ECONOMIC INDICATORS: “Lipstick Index” and “Cosmetic” Others?

By Staff Reporters

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DEFINITION: According to Wikipedia, the lipstick index is a term coined by Leonard Lauder, chairman of the board of Estee Lauder, used to describe increased sales of cosmetics during the early 2000s recession. Lauder made the claim that lipstick sales could be an economic indicator, in that purchases of cosmetics – lipstick in particular – tend to be inversely correlated to economic health. The speculation was that women substitute lipstick for more expensive purchases like dresses and shoes in times of economic distress.

Lauder identified the Lipstick index as sales across the Estee Lauder family of brands. Subsequent recessions, including the late-2000s recession, provided controverting evidence to Lauder’s claims, as sales have actually fallen with reduced economic activity. Conversely, lipstick sales have experienced growth during periods of increased economic activity. As a result, the lipstick index has been discredited as an economic indicator. The increased sales of cosmetics in 2001 has since been attributed to increased interest in celebrity-designed cosmetics brands.

In the 2010s, many media outlets reported that with the rise of nail art as fad in the English-speaking countries and as far afield as Japan and the Philippines, nail-polish had replaced lipstick as the main affordable indulgence for women in place of bags and shoes during recession, leading to talk of a Nail Polish index. Similar sentiment was noted during the coronavirus pandemic, when the mandated use of face masks to prevent the spread of the disease resulted in an increase of eye makeup purchases, suggesting a Mascara index.

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Now, decades after former Estée Lauder chairman Leonard Lauder first recognized the infamous “lipstick index”—the idea that cosmetics sales hold steady and sometimes spike during economic downturns—the same company posted a relatively downbeat earnings report.

Currently, the economy’s not great, but not abysmal, which makes for two possible interpretations of Estée Lauder’s latest report: Either the economy’s better than it seems, or the lipstick index was always a bit off.

The cosmetics giant reported declining sales figures, while weakening its full-year forecast. “For full-year fiscal 2023, we delivered organic sales growth and prestige beauty share gains in many developed and emerging markets, but Asia travel retail pressured results, particularly in skin care, and we continued to experience softness in North America,” the report said.

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Waffle House Index: https://medicalexecutivepost.com/2022/10/08/what-is-the-waffle-house-index/

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GOLD: Commodity Bullion

By Staff Reporters

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What it is: With its use as a commodity tracing back to Ancient Lydian merchants over 2,500 years ago, gold has the most staying power of any indicator on this list. When investors talk about gold prices today, they’re most likely referring to the price per ounce of gold bullion.

How it works: Gold is priced in U.S. dollars around the world. Investors can buy physical gold in the form of bullion or coins or go for more intangible gold securities, such as futures, ETF shares, or investments in gold mining companies.

Why it matters: In a 21st century economy where currencies aren’t pegged to the gold standard and credit cards are the medium of exchange, some investors argue gold is a relic. But others turn to the metal for diversification or as a “safe-haven asset”—something to buy during times of geopolitical or economic uncertainty because it holds onto its value.

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CCI: Consumer Confidence Index?

By Staff Reporters

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A consumer confidence index (CCI) is an economic indicator published by various organizations in several countries.

In simple terms, increased consumer confidence indicates economic growth in which consumers are spending money, indicating higher consumption. Decreasing consumer confidence implies slowing economic growth, and so consumers are likely to decrease their spending.

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The idea is that the more confident people feel about the economy and their jobs and incomes, the more likely they are to make purchases. Declining consumer confidence is a sign of slowing economic growth and may indicate that the economy is headed into trouble.

FOR EXAMPLE:

Consumers’ assessment of current business conditions was mixed in November, 2022.

  • 18.2% of consumers said business conditions were “good,” up from 17.7%.
  • On the other hand, more consumers, 26.7%, said business conditions were “bad,” up from 24.0%.

Consumers’ appraisal of the labor market was somewhat more favorable.

  • 45.8% of consumers said jobs were “plentiful,” up from 44.8%.
  • 13.0% of consumers said jobs were “hard to get,” unchanged from last month.

OFFICIAL: https://www.conference-board.org/topics/consumer-confidence

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FINANCING: A Medical Practice or Clinic?

By http://www.MarcinkoAssociates.com

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Every medical practice, clinic or healthcare business needs financial organization. At Marcinko Associates, we provide it through our detailed annual reports.

For example, when starting out, the pre-construction phase of a medical practice is crucial, because it sets the course for a successful project. It includes business and financial assessments in which we learn about your goals, vision, financial realities and current clinic, practice and future facility needs.

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DAILY UPDATE: Nvidia Delayed and Covid Tests Mailed as Dow Rises and Technology Stocks Lag

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Nvidia will drop its Q2 numbers on Wednesday. Investors will also look for an update from CEO Jensen Huang about reported delays in production of the company’s highly anticipated new Blackwell chips.

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Andersen, the US unit of Andersen Global, is considering an IPO in 2025, the Wall Street Journal reported. Andersen Global, an association of consulting firms, was formed in the wake of the 2002 collapse of Big Five accounting firm Arthur Andersen. The parent company has more than 17,000 employees worldwide and earned around $1.9 billion in revenue last year.

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What’s up

  • Kroger gained 1.6% as the antitrust trial began over its plan to merge with rival Albertsons in a $25 billion deal.
  • XPeng ADRs (American Depositary Receipts) spiked 7.90% on news that the Chinese EV maker’s CEO bought more than 2 million of the company’s shares. Those ADRs are still down nearly 50% this year. Here’s what an ADR is, by the way.

What’s down

  • Nvidia (-2.25%), Super Micro Computer (-8.27%), and Broadcom (-4.05%) stunk up the joint today. Investors are biting their nails ahead of Nvidia’s earnings report on Wednesday.
  • Uber dropped 2.30% on a day it was hit with a record $324 million fine by the Dutch data protection regulator for violating EU personal data rules.
  • Intel plopped 2% after CNBC reported on Friday that the chipmaker has hired advisors to help defend the castle against activist investors.

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Here’s where the major benchmarks ended:

  • The SPX dropped 17.77 points (–0.32%) to 5,616.84; the Dow Jones Industrial Average® ($DJI) rose 65.44 points (0.16%) to 41,240.52; the NASDAQ Composite®($COMP) fell 152.02 points (–0.85%) to 17.725.77.
  • The 10-year Treasury note yield (TNX) inched up about one basis point to nearly 3.82%.
  • The CBOE Volatility Index® (VIX) edged up to 16.09 but remains below its historic average.

Americans can receive free Covid-19 tests through the mail beginning next month.

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NDAs: Federal Judge Strikes Down Non-Compete [Disclosure] Agreement Ban

By Health Capital Consultants, LLC

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On August 20th, 2024, a Texas federal judge stopped the FTC’s ban on non-compete agreements from going into effect on September 4, 2024. This decision comes after the FTC issued a final rule on April 23, 2024, that bans employers from imposing non-competes on their employees. The FTC asserted that this exploitative practice kept wages low and suppressed new ideas. While the FTC’s ban will affect all industries – not just healthcare – it comes at a time when healthcare employers across the U.S. are struggling with staffing shortages. 

This Health Capital Topics article reviews the court’s ruling and discusses the FTC’s ban on noncompete agreements. (Read more…)

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Selecting a Medical Practice Business Entity?

By http://www.MarcinkoAssociates.com

Incorporating a practice is something many doctors are unaware but at Marcinko Associates, Inc., we are here to help you in getting your medical practice or clinical business up and running. We believe this category is by far the most important when acquiring or starting a new practice as well as a continuing practice. Selecting a business entity that will be the most conducive to your overall clinic or medical practice objectives is vital. 

For example, clinic or medical business entity selection would include: Sole Proprietorship, Limited Liability Company, S-Corporation, C-Corporation, Professional Association or Non-profit organization.

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Valuation of Hospitals [Competitive Environment]

By Health Capital Consultants, LLC

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Demand for a variety of healthcare services – including those provided by hospitals – is likely to increase significantly in the near future, primarily as a result of the changing demographics of the U.S. population, most notably the growth in the number of Americans over the age of 65. Indeed, a Health Affairs study found that population aging alone will create approximately 0.74% annual growth in the demand for inpatient hospital services. While hospital consolidation is leading to operational efficiency for hospitals in providing services to an increasing number of patients, the federal government’s intensifying focus on anti-competitive behaviors in healthcare may hinder traditional consolidation efforts going forward.

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This second installment in a five-part series on the valuation of hospitals reviews the competitive environment in which hospitals operate. (Read more...) 

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WHAT IS COMMON STOCK “PAR” VALUE?

WHAT IS COMMON STOCK “PAR” VALUE?

DEFINITION:

For common stock, the value on the books of the corporation. It has little to do with market value or even the original price of shares at first issuance. The difference between par and the price at first issuance is carried on the books of a corporation as “paid-in capital” or “capital surplus.”

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Par value for preferred stocks is also liquidating value and the value on which dividends (expressed as a percentage) are paid, generally $100 per share.

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DAILY UPDATE: Medicare Part C and CON Laws as Stocks Drift Higher

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Read: Georgia’s bipartisan effort to amend its “certificate of need” system to bring back shuttered rural hospitals. (KFF Health News)

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Here’s where the major benchmarks ended:

  • The S&P 500® index (SPX) rose 63.97 points (1.15%) to 5,634.61, up 1.5% on the week; the Dow Jones Industrial Average® ($DJI) added 462.30 points (1.14%) to 41,175.08, up 1.3% for the week; the NASDAQ Composite®($COMP) advanced 258.43 points (1.47%) to 17,877.79, up 1.4% for the week.
  • The 10-year Treasury note yield (TNX) fell nearly six basis points to just under 3.81%.
  • The CBOE Volatility Index® (VIX) dropped sharply to 15.79, the lowest close since Monday.

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As Medicare Advantage (MA) enrollment grows, hospitals are breaking up with MA [Part C] insurance plans. Becker’s Healthcare reported that, so far in 2024, at least 17 systems ended a contract with an MA insurer.

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TRANSACTIONAL STOCK ANALYSIS: What Is It?

Versus Technical Analysis

By Staff Reporters

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In traditional finance transaction data is guarded by exchanges, brokers, banks and regulators. It’s not accessible to everyone and big players pay a fortune for it.

But, in crypto, Transaction Data is public and on-chain – but it’s not usable by everyone. So, manually making sense of raw blockchain data is practically impossible. The data needs to be processed and analyzed to be made useful. That’s what sophisticated blockchain analytics tools are doing.

The combination of on-chain data and transaction analysis is something that hasn’t been before – in crypto or traditional finance. Getting access to transaction data and tools for searching and analyzing it will unlock a goldmine of potential insight.

People who have been on the inside of projects and see how the sausage is made know that the explanations for price movements are often simple and based on key players buying and selling. When the biggest holders are dumping the price is likely to go down. When a major new buyer takes a position prices are likely to go up.

That’s insight traditional Technical Analysis cannot provide, because it’s limited to looking at price movements. Transaction data, instead, is the underlying activity that generates prices in crypto.

CITE: https://www.r2library.com/Resource/Title/0826102549

Technical Analysis: https://medicalexecutivepost.com/2022/06/23/the-technicians/

Related: https://medicalexecutivepost.com/2022/09/25/what-is-sentimental-stock-market-analysis/

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FAIR MARKET VALUATION DETERMINATION: Medical Practices or Clinics

MEDICAL PRACTICE OR AMBULATORY SURGERY CENTER

MARCINKO ASSOCIATES, Inc.

http://www.MARCINKOASSOCIATES.com

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FAIR MARKET VALUATION DETERMINATION

There are a Myriad of Reasons for Obtaining a Medical Practice Valuation and Appraisal Engagement:

  • Outright selling-buying
  • Partnership and Associate buy-in / buy-out
  • Mergers and Acquisitions
  • Organic growth tracking
  • Hospital integrations
  • Private and public reporting
  • Financing and Venture Capital
  • Estate and tax planning

Our Capability

We have the ability to provide extensive analysis of value components in healthcare practices and provide appraisals based on business, economic, and market conditions. This involves detailed examination of financials and clinical data in the context of numerous factors including medical specialty, physician supply and demand, payer mix, regulatory environment, regional dynamics, and risk premium.

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What is the Investing “EFFICIENT MARKET ” Hypothesis?

By Dr. David Edward Marcinko MBA MEd CMP

SPONSOR: http://www.MarcinkoAssociates.com

According to colleagues Jeffrey S. Coons PhD CFA, the Efficient Market Hypothesis (EMH) states that securities are fairly priced based on information about their underlying cash flows and that physician investors should not expect to consistently outperform the market over the long-term. 

There are three distinct forms of EMH that vary by the type of information that is reflected in a security’s price:

Weak Form: This form holds that investors will not be able to use historical data to earn superior returns on a consistent basis.  In other words, the financial markets price securities in a manner that fully reflects all information contained in past prices.

Semi-Strong Form: This form asserts that security prices fully reflect all publicly available information. Therefore, investors cannot consistently earn above normal returns based solely on publicly available information, such as earnings, dividend, and sales data.

Strong Form: This form states that the financial markets price securities such that, all information (public and non-public) is fully reflected in the securities price; investors should not expect to earn superior returns on a consistent basis, no matter what insight or research they may bring to the table. 

While a rich literature has been established for doctors regarding to test whether EMH actually applies in any of its three forms in real world markets – probably the most difficult evidence to overcome for backers of EMH is the existence of a vibrant money management and mutual fund industry charging value-added fees for their services. 

In fact, no less than Warren Buffett has suggested that the markets are decidedly not efficient. 

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PREFERRED versus COMMON Stock?

Is there a Difference?

What is the Difference?

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By Dr. David Edward Marcinko MBA MEd CMP®

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A common stock is the least senior of securities issued by a company. 

A preferred stock, in contrast, is slightly more senior to common stock, since dividends owed to the preferred stockholders should be paid before distributions are made to common stockholders. 

However, distributions to preferred stockholders are limited to the level outlined in the preferred stock agreement (i.e., the stated dividend payments).  Like a fixed income security, preferred stocks have a specific periodic payment that is either a fixed dollar amount or an amount adjusted based upon short-term market interest rates. 

However, unlike fixed income securities, preferred stocks typically do not have a specific maturity date and preferred stock dividend payments are made from the corporation’s after tax income rather than its pre-tax income.  Likewise, dividends paid to preferred stockholders are considered income distributions to the company’s equity owners rather than creditors, so the issuing corporation does not have the same requirement to make dividend distributions to preferred stockholders. 

So, preferred stock is generally referred to as a “hybrid” security, since it has elements similar to both fixed income securities (i.e., a stated periodic payments) and equity securities (i.e., shareholders are considered owners of the issuing company rather than creditors). 

Convertible preferred stocks (and convertible corporate bonds) are also considered hybrid securities since they have both equity and fixed income characteristics.   A convertible security whether a preferred stock or a corporate bond, generally includes a provision that allow the security to be exchanged for a given number of common stock shares in the issuing corporation. The holder of a convertible security essentially owns both the preferred stock (or the corporate bond) and an option to exchange the preferred stock (or corporate bond) for shares of common stock in the company. 

ASSESSMENT: Thus, at times the convertible security may behave more like the issuing company’s common stock than it does the issuing company’s preferred stock (or corporate bonds), depending upon how close the common stock’s market price is to the designated conversion price of the convertible security.

CITATION: https://www.r2library.com/Resource/Title/0826102549

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What is an INVERSE ETF?

By Staff Reporters

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What are inverse ETFs?

An inverse ETF, often known as a bear or short ETF, is an exchange-traded fund designed to profit from a market decline. These short-term, publicly traded investments are utilized by investors who believe that a particular market or individual security will lose value in the near future. They may use inverse ETFs as a way of hedging losses during a downturn.

“Inverse ETFs are a tool to hedge a stock portfolio,” according to John DeYonker. “If the S&P 500 is your benchmark, and it goes up 1%, then your hedge will go down 1% and vice versa. Hedging with inverse ETFs can reduce volatility for investors—it’s like insurance.”

Investors may also use inverse ETFs as a way to take advantage of a predicted decline. In this way, they may be used as an alternative to short selling. For example, if an investor believes that the oil industry will have a setback in the immediate future, they may choose to purchase an inverse ETF of securities tied to energy producers. If correct in their prediction, the investor’s inverse ETF may recognize a profit. If the investor is incorrect, and the market or individual security increases in price, they may see a loss.

An investor who believes that the S&P 500 will decline, for example, may choose to purchase shares of the ProShares Short S&P 500. This inverse ETF’s value is inversely proportional to the overall S&P 500 index.

Inverse ETFs are generally considered to be highly volatile investments, as their losses typically compound daily. This makes inverse ETFs more risky than the index to which they are tied.

CITE: https://en.wikipedia.org/wiki/Exchange-traded_fund

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J. POWELL: To Speak At Jackson Hole

By Staff Reporters

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Later this week, central bankers will meet in the shadow of the Tetons for the Jackson Hole Symposium, an annual retreat for global economic officials to talk monetary policy.

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The main event: Federal Reserve Chairman Jerome Powell’s keynote speech on Friday, which investors hope will clarify the timing and pace of interest rate cuts.

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DAILY UPDATE: Telehealth Down but Stock Markets Up for the Week

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In April, UnitedHealth Group announced it was shutting down its Optum Virtual Care program. Days later, Walmart announced it would shutter both Walmart Health and Walmart Health Virtual Care.

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And in July, Teladoc posted a net loss of $838 million in Q2. The drop was largely driven by an impairment charge of ~$800 million for BetterHelp, the virtual mental health platform it acquired in 2015, Fierce Healthcare reported. Executives attributed the decline to increased customer acquisition costs, among other factors.

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Finally, Stocks are way out of whack with reality, the WSJ argues. Nevertheless, a slew of encouraging economic data helped propel the S&P 500 to its best week of the year—a welcome change from the whiplash volatility of the week before. Bayer jumped after scoring an appeals court victory in a case over claims its Roundup weed killer causes cancer.

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

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CREDIT CARD SWIPE FEES: Capped

Visa and Mastercard agree to $30 billion deal to cap credit card swipe fees

By Staff Reporters

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After a nearly 20-year legal battle, the credit card behemoths said they’ll slightly reduce the 2% fees that they charge retailers every time a consumer uses one of their cards.

Retailers will also be able to adjust prices at checkout depending on the type of card used. The banks that issue cards—like JPMorgan Chase, Citigroup, and Bank of America—will likely bear the brunt of the changes, as they typically receive most of the revenue from swipe fees.

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USE: Credit Cards -NOT- Debit Cards

By Staff Reporters

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

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

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DAILY UPDATE: Cisco Lays Off as Stock Markets Blast Off

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What’s up

What’s down

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

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Here’s where the major benchmarks ended:

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

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

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DAILY UPDATE: Hospital Private Equity and AI with Upbeat DJIA

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

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What’s up

What’s down

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

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Here’s where the major benchmarks ended:

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

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

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

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

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

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The Long and Short of Portfolio Construction

Long-Short Portfolio Construction vs. Long-Only

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

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

Misconceptions

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

Long-Short Advantages

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

Disadvantages

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

Assessment

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

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

Conclusion

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COMMODITIES UTILITY: Gold v. Silver

By Staff Reporters

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

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Gold vs. Silver: Utility

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

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

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

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

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WTI: Crude Oil

West Texas Intermediate

By Staff Reporters

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

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

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

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Why I Hate Non-Publicly Traded REITS

On Product Frustration

Lon JefferiesBy Lon Jefferies MBA CFP® CMP®

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

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

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

If Brokers Were Transparent:

Rep:

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

Client:

Sounds great, give me the details.

Rep:

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

Client:

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

Rep:

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

Client:

You have to be kidding.

Rep:

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

Client:

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

Rep:

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

Client:

Are we on hidden camera or something?

Rep:

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

Client:

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

Rep:

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

Client:

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

Rep:

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

Client:

This is crazy, what is this investment?

Rep:

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

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Currency

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

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

Assessment

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

Conclusion

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What is an “INTERVAL” Mutual Fund?

By Staff Reporters

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

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

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

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DAILY UPDATE: Consumer Spending with Spotlight on Intel

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

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

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

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

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

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

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

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Correlate: A website that shows spurious correlations.

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Appreciating the Six Types of Investment Fees

dr-marcinkoDR. DAVID EDWARD MARCINKO MBA MEd CMP

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investing

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

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

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

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

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

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

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

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

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

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

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

Assessment

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

Conclusion

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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™

ETFs: Happy 31st. Birthday

EXCHANGE TRADED FUNDS

By Staff Reporters

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

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Exchange Traded Funds

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

ETFs and Tax Efficiency

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

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

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

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

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

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

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

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What’s up

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

What’s down

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Here’s where the major benchmarks ended:

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

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

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What is Financial – Tech?

The Definition of Fin-Tech

cropped-dem

By Dr. David E. Marcinko MBA MEd CMP

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

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

BREAKING DOWN ‘Fintech’

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

Fintech’s Expanding Horizons

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

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New Tech in Fintech

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

Fintech Users

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

Conclusion

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:

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What is a CARRY TRADE?

By Staff Reporters

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

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

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

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

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

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Here’s where the major benchmarks ended:

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

What’s Up

What’s down

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

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

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Stock Markets, Magnificent 7, Nikkei and DuckDuckGo

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

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

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

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About Securities Order and Position Types

A Primer for Physician Investors and Medical Professionals

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

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

[PART 6 OF 8]

BC Dr. Marcinko

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

Introduction

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

Market Order:

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

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

Limit Order:

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

Order Length:

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

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

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

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

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

Stop Orders:

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

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

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

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

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

Preventive:

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

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

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Miscellaneous Orders and Positions

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

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

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

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

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

Long and Short Positions

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

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

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

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

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

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

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

The Short Sale

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

Odd Lots

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

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

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

Part 5 of 8: About Securities “Shelf Registration”

Conclusion

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

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

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

Product DetailsProduct DetailsProduct Details

  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™

Product DetailsProduct Details

Product Details

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DAILY UPDATE: New Coronavirus Variant and Stock Markets Both Up

MEDICAL EXECUTIVE-POST TODAY’S NEWSLETTER BRIEFING

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


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


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

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What’s up

What’s down

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Here’s where the major stock market benchmarks ended:

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

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

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RSI: Relative Strength Index [Stock Markets]

By Staff Reporters

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

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

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

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

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

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

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

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

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

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

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Here’s where the major benchmarks ended:

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

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

What’s up

What’s down

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

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

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

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

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

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

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

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

A Guide To The Myths And Realities Of Medical Practice Valuation

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

Knowing The Distinctions Among Engagement Types

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

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

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

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

Are You Following Industry Standards And Rules?

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

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

What About Personal Goodwill And Practice Goodwill?

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

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

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

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

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

Understanding ‘Excess Earnings Capitalization’ And Compensation Issues

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

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

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

Emphasize Practice Specifics Over Benchmarks And Formulas

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

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

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

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

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

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

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

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

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

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

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

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

Keys To Selecting The Right Valuator Professional

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

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

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

Essential Insights On Professional Fees And What You Can Expect

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

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

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

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

Final Notes

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

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

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

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The Author

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

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HEALTH ECONOMICS: Podcast and Research Paper Presentations

By Staff Reporters

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

PODCAST: https://tinyurl.com/wdyk65mw

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RECESSION INDICATOR: Inverted Yield Curve?

By Staff Reporters

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

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

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

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

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On the Financial Advice “Suitability” Standard

 It  Does Not Mean What You Think

By Rick Kahkler CFP® 

If you wanted hiking footwear, you probably would be surprised if a salesperson at an outdoors store suggested flip-flops. You would expect someone knowledgeable about hiking to recommend sturdy boots or shoes more suitable for your needs.

In the same way, if you consulted someone who sells financial products, you probably would expect them to recommend investments that are suitable for your needs. In fact, securities law provides a “suitability” standard for financial advisers who receive commissions for selling products like insurance, annuities, or non-public REITs.

Definition

Unfortunately, when it comes to investments, the word “suitability” does not mean what you probably think it means. It requires only that the adviser is honest with you and that you are legally able to evaluate and purchase the product. It does not require that the product be good for you to own in terms of being best for or even appropriate for your needs.

On the other hand, securities law requires advisers who charge fees for financial advice to be held to a “fiduciary” standard, which means they must be impartial, unbiased, and work as an advocate for clients.

http://www.HealthDictionarySeries.org

Assuming a financial representative is giving you “fiduciary” advice when in fact that person is only required to provide “suitable” advice could mean the difference between investment success or financial disaster. I mean for that to sound dire and alarming, because it is. I will even dare to say that understanding the difference between fiduciary and suitable advice is more important than the investment itself.

My alarmist opinion is supported by a recent article, “The Real Cost(s) of Suitability,” by financial editor Bob Veres. To find out whether consumers are actually harmed by relying on “suitable” advice, he gathered stories from over 100 subscribers to his Inside Information newsletter, most of whom are fiduciaries.

These examples are heartbreaking.

They include:

  • Financial advisers who sold high-premium, high-commission life insurance “investments” to customers who, in some cases, had to borrow from retirement accounts or take distributions to pay the premiums—as well as pay income taxes and penalties on the distributions.
  • Financial advisers who moved customers’ conservatively invested retirements funds into high-fee annuities, promising guarantees of no losses and returns of 5% that under scrutiny proved fictitious and will never be realized.
  • Financial advisers who made excessive numbers of trades, not to benefit customers but to generate transaction fees.
  • Financial advisers whose “suitable” recommendations, in too many cases, not only reduced clients’ investment returns, but actually drained clients’ portfolios and greatly damaged their ability to provide adequately for themselves in retirement.

Veres quoted Kathleen Campbell, of Campbell Financial Partners in Fort Myers, FL, as saying, “Suitable means plenty suitable for the broker and not so suitable for the client.” She called suitability “one of the biggest farces in the financial advisory world.”

I absolutely agree. It is essential to know whether a financial representative is held to a fiduciary or suitability standard.

Here’s how to tell the difference:

  • If you pay a fee for financial advice, with no sale or obligation to purchase a product, that’s a fiduciary adviser.
  • If there is no fee, you are dealing with a “suitability standard” broker, agent, or representative who has no legal requirement to give you unbiased advice.

Assessment

Understanding when you are getting impartial advice that’s in your best interests, and when you are getting conflicted and biased advice that is in the adviser’s best interest, is critical to your financial health.

Please, be wary of advisers whose recommendations emphasize “no fees.” Their “suitable” advice may leave you in a perilous situation—one much worse than wandering through the wilderness in flip-flops instead of hiking shoes. 

Conclusion

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

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

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

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IPO: Ackman Fund Postponed

By Staff Reporters

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Bill Ackman’s fund postpones IPO

The billionaire hedge fund boss and frequent main character on X has delayed the stock market debut of the closed-end fund Pershing Square USA, which was scheduled for early next week, a notice on the New York Stock Exchange’s website said.

The decision to wait came days after Ackman said in a letter to investors that the firm was downsizing its expectations for the share sale from a target of about $25 billion (which would have made it the largest-ever IPO of its kind) to something between $2.5 billion and $4 billion.

Ackman has a similar fund already trading shares in Europe and has hinted he might take his larger firm, Pershing Square, public as soon as next year.

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The “Magnificent 7” and the Dangers of Stock Market Hype

By Vitaliy Katsenelson CFA

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The Magnificent 7 and the Dangers of Market Hype
You can also listen to a professional narration of this article on iTunes & online.
Despite the S&P 500 showing gains in the mid-teens, the average stock on the market is either up slightly or flat for the year. Most of the gains in the index came from the Magnificent 7 stocks, which constitute 35% of the index! The equal-weighted index, where the Magnicent 7 have only a 1.4% weight, is up only about 4% this year (as of this writing). 

The Magnificent 7 are starting to look like the Nifty Fifty stocks from the 1970s (Kodak, Polaroid, Avon, Xerox, and others) – stocks you “had to own” or you were left behind – until all your gains were taken away or you faced a decade or two of no returns. Forty years later, it’s easy to dismiss these companies as has-beens. They’ve all either gone bankrupt or become irrelevant.

But back then, they were the stars of corporate America, just like the Magnificent 7 are today.
As an investor, it’s crucial to know which games you play and which ones you don’t.

Let me explain: The Magnificent 7 and the Dangers of Market Hype

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STOCK MARKET “FRONT RUNNING”

By Staff Reporters

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According to Wikipedia, front running, also known as tailgating, is the practice of entering into an equity (stock) trade, option, futures contract, derivative, or security-based swap to capitalize on advance, nonpublic knowledge of a large (“block”) pending transaction that will influence the price of the underlying security. In essence, it means the practice of engaging in a personal or proprietary securities transaction in advance of a transaction in the same security for a client’s account.

Front running is considered a form of market manipulation in many markets. Cases typically involve individual brokers or brokerage firms trading stock in and out of undisclosed, unmonitored accounts of relatives or confederates. Institutional and individual investors may also commit a front running violation when they are privy to inside information.

A front running firm either buys for its own account before filling customer buy orders that drive up the price, or sells for its own account before filling customer sell orders that drive down the price. Front running is prohibited since the front-runner profits come from nonpublic information, at the expense of its own customers, the block trade, or the public market.

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High-profile short seller accused of fraud.

Citron Research founder Andrew Left is used to being the one calling out fraud, but federal prosecutors and the SEC claimed he’s the one pulling a financial fast one. The government alleges that Left committed securities fraud by using his appearances on television and his social media accounts to make misleading statements that manipulated the market—and reaped $16 million in profit for doing so.

Left declined to comment to news outlets, but his lawyer told the Wall Street Journal that the government’s cases were “based on a defective theory” and targeted Left for sharing his opinions.

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What is the “Endowment” Effect?

The “Endowment” Effect

[By staff reporters]

In psychology and behavioral economics, the endowment effect (also known as divestiture aversion and related to the mere ownership effect in social psychology) is the hypothesis that people ascribe more value to things merely because they own them.

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MORE: https://www.interaction-design.org/literature/topics/endowment-effect

MORE: What is the “Butterfly” Effect?

Assessment: Your thoughts are appreciated.

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

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DAILY UPDATE: Hacking Hospitals and Urinary Catheter Scam as Broad Stock Markets Gain

MEDICAL EXECUTIVE-POST TODAY’S NEWSLETTER BRIEFING

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Essays, Opinions and Curated News in Health Economics, Investing, Business, Management and Financial Planning for Physician Entrepreneurs and their Savvy Advisors and Consultants

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

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Daily Update Provided By Staff Reporters Since 2007.
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According to a recent report in the Washington Post, a $3 billion scam involving urinary catheters has brought to light serious flaws in Medicare, prompting strong calls for reform.

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Here’s where the major benchmarks ended:

  • The S&P 500 rose about 60 points (1.1%) to 5,459.10; the Dow Jones Industrial Average was up 654 points (1.6%) at 40,589.34; the NASDAQ Composite ended 176 points higher (1.0%) at 17,357.88.
  • The 10-year Treasury note yield (TNX) fell five basis points to 4.197%.
  • The CBOE Volatility Index® (VIX) slipped 10% to 16.56.

What’s up

What’s down

  • Dexcom plummeted 40.66% after management cut the diabetes monitoring company’s full-year revenue guidance.
  • Biogen sank 7.15% after European regulators denied marketing authorization for the pharma company’s new Alzheimer’s drug.
  • Weight Watchers fell 12.50% after Morgan Stanley analysts downgraded the company from overweight to equal weight based on the long-term headwinds it faces from obesity drugs.

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The US is raising alarm bells about a North Korean hacking group that broke into NASA, two US Air Force bases, and several defense companies.  The FBI, NSA and State Department just called out the North Korean hacking group “Andariel” for committing cyber espionage and using ransomware attacks on US hospitals to fund its operations. 

CITE: https://tinyurl.com/tj8smmes

Stat: 524. That’s how many employees Optum is laying off in California. (Becker’s Health IT)

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SPAC v. Direct Listing v. IPO?

What’s the difference between an IPO, a special purpose acquisition company (SPAC), and a direct listing?

[By staff reporters]

IPOs are a 6–12 month journey where a company works with investment banks and underwriters, who buy a bunch of shares and then sell them to investors in the public market during the actual IPO. Early investors are able to liquidate their shares, and the company raises new funds.

Direct listings skip the underwriting hullabaloo. But without that stability guarantee, direct listings can result in a more volatile opening. Some companies, like Coinbase, find that it’s worth it to keep their hard-earned money out of bankers’ hands.

SPACs, aka “blank-check companies,” offer yet another alternative path to public markets. A SPAC is a shell company that raises money through the traditional IPO process, then merges with a private company and takes it public. 

MORE: https://medicalexecutivepost.com/2019/06/24/what-is-a-direct-listing-process-on-wall-street/

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