DAILY UPDATE: Mobile Payment Fraud Up as Economy Grows and Stock Markets Extend Gains

By Staff Reporters

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Alarmed by a surge in fraud draining bank accounts through popular mobile payment apps like Venmo, Cash App and Zelle, Manhattan District Attorney Alvin Bragg, Jr., has sent scathing letters to the CEOs of each company, demanding immediate action to protect consumers.

In the letters, Bragg described the crimes as involving an unauthorized user gaining access to unlocked devices, then stealing significant sums of money from bank accounts by making purchases with the mobile payment apps and using financial information from them to open new accounts.

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And, the U.S. economy expanded at a 3.3% annualized pace in the final quarter of 2023, the Commerce Department said on Thursday.

Why it matters: It’s much stronger growth than economists expected and caps a year of economic resilience as the nation avoided a projected recession.

Here’s where the major benchmarks ended:

  • The S&P 500 index rose3.95 points (0.1%) to 4,868.55; the Dow Jones Industrial Average® (DJI) lost 99.06 points (0.3%) to 37,806.39; the NASDAQ Composite gained 55.97 points (0.4%) to 15,481.92.
  • The 10-year Treasury note yield (TNX) increased about 4 basis points to 4.18%.
  • The CBOE Volatility Index® (VIX) rose 0.59 to 13.14.

Tech-related strength helped boost the NASDAQ-100® (NXD), which includes the NASDAQ’s largest non-financial companies, by 0.6% to a record close. Energy shares were also strong behind continued gains in WTI Crude Oil (/CL) futures, which rose 1.4% and settled near a two-month -high after the Energy Information Administration reported a 7.5% drop in U.S. oil production last week, reflecting disruptions from winter storms. Small-cap shares lagged as the Russell 2000® Index (RUT) fell 0.7%.

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

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PODCAST: Patient-Doctor Mismatch in Population Health

By Eric Bricker MD

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DAILY UPDATE: R.I.P. Medical Debt as Stock Markets End Mixed

By Staff Reporters

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New York City intends to wipe out more than $2 billion in medical debt for up to 500,000 residents, tackling a top cause of personal bankruptcy, Mayor Eric Adams just announced yesterday.

The city is working with RIP Medical Debt, a nonprofit that buys medical debt in bulk from hospitals and debt collectors for pennies on the dollar. The group targets the debt of people with low incomes or financial hardships and then forgives the amounts.

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

Here’s where the major benchmarks ended:

  • The S&P 500 index rose 14.17 points (0.3%) to 4,864.60; the Dow Jones Industrial Average lost 96.36 points (0.3%) to 37,905.45; the NASDAQ Composite® (COMP) rose 65.66 points (0.4%) to 15,425.94.
  • The 10-year Treasury note yield (TNX) gained about 4 basis points to 4.138%.
  • The CBOE Volatility Index® (VIX) fell 0.64 to 12.55.

Shares of banks and retailers were among the market’s weakest areas Tuesday, while consumer staples were among the upside leaders. Oilfield services companies were also strong, as strong quarterly results from Halliburton (HAL) helped offset a slide in crude oil futures. In other markets, the U.S. dollar index (DXY) hit its strongest level since mid-December, partly reflecting the Bank of Japan’s decision to keep short-term interest rates unchanged.

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FEDERAL HEALTH PROGRAMS: Defined

By Staff Reporters

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Theranos founder and ex-CEO Elizabeth Holmes was just banned from US federal health care programs for nine decades, according to the US the health department. Holmes was sentenced in November 2022 to 11 years in prison following a trial that determined she knew her blood-testing startup, which was founded in 2003 and which claimed to be able to test for a range of diseases and risks with one finger prick, produced inaccurate and faulty results. Before government probes, Theranos raised hundreds of millions of dollars, named prominent former U.S. officials to its board, and explored a partnership with the U.S. military to use its tests on the battlefield.

So, just what is a Federal Health Care Program?

Federal Health Care Program means any plan or program that provides health benefits, whether directly, through insurance, or otherwise, which is funded directly, in whole or in part, by the United States Government, including, but not limited to, Medicare, Medicaid/MediCal, managed Medicare/Medicaid/MediCal, TriCare/VA/CHAMPUS, SCHIP, Federal Employees Health Benefit Plan, Indian Health Services, Health Services for Peace Corp Volunteers, Railroad Retirement Benefits Black Lung Program, Services Provided to Federal Prisoners, and Pre- Existing Condition Insurance Plans (PCIPs).

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DOCTORS Getting OUT of Medical Practice!

By Staff Reporters

SPONSOR: http://www.MARCINKOASSOCIATES.com

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Why are doctors leaving practice?

For many physicians it’s about demographics. Just like the rest of us, doctors are aging too. Already the average physician age is about 53 years old. The Association of American Medical Colleges reports that about half of doctors are over the age of 55. Over the next decade, an estimated 40% of physicians will be over 65 years old. This means more than two of every five active physicians will reach age 65 within the next 10 years.

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Moreover, compared with their boomer colleagues who were more likely to work past retirement, a robust 60% of younger Generation X doctors are reporting that they plan to retire by age 60.

Doctors cite poor quality of life and stress as reasons for their early departure. The pandemic certainly crushed many providers and has led to burnout. Generation X physicians in their 40s and early 50s were more likely than boomers to report that their current work life was not making the grade. In short, 43% of middle-aged doctors, compared with 31% of doctors over age 55, were reporting lower levels of professional fulfillment. Moreover, 47% of mostly Gen X doctors indicated dissatisfaction with their level of personal fulfillment compared with 36% of practicing boomer physicians.

COACHING: https://marcinkoassociates.com/process-what-we-do/

That dissatisfaction is translating into action and the pandemic is not the only reason for discontent. One survey of physicians in Massachusetts indicated that one in four doctors plans to leave medicine in the next two years and that staffing shortages and related administrative demands, e.g., hospital system metrics, paperwork, eMRs and meeting insurance requirements, were the most cited source of workplace stress. 

RISK MANAGEMENT: https://www.routledge.com/Risk-Management-Liability-Insurance-and-Asset-Protection-Strategies-for/Marcinko-Hetico/p/book/9781498725989

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BUYING: Home Economics

By Staff Reporters

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A report released last month by the National Association of Realtors (NAR) confirms what many Americans suspect: home affordability is down. Due to rising interest rates and low inventory, NAR found that the average income of a home buyer between July 2022 and June 2023 was $107,000, up from $88,000 the year prior—one of the highest levels since NAR started tracking in 1981.

But the housing market continues to churn. The organization found…

  • More and more home buyers are single women. The share of single women buying homes is almost double that of men. They’re also slightly older—a single woman buying her first home is 38 on average, while a single man is 33 years old.
  • Buyers are older. The average first-time home buyer is 35, up from 29 in the 1980s, but it’s older people who are buying up the three-bedrooms after selling their starter homes: NAR found that the median age of a repeat home buyer last year was 58. In 1981, it was 36 years old.

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PHYSICIAN: Executive Leadership Thoughts

By Dr. David Edward Marcinko MBA

SPONSOR: http://www.MARCINKOASSOCIATES.com

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[Human Nature, Medical and Financial Ethics and Modern Principles]

In any medical blog or investing treatise of gravitas, thoughts on human nature are usually placed at the end of the work, or an afterthought if included at all. However, we elected to prominently place this material as a stand alone feature. Why?

In the end, the success of any financial advisor or physician endeavor ultimately comes down to changing human behavior – helping a doctor/nurse/technician alter whatever s/he was doing toward something that will better allow them to avoid errors and pursue quality care and investing or practice management goals.

Yet, there is still remarkably little education or training for financial planners or medical professionals focused directly on motivation or change theory, in any related area except psychiatry/psychology or perhaps professional liability. Instead, doctors and advisors/planners are increasingly turning to professional consultants to learn best practices on how to help them actually make the behavioral changes necessary to achieve their medical quality improvement and client acquisition goals; as we attempt to answer these questions:

  • Are you and your medical practice, or financial advisory practice, ready for change?
  • How to transition from [traditional] solo practitioner B-models to modern forms?
  • What are leadership, management and governance?
  • In group practices, how is leadership shared?
  • What issues need be considered when hiring a financial planner or practice administrator or clinic CEO?
  • What is medical ethics and financial munificence? Why is it needed? How does it work?
  • What are the types of risk?
  • How are risks managed in the medical practice space or financial advisory eco-system?

In addition, medical and financial planning practitioners need to strive to avoid what Zenger and Folkman describe as the 10 most common leadership shortcomings based on a survey of 11,000 leaders. They include:

  1. Lacks energy and enthusiasm
  2. Accepts mediocre self performance
  3. Lacks clear vision and direction
  4. Poor judgment
  5. Not collaboration
  6. Not following standards
  7. Resistant to new ideas
  8. Doesn’t learn from mistakes
  9. Lacks interpersonal skills
  10. Fails to develop others.
  •  Source: Zenger and Folkman: The Daily Stat: The 10 Most Common Failures of Business Leaders, Harvard Business Publishing, June 4, 2009.

Leadership V. Management: https://medicalexecutivepost.com/2023/04/14/healthcare-leadership-vs-management/

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Can this Doctor RETIRE?

AFFORDABILITY IN 2024

By Staff Reporters

SPONSOR: http://www.MARCINKOASSOCIATES.com

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CAN THIS DOCTOR RETIRE – HE ASKS?

I’m a late career entry and 55 year old burned out doctor who wants out. Can I retire in 2 years with a pension of $6,100 a month (net). I have $825,000 in my 401(k) and 457 plan and a mortgage of $95,000 at 5.30%. I am not planning to move and will retire in place.

SOME THOUGHTS AND ANSWERS?

Congratulations on you solid retirement fund on top of a pending pension. 

The first step you should take is to create a detailed budget for your retirement years. Consider expected living costs, healthcare expenses, travel and any other major expenses. Many folks make the mistake of setting up a monthly budget, but keep out significant milestones that are often costly, such as paying for a child’s college education or wedding.

Next, you should figure out your plan for housing. Mortgage payments, upkeep and taxes are important considerations. There was no mention of mortgage equity. 

Another factor to take into account is state and Federal tax projections. If the 401(k) funds are all pre-tax dollars, any distributions will be taxable and there may be penalties if funds are withdrawn prior to 59 ½ years old. That will impact your retirement plan if you’re preparing to retire at 57-58.

It also sounds like you haven’t taken into account your Social Security allowance. It’s possible that your pension is one that comes with a government pension offset which would explain why you didn’t include it. On the other hand, maybe you’re thinking it’s far out enough that it doesn’t factor into your calculations?

Finally, you may want to look for a fee-only financial advisor that is paid directly by the client and doesn’t receive commissions for recommending financial products. So, advice is less biased. And get a fiduciary advisor which means they are required to put your best interests ahead of their own. 

Also, someone with medical niche specificity. Good Luck!

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NOTE: This is not an offer to buy or sell any security or interest. All investing involves risk, including loss of principal. Working with an adviser may come with potential downsides such as payment of fees (which will reduce returns). There are no guarantees that working with an adviser will yield positive returns. The existence of a fiduciary duty does not prevent the rise of potential conflicts of interest.

Refer a Colleague: MarcinkoAdvisors@msn.com

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ADVERSE: Medical Events

By Dr. David Edward Marcinko MBA

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Aggregated experience from the Doctors Company and other malpractice insurers has shown that adverse medical events tend to fall into three categories:

A. Medical and/or System Error 
Error is defined by the National Quality Forum Consensus report titled Standardizing a Patient Safety Taxonomy as “the failure to perform a task satisfactorily against customary standards and the failure cannot be attributed to causes beyond the patient or provider.” When the investigation (including a sentinel event root cause analysis) is complete and the cause is determined to be medical and/or system error, a disclosure meeting should take place with the patient or family.

B. Known Risk/Complication or Unforeseeable Event 
The key factor in this category is pre-ventability. Disclosure communications following unpreventable complications or unforeseeable events need to be forthright, open, and compassionate, though they differ qualitatively from apologies after preventable errors.

  1. Review the known facts surrounding the adverse outcome.
  2. Determine if the event was preventable.
  3. Review your process of informed consent to determine if the known risk or complication was discussed.
  4. Proceed to the disclosure meeting with the patient or family. Focus on discussing the cause(s) of the known risk or complication. Review the informed consent if appropriate.

C. Unexplained Change in Patient Status or New Diagnosis of Late-Stage Disease 

  1. The main challenge in communicating after a Category C event is the avoidance of a premature conclusion that a severe and surprising outcome must be due to a negligent error. It is especially important in these circumstances to limit the information conveyed to the confirmed details and to provide ongoing updates as new information becomes available. These cases are particularly vulnerable to retraction and correction cycles that render all subsequent communications with the patient and family questionable.
  2. Conduct an internal review of the medical records to determine exactly what happened and to determine if the status change was preventable or if the new diagnosis could have or should have been made earlier.
  3. If appropriate, initiate an external expert review. Peer reviews of the medical care with the outcome blinded can lend unique insight into these events.
  4. If a sentinel event occurred, a root cause analysis is appropriate.
  5. Proceed to the disclosure meeting. Review the findings of your medical record review and investigation. Explain the implications of the change in the patient’s health status and how this will affect his or her subsequent disease management. Discuss the prognosis and management of the newly diagnosed late-stage disease.

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Disruptive Behavior and Bullies in Medicine

“Micro-Aggressors” in Healthcare

[By staff reporters] http://www.CertifiedMedicalPlanner.org

Every workplace has “micro-aggressors” or/or bullies that exhibit disruptive behavior.

But, when the workplace is a hospital, it’s not just an employee problem.

Definition

Microaggression is a term coined by psychiatrist and Harvard University  professor Chester M. Pierce in 1970 to describe insults and dismissals he said he had regularly witnessed non-black Americans inflict on African Americans.

In 1973, MIT economist Mary Rowe extended the term to include similar aggression directed at women; eventually, the term came to encompass the casual degradation of any socially marginalized group, such as the poor and the disabled.

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Case Report

In one reported case, the worker, felt threatened: His superior came at him “with clenched fists, piercing eyes, beet-red face, popping veins, and screaming and swearing.” He thought he was about to be hit. Instead, his angry co-worker stormed out of the room.

But, it wasn’t just any room: It was in a hospital, adjacent to a surgical area. The screamer was a cardiac surgeon, and the threatened employee was a perfusionist, a person who operates a heart/lung machine during open heart surgery. In 2008, the Indiana Supreme Court ruling in Raess v. Doescherupheld a $325,000 settlement for the perfusionist, who said he was traumatized.

PHYSICIAN COACH: https://marcinkoassociates.com/process-what-we-do/

Conclusion

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

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

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

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

 Harvard Medical School

Boston Children’s Hospital – Psychiatrist

Yale University

PODCAST: The United Health Group Financial Giant

By Eric Bricker MD

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

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Crafting a Medical Practice Strategic Marketing Plan

Necessary Today – Not So In the Past

http://www.MarcinkoAssociates.com

dem

[By Dr. David Edward Marcinko; MBA, CMP™]

Invite Dr. Marcinko

Marketing plays a vital role in successful practice ventures. How well you market your practice, along with a few other considerations, will ultimately determine your degree of success or failure. 

The key element of a successful marketing plan is to know your patients – their likes, dislikes and expectations. By identifying these factors, you can develop a strategy that will allow you to arouse and fulfill their wants and needs. 

The Beginning

Identify your patients by their age, sex, income/educational level and residence. At first, target only those patients who are more likely to want or need your medical services. As your patient base expands, you may need to consider modifying the marketing plan to include other patient types or medical services. 

Your marketing plan should be included in your medical business plan and contain answers to the questions asked below:

·Who are your patients; define your target market(s)?

·Are your markets growing; steady; or declining?

·How is the practice unique?

·What is its market position?

·Where will we implement the marketing strategy?

·How much revenue, expense and profit will the practice achieve?

·Are your markets large enough to expand?

·How will you attract, hold, increase your market share?

·If a franchise, how is your market segmented?

·How will you promote your practice and services?

Practice Competition

Competition is a way of life. We compete for jobs, promotions, scholarships to institutions of higher learning, medical school, residency and fellowship programs, and in almost every aspect of our lives. 

When considering these and other factors, we can conclude that medical practice is a highly competitive, volatile arena. Because of this volatility and competitiveness, it is important to know your medical competitors. Questions like these can help you determine:

·Who are your five nearest direct physician competitors?

·Who are your indirect physician competitors?

·How are their practices: steady; increasing; or decreasing?

·What have you learned from their operations or advertising?

·What are their strengths and weaknesses?

·How do their services differ from yours?

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Chief-Marketing-Officer

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Patient Targeting

Patient targeting generally describes the strategic competitive advantage and/or professional synergy that is specific and unique to the practice. Intuitively, it answers such questions as:

·Who is the target market?

·How is the practice unique?

·What is its market position?

·Where will we implement the marketing strategy?

· How much revenue, expense and profit will the practice achieve?  

The science of modern marketing however, is based on intense competition largely derived from the interplay of five forces, codified in the early 1980s, by Professor Michael F. Porter of Harvard Business School. They are placed in this section of the business plan and include the following:

Power of suppliers: The bargaining power of physicians has weakened markedly in the last managed care decade.  Reasons include demographics, technology, over/under supply and a lack of business acumen. 

Power of buyers: Corporate buyers of employee healthcare are demanding increased quality and decreased premium costs within the entire healthcare industry. The extents to which these conduits succeed in their bargaining efforts depend on several factors:

·Switching Costs: Notable emotional switching costs include the turmoil caused by uprooting a trusted medical provider relationship.

·Integration Level: The practitioner must decide early on whether or not he will horizontally integrate as a solo practitioner, or vertically integrate into a bigger medical healthcare complex.

·Product Importance: Increasingly, HMOs do not often strive to delight their clients and may be responsible for the beginning backlash these entities are starting to experience. Additionally, some medical specialties have more perceived value than others (i.e., neurosurgery v. dermatology)

· Concentration:  Insurance companies, not patients, represent buyers that can account for a large portion of practice revenue, thereby bringing about certain concessions.  A danger sign is noted when any particular entity encompasses more than 15-25% of a practice’s revenues.

Threat of new entrants: Some authorities argue that medical schools produce more graduates than needed, inducing a supply side shock. Others suggest that there too many patients? Regardless, this often can be mitigated by practicing in rural or remote locations, away from managed care entities, or in areas with under-served populations.

Current or existing competition: Heightened inter-professional competition has increased the intensity and volume of certain medical services and referrals may be correspondingly with-held.  Rivalry occurs because a competitor acts to improve his standing within the marketplace or to protect its position by reacting to moves made by other specialists.

Substitutions: Examples include: PAs for DOs, nurse practitioners for MDs, technicians for physical therapists, hygienists for dentists, cast technicians for orthopedists, nurse midwives for obstetricians, foot care extenders for podiatrists and even, hospital sanitation workers for medical and surgical care technicians.  Any strategy to ameliorate these conditions will augment the successful business practice plan. 

MORE: Healthcare Market.Tensions 2,0 MARCINKO

MORE: Strategic Management Improvement

Enter the Chief Marketing Officer [CMO]

A Chief Marketing Officer or marketing director is a corporate executive responsible for marketing activities in an organization.  The CMO leads brand management, marketing communications, market research, product management, distribution channel management, pricing, often times sales, and customer service, etc.

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DEM at Drexel

Invite Dr. Marcinko

Academic Metaphor?

Now, with all the competition today at the college and university level; notwithstanding the recent Hollywood Elite University acceptance debacle, can you see how these basic ideas might also be helpful in the academic and educational strategic marketing ecosystem?



The Emerging Role of University CHIEF STRATEGY OFFICER

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 The changing role of a college / university Chief Marketing Office [narrow focus] –versus–  Chief Strategy Officer [broader entity focus].

Assessment

A good way to accomplish and codify the above marketing plan concept is through a SWOT analysis. Mention the Strengths, Weaknesses, Opportunities and Threats of your specialty specific practice and what you plan do to maximize the positive, and minimize the negative aspects of the analysis.

Conclusion

Only after the above forces have been considered, should you begin the process that many physicians mistake for crafting their marketing efforts; executing the actual marketing plan. 

If you are not going to the right audience, making the correct statements or delivering your message through the proper advertising channels, you might as well put your medical practice marketing plan into the trash can because it will not secure you funds, or benefit your practice. 

Do you have a marketing plan, and more importantly, how well do you execute it? 

More info: http://www.springerpub.com/prod.aspx?prod_id=23759

Speaker: If you need a moderator or a speaker for an upcoming event, Dr. David Edward Marcinko; MBA is available for speaking engagements. Contact him at: MarcinkoAdvisors@msn.com

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

Product DetailsProduct Details

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PODCAST: Hospitals Post Laboratory Test Prices on EMRs

By Eric Bricker MD

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BUSINESS START-UPS: Innovative Disruption is Going Down!

GOOD-BYE VENTURE CAPITAL

By Staff Reporters

SPONSOR: http://www.MARCINKOASSOCIATES.com

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DEFINITION: Venture capital (VC) is a form of private equity and a type of financing that investors provide to start-up companies and small businesses that are believed to have long term growth potential. Venture capital generally comes from well-off investors, investment banks, and any other financial institutions. Venture capital doesn’t always have to be money. In fact, it often comes as technical or managerial expertise. VC is typically allocated to small companies with exceptional growth potential or to those that grow quickly and appear poised to continue to expand.

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

DEFINITION: Disruptive innovation is a business that creates a new market or value network, or enters at the bottom of an existing market and eventually displaces established market-leading firms, products, and alliances. The term, “disruptive innovation” was popularized by the American academic Clayton Christensen and his collaborators beginning in 1995, but the concept had been previously described in Richard N. Foster‘s book “Innovation: The Attacker’s Advantage” and in the paper Strategic Responses to Technological Threats.

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

Start-Ups and industry disruptors: Here are just a few of the recent collapses, as per the New York Times:

  • WeWork, which raised over $11 billion as a private startup, went bankrupt earlier this fall.
  • Hopin, the virtual events startup that rode a Covid Virus wave to a $7.6 billion valuation, sold its primary business units for $15 million.
  • The e-scooter company Bird, which became the fastest startup ever to land a $1 billion valuation, was de-listed from the NYSE and is now worth $7 million.
  • We [Don’t] Work: https://medicalexecutivepost.com/2023/11/07/wework-officially-bankrupt/

Overall, more than 3,200 private venture-capital backed US startups that have collectively raised $27.2 billion have gone out of business this year, according to the New York Times and PitchBook. So, why are the disruptors doing down?

MORE: https://www.cnbc.com/2021/05/25/these-are-the-2021-cnbc-disruptor-50-companies.html

Well, the Federal Reserve raised interest rates to a 22-year high. The cost of capital has become far more expensive, and investments that are less risky have gotten more attractive. This year has been particularly bad.

It’s a sad and instantaneous end to the golden Venture Capital years fueled by low interest rates and the growth of the mobile interne. Investment in US startups jumped by 8x between 2012 and 2022 to $344 billion dollars.

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New C-Suite Title Innovations

Who’s Reaching the C-suite in 2020?

A new analysis by LinkedIn’s Economic Graph team shows the fastest-growing “chief” titles of this year.

Chief diversity officer tops the list: Hiring for the title has grown about 84% as a proportion of total C-suite hires this year, relative to 2019’s share. While that’s the fastest expansion of any C-suite job this year, the title itself is still relatively uncommon in corporate America, accounting for less than half of 1% of all C-suite hires.

Chief growth officers — which often combine oversight of marketing, strategy and other functions — have also been in high demand. The title has been popular for a long time among consumer products companies, but it’s now popping up more often at tech companies.

Others on the list include chief underwriting officer (+43%) and chief revenue officer (+29%), as well as roles focused on people and talent. Regardless of the specialty, there’s widespread agreement that when a specific domain becomes important enough to win a spot in the C-suite, that’s a powerful signal about a company’s overall priorities.

The Emerging Role of Chief Diversity Officer [CDO] 2.0

dem-2

By Dr. David Edward Marcinko MBA MEd

http://www.CertifiedMedicalPlanner.org

My history

I came of age on the mean inner city streets of Baltimore, Maryland and developed a special interest in diversity, inclusion and urban renewal at a young age.

Today, I resonate with the identity of human capital educational leadership; small classes or teams; engaged students and stakeholders; parents and teachers; research and development; and a motivated staff inculcating life-long learning initiatives and critical thinking skills.

Career

Yet, I am not a career opportunist seeking incremental advancement through the halls of academia. Rather, I am a culturally sensitive and bi-racial physician-executive who senses there are deep, but often untapped, human resources embedded within many universities. If true; they are best released by an externally recruited champion of diversity and inclusion.

A Chief Diversity Officer [CDO]; if you will.

This includes a respect for values that celebrate the unique attributes, characteristics and perspectives that make each person who they are; ethnicity; gender; gender identity; language differences; nationality; parental status; physical, mental and developmental abilities; race; religion; sexual orientation; skin color; socio-economic status; work and behavioral styles; the perspectives of each individual DNA shaped by their nation, experiences and culture—and more.

Even when people appear the same on the outside, they are different.

Importantly, such inclusion includes a strategy to leverage diversity.

  • Diversity always exists in social systems.
  • Inclusion, on the other hand, must be created.

In order to leverage diversity, an environment must be created where people feel supported, listened to and able to do their personal best; for example:

The BAKKE DECISION

Historically, and for me, an important ruling on affirmative action by the Supreme Court in 1978 was the BAKKE Case. Allan Bakke, a white man, was denied admission to a medical school that had admitted black candidates with weaker academic credentials. Bakke contended that he was a victim of racial discrimination. The Court ruled Bakke had been illegally denied admission to the medical school, but also that medical schools were entitled to consider race as an admission factor.

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My story

As Department Chair and Residency Director at a local hospital, I was credited with accepting the first women residents and African Americans into our post-graduate education and surgical training program.

So, at this level of blended pedagogy, andragogy and heutagogy, my mission is to be a modern guide on the side; not bombastic sage on the stage. Moreover, this CDO 2.0 position holds special gravitas in order to set the tone for the future growth of inclusion and diversity thru example; in words and deeds.

Assessment

Frankly, I don’t see the CDO role as a mere “job”. It is a calling that requires a “hands-on” ambassador — helping to advise and lead in all related matters. As the sage once opined:

There is no limit to what you can accomplish if you don’t care who gets the credit!

Conclusion

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

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

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

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

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COMPETITION: Apple, MSFT & Google

Chat-Bots

By Staff Reporters

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Microsoft just unseated Apple yesterday as the world’s most valuable publicly traded company…and then gave the throne right back. The AI-fueled stock rally that Microsoft has enjoyed for months finally buoyed the software company’s market capitalization to $2.9 trillion Thursday-Firday morning, briefly edging past Apple’s $2.89 trillion. Apple had been the most valuable company in the world for a year and a half, and on-and-off for more than a decade.

Apple was back on top by midday, but Microsoft’s momentary reign—the fourth time it’s briefly overtaken Apple since 2018—indicates that the tables may be turning between these longtime rivals.

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Employees in its streaming divisions, Google cut about a thousand roles across its Assistant and core engineering teams, The Verge reported. The company is also reportedly removing 17 “underutilized” features from its voice-activated Google Assistant software, which launched in 2016 to compete with Apple’s Siri and Amazon’s Alexa. Google announced last year that it would integrate its generative AI chatbot, Bard, into Assistant.

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WALGREENS: Quarterly Dividend Cuts

By Staff Reporters

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Walgreens doled out some tough medicine to its investors this week when it cut its quarterly dividend to shareholders nearly in half, in a move to conserve cash and strengthen its long-term financial position, according to CEO Tim Wentworth.

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Illinois-based Walgreens Boots Alliance Inc (WBA), which operates one of the largest US drugstore chains, on Thursday declared a quarterly dividend of 25 cents per share, a reduction from 48 cents per share the previous quarter. The dividend will be payable on March 12th.

The move will allow Walgreens to increase cash flow and free up capital “to invest in sustainable growth initiatives in our pharmacy and healthcare businesses, which we believe will ultimately improve shareholder value,” Wentworth said in a statement.

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DAILY UPDATE: Canadian Drugs, ACA and the Mixed Stock Markets

By Staff Reporters

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SPONSOR: http://www.MarcinkoAssociates.com

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States that have long pushed the FDA to allow drug importation from Canada touted the move as a major step forward in their efforts to lower prescription drug spending and rein in healthcare costs. But while the idea of importing drugs from Canada is new for states, some businesses have been using existing drug import pathways to help consumers save money on certain high-cost medications.

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More than 20 million US residents—a record number, according to the Biden administration—have signed up for health insurance through the Affordable Care Act’s marketplaces. (the New York Times)

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Here’s where the major benchmarks ended:

Stocks were a mixed bag yesterday as investors pored over the first big earnings reports and new data showing that wholesale prices surprisingly went down in December. Airlines took a hit after Delta beat earning expectations but lowered its profit forecast.

  • The S&P 500 index rose 3.59 points (0.1%) to 4,783.83, up 1.8% for the week; the Dow Jones Industrial Average® (DJI) fell 118.04 points (0.3%) to 37,592.98, up 0.3% for the week; the NASDAQ Composite rose 2.57 points to 14,972.76, up 3.1% for the week.
  • The 10-year Treasury note yield (TNX) fell about 3 basis points to 3.943%.
  • The CBOE® Volatility Index (VIX) rose 0.26 to 12.70.

Retailers and consumer discretionary shares were among the market’s weakest performers Friday, and regional banks were also under pressure. The KBW Regional Banking Index (KRX) fell 2% for the week and ended at a one-month low. Energy shares led gainers behind strength in crude oil futures. The small-cap-focused Russell 2000® Index (RUT) ended little-changed for the week but is still down 3.8% so far this year.

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BANKS: JPMorgan Chase, BoA, Wells Fargo and CitiGroup Report

By Staff Reporters

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JPMorgan Chase’s profit fell in the fourth quarter as the lender set aside nearly $3 billion to help refill a government deposit insurance fund. JPMorgan and several major banks are required to pay a bulk of the $16 billion to replenish the Federal Deposit Insurance Corporation’s deposit insurance fund (DIF), which was drained after Silicon Valley Bank and Signature Bank failed last year.

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Bank of America’s fourth-quarter profit shrank as the lender took $3.7 billion in combined charges to refill a government deposit insurance fund and phase out a loan index. Its net interest income (NII) – the difference between what banks earn from loans and pay to depositors – fell 5% to $13.9 billion as the company spent more to keep customer deposits and demand for loans stayed subdued amid high interest rates.

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Wells Fargo press release (NYSE:WFC): Q4 Non-GAAP EPS of $1.29 beats by $0.20. Revenue of $20.48B (+2.2% Y/Y) beats by $100M. Shares -1% PM. Fourth quarter 2023 results included: ◦ $(1.9) billion, or ($0.40) per share, of expense from an FDIC special assessment ◦ $(969) million, or ($0.20) per share, of severance expense for planned actions ◦ $621 million or $0.17 per share, of discrete tax benefits related to the resolution of prior period tax matters ◦ Provision for credit losses in fourth quarter 2023 included an increase in the allowance for credit losses driven by credit card and commercial real estate loans, partially offset by a lower allowance for auto loans. The change in allowance for credit losses also included higher net loan charge-offs for commercial real estate office and credit card loans

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Citigroup (C) is in the middle of a complicated restructuring. It made it clear Wednesday that its fourth quarter earnings report Friday will be complicated, too.

The giant New York-based bank said in a regulatory document it will take more than $3 billion in one-time reserves and expenses as part of those fourth quarter results. They include everything from a $1.3 billion reserve build for currency exposure in Argentina and Russia to $780 million in charges related to severance costs and other aspects of a wide-ranging restructuring of the bank led by CEO Jane Fraser.

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SAMPLE: New Physician Letter of Employment Contract

BY DR. DAVID E. MARCINKO MBA CMP®

CMP logo

SPONSOR: http://www.CertifiedMedicalPlanner.org

SAMPLE NEW PHYSICIAN LETTER OF EMPLOYMENT INTENT

Dear Dr. [Name of Physician]

On behalf of [Name of medical practice or clinic] (hereinafter called the “practice”), this letter sets out a proposed agreement for your initial employment in Dr. [Name of physician]’s medical practice. After both you and Dr. [Name of physician] have agreed upon all issues related to your employment, a formal physician employment agreement will be prepared for your review and signature.

1.   Term: You will be an employee of the practice for an initial [Duration]-month period starting [Month, Date, Year]. Should you and the practice want to proceed past this initial employment period, an offer of co-ownership may be made to you as described in item nine below.

      Your employment with the practice will essentially be “at will,” since you or the practice may voluntarily terminate it at any time upon 30 days’ written notice to the other. However, the following are conditions under which the practice may terminate your em­ployment immediately: (a) upon your death or disability for three (3) consecutive months; (b) upon the suspension, revocation, or cancellation of your right to practice medicine in the State of [State]; (c) if you should lose privileges at any hospital at which the practice regularly maintains admission privileges; (d) should you fail or refuse to follow reasonable policies and directives es­tablished by the practice; (e) should you commit an act amounting to gross negligence or willful misconduct to the detriment of the practice or its patients; (f) if you are convicted of a crime involving moral turpitude, including fraud, theft, or embezzlement; and (g) if you breach any of the terms of your employment contract.

2.   Compensation: Your salary for the initial 12-month period will be $[dollar value] and $[dollar value] in the second 12-month period, each year payable in monthly installments. You will also be enti­tled to an incentive bonus calculated as follows: [Percentage] % of your collected production when such collections exceeds $[dollar value] in the first year and $[dollar value] in the second year. The bonus each year will be calculated and paid on a semiannual basis. You will also be entitled to receive a one-time signing bonus of $[dollar value] if you sign your employment contract before [Month, Date, Year].

      A portion of your compensation may be paid for by proceeds received from [Name of hospital] under the terms and conditions of a hospital recruitment agreement. The parties to this agreement will be the hospital and the practice only. However, forgiveness of any advances made by the hospital will be directly contingent upon the length of time you remain with the practice. Therefore, should your employment terminate for any reason, the practice will re­quire you to repay to it any amounts the practice repays the hospi­tal, in no matter what form, per the terms and conditions in the hospital recruitment agreement. [Note: Use this if the practice signs a hospital recruitment agreement with the hospital.]

3.   Benefits: In addition to your base compensation and incentive bo­nus, the practice will pay for the following: (a) health insurance, (b) malpractice insurance, (c) continuing medical education (CME) costs, (d) medical license fee, (e) board certification exam fee, (f) reasonable cellular phone costs, and (g) a pager. You will also be entitled to a moving cost allowance for relocating to [Location.] You will be entitled to two weeks of paid vacation, 10 working days as paid sick leave, and four days paid time off for CME or the board certification exam.

4.   Disability Leave: In case of absence because of your illness or injury, your base salary will continue for a period not exceeding 30 days per calendar year, plus any unused vacation time and sick leave. You will be entitled to any incentive bonus payments that may be due to you as collections are received on your prior production. Absence in excess of 30 days would be without pay. Unused sick leave cannot be carried over to succeeding years, nor will it be paid for at any time.

5.   Exclusive Employment: As an employee, you will be involved full-time in the practice and you may not take any outside employ­ment during the term of your employment agreement without the practice’s written approval. However, you will be entitled to keep compensation from honorariums, royalties, and copyrights if ap­proved by the practice in writing. If the practice does not give approval, then the income from such activities shall remain the property of the practice.

6.   Termination Compensation:  Should your employment terminate for any reason, you will be entitled to accrued but unpaid base compensation, earned but unpaid incentive bonus, and unused va­cation leave.

7.   Non-Solicitation: During the course of your employment, the prac­tice will introduce and make available to you its contacts and refer­ring physician relationships, ongoing patient flow, general hospital sources, business and professional relationships, and the like. Since you have not been in private practice in the area previously, you acknowledge that you currently have no established patients following you. If there should be a termination, the practice will not restrict your ability to practice medicine in the area; however, it will require you to enter into a nonsolicitation agreement in which you agree not to solicit the employees of the practice nor its patients to follow you into your new medical practice. [Note: Insert Covenant Not to Compete here, if applicable.]

8.   Employee-Only Status: During the term of your employment, you will not be required to contribute any money toward the practice’s equipment or operations, but likewise your work will give you no financial interest in the assets of the practice. However, the prac­tice intends to offer you the opportunity to buy into the ownership of the practice as set forth in item 9 below.

9.   Ownership Opportunity: At the end of your employment period, the practice will evaluate your relationship and may offer you the opportunity to become a co-owner in the practice (or enter into an office-sharing relationship). This offer is not mandatory and is at the total discretion of the practice. Should an offer not be tendered for some reason, the practice will wait until the end of your next 12-month employment period to decide whether to tender an offer of co-ownership.        If an offer of co-ownership is made, Dr. [Name of physician] will discuss with you the following: (a) what percentage of the practice you will be allowed to acquire, (b) how best to value such interest, and (c) how you will pay for the acquisition of such interest. The practice hopes to achieve mutually agreeable solutions to these ownership issues.

We hope this offer meets with your approval. If so, please contact Dr. [Name of physician] as soon as possible. This letter is not intended to be a legally binding agreement; it is, rather, a tool to be used to prepare your formal physician employment agreement. If you should have any questions, please do not hesitate to contact myself or Dr. [Name of physician] at your convenience.

Sincerely,

Atlantic Physicians Group

MEDICAL GROUP PRACTICE, LLC

Lantana FLA

ASSESSMENT: Your thoughts are appreciated.

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

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

INVITE DR. MARCINKO: https://medicalexecutivepost.com/dr-david-marcinkos-

THANK YOU

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Inflation Up a Bit While the SEC Approves Spot Bitcoin ETFs

By Staff Reporters

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Inflation climbed from 3.1% to 3.4% in December, a sign the Federal Reserve will continue to have to wrestle consumer price growth down to its desired 2% level. Forecasts had been for a reading of 3.2%.

On a monthly basis, inflation hit 0.3%, while core inflation, which strips away the more volatile costs of food and energy, was 3.9%, down from 4% in November but ahead of forecasts for a reading of 3.8%.

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The Securities and Exchange Commission (SEC) officially approved spot bitcoin ETFs yesterday for the first time. The 11 exchange-traded funds will let old-school investors and bitcoin enthusiasts alike access the world’s biggest cryptocurrency without having to keep a long password for a crypto wallet.

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

The long-awaited win for the beleaguered crypto industry came after a false start on Tuesday, when someone hacked the agency’s X account that…didn’t have two-factor authentication enabled…and spuriously said the ETFs had been approved.

Crypto investors have been asking for spot bitcoin ETFs since roughly 2013, but the SEC has historically grimaced at the idea of inviting such a volatile asset into the financial system, concerned that a bitcoin ETF could be easily manipulated. Trading could begin as early as today.

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DAILY UPDATE: Stock Markets Rocket Upward

By Staff Reporters

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SPONSOR: http://www.MarcinkoAssociates.com

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Investors are a day away from an inflation report that may offer some direction in a young year that has seen markets meander, with a brief sell-off and a partial rally back. More action may come as Wall Street banks kick off earnings season on Friday.

Here is where the major benchmarks ended:

  • The S&P 500 index rose 26.95 points (0.6%) to 4,783.45, a two-year closing high; the Dow Jones Industrial Average® (DJI) increased 170.57 points (0.5%) to 37,695.73; the NASDAQ Composite gained 111.94 points (0.8%) to 14,969.65.
  • The 10-year Treasury note yield (TNX) added about 2 basis points to 4.04%.
  • The CBOE® Volatility Index (VIX) fell 0.06 to 12.70.

Among market sectors, the S&P 500 Communication Services Index (SP500#50), which includes “mega-cap” tech companies like Google parent Alphabet (GOOGL) and Facebook parent Meta Platforms (META), gained 1.2% and ended near a two-year high. Consumer discretionary shares were also firm. Energy stocks were one of the weakest performers behind a 1.3% drop in crude oil futures.

Peterson noted strength in tech shares may in part reflect news from this week’s Consumer Electronics Show in Las Vegas, with escalating bullishness surrounding artificial intelligence (AI) driving further gains in Nvidia (NVDA) and other chip companies capable of serving the most advanced forms of AI. Nvidia has jumped more than 10% so far this week and posted a record high for the third straight day.

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DOWN: Digital Health Care Funding

By Dr. David Edward Marciniko MBA CMP

SPONSOR: http://www.MarcinkoAssociates.com

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DEFINITION: According to the Food and Drug Administration [FDA], the broad scope of digital health includes categories such as mobile health (mHealth), health information technology (IT), wearable devices, tele-health and tele-medicine, and personalized medicine. From mobile medical apps and software that support the clinical decisions doctors make every day to artificial intelligence and machine learning, digital technology has been driving a revolution in health care. Digital health tools have the vast potential to improve our ability to accurately diagnose and treat disease and to enhance the delivery of health care for the individual. Digital health technologies use computing platforms, connectivity, software, and sensors for health care and related uses. These technologies span a wide range of uses, from applications in general wellness to applications as a medical device. They include technologies intended for use as a medical product, in a medical product, as companion diagnostics, or as an adjunct to other medical products (devices, drugs, and biologics). They may also be used to develop or study medical products.

Cite: http://tinyurl.com/2jbafuc7

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As many investors predicted, digital health funding took a dive in 2023, according to Rock Health’s year-end funding report. Startups got creative to stay afloat but many digital health founders will have to “face the music” in 2024, the VC firm’s analysts say.

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Editor’s Note: I am on the Advisory Board of Medblob™a start-up based in Boston, MA. The digital mission of Medblob™ is to improve community and national health by allowing patients to better manage their health, providers to better treat their patients, and researchers to have the best information to discover cures to the most prevalent and pernicious diseases.

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HACKED: The SEC’s X Account

By Staff Reporters

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SEC stands for the U.S. Securities and Exchange Commission which is an ...

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Everyone is waiting for the SEC’s decision, expected today, about whether it will allow spot bitcoin ETFs that would make buying the cryptocurrency easier and more accessible. But it seems someone wasn’t willing to wait it out!

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

After the SEC’s account posted to X yesterday that the ETFs had been approved, Chair Gary Gensler said on his own account that there had been no approval and the agency’s account was “compromised.” The false post briefly caused a spike in bitcoin prices.

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PRIVATE HOSPITAL EQUITY: Adverse Events Rise?

By Staff Reporters

DEFINITION: Adverse events are medical errors that healthcare facilities could and should have avoided. The National Quality Forum (NQF) defines these errors, which are also called serious reportable events. There are 29 adverse events listed as reportable errors. The events may result in patient death or serious disability. The department manages aggregate data on adverse events and posts quarterly reports on this website.

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

NEVER EVENTS: https://medicalexecutivepost.com/2007/12/20/new-never-events-policy/

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A hospital’s acquisition by a private equity firm is linked to a rise in adverse events despite the pool of lower-risk patients they tend to admit, according to a Medicare Part A claims analysis just published in the Journal of the American Medical Association [JAMA], and according to Dave Muoio of Fierce Healthcare.

JAMA: https://jamanetwork.com/journals/jama/article-abstract/2813379

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DAILY UPDATE: Stocks Rocket Back for Highest 2024 Close as Key Inflation Updates Loom

By Staff Reporters

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SPONSOR: http://www.MarcinkoAssociates.com

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Here is where the major benchmarks ended:

Bond yields and stock prices often move inversely to each other, in part because higher interest rates on virtually risk-free bonds lower the premium investors can expect from riskier assets like stocks, making it less appealing to buy equities. Last week, the 10-year Treasury yield briefly increased to 4.10%, near a three-week high, before dropping back near 4% Monday.

  • The S&P 500 index was up 66.30 points (1.4%) at 4,763.54; the Dow Jones Industrial Average was up 216.90 points (0.6%) at 37,683.01; the NASDAQ Composite was up 319.70 points (2.2%) at 14,843.77.
  • The 10-year Treasury note yield (TNX) was down about 3 basis points at 4.015%.
  • The CBOE® Volatility Index (VIX) was down 0.28 at 13.07.

Semiconductors shares were among the strongest performers, helped by a surge of 6.4% in Nvdia Corp. (NVDA), the top 2023 performer in the S&P 500 with a gain of 239%. Small-cap stocks were also firm as were consumer discretionary and communication services. The Russell 2000® Index (RUT) gained 1.9% to partly climb back from last week’s 3.7% drop.

Energy shares were soft because crude oil futures sank nearly 4% following reports Saudi Arabia lowered its prices.

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PODCAST: Impact of Education on Employee Health Care

HEALTH INSURANCE DEMOGRAPHICS

By Eric Bricker MD

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DAILY UPDATE: Crypto-Currency, ETFs and the Stock Markets

By Staff Reporters

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SPONSOR: http://www.MarcinkoAssociates.com

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The Markets as of 10:00am ET. Here’s what these numbers mean.
Markets: One week into 2024, stocks and bonds are off to their worst start in 21 years as investors maybe got a bit ahead of their skis in anticipating Fed rate cuts.

This week, Wall Street will be focused on fresh inflation data and the beginning of Q4 earnings season.

                        

Bitcoin ETF cleared for launch? The first spot bitcoin ETF—could be approved by regulators this week in what would be a watershed moment for Wall Street’s embrace of digital tokens. The hype around these proposed funds, which would allow regular investors to gain exposure to bitcoin without buying it directly, drove bitcoin’s price up 162% over the past year.

Here is where the major benchmarks ended:

  • The S&P 500 Index was up 84.15 points (1.9%) at 4,495.70; the Dow Jones Industrial Average (DJI) was up 489.83 points (1.4%) at 34,827.70; the NASDAQ Composite (COMP) was up 326.64 points (2.4%) at 14,094.38.
  • The 10-year Treasury note yield (TNX) was down about 18 basis points at 4.453%.
  • CBOE’s Volatility Index (VIX) was down 0.60 at 14.16.

The small-cap focused Russell 2000 Index (RUT), which has lagged large-cap benchmarks for most of the year, jumped more than 5% Tuesday. Small-caps are often seen as being more exposed to the economic cycle and had suffered because of concerns that high interest rates could push the economy into recession.

Other interest rate-sensitive sectors, such as real estate, materials, and utilities, also saw outsize gains.

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DAILY UPDATE: “Medical Properties Trust” Tanks, FDA Approves Canadian Drugs and Medicare Advantage Health Plan [Part C] Patient Traps

By Staff Reporters

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SPONSOR: http://www.MarcinkoAssociates.com

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Markets: Stocks climbed a bit on Friday as investors took in the news that the US added more jobs than expected in December, capping off an epic 2023 for the labor market. But it wasn’t a bright start to the year, as all three major averages broke a nine-week winning streak. Stock spotlight: The country’s largest hospital landlord, Medical Properties Trust, tanked after revealing that its biggest tenant was $50 million behind on rent.

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Yesterday, the Food and Drug Administration (FDA) approved Florida’s request to import bargain medications from the country. It’s the first state to get permission from the agency to bring in medications from Canada under a law Congress passed 20 years ago to help Americans pay less for drugs. Florida officials say ordering cheaper drugs for conditions like HIV and diabetes from Canadian wholesalers will save Medicaid and other state programs $150 million over the first year.

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Older Americans say they feel trapped in Medicare Advantage plans.

READ HERE: http://tinyurl.com/yck2yb8z

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IMPLICATION OF WITHDRAWALS IN A MODERATE INTEREST RATE ENVIRONMENT

  A SPECIAL ME-P REPORT

A Retrospective Review … and Implications for Modernity

[Copyright Manning & Napier Advisors, Inc.]

Dr. Jeff Coons

By Jeff Coons PhD CFA

By Dr. David Edward Marcinko MBA CMP

SPONSOR: http://www.CertifiedMedicalPlanner.org

The general trend of declining interest rates experienced over the last several decades, part of a long-term trend Manning & Napier Advisors, Inc. and others have focused on since the early 1980’s, created new challenges for managing investment portfolios with regular and significant cash withdrawals.

Historical Review

This continuing report, first prepared 25 years ago, will provide an analysis of the investment implications of withdrawals in light of the secular shift in the economic and market conditions today. This analysis and historical review aims to guide decisions as to the appropriate level of withdrawals from an account in the more current moderate interest rate environment of 2014; and estimated thru to 2023.

The Questions

Declining interest rates restrict the ability to generate income from high quality investments, so a greater proportion of a given withdrawal requirement must come from the potential price appreciation of the securities.  Of course, the inherently volatile nature of the financial markets makes price appreciation the less predictable of the sources of total return available to fund withdrawal needs.

The natural questions that arise from this observation include:

  • What withdrawal rate inhibits the ability to pursue long-term capital growth as a primary investment objective?
  • What withdrawal rate may create a significant risk of a sustained deterioration of capital?
  • What is a reasonable range of withdrawal rates given the relatively low interest rate environment that we face? 

The answer to the first question can be derived from interest rates and dividend yields.  With a dividend yield of 1.0%-2.0% on stocks (e.g., the yield on the S&P 500 Index as of December 2000 was 1.2%) and yields on intermediate-term and long-term fixed income securities between 5.0% and 6.0% (e.g., as of December 2000, a one-year Treasury Bill had a yield of 5.4% and a thirty-year Treasury bond had a yield of 5.5%), growth-oriented portfolios should generally produce a level of income adequate to allow 2.5%-3.5% withdrawals on an annual basis.

Thus, rates of withdrawal of less than 3.5% generally should not inhibit the pursuit of long-term capital growth as a primary investment objective.

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Portfolio analysis

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Management Approach

To establish the high end of the achievable withdrawals under a management approach pursuing long-term capital growth, consider some historical evidence.

Assume that withdrawals are taken from each of three portfolios (i.e., 100% stocks, 80% stocks/20% bonds, and 50% stocks/50% bonds using data from Ibbotson Associates, Inc.) starting at the beginning of 1973.  How many years did it take to regain the original capital of the portfolio?

As can be seen in the following table, it took between 4-8 years for these portfolios to recover from the 1973-74 bear market with a 5.0% withdrawal rate.  If withdrawals are at a 7.5% rate per year, over ten years elapsed before the original capital was restored.

Finally, with a 10.0% withdrawal rate, it took between 13-15 years to restore the capital.  While the 1973-74 bear market was severe, it is not the worst bear market that can be used to illustrate the risk of significant withdrawals taken when the portfolio’s market value is depressed.

The clear conclusion is that withdrawals of greater than 5.0% are a potential impediment to pursuing long-term capital growth, given the long periods required to restore capital for the various growth-oriented asset mixes offered in this analysis.

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When Was Original (12/72) Capital Restored?
  1. 0% W/D
 

  1. 5% W/D
 

  1. 0% W/D
 100% Stock  9/80(7.75 years) 6/83(10.5 years) 6/86(14.5 years)
80% Stock/ 20% Bond  9/80(7.75 years) 3/83(10.25 years) 6/86(14.5 years)
50% Stock/ 50% Bond  12/76(4.0 years) 3/83(10.25 years) 3/87(15.25 years)

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Another key issue to remember is that the withdrawal rates above are a percentage of current market value, so the dollar value of the cash withdrawn from the account is assumed to decline in a bear market.  However, most of us think of our withdrawal needs in terms of dollars instead of percentages (e.g., $50,000 from a $1,000,000 account, which translates to 5%).

If we attempt to maintain the dollar value of withdrawals in bear market periods, the percentage of current market value being withdrawn actually increases, and the impact on the portfolio far exceeds the example provided above.

SAMPLE:

To demonstrate, consider maintaining withdrawals of $50,000, $75,000 and $100,000 on an account with a $1,000,000 market value as of 12/72 (see table below).

In the case of a $50,000 annual withdrawal, approximately 8-10 years elapse before the original $1,000,000 market value is restored.  If the withdrawals are $75,000 per year, 13 years elapse for the 50/50 asset mix and almost 19 years pass for the 80/20 asset mix before the $1,000,000 is restored.  For the 100% stock portfolio, nearly 25 years elapse before the original $1,000,000 is restored.

Finally, for $100,000 withdrawals off of a $1,000,000 market value in 1972, all capital in the account is depleted within 10-15 years given these withdrawals.  Thus, the risk of significant cash withdrawals having a detrimental impact on the ability to preserve and grow capital is much more pronounced when withdrawals remain high in dollar terms.

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When Was Original Capital ($1,000,000 in 12/72) Restored?
$50,000 W/D  $75,000 W/D  $100,000 W/D
 100% Stock  3/83(10.25 years) 9/97(24.75 years) Capital Depleted9/83
80% Stock/ 20% Bond  12/80(8.0 years) 9/91(18.75 years) Capital Depleted3/85
50% Stock/ 50% Bond  9/80(7.75 years) 3/86(13.25 years) Capital Depleted9/87

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So far, the major point we have established is that a withdrawal rate of 2.5%-3.5% may be achievable without hampering the pursuit of long-term capital growth, but withdrawals of 5% or greater may have a significant impact on the ability to manage for growth.  Therefore, accounts expected to experience withdrawals of 4%-5% (or greater) should be managed with a goal of satisfying these withdrawal needs on a regular basis first, with the pursuit of capital growth taking secondary importance.

However, the analysis provided above also implies that there is a rate of withdrawals that forces us to focus on capital preservation, because depletion of capital is a likely outcome.  For withdrawals in the range of 10.0%, the example above shows that the risk of depletion of capital is significant at these high annual levels, especially if the withdrawals are on a dollar basis and not adjusted by the decline of current market value in a bear market.

In fact, with long-term U.S. government bond yields at approximately 5.0%-6.0%, annual withdrawals greater than 7.5% are likely to be too high to allow a manager to effectively pursue long-term capital growth without a high degree of risk to the capital of the account.  That is, since attempts to provide returns above the current Treasury yields imply risk of volatility, and volatility can lead to the examples provided above, withdrawals at 7.5% or more and maintained on a dollar basis imply a high likelihood that original capital will be depleted over a 15-20 year period.

In general, the current level of yields in the market imply that management of a portfolio requiring over 7.5% per year in withdrawals faces a strong possibility of depleting capital under any scenario, and so portfolio management should focus on dampening market volatility so as to extend the life of the capital for as long as possible as it is drawn down.

Final Questions

The final question[s] (i.e., the appropriate level of withdrawals) is driven by both the client’s need for the assets and the parameters outlined above:

  1. Withdrawals less than 3.5% of current market value should not inhibit the pursuit of long-term capital growth as a primary objective.
  2. Withdrawal rates between 3.6% and 7.4% require a primary focus on satisfying withdrawal needs over the market cycle, possibly with a secondary goal of long-term capital growth to protect future withdrawal needs.
  3. Withdrawal rates greater than 7.5% are likely to result in a depletion of capital, so the goal should be to manage the drawdown of capital by dampening year-to-year volatility of the portfolio.

While we all would like to achieve capital growth, the ability to pursue growth-oriented strategies depends on the flexibility to moderate withdrawals, if required by market conditions, and on the overall reliance on these assets.

As another example, an endowment can control its withdrawals to some extent, but there is a level beyond which the belt cannot be tightened without harming the services being funded.

Yet another example comes from a physician-executive or someone living primarily on an IRA account, especially after becoming accustomed to the high (and falling) interest rate/high asset return environment of the last fifteen years.  Aggressively pursuing capital growth in the face of large withdrawals may result in exposure to significant risk of depletion of the IRA assets when other sources of income are unavailable.

If, on the other hand, the IRA was a small part of the wealth available in retirement, then there is some flexibility to work towards long-term capital growth.

Financial Planning MDs 2015

Implications for defined benefit retirement plans

A defined benefit retirement plan may have an outside source of funding to help restore capital (i.e., contributions from the employer), but defined contribution and Taft-Hartley plans have much less of a safety net.  As a result, the risk taken to pursue growth in the face of significant withdrawals must take into account the nature of the assets and the problems associated with a deterioration of capital in the account.

Assessment

And so, withdrawals can have a significant impact on the ability of a manager to preserve capital and pursue long-term capital growth.  However, while lessening the level of withdrawals will help provide flexibility for the manager to pursue these goals, the need for the assets may require that withdrawals are maintained at a certain level.  Once withdrawals are minimized, the manager should focus on investment goals that correspond with this minimum level.

If withdrawals are below 3% of current market value, pursuit of long-term capital growth can be a primary objective.  Withdrawals between 4% and 7.5% of market value on an annual basis require a focus on working towards satisfying these annual needs.  Long-term capital growth, in this case, should be a secondary goal.

Finally, if withdrawals are above a 7.5% annual rate, then the investment management approach should focus on preserving capital and dampening market volatility so as to work towards allowing the assets to last as long as possible as they are drawn down.

NOTE: The 10-year Treasury rate’s just fell below 3.91% after Fed, ECB nominees; today.

Conclusion

This historical review paper provides a retrospective review of IRs and implications for modernity.

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: Walgreens’s Dividend Dives as Stocks Post Down Week

By Staff Reporters

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DEFINITION: A stock dividend is a payment to shareholders that consists of additional shares rather than cash. The distributions are paid in fractions per existing share. For example, if a company issues a stock dividend of 5%, it will pay 0.05 shares for every share owned by a shareholder. The owner of 100 shares would get five additional shares.

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Stat: 3.9%. That’s Walgreens’s new dividend yield after the pharmacy chain cut its quarterly dividend of 7.0%. The company said that it was using the money to “strengthen [its] long-term balance sheet and cash position.” Walgreens stock fell 11% the day after the announcement. (CNBC)

Here is where the major benchmarks ended:

  • The S&P 500 index was up 8.56 points (0.2%) at 4,697.24, down 1.6% for the week; the Dow Jones Industrial Average® (DJI) was up 25.77 points (0.1%) at 37,466.11, down 0.6% for the week; the NASDAQ Composite® (COMP) was up 13.77 points (0.1%) at 14,524.07, down 3.2% for the week.
  • The 10-year Treasury note yield (TNX) was up about 6 basis points at 4.051%.
  • The CBOE® Volatility Index (VIX) was down 0.77 at 13.36.

Consumer staples and real estate ranked among the market’s weakest performers Friday, and technology shares remained under pressure with tech bellwether Apple (AAPL) extending this week’s nearly-6% slide and ending near a two-month low. Financial shares were one of the stronger sectors with the Philadelphia KBW Bank Index (BKX) rising 1.6% to a 10-month high. Small-cap stocks remained in the red with the Russell 2000® Index (RUT) ending the week down 3.7%. 

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DAILY UPDATE: Second Apple Downgrade with Mixed Markets as Investors Await Payroll Data and Lilly Sells Medications Directly to Patients

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Here’s where the major benchmarks ended:

  • The S&P 500® index (SPX) was down 16.13 points (0.3%) at 4,688.68; the Dow Jones Industrial Average® (DJI) was up 10.15 points at 37,440.34; the NASDAQ Composite was down 81.91 points (0.6%) at 14,510.30.
  • The 10-year Treasury note yield (TNX) was up about 9 basis points at 3.997%.
  • The CBOE® Volatility Index (VIX) was up 0.08 at 14.12.

Oilfield services and consumer discretionary shares were also among the market’s weakest performers Thursday. Banking and health care were among the strongest sectors, illustrating renewed investor interest in stocks that lagged the broader market last year.

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And, Eli Lilly is poised to sell medicine directly to consumers — with an emphasis on newly popular weight-loss drugs — in a move toward cutting out the controversial middle players in drug distribution.

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DAILY UPDATE: Technology Stocks Tank on Perihelion Day

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Today the Earth is the closest it can get to the sun, a point in orbit known as perihelion, which happens every year two weeks after the December solstice.

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Here’s where the major benchmarks ended:

  • The S&P 500® index (SPX) was down 38.02 points (0.8%) at 4,704.81; the Dow Jones Industrial Average® (DJI) was down 284.85 points (0.8%) at 37,430.19; the NASDAQ Composite was down 173.73 points (1.2%) at 14,592.21.
  • The 10-year Treasury note yield (TNX) was down about 3 basis points at 3.91%.
  • The CBOE® Volatility Index (VIX) was up 0.84 at 14.04.

In addition to tech shares, retailers and banks were also among the market’s weakest performers Wednesday. Small-cap stocks were also under pressure with the Russell 2000® Index (RUT) down about 2.7% to a three-week low. Energy shares strengthened behind a jump of nearly 4% in crude oil futures.

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PODCAST: Hospital Cost to Charge Ratios Explained

By Eric Bricker MD

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DAILY UPDATE: Apple and the “Magnificent 7” Stocks Drop with the Markets

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Driving much of the tech slump was a 4% drop by Apple’s stock, a dive precipitated by an analyst downgrade questioning why the $2.9 trillion (market capitalization) company is trading at such an expensive valuation considering its negative earnings and profit growth.

Other members of the “magnificent seven” tech stocks, which gained a collective $5.1 trillion in market cap last year, also flailed Tuesday. Alphabet, Amazon, Meta, Microsoft, Nvidia and Meta each fell 1.6% or more, while Tesla was the sole magnificent seven member in the green, as its shares slipped less than 1% after reporting more fourth-quarter electric vehicle deliveries than fore-casted.

Here is where the major benchmarks ended:

  • The S&P 500 index was down 27.00 points (0.6%) at 4,742.83; the Dow Jones Industrial Average® (DJI) was up 25.50 points (0.1%) at 37,715.04; the NASDAQ Composite was down 245.41 points (1.6%) at 14,765.94.
  • The 10-year Treasury note yield (TNX) was up about 7 basis points at 3.931%.
  • The CBOE® Volatility Index (VIX) was up 0.73 at 13.18.

Semiconductor companies led the way lower Tuesday after Bloomberg reported Netherlands-based ASML Holding NV (ASML) canceled shipments of some of its machines to China at the request of U.S. President Biden’s administration weeks before export bans on the high-end chipmaking equipment came into effect. The Philadelphia Semiconductor Index (SOX) tumbled 3.7%. Health care and energy sectors were among the few areas of strength, the latter gaining despite a 1.6% drop in crude oil futures.

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PODCAST: Why Hospitals Cry “Poor”

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DAILY UPDATE: ChristianaCare Settles FCA Lawsuit as Stock Markets Celebrate 2023 but Start Off Rocky in 2024

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ChristianaCare agreed to pay $47.1 million to resolve illegal kickback allegations flagged by its former chief compliance officer.

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Markets: The stock market was closed yesterday to give investors time to celebrate New Year’s Day 2024. As the just passed old year, 2023, provided plenty of reasons to pop bottles and celebrate:

For example, global stock markets had their best year since 2019, and all three major US indexes finished the year higher than they started it, with tech company gains pushing the NASDAQ up the most. Even among tech giants, Nvidia was a standout, boosted by A.I. suddenly being everywhere.

But, all major markets are down as of this posting time, today.

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HELPING DOCTORS ACHIEVE: New Year Resolutions

COACHING AND MENTORING

Physician Goal Setting [Business V. Personal Approach] in 2024

By Marcinko Associates, Inc.

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CORPORATE APPROACH

The year-end physician, nurse and/or medical employee reviews in general aren’t very effective at motivating employees in ACOs, and VBC organizations, etc.

And, according to a Gallup [non-medical worker] poll, only 14% of employees “strongly agreed” that a performance review inspired them to improve. But in recent years, some workplaces have changed how they conduct performance reviews—or abandoned them altogether especially in technology.

  • A decade ago, Microsoft disbanded its version of stack ranking, the practice pioneered by General Electric CEO Jack Welch in the 1980s in which the company would rank every employee. Experts say it hurts morale and can create a toxic work culture.
  • Netflix has around 10,000 employees but has eschewed the year-end review for informal conversations during the year.
  • Google revamped its system last May by reducing performance reviews from twice to once a year.
  • Apple dropped performance reviews completely.

Healthcare business and corporate employees want feedback, even physicians, but it has to be useful.

PERSONAL APPROACH

Now that you’ve set your personal goals on your landmark date (New Year 2024), how you pursue it will go a long way toward whether you achieve it. There are generally two ways to tackle the goals you’ve set for yourself—and one yields more success than the other.

  • Avoidance goals: While this works well when it comes to your ex-medical partner or spouse, it’s not how you want to attack resolutions. Avoidance goals include “stop eating sweets” or “watch less TV.”
  • Approach goals: Instead of avoiding a behavior, you create a new one. Your goals would be “eating more vegetables” or “reading more books” to replace the habits you want to shake.

And, a recent study found that approach goals are more likely to be accomplished (59%) than avoidance goals (47%) across a wide range of potential resolutions. Good luck with that!

WE CAN HELP.

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HAPPY NEW YEAR: From All of Us at the ME-P

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 From us all to you and yours.
Here’s to making a difference and paying it forward today, in 2024, and beyond. 

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DAILY UPDATE: S&P 500 is High as McKinsey Settles Opioid Claims

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The S&P 500 has climbed about 24% in 2023, hovering right around its all-time high. And, the NASDAQ Composite is up 44%, although the tech-heavy index still has some ground to cover before it starts carving out new all-time highs of its own.

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Consulting firm McKinsey and Co. has agreed to pay $78 million to settle claims from insurers and health care funds that its work with drug companies helped fuel an opioid addiction crisis. The agreement was revealed late Friday in documents filed in federal court in San Francisco. The settlement must still be approved by a judge.

Under the agreement, McKinsey would establish a fund to reimburse insurers, private benefit plans and others for some or all of their prescription opioid costs. The insurers argued that McKinsey worked with Purdue Pharma – the maker of OxyContin – to create and employ aggressive marketing and sales tactics to overcome doctors’ reservations about the highly addictive drugs. Insurers said that forced them to pay for prescription opioids rather than safer, non-addictive and lower-cost drugs, including over-the-counter pain medication. They also had to pay for the opioid addiction treatment that followed.

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