SURVEY: Medical Clinicians of the Future?

By Staff Reporters

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Clinician of the Future Study – 5 Key Findings

 •  62% of clinicians agreed the role of the clinician will change to be more of a partnership with the patient in 10 years’ timer.
 •  51% of clinicians agreed tele-health will negatively impact their ability to demonstrate empathy with patients.
 •  56% agreed patients will be more empowered to take care of their own health.
 •  77% of clinicians expect real-time patient analytics to be critical to personalized care in the future.
 •  43% expect every individual will have their genome sequenced to support illness prevention.

Source: Elsevier, Clinician of The Future, Report 2022

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UPDATE: Vitalik Buterin, Recession Risk the Euro and BOA

By Staff Reporters

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  • Vitalik Buterin tweeted Friday that he’s no longer a billionaire. Crypto has crashed in recent weeks amid a broad sell-off in traditional markets. Ethereum cofounder Vitalik Buterin tweeted Friday that he’s no longer a billionaire. Buterin, who cofounded the blockchain network in 2014, has seen its Ether token crash by 59% since hitting a high of around $4,800 in November 2021, when his holding was valued at around $1.5 billion.
  • Historically, the S&P 500 has fallen an average of 29% around recession (median of 24%). With the S&P 500 currently showing a peak-to-trough decline of almost 19%, the market is effectively already pricing in a 60%-75% chance of recession based on the average and median.
  • Thanks to a surging US dollar and a faltering Euro, many analysts expect that the two currencies could reach parity this year—meaning one dollar would fetch you one euro. The two currencies haven’t reached a 1:1 exchange rate since 2002, three years after the euro was introduced in an effort to bring stability to Europe. The euro closed at $1.057 against the dollar, just 5% above equal value with the US currency.
  • Finally, the current market plunge hasn’t yet scared investors like downturns in years past. Bank of America’s private clients are still dedicating 63% of their portfolios to stocks, compared to 39% after the 2008 financial crisis.

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SDOH = Social Determinants of Oral Health

By Staff Reporters

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Social determinants of oral health and tooth loss

A study led by investigators at the Harvard School of Dental Medicine suggested that “machine-learning algorithm models incorporating socioeconomic characteristics were better at predicting tooth loss than those relying on routine clinical dental indicators alone.”

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

Furthermore, new research reported that

  • adults living in urban areas visited the dentist more than those in rural areas
  • women were more likely than men to visit the dentist in both rural and urban areas
  • the number of adult dental visits increased as family income increased
  • non-Hispanic white adults were more likely than Hispanic and non-Hispanic black adults to have a dental visit in urban areas.

Therefore, it is important to consider how disparities in access to and use of dental care impact not only tooth loss but also oral and overall health.

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COLLEAGUE: Dr. Mike Burry Opines on the Markets

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By Dr. David Edward Marcinko MBA

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Big Short’ investor Michael Burry MD warns stocks will crash and rallies won’t last.

  • “The Big Short” investor Michael Burry expects a far steeper decline in the stock market.
  • The Scion Asset Management chief’s view is based on how past crashes have played out.
  • Burry warned brief rallies were likely, and joked about his penchant for premature predictions.

Michael Burry, the hedge fund manager of “The Big Short” fame, rang the alarm on the “greatest speculative bubble of all time in all things” last summer. He warned the retail investors piling into meme stocks and cryptocurrencies that they were careening towards the “mother of all crashes.”

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Mike also wrote a popular chapter in our financial planning textbook for physician investors. With our appreciation and gratitude.

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UPDATE: The EEOC, Yen, Wells Fargo & Tesla

By Staff Reporters

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The Equal Employment Opportunity Commission (EEOC) and the Department of Justice (DOJ) Civil Rights Division each put employers on notice: When using AI in employment processes, employers are responsible for inspecting tools for disability bias, and they better have a plan to provide reasonable accommodations, because federal agencies say they have their eyes on how using artificial intelligence could lead to discrimination under the Americans with Disabilities Act (ADA).

The Yen has the potential to drop to levels last seen in 1990 on Japan’s deepening monetary policy divergence with the US. And, selling the yen has become a favorite macro trade this year as rising Treasury yields spur investors to ditch Japan’s currency for the higher-yielding greenback. The Bank Of Japan has vowed to maintain its easing bias even in the face of the currency’s losses, making it unlikely that the declines will reverse anytime soon.

Berkshire Hathaway Inc (NYSE: BRK-B) bought $3 billion worth of shares in Citigroup Inc (NYSE: C) in Q1, giving the group a stake of about 2.8%, according to filings with regulators. The investment came as Berkshire sold the remainder of its position in Wells Fargo & Co (NYSE: WFC), a rival bank that had been a staple in Buffett’s portfolio for more than three decades, Financial Times reported.

Finally, Tesla shares continued their fall, dropping ~35% since the announcement that Elon Musk was buying Twitter. That may imperil Musk’s ability to complete the deal, given that he’s taken out meaty loans tied to the value of Tesla’s stock.

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FINANCE: https://www.amazon.com/Comprehensive-Financial-Planning-Strategies-Advisors/dp/1482240289/ref=sr_1_1?ie=UTF8&qid=1418580820&sr=8-1&keywords=david+marcinko

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On Employee “Burnout”

Prevention is better than cure

[By TrainHR]

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https://trainhrtraining.wordpress.com/2020/01/06/dealing-with-difficult-people/

Assessment: Your thoughts and comments on this ME-P are appreciated.

MORE: OSHA

COACHING

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OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

Product DetailsProduct Details

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FRUSTRATED Physicians!

By Staff Reporters

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65% of Physicians Report Feeling Frustrated in Past 3 Months

A recent study by Survey Healthcare Global on the mental health of healthcare professionals found:

 •  65% of physicians report feeling frustrated.
 •  54% of physicians report feeling burned out.
 •  52% of physicians report feeling unappreciated.
 •  Respondents rank constant stress (34%) and staff shortages (30%) as the leading factors for stress.
 •  18% report that they are more likely to drink, smoke, or use/abuse substances as a result.
 •  75% say their organizations do not offer any wellness resources and programs to HCP employees.

Source: Survey Healthcare Global Via Business Wire, March 21, 2022

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

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RECAST: An Interview with Fiduciary Bennett Aikin AIF®

On Financial Fiduciary Accountability

[By Dr. David E. Marcinko MBA CMP™]

[By Ann Miller; RN, MHA]

Currently, there is a growing dilemma in the financial sales and services industry. It goes something like this:

  • What is a financial fiduciary?
  • Who is a financial fiduciary?
  • How can I tell if my financial advisor is a fiduciary?

Now, in as much as this controversy affects laymen and physician-investors alike, we went right to the source for up-to-date information regarding this often contentious topic, for an email interview and Q-A session, with Ben Aikin.ben-aikin

About Bennett Aikin AIF® and fi360.com

Bennett [Ben] Aikin is the Communications Coordinator for fi360.com. He oversees all communications for fi360. His responsibilities include messaging, brand management, copyrights and trademarks, and publications. Mr. Aikin received his BA in English from Virginia Tech in 2003 and is currently an MS candidate in Journalism from Ohio University.

Q. Medical Executive Post 

You have been very helpful and gracious to us. So, let’s get right to it, Ben. In the view of many; attorneys, doctors, CPAs and the clergy are fiduciaries; most all others who retain this title seem poseurs; sans documentation otherwise.

A. Mr. Aikin

You are correct. Attorneys, doctors and clergy are the prototype fiduciaries. They have a clear duty to put the best interests of their clients, patients, congregation, etc., above their own. [The duty of a CPA isn’t as clear to me, although I believe you are correct]. Furthermore, this is one of the first topics we address in our AIF training programs, and what we call the difference between a profession and an industry.  The three professions you name have three common characteristics that elevate them from an industry to a profession:

  1. Recognized body of knowledge
  2. Society depends upon practitioners to provide trustworthy advice
  3. Code of conduct that places the clients’ best interests first

Q. Medical Executive Post 

It seems that Certified Financial Planner®, Chartered Financial Analysts, Registered Investment Advisors and their representatives, Registered Representative [stock-brokers] and AIF® holders, etc, are not really financial fiduciaries, either by legal statute or organizational charter. Are we correct, or not? Of course, we are not talking ethics or morality here. That’s for the theologians to discuss.

A. Mr. Aikin

One of the reasons for the “alphabet soup”, as you put it in one of your white papers [books, dictionaries and posts] on financial designations, is that while there is a large body of knowledge, there is no one recognized body of knowledge that one must acquire to enter the financial services industry.  The different designations serve to provide a distinguisher for how much and what parts of that body of knowledge you do possess.  However, being a fiduciary is exclusively a matter of function. 

In other words, regardless of what designations are held, there are five things that will make one a fiduciary in a given relationship:

  1. You are “named” in plan or trust documents; the appointment can be by “name” or by “title,” such as CFO or Head of Human Resources
  2. You are serving as a trustee; often times this applies to directed trustees as well
  3. Your function or role equates to a professional providing comprehensive and continuous investment advice
  4. You have discretion to buy or sell investable assets
  5. You are a corporate officer or director who has authority to appoint other fiduciaries

So, if you are a fiduciary according to one of these definitions, you can be held accountable for a breach in fiduciary duty, regardless of any expertise you do, or do not have. This underscores the critical nature of understanding the fiduciary standard and delegating certain duties to qualified “professionals” who can fulfill the parts of the process that a non-qualified fiduciary cannot.

Q. Medical Executive Post 

How about some of the specific designations mentioned on our site, and elsewhere. I believe that you may be familiar with the well-known financial planner, Ed Morrow, who often opines that there are more than 98 of these “designations”? In fact, he is the founder of the Registered Financial Consultants [RFC] designation. And, he wrote a Foreword for one of our e-books; back-in-the-day. His son, an attorney, also wrote as a tax expert for us, as well. So, what gives?

A. Mr. Aikin

As for the specific designations you list above, and elsewhere, they each signify something different that may, or may not, lend itself to being a fiduciary: For example:

• CFP®: The act of financial planning does very much imply fiduciary responsibility.  And, the recently updated CFP® rules of conduct does now include a fiduciary mandate:

• 1.4 A certificant shall at all times place the interest of the client ahead of his or her own. When the certificant provides financial planning or material elements of the financial planning process, the certificant owes to the client the duty of care of a fiduciary as defined by CFP Board. [from http://www.cfp.net/Downloads/2008Standards.pdf]

•  CFA: Very dependent on what work the individual is doing.  Their code of ethics does have a provision to place the interests of clients above their own and their Standards of Practice handbook makes clear that when they are working in a fiduciary capacity that they understand and abide by the legally mandated fiduciary standard.

• FA [Financial Advisor]: This is a generic term that you may find being used by a non-fiduciary, such as a broker, or a fiduciary, such as an RIA.

• RIA: Are fiduciaries.  Registered Investment Advisors are registered with the SEC and have obligations under the Investment Advisers Act of 1940 to provide services that meet a fiduciary standard of care.

• RR: Registered Reps, or stock-brokers, are not fiduciaries if they are doing what they are supposed to be doing.  If they give investment advice that crosses the line into “comprehensive and continuous investment advice” (see above), their function would make them a fiduciary and they would be subject to meeting a fiduciary standard in that advice (even though they may not be properly registered to give advice as an RIA).

• AIF designees: Have received training on a process that meets, and in some places exceeds, the fiduciary standard of care.  We do not require an AIF® to always function as a fiduciary. For example, we allow registered reps to gain and use the AIF® designation. In many cases, AIF designees are acting as fiduciaries, and the designation is an indicator that they have the full understanding of what that really means in terms of the level of service they provide.  We do expect our designees to clearly disclose whether they accept fiduciary responsibility for their services or not and advocate such disclosure for all financial service representatives.

Q. Medical Executive Post 

Your website, http://www.fi360.com, seems to suggest, for example, that banks/bankers are fiduciaries. We have found this not to be the case, of course, as they work for the best interests of the bank and stockholders. What definitional understanding are we missing?

A. Mr. Aikin

Banks cannot generally be considered fiduciaries.  Again, it is a matter of function. A bank may be a named trustee, in which case a fiduciary standard would generally apply.  Banks that sell products are doing so according to their governing regulations and are “prudent experts” under ERISA, but not necessarily held to a fiduciary standard in any broader sense.

Q. Medical Executive Post 

And so, how do we rectify the [seemingly intentional] industry obfuscation on this topic. We mean, our readers, subscribers, book and dictionary purchasers, clients and colleagues are all confused on this topic. The recent financial meltdown only stresses the importance of understanding same.

For example, everyone in the industry seems to say they are the “f” word. But, our outreach efforts to contact traditional “financial services” industry pundits, CFP® practitioners and other certification organizations are continually met with resounding silence; or worse yet; they offer an abundance of parsed words and obfuscation but no confirming paperwork, or deep subject-matter knowledge as you have kindly done. We get the impression that some FAs honesty do-not have a clue; while others are intentionally vague.

A. Mr. Aikin

All of the evidence you cite is correct.  But that does not mean it is impossible to find an investment advisor who will manage to a fiduciary standard of care and acknowledge the same. The best way to rectify confusion as it pertains to choosing appropriate investment professionals is to get fiduciary status acknowledged in writing and go over with them all of the necessary steps in a fiduciary process to ensure they are being fulfilled. There also are great resources out there for understanding the fiduciary process and for choosing professionals, such as the Department of Labor, the SEC, FINRA, the AICPA’s Personal Financial Planning division, the Financial Planning Association, and, of course, Fiduciary360.

We realize the confusion this must cause to those coming from the health care arena, where MD/DO clearly defines the individual in question; as do other degrees [optometrist, clinical psychologist, podiatrist, etc] and medical designations [fellow, board certification, etc.]. But, unfortunately, it is the state of the financial services industry as it stands now.

Q. Medical Executive Post 

It is as confusing for the medical community, as it is for the lay community. And, after some research, we believe retail financial services industry participants are also confused. So, what is the bottom line?

A. Mr. Aikin

The bottom line is that lay, physician and all clients have a right to expect and demand a fiduciary standard of care in the managing of investments. And, there are qualified professionals out there who are providing those services.  Again, the best way to ensure you are getting it is to have fiduciary status acknowledged in writing, and go over the necessary steps in a fiduciary process with them to ensure it is being fulfilled.

Q. Medical Executive Post 

The “parole-evidence” rule, of contract law, applies, right? In dealing with medical liability situations, the medics and malpractice attorneys have a rule: “if it wasn’t written down, it didn’t happen.”  

A. Mr. Aikin

An engagement contract accepting fiduciary status should trump a subsequent attempt to claim the fiduciary standard didn’t apply. But, to reiterate an earlier point, if someone acts in one of the five functional fiduciary roles, they are a fiduciary whether they choose to acknowledge it or not.  I have attached a sample acknowledgement of fiduciary status letter with copies of our handbook, which details the fiduciary process we instruct in our programs, and our SAFE, which is basically a checklist that a fiduciary should be able to answer “Yes” to every question to ensure the entire fiduciary process is being covered.

Q. Medical Executive Post 

It is curious that you mention checklists. We have a post arguing that very theme for doctors and hospitals as they pursue their medial error reduction, and quality improvement, endeavors. And, we applaud your integrity, and wish only for clarification on this simple fiduciary query?

A. Mr. Aikin

Simple definition: A fiduciary is someone who is managing the assets of another person and stands in a special relationship of trust, confidence, and/or legal responsibility.

Q. Medical Executive Post 

Who is a financial fiduciary and what, if any, financial designation indicates same?

A. Mr. Aikin

Functional definition: See above for the five items that make you a fiduciary.

Financial designations that unequivocally indicate fiduciary duty: Short answer is none, only function can determine who is a fiduciary. 

Q. Medical Executive Post 

Please repeat that?

A. Mr. Aikin

Financial designations that indicate fiduciary duty: none. It is the function that determines who is a fiduciary.  Now, having said that, the CFP® certification comes close by demanding their certificants who are engaged in financial planning do so to a fiduciary standard. Similarly, other designations may certify the holder’s ability to perform a role that would be held to a fiduciary standard of care.  The point is that you are owed a fiduciary standard of care when you engage a professional to fill that role or they functionally become one.  And, if you engage a professional to fill a non-fiduciary role, they will not be held to a fiduciary standard simply because they have a particular designation.  One of the purposes the designations serve is to inform you what roles the designation holder is capable of fulfilling.

It is also worth keeping in mind that just being a fiduciary doesn’t equate to a full knowledge of the fiduciary standard. The AIF® designation indicates having been fully trained on the standard.

Q. Medical Executive Post 

Yes, your website mentions something about fiduciaries that are not aware of same! How can this be? Since our business model mimics a medical model, isn’t that like saying “the doctor doesn’t know he is doctor?” Very specious, with all due respect!

A. Mr. Aikin

I think it is first important to note that this statement is referring not just to investment professionals.  Part of the audience fi360 serves is investment stewards, the non-professionals who, due to facts and circumstances, still owe a fiduciary duty to another.  Examples of this include investment committee members, trustees to a foundation, small business owners who start 401k plans, etc.  This is a group of non-sophisticated investors who may not be aware of the full array of responsibilities they have. 

However, even on the professional side I believe the statement isn’t as absurd as it sounds.  This is basically a protection from both ignorant and unscrupulous professionals.  Imagine a registered representative who, either through ignorance or design, begins offering comprehensive and continuous investment advice.  Though they may deny or be unaware of the fact, they have opened themselves up to fiduciary liability. 

Q. Medical Executive Post 

Please clarify the use of arbitration clauses in brokerage account contracts for us. Do these disclaim fiduciary responsibility? If so, does the client even know same?

A. Mr. Aikin

By definition, an engagement with a broker is a non-fiduciary relationship.  So, unless other services beyond the scope of a typical brokerage account contract are specified, fiduciary responsibility is inherently not applicable.  Unfortunately, I do imagine there are clients who don’t understand this. Furthermore, AIF® designees are not prohibited from signing such an agreement and there are some important points to understand the reasoning.

First, by definition, if you are entering into such an agreement, you are entering into a non-fiduciary relationship. So, any fiduciary requirement wouldn’t apply in this scenario.

Second, if this same question were applied into a scenario of a fiduciary relationship, such as with an RIA, this would be a method of dispute resolution, not a practice method. So, in the event of dispute, the advisor and investor would be free to agree to the method of resolution of their choosing. In this scenario, however, typically the method would not be discussed until the dispute itself arose.

Finally, it is important to know that AIF/AIFA designees are not required to be a fiduciary. It is symbolic of the individuals training, knowledge and ongoing development in fiduciary processes, but does not mean they will always be acting as a fiduciary.

Q. Medical Executive Post 

Don’t the vast majority of arbitration hearings find in favor of the FA; as the arbitrators are insiders, often paid by the very same industry itself?

A. Mr. Aikin

Actual percentages are reported here: http://www.finra.org/ArbitrationMediation/AboutFINRADR/Statistics/index.htm However, brokerage arbitration agreements are a dispute resolution method for disputes that arise within the context of the securities brokerage industry and are not the only means of resolving differences for all types of financial advisors.  Investment advisers, for example, are subject to respond to disputes in a variety of forums including state and federal courts.  Clients should look at their brokerage or advisory agreement to see what they have agreed to. If you wanted to go into further depth on this question, we would recommend contacting Brian Hamburger, who is a lawyer with experience in this area and an AIFA designee. Bio page: http://www.hamburgerlaw.com/attorneys/BSH.htm.

Q. Medical Executive Post 

What about our related Certified Medical Planner® designation, and online educational program for financial advisors and medical management consultants? Is it a good idea – reasonable – for the sponsor to demand fiduciary accountability of these charter-holders? Cleary, this would not only be a strategic competitive advantage, but advance the CMP™ mission to put medical colleagues first and champion their cause www.CertifiedMedicalPlanner.org above all else. 

A. Mr. Aikin

I think it is a good idea for any plan sponsor to demand fiduciary status be acknowledged from anyone engaged to provide comprehensive and continuous investment advice.  I also think it is a good idea to be proactive in verifying that the fiduciary process is being followed.

Q. Medical Executive Post 

Is there anything else that we should know about this topic?

A. Mr. Aikin

Yes, a further note about fi360’s standards. I wrote generically about the fiduciary standard, because there is one that is defined by multiple sources of regulation, legislation and case law.  The process defined in our handbooks, we call a Fiduciary Standard of Excellence, because it covers that minimum standard and also best practice standards that go above and beyond.  All of our Practices, which comprise that standard, are legally substantiated in our Legal Memoranda handbook, which was written by Fred Reish’s law firm, who is considered a leading ERISA attorney.

Additional resources:

Q. Medical Executive Post 

Thank you so much for your knowledge and willingness to frankly share it with the Medical-Executive-Post.

Assessment

All are invited to continue the conversation with Mr. Aikin, asynchronously online, or thru this contact information:

fi360.com
438 Division Street
Sewickley, PA 15143
412-741-8140 Phone
866-390-5080 Toll-free phone
412-741-8142 Fax

Conclusion

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Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

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:

LEXICONS: http://www.springerpub.com/Search/marcinko
PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
BLOG: www.MedicalExecutivePost.com

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

UPDATE: Dr. Mike Burry, I-Bond Web-Site Crash and Wall Street

By Staff Reporters

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“The Big Short” celebrity investor and colleague Michael Burry MD recently disclosed that he is short Apple stock. Could he be right about AAPL dipping even further from here? Famous hedge fund manager Michael Burry, the real-life character in “The Big Short”, became famous for his short position on subprime CDOs ahead of the 2008 crash. This time, he is shorting Apple stock. The bombshell news has come recently via a 13F filing released by Burry’s hedge fund.

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

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People searching for a respite from inflation have flooded the Treasury Department phone lines and website to try to buy Series I savings bonds, causing much longer waits than usual. It’s the latest example of outdated government computer systems causing anguish for Americans. On May 2nd, the Treasury Department announced that the inflation-protected I bonds will earn 9.62 percent interest at least until the end of October. A day later, TreasuryDirect, the website that people have to use to purchase the bonds, crashed.

Finally, Wall Street rumbled to the edge of a bear market after another drop for stocks briefly sent the S&P 500 more than 20% below its peak set early this year. The S&P 500 index, which sits at the heart of most workers’ 401(k) accounts, was down as much as 2.3% for the day before a furious comeback in the final hour of trading sent it to a tiny gain of less than 0.1%. It finished 18.7% below its record, set on January 3rd. The tumultuous trading capped a seventh straight losing week, its longest such streak since the dot-com bubble was deflating in 2001.

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Impact of Stress on Health Risk

Join Our Mailing List

The three types

By http://www.MCOL.com

stress

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COACHING

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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MEDICARE Fraud and Abuse Scams

REPORTING SCAMS

By Staff Reporters

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LINK: https://www.medicare.gov/basics/reporting-medicare-fraud-and-abuse

BLOG: https://www.medicare.gov/blog/how-to-protect-medicare-card

SPOOFS: https://www.bing.com/videos/search?q=medicare+phone+scams&&view=detail&mid=147902000F772B221DC9147902000F772B221DC9&&FORM=VRDGAR&ru=%2Fvideos%2Fsearch%3Fq%3Dmedicare%2Bphone%2Bscams%26FORM%3DHDRSC3

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On Psychological Stress

And Out-Patient Care

By http://www.MCOL.com

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COACHING

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Conclusion

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HOSPITALS:

“Financial Management Strategies for Hospitals” https://tinyurl.com/yagu567d

“Operational Strategies for Clinics and Hospitals” https://tinyurl.com/y9avbrq5

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

SDOH Challenges = Physician Stress?

SOCIAL DETERMINANTS OF HEALTH

By Staff Reporters

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SDOH Challenges Cause Physicians Stress

A recent Physicians Foundation survey that asked questions relating to whether Social Determinants of Health [SDOH] challenges cause them to experience stress or frustration.

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

The survey found:

 •  71% Identified limited time during patient visit to discuss SDOH
 •  64% Identified insufficient workforce to navigate patients to community resources to address SDOH
 •  63% Identified existing payer reporting requirements taking time away from being able to address patients’ SDOH
 •  57% Identified lack of reimbursement for screening for or addressing SDOH
 •  57% Identified community resources unavailable, inadequate or difficult to access.

Source: The Physicians Foundation 2022 Physician Survey: Part 1, March 22, 2022

Physician Suicide: https://medicalexecutivepost.com/2016/04/23/more-on-physician-suicide-video/

COACHING: https://medicalexecutivepost.com/coach/

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ECONOMIC INFLATION: Why So High Right Now?

SIX REASONS

By Vitaliy Katsenelson CFA

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DEFINITION: In economics, inflation is a general increase in the prices of goods and services in an economy. When the general price level rises, each unit of currency buys fewer goods and services; consequently, inflation corresponds to a reduction in the purchasing power of money.

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

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The war in Ukraine will likely pour more gasoline on the already raging inflationary fire, threatening to send the global economy into stagflation. Stagflation is a slowdown of economic activity caused by inflation.

READ: https://contrarianedge.com/why-is-inflation-so-high-right-now-6-reasons/?utm_source=IMA++-+Main+Articles&utm_campaign=8be9ec7af7-UBER_MONEY_MANAGER_KIDNAPPED_COPY_03&utm_medium=email&utm_term=0_f1c90406d1-8be9ec7af7-55139025

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MENTAL HEALTH Action Day 2022

By Staff Reporters

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As part of its Mental Health initiative, MTV’s second-annual Mental Health Action Day – an open-source movement of brands, organizations, government agencies, and cultural leaders to drive culture of mental health from awareness to action – will bring together more than 1,600 organizations in cities across the country to encourage and empower people to take action for mental health on Thursday, May 19, 2022.

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LINK: https://www.mentalhealthactionday.art/

COACHING: From Chaos to Calm: https://medicalexecutivepost.com/coach/
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Is the Financial “Stagflation” Risk Real?

Is Stagflation Risk Real?

By Merk Insight

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DEFINITION: In economics, stagflation or recession-inflation is a situation in which the inflation rate is high, the economic growth rate slows, and unemployment remains steadily high. It presents a dilemma for economic policy, since actions intended to lower inflation may exacerbate unemployment.

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

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A few days ago, I had the pleasure of attending the Hoover Monetary Conference – I would call it a Powwow of central bankers, if there had not been an actual Powwow a few steps outside the venue. While Hoover is known to reflect “hawkish” views, “hawks” and “doves” alike used the question of whether the Fed is “behind the curve” to argue all things inflation and stagflation.

I left the conference even more concerned about the risk of stagflation; let me explain.

Please read our latest insight: Is Stagflation Risk Real?

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Happiness Defined = Physiologically

Anxiety, Depression, Love and More!

[By staff reporters]

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https://medicalexecutivepost.com/2022/05/17/personal-coaching-dr-marcinko-at-your-service/

HIMSS REPORT: The State of Healthcare IT in 2022

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By Staff Reporters

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4 Takeaways from HIMSS

 •  84% of respondents say their organizations require them to use digital health tools and most clinicians see the value in digital transformation.
 •  99% of leaders in U.S.-based health systems say it is important for their organizations to invest in digital transformation and 95% of international health system leaders agree.
 •  93% of international payer respondents and 74% of U.S. payers say their organizations have a team focused on digital transformation.
 •  80% of health system leader respondents in the U.S. think that a physician visit deserves to be reimbursed at the same or higher levels than an in-person visit.

Source: HIMSS via Healthcare Innovation, March 18, 2022

NOTE: The Healthcare Information and Management Systems Society is an American not-for-profit organization dedicated to improving health care in quality, safety, cost-effectiveness and access through the best use of information technology and management systems.

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

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Determining Your [PHYSICIAN] Retirement Vision?

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Determining Your Retirement Vision

Dr David E Marcinko MBABy Dr. David Edward Marcinko MBA CMP®

http://www.CertifiedMedicalPlanner.org

There’s an aspect to retirement that many physicians do not plan for … the transition from work and practice to retirement. Your work has been an important part of your life.  That’s why the emotional adjustments of retirement may be some of the most difficult ones.

Examples:

For example, what would you like to do in retirement? Your retirement vision will be unique to you. You are retiring to something not from something that you envisioned. When you have more time, you would like to do more travelling, play golf or visit more often, family and friends. Would you relocate closer to your kids? Learn a new art or take a new class? Fund your grandchildren’s education? Do you have philanthropic goals? Perhaps you would like to help your church, school or favorite charity? If your net worth is above certain limits, it would be wise to take a serious look at these goals. With proper planning, there might be some tax benefits too. Then you have to figure how much each goal is going to cost you.

Lists

If have a list of retirement goals, you need to prioritize which goal is most important. You can rate them on a scale of 1 to 10; 10 being the most important. Then, you can differentiate between wants and needs. Needs are things that are absolutely necessary for you to retire; while wants are things that still allow retirement but would just be nice to have.

Recent studies indicate there are three phases in retirement, each with a different spending pattern [Richard Greenberg CFP®, Gardena CA, personal communication].

The three phases are:

  1. The Early Retirement Years. There is a pent-up demand to take advantage of all the free time retirement affords. You can travel to exotic places, buy an RV and explore forty-nine states, go on month-long sailing vacations. It’s possible during these years that after-tax expenses increase during these initial years, especially if the mortgage hasn’t been paid off yet. Usually the early years last about ten years until most retirees are in their 70’s.
  2. Middle Years. People decide to slow down on the exploration. This is when people start simplifying their life. They may sell their house and downsize to a condo or townhouse. They may relocate to an area they discovered during their travels, or to an area close to family and friends, to an area with a warm climate or to an area with low or no state taxes. People also do their most important estate planning during these years. They are concerned about leaving a legacy, taking care of their children and grandchildren and fulfilling charitable intent. This a time when people spend more time in the local area. They may start taking extension or college classes. They spend more time volunteering at various non-profits and helping out older and less healthy retirees. People often spend less during these years. This period starts when a retiree is in his or her mid to late 70’s and can last up to 20 years, usually to mid to late-80’s.
  3. Late Years. This is when you may need assistance in our daily activities. You may receive care at home, in a nursing home or an assisted care facility. Most of the care options are very expensive. It’s possible that these years might be more expensive than your pre-retirement expenses. This is especially true if both spouses need some sort of assisted care. This period usually starts when the retiree is their 80’s; however they can sometimes start in the middle to the late 70’s.

[A] Planning issues – early career

Most retirement lifestyle issues do not have to be addressed at this point. Keeping a healthy, balanced lifestyle will help to ensure a more productive retirement.  This is the time to focus on the financial aspects of retirement planning.

[B] Planning issues – mid career

If early retirement is a major objective, start thinking about activities that will fill up your time during retirement. Maintaining your health is more critical, since your health habits at this time will often dictate how healthy you will be in retirement. 

[C] Planning issues – late career

Three to five years before you retire, start making the transition from work to retirement.

  1. Try out different hobbies;
  2. Find activities that will give you a purpose in retirement;
  3. Establish friendships outside of the office or hospital;
  4. Discuss retirement plans with your spouse.
  5. If you plan to relocate to a new place, it is important to rent a place in that area and stay for few months and see if you like it. Making a drastic change like relocating and then finding you don’t like the new town or state might be very costly mistake. The key is to gradually make the transition. 

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.

https://medicalexecutivepost.com/2022/05/16/personal-coaching-dr-marcinko-at-your-service/

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

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

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

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SECURE Act 2.0 and Retirement Planning?

By Staff Reporters

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On March 29, the House of Representatives voted 414-5 in favor of the Securing a Strong Retirement Act of 2022. If passed by the Senate, and then signed into law by President Joe Biden, the act could represent a massive economic policy shift regarding retirement savings and investment.

The retirement savings legislation, also known as SECURE Act 2.0, expands on the original SECURE Act and includes provisions to boost the required minimum distribution (RMD) age from 72 to 75 over time, broaden automatic enrollment in retirement plans, and enhance 403(b) plans.

READ: https://waysandmeans.house.gov/?s=secure+act

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How to Submit an Article to the ME-P

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Spread the Word – Become a Published Author

By Ann Miller RN MHA [Executive-Director]

To submit an article, an article idea or an article abstract to the ME-P, send an email with the subject “New Article Submission” to Ann Miller RN MHA MarcinkoAdvisors@msn.com

Guidelines

New articles and ideas for articles are welcomed from throughout the world. Please submit ideas, abstracts or article drafts at least initially in English and, preferably, in Microsoft Word or, if not in MSWord, then in an “RTF” (rich text file).

There is no length restriction on articles, and the publisher encourages the use of graphs, charts, exhibits, etc.

Articles are welcomed that deal with any health care finance aspect our topical ecosystem; in addition, articles are also welcomed that deal with topics outside the U.S.

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Requirements

—Articles should be single-spaced with two spaces between paragraphs and the paragraphs should be left/right justified. We prefer that citations take the form of “footnotes” although “general references” may also be placed at the end of the article.

—Articles should have a cover page with the full article title and, below that, the names of authors, their titles, and brief affiliations (i.e., “Professor, XYZ University, City/State/Country). A working email address and telephone number of the lead author or corresponding author should appear on the cover page

—If there is only one author and you are submitting a full article, an “Abstract” can also be placed on the first page below the author’s name and affiliation. If there is more than one author, place the Abstract on the second page, followed by the article itself. Exhibits are encouraged.

NOTE: Please place exhibits, charts, etc. in the main body of the article at a logical point for the reader; depending on the size of exhibits, they can be on a page that also contains text or, using page breaks, on a separate page. Copyright laws for exhibits do apply of course.

  • We will receive the article, review it, and if accepted for publication.
  • We will proof/copy-edit it and may send it back to the corresponding author for final check/approval. Then we convert the article to a final product for insertion on the web site.

Than you in advance for your consideration.

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UPDATE: Stock Market Sentiment and Capitulation?

By Staff Reporters

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More than $11 trillion in value has been erased from global stocks since the end of March. And, despite a a pop last Friday, many analysts don’t think we’ve hit the bottom yet. Fewer than 30% of S&P companies have hit a one-year low during this downturn, compared to almost 50% during 2018’s rout and 82% during the financial crisis in 2008, according to Bloomberg.

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Capitulation means surrender. In financial markets, capitulation marks the point in time when a large enough proportion of investors simultaneously give up hopes of recouping recent losses, typically as the decline in prices gathers speed.

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

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According to MarketWatch, the latest bull market for U.S. stocks remains on the brink of expiring, with the benchmark S&P 500 just shy of the threshold that marks bear territory.

Going ganular, the S&P 500 SPX, +2.39% finished 0.1% lower at 3,930.08 on Wednesday, after falling as far as 3,858.87 at its session low. That was the index’s lowest close since March 25, 2021, and left it 18.1% below its record finish from early January. A Friday bounce for stocks saw the S&P 500 nearly halve its decline for the week to 2.4%, closing at 4023.89.

In One Chart: Stock market’s ‘ultimate lows’ are still ahead as investors have not yet capitulated, says B. of A.

A finish below 3,837.25 would mark a 20% fall, according to Dow Jones Market Data, meeting the widely used technical definition of a bear market.

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Did Public Health Fail America During the Pandemic?

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By Dr. David E. Marcinko MBA

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LINK: https://www.msn.com/en-us/news/us/how-public-health-failed-america/ar-AAXid2L?li=BBnb7Kz

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CDC: https://www.cdc.gov/publichealthgateway/publichealthservices/essentialhealthservices.html

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OUTCOMES: In-Person and Tele-Health Encounters During COVID-19

By Staff Reporters and MCOL

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Outcomes of In-Person and Tele-Health Encounters During COVID-19

 •  Ambulatory encounters decreased by 1.0% and the number of in-person encounters per enrollee decreased by 17.0% from 2019 to 2020.
 •  For members with an initial telehealth encounter for a new acute condition, the adjusted odds ratio was 1.44 for all follow-ups combined and 1.11 for an emergency department encounter.
 •  For members with an initial telehealth encounter for a new chronic condition, the adjusted odds ratios were 0.94 for all follow-ups combined and 0.94 for in-patient admissions.

Source: JAMA Network, April 26, 2022

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Our ME-P Second Opinion Service

By Staff Reporters

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Finally, telephonic, video or electronic advice for medical professionals that is:

  • Objective, affordable, medically focused and personalized
  • Rendered by a pre-screened financial consultant or medical management advisor
  • Offered on a pay-as-you-go basis, by phone or secure e-mail transmission.

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Second Opinions: https://medicalexecutivepost.com/schedule-a-consultation/

Coaching: https://medicalexecutivepost.com/coach/

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How the “6 percent rule” can help with a pension plan payout decision

A general guide

[By staff reporters]

As a general guide, according to financial advisor Wes Moss, if your monthly pension check equals 6 percent or more of the lump-sum offer, then you may want to go for the perpetual monthly payment. If the number is below 6 percent, then you could do as well (or better) by taking the lump sum and investing it, and then paying yourself each year (like a personal pension that you control).

Here’s how the math works:

Take your monthly pension offer and multiply it by 12, then divide that number by the lump-sum offer.

Example 1: $1,000 a month for life beginning at age 65 or $160,000 lump sum today?

$1,000 x 12 = $12,000 divided by $160,000 equals 7.5 percent.

Here, you would have to make approximately 7.5 percent per year on the $160,000 to earn the same $12,000 a year. Earning 7.5 percent a year consistently and over many years is a tall order. Taking the monthly amount in this case (7.5 percent is greater than 6 percent) may likely be a better deal over the long haul.

Example 2: $708 a month for life or a $170,000 lump sum today?

$708 x 12 = $8,496 divided by $170,000 equals 5 percent.

In this scenario, the monthly pension amount is offering you a return for life of about 5 percent. Remember, for the first 20 years even earning zero percent, you could do the same before you run out of money. If you made even a modest return (say, 2 percent per year), you would be far ahead of what the monthly pension would pay you. In this case, 5 percent is less than the benchmark of 6 percent, so you might be better off taking the lump sum of $170,000.

When You Should Take the Lump Sum Over the Pension

Assessment

Your thoughts are appreciated.

MORE FOR DOCTORS:

“Insurance & Risk Management Strategies for Doctors” https://tinyurl.com/ydx9kd93

“Fiduciary Financial Planning for Physicians” https://tinyurl.com/y7f5pnox

“Business of Medical Practice 2.0” https://tinyurl.com/yb3x6wr8

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

GO FUND ME: Medical Campaigns Reveal a Big Problem with Health Care

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By Jules Lipoff, MD: Senior fellow at the Leonard Davis Institute of Health Economics and an assistant professor of clinical dermatology at Perelman School of Medicine, both of the University of Pennsylvania. Erica Mark, medical student at the University of Virginia, contributed to this article. The opinions expressed in this article do not necessarily represent those of the University of Pennsylvania Health System or the Perelman School of Medicine.

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If you follow the news or your social media feed, you know that crowdsourcing medical expenses is increasingly popular for financing health care costs. In fact, you might have contributed to one; 22 percent of American adults report donating to GoFundMe medical campaigns.

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

As of 2021, approximately $650 million, or about one-third of all funds raised by GoFundMe, went to medical campaigns. That staggering amount of money highlights how dysfunctional our health care system is, forcing people to resort to crowdsourcing to afford their medical care — but it’s not surprising. In the United States, 62 percent of bankruptcies are related to medical costs. This should be a wake-up call to address and reform the system further.

Related: https://medicalexecutivepost.com/2021/12/30/does-crowd-sourcing-democratize-the-health-care-insurance-system/

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ESSAY: https://www.msn.com/en-us/news/politics/gofundme-medical-campaigns-reveal-a-big-problem-with-health-care/ar-AAXabGB?li=BBnbfcL

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SURVEY: Employee Financial Healthcare Affordability

By Staff Reporters and MCOL

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WTW: Employee Healthcare Affordability Survey

 •  By the end of 2023, most employers (95%) are expected to offer virtual care for medical and behavioral health issues, and 61% expect to offer lower cost sharing for virtual care.
 •  Over half (55%) think the expansion of virtual care will help decrease costs in the long run, and 50% think it will improve outcomes.
 •  Employer confidence in sponsoring healthcare benefits over the next 10 years is at its highest point in over 10 years (84% in 2022 versus 38% in 2011).
 •  One in 10 employers (9%) currently offer genetic testing as a screening for early-stage cancer with another 5% planning to do so by 2023.

Source: Willis Towers Watson, April 26, 2022

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

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UPDATE: Carvana, DJIA, NASDAQ, S&P, Crypto, Gasoline and the US Budget Deficit

By Staff Reporters

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Carvana, the fast-growing used-car seller based in Tempe, announced its plans to lay off 2,500 employees – more than 10% of its workforce – as losses mount. The company, which operates a network of high-profile vehicle “vending machines” including one at Loop 202 and Scottsdale Road, said the move was designed to “better align staffing and expense levels with sales volumes.” Carvana reported a $506 million loss in its first quarter ending March 31st, well above red ink of $82 million during the same stretch of 2021, despite a 56% jump in revenue to $3.5 billion and a 14% increase in vehicles sold.

And, new inflation data scared some investors, who continued to dump riskier assets like cryptocurrencies amid the ongoing market selloff: The price of Bitcoin fell up to 7%, to around $29,000, according to Coin Metrics, before paring back losses. The price of the Terra (LUNA) cryptocurrency has fallen by more than 99 per cent, wiping out the fortunes of crypto investors. Terra, which ranked among the top 10 most valuable cryptocurrencies, dropped below $1 on Wednesday, having peaked close to $120 last month.

LINK: https://www.msn.com/en-us/money/markets/crypto-billionaires-vast-fortunes-are-destroyed-in-weeks/ar-AAXaijp?li=BBnb7Kz

Indices:

  • The Dow Jones Industrial Average fell 215 points, or 0.7%, to 31,949 after swinging between gains and losses after the opening bell.
  • The S&P 500 shed 46 points, or 1.2%, to 3,954.
  • The NASDAQ Composite fell 296 points, or 2.5%, to 11,445.

The national average for a gallon of gas surged to $4.40, the highest price recorded by AAA since it began keeping track in 2000 (though lower when adjusted for inflation than the high-water mark in July 2008, when gas was $5.36 per gallon in today’s dollars).

Finally, the US federal government’s budget deficit has shrunk by some $1.57 trillion so far this fiscal year, driven by record receipts from a strong economy and a slowdown in spending as pandemic-era programs fade.

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The GAP between Medicare and Commercial Hospital Prices

THE GAP INCREASES!

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By Health Capital Consultants, LLC

Gap between Medicare and Commercial Hospital Prices Increases

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A recent study examined the growth in hospital prices paid by commercial health insurance companies compared to Medicare over a seven-year period and found that commercial health plan rates were, on average, 180% higher than Medicare rates as of 2019.

While the national ratio between commercial and Medicare hospital payment growth rates remained relatively stable during the seven-year study period, ratios varied widely on a regional basis. This Health Capital Topics article will discuss this recent study and its implications. (Read more…)

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BITCOIN: A Subjective Theory for Physicians

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By Michel Accad, MD

Michel Accad MD Practices internal medicine and cardiology in San Francisco

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Bitcoin Cash - Wikipedia

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In a recent article on the Mises Institute’s Power and Market blog, Kyle Ward appealed to the subjective theory of value to castigate Peter Schiff for his notorious skepticism of Bitcoin:

READ: http://alertandoriented.com/the-subjective-theory-of-bitcoin/

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

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What Really is a STABLECOIN?

Types with Guide

By Staff Reporters

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According to Investopedia, a stablecoin is a class of cryptocurrencies that attempt to offer price stability and are backed by a reserve asset. Stablecoins have gained traction as they attempt to offer the best of both worlds—the instant processing and security or privacy of payments of cryptocurrencies, and the volatility-free stable valuations of fiat currencies.

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Stablecoins are cryptocurrencies where the price is designed to be pegged to a cryptocurrency, fiat money, or to exchange-traded commodities (such as precious metals or industrial metals).

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

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Key Points

  • Stablecoins are cryptocurrencies that attempt to peg their market value to some external reference.
  • Stablecoins may be pegged to a currency like the U.S. dollar or to a commodity’s price such as gold.
  • Stablecoins achieve their price stability via collateralization (backing) or through algorithmic mechanisms of buying and selling the reference asset or its derivatives.

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The BUSINESS of Medical Practice

“NO MARGIN – NO MISSION”

Within Reason

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BY DR. DAVID E. MARCINKO MBA CMP®

SPONSOR: http://www.CertifiedMedicalPlanner.org

CMP logo

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

Your thoughts are appreciated.

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CELEBRATE: National Women’s Health Week 2022

MAY 8 – 14th, 2022

By Staff Reporters

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Prioritizing your health – both physical and mental – has never been more important. Over the past few years, many women have put off taking care of their general health and wellness needs. They have adjusted their daily routines, including the way they connect with family and friends. The combination has led to serious health problems for some women.

LINK: https://www.womenshealth.gov/nwhw/about

DAY: https://medicalexecutivepost.com/2022/03/08/today-is-international-womens-day/

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Fake Prescription Drug Rx Example

Altered and Poorly Written Rx for Vicodin

By Dr. David Edward Marcinko MBA

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Poorly-written Rx for vicodin

Drug: Rx Vicodin

Disp: # 10

Sig: Take I, as needed for pain.

Refills: 1 2 3 4 or 5

AM2685591

David Edward Marcinko, MBBS DPM MBA

The patient abuser may change drug quantity numbers, copy or remember the doctors’ DEA number, or take extra Rx pads. For this reason, a physician’s Rx pad should contain his/her name, address and telephone number. The doctor’s DEA number should not be pre-printed on the pad, for fear of mis-use.

Example:

  • Increase the quantity 10, to 100, by adding a zero, so that the additional capsules can be used, sold or bartered with on the street.
  • Change the directions to take 2 capsules, rather than 1 in order to produce greater euphoria.
  • Increase the Rx refills, from one to two, by extending the underline, or checking an additional quantity box.
  • Pre-printed DEA number can be stolen, sold or reused.
  • Pre-printed (not original) physician signature can be reproduced and widely distributed for more prescriptions.

Altered Rx for vicodin

Drug: Rx Vicodin

Disp: # 100

Sig: Take II, as needed for pain.

Refills: 1 2 3 4 or 5

AM2675591

David Edward Marcinko, MDBBS DPM MBA

 The doctor drug addict, or a doc in need of funds, may write for more narcotic agent than needed, and receive the additional pills back from the patient-shill for personal consumption, sell them on the street himself for money, or receive a monetary kickback from the patient-shill.

A pharmacist may also indirectly alter a prescription using the above methods, or simply short-change the patient with fewer narcotic capsules than the prescription intends. This is more difficult to do with pills or tablets in the out patient setting, but easy to do in the in-patient setting when liquid IV drugs are used, by dilution and placing less than the full amount in IV bottles or bags. The harm to patients, of course, may be fatal.

Well-written Rx for vicodin

Drug: Rx Vicodin

Disp: # 10 (ten) capsules

Sig: Take one or two capsules, po, prn pain.

Refills: 1 2 3 4 or 5

AM2685591

David Edward Marcinko, MBBS DPM MBA

Example:

  • Drug quantity can-not be changed.
  • Directions can-not be changed. Route of administration (by mouth) indicated.
  • Rx refills clearly indicated.
  • Handwritten, not pre-printed, DEA number.
  • Original physician signature, only.

Doctor Rx prescription abuse foibles are legendary in the DEA and include a Maryland podiatrist who wrote prescriptions for more than 1,235 Mepergan Fortis capsules ostensibly for his wife following minor foot surgery. Or, the Florida physician who prescribed more than 2,150 Vicodin capsules for a patient with whom he was having an extra-marital affair in order that his consort not disclose the fling to his wife. Or, the osteopath from New Jersey who wrote more than 100 narcotic prescriptions every 8 hour day, for more than a year, to any patient standing in a line in front of his office. And, finally the California dentist whose excuse for writing more than 1,845 narcotic tablet prescriptions in a six month period for the same patient was that they would be needed in his next reincarnation. Yes, all of these incidents are laughable if not for their serious consequences to the involved individuals, and society, alike. The bastards!

Fortunately, unlike drug local domestic drug kingpins or international narco-traffickers who ply their trade virtually undetected, these naive white-collared nerds, always get caught by the Drug Enforcement Agency. Their Rx abuse tactics are so amateurish!

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SURVEY on COVID-19’s Impact On Physician Practices and Employment

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By Staff Reporters

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• 108,700 additional physicians became employees of hospitals or other corporate entities – 83,000 of that shift occurred after the onset of COVID-19.
• Hospital and other corporate entities acquired 36,200 additional physician practices over the three-year period, resulting in a 38% increase in the percentage of corporate owned practices.
• 58,200 additional physicians become hospital employees – 51,000 of that shift occurred after the onset of COVID-19.
• 50,500 additional physicians became employees of corporate entities – 32,000 of that shift occurred after the onset of COVID-19.

Source: Physicians Advocacy Institute, April 2022

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Great Resignation: https://medicalexecutivepost.com/2022/03/08/healthcare-industry-hit-with-the-great-resignation-retirement/

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Prescription Drug Rx ABUSE

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By Dr. David Edwarrd Marcinko MBA

Rx DRUG ABUSE

Traditional medicinal agents come in a variety of ways, known as dispensing vehicles. Drugs may be in liquid, pill or inject able form, they may be compounded in capsules, caplets, gelatin tablets, powders or suppositories, or they may come in creams or ointments for the eye, anus and vagina. They may be ingested into the stomach, placed and dissolved under the tongue, put into the eyes, popped, injected or smeared and transported through the human skin from patches.   

A valid drug prescription is a written order, by a doctor, to a pharmacist. In this country, prescriptions are written by physicians, podiatrists, osteopaths, dentists. and some optometrists, physician assistants and nurse practitioners. In addition to the name of the patient and that of the medical prescriber, the prescription contains the name of the drug (not necessarily a narcotic), its quantity, instructions to the pharmacist, and directions to the patient. Narcotic prescriptions may not be prescribed to a drug addict to prevent withdrawal symptoms, as there must be some other therapeutic purpose for such an order.

The art of medicinal prescription writing, and pharmaceutical compounding, has declined in modern medicine for several reasons. Most drugs are made by pharmaceutical companies, and the role of the pharmacist, in most cases, consists only of compounding and error prevention. Many drugs are even automatically dispensed, and tracked, in the hospital setting with bar coding technology and modern inventory tracking mechanisms. Also, the practice of writing long and complicated prescriptions, containing many active ingredients, adjuvants, correctives, and elegant vehicles, has been abandoned in favor of using pure compounds.

Drugs may be prescribed by their official names, which were first given by the United States Pharmacopeia (USP), in 1920, or by the National Formulary (NF), since 1906. Unofficial or generic names may be used, known as New and Non-Official Drugs (NND) or by the United States Adopted Names (USAN), or by the manufactures trade name. For example, the generic narcotic meperidine or pithidine, is also known by the trade named, demerol. The designation USAN does not imply endorsement by the American Medical Association (AMA) Council on Drugs (CODs), or by the USP.

Of course, there is an advantage and disadvantages to prescribing drugs by their trade name, or generic names. Advantages of generics include economies of scale for both the patient and pharmacist, and although the active ingredient in generics are identical to trade drugs, they are often less expensive since research and development costs are absent, and various binders, colorizing agents, preservatives or dispersing agents are of an inferior quality, and hence cheaper for the patient. Appearance, size and taste issues are common. For the pharmacist, generics are cheaper since a multiplicity of very similar drugs need not be shelved.

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For example, the tablet or capsular form of many drugs contains inactive ingredients, such as: ammonio methacrylate copolymer, hydroxypropyl methylcellulose, lactose, magnesium stearate, povidone, red iron oxide, stearyl alcohol, talc, titanium dioxide, triacetin, yellow iron oxide, yellow iron oxide with FD&C blue No.2 (80 mg strength tablet only), FD&C blue No.2 and other ingredients. And yes, I’ve seen an addict do into shock, or die from acute anaphylaxis, after taking drugs containing ingredient he was highly allergic to.

Shock is a life-threatening condition where blood pressure falls too low to sustain life. It occurs when low blood volume (due to severe bleeding, excessive fluid loss or inadequate fluid uptake), inadequate pumping action of the heart or excessive dilation of the blood vessel walls (vasodilation) causes low blood pressure. This in turn results in inadequate blood supply to body cells, which can quickly die or be irreversibly damaged.

Anaphylactic shock is the severest form of allergy that is a medical emergency. It is a Type I reaction according to the Gell and Coombs medical classification, and is often severe and sometimes fatal systemic reaction in a susceptible individual upon exposure to a specific antigen (such as wasp venom or penicillin) following previous sensitization, or drug use. Characterized especially by respiratory symptoms, fainting, itching, itching and swelling of the throat or other mucous membranes and a sudden decline in blood pressure! The victim literally cannot breathe and drowns in its own congested and fluid filled lungs

So, patients in need of routine drugs for acute or chronic conditions like arthritis, high blood pressure, asthma, acne, hay fever, performance enhancing steroids or, so called life style drugs, like Viagra for a limp woody, or hair growth stimulator Rogaine, may get a good deal by going to Canada or Mexico for generics. But for important drugs, like nitroglycerine fro your heart, blood thinner coumadin, birth control pills or various anti-cancer agents, stick with brand names.

The main disadvantage of trade drugs is increased cost, due to R & D, patents, trademarks, marketing and company advertising expenses. Of course, trade drug are first to market, and hence may be beneficial as a new treatment modality, or injurious if significant side affects or other complications arise.

Today, the prime source for drug information is probably the well known, Physicians Desk Reference (PDR). Now, in its 58th edition, the PDR® provides the latest information on prescription, but not illegal street drugs. It is considered the standard reference that can be found in virtually every physician’s office, hospital and pharmacy in the United States. The current edition is over 3,000 pages long, and is where you can find data on more than 4,000 drugs, by brand and generic name, manufacturer and product categories. The PDR also provides usage information and warnings, drug interactions, plus full-size, full-color photos cross-referenced to specific drugs. For the layman, it also includes: phonetic spelling for each listing, a key to controlled substances, adverse reactions and contraindications, pregnancy ratings, dosages and all other FDA-required information. Of course, on the street, or in Mexico, none of this information matters.

Latin abbreviations, sometimes still used by doctors on prescription blanks include:

Rx = take thou (receipe)

po = by mouth (para orbis)

prn = as needed (pro re’nata)

hs = at bed time (hora somnae)

BID = twice daily

TID = three times daily

QID = four times daily

M = Mix

Traditionally, a medical prescription is written in a certain order, well known to drug abusers, and DEA agents, and consist of six basic parts:

  • Superscription: This is the Rx, or recipe. In Latin it means take thou.
  • Inscription: Represents the ingredients and amounts.
  • Subscription: Represent the description for drug dispensing, and may be represented by the letter M, for mix.
  • Signature:  Often abbreviated as Sig, and contains the directions for patient use.
  • Refill Status: Indicates the number of refills allowed.
  • DEA Number: This is nine-character alpha-numeric sequence, used by all licensed physicians who prescribe narcotic agents. An example is AM2685591. The second letter is the first letter of the doctor’s last name, (ie, Marcinko) and the first two digits add up to the third (ie, 2+6=8).

Finally, in addition to the basic parts of a prescription, it should have the patient’s name, and physician signature written in ink, followed by degree designation, such as MD, DPM, DO or DDS, etc.

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Perhaps the most egregious narcotic prescribing habits recently encountered by DEA agents have been by doctors of all degrees and medical designations. Reasons are generally two-fold. First, the doctor may become a drug addict himself, either by accident or through initial legitimate therapeutic use, and over-prescribe the narcotics. Or, increasing office costs, and decreased reimbursement fee reductions of many managed medical care have so economically destabilized the medical community, that economically impoverished doctors desperately sell prescriptions to finance their personal lifestyles, automobiles, clothes, fancy vacations or own addictions.

For example, a staggering medical student loan debt burden of  $100,000-$250,000 is not unusual for new practitioners. In fact, the federal Health Education Assistance Loan (HEAL) program reported that for the Year 2001, it squeezed significant repayment settlements from its Top 5 list of deadbeat doctor debtors. This included a $303,000 settlement from a New York dentist, $186,000 from a Florida osteopath, $158,000 from a New Jersey podiatrist, $128,000 from a Virginia podiatrist, and $120 from a Virginia dentist. The agency also excluded 303 practitioners from Medicare, Medicaid and other federal healthcare programs and had their cases referred for non-payment of debt.

These facts indicate that the current healthcare reimbursement climate has caused more pain and tumult to doctors than the pubic realizes. Older medical practitioners are retiring prematurely, mature providers are frustrated and in despair, and young physicians have no concept of the economic servitude to which they are about to be subjected. Frustration is high and physician suicides have been documented. Many doctors get divorced at the start of their careers. Even the U.S. Inspector General has declared healthcare providers to be public enemy  #2,behind international narco-traffickers, for their federal drug, fraud and abuse initiatives.  Still, the statistic above lends itself to narcotic drug prescription abuse, either on the part of the doctor or patient, since only these two parties that can directly alter a prescription for illicit drug use, as illustrated by this poorly written prescription for a narcotic pain killer, vicodin.

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INVITE: https://medicalexecutivepost.com/dr-david-marcinkos-bookings/

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COMMENTS APPRECIATED

Thank You

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