase by nearly 30% by 2029—so does the concern that home healthcare professionals are increasingly vulnerable to assault and harassment.

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

Here’s where the major benchmarks ended:

  • The S&P 500 index® (SPX)rose 30.17 points (0.54%) to 5,567.19; the Dow Jones Industrial Average® ($DJI) rose 67.87 points (0.17%) to 39,375.87; the NASDAQ Composite® ($COMP) climbed 164.46 points (0.9%) to 18,352.76.
  • The 10-year Treasury note yield (TNX) dropped nearly seven basis points to just below 4.28%.
  • The CBOE Volatility Index® (VIX) increased slightly to 12.45.

What’s up

  • Meta Platforms rose 5.88% a day after CEO Mark Zuckerberg posted a video of himself wearing a tux, holding an American flag and a beer, and wakeboarding. Shareholders apparently approve of such an absolute stud running the company.
  • Koss Corp. rose another 25.68% as the latest meme stock continues to rally for no reason at all.
  • Macy’s popped 9.48% after bidders looking to acquire the beleaguered retailer raised their offer from $6.6 billion to $6.9 billion.
  • Smith & Nephew rose 6.67% on the news that activist investor Cevian Capital has taken a 5% stake in the medical device maker.
  • Instructure Holdings rose 5.25% on the news that a bidding war is building for the education software company.

What’s down

  • Nvidia fell 1.91% after it received a rare analyst downgrade due to the company’s valuation.
  • Southwest sank 5.67% on the first full trading day after the company adopted a “poison pill” to fend off activist investor Elliott Management.
  • Budget airline companies took a blow after a Raymond James analyst downgraded the industry due to a “clear as mud” outlook for the third quarter. Frontier Group fell 6.79%, while Spirit Airlines dropped 8.70%.
  • Crypto-related stocks tumbled after bitcoin fell below $54,000 at one point today, though they recovered alongside the cryptocurrency later in the trading session. Coinbase Global fell 0.56%, Robinhood Markets dropped 0.98%, and MicroStrategy fell 1.56%.

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

Stat: 9.9%. That’s the current vacancy rate for nurses in the US, down from 15.7% in 2023. (2024 NSI National Health Care Retention & RN Staffing Report)

PBMs: How pharmacy benefit managers are “driving up drug costs for millions of people, employers, and the government.” (the New York Times)

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