USE: Credit Cards -NOT- Debit Cards

By Staff Reporters

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When you plastic, use a credit card instead of a debit card whenever possible.

Credit cards are protected under The Fair Credit Billing Act (FCBA), while debit cards are protected by the Electronic Fund Transfer Act (EFTA). As the Federal Trade Commission explains, the FCBA limits your potential liability to $50, while the EFTA can leave you responsible for up to $500 of fraudulent charges (and occasionally more) in certain situations.

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

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DAILY UPDATE: Medicare Drug Price Negotiations as Stock Markets Hold Steady

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Here’s where the major stock market benchmarks ended:

  • The S&P 500® index (SPX) rose slightly, up 11 points (0.2%) to end the day at 5,554.25, finishing up 3.9% for the week; the Dow Jones Industrial Average® ($DJI) jumped 96.7 points (0.24%) to close the week at 40,659.76, up 2.9% from last Friday; the NASDAQ Composite®($COMP) gained 37.2 points (0.21%) to 17,631.72, up 5.3% for the week.
  • The 10-year Treasury note yield (TNX) fell three basis points to just above 3.89%.
  • The Cboe Volatility Index (VIX) dropped to 14.74, the lowest in three weeks.

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What’s up

  • Bavarian Nordic, which makes an m-pox vaccine, jumped 15.64%, continuing its surge after the World Health Organization on Wednesday declared a public emergency over the disease’s spread in Africa.
  • Bayer popped 8.36% after the firm won a legal dispute against claims that its weedkiller Roundup causes cancer.
  • Rocket Lab rose 12.52% after the aerospace company announced it shipped two spacecraft to Cape Carnival in preparation for a launch to Mars.
  • H&R Block had its best day since 2022 (up 12.24%) after raising its dividend by 17% and announcing a $1.5 billion share buyback.
  • Maravai LifeSciences leaped 21.46% on reports that the drugmaker received a takeover offer from Repligen Corp.

What’s down

  • On the flip side of that last gainer, Repligen Corp. plummeted 9.26% on the takeover news.
  • Astera Labs dropped 5.52% after several investment firms, including Evercore and JPMorgan, lowered their price target for the chipmaker.
  • ReNew Energy Global dropped 5.91% after the company reported it missed earnings and revenue expectations yesterday.

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The Biden administration announced yesterday that Medicare used its newfound power to negotiate with drug makers to win landmark discounts for 10 widely prescribed drugs to treat ailments like heart disease, cancer, and diabetes. The Inflation Reduction Act, signed into law two years ago, allows the federal health insurance program to directly bargain with pharma companies for the first time.

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

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Documentation for a Medical Practice FMV Appraisal

Office Operations and Processes also Important

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

[Editor-in-Chief]

To successfully complete a medical practice financial analysis and fair-market valuation [FMV] engagement, the following is a description of the documents that are typically required.

According to Robert James Cimasi MHA, AVA, CMP™ of Health Capital Consultants LLC, most of this information is analogous to that required for the valuation of other types of healthcare service sector entities.

A. Important Documents

  • Historical Financial Statements

Important for identifying key variables and trends for analysis. The consultant should obtain year-end financial statements for a sufficient, relevant period to allow reliable analysis, e.g., the most recent three-five years. If, however, significant changes such as technological upgrades, product shifts, or environmental changes have occurred or the five-year period is not long enough, or too short, to assess the entity’s performance during changes in its business cycle or economic conditions, a longer or shorter period may be needed.

  • Tax Returns

Obtain tax returns to understand the entity’s tax position and to obtain additional accurate financial data. The returns provide a summary of tax policies and elections that affect tax expense and net income.

  • Forecasts and Proformas

Prospective financial information (e.g., forecasts, proformas, and budgets) should be requested to provide an indication of the entity’s opinion of its earnings potential as well as its historical ability to meet projections. This data may be especially useful if the consultant must produce a proforma or valuation of future earnings or cash flows.

  • Legal Documents

The consultant should review all significant legal documents to obtain an understanding of the ownership interests and relationships and to determine if contractual arrangements affect the entity’s operations and overall value. Some of the documents to be reviewed include:

Articles of Incorporation, stockholder, or partnership agreements. These agreements indicate ownership interests and the owners’ rights and obligations. Also, any stock option agreements should be considered. This will help the consultant determine or verify the type of interests involved.

Stock books. Review of these can help the consultant ascertain the relative size of various ownership interests and identify transactions in the entity’s stock.

Existing buy-sell agreements. These may provide an indication of the value of the entity or an ownership interest in it. Such agreements, however, are often structured based on factors other than the entity’s fair market value.

Purchase and sale agreements involving prior transactions of the entity’s stock. These provide indications of the entity’s value and any offers or letters of intent to sell or purchase stock should be carefully reviewed under IRS Revenue Ruling 59-60, which includes “Sales of the stock and the size of the block of stock to be valued” in a list of factors that, “although not all-inclusive are fundamental and require careful analysis in each case.” IRS Ruling 59-60 further requires:

   Sales of stock of a closely held corporation should be carefully investigated to determine whether they represent transactions at arm’s length. Forced or distress sales do not ordinarily reflect fair market value nor do isolated sales in small amounts necessarily control as the measure of value. This is especially true in the valuation of a controlling interest in a corporation. Since, in the case of closely-held stocks, no prevailing market prices are available, there is no basis for making an adjustment for blockage. It follows, therefore, that such stocks should be valued upon a consideration of all the evidence affecting the fair market value. The size of the block of stock itself is a relevant factor to be considered. Although it is true that a minority interest in an unlisted corporation’s stock is more difficult to sell than a similar block of listed stock, it is equally true that control of a corporation, either actual or in effect, representing as it does an added element of value, may justify a higher value for a specific block of stock.

Managed care and other service contracts. Types and numbers of managed care contracts should be reviewed, including whether they are with healthcare maintenance organizations (HMOs), preferred provider organizations (PPOs), or point-of-service (POS) contracts; whether they are on a discounted fee-for-service basis and if so, the size of the discount; whether they include a withhold percentage to only be paid based on quality criteria; or whether they are a flat fee per enrollee (“capitated”). Special terms such as the non-transferability of the contract to a new owner must be noted, e.g., managed care contracts often require that the provider be included on a panel of credentialed providers in order to contract to provide services.

Key doctor and managers’ employment contracts. Such agreements can reveal excess compensation above fair market value or “golden parachute” provisions in the event the business is sold.

Loan and lease agreements. These agreements may contain restrictive covenants, special demand clauses, or working capital requirements that affect the value of the entity. The length and terms of lease agreements is also important.

Documents relating to current, pending, or threatened litigation. These may indicate major contingent liabilities that may affect an entity’s value.

Patent/trademark documents. These documents may indicate the existence of valuable intangible assets. The absence of these documents could indicate the absence of a value consideration claimed by the client.

appraisers

  • Office operations and Staff

Consultants should also gain an understanding of the entity’s operations and key personnel. This can be accomplished by touring the facilities, interviewing key managers, and obtaining additional operational data. Obtaining enough information to thoroughly understand the entity, its operations, and its environment is the objective. The consultant becomes aware of operational data or contracts that may affect value by reviewing the following types of documents:

Corporate documents, including stockholder and director lists, compensation schedules for officers and directors, schedule of key man life insurance policies and organizational charts.

Operational documents, including practice business plans, brochures, price lists, catalogs and other product information, sales forecasts, data on customers and suppliers, and capital budgets.

Reports of other professionals, including appraisals on specific assets and reports by other consultants.

Other internal information, including documents or details relating to potential public offerings for debt or equity, venture capital prospectus or similar information, and tracking of incurred but not reported (IBNR) expenses.

  • Loan Agreements

The medical practice may have loaned or borrowed funds from affiliates. Such loan arrangements may require adjustments to be made to the economic value of the subject entity.

Uncollectible loans receivable should have been written off.

Collectible loans receivable may still be considered non-operating assets and evaluated separately.

Loans payable to related parties may be structured as demand notes, but there may be little chance that such loans will be repaid. Such loans may be considered either long-term debt or a form of owners’ equity.

B. Site Visit / Interview Information

The following types of information specific to the medical practice should be gathered by the financial executive or healthcare consultant. This information may be obtained through an interview, questionnaire, or preferably a site visit.

Valuation

  • Background Information

Include such information as the number of years the entity has operated at its current location and in the community, as well as the office hours.

  • Building Description

Include the location (urban/suburban), proximity to hospitals and other medical facilities, and its size, construction, electrical and computer wiring, age, access to parking, and so on.

  • Office Description

Approximate acquisition details and price, as well as ownership or lease details should be included.  The square footage and number of rooms, and a description of different office areas should be outlined, including, where applicable: medical equipment, including all diagnostic imaging and major medical equipment; pharmacy, laboratory, examination rooms, waiting rooms, and other areas.

  • Management Information Systems

Document types of hardware and software and the cost, age, and suitability of all components, including their management functions, reporting capabilities, and integration between programs.

  • History of the Practice Entity

Give the date founded and by whom, the number of full-time equivalent (FTE) physicians in practice by year, the physicians who have joined and left the entity, the dates they practiced at the entity, and their relationship and practice arrangement with the entity.

  • Office Staff Description

Include the number and types of non-physician positions as well as the tenure and salary of all current employees.

  • Competitive Analysis

Include details of hospital programs impacting practice, growth or decline in the volume of business and the reasons, association with other physicians, competitive strengths and threats, the number and volume of procedures performed, any change in the number and volume, and the corresponding fees.

  • Patient Base Information

Encompass income distribution and percentages from different payors, the number of new patients and total patients seen per week, the age mix of patients, the number of hours spent in patient care per week, and the number of surgeries performed.

  • Managed Care Environment

Detail the terms and conditions of all managed care contracts including discounts and withholds, the impact on referral patterns and revenues, willingness to participate in risk sharing contracts and capitation, and the entity’s managed care reporting capabilities.

  • Hospital Privileges and Facilities

List all hospital privileges held by physician members of the medical practice and the requirements for acquiring privileges at the different local hospitals.

  • Credit Policy and Collections

Include practice policies for billing and payment, use of collection agencies, acceptance of assignments, other sources of revenues, and an aged breakdown of accounts receivable.

  • Financial Management

Include cash management procedures and protections, credit lines and interest, controls to improve payment of accounts payable, late payment frequency, formal or informal financial planning methods, and budgeting processes.

  • Operational Assessment Include governance structure for the entity, detailing responsibilities and procedures for performance, conflicts, recruitment, outcomes measures, case management, reimbursement, income, continuing medical education (CME), credentialing, and utilization review.

Assessment

Allow for discussion of overall relationships with physicians in the community, practice concerns, and needs.

Source: “Research and Financial Benchmarking in the Healthcare Industry”

By Robert James Cimasi; MHA, ASA, CBA. AVA, CM&AA, CMP™
By Todd A. Zigrang; MHA, MBA, CHE
By Anne P. Sharamitaro; Esq

Conclusion

And so, your thoughts and comments on this ME-P are appreciated. What did we forget and what is your experience? Why did you need a medical practice valuation?

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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FINANCE: Financial Planning for Physicians and Advisorsation?

Product DetailsProduct Details

Product Details

Four Percent Rule VERSUS Rule of Twenty-Five

PHYSICIAN RETIREMENT PLANNING

By Staff Reporters

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The rule of 25 is just a different way to look at another popular retirement rule, the 4% rule. It flips the equation (100/4% = 25) to emphasize a different part of the retirement planning process — withdrawing vs. saving.

The 4% rule outlines a safe rate to withdraw funds for 30 years without running out of money. On the other hand, the rule of 25 is a savings-focused approach, providing a quick estimate of how much you need to accumulate before exiting the workforce.

LINK: https://www.nerdwallet.com/calculator/retirement-calculator

Let’s consider a scenario to highlight the difference:

  • Rule of 25: After accounting for her Social Security and other sources of retirement income, Dr. Matie PhD plans to spend $40,000 a year in retirement. 40,000 x 25 = $1 million, so Matie would need $1 million invested to cover annual expenses of $40,000.
  • The 4% rule: Dr. Matie, now a retiree, has $1 million in retirement savings and follows the 4% rule. She can safely withdraw $40,000 annually (4% of $1 million).

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While the 4% rule helps plan withdrawals during retirement, the rule of 25 helps establish a savings goal before retirement begins.

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DAILY UPDATE: Cisco Lays Off as Stock Markets Blast Off

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What’s up

What’s down

  • T-Mobile US fell 0.95% after the Committee on Foreign Investment in the US fined the company after sensitive customer data was exposed.
  • Dillard’s slid 10.85% after reporting lower earnings and sales than expected as the retailer struggles to lure customers through its doors.
  • AT&T stumbled 2.78% on the news that a major shareholder sold off a large portion of its stake in the company last quarter.
  • Pilgrim’s Pride dropped 3.28% thanks to a re-rating from Bank of America analysts pushing the company from Buy to Neutral.
  • Grab Holdings sank 7.42% after the app maker reported a terrible quarter.

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Here’s where the major benchmarks ended:

  • The S&P 500 index rose 88.02 points (1.61%) to 5,543.23; the Dow Jones Industrial Average® ($DJI) added 554.67 points (1.39%) to 40,563.06; the NASDAQ Composite advanced 401.89 points (2.34%) to 17,594.50. 
  • The 10-year Treasury note yield (TNX) rebounded about 10 basis points to nearly 3.93%, lifted by strong U.S. data. 
  • The CBOE Volatility Index® (VIX) finished at 15.45, the lowest since July 23 and back under the historic average near 19.

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Cisco will lay off 7% of its workforce to cut costs, although it projects an improvement in sales.

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On “Covered Call” Overlays

Buy / Writes

RB

By Ross Barnett Terry

www.TradersExclusive.com

There are many benefits that come with the ownership of stock. They range from prestige to the opportunity to be invested and, through dividends and other corporate actions, share in the prosperity of the company in question. At times we are even awarded shares of stock from companies we are affiliated. The overall goal should always be wealth accumulation. After all, why stay invested in or even work for a company that you truly do not believe in?

The benefits, as stated, all afford the chance at wealth accumulation. Once we start to look at that rate we can even better understand the fact that stocks are truly an investment vehicle similar to bonds, real estate, commodities, etc.

 What is a Call Option?

In its simplest definition, a call option is a contract that specifies that: 1) for a specified price; 2) for a specified amount in time; 3) for a specified price; 4) on a specifically identified or predetermined underlying, in this case, an exchange listed company stock. The contract gives the owner the right to take delivery of shares at the strike price.

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Example:

In early February, if a physician or other investor wanted to take a position in shares of Pfizer (NYSE: PFE) which are say trading around $31.00. He would be invest $3,100.00 for every 100 shares. Buying a  calls on the $32.00 strike at say .68 and with an expiration date of April 2015 affords the investor the chance at appreciation on 100 shares out to the 3rd week in April  after the strike price (32.00) + the price of the option (.68) (in this case 32.68) is surpassed. That’s less than a penny a day to have the chance at participating in an up move, while being afforded that chance at a greatly reduced risk. So the trade of is foregoing a 5.41% appreciation for a 97.81% reduction in risk. The owner of the option can only lose the price they pay for the contract where as the owner of shares stands to risk any and all of the share value in question.

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We can now see certain benefits that favor owning calls in lieu of owning shares of stock. But why write calls. First understand that, when you enter into a short call position, the seller is guaranteeing that, at any point during the life of the contract the buyer can exercise his right to take possession of those shares and the seller must deliver the shares upon assignment of the short contract.

The benefit of writing a call is that it enhances the rate of return. Normally; but not always, stocks move up or down in reaction to earnings calls or specific event news possibly even industry related. That said once investors react and stocks stabilize, call premiums tend to settle down. This presents the opportunity to enhance the rate of return on shares owned.

Example:

A physician corporate executive owns 1,000 shares of xyz stock and is restricted from selling those shares. Same as renting a condominium that we own for investing, selling options on a monthly basis provides a similar income stream that the rent from the condominium provides.

The executive, physician or investor owns the shares which using the above example of PFE trading at $31.00 is a cash value equivalent $31,000.00. Selling the February 32.5 call on the 1st trading day of the month for say .10 affords the owner of the shares a chance to gain a .03% rate of return in around 21 days’ time, while being afforded the luxury of the stock being able to appreciate to $32.60 which is the predetermined sale price via the sale of the call. If the owner of the shares does this each month they can gain another 3.87% return which, in addition offers a little downside protection should shares fall under pressure for whatever reason.

Professional Management?

Professional management allows for strategic points when stocks react to news or simple market weighting. “The determination to exercise or not must be weighed with all the benefits and costs taken into account; this will require additional homework by the investor” (Grigoletto, 2008). The most important aspect of call writing is active management. The reality is that only approximately 17% of options get exercised. Many expire worthless, some are traded out of before expiration, and some, such as the ones that end up in the money, just slightly above the strike do not warrant being exercised. With the returns investors face today, every possible avenue must be, at the very least, addressed and understood so they can make careful choices based on educated decisions. Considering a separately managed account by industry professionals may be an excellent alternative for many.

More:

Selling

As always in selling options, just as in any type of investment, careful analysis of the underlying investment vehicle in question is key. Additionally, in selling monthly options, the risk of assignment is greatly reduces and the seller can essentially determine how close to the price the owner wants to overlay. Fundamental analysis can help to reduce the chance at assignment. Before seeking advice, the best thing to do is contact an accountant, as well as using due diligence in researching which Registered Investment Advisor [RIA] may best suits your needs.

Assessment

But that said, always remember; the overall goal should is wealth accumulation, capital appreciation and overall enhancement of return on capital. As for the reason to own stocks, again after all, why stay invested in or even work for a company that you truly do not believe in?

Channel Surfing the ME-P

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About the Author

  • Present: Capital Wealth Planning, LLC
  • Illinois Indiana Regional Business Development Officer
  • Previous: Think Or Swim, LLC
  • Registered Securities Representative
  • Market Maker Chicago Board of Options Exchange (CBOE) 1985 – 2004

Reference

Conclusion

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

DAILY UPDATE: Hospital Private Equity and AI with Upbeat DJIA

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Private equity (PE) firms might make it rain cash for investors, but hospitals under their ownership are facing an asset drought, according to a research letter published in JAMA on July 30th. While fans of PE argue it can bring much-needed financial resources to struggling hospitals, the data disagrees. “Private equity acquisitions appear to have depleted, rather than augmented, hospital assets,” the authors, a group of physicians from medical institutions across the US, wrote.

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What’s up

What’s down

  • Peloton Interactive stumbled 4.64% on the news of a deal allowing Google’s Fitbit users to have access to Peloton classes.
  • Brinker International sank 10.51% after the parent company of Chili’s announced lower-than-expected earnings last quarter.
  • Ouster plummeted 27.44% after the lidar manufacturer reported disappointing revenue last quarter and forecast for worse to come next quarter.
  • Starbucks fell 2.09% as investors took some profits after yesterday’s gigantic pop.

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Here’s where the major benchmarks ended:

  • The S&P 500 rose 20.78 points (0.38%) to 5,455.21; the Dow Jones Industrial Average® ($DJI) added 242.75 points (0.61%) to 40,008.39; the NASDAQ Composite®($COMP) squeaked out a slight gain of 4.99points (0.03%) to 17,192.60.
  • The 10-year Treasury note yield (TNX) dropped three basis points to 3.82%, the lowest close in more than a week.
  • The Cboe Volatility Index® (VIX) fell to 16.22, the lowest since July 23.

CITE: https://tinyurl.com/tj8smmes

Stat: 21%. That’s the percentage of US physicians who are still paying off student loan debt. (Becker’s Hospital Review)

Quote: “The federal government is particularly ineffective and slow these days.”—Rep. Brianna Titone, a Colorado Democrat, on why states need to “step up” and make their own laws regulating the use of artificial intelligence in healthcare (Axios)

Read: A US Olympic athlete is taking advantage of free healthcare to catch up on preventive care while in Paris. (the Washington Post)

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

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The Long and Short of Portfolio Construction

Long-Short Portfolio Construction vs. Long-Only

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best-dem-1

[By Dr. David Edward Marcinko MBA MEd CMP™]

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Long-Short is an active portfolio construction discipline that balances long positions in high expected return securities and short positions in low expected return securities of approximately equal value and market sensitivity. This type of portfolio is “neutralized” or immunized against changes in value of the underlying market and, therefore, has zero systematic (beta) risk. If the selected securities perform as expected, the long-short positions will provide a positive return, whether the market rises or falls.

Misconceptions

While long-short portfolios are often perceived and portrayed as much costlier and much riskier than long-only, it is inherently neither. Much of the incremental cost and risk is either largely dependent on the amount of leverage employed or controllable via optimization. Those costs and risks that are not controllable—financial intermediation costs of borrowing shares to short, the trading costs incurred to meet long-short balancing, margin requirements, uptick rules, and the risks of unlimited losses on short positions—do not invalidate the viability of long-short strategies.

Long-Short Advantages

Compared with long-only portfolios, long-short portfolios offer enhanced flexibility not only in the control of risk and pursuit of return, but also in asset allocation. Basic market-neutral portfolios achieve a return consisting of three components: (1) interest on funds held as a liquidity buffer, (2) interest on the short sale proceeds maintained with the broker, and (3) the return spread between the aggregate long and aggregate short positions in the portfolios.

Disadvantages

Share borrow-ability and uptick rules make short-selling more difficult and costly than going long. Also, it may be legally or contractually restricted for some investors, such as mutual funds. Inefficiencies may be concentrated in overpriced stocks and, accordingly, short sales of the most overpriced stocks may offer higher positive returns than long purchases of underpriced stocks.

Assessment

Long-only portfolios are confined to altering the weighting of securities within an index in order to realize an excess return. Long-short portfolios are not constrained by index weights and, because they can short securities, they can “underweight” a security by as much as investment insights and risk considerations dictate. Long-short portfolios can be enhanced by “equitizing” them using stock index futures.

Note: “The Long and Short on Long-Short” by Bruce I. Jacobs and Kenneth N. Levy, The Journal of Investing, Spring 1997, pp. 73–86, Institutional Investor, Inc.

Conclusion

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The GOLD and Gold Miners Chart-Book

By Merk Investments

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READ BOOK: https://www.merkinvestments.com/downloads/2022-09-01-gold-chart-book.pdf

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COMMODITIES UTILITY: Gold v. Silver

By Staff Reporters

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Commodities trading means you’re buying and selling raw materials rather than finished products (like a house) or financial assets (like stocks and bonds). Commodities are assets like corn, coffee, lumber and ore. One common form of commodities trading is investing in precious metals, namely gold and silver. As an investment asset, gold and silver have very different properties and uses in a portfolio.

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Gold vs. Silver: Utility

The biggest thing that differentiates precious metal investing from other commodity investing is utility. For most other commodities, investors judge value based on supply and consumer demand. If you want to invest in coffee beans, for example, you can judge prices by how much coffee people are currently drinking, how tastes are changing, etc.

Precious metals are different in that they have relatively low commercial utility. Compared with other metals, here are relatively few consumer or industrial uses for assets like gold and silver.

However, silver does have much more industrial and commercial use than gold. Approximately half of all silver bought and sold on the market is used commercially, with applications ranging from dentistry to electronics. (This is still quite small compared to other metals, which are almost entirely used for production.)

By contrast, gold has very few commercial applications aside from jewelry. This gives investors a basis on which to judge and predict price movements for silver, since you can make decisions based on factors such as industry need and how the global economy is moving.

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WTI: Crude Oil

West Texas Intermediate

By Staff Reporters

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What it is: The North American crude oil benchmark, known as West Texas Intermediate (WTI), is one of three main oil benchmarks used around the globe. While WTI is sourced primarily from Texas, it’s considered one of the highest-quality oils and is often refined into gasoline.

How it works: WTI is the physical commodity behind oil futures contracts traded on the New York Mercantile Exchange. Oil futures = financial instruments that allow investors to buy “abstract oil.” When the futures contract expires, that investment is converted into IRL oil, cashed out, or rolled into a future futures contract.

Why it matters: Oil prices are affected by economic conditions, supply and demand, and geopolitical forces. The coronavirus pandemic caused a historic collapse in prices this spring, and while prices have stabilized, the outlook is shaky.

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DAILY UPDATE: United Health, CVS, Talkspace, Health Catalyst and the Rocketing Stock Markets

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The Fierce Healthcare team recapped second quarter earnings for the country’s biggest payers and health tech companies. See how UnitedHealth, CVS, Talkspace and Health Catalyst fared.


Walgreens could sell its stake in VillageMD and Roche may sell health tech startup Flatiron Health.


And … Texas Children’s Hospital reduced its workforce by 5%, or approximately 1,000 jobs. Keep up with other cuts with Fierce Healthcare’s layoff tracker.

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What’s up

What’s down

  • Trump Media & Technology Group sank 3.62% following the Donald Trump and Elon Musk interview on X.
  • Tencent Music Group plummeted 15.18% thanks to a mixed quarter with lower revenue but a higher subscriber count.
  • ViaSat tanked 22.57% after the company revealed that some of its biggest shareholders plan to sell 11.2 million shares of the satellite company.
  • Baxter International slid 6.53% after it struck a deal with The Carlyle Group to sell its kidney-care unit for $3.8 billion.

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Here’s where the major benchmarks ended:

  • The S&P 500® index (SPX)rose 90.04points (1.68%) to 5,434.43; the Dow Jones Industrial Average® ($DJI) added 408.63 points (1.04%) to 39,765.64; the NASDAQ Composite®($COMP)rallied406.99points (2.43%) to 17,187.61.
  • The 10-year Treasury note yield (TNX) fell about six basis points to 3.85%.
  • The CBOE Volatility Index dropped nearly 13% to 18.04, its lowest close since July 31.

Every S&P sector besides energy finished higher today, with info tech and consumer discretionary in the lead and both gaining more than 2%.

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

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The [Negative] Short-Term Implications of Investment Portfolio Diversification

Delving Deeper into Asset Allocation

By Lon Jefferies MBA CFP® CMP®

Lon JeffriesAsset allocation is one of the key factors contributing to long-term investment success.

When designing a portfolio that represents their risk tolerance, investors should be aware that a portfolio that is 50% stocks is likely to obtain approximately half of the gain when the market advances but suffer only half the loss when the market declines.

This general principle frequently holds true over extended investing cycles, but can waiver during shorter holding periods.

Case Model

For example, a fairly typical physician client of mine who has a 50% stock, 50% bond portfolio has obtained a return of 4.62% over the last 12 months, while the S&P 500 has obtained a return of 14.31% over the same time period (as of 10/30/14).

An investor expecting to obtain half the return of the index would anticipate a return of 7.15%, and by this measuring stick, has underperformed the market by over 2.50% during the last year.

What caused this differential?

Answer

The issue resides in how we define “the market.” In this example, we use the S&P 500 index as a measure for how the market as a whole is performing. As you may know, the S&P 500 (and the Dow Jones Industrial Average, for that matter) consists solely of large company U.S. stocks.

Of course, a diversified portfolio owns a mixture of large, mid, and small cap U.S. stocks, as well as international and emerging market equities. Consequently, comparing the performance of a basket of only large cap stocks to the performance of a diversified portfolio made up of a variety of different asset classes isn’t an apples-to-apples comparison.

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Stock_Market

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Frequently, the diversified portfolio will outperform the non-diversified large cap index because several of the components of the diversified portfolio will obtain higher returns than those achieved by large cap holdings.

However, the past 12 months has been a case where a diversified portfolio underperformed the large cap index because large cap stocks were the best performing asset class over the time period. In fact, over the last twelve months, there has been a direct correlation between company size and stock performance (as of 10/30/14):

  • Large Cap Stocks (S&P 500): 14.92%
  • Mid Cap Stocks (Russell Mid Cap): 11.08%
  • Small Cap Stocks (Russell 2000): 4.45%
  • International Stocks (Dow Jones Developed Markets): -1.05%
  • Emerging Market Stocks (iShares MSCI Emerging Markets): -1.04%

Since large cap stocks were the best performing element of a diversified portfolio over the last 12 months, in retrospect, an investor would have obtained a superior return by owning only large cap stocks during the period as opposed to owning a diversified mix of different equities. Does this mean owning only large cap stocks rather than a diversified portfolio is the best investment approach going forward? Of course not.

Year after year, we don’t know which asset category will provide the best return and a diversified portfolio ensures we have exposure to each year’s big winner. Additionally, although large caps were this year’s winner, they could easily be next year’s big loser, and a diversified portfolio ensures we don’t have all our investment eggs in one basket.

Financial Planning MDs 2015

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

Assessment

Don’t be overly concerned if your diversified portfolio is underperforming a non-diversified benchmark over a short period of time. As always, long-term results should be more heavily weighted than short-term swings, and having a diversified portfolio is likely to maximize the probability of coming out ahead over an extended period.

Conclusion

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Why I Hate Non-Publicly Traded REITS

On Product Frustration

Lon JefferiesBy Lon Jefferies MBA CFP® CMP®

As my experience in the financial planning and investment advisory industries has grown over the years, there is one investment that I’ve seen no logical reason to own — non-publicly traded real estate investment trusts.

Josh Brown, one of my favorite analysts and author of TheReformedBroker.com nailed each of my frustrations with these products. Here is a significant excerpt from his post:

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I consider non-traded REITs or nREITS to be part of the group of investments that are just absolute murderholes for clients – they pay the brokers so much that they cannot possibly work out (and they rarely do without all kinds of aggravation and additional costs). Further, I have yet to hear a single credible explanation as to why a broker would recommend a non-traded REIT over a public REIT other than compensation. The only explanation that makes sense to me is that 7% is a lot more than the 1% commission you get doing an agency trade on a NYSE-traded REIT. A reader with experience in the industry sent this to me and I found it hilarious. Below, a fictional, transparent conversation between an indie broker and his “client” that would never occur…

If Brokers Were Transparent:

Rep:

Before we wrap up our quarterly portfolio review I would like to talk to you about a new investment I think you might be interested in.  You have been looking for more income and this is an investment vehicle that pays a 7% dividend.

Client:

Sounds great, give me the details.

Rep:

With your portfolio size and risk tolerance I would recommend a $100,000 investment.  Given that amount let’s first go over the fees. If you invest $100,000 I will be paid a commission of $7,000. My firm is going to get $1,500 – $2,000 in revenue share. My wholesaler, the salesman that works for the investment’s sponsor company, will get $1,000. He is a great guy, buys me dinner and takes me golfing. The sponsor company is going to get around $3,000 to pay for some of the costs they incurred in setting up the investment. So after Day 1 there will be around $87,000 left over to actually invest.  I bet you are getting excited.

Client:

Are you on drugs? Why would I pay 13% in fees on anything?

Rep:

Don’t worry, it won’t feel like you are paying $13,000 in fees. The rules allow my firm to report your investment at $100,000 on your statement. You never really know what its worth but you will think you never lost money. Pretty sweet huh?

Client:

You have to be kidding.

Rep:

No, this is a really good investment. Let me tell you about the income component before you jump to any conclusions. Like I said this investment pays a 7% dividend and the dividend won’t change.

Client:

That sounds high and how do you know it won’t change?

Rep:

You see, the sponsor just picks the 7% dividend number out of thin air. Here’s how it works. You see the vehicle you are going to invest in is new and it’s going to take the firm a while before your net $87,000 is actually invested. Later on, maybe 2-4 years from now they will have the money fully invested and it will generate actual cash flow. So they just pay a quarterly dividend of 7% by giving you your money back. This is great from a tax perspective because return of capital isn’t taxed as income.

Client:

Are we on hidden camera or something?

Rep:

Ha, you are funny. I bet this next benefit will change your mind.

Client:

I hope so or I should start looking for another financial advisor.

Rep:

This is the best feature. You can’t sell your investment until the sponsor has the opportunity to create liquidity. You might be locked up in this investment for 7-10 years.

Client:

This feels like the Twilight Zone. Your firm allows you to sell this crap?

Rep:

Oh yeah, our firm sells a ton of it. In fact independent broker dealer firms like mine sold over $20 billion of these investments in 2013. Think about that. Reps like me made over $140 million dollars and our firms pocketed $20-$30 million.

Client:

This is crazy, what is this investment?

Rep:

Non-traded REITs. $100,000 sound about right?

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Currency

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Josh touched on every part of these investments that I despise — excessive commission paid to the so-called “financial advisor” (salesman), a supposed “dividend” that is really just paying the investor his own money back (essentially providing an interest-free loan), and a complete lack of liquidity and transparency.

When I begin working with a new client who owns one of these products, it is impossible to obtain accurate, current information on the investment (not even a true value is apparent). Even worse, if the client wants to sell the investment he would need to do so at pennies on the dollar. For the most part, once an investor purchases one of these products he just needs to forget about it and hope that one day he can get his money back.

Assessment

The bottom line is that if your advisor ever recommends a non-publicly traded REIT, I’d strongly recommend you walk out the door and start searching for a true financial advisor with a fiduciary responsibility to act in your best interest.

Conclusion

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On non-traded real estate investment trusts (REITS)

Private real estate investment trusts (REITS)

By Rick Kahler CFP®

In February 2016, I published an article that was not kind to non-traded or private real estate investment trusts (REITS). Unlike the traded variety that can be sold immediately on a public exchange, non-traded REITS have no public market if you want to liquidate the shares, making them much more illiquid. I contended that even though non-traded REITS had some theoretical benefits, the high fees and commissions, illiquidity, lack of transparency, and lack of a track record associated with them negate any advantage. My longstanding recommendation has been to stay with traded public REITS for your portfolio.

That article was picked up by Barron’s, where it was read by Tom Lonergan of JLL Income Property Trust. He agreed with me that most non-traded REITS did have all the negatives I listed, but pointed out that others did not. While I was skeptical, I decided to investigate further.

A Sleuth

My investigation over the past year did turn up a handful of non-traded REITS that don’t pay a commission, have reasonable fees, have limited liquidity, offer transparency, and do have an existing portfolio of properties that offers an easily discernable track record. This article is my acknowledgement that not all non-traded REITS are equal.

First, why should you even care if real estate is in your portfolio? The biggest reason is that it’s the third largest asset class, behind bonds and stocks. Of all that real estate, about 7% is owned by public REITS. The remaining 93% is owned by publicly traded corporations, private partnerships and REITS, and individuals.

One of the strongest arguments for including a non-traded REIT in your portfolio is that it acts much more like directly owning real estate than a traded REIT. The big difference between non-traded and traded REITS is volatility. Traded REITS are more volatile than stocks. Traded REITS have a potential annual volatility (referred to as standard deviation) of 22%, while the stocks of large companies are 16%. A non-traded REIT has a volatility of around 2%, which is almost that of bonds at 3%.

Why the huge difference in non-traded and traded REITS when they are the same asset class? The answer is liquidity. With traded REITS, liquidity is both a major strength and an Achilles heel. Traded REITS are subject to public sentiment, just like stocks. Their price is driven by behavior. Since they are liquid and can be bought and sold in a nanosecond, their price can swing wildly. In this regard, traded REITS act more like a stock investment than a real estate investment.

Non-traded REITS, just like rental houses or office buildings owned directly by an investor, can’t be traded or liquidated quickly. The price of a non-traded REIT is set by the value of the properties that are owned, not public sentiment. That is why the share value of traded REITS dropped around 75% in 2009, while non-traded REITS dropped around 25%. The properties owned by the traded REITS didn’t decrease any more than the non-traded REITS, but the wholesale panic in the public exchanges dropped their share value three times more than the decline in the actual value of the real estate.

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Assessment

As with many things in life, when it comes to real estate we can’t have our cake and eat it too. One factor that makes real estate such a stable investment is that it is inherently illiquid. You can’t have both liquidity and low volatility. But you can have a non-traded REIT that has limited liquidity, a track record, with reasonable fees and no commission. However, you do have to look hard to find them.

Conclusion

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DAILY UPDATE: Aetna Ratings Down as Stock Markets Flatten

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Aetna, CVS’s health insurance arm and the third largest payer in the US, is struggling amid higher medical costs and lower Medicare Advantage star ratings. After CVS reported a nearly 40% YoY drop in operating income in its Q2 2024 earnings released on August 7th, President and CEO Karen Lynch announced the company will replace Aetna’s president, Brian Kane, and initiate a $2 billion cost-savings plan.

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What’s up

  • Nvidia jumped 4.08% after it was named a top “rebound” stock by Bank of America.
  • Keycorp leaped 9.24% on the news that the Bank of Nova Scotia will invest $2.8 billion in the company.
  • Robinhood Markets rose 3.46% due to an upgrade from Piper Sandler analysts who say the company’s sudden decline gives it an attractive entry point.
  • Monday.com popped 14.78% thanks to a strong earnings report from the software maker, due in no small part to sealing the largest deal in company history.
  • Barrick Gold soared 9.36% after beating earnings estimates on both the top and bottom lines thanks to the rising price of gold.

What’s down

Here’s where the major stock benchmarks ended:

  • The S&P 500®  index (SPX)added 0.23(0.00%) to 5,344.39; the Dow Jones Industrial Average® ($DJI) fell 140.53 points (–0.36%) to 39,357.01; the NASDAQ Composite rose 35.30points (0.21%) to 16,780.61.
  • The 10-year Treasury note yield (TNX) fell three basis points to just under 3.91%.
  • The CBOE Volatility Index® (VIX) increased 0.34 points (1.67%) to 20.71.

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Stat: 8.2%. That’s the percentage of people in the US without health insurance in the first quarter of 2024. (Healthcare Dive)

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

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What is an “INTERVAL” Mutual Fund?

By Staff Reporters

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An interval fund is a closed-end mutual fund that buys back shares only during specific intervals. Shares of the First Eagle Credit Opportunities Fund aren’t traded on public exchanges, and purchases or sales take place at the close of business, at the net asset value (NAV).

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A fund’s NAV is simply the sum of its assets divided by the number of shares. A traditional open-ended mutual fund isn’t publicly traded either, and investors can buy or sell at NAV at the market close every business day. This means the manager of an open-ended fund has limited investment choices because a relatively high level of liquidity is needed to handle daily re-demptions.

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An interval fund sets intervals (time periods) during which shares can be sold back to the fund manager and the number of shares it is willing to redeem during any interval. This makes it possible for the manager to go for higher yields by participating in less liquid markets.

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DAILY UPDATE: Consumer Spending with Spotlight on Intel

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US consumers in the spotlight: How much have you been shopping? We’ll find out this week when crucial July retail sales data is released on Thursday, and Walmart and Home Depot report earnings. The resilience of the US consumer is at the heart of recent concerns over a potential downturn since consumer spending drives 70% of the US economy. So far this earnings season, companies have given more mixed signals than a menu offering jumbo shrimp.

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Tech giant Intel will be shedding more than 15% of its workforce—or over 19,000 employees—as part of a plan to cut $10 billion in costs after it failed to meet quarterly expectations.

Intel reported revenue of $12.83 billion on expectations of $12.94 billion in revenue in its second quarter 2024 earnings, reported CNBC. The company reported plunging from a net income of $1.48 billion in Q2 2023 to a net loss of $1.61 billion YOY.

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What is a Stock Market Index IMPLIED OPEN?

FINANCIAL TERMS AND DEFINITIONS FOR PHYSICIANS AND ALL INVESTORS

By Dr. David E. Marcinko MBA MEd CMP®

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The stock markets have been near all time highs, lately. Physician colleagues and clients are so excited that they are even checking the overnight status of favorite stocks and/or the domestic/overseas markets.

Some colleagues are even becoming a bit OCD by checking the implied open of various markets the night before. But, what exactly is the Implied Open? How is it calculated?

DEFINITION: The Implied Open attempts to predict the prices at which various stock indexes will open, at 9:30am New York time. It is frequently shown on various cable television channels prior to the start of the next business day.

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EXAMPLE: Considering the DJIA as an example, the basis of calculating implied open is the price of a “DJX index option futures contract”. This is not the price of the DJIA itself but rather the current ticker price of an option issued by the Chicago Board Options Exchange.

CBOE: The Chicago Board Options Exchange, located at 400 South LaSalle Street in Chicago, is the largest U.S. options exchange with annual trading volume that hovered around 1.27 billion contracts at the end of 2014. CBOE offers options on over 2,200 companies, 22 stock indices, and 140 exchange-traded funds.

CALCULATION: https://www.quora.com/How-do-you-calculate-the-implied-open-from-futures

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NOTE: We would like to remind you that new amendments adopted by the U.S. Securities Exchange Commission (SEC) have gone into effect as of September 28, 2021. These amendments restrict the ability of market makers to publish OTC quotations for those companies that have not made required current financial and company information available to regulators and investors.

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PODCAST: Direct Primary Care Entrepreneurship and Innovation

By Free Market Medical Association

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DEFINITION:
Direct Primary Care (DPC) is an innovative alternative payment model improving access to high functioning healthcare with a simple, flat, affordable membership fee.  No fee-for-service payments.  No third party billing.  The defining element of DPC is an enduring and trusting relationship between a patient and his or her primary care provider.  Patients have extraordinary access to a physician of their choice, often for as little as $70 per month, and physicians are accountable first and foremost their patients.  DPC is embraced by health policymakers on the left and right and creates happy patients and happy doctors all over the country!

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PODCAST: Healthcare Start-Ups, Accelerators and Incubators

By Eric Bricker MD

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DAILY UPDATE: MDMA, Stellantis & Zelle While Correlation is not Causation

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The FDA declined to approve MDMA as a PTSD treatment, which would have been a big step forward for psychedelics use in mental health care, saying further study is needed. But the agency did approve a nasal spray to treat severe allergic reactions as an alternative to shots like EpiPen.

Stellantis will lay off 2,450 factory workers this year as it phases out an older version of its Ram pickup truck.

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Scams via Zelle, the payment service you turn to when you run out of wedding gift ideas, are the subject of an ongoing inquiry by the Consumer Financial Protection Bureau (CFPB), the Wall Street Journal reported this week. Zelle was founded in 2017 by seven of the biggest US banks to compete with peer-to-peer payment apps like Venmo and Cash App. It outgrew its rivals but became a magnet for scams, which customers typically don’t get reimbursed for.

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Correlate: A website that shows spurious correlations.

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

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Appreciating the Six Types of Investment Fees

dr-marcinkoDR. DAVID EDWARD MARCINKO MBA MEd CMP

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investing

Investment fees matter. They can make a big difference to your financial health in the long run. Before you put money into any investment, it’s vital to uncover the real costs.They typically include these six types of fees:

1. An up-front commission earned by the salesperson or their firm. Don’t rely on a vague assurance or a verbal answer: get a specific number in writing.If you have trouble getting a number, ask, “If I buy this investment today and want to get out tomorrow, how much do I get back?” If the answer is not “all your money,” the difference is probably the upfront fees and commissions.

I don’t recommend purchasing financial products with significant upfront commission or costs. I have seen investments where these fees run as high as 30% of the money invested. If you were to earn 5% a year on the investment, it would take 8 years just to break even.

2. Ongoing advisory fees. These are monthly, quarterly, or annual fees you pay advisors for their investment advice and oversight. This includes working with you to pick the asset classes, set the diversification, select the managers, tax optimization, rebalancing, and other periodic tasks.

This fee can have many names including wrap fee or investment advisory fee. The normal “rule of thumb” is 1% of the assets the advisor is managing, although fees can range from 0 to 7%. This fee can be charged to you even if the advisor receives an upfront commission. It can be easy to see or hidden away in the fine print of the investment.

3. Additional fees for services. Find out specifically what services are included in the advisor fee. Additional fees for financial planning or ancillary services are rarely disclosed or discussed.

Services can range from minimal hand-holding only focused on your investments to comprehensive, holistic financial planning. Amazingly, there is no correlation between price and the breadth of services. That’s illogical, but the financial services industry gets away with this, in part because consumers don’t do their homework.

4. Ongoing fees charged by the managers of the specific funds or investment products. These fees are referred to as the fund’s expense ratio. This comes out of the profits generated by the manager, and it is one of the hardest fees to find. Only the most transparent advisor or salesperson will disclose it. It is incredibly well hidden; you will never see it in your brokerage statements or your advisor’s invoices. The only way to know the amount of this fee is to read the prospectus or some other third party analysis of the investment, like Morningstar.

These fees can vary greatly for the same investment, depending on the class of share you buy. For example, American Fund’s New Perspective Fund’s expense ratio ranges from0.45% to 1.54%.  The average expense ratio of a mutual fund that invests in stocks is 1.35%. Conversely, the average expense ratio of a Vanguard S&P 500 fund is 0.10%. The difference of 1.25% is staggering over time.

5. Miscellaneous fees. These are also rarely talked about and hard to find. Many advisors charge $50 to $100 a year per account, hundreds of dollars to open or close an account, and even fees to dollar cost average your funds into the market.

6. Transaction fees. Every time you buy or sell a fund, a fee is typically paid to a custodian. These can range from $5 to hundreds of dollars per transaction.

Assessment

Remember, it’s your job to persist until you find out the total costs of an investment. Next week I’ll suggest ways to ask the tough questions about fees.

Conclusion

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2025 Proposed Physician Fee Schedule Cuts Payments – Again

By Health Capital Consultants, LLC

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On July 10, 2024, the Centers for Medicare & Medicaid Services (CMS) released its proposed Medicare Physician Fee Schedule (MPFS) for calendar year (CY) 2025.

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In addition to the agency’s suggested cut to physician payments, the proposed rule also announced new covered services. According to CMS, the proposed rule “reflect[s] a broader Administration-wide strategy to create a more equitable health care system that results in better accessibility, quality, affordability, empowerment, and innovation for all Medicare beneficiaries.(Read more…)

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ETFs: Happy 31st. Birthday

EXCHANGE TRADED FUNDS

By Staff Reporters

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Thirty one years ago yesterday, the first exchange-traded fund (ETF) in the US launched. In the decades since, these once-niche investment products have become ubiquitous on Wall Street, disrupting the mutual fund industry and transforming people’s relationship with the stock market.

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Exchange Traded Funds

On January 29th, 1993, a spider decoration hanging in the American Stock Exchange heralded the arrival of the first US ETF—what’s now called the SPDR S&P 500 ETF Trust. It had a measly $6.5 million in assets and no one really paid much attention to it. The first US ETF is now the world’s biggest, with $375 billion in assets, and the ETF sector in total had amassed $6.5 trillion in assets by the end of 2022. While mutual funds still have 3x the amount of assets that ETFs have, the tide is turning: Investors poured $600 billion into US ETFs on a net basis last year, but pulled out almost $1 trillion from mutual funds.

ETFs and Tax Efficiency

Definition: An ETF is simply a security that tracks the performance of a particular basket of investments, like stocks. The SPDR S&P 500 ETF, for example, tracks the performance of companies in the S&P 500. Many other ETFs also track indexes, allowing people to park their money in funds that follow the ebbs and flows of the broader market.

If that sounds like a mutual fund…it’s similar. But ETFs have a few advantages over its stuffy, older cousin.

  • ETFs generally have lower fees than mutual funds.
  • They have built-in tax benefits.
  • They’re accessible to anyone with a brokerage account—you can buy or sell them like you would a stock.

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Finally, all these advantages aside, the rise of ETFs has been also fueled by the growing recognition that trying to invest in individual stocks is foolish. Passive index funds, which aren’t designed for frequent trading, have surged to represent almost half of US fund assets, compared to less than 2% in the early ’90s.

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DAILY UPDATE: Medicare, Google & Meta, FTX and the Rising Markets

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FTX was ordered to pay $12.7 billion to customers. All customers will recoup their deposits that were locked when the crypto exchange went under in 2022, the Commodity Futures Trading Commission just said last Thursday.

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Read: How one-hour patient home visits allowed insurers to collect $15 billion from Medicare between 2019 and 2021. (the Wall Street Journal)

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What’s up

  • Sweetgreen popped 33.33% after a strong earnings report coupled with forecasts of higher-than-expected sales in 2024.
  • Doximity soared 38.70% thanks to a beat-and-raise quarter from the medical platform that has been investing in its own DoximityGPT AI model.
  • Nikola rose 8.21% after a surprisingly strong quarter in which sales soared 318%.
  • Unity Software jumped 8.22% despite revenue coming in lower year over year, but it was still higher than Wall Street expected.
  • Take-Two Interactive Software surged 4.35% after it beat earnings estimates last quarter, but no word yet on how its Gearbox acquisition is helping its bottom line, nor when GTA 6 is going to be released.
  • Expedia traveled 10.21% higher due to an earnings beat, with the company sidestepping a consumer spending slowdown quite nicely.

What’s down

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Here’s where the major benchmarks ended:

  • The S&P 500® index (SPX) rose 25 points (0.5%) to 5,344.16, ending the week little changed; the Dow Jones Industrial Average® ($DJI) rose 51 points (0.1%) to 39,497.54 to end the week down about 0.6%; the NASDAQ Composite® ($COMP) ended 85 points higher (0.5%) at 16,745.30, leaving it about 0.2% lower for the week.
  • The 10-year Treasury note yield (TNX) dropped five basis points to 3.944%.
  • The Cboe Volatility Index (VIX) declined three points (13%) to 20.7.

Google and Meta teamed up to target teens with ads for Instagram on YouTube, going against Google’s own rules, the Financial Times reported.

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What is Financial – Tech?

The Definition of Fin-Tech

cropped-dem

By Dr. David E. Marcinko MBA MEd CMP

Fintech is a portmanteau of financial technology that describes an emerging financial services sector in the 21st century.

Originally, the term applied to technology applied to the back-end of established consumer and trade financial institutions. Since the end of the first decade of the 21st century, the term has expanded to include any technological innovation in the financial sector, including innovations in financial literacy and education, retail banking, investment and even crypto-currencies like bitcoin.

BREAKING DOWN ‘Fintech’

The term financial technology can apply to any innovation in how people transact business, from the invention of money to double-entry bookkeeping. Since the internet revolution and the mobile internet revolution, however, financial technology has grown explosively, and fintech, which originally referred to computer technology applied to the back office of banks or trading firms, now describes a broad variety of technological interventions into personal and commercial finance.

Fintech’s Expanding Horizons

Already technological innovation has up-ended 20th century ways of trading and banking. The mobile-only stock trading app Robinhood charges no fees for trades, and peer-to-peer lending sites like Prosper and Lending Club promise to reduce rates by opening up competition for loans to broad market forces. Technologies being designed that should reach fruition by 2020 include mobile banking, mobile trading on commodities exchanges, digital wallets (like Apple (AAPL) and Google’s (GOOG) developing mobile wallet systems), financial advisory and robo-advisor sites like LearnVest and Betterment, and all-in-one money management tools like Mint and Level.

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New Tech in Fintech

In the olden days, individuals and institutions used the invisible hand of the market – represented by the signaling function of price – to make financial decisions. New technologies, like machine learning, predictive behavioral analytics and data-driven marketing, will take the guess work and hocus pocus out of financial decisions. “Learning” apps will not only learn the habits of users, often hidden to themselves, but will engage users in learning games to make their automatic, unconscious spending and saving decisions better. On the back end, improved data analytics will help institutional clients further refine their investment decisions and open new opportunities for financial innovation.

Fintech Users

Who uses fintech? There are four broad categories: 1) B2B for banks and 2) their business clients; and 3) B2C for small businesses and 4) consumers. Trends toward mobile banking, increased information, data and more accurate analytics and decentralization of access will create opportunities for all four groups to interact in heretofore unprecedented ways.

Conclusion

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Musings on “Sector” Mutual Funds

A Historical Review

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

www.CertifiedMedicalPlanner.org

[Publisher-in-Chief]

Although less than 5-10% of the total number of mutual funds are considered true sector funds, year after year, 40-50% or more of the top-performing funds have been sector funds. However, for some physician investors sold on a buy-and-hold strategy, sector funds may not be their cup of tea. But, sector funds do offer an opportunity to outperform the market indices, possibly even substantially, according to Marshall Schield in “Developing a Sector Funds Strategy” (Personal Financial Planning, November/December 1996, pp. 39–42, Warren, Gorham & Lamont, [800] 950-1205).

A Volatile Strategy

Typically sector funds are more volatile than the majority of growth funds. This volatility springs from: (1) the fact that the majority of stocks in a particular sector fund move together, thereby magnifying the fund’s movement; (2) the focus of the sector fund manager only on stocks in that sector, enabling him or her to target high potential stocks; and (3) the rotation of “in” and “out” sectors at particular times.

So – What’s a Doctor Investor to Do?

An investor in sector funds needs a strategy that will target sectors on the upswing and signal when to move out of declining funds. When selecting sector funds, Schield recommends building a list of funds that are manageable, full of choices in all types of markets, diversified (three to four funds for an aggressive portfolio or 10–12 for a less aggressive approach) and liquid.

The Balancing Act

Also, develop a healthy balance—not a “hit-or-miss” approach. Schield suggested using the “relative strength” approach for sector selection by computing the percent change in the price of funds over a certain number of days and then ranking them for short-term, intermediate, and long-term periods. With respect to determining the proper timing for buying or selling, the author suggests the use of an individual fund timing system, such as comparing the current NAV of the sector against a moving average for 50 or 75 days or combining both short- and long-term moving averages.

Simplicity Rules

In creating buy-and-sell signals:

  • Keep it simple and manageable.
  • Do not look for perfection.
  • Practice patience.
  • Cut losses and let profits run.
  • Stick with your relative strength.
  • Buy/sell signals consistently.

Assessment

Most of all; be prepared to spend and invest the time necessary to be successful. But, have you or your sector funds been successful in the last decade, or so? If so, which sectors? Please opine?’

Conclusion

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Product Details  Product Details

   Product Details 

What is a CARRY TRADE?

By Staff Reporters

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A carry trade is a tactic in which an investor borrows a currency with lower interest rates and invests the proceeds in a higher-yielding asset, often in a different market with higher interest rates.

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Over the past few years, many funds were using this strategy by buying US equities or selling US bonds with money borrowed from the yen because of the huge disparity in interest rates between the US and Japan. Japan kept the yen cheap on purpose because its economy is primarily export-driven, and the low price of Japanese products kept exports thriving. And the dollar, as the dominant global currency, has remained impressively strong through thick and thin.

This was all fun and profits, until Japan raised interest rates for the first time in 17 years last week. Suddenly, the yen wasn’t as cheap as it once was. And at the exact same time, the US is expected to cut interest rates in September, which means the dollar would become less valuable, completely throwing this international carry trade out of balance

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What is Risk Adjusted Stock Market Performance?

Update on Some Interesting and Important Financial Calculations

By Timothy J. McIntosh MBA CFP® MPH

By Dr. David Edward Marcinko MBA MEd CMP™

By Jeffrey S. Coons PhD CFA

TMDr. Jeff Coons

dr-david-marcinko9

-INTRODUCTION-

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

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

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

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

[a] The Treynor Ratio

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

[b] The Sharpe Ratio

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

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[c] The Jensen Alpha Measure

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

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

[d] Database Ratings

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

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

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

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Assessment

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

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

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

Channel Surfing

Have you visited our other topic channels? Established to facilitate idea exchange and link our community together, the value of these topics is dependent upon your input.

ABOUT

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

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

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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DAILY UPDATE: Data Breach Up, Novo Nordisk Down as Stock Markets Stumble

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You might be affected by one of the biggest data breaches ever and not even know it. A recent class action lawsuit filed against Jerico Pictures Inc., a background check company that does business under the name National Public Data, claims that the company was breached by hackers earlier this year.

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Here’s where the major benchmarks ended:

  • The SPX dipped 40.5 points (0.8%) to 5,199.5; the Dow Jones Industrial Average® ($DJI) fell 234.2 points (0.6%) to 38,763.45 the NASDAQ Composite ($COMP) fell 171 points (1.1%) to 16,195.8. 
  • The 10-year Treasury note yield (TNX) rose to 3.96%.
  • The Cboe Volatility Index® (VIX) inched up to 27.8, still very elevated.

What’s Up

What’s down

  • Super Micro Computer dropped 20.14% thanks to an earnings miss, as well as the announcement of a 10-for-1 stock split.
  • AirBnB tumbled 13.38% after not only missing analyst estimates last quarter, but warning of slowing demand in the coming quarter.
  • Lyft drove 17.23% lower in spite of strong ridership in the second quarter. Shareholders, however, did not like management’s dour financial forecast for the third quarter.
  • CVS Health sank 3.19% after it slashed its profit guidance for the full year, though it also announced a new cost-cutting program.
  • TripAdvisor took a trip south today, falling 16.61% due to a mixed earnings report and dire warnings of lower revenue in the coming quarter.
  • Amgen stumbled 5% after the biotech company missed Wall Street forecasts in the second quarter.

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Novo Nordisk sales thinned on Ozempic earnings miss. Shares of Danish pharmaceutical giant Novo Nordisk sank 8.27% today after the company missed expectations on its sales of popular weight-loss drugs Ozempic and Wegovy. Novo reported $1.7 billion in Wegovy sales, below the $2 billion analysts expected, while Ozempic sales came in $0.2 billion lower than analyst estimates. Overall, the company reported a net profit of $1.86 billion in the second quarter.

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Stock Markets, Magnificent 7, Nikkei and DuckDuckGo

By Staff Reporters

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Stock Markets seesawed up yesterday, making back some of the ground lost to Monday’s sell-off. Analysts say the market could remain volatile until September, when the Fed is widely expected to cut interest rates—barring an emergency cut before then. One of the day’s big winners was Uber, which revved up after smashing Q2 revenue expectations thanks to unexpectedly strong consumer demand.

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One day after the S&P 500’s worst session since 2022, stocks partially rebounded, putting fears of a recession on hold. Tuesday started well, with Japan’s Nikkei—which had cratered on Monday—logging its best day since 2008, giving US investors some positive energy From there, US stocks, including Magnificent Seven stalwarts like Microsoft and Nvidia, and both major cryptocurrencies, moved up. “Get used to the volatility,” one Bank of America analyst told Bloomberg. The S&P 500 is still up over 10% this year despite this week’s turbulence.

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Finally, DuckDuckGo might soon get its time to shine. A federal judge just ruled that Google has a monopoly over the search engine business, creating the potential for curbs to its power that could change how you look up people you just met online. Google said it will appeal the ruling, but that’s just on one front. It faces another lawsuit questioning whether it abused its monopoly on online advertising technology.

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ACCOUNTING: Mark to Market [MTM] Fair Value

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By Staff Reporters

According to Wikipeida, Mark-to-market (MTM or M2M) or fair value accounting is accounting for the “fair value” of an asset or liability based on the current market price, or the price for similar assets and liabilities, or based on another objectively assessed “fair” value.[1] Fair value accounting has been a part of Generally Accepted Accounting Principles (GAAP) in the United States since the early 1990s. Failure to use it is viewed as the cause of the Orange County Bankruptcy,[2][3] even though its use is considered to be one of the reasons for the Enron scandal and the eventual bankruptcy of the company, as well as the closure of the accounting firm Arthur Andersen.[4]

Mark-to-market accounting can change values on the balance sheet as market conditions change. In contrast, historical cost accounting, based on the past transactions, is simpler, more stable, and easier to perform, but does not represent current market value. It summarizes past transactions instead. Mark-to-market accounting can become volatile if market prices fluctuate greatly or change unpredictably. Buyers and sellers may claim a number of specific instances when this is the case, including inability to value the future income and expenses both accurately and collectively, often due to unreliable information, or over-optimistic or over-pessimistic expectations of cash flow and earnings.[5]

Stock brokers allow their clients to access credit via margin accounts. These accounts allow clients to borrow funds to buy securities. Therefore, the amount of funds available is more than the value of cash (or equivalents). The credit is provided by charging a rate of interest and requiring a certain amount of collateral, in a similar way that banks provide loans. Even though the value of securities (stocks or other financial instruments such as options) fluctuates in the market, the value of accounts is not computed in real time. Marking-to-market is performed typically at the end of the trading day, and if the account value decreases below a given threshold (typically a ratio predefined by the broker), the broker issues a margin call that requires the client to deposit more funds or liquidate the account.

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About Securities Order and Position Types

A Primer for Physician Investors and Medical Professionals

By: DR. David Edward Marcinko; MBA, MEd, CMP™

[Editor-in-Chief] http://www.CertifiedMedicalPlanner.org

[PART 6 OF 8]

BC Dr. Marcinko

NOTE: This is an eight part ME-P series based on a weekend lecture I gave more than a decade ago to an interested group of graduate, business and medical school students. The material is a bit dated and some facts and specifics may have changed since then. But, the overall thought-leadership information of the essay remains interesting and informative. We trust you will enjoy it.

Introduction

At this point  in our long ME-P essay, it is important to understand the different types of orders and positions that can be used to buy and sell securities from the specialist.

Market Order:

A market order is an order to be executed at the best possible price at the time the order reaches the floor. Market orders are the most common of all orders. The greatest advantage of the market order is speed. The doctor specifies no price in this type of order, he merely orders his broker to sell or buy at the best possible price, regardless of what it may be. The best possible price on a buy is the lowest possible price. The best possible price on a sell is the highest possible price. In other words, if a medical professional customer is buying, he logically wants to pay as little as possible, but he is not going to quibble over price. He wants the stock now, whatever it takes to get it. If he’s a seller, the doctor client wants to receive as much as possible, but will not quibble, he wants out, and will take what he can get, right now. No other type of order can be executed so rapidly.

Some market orders are executed in less than one minute from the time the broker phones in the order. Because the investor has specified no price, a market order will always be executed. The doctor is literally saying, “I will pay whatever it takes, or accept whatever is offered”.

Limit Order:

The chief characteristic of a limit order is that the doctor decides in advance on a price at which he decides to trade. He believes that his price is one that will be reached in the market in reasonable time. He is willing to wait to do business until he has obtained his price even at the risk his order may not be executed either in the near future or at all. In the execution of a limit order, the broker is to execute it at the limit price or better. Better, means that a limit order to buy is executed at the customer’s price limit or lower, in a limit order to sell, at price limit or higher. If the broker can obtain a more favorable price for his doctor customer than the one specified, he is required to do so.

Order Length:

Now, even though the doctor has given his price limit, we need to know the length of effectiveness of the order. Is the order good for today only? If so, it is a day order, it automatically expires at the end of the day.  Alternatively, the doctor may enter an open or, “good until canceled” order. This type of order is used when the doctor believes that the fluctuations in the market price of the stock in which he’s interested will be large enough in the future that they will cause the market price to either fall to, or rise to, his desired price, i.e. his limit price. He is reasonably sure of his judgment and is in no hurry to have/his order executed. He knows what he wants to pay or receive and is willing to wait for an indefinite period.

Years ago, such orders were carried for long periods of time without being reconfirmed. This was very unsatisfactory for all parties concerned.  A doctor would frequently forget his order existed and, if the price ever reached his limit and the order was executed, the resulting trade might not be one he wished to make. To avoid the problem, open (GTC) orders must be reconfirmed by the doctor customer each six months. Does that mean six months after the order is entered? …No! The exchange has appointed the last business day of April and the last business day of October as the two dates per year when all open orders must be reconfirmed.

Example: Dr. Smith wants to buy 100 shares of XYZ. The price has been fluctuating between 50 and 55. He places a limit order to buy at 51, although the current market price is 54. Limit orders to buy (buy limit orders) are always placed below the current market. To do otherwise makes no sense. It is possible that, within a reasonable time, the price will drop to 51 and his broker can purchase the stock for him at that price. If the broker can purchase the stock at less that 51, that would certainly be fine with the doctor customer since he wants to pay no more than 51. A sell limit order works in reverse and is always placed above the current market price.

Example: Dr. Smith wants to sell 100 shares of XYZ stock. The order is 54. A sell limit order is place at 56. Sell limit orders are always placed above the market price. As soon as the pride rises to 56, if it ever does, the broker will execute it at 56 or higher. In no case will it be executed at less than 56.

The advantage of the limit order is that the doctor has a chance to buy at less or to sell at more than the current market price prevailing when he placed the order. He assumes that the market price will become more favorable in the future than it is at the time the order is placed. The word” chance ” is important. There is also the “chance” that the order will not be executed at all. The doctor just mentioned, who wanted to buy at 51, may never get his order filled since the price may not fall that low.  If he wanted to sell at 56, the order may also not ever be executed since it might not rise that high during the time period the order is in effect.

Stop Orders:

A very important type of order is the stop order, frequently called a stop-loss order. There are two distinct types of stop orders. One is the stop order to sell, called a sell stop, and the other is a stop order to buy, called a buy stop. Either type might be thought of as a suspended market order; it goes into effect only if the stock reaches or passes through a certain price.

The fact that the market price reaches or goes through the specified stop price does not mean the broker will obtain execution at the exact stop price. It merely means that the order becomes a market order and will be executed at the best possible price thereafter. The price specified on a stop order bears a relationship to the current market price exactly opposite to that on a limit order. Whereas a sell limit is placed at a price above the current market, a sell stop is placed at a price below the current market. Similarly, while a buy limit is placed at a price below the current market, a buy stop is placed at a price above the current market. Why would a doctor investor use a stop order?

There are two established uses for stop orders. One of them might be called protective, the other might be called preventive.

Protective: This order protects a doctors’ existing profit on a stock currently owned.

For example, a doctor purchases a stock at 60. It rises to 70. He has made a paper profit of $10 per share. He realizes that the market may reverse itself. He therefore gives his broker a stop order to sell at 67. If the reversal does occur and the price drops to 67 or less, the order immediately becomes a market order. The stock is disposed of at the best possible price. This may be exactly 67, or it may be slightly above or below that figure. Why? …Because what happened at 67 was that his order became a market order; the price he actually received was dependent upon the next activity in the market. Let us suppose that the sale was made at 66 1/2. The doctor customer made a gross profit of 6 1/2 points per share on his original purchase. Without the stop order, the stock may have dropped considerably below that before the customer could have placed a market order and his profit might have been less or, in fact, he might have even sold at a loss.

Preventive:

A doctor purchases 100 shares of a stock at 30. He obviously anticipates that the price of the stock will rise in the near future (why else would he buy?). However, he realizes that his judgment may be faulty. He therefore, at the time of purchase, places a sell stop order at a price somewhat below his purchase price, for example, at 28. As yet, he has made neither profit nor loss; he’s merely acting to prevent a loss that might follow if he made the wrong bet and the stock does fall in price. If the stock does drop, the doctor knows that once it gets as low as 28, a market order will be turned in for him and, therefore, he will lose only 2 points or thereabout. It might have been much more had he not used the sell stop.

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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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Miscellaneous Orders and Positions

Beside market, limit  and stop orders, there are some other miscellaneous orders to know.

A stop limit order is a stop order that, once triggered or activated, becomes a limit order. Realize that it is possible for a stop limit to be triggered and not executed, as the limit price specified by the doctor may not be available.

In addition, there are all or none and fill or kill orders, and even though both require the entire order to be filled, there are distinct differences. An all or none (AON) is an order in which the broker is directed to fill the entire order or none of it. A fill or kill (FOK) is an order either to buy or to sell a security in which the broker is directed to attempt to fill the entire”‘ amount of the order immediately and in full, or that it be canceled.

The difference between an all or none and a fill or kill order is that with an all or none order, immediate execution is not required, while immediate execution is a critical component of the fill or kill. Be cause of the immediacy requirement, FOK orders are never found on the specialist’s book. Another difference is that AON orders are only permitted for bonds, not stocks, while FOK orders may be used for either.

Also, there exists an immediate or cancel order (IOC), which is an order to buy or sell a security in which the broker is directed to attempt to fill immediately as much of the order as possible and cancel any part remaining. This type of order differs from a fill or kill order which requires the entire order to be filled. An IOC order will permit a partial fill. Because of the immediacy requirement, IOC and FOK orders are never found on the specialist’s book.

Long and Short Positions

A long buy position means that shares are for sale from a market makers inventory, or owned by the medical investor, outright. Market makers take long positions when customers and other firms wish to sell, and they take short positions when customers and other firms want to buy in quantities larger than the market maker’s inventory. By always being ready, willing, and able to handle orders in this way, market makers assure the investing public of a ready market in the securities in which they are interested. When a security can be bought and sold at firm prices very quickly and easily, the security is said to have a high degree of liquidity, also known as marketability.

A short position investor seeks to make a profit by participating in the decline in the market price of a security.

Now, let’s see how these terms, long and short, apply to transactions by medical investors, rather than market makers, in the securities markets.

When a doctor buys any security, he is said to be taking a long position in that security. This means the investor is an owner of the security. Why does a doctor take a long position in a security? Beside, receiving dividend income, to make a profit from an increase in the market price. Once the security has risen sufficiently in price to satisfy the investor’s profit needs, the investor will liquidate his long position, or sell his stock. This would officially be known as a long sale of stock, though few people in the securities business use the label “long sale”. This is the manner in which the above investor had made a profit is the traditional method used; buy low, sell high.

Let’s look at an actual investment in General Motors to investigate this principle further. A medical investor has taken a long position in 100 shares of General Motors stock at a price of $70 per share. This means that the manner in which he can do that is by placing a market order which will be executed at the best “available market price at the time, or by the / placing of a buy limit order with a limit price of $70 per share. The investor firmly believes, on the basis of reports that he has read about the automobile industry and General Motors specifically, that at $70 a share, General Motors is a real bargain. He believes that based on its current level of performance, it should be selling for a price of between $80 and $85 per share. But, the doctor investor has a dilemma. He feels certain that the price is going to rise but he cannot watch his computer, or call his broker, every hour of every day. The reason he can’t watch is because patients have to be seen in the office. The only people who watch a computer screen all day are those in the offices of brokerage firms (stock broker registered representatives), and doctor day traders, among others.

In the above example, with a sell limit order, if the doctor investor was willing to settle for a profit of $12 per share, what order would he place at this time? If you said, “sell at $82 good ’til canceled”, you are correct. Why GTC rather than a day order? Because our doctor investor knows that General Motors is probably not going to rise from $70 to $82 in one day. If he had placed an order to sell at $82 without the GTC qualification, his order would have been canceled at the end of this trading day. He would have had to re-enter the order each morning until he got an execution at 82. Marking the order GTC (or open) relieves him of any need to replace the order every morning. Several weeks later, when General Motors has reached $82 per share in the market, his order to sell at 82 is executed. The medical investor has bought at 70 and sold at 82 and realized a $12 per share profit for his efforts.

Let’s suppose that the medical investor, who has just established a $12 per share profit, has evaluated the performance of General Motors common stock by looking at the market performance over a period of many years. Let’s further assume that the investor has found by evaluating the market price statistics of General Motors is that the pattern of movement of General Motors is cyclical. By cyclical, we mean that it moves up and down according to a regular pattern of behavior. Let’s say the investor has observed that in the past, General Motors had repeated a pattern of moving from prices in the $60 per share range as a low, to a high of approximately $90 per share. Further, our investor has observed that this pattern of performance takes approximately 10 to l2 months to do a full cycle; that is, it moves from about 60 to about 90 and back to about 60 within a period of roughly l2 months. If this pattern repeats itself continually, the investor would be well advised to buy the stock at prices in the low to mid 60’s hold onto it until it moves well into the 80’s, and then sell his long position at a profit. However, what this means is that our investor is going to be invested in General Motors only 6 months of each year. That is, he will invest when the price is low and, usually within half a year, it will reach its high before turning around and going back to its low again. How can the doctor investor make a profit not only on the rise in price of General Motors in the first 6 months of the cycle, but on the fall in price of General Motors in the second half of the cycle? One technique that is available is the use of the short sale.

The Short Sale

If a doctor investor feels that GM is at its peak of $ 90 per share, he may borrow 100 shares from his brokerage firm and sell the 100 shares of borrowed GM at $ 90. This is selling stock that is not owned and is known as a short sale. The transaction ends when the doctor returns the borrowed securities at a lower price and pockets the difference as a profit. In this case, the doctor investor has sold high, and bought low.

Odd Lots

Most of the thousands of buy and sell orders executed on a typical day on the NYSE are in 100 share or multi-100 share lots. These are called round lots. Some of the inactive stocks traded at post 30, the non-horseshoe shaped post in the northwest corner of the exchange, are traded in 70 share round lots due to their inactivity. So, while a round lot is normally 700 shares, there are cases where it could be 10 shares. Any trade for less than a round lot is known as an odd lot. The execution of odd lot orders is somewhat different than round lots and needs explanation.

When a stock broker receives an odd lot order from one of his doctor customers, the order is processed in the same manner as any other order. However, when it gets to the floor, the commission broker knows that this is an order that will not be part of the regular auction market. He takes the order to the specialist in that stock and leaves the order with the specialist. One of the clerks assisting the specialist records the order and waits for the next auction to occur in that particular stock. As soon as a round lot trade occurs in that particular stock as a result of an auction at the post, which may occur seconds later, minutes later, or maybe not until the next day, the clerk makes a record of the trade price.

Every odd lot order that has been received since the last round lot trade, whether an order to buy or sell, is then executed at the just noted round lot price, the price at which the next round lot traded after receipt of the customer’s odd lot order, plus or minus the specialist’s “cut “.  Just like everything else he does, the specialist doesn’t work for nothing. Generally, he will add 1/8 of a point to the price per share of every odd lot buy order and reduce the proceeds of each odd lot sale order by 1/8 per share. This is the compensation he earns for the effort of breaking round lots into odd lots. Remember, odd lots are never auctioned but, there can be no odd lot trade unless a round lot trades after receipt of the odd lot order.

Part 5 of 8: About Securities “Shelf Registration”

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: New Coronavirus Variant and Stock Markets Both Up

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Health tech startup Guidehealth, which assists health systems with value-based care coordination, has raised $14 million in its seed round to make further investments in technology.


Clover Health reported a net income of $7.2 million during the second quarter and raised its full-year guidance.


And … Tenet Healthcare is selling five Alabama hospitals to Orlando Health and is entering into a new revenue cycle management arrangement through Conifer Health Solution

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What’s up

What’s down

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Here’s where the major stock market benchmarks ended:

  • The S&P 500 index (SPX) rose 53.7 points (1%) to 5,240.03; the Dow Jones Industrial Average® ($DJI) climbed 294.39 points (0.76%) to 38,997.66; the NASDAQ Composite ($COMP) advanced 166.77 points (1%) to 16,366,85.
  • The 10-year Treasury note yield (TNX) increased about 10 basis points to 3.88%.
  • The CBOE Volatility Index® (VIX) ended at 27.7, well above lows below 11 last month.

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A new coronavirus variant named KP.3.1.1 has risen to dominance in the U.S., almost doubling in prevalence in just two weeks, the Centers for Disease Control and Prevention reports. Experts are warning that the new variant—which, as of August 3, accounts for more than 1 in 4 U.S. COVID-19 cases—is “more of a challenge” to our immune systems compared to previous variants.

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RSI: Relative Strength Index [Stock Markets]

By Staff Reporters

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The relative strength index (RSI) is a technical indicator used in the analysis of financial markets. It is intended to chart the current and historical strength or weakness of a stock or market based on the closing prices of a recent trading period. The indicator should not be confused with relative strength.

The RSI is classified as a momentum oscillator, measuring the velocity and magnitude of price movements. Momentum is the rate of the rise or fall in price. The relative strength RS is given as the ratio of higher closes to lower closes. Concretely, one computes two averages of absolute values of closing price changes, i.e. two sums involving the sizes of candles in a candle chart. The RSI computes momentum as the ratio of higher closes to overall closes: stocks which have had more or stronger positive changes have a higher RSI than stocks which have had more or stronger negative changes.

The RSI is most typically used on a 14-day time frame, measured on a scale from 0 to 100, with high and low levels marked at 70 and 30, respectively. Short or longer time frames are used for alternately shorter or longer outlooks. High and low levels—80 and 20, or 90 and 10—occur less frequently but indicate stronger momentum.

The relative strength index was developed by J. Welles Wilder and published in a 1978 book, New Concepts in Technical Trading Systems, and in Commodities magazine (now Modern Trader magazine) in the June 1978 issue. It has become one of the most popular oscillator indices.

The RSI provides signals that tell investors to buy when the security or currency is oversold and to sell when it is overbought.

RSI with recommended parameters and its day-to-day optimization was tested and compared with other strategies in Marek and Šedivá (2017). The testing was randomized in time and companies and showed that RSI can still produce good results; however, in longer time it is usually overcome by the simple buy-and-hold strategy.

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DAILY UPDATE: Google Monopoly, Mag 7 Still Down as VIX “Fear Index” Rises and Stock Markets Plunge!

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A federal judge ruled that Google engaged in illegal practices to preserve its search engine monopoly, delivering a major antitrust victory to the Justice Department in its effort to rein in Silicon Valley technology giants. Google, which performs about 90 percent of the world’s internet searches, exploited its market dominance to stomp out competitors, U.S. District Judge Amit P. Mehta said in the long-awaited ruling.

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Stat: $900 billion. That’s the potential market value loss of the Magnificent Seven tech companies as investors shed tech stocks. The selloff comes as investors are looking for safer bets in the event of a recession. (Reuters)

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Here’s where the major benchmarks ended:

  • The S&P 500 index tanked 160.23 points (–3.00%) to 5,186.33; the Dow Jones Industrial Average® ($DJI) plunged 1,033.99 points (–2.60%) to 38,703.27; the NASDAQ Composite plummeted 576.08 points (–3.43%) to 16,200.08.
  • The 10-year Treasury note yield (TNX) dropped to 3.78%, the lowest close since June 2023.
  • The CBOE Volatility Index® (VIX) ended at 37.04, a four-year high but well-off intraday peaks above 60.

Today, the VIX reached levels not seen since early 2020 during the pandemic panic. This type of volatility can suggest oversold conditions. A higher VIX, sometimes called the “fear index,” reflects uncertainty and can suggest quicker, more intense market swings.

What’s up

What’s down

  • Apple stumbled 4.82% after Warren Buffett’s Berkshire Hathway revealed it has cut its position in the tech company by nearly 50%.
  • Nvidia fell 6.36% after a report this weekend revealed that its brand new chips will be delayed by three months or more due to design flaws.
  • Tesla sank 4.23% due to concerns about the auto maker’s global growth, despite Elon Musk’s recent positivity.
  • Intel continued to crumble, sliding 6.38% as the after-effects of its terrible second-quarter earnings report continue to be felt.
  • Bitcoin-related stocks plummeted today as cryptocurrencies were unable to avoid a major selloff. Coinbase plunged 7.32%, while MicroStrategy dropped 9.60%, and even Robinhood tumbled 8.17%.

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

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KEY PRINCIPLES: Assessing Medical Practice Financial Value via U.S.P.A.P. Rules

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When it comes to purchasing a medical practice, there are a variety of factors that one must consider in evaluating the worth of the practice. Assessing the value of a practice is fraught with potential landmines if one does not go into the process with a strong understanding of some key principles to medical practice valuation.

   According to the Dictionary of Health Economics and Finance, practice valuation is the “formal process of determining the worth of healthcare or other medical business entity at a specific point in time and the act or process of determining fair market value.” Fair market value is defined as “ … the price at which a willing buyer will buy and a willing seller will sell an asset in an open free market with full disclosure.”

   The Internal Revenue Service (IRS) Revenue Ruling 59-60 clearly states that fair market value “is essentially a future prophecy and must be based on facts available at the required date of appraisal.”

   Unfortunately, one cannot directly observe the value of a medical practice as there are a number of underlying issues. Obviously, the buyer and seller are pursuing opposite objectives, and this reality is not necessarily conducive to facilitating clarity on those issues.

   Accordingly, let us consider a few mistakes that are commonly made by physicians who are considering the purchase of a medical practice.

A Guide To The Myths And Realities Of Medical Practice Valuation

   • Valuations are material representations providing a range of transferable worth.
   • Valuations are reproducible estimates based on economic assumptions.
   • Valuations are not “back of the envelope multiples” using specious benchmarks.
   • Valuations are defensible and should be “signed off” by the completing firm attesting to origination guidelines and in accordance with the Uniform Standards of Professional Appraisal Practice (USPAP) and IRS formats as needed.
   • Financial accounting value (book value) is not fair market value.
   • Professional valuators represent only one party. The buyer or seller-owner is the client.
   • Unbiased valuators do not provide financing or equity participation schemes.

Knowing The Distinctions Among Engagement Types

   The Institute of Medical Business Advisors uses three levels that approximate engagement types for the industry. These levels are comprehensive valuation, limited valuation and ad-hoc valuation.

   A comprehensive valuation is an extensive service designed to provide an unambiguous opinion of the value range. It is supported by all procedures that valuators deem relevant with mandatory onsite review. This gold standard is suitable for contentious situations like divorce, partnership dissolution, estate planning and gifting, etc. The written opinion of value is applicable for litigation support activities like depositions and trial. It is also useful for external reporting to bankers, investors, the public and IRS, etc.

   A limited valuation lacks additional suggested USPAP procedures. It is considered to be an “agreed upon procedure,” which is used in circumstances in which the client is the only user. For example, one may use the limited valuation when updating a buy-sell agreement or when putting together a practice buy-in for a valued associate. This limited valuation would not be for external purposes. No onsite visit is needed. A formal opinion of value is not rendered.

   An ad-hoc valuation is a low level engagement that provides a gross and non-specific approximation of value based on limited limited parameters or concerns by involved parties. Neither a written report nor an opinion of value is rendered. The ad-hoc valuation is often used periodically as an internal organic growth/decline gauge.

Are You Following Industry Standards And Rules?

   Specifically, when it comes to USPAP transactions involving physician practices, the following points are implied by the industry and the IRS.

   • Discounted cash flow analysis is the most relevant income approach and must be done on an “after-tax” basis. It generally produces a higher value but is costly, detail-oriented and time consuming.
   • Project practice collections based on reasonable assumptions for the practice and market, etc.
   • Physician compensation is based on market rates consistent with age, experience and productivity.
   • Majority (control) premiums and minority (lack of control) discounts are also to be considered. A majority premium is the amount paid to gain enough ownership to set policies, direct operations and make decisions for the practice. A minority discount for partial ownership does not allow this power. Thus, majority ownership is valuated higher than minority ownership purchase.

What About Personal Goodwill And Practice Goodwill?

   Goodwill represents the difference between practice purchase price and the value of the net assets. Personal goodwill results from the charisma, skills and reputation of a specific doctor. These attributes accrue solely to the individual, are not transferable and cannot be sold. Personal goodwill has little or no economic value.

   Transferable medical practice goodwill has value, may be transferred and is defined as the unidentified residual attributes that contribute to the propensity of patients and managed care contracts (and their revenue streams) to return in the future.

   However, bear in mind that the Goodwill Registry, an older source used to determine the average percentage of revenue contributed to practice goodwill, has sparse to no podiatry input, may be dated for some specialties and leads to abnormally high values.

   In addition to various multiple factors, one must also appreciate the impact of a changing environment and practice transfer in a local market, which can augment or blunt goodwill value. It is also important to determine whether patients or HMOs return because of true goodwill or are mandated to do so by contractual obligations.

   Now to further confuse the issue, how each kind of goodwill is allocated in situations like divorce depends on state law. For example, some courts weigh in on the apportionment of both kinds of goodwill, other courts exclude both kinds of goodwill and other courts pursue a case-by-case approach.

Understanding ‘Excess Earnings Capitalization’ And Compensation Issues

   Another way to determine goodwill value is through “excess earnings capitalization.” This economic method looks at the difference between salary and what you would have to pay a comparable doctor replacement.

   As an example, when you subtract the numbers and divide the result by 20 percent, an important percentage referred to as the capitalization rate emerges. The final number gives a dollar value for practice goodwill. Courts seem to prefer this method in divorce situations because it tends to reflect a practice’s current value.

   Regardless of the practice business model, physician compensation is inversely related to practice value. In other words, the more a doctor takes home in above average salary, the less the practice is generally worth and vice versa.

Emphasize Practice Specifics Over Benchmarks And Formulas

   In the stable economic past, physicians may have used industry benchmarks as quick and inexpensive substitutes for professionally prepared valuations. However, this practice can be fraught with peril if challenged. The courts seem to frown on this simplistic and dated methodology. Moreover, generic benchmark formulas assume a financial statement reporting standard that just does not exist with contemporary professional valuations.

   Therefore, almost every competitive issue that impacts value should be addressed with each practice engagement. This includes but is not limited to:

   • contemporary dislocations by third parties, Medicare and commercial payers;
   • retail clinics and changes in supply/ demand and specialty trends;
   • the rise of ambulatory surgery centers, walk-in clinics and specialty hospitals;
   • outsourced care and medical tourism;
   • alterations in resource based-relative value units, ambulatory payment classifications (APCs), diagnosis-related groups (DRGs) and newer Medicare-severity diagnosis-related groups (MS-DRGs); and
• the Medicare Modernization Act, HIPAA, OSHA, the EEOC and other regulations.

   One must also consider the impact of current employee trends to high-deductible health care plans and private concierge medicine. Another consideration is employer shifts away from defined benefits plans to defined contribution plans.

Aggregating Or ‘Normalizing’ Financial Information: What You Should Know

   In addition to possibly conducting employee interviews, one must gather appropriate financial information in order to properly value a practice. As a starting point, interested physician buyers should be able to see the following information for the most recent three-year period.

   • Practice (corporate) tax returns
   • Equipment/automobile leasing and/or tax depreciation schedules
   • Accounts receivable aging schedule
   • Consolidated financial statements (P&L, cash flow, balance sheet and retained earnings)
   • Prior buy-sell and/or non-compete agreements

   It is especially important to eliminate one-time, non-recurring practice expenses. These are adjusted for excessive or below normal expenses on the profit and loss statement. Such “normalization” can produce a big surprise for benchmark proponents and formula-driven advocates when a selling doctor runs personal expenditures through the practice that a buyer or court would not consider legitimate. Of course, one is less likely to encounter such shenanigans when the valuation is conducted according to professional USPAP and IRS style guidelines.

   For example, we recall one doctor who painted his home and wrote it off as a valid business expense. Deleting other major expenses such as country club memberships make a practice look more profitable. This is good news if you are selling it. It is bad news if you are getting a divorce.

   Conversely, you may have to defend legitimate business expenses that an appraiser may seek to normalize. For example, doctors may pay for a vehicle through their practice. If they use the vehicle to travel between multiple offices and hospitals, the expense may be legitimate.

   Also realize that the appraiser may also add expenses that have not been incurred. For example, the appraiser may add an office manager’s salary if your spouse is in that role for free. This produces a lower appraised value and is common in small podiatry practices. Honorarium is another example that does not figure into value calculations.

   Of course, normalization is a sophisticated and time intensive process. However, the expert earns his or her professional fee, and defends the resulting valuation range when challenged.

Keys To Selecting The Right Valuator Professional

   The most important credentials to look for are fiduciary level experience, specificity and independence. Some doctors mistakenly turn to those who may have never appraised a practice before. Just because an appraiser has initials behind his or her name, it does not mean he or she understands the peculiarities of medical specialties. Agents, brokers, solicitors and other intermediaries are not fiduciaries.

   Physicians looking to assess a practice for possible sale/purchase should only select an independent health economist, who will be your advocate under Securities Exchange Commission (SEC), IRS or other relevant managerial accounting guidelines.

   Moreover, be very wary if the valuation is not done in an independent manner or, worse, performed for both parties simultaneously.

Essential Insights On Professional Fees And What You Can Expect

   Of course, it is almost impossible to answer concerns regarding fees without specific information. The cost of a valuation can range from $0 to $50,000 for an onsite team of experts for behemoth practices and ambulatory surgery centers. Keep in mind that in most cases you want to ensure the value determination will stand up to IRS scrutiny so the $0 rule of thumb approach is not an option.

   However, most reputable firms use a blended fee schedule of fixed and hourly rates (plus expenses). Internists should expect to spend approximately $5,000 to $10,000 for an average sized practice and a limited appraisal that is completely suitable for most internal activities.

   External appraisals or poorly aggregated financial information, onsite reviews and litigation support services incur additional costs. However, most doctors find the money well spent. Expect to pay a retainer and sign a formal professional engagement letter.

   Finally, once the practice price is agreed upon, sales contract terms and agreements present a plethora of financing challenges for both parties to consider. For example, one must negotiate bank loans (if they are even available), payment rates and length, personal promissory guarantees, down payment offsets, earn-out arrangements and Uniform Commercial Codes.

Final Notes

   Do not be surprised if a sales broker does not consider the aforementioned issues as the modern health era emerges. Most agent-appraisers are predominantly concerned with earning commissions by working both transaction parties and may not represent your best interests. Also be aware that they are usually not obliged to disclose conflicts of interest and do not provide testimony as a court approved expert witness.

   However, it is a fait accompli that medical practice worth is presently deteriorating. As the population ages and third-party reimbursements plummet, doctors are commoditized and traditional retail medicine is replaced by more efficient wholesale business models like workplace health clinics. The subprime mortgage default fiasco, credit freeze, potential tax reform law expiration, the ACA, VBC, capitation payments and the political specter of a nationalized healthcare system only add fuel to the macroeconomic fires of uncertainty. Do not forget the corona pandemic.

   As a result, a good medical practice is no longer good business necessarily and retiring doctors can no longer automatically expect to extract premium sales prices. Moreover, uninformed young physicians should not be goaded to overpay.

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The Author

Dr. Marcinko is a nationally known speaker and the founding partner of the iMBA Inc and http://www.MedicalExecutivePost.com He is also the Academic Provost for http://www.CertifiedMedicalPlanner.org

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HEALTH ECONOMICS: Podcast and Research Paper Presentations

By Staff Reporters

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RESEARCH PAPER: https://scholar.harvard.edu/files/mankiw/files/economics_of_healthcare.pdf

PODCAST: https://tinyurl.com/wdyk65mw

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

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DAILY UPDATE: Turn Key Health, Intel, Coke and Eli Lilly

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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

Serving Almost One Million Doctors, Financial Advisors and Medical Management Consultants Daily

A Partner of the Institute of Medical Business Advisors , Inc.

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The FDA said shortages of Eli Lilly’s popular weight loss and diabetes drugs are over.

Coca-Cola must pay $6 billion in back taxes and interest to the Internal Revenue Service, a federal tax court ruled. Coke is appealing but will pay the bill for now.

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

Stat: 40.1%. That’s the percentage of people in the US who said they had “a lot of trust” in physicians and hospitals in January 2024, down from 71.5% in April 2020. (JAMA Network Open)

Quote: “We can usher people here and they can get the help that they need because the hospitals are clearly overwhelmed.”—Yolanda Gales, a program director with a Maryland County mobile crisis response team, on the opening of the county’s first 24/7 mental health centers (the Washington Post)

Read: One report says that dozens of incarcerated patients died while under the care of Turn Key Health Clinics. (the Marshall Project)

Careers in care: Indeed has a dedicated job board for healthcare pros. It features employers with top company ratings for your perusing pleasure. Check it out.*

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

Stocks plunged Friday as an unexpectedly bleak jobs report had investors second-guessing the Fed’s decision to wait until September to cut interest rates. Intel suffered its worst drop in 50 years and traded at its lowest price since 2013 after it missed on earnings, announced major layoffs, and suspended its dividend.

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

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RECESSION INDICATOR: Inverted Yield Curve?

By Staff Reporters

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

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

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

In December 2022, this recession probability tool hit 47.31%. That’s the highest reading since 1981, and a very clear indication that economic activity is expected to slow at some point in 2024?

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FINANCIAL EDUCATION PODCAST: CMPs™ are In … Are CPAs Out?

CERTIFIED MEDICAL PLANNER

By Staff Reporters

SPONSOR: http://www.CertifiedMedicalPlanner.og

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Statistics: 7.4%. That’s the percentage drop in students who graduated with a degree in accounting in the 2021–2022 school year than the year before. Low starting salaries, heavy workloads, and uncertainty around AI are driving the exodus of students from choosing accounting degrees. (the Wall Street Journal).

MORE: https://www.wsj.com/lifestyle/careers/accounting-salary-cpa-shortage-dec2caa2?utm_campaign=mb&utm_medium=newsletter&utm_source=morning_brew

PODCAST: https://www.ted.com/talks/dan_bricklin_meet_the_inventor_of_the_electronic_spreadsheet

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DAILY UPDATE: Wells Fargo and Record Stock Market Sell Off

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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

Serving Almost One Million Doctors, Financial Advisors and Medical Management Consultants Daily

A Partner of the Institute of Medical Business Advisors , Inc.

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Here’s where the major benchmarks ended:

  • The S&P 500® (SPX) index dropped 100.12 points (-1.8%) to 5,346.56, and finished down 2.1% for the week; the Dow Jones Industrial Average® ($DJI) dropped 610.71 points (-1.5%) to 39,737.26, and finished down 2.1% for the week; the NASDAQ Composite®($COMP) fell 417.98 points (-2.4%) to 16,776.16, and ended down 3.4% for the week.  
  • The 10-year Treasury note yield (TNX) fell to 3.79%, the lowest close since last December 27.
  • The CBOE Volatility Index® (VIX) rose to 23.66, the highest close since March 2023 after topping 29, a nearly two-year high, intraday.

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

What’s up

What’s down

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Wells Fargo wealth management client is suing the company for alleged breach of fiduciary duty related to its cash sweep program, which pays customers interest rates as low as 0.05% on their uninvested cash.

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“Triple Entry Accounting”

What it is – How it works?

[By staff reporters]

The term “Triple Entry Accounting,” was first used by Ian Grigg, financial cryptographer, and described in his paper published in 2005, three years before the emergence of Bitcoin and its underlying Blockchain protocol.

Here is the original historical article on “Triple Entry Accounting” by Grigg:

LINK: https://nakamotoinstitute.org/triple-entry-accounting/

Conclusion

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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™

Accounting -VERSUS- Economic Profit

Yes – There is A Difference

[By staff reporters]

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

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DAILY UPDATE: Intel, Colon Cancer, Fewer Cardiologists and UnitedHealth Tactics as the Stock Markets Tank!

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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

Serving Almost One Million Doctors, Financial Advisors and Medical Management Consultants Daily

A Partner of the Institute of Medical Business Advisors , Inc.

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Stat: $895. That’s the out-of-pocket cost for a blood test that screens for colon cancer, which may receive more widespread insurance coverage now that it has FDA approval. (CNBC)

Quote: “There’s no question that the health statistics of rural America are worse than the health statistics of more urban America.”—Robert Harrington, a cardiologist and dean of Weill Cornell Medicine, on the lack of cardiologists in rural parts of the US (the Washington Post)

Read: Critics say that UnitedHealth has used questionable tactics and exploitation to achieve dominance in healthcare. (Stat)

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

Intel is slashing 15% of its staff as part of a $10 billion plan to reduce costs, the tech company announced in its second-quarter earnings Thursday.

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

What’s up

What’s down

CITE: https://tinyurl.com/tj8smmes

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

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