BOARD CERTIFICATION EXAM STUDY GUIDES Lower Extremity Trauma
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Posted on November 8, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
“BIRTHING-FRIENDLY”
By Staff Reporters
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The Centers for Medicare and Medicaid Services (CMS) added a new designation to identify which hospitals are “Birthing-Friendly”—a label it will begin adding to qualifying hospitals in fall 2023.
The designation aims to reduce maternal mortality and complications in the US; maternal mortality rose by 25% in 2020, and Black women die at nearly three times the rates of white women, according to a CDC report from February. The US ranked last in maternal mortality that year compared to 10 other high-income countries, according to the Commonwealth Fund.
To earn the designation, CMS said, hospitals must participate in a statewide or national collaborative program where medical teams and public health leaders work together to improve care quality for birthing parents and babies. Hospitals that opt in qualify for an operating payment rate increase of 4.3%, a much-needed boost for hospitals struggling with profitability in the wake of the Covid-19 pandemic and inflation.
But there’s no single set of metrics that hospitals will be required to follow to earn CMS’s new designation, and any changes they make may depend on what areas need improvement. For example, hospitals could focus on reducing pregnancy complications and early births, which happen before 39 weeks, according to the CDC.
CMS’s designation—at least in its initial form—isn’t tied to outcomes. However, medical professionals said there are a variety of measures and outcomes that have been shown to make a hospital truly birthing-friendly.
When it comes to measuring maternal-care quality, one metric comes up over and over again: a hospital’s C-section rate, said Holly Loudon, chair of obstetrics, gynecology, and reproductive science at Mount Sinai West and Mount Sinai Morningside in New York City.
Posted on November 7, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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Meta will reportedly begin to lay off thousands of employees this week in what could amount to the company’s most significant job cuts since it was founded in 2004.
Apple said that iPhone 14 production has been hamstrung by Covid restrictions at its huge assembly plant in China.
PreCheck deflation: TSA is lowering the price for its PreCheck program ahead of the holiday travel season.
Mastodon, a Twitter-esque social media site, has seen a spike in users since Musk’s takeover of the bird app.
Posted on November 7, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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Last week was a rough one in the stock market, and this week could be even worse. The inflation report Thursday, and another group of earnings will give investors plenty of new information to absorb. Finally, Warren Buffett reported his company’s earnings over the weekend as Berkshire’s $109 billion cash pile has ballooned thanks to rising interest rates.
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Cathie Wood is once again offloading shares in her long-time favorite Nvidia Corp., as a slight rebound emerged ahead of the company’s earnings. Her flagship Ark Innovation ETF sold 167,914 shares on Friday, adding to a sale of 50,252 shares on Oct. 20, according to Wood’s firm Ark Investment Management LLC’s daily trading disclosures.
Meanwhile, the Ark Next Generation Internet ETF sold 24,423 Nvidia shares on Thursday. Ark’s latest sales come days ahead of Nvidia’s third-quarter earnings — scheduled for Nov. 17 — similar to the prior quarter when the funds dumped the stock before the chipmaker reported revenue forecast that was about $1 billion short of the average Wall Street estimate. The stock has rebounded 26% from a more than two-year low on Oct. 14 to $141.46. That’s above the average closing price of $131.74 in September, when ETFs controlled by ARK Investment Management LLC picked up more than 400,000 Nvidia shares throughout the month.
Still, Nvidia is down more than 50% this year as historical tightening by the Federal Reserve and global recession fears have continued to batter growth stocks.
Posted on November 6, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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What Is Tax-Loss Harvesting?
Tax-loss harvesting is the timely selling of securities at a loss in order to offset the amount of capital gains tax due on the sale of other securities at a profit.
This strategy is most often used to limit the amount of taxes due on short-term capital gains, which are generally taxed at a higher rate than long-term capital gains. However, the method may also offset long-term capital gains. This strategy can help preserve the value of the investor’s portfolio while reducing the cost of capital gains taxes.
There is a $3,000 limit on the amount of capital gains losses that a federal taxpayer can deduct in a single tax year. However, Internal Revenue Service (IRS) rules allow additional losses to be carried forward into the following tax years.
4 Key Points
Tax-loss harvesting is a strategy investors can use to reduce the total amount of capital gains taxes due from the sale of profitable investments.
The strategy involves selling an asset or security at a net loss.
The investor can then use the proceeds to purchase a similar asset or security, maintaining the portfolio’s overall balance.
The investor must be careful not to violate the IRS rule against buying a “substantially identical” investment within 30 days.
Posted on November 6, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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Markets: Stocks closed their otherwise terrible week on a high note following another solid jobs report for October. The US economy added 261,000 jobs last month, more than expected, though the unemployment rate ticked up to 3.7%. The Fed wants to see the labor market loosen up before it’s willing to slow down its rate hikes.
Stock spotlight: Carvana, the online used car retailer that surged during the pandemic, suffered its worst day ever and closed near its all-time low. Carvana’s plunge of more than 95% this year makes it a prime example of Covid darlings that were caught flat-footed when the macroeconomic environment deteriorated and pandemic trends (like huge demand for used cars) snapped back to normal.
DraftKings stock had its worst day on record, down nearly 28%, after revealing a longer-than-expected path to profitability.
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Is China going to loosen its Covid policies? Investors pounced on rumors this week that Beijing was thinking about relaxing its draconian Covid precautions, sending Hong Kong’s Hang Seng Index to its best week in a decade. Separately, Reuters obtained a recording of a former Chinese disease control official telling a conference that China would be making big changes to its “dynamic-zero” Covid policy.
Posted on November 6, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
By Health Capital Consultants, LLC
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The American Hospital Association (AHA) is advocating for the creation of a new hospital designation for certain urban safety net hospitals.
In a report released in mid-October 2022, as well as in an accompanying fact sheet and letter sent to congressional leaders, the AHA defines these so-called Metropolitan Anchor Hospitals (MAHs), outlines their importance to the communities they serve, and explains why MAHs deserve supplemental financial support from the government.
Electronic Classes can require intense interaction between live faculty members and adult-learners, often more so than in many traditional on-ground courses; and most automated Computer Based Training (CBT) programs.
Students [adult learners] are typically expected to log-in and contribute three to five times each week. With this frequency of interaction, students and faculty all get to know one another, well. There are few opportunities for passivity.
In fact, in the iMBA CERTIFIED MEDICAL PLANNER™ program, students tend to interact with instructors much more than in traditional settings; thus promoting future peer-based discussions and real world applications.
Moreover, in the electronic iMBA classroom, everyone must write; particularly for the R&D loaded CERTIFIED MEDICAL PLANNER™ program. All assignments are typed, creating a permanent record of each person’s contribution. Faculty members find this promotes careful, reflective submissions from most students.
Additionally, instructors can easily monitor student progress and communicate with those who need help, or who have trouble keeping up. This is usually done privately by e-mail, fax or phone after certain online expectations have been clarified.
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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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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Posted on November 5, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
The clocks change at 2 a.m. to create the least disruption for early workers.
By Staff Reporters
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People who don’t have a digital clock that changes automatically will often switch their watches on Saturday night before bed. This year, Daylight Saving Time began on March 13, 2022, and ends on November 6, 2022.
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When you wake up tomorrow morning, you’ll be well rested and smacked with a pocketful of sunshine: In 48 states and DC, daylight saving time is ending overnight Sunday, which means a 25-hour day tomorrow and, going forward, darker evenings and sun-splashed mornings. And, when our clocks change every six months, it inevitably sparks debate about why we participate in this curious tradition in the first place, and whether we should just pick one time system and stick with it.
The arguments for abolishing daylight saving time
Most experts on sleep and circadian rhythms argue that tomorrow should be the last time we ever switch our clocks. They claim that, by artificially pushing the sun to set later in the evening, daylight saving time disrupts our internal clock’s natural alignment with the sun (for example, by discouraging the production of sleep-inducing hormones like melatonin). That can lead to negative impacts on our physical and mental health. Other proponents of permanent standard time point to research that shows how adopting it would reduce crime, energy costs, and car crashes. A study published Wednesday found that brighter work commutes due to permanent standard time would save about $1.2 billion in collision costs from drivers hitting deer—and prevent 37,000 deer from being killed in the process.
Congress and Politics
This March, the Senate passed the Sunshine Protection Act, which intends to, uh, protect sunshine by making daylight saving time permanent. Senators say their constituents have been flooding their phones with requests for more daylight in the evenings—to enjoy the outdoors, yes, but also to squeeze in more time to farm.
But the US has tried that before, in 1974, and it flopped miserably. Just four months after Congress approved permanent daylight standard time, it was scrapped following public backlash.
Posted on November 5, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
The MIT Westgate Studies
By Prasad Nilanth
The “P” theory was first crafted by psychologists Leon Festinger, Stanley Schachter, and Kurt Back in what came to be called the Westgate Studies conducted at MIT.
The study investigated how friendships developed among students at the new Westgate Complex at MIT. The results clearly showed the role of proximity in the formation of friendships. The strongest friendships developed between students who lived next to each other on the same floor. Where friendships developed between students who lived on different floors, one of those students tended to live near the stairways.
In social psychology, propinquity (/prəˈpɪŋkwɪtiː/; from Latin propinquitas, “nearness”) is one of the main factors leading to interpersonal attraction. It refers to the physical or psychological proximity between people. Propinquity can mean physical proximity, a kinship between people, or a similarity in nature between things (“like-attracts-like”).
Two people living on the same floor of a building, for example, have a higher propinquity than those living on different floors, just as two people with similar political beliefs possess a higher propinquity than those whose beliefs strongly differ.
Propinquity is also one of the factors, set out by Jeremy Bentham, used to measure the amount of (utilitarian) pleasure in a method known as felicific calculus.
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
Posted on November 5, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
AFFINITY MARKETING!
Physicians and All Investors Beware!
By Staff Reporters
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Celebrity Matt Damon’s infamous “fortune favors the brave” Crypto.com commercial premiered one year ago today, and its timing couldn’t have been worse. Had you been inspired to buy $1,000 worth of bitcoin on that day (the token was then worth $60,608, near its peak price) you would have just ~$340 now.
Fortune isn’t exactly what’s favored Crypto.com in the year since the ad debuted. The price of bitcoin has plunged ~70%, the company reportedly slashed about 40% of its workforce this summer, and the YouTube version of the Damon commercial has been set to private.
Today, the coin has been pretty stable since mid-June, 2022 and hovering at around $20,000.
Posted on November 5, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reportersand BLS
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U.S. equities posted a weekly loss, despite ending the day higher in a choppy trading session, following a larger-than-expected increase in non-farm payrolls for October, 2022. The choppiness came amid an increase in the unemployment rate that was also above estimates, and in the wake of FOMC Chair Powell’s comments earlier this week, in which he reiterated the central bank’s aim at cooling the robust labor market.
Earnings surprises were mostly positive, as Amgen bested expectations and upped its guidance, Starbucks also exceeded estimates despite a tumble in sales in China, and PayPal posted upbeat results and announced a collaboration with Apple, while DoorDash rose despite posting a wider-than-expected loss.
Treasury yields were mixed, and the U.S dollar erased all of yesterday’s rally, while crude oil and gold prices surged.
Overseas, Asian stocks were higher for the most part, led by a rally in the Hong Kong markets. European stocks ended the volatile week on a positive note, as the international markets continued to digest the implications of monetary policy actions from central banks all over the world.
Posted on November 5, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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DEFINITION
Upcoding is a type of fraud where healthcare providers submit inaccurate billing codes to insurance companies in order to receive inflated reimbursements. These false “current procedural technology” (CPT) submissions indicate that doctors provided patients with treatments that were more complex, costly, and time-consuming than what they actually received. This unlawful scheme is a violation of the False Claims Act (FCA) because it defrauds federal programs including Medicare, Medicaid, and Tricare.
There are nearly 7,800 CPT codes used by healthcare providers. Collectively, these codes represent all of the procedures, conditions, and drugs that are currently reimbursable by the health insurance industry. Each one of them has an associated cost for individuals and insurance companies, based upon the urgency of the issue and the complexity of the decision-making required of the healthcare provider. Medicaid and Medicare reimburse providers based on this system. For example, a five-minute consultation with a nurse for a minor medical question would receive a different, less expensive CPT than the one for a full examination by a doctor lasting 45-minutes. However, if the physician charges the federal programs for the more expensive 45-minute examination when the five-minute consultation is what actually occurred, this would constitute upcoding.
Unbundling
Unbundling is another common form of upcoding. This fraudulent scheme involves billing for individual procedures that are usually performed and billed together under a single CPT code. In some cases, the billing codes for complicated medical operations have associated components built into their CPTs. For example, a hip replacement surgery may factor in the costs of the surgeon’s as well as the use of the operating room. Unbundling occurs when a healthcare provider submits each component within a CPT to Medicare or Medicaid separately. This creates a cost redundancy where wrongdoers can unlawfully seek reimbursement for the same procedure several times over.
Downcoding is the opposite of upcoding. If you perform a service but record the CPT for a lower-level service, that is downcoding. Downcoding also leaves you vulnerable to an audit, which is never good. But, it can also cost a practice thousands of dollars a year in lost revenue because you’re not getting the higher rate of pay that you would if you had recorded the service properly.
According to the National Correct Coding Initiative (NCCI): “Physicians must avoid downcoding. If an HCPCS/CPT code exists that describes the services performed, the physician must report this code rather than report a less comprehensive code with other codes describing the services not included in the less comprehensive code.”
The IHS provides health care in 36 states to approximately 2.2 million out of 3.7 million American Indians and Alaska Natives (AI/AN). As of April 2017, the IHS consisted of 26 hospitals, 59 health centers, and 32 health stations. Thirty-three urban Indian health projects supplement these facilities with a variety of health and referral services. Several tribes are actively involved in IHS program implementation. Many tribes also operate their own health systems independent of IHS. It also provides support to students pursuing medical education in order staff Indian health programs.
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EDITOR’S NOTE: I did a rotation at a Federally Qualified Health Center through the I.H.S. when I was a surgical fellow back in the day. I enjoyed it immensely. Consulting services since then.
Posted on November 4, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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U.S. bond yields just rose to new cycle highs as the fallout from the Federal Reserve’s latest interest rate hike and commentary reverberated across markets. The policy-sensitive 2-year rate broke intermittently above 4.7%, shrinking its spread to the 10-year rate to as little as minus 60.9 basis points in a worrisome sign of the economic outlook. The 2-year yield finished the New York session at its highest level in more than 15 years.
What’s happening
The yield on the 2-year Treasury rose 13.1 basis points to 4.699% from 4.568% on Wednesday. Thursday’s level is the highest since July 25, 2007, based on 3 p.m. figures from Dow Jones Market Data.
The yield on the 10-year Treasury advanced 6.4 basis points to 4.123% from 4.059% as of late Wednesday. Thursday’s level is the highest since Oct. 24.
The yield on the 30-year Treasury climbed 2.9 basis points to 4.151% from 4.122% Wednesday afternoon.
The lowering of the book or market value of the shares of a company’s stock as a result of more shares outstanding. A company’s initial registration may include more shares than are initially issued when the company goes public for the first time.
Later, an issue of more stock by a company (called a “primary offering,” distinguished from the “initial public offering”) dilutes the existing shares outstanding.
Also, earnings-per-share calculations are said to be “fully diluted” when all common stock equivalents (convertible securities, rights, and warrants) are included. “Fully diluted” numbers are used in analysis when there is a likelihood of conversion or exercise of rights and warrants.
Posted on November 4, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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DEFINITION: Stablecoins are cryptocurrencies where the price is designed to be pegged to a reference asset. The reference asset may be fiat money, exchange-traded commodities, or a cryptocurrency.
In fact, Stablecoins could have such a profound effect on the established banking system that U.S. regulators need to require that the digital tokens fit in without disrupting it, said Martin Gruenberg, the acting chairman of the Federal Deposit Insurance Corp. (FDIC). His remarks were delivered at a Brookings Institution event recently.
Gruenberg’s agency is among the U.S. banking watchdogs that will have significant influence over how stablecoins are regulated, and the FDIC has also had to weigh in with recent sanctions against firms – such as FTX US – that have made claims misrepresenting how FDIC deposit insurance backstops their operations. As U.S. banks have increasingly sought to offer crypto services, including maintaining custody of customer’s digital assets, Gruenberg said that his agency has been cautious about allowing regulated lenders to engage.
Posted on November 4, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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U.S. equities extended yesterday’s sharp drop that followed the Federal Reserve’s fourth-straight 75-basis point rate hike and some hawkish comments. As a result of the Fed’s monetary policy decision, Treasury yields and the U.S. dollar climbed noticeably higher. The Fed’s rate hike was trailed by today’s announcement from the Bank of England to hike its benchmark interest rate by 75 bps, though it tried to suppress expectations of future aggressiveness of that magnitude. The U.S. dollar’s rally came as the British pound fell, along with the euro, as the markets digested the monetary policy actions and comments.
Crude oil prices fell, and gold traded lower. In economic news, jobless claims dipped, the trade balance widened more than expected, Q3 productivity rebounded less than fore-casted and labor costs moderated more than projected. Additionally, factory orders figures were mixed, along with October reads on services sector output. Earnings season continues to roll on, with Qualcomm cutting its guidance, though eBay topped estimates and issued a positive outlook. Moreover, Booking Holdings topped expectations and Marriott decreased despite exceeding profit projections.
Asian stocks declined, though markets in Japan were closed for a holiday, and European stocks were mostly lower as the markets digested the decisions from the Fed and Bank of England.
Posted on November 4, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
By Health Capital Consultants, LLC
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According to the White House, “Americans pay two to three times as much as people in other countries for prescription drugs, and one in four Americans who take prescription drugs struggle to afford their medications. Nearly 3 in 10 American adults who take prescription drugs say that they have skipped doses, cut pills in half, or not filled prescriptions due to cost.” In an effort to combat this growing crisis, both the federal government and private companies have taken a number of steps over the past year aiming to lower drug prices. This Health Capital Topics article will review those actions and the potential unintended consequences of these actions.
Posted on November 3, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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CVS, Walgreens, and Walmart agree to pay $13 billion over opioids
The pharmacy chains have reached a tentative deal to settle thousands of lawsuits brought by state and local governments that accuse them of contributing to the opioid epidemic.
If the deal goes through, CVS and Walgreens will each cough up around $5 billion, and Walmart will reportedly be on the hook for $3 billion.
The rate for I bonds, an asset that’s tied to the rate of inflation, was lowered to 6.89% yesterday from its record high of 9.62%. But in the final days of the previous rate, investors hoarded I bonds like crazy.
Now, on Friday, the Treasury sold $979 million of I bonds, nearly as much as the entire amount sold in the three years from 2018 to 2020, per CNBC. The investors also crashed the website.
U.S. equities finished lower with the Dow whipsawing within a more than 900-point range following the Fed’s monetary policy decision. The Central Bank raised rates by 75 basis points for a fourth-straight meeting, but opened the door to slowing within its statement. However, in his presser following the announcement, Chairman Powell reiterated that any notion of a pause was premature.
Treasury yields were mixed and the U.S. dollar traded to the upside, while crude oil prices gained ground, and gold saw a modest loss. In economic news, mortgage applications fell for a sixth-straight week even as mortgage rates snapped a string of increases, and ADP’s private sector employment report came in above estimates ahead of Friday’s key labor report.
Earnings season continued to roll on, with Advanced Micro Devices missing earnings forecasts, and CVS Health exceeding profit projections and raising its guidance. Ford Motor Company reported October sales that showed a year-over-year decline, but EV sales grew.
Asia finished mixed with mainland Chinese markets and Hong Kong continuing rallies, while Europe also diverged amid some likely trepidation ahead of the Fed decision.
Posted on November 2, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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The Federal Reserve jut raised its short-term borrowing rate another 0.75% to slow key areas of the economy and tame inflation, which is at a 40-year high. The central bank said its new target range is 3.75%-4%, the highest level since January 2008.
The aggressive move is the latest in a string of borrowing cost increases imposed by the Fed in recent months as it tries to slash price increases by cooling the economy and choking off demand. The approach, however, risks tipping the U.S. into a recession and putting millions out of work.
The fourth rate hike of 2022 also arrives less than a week before the midterm elections.
Posted on November 2, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
CMS Cracks Down on Medicare Advantage TV Marketing
Dr. David Edward Marcinko MBA
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CMS is cracking down on deceptive marketing practices and will no longer allow Medicare Advantage or Part D prescription drug plans to advertise on television without agency approval first. The new policy is effective Jan. 1st and was discussed in an Oct. 19th memo from CMS to MA and Part D providers. The agency said it issued the new policy after reviewing thousands of beneficiary complaints regarding confusing, misleading or inaccurate information from plans — plan sponsors are also responsible for all marketing activities from brokers and third-party agencies.
“CMS has conducted so-called ‘secret shopping’ by calling numbers associated with television advertisements, mailings, newspaper advertisements and internet searches to monitor the experience beneficiaries have engaging these entities,” the agency wrote.
“Our secret shopping activities have discovered that some agents were not complying with current regulation and unduly pressuring beneficiaries, as well as failing to provide accurate or enough information to assist a beneficiary in making an informed enrollment decision.”
Source: Jakob Emerson, Becker’s Payer Issues [10/27/22]
Posted on November 2, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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U.S. equities were modestly lower, as investors awaited tomorrow’s conclusion of the Federal Open Market Committee (FOMC) meeting. The Fed is widely expected to hike the target for its fed funds rate by another 75-basis points. On the economic front, the Job Openings and Labor Turnover Survey (JOLTS) posted an unexpected rebound—indicating a still-tight labor market—which seems to be enhancing monetary policy tightening concerns. Reports on manufacturing showed that activity remained in expansion territory, while construction spending unexpectedly rose month-over-month.
In equity news, pharmaceutical companies Eli Lilly and Pfizer both topped earnings estimates, while the former lowered its full-year guidance, and the latter raised its outlook.
Treasury yields were mixed, while the U.S. dollar ended little changed in choppy action. Crude oil prices gained ground, and gold was higher.
And, Asian stocks finished to the upside amid a host of mixed economic news, and after the Reserve Bank of Australia hiked rates by 25-basis points for a second-straight meeting. European markets were mostly higher in the wake of mixed manufacturing data, and ahead of today’s decision by the FOMC.
In the past two months, two retail giants – Walmart and Apple – have announced plans to enter the health insurance space. This direct entry into the health insurance market by non-traditional players has been encouraged in part by health insurer-retailer partnerships, which gained traction due to rising demand for Medicare Advantage (MA) in particular and the expansion of the types of benefits that MA plans may offer.
This Health Capital Topics article will discuss reasons behind the insurer-retailer partnerships and how Walmart and Apple plan to disrupt the health insurance market.(Read more…)
Posted on November 1, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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Prime Medicine (NASDAQ:PRME) opened up its shares for public trading for the first time since it filed for IPO in September 2022. The company agreed to initially offer 10.29 million shares to the public at $17.00 per share. On its first day of trading, the stock decreased 18.98% from its opening price of $18.97 to its closing price of $15.37.
Posted on November 1, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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GameStop Corp. is an American video game, consumer electronics, and gaming merchandise retailer. The company is headquartered in Grapevine, Texas, and is the largest video game retailer worldwide.
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Stocks dipped a bit yesterday as investors wait for the FOMC’s likely move to raise interest rates by 75 basis points again on Wednesday. But it wasn’t a total fright fest on the last day of October:
The Dow closed out its best month since 1976. Meme stocks also had another moment as GameStop shares were briefly halted after spiking early in the day. The price dropped back down later—and, as usual, no one can quite explain the unease.
Posted on November 1, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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U.S. equities ended the day in the red, failing to continue last week’s positive momentum. The moves came amid a quiet day on the economic and earnings fronts, but both are set to heat up as the week progresses.
In earnings news, Global Payments bested estimates and reaffirmed its guidance, and Emerson Electric also beat the Street, while also announcing the sale of a majority stake in its climate unit to Blackstone.
Meanwhile, a couple of reads on regional manufacturing showed activity continued to contract. Treasury yields traded higher and the U.S. dollar gained ground, continuing to rebound from a recent drop, while gold and crude oil prices were lower.
Stocks in Asia were mixed amid a slew of economic data in the region, and Europe ended higher as investors continued to digest last week’s 75 basis point rate hike by the European Central Bank.
Posted on November 1, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
THIS IS NOT A POST-HALLOWEEN TRICK!
By Staff Reporters
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Most hospitals seem to have enough blood in their inventory to meet the immediate needs of patients. That’s no small feat given that just this past January, the American Red Cross declared the “first-ever blood crisis,” indicating the country was experiencing “its worst blood shortage in over a decade” amid the omicron surge.
While blood centers and hospitals aim to have at least a five-day supply of blood—enough to treat trauma patients, surgical cases, blood disorders, and other issues—facilities nearly reached blood insolvency during the crisis. The Red Cross said it saw donor turnout dip after the delta variant became dominant in summer 2021, which continued as omicron took over, until blood supplies reached crisis levels in January.
“We went down to many blood centers having only a one-day supply on their shelf,” said Claudia Cohn, chief medical officer at the Association for the Advancement of Blood and Biotherapies (AABB), a nonprofit that develops standards for the industry and accredits blood centers. “Which means one significant event—like a big car crash or a natural disaster or a human-made disaster—could have wiped out the blood supply for that particular metropolitan area.”
Closing up shop: Covid lockdowns shuttered traditional venues for blood drives, including businesses and schools. Even after workers returned to the office and students to classrooms, many organizations were hesitant to allow in-person events to occur in their facilities, including blood drives.
Paying the price: Another dagger undermining the stability of the nation’s blood supply has been a drop in the price paid for blood. Changes in medical practice, like the introduction of minimally invasive procedures, have decreased demand for blood, and hospitals have been able to pay less for it.
Posted on October 31, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
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SOURCE: Dianna “Mick” McDougall, Sources: Home Depot, Getty Images
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Good Evening
We’re not sure anyone’s administered a Halloween costume contest for almost 1million ME-P readers, but we’re going to give it a shot.
Subscribe, Like and Comment Reply to this post with a pic of your Halloween costume (PG-13 rated or less), and we’ll choose a winner[s] to shout out in a future ME-P.
Posted on October 31, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
Versus Technical Analysis
By Staff Reporters
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In traditional finance transaction data is guarded by exchanges, brokers, banks and regulators. It’s not accessible to everyone and big players pay a fortune for it.
But, in crypto, Transaction Data is public and on-chain – but it’s not usable by everyone. So, manually making sense of raw blockchain data is practically impossible. The data needs to be processed and analyzed to be made useful. That’s what sophisticated blockchain analytics tools are doing.
The combination of on-chain data and transaction analysis is something that hasn’t been before – in crypto or traditional finance. Getting access to transaction data and tools for searching and analyzing it will unlock a goldmine of potential insight.
People who have been on the inside of projects and see how the sausage is made know that the explanations for price movements are often simple and based on key players buying and selling. When the biggest holders are dumping the price is likely to go down. When a major new buyer takes a position prices are likely to go up.
That’s insight traditional Technical Analysis cannot provide, because it’s limited to looking at price movements. Transaction data, instead, is the underlying activity that generates prices in crypto.
Posted on October 31, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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Also known as the internet bubble or the information technology bubble, the dotcom bubble was the unprecedented rise in equity valuations of internet-based tech companies during the bull market of the late 1990s.
Thanks mainly to speculation and substantial funding for these new internet start-ups, investments in dot-coms (named as such for the .com online top-level domain [TLD] used by such companies) boosted the NASDAQ Composite Index (COMP) from 751 in January 1995 to a peak of 5,048.62 on March 10, 2000. But the bubble eventually burst in March 2000, with many companies failing to even come close to fulfilling their promise. As such, the NASDAQ fell by more than 75 percent between March 2000 and October 2002, thus wiping out more than $5 trillion in market value.
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Some financial and economic analysts are beginning to compare this year’s tech rout (which has cost the NASDAQ $8 trillion in value so far) with the bursting of the dot-com bubble in 2000–2002, when the NASDAQ lost the equivalent of $8.6 trillion in today’s dollars. The industrial-focused Dow, on the other hand, is on track for its best October in history.
The FOMC is likely a lock to hike interest rates by a large75 basis points on Wednesday for the fourth straight meeting. Evidence that its inflation-fighting campaign is working could come on Friday, with the October jobs report.
Posted on October 30, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
HOW DO THEY WORK?
By Staff Reporters
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What is an I bond and how do they work?
DEFINITION: A a 30-year Treasury bond that protects you against inflation. It pays both a fixed interest rate and a rate that changes twice a year with inflation.
Interest is compounded semiannually, meaning every 6 months a new interest rate is applied to a new principal value that equals the prior principal plus the interest earned in the last 6 months. The bond’s value grows because it earns interest and because the principal value gets bigger.
You can buy $10,000 worth from the Treasury and another $5,000 using your tax refund. You can cash them in after 12 months, but if you do so in less than 5 years, you lose the last 3 months of interest.
Taxes on I Bonds?
You must pay federal income tax but no state and local taxes on I bonds. You can either report each year’s earnings or wait to report all the earnings when you cash the bond.
If you use the money for qualified higher education expenses, you may not owe tax on the earnings.
Current Interest Rates
The current the record high 9.62% interest rate on I bonds issued through October will drop Nov. 1st, 2022 to 6.48%.
Posted on October 30, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
Modernizing the $19.6B Knee Replacement Industry
By Staff Reporters
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One way to classify joints is by range of motion. Immovable joints include the sutures of the skull, the articulations between teeth and the mandible, and the joint located between the first pair of ribs and the sternum. Some joints have slight movement; an example is the distal joint between the tibia and fibula. Joints that allow a lot of motion (think of the shoulder, wrist, hip, and ankle) are located in the upper and lower limbs.
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KNEE: No bones about it
The $19.6b joint-replacement industry uses outdated methods, leading to 100,000 surgeries failing annually.Monogram aims to fix it with precision surgical robots + personalized implants.
Posted on October 29, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
SELL IN MAY – AND GO AWAY
By Staff Reporters
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Essentially, the HALLOWEEN INDICATOR is a market-timing strategy. It argues that, by buying into the stock market after Halloween and selling at the end of April, investors would generate a better annual return on their portfolio than if they had remained invested throughout the year. Sell in May and go away is an investment strategy for stocks based on a theory that the period from November to April inclusive has significantly stronger stock market growth on average than the other months
The practice of abandoning stocks beginning in May of each year is widely thought to have its origins in the United Kingdom. The privileged class would leave London and head to their country estates for the summer months, where they would largely ignore their investment portfolios. To this day, many stock market watchers have postulated that the corresponding impact of summer vacations on market liquidity and investors’ risk aversion is at least partly responsible for the difference in seasonal returns.
In what is considered to be a seminal piece of research on the subject, “The Halloween Indicator, ‘Sell in May and Go Away’: Another Puzzle,” authors Sven Bouman and Ben Jacobsen were among the first to document a strong seasonal effect in global stock markets. In 36 of the 37 developed and emerging markets they studied between 1973 and 1998, the authors found returns in the November through April period to be, on average, significantly higher than those in the May through October period, even after taking transaction costs into account. What puzzled the authors was the fact that, while the anomaly was widely known and seemed to offer considerable economic rewards, it had not been arbitraged away.
More recently, Jacobsen partnered with Cherry Zhang on a follow up study, titled, “The Halloween Indicator: Everywhere and All the Time,” and extended the research to 108 stock markets using all historical data available. The result was a sample of 55,425 monthly observations (including more than 300 years of UK data), which helped to rebut any criticisms of data mining and sample selection bias. The results were compelling, as the November through April “winter” period delivered returns that were, on average, 4.52% higher than the “summer” returns. The Halloween effect was evident in 81 out of 108 countries. The size of the Halloween effect varied across geographies. It was found to be stronger in developed and emerging markets than in frontier markets.
Posted on October 29, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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The future of healthcare will be defined by nurses. Giving them a platform where they can be seen, heard, and valued for what they contribute each and every day is healthcare innovation.
connectRN is an empowered community of nurses, helping them access the flexible work opportunities they want. Nurses use connectRN to find work, access resources, and get much-needed peer support. And healthcare facilities can get the staff they need to provide high-quality patient care.
From in-app shift scheduling to same-day pay to 24/7 support, connectRN offers nurses a modern, seamless, and stress-free experience. After all, thriving clinicians provide the best care.
U.S. Financial Planning Month is observed nationwide during October.
With the holiday season coming up (aka hefty gifting expenses) and the new year just around the corner, Financial Planning Month is a great opportunity to get your finances and budgets in order before life gets too busy.
Posted on October 28, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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NEWS FLASH!
Elon Musk, the richest person on the planet, is the CEO of the world’s most valuable automaker TESLA, heads up a $125 billion aerospace giant, and as of yesterday, is the owner of a social media company Twitter.
According to multiple reports, Musk closed the $44 billion deal last night, less than 24 hours before today’s 5pm ET deadline. He began his reign as “Chief Twit” by firing at least four executives, including CEO Parag Agrawal (who was reportedly escorted out of Twitter’s SF headquarters). Later today, Musk is expected to address anxious employees, who might be worried they’ll face the same fate as their former leader. Historically:
Musk acquired a large stake in Twitter and later signed a deal to buy all of it.
Then he tried to back out, citing bot issues, but Twitter sued him to enforce the agreement.
Musk blinked weeks ahead of a trial, and said he would buy Twitter.
Now What?
So begins Musk’s attempt to, in his words, “help humanity” by trying to turn Twitter into a “common digital town square.”
We know that Musk has ultra-ambitious goals for the company: 5x Twitter’s revenue by 2028, supercharge the subscriptions business, and turn Twitter into a super app called “X.” But murkier is the path he intends to take to get there, and he’s already sending mixed signals about his intentions. And what about doctors and the healthcare industrial complex? Will it remain the same or change?
History
Back in early 2014 the first list of the “Top 100 Twitter Accounts For Healthcare Professionals To Follow” was born. Then, the biggest social media-related question to hurdle wasn’t, “Who should I be following on social media?” but rather, “Should I even be on social media at all?”
Many years later, it’s safe to say that social media has firmly established itself in the healthcare industry. By finding healthcare Twitter accounts that are related to your specialty, you can have access to the best information and always remain within the loop.
But, with the Elon Musk takeover of Twitter, the medicine and healthcare accounts available may change, remain static or grow, and finding the most valuable medical accounts to follow has become more challenging than ever.
Today
Today, the question truly is, “Who should I be following?” Thankfully, you have been covered since 2020.
Posted on October 28, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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The New York Stock Exchange will suspend Twitter shares today as Elon Musk closes in on a takeover. Musk just bought the social media company for $44 billion after trying to walk away from the deal.
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Stocks Ended Mixed in Volatile Day Full of Reports
U.S. stocks finished mixed in a choppy trading session, as a host of earnings and economic news were released. The markets digested a second-straight 75 basis point rate hike by the European Central Bank (ECB).
Shares of Meta Platforms tumbled after missing earnings estimates and forecasting much higher-than-expected capital expenditures, while Dow members Caterpillar, McDonald’s, Honeywell, and Merck all rallied after beating earnings expectations.
The economic calendar is full as Q3 GDP growth came in stronger than expected, and weekly initial jobless claims were lower than anticipated, but durable goods orders missed forecasts. Treasury yields fell following the data, and the U.S. dollar rebounded from a recent drop amid the ECB rate hike.
Crude oil prices were higher, and gold dipped. Asia diverged as the markets remained choppy, while Europe ended higher following the ECB’s monetary policy decision and amid the flood of earnings reports.
Posted on October 28, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
“Behavioral Economic Strategies”
By Eric Bricker MD
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As Published in the Annals of Internal Medicine by an All-Star Cast of Researchers:
1) Limitations of Information 2) Inertia/Status Quo Bias 3) Choice Overload 4) Immediacy 5) Loss Aversion 6) Relative Social Ranking 7) Threshold Effect 8) Limits of Willpower 9) Mental Accounting
Posted on October 27, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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Plunging tech stocks are dragging the markets down and snapping a brief winning streak. Up next for the economy: The third-quarter GDP report.
America’s internet giants are slumping hard in this era of higher interest rates, lower advertising budgets, and widespread economic uncertainty
For example, Meta recently became the latest Big Tech company to post rough financial results for the prior quarter. It recorded its second straight quarter of declining revenue and provided a gloomy outlook for Q4. Perhaps Meta shouldn’t even be considered “Big Tech” anymore. Since its share price peaked in September 2021, the company lost nearly two-thirds of its value…before diving another ~20% in after-hours trading yesterday.
What went wrong? Younger people are fleeing Facebook, and investors aren’t confident CEO Mark Zuckerberg can reinvent the company as a metaverse platform. “Meta has drifted into the land of excess—too many people, too many ideas, too little urgency,” a prominent shareholder wrote this week in a scathing letter. Meta’s metaverse unit, Reality Labs, has lost $9.4 billion so far this year.
While Meta may be the poster child for Big Tech’s struggles, it’s not the only company that needs a checkup
Google parent Alphabet posted its slowest revenue growth since 2013 (outside of one early pandemic quarter), and YouTube ad sales actually fell in Q3. It’s “a tough time in the ad market,” CEO Sundar Pichai acknowledged. Alphabet shares had their worst day since March 2020.
And Microsoft also had its worst day since March 2020 after giving a disappointing forecast. Its push to dominate the metaverse is also faltering, per the WSJ.
Big view
Tech giants scored record profits during COVID, when interest rates were near zero, stimulus checks were flowing, and everyone was stuck inside with only the internet to entertain themselves. No anymore!
Posted on October 27, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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U.S. equities closed out a volatile session mixed as the markets digested a host of quarterly results with earnings season kicking into high gear. Information Technology and Communications Services sectors were the biggest laggards in the wake of disappointing reports from Google’s parent Alphabet, as well as Dow member Microsoft.
Meanwhile, Dow component Boeing was lower despite optimism about its free-cash flow performance, but Dow member Visa rallied following its results.
Housing data dominated the economic front today, with mortgage applications falling for a fifth-straight week, and new home sales dropping amid the spike in interest rates in September.
Treasury yields were lower and the U.S. dollar tumbled to alleviate some uneasiness in the markets, while a smaller-than-expected rate hike out of Canada appeared to also soothe some nerves.
Crude oil prices were sharply higher, and gold traded to the upside.
Asia finished higher though choppiness remained, while Europe saw widespread gains amid cautious trading ahead of tomorrow’s monetary policy decision from the European Central Bank.
Posted on October 27, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
Hospitals this year are seeing more red than black as growing financial challenges, like spiked labor costs and inflation on medical supplies, puts them on pace to have the worst financial performance into the pandemic thus far.
More than half of hospitals (53% of more than 900 sampled) are projected to have negative margins by the end of the year, compared to 39% in 2019, according to a September report from management consulting firm Kaufman Hall, on behalf of AHA. The firm put the median operating margin for hospitals at about -1%, which could mean service cuts, and for more vulnerable hospitals, including rural ones, closing their doors.
But why is the financial outlook so bleak for hospitals? A few factors are conspiring:
Labor costs: The top reasons hospitals are struggling financially in 2022 are “labor, labor, and labor,” said Kevin Holloran, senior director at Fitch Ratings. The healthcare labor shortage doesn’t just extend to nurses, but across the board.
Rising supply prices: Blame inflation. AHA reported that the “costs for energy, resins, cotton, and most metals surged in excess of 30%” between fall 2020 and early 2022.
Sicker patients, longer stays: Intensive care units across the country were overwhelmed with Covid-19 patients at the outset of the pandemic, but more recently hospitals have been caring for sicker non-Covid patients, said Aaron Wesolowski, AHA’s vice president for policy research and analytics
October is National Financial Planning Month—an ideal time to plan your financial future. The end of the year is approaching and a new one will soon begin, so this is the right time to think about what you have done in 2022 and what you could do in 2023. You might want to do something new; you may want to do some things differently.
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GREAT NEWS: But what about financial planning specificity for physicians, nurses and all medical professionals?
Fear of money: An abnormal and persistent fear of money. Sufferers experience undue anxiety even though they realize their fear is irrational. They worry that they might mismanage money or that money might live up to its reputation as “the root of all evil.” Perhaps they remember well the ill fortune that befell the mythical King Midas. His wish that everything he touched be turned to gold was fulfilled, and even his food was transformed into gold.
The fear of money is termed chrometophobia or chrematophobia, from the Greek “chrimata” (money) and “phobos” (fear). The “chrome” in “chrometophobia” may also be related to the Greek word “chroma” (color) because of the brilliant colors of ancient coins — for example, gold, silver, bronze and copper.
Posted on October 26, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
25% of Clinicians Want Out of Healthcare: Survey
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One quarter of U.S. physicians, advanced practice providers, and nurses are considering switching careers and one third are considering switching employers, according to newly released results from a survey conducted by Bain & Company. Below are some key takeaways from the survey and brief, which was released October 11th and can be found in full here.
1. Of the 25 percent of clinicians who are thinking about exiting healthcare entirely, 89 percent cite burnout as the main driver.
2. The top three things clinicians care about most in their profession are compensation, quality of patient care, and workload, according to the survey. Of those three, they are least satisfied with compensation (59 percent expressed satisfaction) and workload (60 percent). Eighty percent said they are satisfied with the quality of patient care.
3. Burnout shows up throughout clinicians’ days, with 63 percent saying they feel worn out at the end of the workday, 51 percent saying they feel they don’t have time and energy for family and friends during leisure time, and 38 percent feeling exhausted in the morning at the thought of another workday.
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