BOARD CERTIFICATION EXAM STUDY GUIDES Lower Extremity Trauma
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Posted on July 30, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
What is stop-loss insurance AND how does it work?
By Staff Reporters
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A stop-loss health insurance policy covers claims above a health insurance plan’s retained claims. The claims fund of a self-funded employer will pay claims up to the predetermined deductible for each of the company’s covered employees. The role of the stop-loss is to cover all claims above these deductible levels.
According to RoundStone Insurance, aggregate stop-loss insurance is designed to protect an employer who self-funds their employee health plan from higher-than-anticipated payouts for claims. Stop-loss insurance is similar to high-deductibleinsurance, and the employer remains responsible for claims below the deductible amount.
An individual stop-loss insurance carrier determines the average expected monthly claims per employee / per month PEPM based on the employer’s history. Then, this figure is multiplied by a percentage ranging from 110%-150%. That determined amount is then multiplied by the enrollment on a monthly basis to establish the aggregate deductible.
Posted on July 30, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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Procter & Gamble(PG) warned hat consumers were beginning to pull back on their spending as inflation concerns mount. P&G posted 7% sales growth during its most recent quarter ending June 30, its strongest growth in years. The company was able to push through higher prices on consumers. But its sales volumes declined 1% last quarter, a sign consumers were dialing back.The company forecast sales growth of between 3% and 5% for its upcoming fiscal year, down from 7% during its latest fiscal year. On a call with analysts Friday, P&G leaders said that while consumers are still buying household necessities, they are beginning to alter their purchasing behavior. For example, consumers are not stocking up their pantries as much as they were early in the pandemic, and they’re buying more private-label brands, particularly in paper goods. As shoppers are “more exposed to inflation broadly in the marketplace with the highest inflation in 40 years, it’d be naive to assume the consumer is not looking at their cash outlay,” P&G finance chief Andre Schulten told analysts. P&G’s stock fell 5% during midday trading.
The S&P 500 was up 1.3% as of 2:18 p.m. Eastern, while the NASDAQ was up 1.6%. Both indexes are on pace to end July with the biggest gains since November 2020. The Dow Jones Industrial Average was up 0.8%. Positive earnings news from Apple and Amazon, as well as oil giants Exxon and Chevron, helped put traders in a buying mood.
The average rate on the popular 30-year fixed home mortgage fell to 5.22% from 5.54%. “This is an exceptionally fast drop!” wrote Matthew Graham of Mortgage News Daily. The rate fell even further today to 5.13%. The slide in mortgage rates came after a negative GDP report and the Fed’s latest interest rate hike.
Posted on July 30, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
By Eric Bricker MD
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Google Starts Stop Loss Company Called Coefficient
Coefficient Will be a Part of the Verily Healthcare Subsidiary Within Google. Coefficient Will Also Be in Partnership and Partly Owned by the Giant, International ReinsuranceCompany Swiss Re.
Posted on July 30, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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ICYMI: After a celebrated 130-year brand history, last fall GE announced plans to create three new, publicly traded companies, building on its heritage of innovation while marking a new beginning.
And now, these planned companies have names. So meet the three ways GE plans to evolve from building a world that works to creating a future that does, too:
GE HealthCare signals continued confidence and trust from clinicians and will bring better outcomes for patients and health systems.
GE Vernova represents GE’s portfolio of energy businesses and commitment to leading the global energy transition.
GE Aerospace points to a new era of possibility in aerospace and defense for the company’s aviation business.
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Posted on July 29, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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DEFINITION: For its official definition, the NBER considers a recession a “significant decline” in economic activity. Not only that—the decline must be deep, broad, and last for more than a few months. When deciding whether the economy is in a recession, the NBER looks to a variety of indicators (not just GDP) to understand the health of the economy, such as job growth, consumer spending, and industrial production. It’s not a simple or transparent formula.
Top economists don’t believe a downturn has begun but some predict a mild recession is likely by early next year. For example, residential investment plunged last quarter as the housing market slumped amid sharply rising mortgage rates while business stockpiling and investment also declined, more than offsetting a modest advance in consumer spending. Furthermore, the nation’s gross domestic product, the value of all goods and services produced in the U.S., shrank at a seasonally adjusted annual rate of 0.9% in the April-June period, according to the Commerce Department. That followed a 1.6% drop early this year. Economists surveyed by Bloomberg had forecast a 0.5% rise in GDP.
In fact, Treasury Secretary Janet Yellen also said the US economy is seeing an economic slowdown — something vital to bringing down inflation — but isn’t currently in a recession. “We do see a significant slowdown in growth,” Yellen said at a press conference. But a true recession is a “broad-based weakening of the economy,” she said. “That is not what we’re seeing right now.” The country currently is seeing job creation, strong household finances, gains in consumer spending and growth in business, Yellen said. Employment climbed by 1.1 million jobs in the second quarter, a sharp contrast with the average loss of 240,000 in the first three months of past recessions. The Treasury chief was speaking hours after data showed the US economy shrank for a second straight quarter, as higher interest rates slowed business investment and housing demand.
ON THE OTHER HAND: Yesterday was an amazing day for the stock market — especially for growth stocks. The Fed sparked a massive rally across all asset classes. It strongly implied it’ll slow the pace of rate hikes in the coming months. And it may even turn to rate cuts by the end of the year.
QUESTION: We are in near bear market correction territory – especially for tech stocks – so what are the 2 major types of valuation approaches for common stock?
ANSWER: There are basically two different approaches for common stock valuation; top-down and bottom-up. Under either of the two fundamental approaches, a physician investor will have to work with individual company data. In reality, each of these approaches is used by investors and security analysts when doing fundamental analysis.
With the bottom-up approach, investors focus directly on a company’s prospects. Analysis of such information as the company’s products, its competitive position, and its financial status leads to an estimate of the company’s earnings potential, and, ultimately, its value in the market. Considerable time and effort are required to produce the type of detailed financial analysis needed to understand a firm’s standing. The emphasis in this approach is on finding companies with good long-term growth prospects, and making accurate earnings estimates.
The top-down approach is the opposite of the bottom-up approach. Investors begin with the economy and the overall market, considering such important factors as interest rates and inflation. They next consider likely industry prospects, or sectors of the economy that are likely to do particularly well (or particularly poorly). Finally, having decided that factors are favorable for investing, and having determined which parts of the overall economy are likely to perform well, individual companies are analyzed.
Posted on July 28, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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Markets: Stocks soared yesterday after the Fed said it was hiking interest rates by 75 basis points (its fourth rate hike this year) in order to stamp out inflation. Another rate increase could be on its way this fall, Fed Chair Jerome Powell said, depending on the economic data. Powell also rejected claims that the US was currently in a recession.
The DJIA rallied 400 points as Powell hinted the Fed could slow the pace of rate hikes, and the NASDAQ jumped 4%.
Prices for goods in the U.S. are expected to continue rising through 2023. The Federal Reserve [FOMC] waited too long to respond to early signals of inflation. The central bank is correcting the course by raising its interest rate targets at the fastest pace in more than two decades.
Meta, the company formerly known as Facebook, reported a 1 percent decline in quarterly revenue from the previous year. It was the first time the social media giant’s revenue had fallen since it went public a decade ago, as it confronts increased regulatory scrutiny and a turbulent economy while trying to build a new frontier of digital communication.
Posted on July 28, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
By Eric Bricker MD
Healthcare Stock and IPO Investing Can Be Confusing. The Story of Privia Health is a Good Case Study in Understanding the Underlying Economics in Healthcare Investing:
Posted on July 27, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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Microsoft (MSFT) – Get Microsoft Corporation Report posted weaker-than-expected fourth quarter earnings as a surging U.S. dollar blunted the impact of overseas demand for its flagship cloud computing division. Microsoft said revenues for Azure, its flagship cloud division, rose 40% from last year, slowing notably from its prior quarter gains in the mid to high 40-percent range as companies pulled back on digital infrastructure spending and the dollar continued its 2022 climb. Overall group revenues rose 12.4% to $51.87 billion for the three months ending in June, Microsoft’s fiscal fourth quarter, missing analysts’ estimates of a $52.45 billion tally and the company’s owned lowered guidance of between $51.94 billion to $54.74 billion. Microsoft’s bottom line rose 2% to $16.7 billion, as adjusted earnings rose 2.7% from last year to $2.23 per share, well shy of the the Street consensus forecast of $2.29 per share. Microsoft had forecast a range of between $2.24 and $2.32 per share in early June.
And, Google’s revenue growth during the past quarter decelerated to its slowest pace in two years as advertisers reined in their spending amid intensifying fears of an economic recession. The regression reported by Google’s corporate parent, Alphabet, is the latest sign that the tailwinds propelling big technology companies during the pandemic have shifted. The array of new challenges facing the industry has already caused the tech-driven NASDAQ composite index to plummet by 26% so far this year. In Alphabet’s case, revenue during the April-June period totaled $69.7 billion, a 13% increase from the same time last year.
On the other hand, Texas Instruments Inc., the maker of chips used in everything from washing machines to satellites, gave a bullish forecast for the current period, countering concern that a slowing economy is hurting demand for electronics. Third-quarter revenue will be $4.9 billion to $5.3 billion. That compares with the $4.94 billion average estimate from analysts. Profit will be as much as $2.51 a share, the company said, ahead of projections.That helped lift the shares 2.6% in extended trading Tuesday and gave a boost to other chip makers, such as Qualcomm Inc.
The Mega Millions will hold a drawing tonight for a jackpot of $810 million. If won at that amount, it’d be the fourth-largest lottery prize in history.
Let’s get this out of the way first: You won’t win the jackpot. You just…won’t. The odds of winning are about 1-in-302 million, which means you’re far more likely to die from a meteorite strike or go to the ER because of a pogo stick injury than win the Mega Millions.
But let’s say you do win (because someone has to). Once you regain consciousness after fainting, you’ll be faced with a decision: Take the lump sum all at once, or spread the payout over decades in what’s called an “annuity.”
Here’s how each would work.
Lump sum: You’ll receive a payment of $470.1 million, after the 24% federal tax withholding takes a ~$113 million bite out of your total winnings. Plus, the 37% top marginal tax rate means you’ll fork over more of your prize to Uncle Sam come tax season.
Annuity: You’ll receive an immediate payment followed by 29 annual installments over the next 30 years, with each cash infusion increasing by 5% to account for inflation.
So which should you take?
Most people who win the lottery choose the lump sum, and it’s not hard to see why: You can make more money. Thanks to the magic of compound interest, you can invest your lottery winnings right away, and even with a conservative rate of return, make far more over 30 years than you can with the smaller droplets of cash provided by the annuity.
That said, the lump sum may not be for everyone. Are you the type of person who invested in dogecoin right before Elon Musk hosted SNL? If so, the annuity could offer some self-imposed fiscal discipline to prevent you from blowing all your winnings—which definitely happens. The internet is littered with stories of lottery winners who squandered their fortune, or otherwise watched their lives fall apart after thinking they had made it. One small study in Florida found that lottery winners were more likely to declare bankruptcy in three to five years than the average American.
Bottom line: You’re not going to win the Mega Millions (because we are), so consider this a lighthearted economics thought experiment and nothing more.
Posted on July 26, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
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By Staff Reporters
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The $7.25 federal minimum wage is now 13 years old after last being raised in July 2009. The value of the minimum wage has fallen by 40% since the 1960s. And, $7.25 in July 2009 would be worth around $10 now after adjusting for inflation.
In the next jobs report, Turn predicted that the unemployment rate will fall to a seasonal low of 3.5% due to a 64.7% increase in hiring in June, a trend that could continue through July. Turn predicted a significant shift away from filling hourly, pandemic-related jobs, such as warehouse positions, after hiring for traditional economic roles likes retail workers and janitorial services surged 210% in June. Turn also predicted a rise in hiring for semi-skilled hourly and salaried jobs in July such as mechanics and nurses. While hiring for these positions accounted for just 11.5% of monthly jobs over the past 12 months, Turn predicted that these jobs will make up 22% of all new hires in July.
AT&T Inc. and Verizon Communications Inc. shocked investors with their second-quarter results last week — the former warning about the high cost of phone giveaways and the latter failing to meet growth targets. The news sparked a sell-off that erased some $40 billion in market value from the three industry leaders. Now T-Mobile US Inc. is cast as the potential Goldilocks in this drama — if its second-quarter results are just right. T-Mobile reports financial results tomorrow before markets open. Investors will be eager to see if the wireless industry is starting to see a slowdown in consumer spending due to decade-high inflation, or if some of the troubles might be more self inflicted.
Posted on July 26, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
By Dr. Keith L. Gurnick, DPM
[Los Angeles, CA via PM Online]
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Paid spokespersons consisting exclusively of older celebrities, including William Shatner, George Forman, Joe Namath, and Jimmie “J.J.” Walker read similar, if not exact, scripts in an attempt to induce the elderly to phone and check their “zip code” to see if they are eligible. I can’t figure out what the zip code has to do with anything, but maybe someone can help me to understand this fish hook?
As of November 2021, 42% of all Medicare eligible patients are enrolled in Medicare Advantage plans. Does the viewing public not wonder why there is never any mention at all during these commercials that changing to a Medicare Advantage plan means switching their traditional Medicare over to an HMO, and that most likely they will lose their network of doctors and possibly hospitals as well?
Posted on July 25, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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An important week of the summer” for Wall Street, thanks to a deluge of earnings, economic data, and Fed action. For example:
Fed meeting: After the Fed wraps up its meeting on Wednesday, it’s expected to announce another interest rate hike to tame inflation. Central bank officials have signaled that they’ll boost rates by 75 basis points, the same as last month’s increase. That was the biggest rate hike in almost three decades.
Earnings: More than a third of S&P 500 companies will report this week, including tech behemoths Microsoft, Apple, Meta, Amazon, and Alphabet.
Economic growth: Q2 GDP will be released on Thursday, and it could show that the US economy shrunk for two straight quarters.
Finally, former Treasury Secretary Lawrence Summers said Federal Reserve [FMOC] officials need to stay the course to quell inflation that’s proving persistent at a four-decade high. “We do need strong action from our central bank,” he said on CNN’s “Fareed Zakaria GPS”. While Summers said he’s “encouraged” by the Fed’s commitment to bring down inflation, he cast doubt on the likelihood of a soft landing for the US economy, saying it’s “very unlikely.”
Posted on July 24, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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The World Health Organization declared the outbreak of monkeypox to be a public health emergency of international concern. “The global monkeypox outbreak represents a public health emergency of international concern,” WHO Director-General Dr. Tedros Adhanom Ghebreyesus said during a briefing in Geneva. At the virtual press conference, Ghebreyesus also said that the outbreak has spread around the world “rapidly” and that officials understand “too little” about the disease.
And, the U.S. Dollar had an incredible run throughout 2022, appreciating against most major currencies as the world’s central banks continue to combat rising inflation. This year alone, the dollar is up 15% against the Japanese yen, 10% against the British pound, and 5% compared to China’s Renminbi. The Wall Street Journal’s Dollar Index, which measures the dollar against 16 other major currencies, has also had its best first half performance since 2010 this year, rising more than 10% year-to-date. And for the lucky Americans who could find cheap airfare to Europe (and made it through with all their luggage), the dollar even reached equal standing with the euro for the first time in two decades earlier this month.
Posted on July 24, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
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By Neal Freyman [Morning Brew]
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Amazon turned and coughed up $3.9 billion to buy One Medical, a primary care provider, in its biggest push yet into health care. It may not be long until your Prime membership comes with a complimentary physical.
What’s One Medical? A company that operates more than 180 medical offices across 25 US markets, offering both in-person and virtual medical services. When it went public as a unicorn in January 2020, it followed a similar trajectory of other high-flying startups: A huge spike when telehealth was in feverish demand, then an equally huge crash to fall well below its IPO price.
The deal for One Medical represents Andy Jassy’s first major acquisition as CEO of Amazon, showing that he’s willing to make bets on growth in certain areas even as he reins in costs in others.
So why is health care a priority?
As you know all too well from every time you pay a medical bill, health care is a massive industry. With a market size of $4 trillion, it accounts for about 20% of the entire US economy. And as Amazon looks to grow outside of its core areas, it sees potential in sending a digital shock wave through a medical industry that’s entangled in a complex web of insurance companies and government regulations.
Not that it’s even clear what a “core” area of Amazon is anymore. Besides its e-commerce marketplace, Amazon has tentacles in cloud services, grocery stores, entertainment, and many other sectors. Basically, we’re about to live in a world where one company owns the James Bond franchise…and also medical clinics.
But Amazon’s infatuation with health care isn’t new. It acquired the online pharmacy PillPack in 2018, and launched its own on-demand health care services one year later. Some projects, like its buzzy joint venture with Berkshire Hathaway and JPMorgan, collapsed, illustrating the challenges for anyone—even Bezos and Buffett—to break into the medical realm.
Those stumbles won’t stop Amazon, or Big Tech in general, from trying. Just this week, Apple released a 60-page report outlining why health care will be a major focus for the company going forward.—NF
Posted on July 23, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
The Top 10 [Ten] Disruptive Digital Business Models For Health Insurers
By Zhang Jie
Digital technologies will transform the health insurance business. Early adopters have started to implement new digital business models with initial success. A new report describes ten digital business models for health insurers that will disrupt the industry.
Advances in higher-quality digital technology—especially apps, sensors, and artificial intelligence (AI)—along with their proliferation among members have spurred the emergence of new business models.
The new report “The 10 Disruptive Digital Business Models for Health Insurers” published by Research2Guidance describes how start-ups, health insurance and general payer organizations have started using these technologies to venture into new forms of health insurance offerings and increasingly step into the healthcare provider role.
New digital models change the way the insurers interact with patients. For example, digital insurers have reworked the trust equation with the patient, outsourced much of their value chain to their members, and now know much more about them. Digital business models tend to also blur the lines between payer and care giver organizations. Some of the first-movers already crossed the line and started to offer services which have previously been provided exclusively by doctors and nurses. The ten digital business models are defined as follows:
Digitally assisted member acquisition is a freemium business model concept.
Mobile health concierge is a business approach designed for members to complete all health insurance tasks using mobile phones with the support from a concierge team.
Peer-to-peer (P2P) insurance refers to a risk-sharing community.
Mobile micro-insurance refers to the health insurance plans that cover short-term small health events or minimal ongoing health insurance.
Health insurers tech platforms license their technology for the management of health plans and members to their customers.
On-demand insurance is a usage-based model that enables members to access desired health plans upon request with the help of a mobile app.
High-risk patient preventive care model concentrates on insuring and managing potentially costly patient groups.
The payer & provider collaboration model stands for a closer, digitally enabled partnership between payers and care providers, especially hospitals.
The API health insurance model uses a list of pre-defined health insurance products accessible to websites and app providers via an application programming interface (API).
Direct primary care model. Within this model, a care provider or a hospital act like a health insurance company using a monthly subscription model.
First implementations of these models indicate the positive impact that they have on the company evaluation, the ability to attract new members, the cost structure, and new revenue streams. Currently, the main impact of digital business models is on company evaluation, which reflects the hype that some companies have created in the investor community. Companies like Oscar, Clover Health, and Bright Health are valued at over $1 billion USD each after only a few years of operation.
Health insurers and start-ups from the USA and China are the most aggressive in adopting new digital business models. Companies from other regions tend to choose a follower approach or implement copycats.
ASSESSMENT
The report also profiles first-mover digital implementations. Profiles include their target groups, operating models, service offerings, and early evidence for success where available.
Conclusion
Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.
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Posted on July 23, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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The stock markets fell after new data showing U.S. manufacturing activity stalled and the service sector’s pandemic recovery has gone into reverse as a result of high inflation and mounting interest rate hikes, feeding concerns that the Federal Reserve’s efforts to cool decades-high price increases may force the economy into a recession. The Dow Jones Industrial Average fell 138 points, or 0.4%, to close at 31,899, while the S&P 500 fell 0.9% and the tech-heavy NASDAQ 1.9%; for the week, the indexes ended up 2%, 2.5% and 3%, respectively.
US social-media companies also saw more than $130 billion wiped off their stock-market values after disappointing revenue from Snap Inc. and a lackluster report from Twitter Inc. raised new concerns about the outlook for online advertising. The Snapchat parent plummeted 39%, sinking to its lowest level since March 2020. Meanwhile, Facebook parent Meta Platforms Inc. fell 7.6%, Pinterest Inc dropped more than 13%, and Google owner Alphabet Inc. declined 5.6% in its biggest one-day drop since March 2020. Twitter also reported quarterly results on Friday, though Wall Street remains focused on the company’s legal battle with Tesla CEO Elon Musk, who is attempting to withdraw from a deal to buy the company. The stock rose 0.8% on the day.
Posted on July 22, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
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By Staff Reporters
President Biden tested positive for the coronavirus, raising health concerns for the 79-year-old president and underscoring how the virus remains a persistent, if muted, threat in a country trying to put the pandemic in the past.
U.S. Indices
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Senator Elizabeth Warren along with 22 more Democratic lawmakers are pushing the IRS to create its own free tax filing service. The bill also aims to allow eligible taxpayers to choose a “return-free option,” providing a pre-populated filing. “The average American spends 13 hours and $240 every year to file their taxes — that’s too much time and too much money,” Warren said in a press release. But some tax professionals say it’s not a realistic plan for the overburdened agency.
A case of polio has been identified in an un-vaccinated adult in Rockland County, according to a news release from the New York State Department of Health. The agency confirmed that the infection was transmitted from someone who received the oral polio vaccine, which has not been administered in the United States since 2000. Officials believe the virus may have originated outside the United States, where the oral vaccine is still administered.
he New York Times opinion columnist Paul Krugman published a mea culpa in column form flat out admitting he was wrong for thinking inflation wouldn’t be that bad. In his piece, titled, “I Was Wrong About Inflation,” the economics professor noted that he was on “Team Relaxed” when it came to fears of inflation and acknowledged that was a “very bad call.” Krugman began by recounting the “intense debate among economists about the likely consequences of the American Rescue Plan, the $1.9 trillion package enacted by a new Democratic president and a (barely) Democratic Congress.” He mentioned how he originally didn’t see the massive government spending bill as that dangerous for the economy. “Some warned that the package would be dangerously inflationary; others were fairly relaxed. I was Team Relaxed. As it turned out, of course, that was a very bad call,” he confessed.
Posted on July 21, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
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Cigna, do you even have a clue that dentists don’t like you?
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By Darrell K. Pruitt DDS
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Hi Dr. Pruitt,
I’m truly sorry for any negative experience you’ve encountered with us. Is there a claim, benefit, or authorization concern I can help with? Please email me at LetUsHelpU@cigna.com. I’d like an opportunity to assist.
At a time when interest rates are surging, and just when I request an increase, CIGNA REDUCED MY REIMBURSEMENTS! Never again will I do business with you, and will discourage other dentists from falling into your trap …. And that is why dentists don’t like #TeamCigna.
What is your name, anyway. You know mine. Perhaps Linkedin’s transparency makes it a poor choice for marketing Cigna.
Asif things could get no worse between Cigna and dentists, you censored my response!
NOTE: Cigna representatives prefer to remain anonymous for reasons of accountability.
Posted on July 21, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
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By Staff Reporters
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The S&P 500 rose 0.6%, a day after soaring 2.8% for its best day in weeks. The NASDAQ led the market with a 1.6% gain. The Dow Jones Industrial Average added a more modest 0.2%. Smaller company stocks also closed higher. The Russell 2000 rose 28.62 points, or 1.6%, to 1,827.95.
In Europe, stocks slipped amid worries about whether Russia would restrict supplies of natural gas headed for the region after some maintenance on a key pipeline is scheduled to end. Germany’s DAX fell 0.2%, and French stocks dipped 0.3%. The continent is also preparing for the first increase in interest rates by the European Central Bank in 11 years as it tries to beat back inflation.
And, in the letter to investors, Tesla execs reveal the company has sold 75 percent of its Bitcoin holdings. Last year, Tesla made a $1.5 billion investment in bitcoin and announced that it would accept bitcoin as payment. Tesla started accepting Bitcoin in late March, then abruptly reversed itself in May, just 49 days later. In the latest report, Tesla says the value of its remaining “digital assets” is $218 million, which it had reported at around $1.2 billion in previous quarters.
Finally, Microsoft Corp. is eliminating many open jobs, including in its Azure cloud business and its security software unit, as the economy continues to weaken.
Now, just five months into 2021, there were 199 new companies that reached unicorn status (a private company with a $1+ billion valuation), eclipsing the 163 companies that reached unicorn status in all of 2020, according to Crunchbase data shared with Emerging Tech Brew. And it’s not just a pandemic rebound: That figure is higher than any full-year total over the last nine years.
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Landscape lowdown
After a 2020 full of stagnation and uncertainty, the VC scene is making up for lost time and then some.
“Many of the concerns…that ground deal making to a halt have largely been alleviated in what many investors see as a new normal,” Joshua Chao, venture capital analyst at PitchBook told us. “We’re now seeing VCs invest in companies outside of their immediate networks and it’s just full steam ahead on deal making and fundraising.”
Deena Shakir, partner at Lux Capital, said VCs are branching out of their traditional comfort zones to chase opportunities, leading to stiff competition and unprecedented valuations.
“Everyone [is] inching further upstream and downstream than their normal sweet spot,” Shakir said. “Hedge funds [are] now leading seed deals and seed funds [are] participating in growth deals.”
Why so exuberant? Blame the same Big Acceleration society underwent since Covid hit: the shift to digital. Tami Hutchinson, VP at Intel Capital, told us the pandemic-fueled digital transformation has now become “a critical must-have for all enterprises,” creating opportunities for startups to serve that need.
Health Care: Health care, financial services, and privacy and security are the most popular sectors for new $1+ billion companies, per Crunchbase. Shakir echoed that idea, saying Lux is most excited by deals at the intersections of “clinical data and AI, hardware and software, care delivery and clinical insights, [and] physical and digital security.”
More proof…
In Q1 2021, digital health startups amassed a record $6.7 billion in funding, on pace to eclipse the $14 billion raised in all of 2020.
On the fintech side, Webull, the Chinese-owned Robinhood rival, reached unicorn status in February after a $150 million funding round.
Israeli cybersecurity firm Wiz is an example of a fresh unicorn in the space—it was valued at $1.7 billion as of May 2021.
Looking ahead…VCs say it’s a safe bet to assume that more billion-dollar companies are on the horizon this year.
“For entrepreneurs, this is possibly one of the most founder-friendly periods we’ve seen in several years—all-time highs for valuations across the board coupled with all-time lows for deals,” Chao said.
ASSESSMENT: Your thoughts and comments are appreciated.
Posted on July 20, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
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By Staff Reporters
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Cathie Wood is closing down one of her exchange-traded funds, the first time her Ark Investment Management has pulled the plug on an ETF. The St. Petersburg, Florida-based firm is shutting down its ARK Transparency ETF (CTRU), which launched at the end of last year, according to a regulatory filing. With holdings like Teladoc Health Inc. and Spotify Technology SA, the fund aimed to invest in companies that received high scores on transparency.
Several big companies report earnings this week, including Netflix, Tesla, United Airlines, Verizon and Twitter, among others.
Finally, a closely watched Bank of America survey revealed a “dire level of investor pessimism” among 259 fund managers. A few data points:
Investors’ asset allocation to stocks has hit its lowest level since the financial crisis of 2008, showing they have little appetite for risky assets.
Expectations for global economic growth have hit an all-time low.
And the share of investors who deemed a recession “likely” reached its highest point since the onset of COVID in April 2020.
To weather the storm, investors are piling into defensive sectors such as utilities and consumer staples, and hoarding cash at levels not seen in 21 years.
Posted on July 20, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
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By Health Capital Consultants, LLC
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Biden Administration to Overhaul Vertical Merger Guidelines
The U.S. healthcare industry has seen a rise in vertical integration transactions since the passage of the ACA, especially among physician groups integrating with health systems or insurers, as providers seek to fill gaps in their continuum of care. In response to these trends and resulting market imbalances, the Biden Administration is aggressively pursuing antitrust enforcement by updating and revising U.S. antitrust law guidance.
This Health Capital Topics article will discuss the vertical integration movement and the proposed changes to antitrust laws that may affect the future of healthcare. (Read more…)
Posted on July 19, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
ByStaff Reporters
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During regular trade, the Dow Jones Industrial Average fell 215.6 points or 0.7% to 31,072.6, the S&P 500 lost 32.3 points or 0.8% to 3,830.8 and the NASDAQ Composite dipped 92.4 points or 0.8% to 11,360.1.
Among stocks, Goldman Sachs Group Inc (NYSE: GS) added 2.5% after reporting Q2 EPS of $7.73 versus $6.64 expected on revenue of $11.86 billion versus expectations of $10.85 billion. Charles Schwab Corp (NYSE: SCHW) closed 1.5% lower despite reporting Q2 EPS of $0.97, beating expectations of $0.91, while revenue came in at $5.09 billion versus $5.04 billion expected. Meantime, fresh data from the National Association of Home Builders showed that home builder sentiment plunged 12 points to 55, touching the lowest levels since the start of the pandemic.
On the bond markets, United States 10-Year rates were at 2.989%.
Posted on July 18, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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West Texas Intermediate crude for August delivery rose $1.81, or 1.9%, to close at $97.59 a barrel on the New York Mercantile Exchange. The U.S. benchmark suffered a 6.9% weekly fall.
September Brent crude the global benchmark, gained $2.06, or 2.1%, to settle at $101.16 a barrel on ICE Futures Europe. Brent fell 5.5% for the week.
Back on Nymex, August gasoline rose 0.8% to end at $3.2132 a gallon, while August heating oil rose 1.4% to $3.699 a gallon. Gasoline rose 6.8% for the week, while heating oil was up 0.7%.
August natural gas rose 6.3% to $7.016 per million British thermal units, pushing it to a 16.3% weekly gain.
Posted on July 18, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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5 Conditions Total 50% of Healthcare Costs
• Cancer makes up nearly 15% of all healthcare spending with employers in the study paying $533 million for nearly 103,000 cancer claims. • Musculoskeletal conditions (including joint wear, knee injuries, hip pain, etc.) makes up 13% of healthcare spending with employers spending $477 million for 317,000 musculoskeletal claims. • Cardiovascular conditions (including heart rhythm issues, stroke, heart attack, and heart failure) makes up 9% of healthcare spending with employers paying $357 million towards 169,000 claims. • Gastrointestinal conditions (including colitis, irritable bowel system, celiac disease, etc.) makes up 7% of healthcare spending with employers paying $284 million for 136,000 claims. • Neurological conditions (including Parkinson’s disease, migraines, epilepsy, etc.) makes up 6% of total health care spending with employers paying $225 million for 240,000 claims.
Posted on July 17, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
KNOW THETHE DIFFERENCE
By Staff Reporters
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As doctors, nurses and medical professionals try to get an idea of what their home is worth, please go into the process with the knowledge that the concept of “value” can carry a different definition depending on who’s assigning it.
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For example:
Appraised value – The appraised value of your home is the number assigned to it by a professional appraiser. This value is especially important when a home buyer is getting a mortgage. The lender will typically require a professional appraisal to verify that the borrower hasn’t agreed to an unrealistic valuation.
Assessed value – The assessed value of your home is the figure assigned to it by the county where it’s located for property tax purposes. While an appraisal involves someone inspecting the interior and exterior of your home, assessments are often conducted in a mass approach by using pricing trends.
Fair market value – The fair market value of your home doesn’t involve a professional. Instead, it involves other people just like you who might be willing to pay more because they love a home or a certain neighborhood. So, for example, an appraised value might be $300,000, but a recent surge in buying activity and limited supply might motivate a buyer to go above that price. On the flip side, keep in mind that those buyers might be willing to pay less than what you believe it’s worth, too.
Posted on July 17, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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The U.S. budget deficit shrank 49% to $89 billion in June from $174 billion a year earlier, reflecting the end of Covid-relief spending and an increase in tax revenue. Specifically, government spending fell in June by 12% to $550 billion compared to $623 billion in the same month one year ago.
World Emoji Day on July 17th is a celebration of all emojis. Last year, the World Emoji Awards helped crown the Most Popular New Emoji, the Most Anticipated Emoji and the Most 2021 Emoji!
A report from the American Community Survey found, “A one-percentage point increase in the marriage penalty tax rate decreases the probability of marrying for females with children by 3.69 percentage points. For males, a one-point tax increase translates to a 0.21-point decline in the probability of marrying if they have kids and a 1.54-point decline if not.”
Posted on July 16, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
A Real or False Linguistic Conundrum?
By Dr. David E. Marcinko MBA
Heterodox Economics
Heterodox Economics refers to methodologies or schools of economic thought that are considered outside of “mainstream economics”, often represented by expositors as contrasting with or going beyond neoclassical economics. “Heterodox economics” is an umbrella term used to cover various approaches, schools, or traditions.
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Health Economics [not healthcare economics]
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Health Economics is a branch of economics concerned with issues related to efficiency, effectiveness, value and behavior in the production and consumption of health and healthcare. In broad terms, health economists study the functioning of healthcare systems and health-affecting behaviors such as smoking.
Assessment: So, is health economics now mainstream; or still heterodoxic in 2019? OR, is the definitial conundrum just a matter of linguistics and terms-of-art. Your thoughts are appreciated.
Posted on July 16, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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U.S. stock markets finished sharply higher snapping a five-day losing streak thanks in part to stronger-than-expected retail sales data and a moderation in inflation expectations. But the rally — which marked the best daily performance in three weeks — still wasn’t enough to overcome earlier losses, leaving stocks with a weekly loss. The Dow Jones Industrial Average gained 658.09 points, or 2.2%, to 31,288.26. The S&P 500 advanced 72.78 points, or 1.9%, to 3,863.16. The NASDAQ Composite climbed 201.24 points, or 1.8%, to 11,452.42.
And, Citigroup (NYSE: C) reported better-than-expected quarterly results, sending its shares more than 13% higher. The Wall Street bank was helped by blowout performance in its trading business that offset weakness in investment banking revenue and an announcement that stock buybacks would be suspended. Wells Fargo (NYSE: WFC) also surged 6% despite reporting quarterly results that fell short on both the top and bottom lines as the bank set aside more money to cover potential losses from bad loans.
Banks stocks were also helped by steepening in yield curves as data showing the consumer remains in good shape eased some concerns the economy was headed for a significant slowdown.
Posted on July 15, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
By AMA and MCOL
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JAMA: Public Views About Artificial Intelligence in Health Care
A recent JAMA survey asked “Overall, in the next 5 years, do you think AI will make health care in the United States?” The survey results were as follows:
Posted on July 15, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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The Dow Jones Industrial Average shed 0.46%, or 142.62 points, to 30,630.17, while the S&P 500 dipped 0.3% to 3,790.38. The NASDAQ Composite inched 0.03% higher to finish at 11,251.19.
During the Dow’s losing streak, the biggest price decliners were the stocks of Goldman (-$18.82), UnitedHealth Group Inc. (-$18.44), Microsoft Corp. (-$16.48) and Salesforce Inc. (-$15.98); those stocks shaved a combined 460 points off the Dow’s price during the streak.
Posted on July 14, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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U.S. inflation climbed to new 41-year high of 9.1% in June, as gasoline prices surged. Soaring gasoline prices in June drove the rate of U.S. inflation to 9.1%, a nearly 41-year peak. The CPI jumped 1.3% last month to mark the third time in the last four months it’s topped 1%. Economists polled by The Wall Street Journal had forecast a 1.1% advance.
Because of June’s higher-than-expected inflation jump, it’s likely seniors will receive a 10.5% adjustment to their Social Security checks in early 2023, the Senior Citizens League, an advocacy group for older Americans opined.
Nearly a third of job recruiters said they experience extreme stress on a weekly basis because of their work, according to a December survey by human-resources analytics firm Veris Insights. The research found that 77% of high-ranking recruiters are open to changing jobs, along with 65% of HR professionals — a figure that rose 17 percentage points from September to November last year.
And, the S&P 500 slipped 0.5%, and the Dow Jones Industrial Average shed 210 points, or roughly 0.7%, though both indexes pared losses from sharper declines earlier in the day. The NASDAQ Composite closed down 0.2% but was an outlier for much of the session, trading in the green as technology stocks rebounded.
Finally, US Treasury yields were also in focus with the most dramatic moves happening at the front end of the yield curve. The 10-year stood at 3.04% following the CPI print, with 2-year yields rising as high as 3.17%, further inverting the yield curve. The curve “inverts” when yields on shorter-dated Treasuries rise above those of longer-dated ones and have typically preceded recessions on Wall Street.
Posted on July 13, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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Morgan Stanley named Eli Gross and Simon Smith as new global co-heads of investment banking, as part of a leadership shakeup at the top of one of Wall Street’s most powerful deals advisory group. The current investment banking heads, Mark Eichorn and Susie Huang were elevated to executive chairs of the division to lead a newly formed group of senior bankers, according to an internal memo seen by Reuters.
The U.S. Bureau of Labor Statistics will release June data from the closely watched Consumer Price Index (CPI) today, which tracks the prices of a basket of daily goods and services. Investors use the CPI as one way to measure inflation, which has hit a 40-year high this year and forced the Federal Reserve to become increasingly hawkish in terms of monetary policy. While CPI data comes out every month, the reading will be watched more closely than normal, as are the current high levels of inflation.
America has decided the pandemic is over. The corona virus has other ideas. The latestomicron offshoot, BA.5, has quickly become dominant in the United States, and thanks to its elusiveness when encountering the human immune system, is driving a wave of cases across the country. The size of that wave is unclear because most people are testing at home or not testing at all. The Centers for Disease Control and Prevention in the past week has reported a little more than 100,000 new cases a day on average. But infectious-disease experts know that wildly underestimates the true number, which may be as many as a million, said Eric Topol, a professor at Scripps Research who closely tracks pandemic trends. Antibodies from vaccines and previous coronavirus infections offer limited protection against BA.5, leading Topol to call it “the worst version of the virus that we’ve seen.”
Posted on July 13, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
A Nationwide Database Review
This “Guide to Travel Nursing Jobs” presents data obtained from a nationwide information database of travel nurses including motivational factors in choosing a travel nurse career, age demographics, benefits information, and social media usage.
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In addition, the guide highlights the salary info for travel RNs as well as a timeline of the travel nursing process.
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Conclusion
My how things have changed post pandemic. 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:
Posted on July 13, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
By MCOL.com
Dr. Seleem R. Choudhury
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“Uberization” is a catchphrase that has quickly become part of common parlance in discussions about the pandemic-induced economy. Uberization is the movement by organizations to “replace fixed wage contracts with ‘dynamic pricing’ for labor” (Davis, & Sinha, 2021). It is transforming many elements of the economy and replacing employees employed by the organization with a type of self-employed or contract employee. In essence, it allows businesses to “recruit labour at a large scale in new ways” (Davis, & Sinha, 2021).
The global business community has had a range of responses to the trend of uberization (Babali, 2019), as has the healthcare industry in particular. Yet as health systems emerge from the pandemic, Bloomberg reports that “the ongoing elevated costs of [healthcare] workers are causing profit warnings” (KHN, 2022; Court, & Coleman-Lochner, 2022). Regardless of one’s resistance or acceptance of uberization, healthcare employment is in crisis. Change must occur to keep health systems from financial disaster.
It seems that the tide of uberization in the healthcare industry is already rising. An increasing number of employees are contracting with hospitals and health systems via a staffing agency. This trend is likely to evolve, with a portion of staff employed directly by the hospital, and the remaining employees self-contracting with hospitals or health systems with short-term or even daily contracts. In fact, hospitals are reporting that rather than temporary “travel nurses” coming from other states to work on a contract basis, nurses are taking short-term contract work at hospitals a short drive from their own homes rather than pursue permanent employment with these organizations. We are witnessing the uberization of nursing, which will eventually extend to other healthcare occupations.
Why uberization?
The healthcare workforce shouldered the heavy burden of fighting the COVID-19 pandemic. Yet a collaborative study from Indiana University, the nonprofit Rand Corp., and the University of Michigan that analyzed the changes in the U.S. healthcare workforce during the COVID-19 pandemic found that “the average wages for U.S. healthcare workers rose less than wages in other industries during 2020 and the first six months of 2021” (Toler, 2022; Cantor, Whaley, Kosali, & Nguyen, 2022). According to a February 2022 report by the U.S. Bureau of Labor Statistics, only about 35 percent of healthcare and social assistance organizations “increased wages and salaries, paid wage premiums, or provided bonuses because of the COVID-19 pandemic” (U.S. Bureau of Labor Statistics, 2022).
Due to the media attention the “Great Resignation” has received, it is common knowledge that workers across industries have been leaving their jobs at higher rates than before the pandemic (Parker, & Horowitz, 2022). Yet by October 2021, when the “quit rates” were at their highest recorded levels, healthcare and social assistance job resignations had increased to 35% higher than they had been before the pandemic, slightly higher than the increase of resignations among all workers in the same period (29%) (Wager, Amin, Cox, & Hughes-Cromwick, 2021).
Over the last ten years, “the salary of registered nurses increased by 1.67 percent in the United States” (Michas, 2021). Whereas healthcare executives make on average eight times more than their hourly employees (Saini, Garber, & Brownlee, 2022). The pandemic has rebalanced the scales in favor of those underpaid for many years. The salary landscape has changed, and in response many hospital systems blindly grasp to the pre-pandemic state of agency staffing. This, combined with near flat salary increases, contribute to the uberization of healthcare.
For many healthcare professionals, the combination of work-related stress and incommensurate compensation was the final straw. However, in addition to fair salary, flexibility has become a top demand of employees—even in healthcare. “Gone are the days when job security or pay was everything. Workers now are giving more thought to how their jobs fit into their lives. Ambition for ambition’s sake is being reassessed” (Buckingham, & Richardson, 2022).
A recent survey articulated “higher pay and dissatisfaction with management were also key drivers of nurses changing work settings in 2020 or 2021,” with 28% of respondents saying they’ve changed work settings (Lagasse, 2022). The percentage of nurses considering changing employers increased by 6% from 2020 to 2021, with 17% saying they are contemplating making an employment change. The percentage of nurses who are “passive job seekers – not actively looking for a new job but open to new opportunities – also increased, from 38% in 2020 to 47% in the current survey” (Lagasse, 2022).
The moment: contractor or non-contractor
As the trend of uberization continues to spread beyond the transportation industry, the global business community should be watchful of challenges that the trendsetter Uber is facing to understand future implications of this movement in their own industry. For example, recent legal battles regarding the employment status of Uber drivers will likely impact the cost-benefit analysis of those considering traditional employment or independent contracting. While an independent contractor is free to offer services to anyone and doesn’t have the limits on their freedom that comes with being an employee of a single organization, the U.S. National Labor Relations Board decision that Uber drivers are independent contractors means that drivers have no federal right to unionize (HyreCar, 2021; Fishman, 2020). In Europe, however, Uber drivers are considered employees and not independent, which could mean that unionization could occur en masse.
The future
The future of healthcare employment could be via an app on smart phones. Imagine: daily staffing supplemented by workers employed and credentialed through the app. The healthcare worker could choose their rate and shifts, and the hospital could determine the desired experience, quality, and patient experience reviews for the open position. It could shift the future of employment healthcare significantly.
The rate of change in today’s workplace is accelerating whether it is through the uberization of healthcare workers or advancements in workers’ rights. A recent New York Times article entitled “The Revolt of the College-Educated Working Class” states: “The support for labor unions among college graduates has increased from 55 percent in the late 1990s to around 70 percent in the last few years, and is even higher among younger college graduates” (Scheiber, 2022).
This may have a ripple effect on the healthcare workforce. Years of stagnating salaries and organizations’ undefined workforce vision has primed the industry for action with record job-quits within healthcare. This has proven especially true in rural markets where recruitment of permanent and agency staff has posed numerous challenges. Our current climate potentially opens the door for workers to leverage themselves via the advocacy of a union.
Summary
The labor supply and demand are out of balance. The long-term effects on the health sector labor market from the pandemic are unknown, but changes in healthcare delivery (such as the growth of telehealth) may lead to lasting shifts in the healthcare industry. Fierce competition for healthcare workers means that employers must go beyond good pay and benefits to attract the best candidates. Healthcare recruitment is a zero-sum game. There isn’t a pool of healthcare workers lying idle, and so recruitment is often at the cost of a competitor. The employee knows that this demand exists, and this could further drive the uberization of healthcare workers. However, there is potential for this new movement to benefit both parties. As limited number of employees equates to skill scarcity which drives salaries, hospitals could utilize their skilled workforce based on need and demand.
Posted on July 12, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
Understanding the Costs and Risks
[By Dr. David Edward Marcinko MBA]
Gratefully, our book, Financial Management Strategies of Hospitals and Healthcare Organizations [Tools, Techniques, Case Studies and Checklists] has become an academic best seller.
It contains a chapter on Wellness andPopulation Health 2.0; included here for your review [By Jennifer Tomasik, Carey Huntington, and Fabian Poliak]. .
I am especially proud of this work. This managerial book mimics the popular style of colleague Atul Gawande MD in his acclaimed work The Checklist Manifesto.
Why? All hospitals are still subject to the imperative: No Margin – No Mission.
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Assessment
In an example of population health management and policy leadership, another colleague, David B. Nash MD MBA of the Wharton School, and Endowed Dean of Jefferson University Medical School [father of population health], even wrote the “Foreword”.
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:
Posted on July 12, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
PROFESSIONAL Human Resources Options
By Eric Galtress
“In-house service and support activities are monopolies. They have little incentive to improve productivity. In fact, they have considerable disincentive to improve their productivity. Clerical, maintenance and support work, do not make a direct and measurable contribution to the bottom line.”
“Sell the Mailroom” by Peter F. Drucker
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Labor Law
Labor Law compliance begins with the hire of your very first employee, thus a well managed human resources (HR) function should be an area of strategic focus by the medical executive, regardless of practice size or the number of employees. Consideration of this vital role can help contribute to an efficient, highly effective and productive professional staff committed to the goals of the practice encompassing a positive and nurturing culture evident to your patients, while maintaining your competitive edge.
HR
Human Resources are the major expense driver of today’s medical practice and addresses staffing requirements, wages and other compensation, payroll and tax compliance, labor law compliance, employee benefits, training, employee turnover, safety, risk management and workers’ compensation. These responsibilities must be performed in accordance with State and Federal guidelines, beginning with the hire of your very first employee.
At specific employee level thresholds, employers are required to comply with a growing number of employee-related requirements including State and Federal Laws. These laws govern the proper method of how employees must be treated and paid, as well as ensuring that their rights in the workplace are protected. State and Federal Regulators each create vast amounts of workplace legislation every year, many of which become law.
In most cases, the specific requirement (either State or Federal) that affords the employee the most workplace rights and/or protection and benefits takes precedence over the other. Non-compliance can subject the practitioner/business owner to hefty fines, penalties, business interruption, litigation, and in some cases, even practice failure.
Moreover, these HR efforts are backed by labor attorneys, service providers, brokers and other consultants. Given the typical size of a medical practice, this presents a compelling argument that practices should consider taking advantage of an innovative alternative: being able to delegate (outsource) part or most of the HR burden as well as the employee / employerrelated liabilities.
Outsourcing
Simply put, instead of the practitioner/staff performing the HR requirements, part or most of this responsibility can be outsourced to an off-site HR services provider that specializes in labor law compliance, employee management and cost control. The practitioner retains functional control of the employees and the service provider handles the HR issues.
Added value is achieved by the practice in receiving these services more cost effectively since their needs are combined with those of the many other practices and businesses the provider already serves. Outsourcing is a matter of simple economics, enabling the practitioner to gain relief from cumbersome employee administration, while enhancing productivity and benefits for the staff members.
The HR outsourcing relationship is not to be confused with a Physician Practice Management Company (PPMC). The HR services provider has no financial interest or ownership whatsoever in the practice.
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DEFINITIONS
To have an outside firm take responsibility and much of the liability to perform activities traditionally handled by internal staff and resources because:
They can do it cheaper and/or faster.
They can do it better because of their expertise and experience.
They have all of the required professional staff and/or facilities.
They take all or part of the risk and the liability to do it right.
They can expand their service offering commensurate with your growth needs
They save you the time of doing it yourself or having one or more of your key staff members distracted from the priorities of the practice.
They help safeguard against chaos should the key person handling HR suddenly leave
They help maintain the high standards of the practice with regard to the employees and the workplace.
Outsourcing can benefit all parties.
Human resource management
In general, HR management consists of the activities, responsibilities and issues of any practice/business, corporation, partnership or other business entity that comes as a result of having employees (IRS1099 independent contractors are not considered employees).
Some of these requirements are mandatory such as paying minimum wage and providing workers’ compensation insurance protection; other aspects and their related administrative functions can be at the discretion of the owner(s) of the practice or business such as sponsoring health benefits, retirement plans for their employees or paid vacation and sick time.
Employer POV
What follows is an overview of the HR requirements of being the employer. This includes a condensed view of employment and labor laws, government compliance issues, employee related costs and the alarming upsurge in employee litigation. The last poses a growing level of liability, vulnerability and distraction to today’s medical executive and practitioner/owner, second only to that of medical malpractice.
Assessment
As a result, many physicians without available HR expertise are finding it increasingly difficult to focus on growing their practices.
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:
Posted on July 12, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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US stocks closed lower to start the week with the NASDAQ Composite slipping by over 2% as investors get ready for earnings to roll in and await key inflation data set to be released midweek. A wave of companies will kick off quarterly earnings season starting this week.
The Russian ruble slipped back past the 61 level against the dollar after volatile swings in recent sessions, as the market continued to wait for updates on currency interventions.
Shares of Las Vegas Sands (NYSE: LVS) fell as much as 10%, while Wynn Resorts (NASDAQ: WYNN) fell 10%, and Melco Resorts (NASDAQ: MLCO) plunged 13.8%.
The euro and the dollar are under half a penny away from parity for the first time in 20 years
Posted on July 12, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
Emerging Problems
By Dr. David Edward Marcinko; MBA, CMP™
[Publisher-in-Chief]
According to the Dictionary of Health Insurance and Managed Care, informed consent is the oral and written communication process between a patient and physician that results in the agreement to undergo a particular procedure, surgical intervention or medical treatment.
Unfortunately, a lack of standardization surrounding this process represents a major risk for patients and surgeons, and may lead to inaccurate patient expectations, lost or incomplete consent forms, missing encounter documentation and delays in critical surgeries and procedures.
History: Render S. Davis of Emory University [2008 recipient of the Health Care Ethics Consortium’s Heroes in Healthcare Ethics Award] writes for us in the Business of Medical Practice www.MedicalBusinessAdvisors.com that the concept of informed consent is rooted in medical ethics and codified as a legal principle. It is based on the assertion that a competent person has the right to determine what is done to him or her [self-regulated autonomy].
Rationale: The American Medical Association recommends that its members disclose and discuss the following with their patients:
The patient’s diagnosis, if known,
The nature and purpose of a proposed treatment or procedure,
The risks and benefits of a proposed treatment or procedure,
Alternatives (regardless of cost or health insurance coverage),
The risks and benefits of the alternative treatments and,
The risks and benefits of not the procedure.
The requirements for informed consent are spelled out in statutes and case law in all 50 states. It is a necessary protocol for all hospitals, medical clinics, podiatry practices and ASCs.
Inadequacy of Traditional Consent Forms-to-Date
The typical informed consent process, particularly one that relies solely on traditional generic consent forms, is often inadequate, incomplete or offers the potential for not fully explaining and documenting a particular procedure to a given patient.
Traditional consent forms are subject to errors and omissions, such as missing signatures (patient, provider or witness), missing procedure(s), and missing dates that place the validity of consent at risk. Lost or misplaced forms may result in delayed or postponed procedures often at the expensive of costly operating room time. Moreover, far too many forms are generic in nature and wholly unsuited for a specific patient or increasingly sophisticated medical procedure.
Patient Safety Background
According to the Institute of Medicine’s [IOM] repot, To Err is Human, more than 1 million injuries and nearly 100,000 deaths occur annually in the United States due to mistakes in medical care. Wrong patient, wrong-side, wrong-procedure and wrong-toe surgery are particularly egregious. In fact, these are among several other “never-events” that Medicare, and an increasing number of private insurance companies are refusing to reimburse.
Based on the need to make healthcare safer, the Agency for Healthcare Research and Quality (AHRQ) undertook a study to identify patient safety issues and develop recommendations for “best practices”.
AHRQ Evidence Report
The AHRQ report identified the challenge of addressing shortcomings such as missed, incomplete or not fully comprehended informed consent, as a significant patient safety opportunity for improvement.
The authors of the AHRQ report hypothesized that better informed patients “are less likely to experience errors by acting as another layer of protection.” And, the AHRQ study ranked a more interactive informed consent process among the top 11 practices supporting more widespread implementation.
General Accounting Office report found that malpractice insurance premiums were relatively flat for most of the 1990’s, but projections began to increase dramatically to 2010.
Results of Improper Informed Consent
Failure to obtain adequate informed consent, depending on state law, may place surgeons, resident, fellows, ambulatory and office surgery centers, medical clinics and hospitals at risk for litigation ranging from medical negligence to assault and battery.
Proceedings Involving Informed Consent
Informed consent is often a factor in medical malpractice litigation. Some attorneys note that physicians are liable, and that plaintiffs may be able to recover damages, in cases involving improper informed consent, even if the procedure is successful. Inadequate informed consent is often cited as a secondary cause in malpractice complaints and anecdotal evidence suggests this strategy may be especially pursued in podiatric malpractices cases.
Avoiding Litigation
The AMA advises its membership of the following regarding informed consent:
“To protect yourself in litigation, in addition to carrying adequate liability insurance, it is important that the communications process itself be documented. Good documentation can serve as evidence in a court of the law that the process indeed took place. A timely and thorough documentation in the patient’s chart by the physician providing the treatment and/or performing the procedure can be a strong piece of evidence that the physician engaged the patient in an appropriate discussion.”
Impact of Comprehensive Informed Consent Forms
Another study found that providing informed consent information to patients in written form increased comprehension of the procedure. It was also hypothesized that:
Better informed patients are more compliant with medical advice and recover faster.
Informed consent discussions strengthen physician-patient relationships and increase patients’ confidence in their doctor.
Well informed patients are more engaged in their own care, and are thus less likely to experience surgical errors than more passive, or less informed patients.
Medical Ethics
The ethical foundation of informed consent is based on the creation of an environment that supports respect for patients and protects their right to autonomous, informed participation in all collaborative Healthcare 2.0 decisions.
Assessment
Thus, the essence of the informed consent problems of modern medicine today!
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Due to the media attention the “Great Resignation” has received, it is common knowledge that workers across industries have been leaving their jobs at higher rates than before the pandemic (Parker, & Horowitz, 2022). Yet by October 2021, when the “quit rates” were at their highest recorded levels, healthcare and social assistance job resignations had increased to 35% higher than they had been before the pandemic, slightly higher than the increase of resignations among all workers in the same period (29%) (Wager, Amin, Cox, & Hughes-Cromwick, 2021). 
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