PRIVATE EQUITY: Ownership in Physician Practices

By NIHCM

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Private equity acquisition of physician practices continues to grow nationwide. New research focused on specialists in dermatology, gastroenterology, and ophthalmology shows the impact of the trend.

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

Novel evidence by NIHCM grantee Jane Zhu, MD, and her team, reveals shifts in workforce composition and hiring patterns after private equity firms obtain physician practices. The researchers’ findings are particularly important for policymakers and practices considering selling to private equity firms. Highlights include:

  • A significant yearly increase in the number of advanced practice providers at private equity-acquired practices, specifically nurse practitioners and physician assistants. 
  • In acquired practices, entering clinicians replaced exiting clinicians at a higher rate than at non-private equity-acquired practices.

This work adds to the research team’s previous findings, including the geographic variations in private equity ownership across six medical specialties, and the impact of private equity on health care costs and utilization.

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

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DAILY UPDATE: Health Insurers & Hospital Mergers with Light Stock Market Trading

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Here’s where the major benchmarks ended:

The CBOE Volatility Index® (VIX) climbed slightly to 12.37.

The S&P 500 index®(SPX) rose 5.66points (0.1%) to 5,572.85; the Dow Jones Industrial Average® ($DJI) dropped 31.08 points (0.1%) to 39,344.79; the NASDAQ Composite® ($COMP) gained 50.98 points (0.3%) to 18,403.74.

The 10-year Treasury note yield (TNX) was roughly flat at 4.27%.

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

What’s up

  • Intel popped 6.15% after an analyst at Melius Research declared the company could be one of the big AI winners in the second half of this year.
  • Morphic Holding skyrocketed 75.06% on the news that Eli Lilly will acquire the drugmaker for $3.2 billion in cash.
  • SolarEdge climbed 9.26% thanks to an upgrade from “underperform” to “neutral” by Bank of America analysts, who see big upside and few downside risks ahead.
  • Corning rose 11.98% after management raised earnings guidance for the coming quarter thanks to higher demand due to the AI boom.
  • Lucid rose 7.85% on the news that its deliveries rose 70% in the second quarter.

What’s down

CITE: https://tinyurl.com/2h47urt5

Stat: 27. That’s a tally of some of the hospital mergers, acquisitions, joint ventures, affiliations, and partnerships that have been canceled since January 2022. (Becker’s Hospital Review)

Read: Health insurers received $50 billion from Medicare for diseases that doctors did not treat over three years, according to a recent analysis. (Wall Street Journal)

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HEDGE FUNDS: Understanding Fees and Costs

SPONSOR: http://www.MARCINKOASSOCIATES.com

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DEFINITION: A Hedge fund is an investment partnership with freer rein to invest aggressively in a wider variety of financial products than most mutual funds. A hedge fund’s purpose is to pool funds, maximize investor returns, and eliminate risk with hedging strategies. Hedge funds are generally considered more aggressive, risky, and exclusive than mutual funds. The hedge fund industry has grown tremendously since its inception. There are trillions of dollars of assets under management, more than 8,800 hedge fund managers, and over 27,000 funds globally

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

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Many physicians and other investors — even those that meet net worth guidelines — are surprised to learn that there exists a $500 – 999 billion, or more, alternative investment industry that is not generally marketed to the public. Such alternative investments have also been known as hedge funds or private investment funds.

Unlike mutual funds, these alternative investments can be structured in a wide variety of ways. Because of the very same regulations discussed above, these funds cannot be advertised, but they are far from illegal or illicit.

READ MORE: https://marcinkoassociates.com/hedge-funds/

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Novant/CHS Deal Scrapped after FTC Intervenes

By Health Capital Consultants LLC

In February 2023, Novant Health, a 19-hospital, non-profit health system operating throughout the Carolinas, agreed to acquire two North Carolina hospitals – Davis Regional Medical Center and Lake Norman Regional Medical Center – from Community Health System (CHS), a publicly-traded mega-system operating in 15 states.

After the $320 million deal was announced, the Federal Trade Commission (FTC) began an extensive review of the acquisition, and concluded that: (1) the transaction may substantially reduce competition; (2) create a monopoly; and (3) constitute an unfair method of competition. (Read more…)

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DAILY UPDATE: Earnings Season, the FOMC, Threads and Boeing

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Wall Street is counting down the hours until Friday, which is when Q2 earnings season kicks off. Investors are hoping anyone besides Big Tech will post impressive results to keep the rally going. Although the stock market has set record after record this year, it’s mostly been the work of tech giants. As of Tuesday, about 40% of S&P 500 companies were in the red for 2024.

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

Federal Reserve Chair Jerome Powell will give updates on the economy to Congress on Tuesday and Wednesday, where he’ll likely be asked about the prospect of interest rate cuts. Those plans could become clearer on Thursday, when the consumer price index inflation report drops.

CITE: https://tinyurl.com/2h47urt5

Meta’s Twitter clone, Threads, has 175 million monthly users one year after its launch, CEO Mark Zuckerberg said.

CITE: https://tinyurl.com/tj8smmes

Boeing will plead guilty to a criminal fraud charge stemming from two fatal crashes of 737 Max planes and pay an additional $243.6 million fine, allowing it to avoid a criminal trial sought by victims’ families. More here.

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OUR TAKE: Private Equity and Venture Capital

By Lon Jefferies MBA CMP™ CFP®

By Dr. David Edward Marcinko MBA CMP®

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Private equity and venture capital investments typically involve ownership of shares in a company and represent title to a portion of the company’s future earnings. However, private equity is an equity interest in a company or venture whose stock is not yet traded on a stock exchange.

Venture capital is typically a special case of private equity in which the investment is in a company or venture that has little financial history or is embarking on a high risk/high potential reward business strategy.

Like real estate, private equity and venture capital investments generally share a general lack of liquidity and a lack of comparability across different individual investments. The lack of liquidity comes from the fact that private equity and venture capital investments are typically not tradable on a stock exchange until the company has an IPO.

The lack of comparability is due to the fact that most private equity and venture capital investments are the result of direct negotiation between the investor/venture capitalist and the existing owners of the company  /venture.

With widely divergent terms and provisions across different investments, it is difficult to make general claims regarding the characteristics of private equity and venture capital investments.

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HEALTH INFORMATION TECHNOLOGY: Ransomware and Bankruptcy!

Bad things can happen in paperless practices, Doc

By Darrell Pruitt DDS

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“Illinois Hospital First To Shut Down Completely After Ransomware Attack”

-By Karl Bode for Techdirt, Jun 16th 2023.

“Such attacks can have a chain reaction on already broken hospitals and health care systems. Health care workers are sometimes forced to resort to pen and paper for patient charts and prescriptions, increasing the risk of potentially fatal error. Delays in care can also prove fatal. And ransomware is only one of the problems that plague dated medical IT systems whose repair is being made increasingly costly and difficult by medical health care system manufacturers keen on monopolizing repair.”

Remember the MCNA (Managed Care of North America) data breach that was reported by Bill Toulas in Bleeping Computer on May 29th? There have been new developments.

LINK: https://www.bleepingcomputer.com/news/security/mcna-dental-data-breach-impacts-89-million-people-after-ransomware-attack/?fbclid=IwAR29pojexxoxDrrjIbcQqAAgnw17L5xqMXGxCnnDk_ZL0-kIv2PCniVaG0Y

“Patients of a Florida-based dental insurance provider brought a proposed class action lawsuit alleging negligence over a ransomware data breach that leaked the private information of more than 8.9 million people on the dark web, saying they face a lifetime risk of having their identities stolen.”

David Minsky for Law 360

[June 16th, 2023]

If you are still using paper records, don’t change now.

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PHYSICIAN APPRAISAL ENGAGEMENTS: Investment Banking, FMV and Venture Capital

By Staff Reporters

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There are a myriad of reasons for obtaining a Fair Market Value [FMV], Venture Capital [VC} and/or Investment Banking [IB] funding 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

And, there are many cautions, too. On July 19, 2023, the Federal Trade Commission (FTC) and the Department of Justice (DOJ) released a draft update of its Merger Guidelines, which guides the regulatory agencies in their review of both mergers and acquisitions in evaluating compliance with federal antitrust laws.

The new Guidelines replace, amend, and consolidate the Vertical Merger Guidelines and Horizontal Merger Guidelines, which were published in 2020 and 2010, respectively.

Our Value Analysis: https://marcinkoassociates.com/fmv-appraisals/

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DAILY UPDATE: Home Health and Nurse Vacancies as Stock Markets Reach New Highs

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As home hospital programs continue to grow—employment in the home health industry is projected to increase by nearly 30% by 2029—so does the concern that home healthcare professionals are increasingly vulnerable to assault and harassment.

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

Here’s where the major benchmarks ended:

  • The S&P 500 index® (SPX)rose 30.17 points (0.54%) to 5,567.19; the Dow Jones Industrial Average® ($DJI) rose 67.87 points (0.17%) to 39,375.87; the NASDAQ Composite® ($COMP) climbed 164.46 points (0.9%) to 18,352.76.
  • The 10-year Treasury note yield (TNX) dropped nearly seven basis points to just below 4.28%.
  • The CBOE Volatility Index® (VIX) increased slightly to 12.45.

What’s up

  • Meta Platforms rose 5.88% a day after CEO Mark Zuckerberg posted a video of himself wearing a tux, holding an American flag and a beer, and wakeboarding. Shareholders apparently approve of such an absolute stud running the company.
  • Koss Corp. rose another 25.68% as the latest meme stock continues to rally for no reason at all.
  • Macy’s popped 9.48% after bidders looking to acquire the beleaguered retailer raised their offer from $6.6 billion to $6.9 billion.
  • Smith & Nephew rose 6.67% on the news that activist investor Cevian Capital has taken a 5% stake in the medical device maker.
  • Instructure Holdings rose 5.25% on the news that a bidding war is building for the education software company.

What’s down

  • Nvidia fell 1.91% after it received a rare analyst downgrade due to the company’s valuation.
  • Southwest sank 5.67% on the first full trading day after the company adopted a “poison pill” to fend off activist investor Elliott Management.
  • Budget airline companies took a blow after a Raymond James analyst downgraded the industry due to a “clear as mud” outlook for the third quarter. Frontier Group fell 6.79%, while Spirit Airlines dropped 8.70%.
  • Crypto-related stocks tumbled after bitcoin fell below $54,000 at one point today, though they recovered alongside the cryptocurrency later in the trading session. Coinbase Global fell 0.56%, Robinhood Markets dropped 0.98%, and MicroStrategy fell 1.56%.

CITE: https://tinyurl.com/2h47urt5

Stat: 9.9%. That’s the current vacancy rate for nurses in the US, down from 15.7% in 2023. (2024 NSI National Health Care Retention & RN Staffing Report)

PBMs: How pharmacy benefit managers are “driving up drug costs for millions of people, employers, and the government.” (the New York Times)

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PODCAST: How Financial Advisors Acquire Physician Clients

It’s About Deep Niche Knowledge [An AV Presentation]

By Vicki Rackner MD

Enter the CMPs vicki

AUDIO-VIDEO PRESENTATION

PODCAST; https://www.youtube.com/watch?v=W0SGlL0UzXE#t=22

More:

About the Author

Vicki Rackner MD, author, speaker, ME-P thought-leader and President of Targeting Doctors, helps financial advisors accelerate their practice growth by acquiring more physician clients. She calls on her experience as a practicing surgeon, clinical faculty at the University of Washington School of Medicine and nationally-noted expert in physician engagement to offer a bridge between the world of medicine and the world of business.

Conclusion

FROM BULL: To Sideways Markets to Nvidia

By Vitaliy Katsenelson CFA

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Today I am sharing with you an excerpt from a letter I wrote to IMA clients in the winter of 2023.

I discussed my condensed views on the stock market, economy, and our investment strategy. I think it is a good overview of where we are still today, almost a year and a half later. If you’ve read it before, skip to the end, where I share my updated thoughts on the Magnificent Seven and Nvidia.

READ MORE: From Bull to Sideways Markets to Nvidia

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DAILY UPDATE: Walmart, HHS and Geriatrics as Companies and Stock Market Still Rise

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HAPPY JULY FOURTH

The S&P 500 broke above 5,500 yesterday and stayed there for the first time in market history, notching yet another all-time high for the index—its 32nd this year alone. With so much bullishness it’s understandable that investors may be wondering if we’re at the top yet, but chartists suggests gains tend to beget gains. The bulls have too much momentum to stop now—and if/when the FOMC cuts rates later this year, it seems likely that we’ll see more all-time highs in 2024? Any thoughts.

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

The Biden administration has awarded $206.3 million of funding to clinician training programs across 42 universities and provider organizations to bolster the nation’s geriatrics care workforce. Programs will be able to integrate geriatrics training into primary care and will work to educate older adults’ families on their care needs. Health and Human Services, in its announcement, noted that primary care providers are a crucial source of care for much of the aging population.


As Walmart shutters its primary care clinics, the retail giant inked a deal to sell its MeMD telehealth business to health tech startup Fabric. Fabric provides a telemedicine platform for a range of customers, including provider groups, with the goal of improving the clinician and patient experience, as well as operational efficiency. The acquisition will expand its provider network, add virtual behavioral health to the company’s services and build on Fabric’s employer and payer solutions.


And…The U.S. Supreme Court has overturned the Chevron deference, stripping power from federal agencies to interpret and enforce regulations. Courts no longer have to defer to reasonable agency interpretations. One healthcare attorney told Fierce Healthcare he predicts the Centers for Medicare & Medicaid Services will be under a microscope from the courts going forward, and there will be more scrutiny towards provider reimbursement cuts, drug pricing regulation and the Inflation Reduction Act.

CITE: https://tinyurl.com/2h47urt5

Here’s where the major benchmarks ended:

  • The S&P 500 index®(SPX)rose 28.01 points (0.51%) to 5,537.02; the Dow Jones Industrial Average® ($DJI) fell 23.85 points (-0.1%) to 39,308.00; the NASDAQ Composite® ($COMP) gained 159.54 points (0.9%) to 18,188.30.
  • The 10-year Treasury note yield (TNX) dropped seven basis points to 4.36%.
  • The CBOE Volatility Index® (VIX) held steady at 12.09.

What’s up

What’s down

  • First Foundation plummeted 23.81% after the bank announced it will raise $225 million to shore up a balance sheet burdened by commercial real estate loans.
  • Constellation Brands fell 3.76% after the alcoholic beverage maker reported stronger than expected earnings but missed Wall Street’s expectations on revenue.
  • Simulations Plus slid 14.87% after it reported strong third-quarter earnings but announced it’s cutting its dividend.
  • CureVac popped then dropped 6.59% after GSK bought the rights to the smaller pharma company’s Covid-19 and flu vaccines for $1.6 billion.

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DAILY UPDATE: Pitch-Book Health Companies, SCOTUS and the Peaking Stock Markets

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SCOTUS: Two technology company cases involving Texas and Florida laws challenging social-media companies’ content moderation were sent to lower courts. SCOTUS thus effectively granted the companies a victory. The Supreme Court isn’t willing to blow up the internet just yet.

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

PitchBook released its analysis of digital health venture capital deals done in the first quarter. The first quarter saw downturns in telehealth and digital therapeutics, but opportunities exist in mental health chatbots and care search platforms.


Amedisys, a large home health provider, plans to divest a number of care centers to an affiliate of VitalCaring Group in advance of its planned merger with UnitedHealth Group later this year.


And … ACOs may soon be able to take a breath of fresh air, as CMS shared that it has no intention of punishing them for a $2 billion urinary catheter fraud scandal that rocked the industry.  

What’s up

  • Tesla rose another 10.06% today, continuing its push higher thanks to quarterly car deliveries that beat Wall Street’s expectations. Rivian Automotive rose 6.82% today after beating projections for their own deliveries as well.
  • Paramount Global rose 5.97% on a report from the New York Times that Barry Diller’s IAC may be exploring an acquisition of the embattled entertainment company. IAC fell just 0.26%.
  • Archer Aviation popped 8.92% after the air taxi manufacturer received a $55 million investment from Stellantis.
  • Oliveda International is up 19.81% today after the olive oil company announced massive quarterly revenue growth at a key subsidiary.

What’s down

  • Chewy fell yet another 2.24% as fallout from Roaring Kitty’s stake in the company continues to rattle investors.
  • Pure Storage plunged 4.15% after UBS analysts downgraded the stock to “sell,” citing its high valuation and overhyped AI potential.
  • Home builders took a beating after Citi analysts downgraded Lennar and D.R. Horton from “neutral” to “sell,” noting the housing market will remain soft in the second half of the year. Lennar dropped 1.61%, and D.R. Horton fell 1.35%.

Here’s where the major benchmarks ended:

  • The S&P 500 index rose 33.92 points (0.62%) to 5,509.01; the Dow Jones Industrial Average® ($DJI) climbed 162.33 points (0.41%) to 39,331.85; the NASDAQ Composite® ($COMP) rallied 149.46 points (0.84%) to 18,028.76.
  • The 10-year Treasury note yield (TNX) dipped four basis points to 4.43%.
  • The CBOE Volatility Index® (VIX) dropped to 12.03 after earlier trading at its lowest intraday level since late May.

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SCOTUS: Health policy leaders say patients, providers, and health systems should brace for more uncertainty and less stability in the healthcare system. Even routine government functions such as deciding the rate to pay doctors for treating Medicare beneficiaries could become embroiled in long legal battles that disrupt patient care or strain providers to adapt.

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DAILY UPDATE: Nurses & AI, Private Equity & CPAs, Public Companies and the Hot July Stock Markets

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Private equity gets a big accounting firm yet. The March story about private equity firm New Market Capital buying a $2.8 billion stake in accounting firm Grant Thorton was a big story. Private equity is gobbling up accounting firms, signaling a potential sea change in how accounting firms will operate in the future, with “more than half” of the top 20 accounting firms in talks with private equity.

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

Here’s where the major benchmarks ended:

  • The S&P 500® index (SPX) rose 14.61 points (0.27%) to 5,475.09; the Dow Jones Industrial Average® ($DJI) climbed 50.66 points (0.13%) to 39,169.52; the NASDAQ Composite® ($COMP) added 146.70 points (0.83%) to 17,879.30.
  • The 10-year Treasury note yield (TNX) rose 12 basis points to 4.47%, the highest level since May 30 and back above its 50-day moving average, a technically important move.
  • The CBOE Volatility Index® (VIX) slipped to 12.19.

Crude oil is up sharply over the last month amid rising Middle East tensions.

What’s up

What’s down

  • Chewy stock popped then dropped 6.63% after Roaring Kitty revealed a 6.6% stake in the pet products company.
  • GameStop shares fell 5.35% after CEO Ryan Cohen posted on Twitter/X for the first time in months to advertise a job opening.
  • Uber fell 2.17% and Lyft fell 0.92% on the news that Massachusetts now requires both companies to pay rideshare drivers $32.50 an hour, plus benefits.
  • Cruise stocks sank on the news that Hurricane Beryl is stronger than expected and will disrupt service throughout the Caribbean. Norwegian Cruise Line fell 5.86%, Carnival fell 5.40%, and Royal Caribbean fell 1.86%.

CITE: https://tinyurl.com/2h47urt5

The largest nursing union in the US, National Nurses United (NNU), is sounding the alarm about the use of artificial intelligence (AI) in healthcare. In April, the union’s affiliate California Nurses Association (CNA) protested an AI conference helmed by managed care consortium Kaiser Permanente. Like workers in other sectors who are worried about AI encroachment, the nurses fear that the tech is contributing to the devaluation of their skills amid what they say is already a “chronicunderstaffing crisis, nurses reported in an NNU survey of 2,300 registered nurses and members in early 2024.

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DAILY UPDATE: Wall Street Stocks, Dow Dogs, Commodities, Gold, the Fed, Yen and Bitcoin

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If you can believe it, Friday was the final trading day of the first half of 2024. It might be a good time to reflect on your New Year’s resolutions to see how you’re measuring up halfway through the year.

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Dogs of the Dow: The 139-year-old index has never looked more its age, with components Nike, Intel, and Boeing all down more than 30% in 2024. The Dow has gained less than 4% this year.

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But, the S&P 500 gained a sublime 15% in H1, and Nvidia alone was responsible for more than a third of that gain. The maker of AI chips surged ~150% since Jan. 1st to become the most valuable company in the USA at one point.

Going into 2024, investors were expecting the Fed to cut interest rates six times. There hasn’t been a single rate cut yet, but that hasn’t stopped the S&P from notching 31 all-time closing highs, good for the second-best tally of records this century. Stocks have overcome the Fed’s delay thanks to strong earnings, a sturdy economy, and AI fever.

Commodities soar and a currency plummets. Cocoa boomed nearly 85% over shortage concerns. Gold hit a record high last month. The Japanese yen has slumped to a 38-year low against the US dollar.

Bitcoin got a boost from new ETFs, but it’s getting boring.

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CORPORATE: Entrants in Healthcare Struggle

By Health Capital Consultants LLC.

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On April 30, 2024, retail giant Walmart announced their closure of Walmart Health, a network of 51 health centers that provided “primary and urgent care, labs, x-ray and diagnostics, behavioral health, dental, optometry and hearing services.” Walmart cited the lack of profitability, escalating costs of operation, and challenging environment for reimbursement as the reasons behind Walmart Health’s unsustainability.

This Health Capital Topics article discusses Walmart’s closures, the other corporate entrants struggling in the healthcare market, and what these challenges indicate for the primary care space. (Read more…)

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NFTs 101: Taxes, Risks, and More

Randy Frederick

Nonfungible tokens have become the latest investment craze. Here’s what you need to know.

Until recently, nonfungible tokens (NFTs) were written off by many as a virtual fad and a waste of money. After all, why would someone pay $2.9 million to own the very first tweet when anyone with internet access can view it for free?

But when auction house Christie’s sold the NFT of Everydays: The First 5000 Days, a collage by the artist Beeple, for $69.3 million in March 2021, it suddenly put this emerging asset class on par with collecting a Picasso (whose heirs have jumped on the digital bandwagon by selling NFTs of the artist’s ceramics).

So, what’s all the fuss about?

The basics

Like cryptocurrencies, NFTs are stored on a blockchain, which is a digital, publicly available transaction ledger. However, while a single bitcoin can be exchanged for any other bitcoin—just as a $1 bill can be exchanged for any other $1 bill—each NFT is unique (i.e., nonfungible). In that sense, NFTs are more like the Hope Diamond or Picasso’s Guernica—a one-of-a-kind work for which there is no substitute.

Indeed, an NFT’s inherent scarcity, whether because it’s a unique piece of art or a limited-issue collectible, makes it potentially lucrative—but also substantially less liquid than, say, your average stock or bond. As a result, you may need to drop the price or hold on to your NFT if the demand isn’t there when you want or need to sell it. Other risks include:

  • Security: Like bitcoin, NFTs require a private key that functions as a password. If your key is lost or stolen, you may never again be able to access your NFT. Other security risks involve replicas that purport to be the original—as with any collectibles marketplace—and fraudulent sites designed to steal private keys and their attendant assets.
  • Taxation: Although the IRS has yet to issue specific guidance, NFTs are generally treated as collectibles. As such, if you sell an NFT you’ve held on to for less than a year, any short-term gains will be taxed as ordinary income. Any gains on an NFT held for a year or longer will be taxed at a top collectibles rate of 28%—plus a 3.8% net investment income tax if your modified adjusted gross income exceeds $200,000 ($250,000 for married couples).

Where to start

If, after careful consideration, you’re still interested in dipping your toe in NFT waters, you’ll first need to do three things:

  1. Pick a marketplace: To buy or sell NFTs, you’ll need to choose a reputable marketplace. Both Nifty Gateway and OpenSea are popular, although specialty marketplaces also exist, including ArtOfficial if you’re a fine-art collector and NBA Top Shot for basketball enthusiasts.
  2. Get a wallet: Shopping through most NFT marketplaces requires a Web3 wallet, such as MetaMask, that can store both cryptocurrencies and NFTs. Some marketplaces, like Nifty Gateway, will store your NFT, but you’ll have to pay a fee to transfer it to another wallet should you wish to do so later.
  3. Buy cryptocurrency: Some marketplaces accept payment in so-called fiat currencies, such as the U.S. dollar. However, many marketplaces are built on the Ethereum blockchain and prefer to transact in its native cryptocurrency, ether.

Tread with caution

Although the popularity of NFTs has exploded in the past year, with first-quarter sales topping $11 billion by mid-March 2022—up from $53 million for the fourth quarter of 2020—only time will tell if NFTs will realize their long-term potential or fall tragically short of it. 

Either way, it will be fascinating to see how this new form of digital authentication changes how we invest. (Ernst & Young, for example, is working on NFT-inspired technology that can help collectors track the provenance of fine wines.)

Quantum leap

NFTs experienced exponential growth in 2021.Beginning in Q3 2017, quarterly NFT trading volume remained under $20 million until jumping to $28.01 million in Q3 2020, then $52.98 million in Q4 2020. It went above $1 billion in Q1 2021 and, as of Q1 2022, has remained above $10 billion since Q3 2021.

DappRadar.com

Sales figures include only on-chain transactions conducted on the 49 NFT marketplaces that DappRadar tracks, excluding LooksRare.

*Q1 2022 data as of 03/25/2022.

ASSESSMENT

For the time being, however, there’s a lot to be said for taking a go-slow approach to this new asset class and all the risks it entails. 

In general, those interested in crypto assets like NFTs are wise to limit their exposure to no more than 1% of investable assets.

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Are We Over-Optimizing Portfolio Asset Classes?

Too Many Other Asset Classes?

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

Some financial analysts believe that the focus on asset classes may have gone too far as physicians and other investors have sought to “over optimize” their portfolios.

In fact, colleague David Loeper, CEO of Wealthcare Capital Management, explained this concept as follows:

“Where things have really got off track has been the insistence on breaking asset classes into sub-classes by style, market capitalization, etc. The unpredictability of all the inputs into our optimizers, even over long periods of time, has been ignored. We have attempted to take efficient portfolios of stocks, bonds and cash and make them even more efficient by breaking the unpredictable asset classes into even less predictable sub-classes. This has all been done into the pursuit of “efficiency” as the proposal was validated by the Brinson & Beebower study, which purports to find that over 90% of the investment return variance is explained by asset allocation. The risk that you produce inefficient portfolios INCREASES if you increase the number of “asset classes” for which you must forecast not only the risk and returns but also each asset class’ correlation to the others.”

Assessment

If true, and I think it is a valid point, the results of the optimizer and your resulting portfolio’s efficiency is based on the accuracy of the inputs and NOT THE NUMBER OF THE INPUTS.

Stock_Market

Or, is this like the TNTC situation in cell cultures and microbiology [Too Numerous To Count].

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ARTIFICIAL INTELLIGENCE: Healthcare

By Staff Reporters

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The healthcare industry has tried for years—but to little avail—to figure out how artificial intelligence (AI) can be used to make work easier and improve patient care.

Despite the middling success healthcare has had with AI, Andreessen Horowitz (a16z), the largest venture capital firm in the US, has bet big on healthcare AI startups in the past year. The firm has invested in at least four startups and co-led three funding rounds totaling $328 million.

Investment partner Daisy Wolf and general partner Vijay Pande at a16z wrote in an August blog post that the VC firm is aware that “the AI hype cycle has hit healthcare before.” But, the two partners wrote, “we’re excited by today’s overlap of data availability, public foundation models, and widespread interest.”

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DAILY UPDATE: Walgreens, Healthcare Fraud and Opioids as Stock Markets Hurt

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In an interview with the Wall Street Journal, CEO Tim Wentworth said the pharmacy chain Walgreens will shutter a significant share of its 8,600 locations in the US. The closures are part of a broader attempt to boost the ailing company, which also includes reducing its stake in the primary care business VillageMD. Wentworth said the company can reassign most employees instead of conducting layoffs. Shares cratered yesterday after Walgreens whiffed on Wall Street’s earnings projections due to weak consumer spending.

And, read how some counties reduced opioid overdose deaths during the pandemic. (Politico)

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What’s up

  • Oliveda International, which makes beauty products from olive oil, rose 38.33% for no apparent reason. Maybe people just really like the feel of extra virgin olive oil on their skin?
  • Infinera popped 16.38% after Nokia announced it would acquire the telecommunications hardware manufacturer for $2.3 billion.
  • Synchrony Financial rose 6.17% after a Baird analyst initiated coverage of the financial services company with an outperform rating.
  • Regional banking stocks rose on the hopes that a good PCE reading means a better chance of the Fed cutting rates soon. Regions Financial rose 3.83%, while Citizens Financial Group rose 3.16%.

What’s down

A late round of selling in the Treasury market sent yields to fresh highs as the day ended so here’s where the major benchmarks ended:

  • The S&P 500® index (SPX) dipped 22.39 points (0.41%) to 5,460.48; the Dow Jones Industrial Average® ($DJI) fell 45.20 points (0.12%) to 39,118.86; the NASDAQ Composite® ($COMP) lost 126.08 points (0.71%) to 17,732.6.
  • The 10-year Treasury note yield climbed nine basis points to 4.38%.
  • The CBOE Volatility Index® (VIX) moved up slightly to 12.43.

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Nearly 200 people have been charged for their roles in various health care fraud schemes across the U.S. that federal authorities say amounted to over $2.7 billion in intended losses, the Justice Department announced. Attorney General Merrick Garland said charges against 193 people, including 76 doctors, nurse practitioners, and other licensed medical professionals in 32 different federal districts. The defendants were charged over a two-week sweep involving numerous law enforcement agencies nationwide, resulting in the seizure of more than “$231 million in cash, luxury vehicles, gold, and other assets,” according to Garland.

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BEWARE FINANCIAL ADVISORS: ChatGPT and A.I. is Coming for Your Job?

Finance Jobs (Financial Analysts, Personal Financial Advisors and Consultants, etc.)

By Staff Reporters

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Like market research analysts, financial analysts, personal financial advisors, and other jobs in personal finance that require manipulating significant amounts of numerical data can be affected by Artificial Intelligence, Mark Muro, a researcher at The Brookings Institute, said recently.

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“AI can identify trends in the market, highlight what investments in a portfolio are doing better and worse, communicate all that, and then use various other forms of data by, say, a financial company to forecast a better investment mix.” 

These analysts make a lot of money, he said, but parts of their jobs are auto-matable.

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DAILY UPDATE: Tenet, Rivian, Yen, Public Companies and the Light Stock Markets

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Stat: 40%. That’s how much Tenet Healthcare’s shares jumped in Q1. (Yahoo Finance)

Stat: 12%. This is how much the yen has weakened so far this year against the US dollar, which has people wondering whether the Japanese government will need to intervene. (Bloomberg)

Quote: “We believe the opportunity ahead is significant.”—RJ Scaringe, CEO and co-founder of Rivian, commenting on Volkswagen Group’s plans to invest as much as $5 billion in the EV company. (CNBC)

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What’s up

  • McCormick & Co rose 4.34% after the company posted spicy earnings results, absolutely crushing estimates.
  • Arista Networks rose 3.92% after Citigroup reiterated its buy rating for the cloud company but increased its price target from $330 to $385.
  • BlackBerry is still a company, and rose 10.41% after a berry good first quarter.

What’s down

  • Walgreens Boots Alliance plummeted 22.16% due to a worse-than-expected earnings report that saw the company slash its full-year guidance.
  • Hims & Hers dropped 7.19% after Hunter Growth Capital accused the company of using a shady supplier for its new weight-loss drugs.
  • Levi Strauss crashed 15.27% in a denim downfall for the ages, with second quarter earnings missing expectations after consumers spent less on blue jeans.
  • Micron Technology slid 7.12% despite beating analyst expectations in the third quarter. Unfortunately, management isn’t as bullish as analysts about the rest of the year.
  • Chewy fell 0.03% despite a tweet from Roaring Kitty of a cartoon dog—which is apparently all it takes to move markets these days.

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The U.S. government’s final gross domestic product (GDP) estimate announced early Thursday included a downward revision to quarterly consumer spending.

Treasury yields could move on the data, especially if the report is “hotter” than expected. Yields fell Thursday following mostly soft U.S. economic readings this morning.

Here’s where the major benchmarks ended:

  • The S&P 500® index (SPX) rose 4.97 points (0.1%) to 5,482.87; the Dow Jones Industrial Average® ($DJI) rose 36.26 points (0.1%) to 39,164.06; the NASDAQ Composite® ($COMP) rose 53.53 points (0.3%) to 17,858.68.
  • The 10-year Treasury note yield lost two basis points to 4.29%.
  • The CBOE Volatility Index® (VIX) fell to 12.29, its lowest close since June 13.

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ETFs and Tax Efficiency

A Better Financial Product than Mutual Funds?

[By JD Steinhilber]

Exchange-traded funds are inherently more tax efficient than actively managed mutual funds, which have been rightly criticized for their tax-inefficiency. Tax-efficiency is a critical issue for financial advisors and physician-investors because delaying the taxation of appreciating assets normally enhances after-tax returns over time.

For example, it is estimated that between 1994 and 1999, investors in diversified U.S. stock mutual funds lost, on average, 15% of their annual gains to taxes. The tax inefficiency of mutual funds is the result of portfolio turnover at the fund level caused by two factors: the trading activity of the portfolio manager and the activity of other shareholders in the fund.       

The Mutual Fund Performance / Redemption Problem

Due to fund manager efforts to outperform benchmarks, actively managed mutual funds almost invariably experience more “manager-driven” portfolio turnover than ETFs, where trading is generally driven by change in the composition of the underlying indexes being replicated. Mutual fund portfolio turnover can also be caused by the actions of shareholders in the fund. 

In a mutual fund structure, redemption requests by shareholders can force the fund to sell securities to raise cash. These sales may give rise to gains that, by law, must be distributed and will be taxed to all shareholders in the fund.

Unique Architectural Structure

ETFs, in contrast, are structured in such a way that the actions of one shareholder do not result in tax consequences to another shareholder.  ETFs accomplish this through the innovative architecture in which ETF “units” (which are subdivided into individual ETF shares) are created and redeemed to accommodate the fluctuating demand for the shares of a particular ETF.

ETF units are created and redeemed by institutional investors though non-taxable, “in-kind” transactions, which means that only securities – not cash – change hands in the creation and redemption process. 

An example of this process would be an institution exchanging a portfolio of stocks constituting the S&P 500 index for an S&P 500 ETF “creation unit”. And, once created, the S&P 500 ETF can be subdivided into individual shares that are tradable by investors on the exchange.   

Assessment

As a result of the above – physicians may be insulated from a tax standpoint by the actions of other investors – because taxable transactions don’t take place at the fund level.  Instead, ETF shares are traded between retail investors in transactions on the exchanges, so the tax accounting becomes very similar to that associated with individual stocks.    

Have you used ETFs in your own portfolio, and what is your tax efficiency experience with them; truth or hype? 

Conclusion

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DAILY UPDATE: MSFT Teams, Deloitte, HealthcCare Cyber Attacks as Markets Lift

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The EU says Microsoft violated its antitrust laws by bundling Teams with Office, potentially setting the stage for a major fine.

And, Deloitte has billions of dollars’ worth of Medicaid contracts, but the consultancy’s eligibility systems are full of errors. (KFF Health News)

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Here’s where the major benchmarks ended:

  • The S&P 500® index (SPX) rose 8.6 points (0.16%) to 5,477.9; the Dow Jones Industrial Average® ($DJI) added 15.64 points (0.04%) to 39,127.8; the NASDAQ Composite® ($COMP) climbed 87.5 points (0.49%) to 17,805.16.
  • The 10-year Treasury note yield rose 8 points to 4.32%.
  • The CBOE Volatility Index® (VIX) eased to 12.5

What’s up

What’s down

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The disastrous ransomware attacks on Change Healthcare and Ascension this year ran up staggering costs and put a spotlight on the healthcare sector’s vulnerability. But healthcare orgs are hardly new to eye-popping bills after a major hack. Analyzing attacks on organizations in 16 countries, IBM/Ponemon Institute has shown healthcare to be the industry with the highest cost per data breach for over a decade, coming in at an average hit of $10.93 million in 2023.

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The correlation between income and cognitive abilities as measured by IQ?

Is there a correlation between higher incomes and high cognitive abilities as measured by IQ tests?

By Rick Kahler MS CFP®

“The higher your IQ, the greater the probability you will earn more than average.”

Like many people, I have believed this common money script to be true. It seems to make sense that the smarter you are, the more likely you are to succeed financially. Many of us assume there must be a correlation between higher incomes and high cognitive abilities as measured by IQ tests.

The Studies

I was surprised, however, to learn that this is not the case. A study published in November 2016 in the Proceedings of the National Academy of Sciences showed that a high level of innate intelligence is no indicator of financial success.

A December 2016 article in Bloomberg cited one of the co-authors of the study, economist James Heckman. When he asks how much of the difference between people’s incomes can be tied to their IQ’s, most people guess between 25% and 50%. The actual number is about one or two percent.

The study found that personality plays a much bigger part than IQ in financial success. The personality trait that was most strongly associated with earning a high income was conscientiousness.

Conscientiousness?

What, then is conscientiousness? One definition from the English Oxford Dictionary is “wishing to do one’s work or duty well and thoroughly.” A conscientious person is described as diligent, dedicated, perseverant, self-disciplined, meticulous, attentive, careful, studious, rigorous, and hard-working.

The article also warned to be careful not to confuse a high IQ with good grades. They are two very different things. It found that grades and the results of achievement tests were better than raw IQ scores at predicting success. Cognitive ability is only one factor in getting good grades. There are several non-cognitive factors that heavily influence grades, such as perseverance, good study habits, and the ability to collaborate. All of these, of course, are qualities of being conscientious.

The study also found that a secondary trait influencing financial success was curiosity. This is one of the nine traits commonly found in people with high emotional intelligence, according to Dr. Travis Bradberry, author of Emotional Intelligence 2.0.

In a November 2016 article titled “9 Habits Of Highly Emotionally Intelligent People”, Bradberry says that emotionally intelligent people are curious about everyone around them. “Curiosity is the product of empathy, one of the most significant gateways to a high EQ.” Bradberry says the more a person cares about other people and what they’re going through, the more curiosity they will have about them.

The bottom line in financial success is that personality counts, a lot.

This is good news for parents of young children. While you can’t do much to influence a child’s IQ, you can influence conscientiousness and curiosity. One way to do this is through direct teaching.

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Direct Teaching

For example: Give them some responsibility for household chores. Provide work spaces and schedules to foster good study habits. Help them explore and learn about things they show interest in. Show them that you appreciate emotional intelligence and relationships. Encourage them to finish what they start, and celebrate and appreciate their successes when they persevere.

To teach financial conscientiousness, encourage kids to save for things they want. Allow them to experience the consequences of financial misjudgments like spending all their allowance the minute they get it. Involve them in family projects like planning and saving for a vacation.

Of course, just as with most behaviors and personality traits we would like our children to develop, the most effective form of teaching is by example. The best way to raise conscientious and curious kids is to let them see us being conscientious and curious ourselves. 

Conclusion

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DAILY UPDATE: Gun Violence, Health & Public Companies as Technology Stocks Rebound

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The U.S. surgeon general just declared gun violence a public health crisis, driven by the fast-growing number of injuries and deaths involving firearms in the country. The advisory issued by Dr. Vivek Murthy, the nation’s top doctor, came as the U.S. grappled with another summer weekend marked by mass shootings that left dozens of people dead or wounded.

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Here’s where the major benchmarks ended:

  • The S&P 500 index rose 21.43 points (0.39%) to 5,469.30; the Dow Jones Industrial Average® ($DJI) fell 299.05 points (0.76%) to 39,112.6; the NASDAQ Composite® ($COMP) gained 220.84 points (1.26%) to 17,717.65.
  • The 10-year Treasury note yield (TNX) fell slightly to 4.24%.
  • The CBOE Volatility Index® (VIX) dropped to 12.84. 

What’s up

  • Nvidia rose 6.76% as investors realized they could buy shares of the world’s biggest semiconductor company at a discounted price.
  • Trump Media & Technology Group rose another 8.50% today on the hopes of a cash infusion, as well as hype ahead of Thursday’s presidential debate.
  • Carnival popped 8.85% after it beat analyst expectations for the second quarter, and raised its profit forecast for the rest of the year.
  • Novo Nordisk rose 3.25% after its weight-loss drug Wegovy was approved in China.
  • Enovix soared 35.05% on the news that it signed a major deal to provide VR headset batteries for an as-yet-unnamed California company.

What’s down

  • Pool Corp., maker of…pools, fell 8.04% today after cutting guidance for the year ahead.
  • SolarEdge Technologies dropped 20.60% through no fault of its own—instead, a key customer declared bankruptcy, and will be unable to pay the solar power company the $11.4 million it is owed.
  • Airbus fell 9.41% after the company announced it is cutting financial guidance for the remainder of 2024 thanks to supply chain snarls and higher costs.
  • Auto dealer stocks continue to suffer the effects of a massive cyberattack on CDK, a key supplier of dealership management software. The company says its systems will remain down until June 30, but in the meantime shares of Autonation fell 2.04%, Sonic Automotive dropped 2.56%, and Group 1 Automotive slid 2.49%.

CITE: https://tinyurl.com/2h47urt5

Digital health company Sharecare has agreed to be acquired by private equity firm Altaris for $1.43 in cash per share, or about $518 million.


Nearly three months after Kaiser Permanente’s Risant Health acquired Geisinger Health, the group has now agreed to terms with Cone Health in North Carolina.


And ... UnitedHealthcare says its Surest unit improves spending and utilization across all age groups and for people with various conditions.

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PHYSICIANS BEWARE: Financial “Advice”

BEWARE THE “DOCTOR EFFECT”

Bread for the advisor – Crumbs for the client

By Dr. David Edward Marcinko MBA CMP

SPONSOR: http://www.MarcinkoAssociates.com

Several years ago a group of highly trusted and deeply experienced financial services professionals and estate planners noted that far too many of their physician clients, using traditional stock brokers, management consultants and financial advisors, seemed to be less successful than those who went it alone. These Do-it-Yourselfers [DIYs] had setbacks and made mistakes, for sure. But, the ME Inc. doctors seemed to learn from their mistakes and did not incur the high management and service fees demanded from general or retail one-size-fits-all “advisors.

”In fact, an informal inverse relationship was noted, and dubbed the “Doctor Effect.” In others words, the more consultants an individual doctor retained; the less well they did in all disciplines of the financial planning and medical practice management, continuum.

Of course, the reason for this discrepancy eluded many of them as Wall Street brokerages and wire-houses flooded the media with messages, infomercials, print, radio, TV, texts, tweets, and internet ads to the contrary. Rather than self-learn the basics, the prevailing sentiment seemed to purse the holy grail of finding the “perfect financial advisor.” This realization was a confirmation of the industry culture which seemed to be: Bread for the advisor – Crumbs for the client!

And so, at D.E. Marcinko & Associates, our informed cadre’ of technology focused and highly educated doctors, nurses, financial advisors, attorneys, accountants, psychologists and educational visionaries decided there must be a better way for their healthcare colleagues to receive financial planning advice and related management services within a culture of fiduciary responsibility.

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PODCASTS: Avoid 5 Marketing Mistakes Financial Advisors Make Engaging Doctors & More!

Our ME-P MARKETING Colleague

By Vicki Rackner MD

Have you been frustrated in your efforts to attract, engage and serve doctors? In this episode, colleague Dr. Vicki Rackner shares 5 common mistake financial advisors make; with more.

PODCAST: https://www.listennotes.com/podcasts/the-academy-of/avoid-the-5-mistakes-l65YVT4UP3S/

PODCAST: https://www.youtube.com/watch?v=Dr5GXKRd3Xg

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DAILY UPDATE: Dental Staffing, Various Companies & the Stock Markets

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Here’s where the major benchmarks ended:

  • The S&P 500 index lost 16.75 points (0.31%) to 5,447.87; the Dow Jones Industrial Average ($DJI) gained 260.88 points (0.67%) to 39,411.21; the NASDAQ Composite ($COMP) dropped 192.54 points (1.09%) to 17,496.82.
  • The 10-year Treasury note yield (TNX) fell one basis point to 4.25%.
  • The CBOE Volatility Index® (VIX) ended slightly up at 13.47, the highest close since May 30.

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

What’s up

What’s down

  • Nvidia dropped 6.68% as the semiconductor stock continues to fall, with the stock entering correction territory earlier today—a sentence we never thought we’d write.
  • Eli Lilly’s weight-loss drug Zepbound can also help people with sleep apnea, cutting into the sleep-aid market, sending shares of ResMed down 11.40% and Inspire Medical Systems down 16.45% on the news.
  • Bitcoin-connected stocks are taking a hit as the crypto selloff continues. Coinbase Global fell 6%, while MicroStrategy fell 7.52%.

CITE: https://tinyurl.com/2h47urt5

The dental industrylike other parts of healthcare—is facing significant staffing challenges. The US is in need of nearly 10,000 dental professionals and has more than 6,800 health professional shortage areas (HPSAs), which the US Department of Health and Human Services defines as “a geographic area, population, or facility with a shortage of primary care, dental, or mental health providers and services.”

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DAILY UPDATE: Genome Testing, the Stock Markets and Microsoft, Apple & Meta

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Apple and Meta are considering an AI partnership. The two tech giants are discussing integrating Meta’s generative AI model into Apple’s new AI platform, Apple Intelligence, the WSJ reports. Instead of building an in-house AI model, Apple opted for the partnership route and previously announced a deal with OpenAI to bring ChatGPT to iPhones. Apple has also reportedly held talks with AI startups Anthropic and Perplexity to fuse their AI models with Apple Intelligence and get that sweet, sweet distribution Apple provides.

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

Genome testing can spot rare disease risks at birth. Newborn babies typically get blood tested for dozens of diseases, but some parents living in North Carolina and New York have recently been able to get their bundles of joy screened for hundreds of potentially life-threatening medical conditions that regular tests can’t catch thanks to a growing field called genomic medicine. Early results from two ongoing studies are very promising, the Washington Post reported, but scaling the new type of testing could be tricky: A full genome read (which covers all of your DNA) costs around $1,000 per patient. Still, research into the cost-benefit of genome sequencing has found that it can ultimately save families money on hospital care.

CITE: https://tinyurl.com/2h47urt5

Markets: Sweating the upcoming election? Investors aren’t. The S&P 500 is on track for its best first-half performance in an election year going back to 1976, per Dow Jones Market Data. And as trading begins Monday morning, Microsoft is back on the Iron Throne as the US’ most valuable company following Nvidia’s stumbles at the end of last week.

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Understanding Bond Duration

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

fp-book1

Because of today’s stock market volatility, and virtual collapse in some banks and world equities, an interesting question often arises when the physician-investor considers investing in bonds; as more and more are doing.

Question

How much will a bond’s price change from a 1 percent change in interest rates? 

Duration Defined

To answer this, consider the concept of duration.  According to Jeff Coons PhD, CFP™, a bond’s duration is the weighted average life of its cash flows.

Thus, if your bond pays $60 per year in coupon payments for ten years and $1,000 in par value at the end of the ten years, the duration is the length of time that it takes for you to receive the present value of the coupon payments and par value. 

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

Rule-of-Thumb

How does this help answer the original question?  There is a handy rule-of-thumb that says the duration of a bond times the change in market interest rates is the approximate price change of the bond.  Thus, the price of a ten-year Treasury bond with a duration of approximately 7.8 years will appreciate (decline) by about 7.8 percent with a drop (increase) in interest rates of 1 percent.

Assessment

For each of the two basic types of bonds, the duration is the following:

1. Zero-Coupon Bond – Duration is equal to its time to maturity, and

2. Vanilla Bond – Duration will always be less than its time to maturity. 

Channel Surfing the ME-P

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The BANKS: https://www.fool.com/investing/2023/03/30/why-is-everyone-talking-about-duration/

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DAILY UPDATE: Reverse Aging, Credit Card Competition Act, Nvidia and a Market Re-Cap

MEDICAL EXECUTIVE-POST TODAY’S NEWSLETTER BRIEFING

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The de-aging biz: Time to pull back the hospital curtain and see who’s behind the booming longevity market. This article, sponsored by Timeline, lays out who’s making $$$ on “reverse aging.*

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

  • The S&P 500 and NASDAQ have often outperformed the Dow in recent years thanks to their focus on tech, as well as their market-cap weighting vs the Dow’s price weighting. When tech stocks roar higher, the younger indexes rise above their older peer—but the last few days have seen a sell off of tech stocks led by NVIDIA, bringing the S&P 500 and NASDAQ lower to end the week while the Dow has continued to rise.
  • Bonds remained unchanged for most of the day, ending the trading session flat as investors parse through a week of economic data and prepare for next week’s PCE report.
  • Gold plunged after the dollar rose, making it more expensive for gold bugs to hold the precious metal.
  • As for oil, read on to learn why crude has high hopes today but may not be a smart investment tomorrow.

Nvidia faltered for the second day in a row, falling off the world’s most valuable company perch and shedding $220+ billion in market cap. But the S&P 500 has gone 377 days without a 2.05% sell-off, the longest streak since the 2008 financial crisis, per CNBC.

CITE: https://tinyurl.com/2h47urt5

The Credit Card Competition Act is proposed legislation in Congress that could fundamentally change credit card systems. If passed, it could devastate the future of cash-back and travel rewards.

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PODCAST: What is Public Health?

By American Journal of Public Health

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Public health is now part of the political conversation but everyone doesn’t understand it in the same way. Hence the idea of interviewing Governor John Kasich, former governor of Ohio, who has been promoting a greater attention to public health, about what is public health for him.

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INSURANCE: https://www.amazon.com/Dictionary-Health-Insurance-Managed-Care/dp/0826149944/ref=sr_1_4?ie=UTF8&s=books&qid=1275315485&sr=1-4

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TECH: https://www.amazon.com/Dictionary-Health-Information-Technology-Security/dp/0826149952/ref=sr_1_5?ie=UTF8&s=books&qid=1254413315&sr=1-5

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PODCASTS: The Physician-Patient Population Health Mis-Match

By Eric Bricker MD

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PODCAST: https://medicalexecutivepost.com/2022/10/23/podcast-help-your-medical-practice-embrace-population-health/

Population Health: https://medicalexecutivepost.com/2022/07/12/enter-population-health-management/

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PODCAST: Hospital Healthcare Finance Explained

By Eric Bricker MD

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17 Math Equations that Changed the World

How many do you know?

via Ian Stewart

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[Click image to enlarge]

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Editor’s Note:

I have a bit of math background in algebra, geometry and trigonometry as well as integral and differential calculus, and parametric and non-parametric statistics.  So, this ME-P was a no-brainer. Enjoy with thanks to Ian.

So, how many equations do you know? Please tell us?

Dr. David E. Marcinko MBA MEd CMP

Conclusion

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

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

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

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

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DAILY UPDATE: Amazon Pharmacy, Healthcare Spending Boom, Companies and the Bi-Hybrid Markets

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Amazon Pharmacy announced on June 18 that, effective immediately, its RxPass medication delivery service will be available to more than 50 million Medicare beneficiaries, a move the company says could save up to $2 billion annually for the federal health insurance program.

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

Here’s where the major benchmarks ended:

  • The S&P 500 index fell 8.55 points (0.2%) to 5,464.62, up 0.6% for the week; the Dow Jones Industrial Average® ($DJI) gained 15.57 points (0.04%) to 39,150.33, up 1.5% for the week; the NASDAQ Composite® ($COMP) shed 32.23 points (0.2%) to 17,689.36, little changed for the week.
  • The 10-year Treasury note yield (TNX) was little changed at 4.255%.
  • The CBOE Volatility Index® (VIX) dipped 0.06 to 13.22.

What’s up

  • Sarepta Therapeutics soared 30.14% thanks to FDA approval of Elevidys, its new Duchenne muscular dystrophy treatment.
  • Zealand Pharma rose 18.62% after Phase 1b trial results revealed its new weight-loss drug could compete with Ozempic.
  • Asana jumped 14.95% on the news that its board has approved a share repurchase program of up to $150 million of its own stock.
  • CarMax shares rose 0.37% after the company reported first-quarter earnings. The number isn’t big, but the performance is impressive considering the used car company posted a 33% decline in profits.
  • Hertz Global popped 15.95% after the company announced it was raising the size of its bond offering to $1 billion as it looks to update its fleet of rental cars.

What’s down

  • Nvidia fell another 3.22% today as the sell off continued, with investors taking profits after a record run higher.
  • Smith & Wesson Brands dropped 12.87% after the gun maker beat earnings forecasts but announced that next quarter’s sales will be lower than expected.
  • LendingTree slid 2.48% after a Bloomberg report revealed that hackers are auctioning off stolen customer data.
  • Palantir fell 6.78% after the company earned an analyst downgrade for its “gluttonous valuation,” a phrase you never want to hear as an investor.
  • Bitcoin mining stocks took a hit today, selling off after popping higher yesterday after bitcoin prices rallied. Marathon Digital Holdings dropped 7.02%, Riot Platforms fell 8.35%, and CleanSpark sank 9.81%.

CITE: https://tinyurl.com/2h47urt5

With a record number of people insured and seeking healthcare services post-pandemic, US health spend growth is outpacing GDP growth, and is expected to keep doing so through 2032, according to a June 12 report from actuaries at the Centers for Medicare and Medicaid Services (CMS). By 2032, CMS actuaries project healthcare spending will total $7.7 trillion and make up 19.7% of total US GDP, compared to $4.8 trillion and 17.6% of GDP in 2023.

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DAILY UPDATE: Bilt, Mortgage Rates, Private Equity in Behavioral Health and the Stock Markets

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Wells Fargo is losing $10 million per month on its partnership with Bilt, whose credit card offers users reward points for paying rent, and is looking to renegotiate, the WSJ reports. Apple has stopped offering its buy now, pay later program, Apple Pay Later, after partnering with outside companies, including Affirm.

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

Private equity (PE) is all over healthcare, with investment firms owning more than 400 hospitals around the US. But as the country faces a mental health crisis—US Surgeon General Vivek Murthy called it the “the defining public health crisis of our time”—PE has its sights set on one of the fastest-growing areas of the industry: behavioral health care. PE has accounted for over 60% of all behavioral health deal flow since 2018, and firms like Thurston Group and Five Points Capital now own about a quarter of facilities offering behavioral health care in some states, according to a recent cross-sectional study published in JAMA Psychiatry.

CITE: https://tinyurl.com/2h47urt5

U.S. markets were closed Wednesday for the Juneteenth holiday. Here’s where the major benchmarks ended:

  • The S&P 500 index fell 13.86 points (0.3%) to 5,473.17; the Dow Jones Industrial Average® ($DJI) gained 299.90 points (0.8%) to 39,134.76; the NASDAQ Composite® ($COMP) dropped 140.64 points (0.8%) to 17,721.59.
  • The 10-year Treasury note yield (TNX) climbed about 4 basis points to 4.257%.
  • The CBOE Volatility Index® (VIX) rose 0.80 to 13.28.

What’s up

  • Gilead jumped 8.46% after clinical data revealed that its new twice-a-year shot prevents 100% of HIV cases.
  • Penn Entertainment rose 9.93% on the news that Boyd Gaming has approached its competitor with an acquisition offer.
  • Accenture rose 7.30% after the IT consulting company missed earnings estimates but more than made up for it with bullish bookings data thanks to AI.
  • Darden Restaurants rose 1.53% after a mixed earnings report. Its acquisition of Ruth’s Chris Steak House propped up earnings, while Olive Garden’s same-store sales came in flat, probably because I eat several hundred free breadsticks there every month.

What’s down

  • Trump Media & Technology Group fell 14.56% after the SEC ruled that early shareholders can resell their stock in the company, diluting new shareholders—though providing upward of $247 million in funding for the beleaguered company.
  • Nikola plummeted 31.46% after the company announced a 1-for-30 stock split in a bid to stay listed on the Nasdaq.
  • Kroger fell 3.27% despite beating analyst revenue estimates in its fiscal first quarter as investors digest the chances of the company sealing a deal to buy Albertsons.
  • Tempest Therapeutics dropped 29.47% upon the release of the latest trial data for its liver cancer treatment.
  • Jabil fell 11.45% today after the electronics supplier beat earnings estimates but warned of softer growth in the year ahead.

Mortgage rates fell below 7% last week to their lowest level since March, but this didn’t spur much extra demand.

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MURTHY: Warnings on Social Media Apps

By Staff Reporters

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The top health official in the US is urging Congress to pass legislation that would stamp social media apps with a surgeon general’s warning “stating that social media is associated with significant mental health harms for adolescents,” he wrote in an op-ed for the New York Times recently.

Surgeon General Dr. Vivek Murthy’s push for a warning label follows years of alarm-sounding with his strongest appeal to lawmakers yet.

  • In his statement, Murthy referenced a 2019 study that found risks of depression doubled among teens who scroll for more than three hours per day, and a 2023 Gallup poll showing that US teens log a daily average of 4.8 hours on social media.

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Whither the CERTIFIED MEDICAL PLANNER™ Marks?

Wither the CERTIFIED MEDICAL PLANNER™ Professional Certification?

CMP logo

DEAR INVESTMENT ADVISORS, CPAs, FINANCIAL PLANNERS, FINANCIAL ADVISORS & INSURANCE AGENTS

We believe that:

If you do not have a market niche; you are not deeply informed
If you are not deeply informed; you can’t different yourself
If you can’t differentiate yourself; you can’t differentiate price
If you can’t differentiate price; you have no market power
If you have no market power; you have no unique knowledge
If you have no unique knowledge; you have fewer profits

If you have fewer profits; you are not likely a CMP™

CMP

PROGRAM CURRICULUM: Enter the CMPs

POPULAR BOOKS: https://medicalexecutivepost.com/2021/04/29/why-are-certified-medical-planner-textbooks-so-darn-popular/

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PODCAST: A Full Course on Bio-Statistics

By Quinnipiac University

Biostatistics are the development and application of statistical methods to a wide range of topics in biology. It encompasses the design of biological experiments, the collection and analysis of data from those experiments and the interpretation of the results.

The following topics of #biostatistics are discussed in this course

⭐️ Table of Contents ⭐️ 0:00

Module 1 – Introduction to Statistics 29:13 Module 2 – Describing Data: Shape 45:44 Module 3 – Describing Data: Central Tendency 1:03:34 Module 4 – Describing Data: Variability 1:34:51 Module 5 – Describing Data: Z-scores 1:43:25 Module 6 – Probability (part I) 2:09:21 Module 6 – Probability (part II) 2:26:22 Module 7 – Distribution of Sample Means 2:41:24 Module 9 – Estimation & Confidence Intervals & Effect Size 2:56:59 Module 10 – Misleading with Statistics 3:17:43 Module 11 – Biostatistics in Medical Decision-making 4:13:36 Module 11b – Biostatistics in Medical Decision-Making: Clinical Application 4:56:51 Module 12 – Biostatistics in Epidemiology 5:05:16 Module 13 – Asking Questions: Research Study Design 5:10:15 Module 14 – Bias & Confounders 5:39:20 Module 16 – Correlation & Regression 6:06:19 Module 17 – Non-parametric Tests ⭐️

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DAILY UPDATE: Nvidia, Golden Goose and the Summer Solstice

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HAPPY SUMMER SOLSTICE

Today is the first day of summer in the Northern Hemisphere, aka summer solstice. It’s also the longest day of the year.

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The markets were closed yesterday for Juneteenth, but they’ll be back today to see if they can keep their hot streak going.

But, the company known for selling shoes that look like they’ve been dragged through mud postponed its IPO, putting a pause on what has been a big year for European companies going public. Golden Goose announced Tuesday it wouldn’t go public in Milan on Friday as planned due to fraught market conditions in Europe stemming from parliamentary elections across the Continent.

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Nvidia is now the most valuable company in the world. The chipmaker passed Microsoft to become the world’s most valuable public company, topping $3.3 trillion in market cap. Earlier this month, it reached the $3 trillion mark for the first time, flying past Apple for second place. The AI boom has propelled Nvidia—which owns about 80% of the industry’s data center chip market—to new heights, enriching investors and CEO Jensen Huang along the way. Huang has added nearly $100 billion to his net worth in less than two years, making him the 13th richest person in the world as of June.

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DAILY UPDATE: Wells Fargo, Public Companies as Stock Markets Extend Rally

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Wells Fargo is losing $10 million per month on its partnership with Bilt, whose credit card offers users reward points for paying rent, and is looking to renegotiate, the WSJ reports. Apple has stopped offering its buy now, pay later program, Apple Pay Later, after partnering with outside companies, including Affirm.

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Here’s where the major benchmarks ended:

  • The S&P 500 index gained 13.80 points (0.3%) to 5,487.03; the Dow Jones Industrial Average® ($DJI) added 56.76 points (0.2%) to 38,834.86; the NASDAQ Composite® ($COMP) rose 5.21 points (0.03%) to 17,862.23, a record close for the seventh day in a row.
  • The 10-year Treasury note yield (TNX) dipped more than 6 basis points to 4.215%.
  • The CBOE Volatility Index® (VIX) fell 0.45 to 12.30.

What’s up

What’s down

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And … precision medicine company Tempus AI is going public, raising $410.7 million through its initial public offering.

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PODCAST: Artificial Intelligence in Healthcare

By Eric Bricker MD

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Invite Dr. Marcinko to Speak at your Next Seminar, Webcast or Event in 2024?

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Colleagues know that I enjoy personal coaching and public speaking and give as many talks each year as possible, at a variety of medical society and financial services conferences around the country and world.

These include lectures and visiting professorships at major academic centers, keynote lectures for hospitals, economic seminars and health systems, keynote lectures at city and statewide financial coalitions, and annual keynote lectures for a variety of internal yearly meetings.

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DAILY UPDATE: Microsoft & Google Cyber Security Discounts as Stock Markets Rally

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  • Microsoft. According to a same-day announcement on its site, the company will give “nonprofit pricing and discounts for its security products optimized for smaller organizations, providing up to a 75% discount,” along with free cybersecurity training, assessments, and—for at least one year, the company says—Windows 10 security updates.
  • Google. The White House said that Google will “provide endpoint security advice to rural hospitals and nonprofit organizations at no cost,” as well as a pilot program designed to help rural facilities “develop a packaging of security capabilities that fit these hospitals’ unique needs.”

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What’s up

What’s down

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Here’s where the major benchmarks ended:

  • The S&P 500 index gained 41.63 points (0.8%) to 5,473.23; the Dow Jones Industrial Average® ($DJI) added 188.94 points (0.5%) to 38,778.10; the NASDAQ Composite advanced 168.14 points (1.0%) to 17,857.02.
  • The 10-year Treasury note yield (TNX) rose more than 6 basis points to 4.279%.
  • The CBOE Volatility Index® (VIX) increased 0.10 to 12.76.

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DAILY UPDATE: Done Global TeleHealth

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The NASDAQ nabbed its fifth-straight record close last week, and the S&P 500 snapped its four-day streak. Both were up for the week as investors digested data that showed inflation cooling. Adobe became the latest company to soar thanks to AI, spiking after delivering better-than-expected earnings and forecasts.

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Those who rely on ADHD medication got some bad news last week when the CDC issued a health advisory alerting patients that there may be possible “increased risks for injury and overdose,” after two executives at Done Global, a telehealth company, were arrested for fraud linked to allegedly selling Adderall over the internet. The CDC warned that as many as 30,000 to 50,000 adult patients could be affected. https://tinyurl.com/3rf5py6c

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DAILY UPDATE: Father’s Day, Medical Debt and USAA

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HAPPY FATHER’S DAY

News 4 in San Antonio Texas organized a video call with several USAA members who lost funds due to fraud — and have been left with little to no recourse. Some of them also belong to the Facebook group, USAA Fraud and Victims, which has 2,900 members. A few USAA members even reported being asked by the institution to cover the negative balances on their accounts after their money was stolen.

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The race to a $3 trillion market cap seemed like it would always be between Apple and Microsoft. But over the last twelve months, Nvidia has come roaring to the front of the pack, neck and neck with the big tech incumbents. In the last two weeks alone it has replaced Apple in the #2 spot, only to be supplanted earlier this week when Apple’s AI plans propelled it back ahead. Now, it’s anybody’s race to the next big benchmark: a $4 trillion market cap.

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In a move that could be good for patients but bad for hospitals, the Consumer Financial Protection Bureau (CFPB) on Tuesday proposed regulation that would wipe medical debt from many consumers’ credit reports. The rule is meant to help the 15 million people in the US who creditors say still have a combined $49 billion of medical debt that negatively affects their credit scores, Rohit Chopra, director of the CFPB, said during a June 11 press briefing. About 100 million people in the US have some amount of medical debt, which totals roughly $220 billion, according to data from the Peterson-KFF Health System Tracker. The proposed regulation comes after three credit-reporting conglomeratesEquifax, Experian, and TransUnion—removed paid-off medical debt and medical debts under $500 from credit reports in 2022 and 2023, respectively.

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Ride Sharing for Elderly Patients

Emerging Transportation Models

By Rick Kahler CFP

For elderly people facing the reality of diminishing capabilities, a service that can help maintain their independence is ridesharing.

Ride – Sharing

Ridesharing is hardly news for most Americans, particularly those in urban areas. After all, it has been around for a decade. In more rural areas of the US, however, ridesharing is just becoming an option. In my home town of Rapid City, South Dakota, for example, Lyft started operations only recently, and Uber  began last September.

Many of us in rural parts of the US, myself included, use ridesharing primarily when we travel. It has changed the way I travel in large cities, and I appreciate it for its convenience, flexibility, and economical cost.

For many others outside of big cities, however, especially senior citizens, ridesharing has the potential to be a game changer for those willing to take advantage of it.

There are a lot of emotional benefits and pitfalls to ridesharing for seniors. The greatest benefit is that, instead of relying on the gratuity and schedules of friends, family, and limited public transportation, they can literally reclaim most of the freedom they once had when they could drive. This alone can be uplifting and empowering. It allows seniors who may be isolated socially to reenter their communities and gives them a renewed sense of independence and autonomy.

However, I find many seniors emotionally resistant and reluctant to embrace the benefits of ridesharing. Many fear the unknown and unfamiliarity of ridesharing. Using the app inherently means owning a smart phone, which many seniors resist. Even those who have smartphones may feel overwhelmed about downloading and learning the app. This is where reaching out to younger family and friends to show you the ropes can be critical.

Another factor that often contributes to reluctance to use the freedom and convenience of ridesharing is a money script of frugality. The assumption may be “I can’t afford it.” While this can be absolutely true for some, many who could easily afford ridesharing also buy into that belief.

Economically, using ridesharing can cost the same as or less than owning a car. This is especially the case if you don’t have a demanding schedule and your need for transportation is moderate for activities like grocery shopping, medical appointments, and occasional social events.

Example:

Let’s assume you average one 10-mile round trip per day, or seven per week.  If you owned a car the gas would cost $50 a month. Insurance could run about $100. Oil, changing tires, servicing, and periodic repairs could average another $50 a month. That’s a total of $200 a month in out-of-pocket costs. The biggest cost is the depreciation on your car. Let’s assume your car is worth $20,000. You could expect it to depreciate 1% per month or around $200. That puts the total cost of owning the car at $400 per month.

Ridesharing costs about $7.00 each way when you are traveling up to 5 miles. That puts the daily average cost at $14.00 per trip, or $420 a month, about the same cost as owning a car—and a cost that could be covered for months through selling your vehicle.

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Assessment

Ridesharing can open up a whole new world of convenience, autonomy, and choices. Its benefits can even be a matter of life and death when seniors reach that difficult time when they can still legally drive but in reality they should not. With physical impairments like deteriorating vision and slower reaction time, driving means putting themselves and others at risk. Having the option of ridesharing can make that tough decision to give up driving just a little easier.

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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