VIAMEDIS: French Company Health Data Breach

By Staff Reporters

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Viamedis did not state how many people were affected by the breach, but it did confirm that it manages third-party payments for 84 complementary health insurance companies which when combined, service 20 million people.  As soon as the data breach was spotted, Viamedis disconnected its third-party payment management platform.

“Beneficiaries will be able to continue to use their carte vitale and their third-party payment card, the temporary disconnection from the Viamedis platform will only have an impact on certain health professionals, in particular opticians and audio-prosthetists,” it said.

Speaking to Agence France-Presse (AFP), Viamedis General Director, Christophe Cande, said the attack wasn’t ransomware, but rather a successful phishing attack against one of the company’s employees. 

“To date, we do not have the number of insured individuals impacted; we are still in the process of investigation,” Cande said. 

Viamedis filed a complaint with the public prosecutor, and notified other relevant authorities. For healthcare professionals, it said it would notify them on the details of exposed data later.

Via BleepingComputer

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PODCASTS: The Case Against Value Based Care [VBC]

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And Now – The Other Perspective

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BY ERIC BRICKER MD

Your comments are appreciated.

THANK YOU

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

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https://www.amazon.com/Hospitals-Healthcare-Organizations-Management-Operational/dp/1439879907/ref=sr_1_4?s=books&ie=UTF8&qid=1334193619&sr=1-4

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https://www.amazon.com/Financial-Management-Strategies-Healthcare-Organizations/dp/1466558733/ref=sr_1_3?ie=UTF8&qid=1380743521&sr=8-3&keywords=david+marcinko

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PODCAST: VBC Financial Risks: https://medicalexecutivepost.com/2021/07/13/podcast-value-based-care-financial-risks/

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DAILY UPDATE: Impending C.P.I. and UPS

By Staff Reporters

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US Economists just polled by The Wall Street Journal forecast a mild 0.2% in increase in consumer prices in the first month of 2024. The inflation rate in the past 12 months would decelerate to 2.9% from a prior 3.4%. If forecasters are right, it would mark the first time the CPI has fallen below 3% in almost three years.

The drama in the report, if there’s any, is likely to come from the more closely followed core CPI that omits food and energy prices. The core rate is viewed as a better predictor of future inflation. Wall Street expects the core rate to rise 0.3% — the upper limit of what the Fed would find tolerable in the short run. The 12-month increase in the core rate could also dip to 3.7% from 3.9%.

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

UPS, the shipping giant, which forecast weak demand for parcel delivery in 2024, has said it plans to lay off 12,000 employees to save $1 billion in costs. It’s also mulling a sale of its Coyote brokerage unit.

This shocking announcement was made on January 30th and comes just six months after unionized UPS workers landed a “lucrative” new labor deal, which will see delivery drivers earning an average of $170,000 in annual pay and benefits by the end of the five years. “2023 was a unique, and quite candidly, difficult and disappointing year,” said UPS CEO Carol Tomé during the company’s earnings call. “We experienced declines in volume, revenue and operating profits and all three of our business segments.”

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VALUE BASED CARE: Guidelines and Best Practices?

http://www.MarcinkoAssociates.com

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Three healthcare industry groups—America’s Health Insurance Plans (AHIP), the American Medical Association (AMA), and the National Association of Accountable Care Organizations (NAACOS)—released the 36-page playbook on July 25th, 2023. Adoption of the best practices in the playbook is voluntary; the playbook is intended to encourage the adoption of value-based care arrangements in the private sector, according to a news release from the three groups.

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

Under a value-based care model, providers are reimbursed based on patient outcomes rather than the quantity of services provided like in the traditional fee-for-service model. The value-based care model has been around since the late 1960s. But, widespread adoption has been slow—less than half of the primary care physicians said in a 2022 survey from the Commonwealth Fund that they had received any value-based payments.

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DAILY UPDATE: S&P 500 Stocks Extend Rise!

By Staff Reporters

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The S&P 500 index closed above 5,000 for the first time ever, as investors reflected on robust company earnings and data showing inflation rose even less than was previously thought in December. One stock that wasn’t going places: Expedia, which fell after reporting earnings that took a hit from low airfares.

Here’s where the major benchmarks ended:

  • The S&P 500 index rose 28.70 points (0.6%) to 5,026.61, up 1.4% for the week; the Dow Jones Industrial Average lost 54.64 points (0.1%) to 38,671.69, up 0.04% for the week; the NASDAQ Composite® (COMP) surged 196.95 points (1.3%) to 15,990.66, up 2.3% for the week.
  • The 10-year Treasury note yield (TNX) rose less than 1 basis point to 4.175%.
  • The CBOE Volatility Index® (VIX) rose 0.14 to 12.93.

Technology sector strength was highlighted by chip makers, as the Philadelphia Semiconductor Index (SOX) gained 2%. Regional banks also ended the week on a firm note after slumping in recent days, and small-cap stocks also firmed. The small-cap Russell 2000® Index (RUT) jumped 1.5% Friday and ended the week with a gain of 2.4%, ending just below its high for the year.

In other markets, WTI crude oil (/CL) futures gained for the fifth straight day, completing a 7.2% gain for the week amid growing concern the Middle East conflict may disrupt supplies.

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

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Healthcare Corporate Business Updates

By Staff Reporters

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Walgreens tapped Mary Langowski, a former CVS Health executive, to lead its U.S. healthcare segment. The move comes as the retail pharmacy giant looks to boost profitability in its healthcare business.


CVS Health cut its outlook for 2024 on the back of higher medical costs in the fourth quarter. The drugstore chain, which owns Aetna, joins other healthcare companies to see a spike in utilization.


And … following up on a federal law passed in September to increase competition among organ transplant contractors, HRSA is issuing requests for proposals for several different contracts.

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


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DAILY UPDATE: Uber Profits with Extended Stock Market Gains

By Staff Reporters

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Stat: $1.43 billion. That’s Uber’s first full-year profit since 2018. And, it’s the first time the rides hare giant has shown a profit from its operations. The company has had $30 billion in operating losses since 2016. (the Wall Street Journal)

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

Stocks ticked up, putting the S&P 500 over the 5,000-point milestone for the first time, as more strong company earnings poured in. And, Arm soared 48% after it surprised investors with record computer chip sales.

Here’s where the major benchmarks ended:

  • The S&P 500 index added 2.85 points (0.1%) to 4,997.91, after briefly rising to 5,000.40, breaching the 5,000 level for the first time; the Dow Jones Industrial Average gained 48.97 points (0.1%) to 38,726.33; the NASDAQ Composite climbed 37.07 points (0.2%) to 15,793.71.
  • The 10-year Treasury note yield (TNX) rose more than 5 basis points to 4.154%.
  • The CBOE Volatility Index® (VIX) fell 0.04 to 12.79.

Semiconductor shares were among the strongest performers Thursday behind Arm Holdings (ARM), which soared 48% after the chip maker reported a better-than-expected quarter profit. The Philadelphia Semiconductor Index (SOX) gained 1.6%. Energy shares were also firm as WTI crude oil (/CL) futures surged 3.6% to a high for the month above $76 per barrel, reflecting growing concern the Middle East conflict may disrupt supplies.

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META: Stock Up!

By Staff Reporters

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2022 was a rough year for Meta. Inflation and high interest rates dinged the company, and Apple made changes to its operating system that made it harder for brands to target customers, and rival TikTok kept on growing. Meta’s stock price fell more than 60%.

But the company saw a dramatic turnaround of its fortunes in 2023. Its full-year net income rose 69% over 2022 to $39.1 billion. Its diluted earnings per share went from $8.59 to $14.87, a 73% YoY jump. Q4 2023 was especially good for Meta: Its net income more than tripled and its revenue rose 25%.

And for the first time, the company gave out cash dividends to investors. Technology analyst Ben Barringer described the move to CNBC as a “symbolic moment” that showed Meta viewed itself as a “mature, grown-up business.”

Meta’s success, though, required paring down. It reduced operating expenses in 2023 by laying off some 20,000 people, slashing its headcount by 22%. It spent $2.5 billion on “facilities consolidation,” or reducing its office footprint. The changes were part of a plan to make the company “leaner” so it would be better able to weather volatility over the next five to 10 years, CEO Mark Zuckerberg said.

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DAILY UPDATE: Bloomberg Health Staffing Philanthropy as Stock Markets Hit Record Highs, Again!

By Staff Reporters

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Billionaire Michael Bloomberg is taking a swing at the healthcare staffing shortage. His philanthropy arm recently dedicated $250 million to create high schools that move grads straight into healthcare jobs. The schools plan to partner directly with big-name health systems, including Mass General Brigham and Northwell Health.

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

Stocks climbed as investors got good news from companies reporting their quarterly earnings, including Chipotle and Ford. NY Community Bancorp continued its wild ride since reporting surprise Q4 losses, finishing on an upward swing yesterday after reassuring investors about its liquidity and deposits—though it’s still down 31% from the beginning of the month.

Here’s where the major benchmarks ended:

  • The S&P 500 index rose 40.83 points (0.8%) to 4,995.06; the Dow Jones Industrial Average gained 156.00 points (0.4%) to 38,677.36; the NASDAQ Composite® (COMP) added 147.65 points (1.0%) to 15,756.64.
  • The 10-year Treasury note yield (TNX) rose slightly more than 2 basis points to 4.117%.
  • The CBOE Volatility Index® (VIX) fell 0.23 to 12.83.

Transportation shares were among the strongest performers behind gains in trucking companies like XPO, Inc. (XPO), which rallied 18% after reporting stronger-than-expected earnings before Wednesday’s open. The Dow Jones Transportation Average (DJT) rose 0.4% and hit its highest level since mid-August. Consumer discretionary and semiconductor shares also ranked among the strongest sectors.

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DAILY UPDATE: Stock Markets Unchanged

By Staff Reporters

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Stocks rose yesterday as investors mulled earnings reports that beat expectations from companies like Palantir and Spotify. But not every company had good news to share: Snap plunged after hours when it reported less revenue than expected and said the Middle East conflict was a headwind to growth. Meanwhile, New York Community Bancorp fell to its lowest since 1997, and Moody’s downgraded it to junk.

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Here’s where the major benchmarks ended:

  • The S&P 500® index (SPX) rose 11.42 points (0.2%) to 4,954.23; the Dow Jones Industrial Average® (DJI) gained 141.24 points (0.4%) to 38,521.36; the NASDAQ Composite® (COMP)added 11.32 points (0.1%) to 15,609.00.
  • The 10-year Treasury note yield (TNX) fell about 7 basis points to 4.089%.
  • The CBOE Volatility Index® (VIX) dropped 0.60 to 13.07.

Transportation shares were among the strongest performers Tuesday behind strength in United Parcel Service (UPS), which jumped 4.8% following an analyst upgrade. The Dow Jones Transportation Average (DJT) rose 2.1% to end at its highest level since late December. Energy shares also firmed as WTI Crude Oil (/CL) futures gained 1%. 

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

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PODCAST: Healthcare Advertising & Spending in the USA

By Eric Bricker MD

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Digital Entrepreneurial Health for Aging Populations

THE FUTURE OF ELDER CARE FOR ENTREPRENEURIAL DOCTORS?

By Dr. David Edward Marcinko MBA

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I was delighted to read a scientific paper that goes beyond just detailing a complex topic and encourages us to broaden our horizons, imagine what the future of elder care could hold and define our roles in shaping it’s future.

It was sent to me my colleague Bertalan Meskó, MD PhD [The Medical Futurist]

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DAILY UPDATE: Powell Speaks and the Stock Markets Tumble

By Staff Reporters

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As Jerome Powell goes, so goes the market. Stocks tumbled yesterday after Federal Reserve Chairman Jerome Powell went on 60 Minutes over the weekend and said he’s in no rush to cut interest rates. Meanwhile, shares of Estée Lauder jumped ~12% after the cosmetics company announced it was laying off 5% of its employees amid weak demand in Asia.

Here’s where the major benchmarks ended:

  • The S&P 500 index fell 15.80 points (0.3%) to 4,942.81; the Dow Jones Industrial Average dropped 274.30 points (0.7%) to 38,380.12; the NASDAQ Composite® (COMP) declined 31.28 points (0.2%) to 15,597.68.
  • The 10-year Treasury note yield surged nearly 14 basis points to 4.166%.
  • The CBOE Volatility Index® (VIX) fell 0.18 to 13.67.

Materials and real estate sector shares were among the market’s weakest performers Monday, and banks and utilities were also under pressure. Semiconductors were one of the few sectors to post gains. In other markets, the U.S. Dollar Index (DXY) strengthened to its highest level since mid-November amid expectations interest rates will remain elevated. 

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

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HOSPITAL OPERATING MARGINS: Non-Profits Still Down

By Staff Reporters

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Operating margins at not-for-profit hospitals are expected to “gradually improve” in 2024 but will still lag far behind pre-pandemic levels, according to a January report from credit rating agency Fitch Ratings.

Median operating margins for not-for-profit hospitals dipped to record lows during the pandemic, falling to 0.2% in 2022, according to the agency, which has yet to report numbers for 2023. In 2019, the median not-for-profit hospital operating margin was 2.4%, according to Moody’s.

Despite signs that margins are improving, they’re still “nowhere near” where they were pre-2020, and a “larger expense base will keep huge gains unlikely,” according to Fitch.

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

“2024 will not be markedly better and certainly not the V-shaped recovery we’re hoping for,” Kevin Holloran, senior director and sector head at Fitch, said in a statement.

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DAILY UPDATE: Name Brand Drug Prices Up as Corporate Earnings Week Awaits

By Staff Reporters

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As the federal government seeks to rein in drug prices, pharmaceutical companies this year have been raising prices on hundreds of name-brand drugs. A new analysis by the drug research firm 46brooklyn Research found that companies increased prices on 910 branded drugs in January, although the median increase was 4.7% – the lowest drug inflation rate in more than a decade, the analysis shows.

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

Whether you’re into (McDonald’s), (Disney), (Ford), (Chipotle), or paying extra for medicine (Eli Lilly), there’s an earnings report for you this week. A strong earnings season so far has helped push the major stock indexes to four straight weekly gains.

And, while Meta’s historic stock-pop hosted the headlines last week, Nvidia has quietly put together a phenomenal start to 2024. The chip-making giant added nearly $300 billion in market value in January, its biggest monthly gain ever. That’s one reason the S&P 500 is kicking off the week at a record high.

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PODCAST: Healthcare Quality is Due Diligence

By Eric Bricker MD

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BUSINESS SCHOOL: Case Studies for Physicians and Healthcare CXOs

MARCINKO ASSOCIATES, Inc.

http://www.MarcinkoAssociates.com

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READ – STUDY – LEARN – PROSPER

The Marcinko & Associates case study and white-paper compendium is a teaching vehicle that presents potential clients with a critical management issue that serves as a spring board to lively debate in which participants present and defend their analysis and prescriptions. The average case is 2 to 100 pages long (prose, tables, graphs, charts, spread sheets and figures, etc).

CASE MODEL Sample Privatization: https://tinyurl.com/3af5nf7s

Our two main types of cases are actual “field cases” based on onsite research, and “library cases”, written from public reference sources. We also write “Marcinko & Associates “armchair cases” based entirely on our general knowledge and subject matter experience.

PURCHASE: $99 PURCHASE “CASE MODELS IN HEALTHCARE: https://tinyurl.com/26ke3n9w

Unfortunately and regardless of specialty, most doctors quickly realize there are few case model guidelines available to steer them through the day-to-day management maze. One solution is to discuss best-of-breed practices with leading practitioners in order to discern what successful doctors are doing [coaching concept].

READ MORE: https://marcinkoassociates.com/case-studies/

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DAILY UPDATE: Prior Medical Authorizations Up as Stock Markets Rise to Record Highs!

By Staff Reporters

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A new set of rules from the Biden administration seeks to rein in private health insurance companies’ use of prior authorization – a byzantine practice that requires people to seek insurance company permission before obtaining medication or having a procedure. The cost-containment strategy often delays care and forces patients, or their doctors, to navigate opaque and labyrinthine appeals.

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

Here’s where the major benchmarks ended:

  • The S&P 500 index rose 52.42 points (1.1%) to 4,958.61, up 1.4% for the week; the Dow Jones Industrial Average gained 134.58 points (0.4%) to 38,654.42, up 1.4% for the week; the NASDAQ Composite rallied 267.31 points (1.7%) to 15,628.95, up 1.1% for the week.
  • The 10-year Treasury note yield (TNX) surged about 16 basis points to 4.024%.
  • The CBOE Volatility Index® (VIX) fell 0.04 to 13.84.

The market’s strength continued to be driven by the biggest companies, while smaller names lagged. The small-cap Russell 2000® Index (RUT) fell 0.6% Friday and posted a drop of 0.8% for the week. In other markets, the U.S. dollar index (DXY) rose 0.8%, reaching its strongest level in nearly two months, amid expectations interest rates will remain elevated, which boosted demand for dollar-denominated assets, such as Treasuries.

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DAILY UPDATE: Tech Industry Sheds Workers as the Stock Markets Rebound

By Staff Reporters

LEAP YEAR: This February month is a Leap Year. It’s stuffed with 29 days for 2024. If we didn’t have leap years, then our seasons would completely flip every ~750 years!

GROUND HOG DAY: A tradition observed in the United States and Canada on February 2nd of every year. It derives from the Pennsylvania Dutch superstition that if a ground hog emerges from its burrow on this day and sees its shadow, it will retreat to its den and winter will go on for six more weeks; if it does not see its shadow, spring will arrive early.

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The tech industry has shed tens of thousands of workers over the last year or so, including thousands this month alone across companies including Unity, Twitch, Amazon, Meta, Microsoft, eBay and Google. It also emerged that PayPal is firing around 2,500 people

Here’s where the major benchmarks ended:

  • The S&P 500® index (SPX) rose 60.54 points (1.3%) to 4,906.19; the Dow Jones Industrial Average (DJI) gained 369.54 points (1.0%) to 38,519.84; the NASDAQ Composite® (COMP) added 197.63 points (1.3%) to 15,361.64.
  • The 10-year Treasury note fell over 10 basis points to 3.86%.
  • The CBOE Volatility Index® (VIX) fell 0.47 to 13.88.

Regional bank shares remained under pressure in the wake of poorly received quarterly results earlier this week from New York Community Bancorp (NYCB), which took over the failed Signature Bank in 2023. The bank’s shares fell another 11% on top of a 38% drop Wednesday while the KBW Regional Banking Index (KRX) sank 2.3% to a two-month low. The bank weakness was offset by strength in several other sectors, including retail and consumer discretionary.

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

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Cigna Sells Medicare Part C as 23andMe Crashes

By Staff Reporters

HCSC will acquire Cigna’s Medicare Advantage, Part D, supplemental benefits and CareAllies businesses, and the parties expect the deal to close in the first quarter of 2025. And, as January exits, we enter the thick of earnings call season. This week executives at AbbVie, Cigna, and Merck—to name a few—will brief healthcare investors on how their companies fared in 2023, and provide insights on what to expect in 2024.

And, Anne Wojcicki’s billions have vanished. 23andMe’s valuation has crashed 98% from its peak and NASDAQ has threatened to delist its sub-$1 stock. Wojcicki reduced staff by a quarter last year through three rounds of layoffs and a subsidiary sale. The company has never made a profit and is burning cash so quickly it could run out by 2025.

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

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DAILY UPDATE: Microsoft, Google and IMF Up Yesterday, as UPS and the Stock Markets Collapse Today

By Staff Reporters

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Microsoft and Google rode the AI wave to huge quarters. Microsoft posted revenues of ~$62 billion in its fiscal Q2 ending Dec. 31, a year over year increase of 17.6% and ahead of analyst’s expectations. That was its best revenue growth in seven quarters, thanks to the release of new AI-enabled Office products. Meanwhile, Google reported strong results, too: Ad revenue at YouTube skyrocketed to $9.2 billion in Q4 of last year, up from below $8 billion the year before. Alphabet CEO Sundar Pichai said YouTube is “already benefiting from our AI investments and innovation.” Alphabet’s total revenue was up 13% year over year to ~$86 billion.

UPS slashed 12k jobs. The shipping giant said it will require employees to return to the office five days a week this year as it changes how it operates amid a slowdown in demand. Revenue declined in Q4, while annual sales fell 9.3% in 2023. Amazon, its biggest customer, accounted for 11.8% of revenue last year, up from the year before, as revenue from other customers declined due to lower demand and more in-store pickups, executives said. UPS is also dealing with higher labor costs due to the deal it made with the Teamsters union to avoid a strike last summer.

The IMF has the US to thank for raising its global forecast. The International Monetary Fund—the UN’s flagship financial agency—said the global economy will grow 3.1% this year, a slight increase from its projection in October. That’s largely due to the strength of the US economy, which has defied economists’ expectations, growing 3.3% in the fourth quarter of 2023. But the improved outlook was also boosted by economic stimulus in China, which has faced deflation and a real estate crisis, among other issues. Other economies, including India, Brazil, and Russia, also performed better than expected, helping to juice the IMF’s forecast.

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

Here’s where the major benchmarks ended:

  • The S&P 500® index (SPX) fell 79.32 points (1.6%) to 4,845.65; the Dow Jones Industrial Average® (DJI) lost 317.01 points (0.8%) to 38,150.30; the NASDAQ Composite® (COMP) dropped 345.89 points (2.2%) to 15,164.01, a two-week low.
  • The 10-year Treasury note yield (TNX) decreased nearly 9 basis points to 3.969%.
  • The CBOE Volatility Index® (VIX) jumped 1.03 to 14.34.

Regional banks led Wednesday’s declines after New York Community Bancorp (NYCB), which took over the failed Signature Bank last year, reported a fourth-quarter loss of $193 million, sending its shares down nearly 38%. The KBW Regional Banking Index (KRX) sank 6%. Communications services shares were also among the weakest performers. Energy companies were also under pressure as WTI Crude Oil futures (/CL) shed nearly 3%.

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JANUARY: Doctors Beware Divorce Month

OVERHEARD IN THE ADVISOR’S LOUNGE
[January is Divorce Month]

SPONSOR: http://www.MARCINKOASSOCIATES.com

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January is nick-named the “divorce month” because of an uptick in activity for divorce lawyers after the New Year. Yet, January to April 15th is also a very low period in terms of people inquiring about divorce mediation. The reason is that couples generally want to know where they stand financially before pursuing divorce.

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

And, with the economy improving in 2024, people may be less inclined to wait. While anecdotal evidence abounds, hard figures are more elusive. An analysis of national divorce filings between 2008 and 2011 by legal information website FindLaw.com found a spike in January and a gradual rise until a peak in late March.

Mediation: https://medicalexecutivepost.com/2023/08/12/a-step-wise-approach-to-the-divorce-mediation-process-for-doctors/

UPDATE 2024: The exclusivity of marriage in the contemporary era has dire, compounding consequences across generations. As researchers Shelly Lundberg, Robert A. Pollak and Jenna Stearns document, in 1960, people with and without college degrees married and formed families in a similar manner, but today, just 11% of childbirths for those with college degrees are non-marital, while 58% of childbirths for those without are. This cleavage makes possible what the Brookings Institution’s Melissa Kearney describes as “two-parent privilege,” an emerging phenomenon through which well-off couples transmit educational and economic advantages to their children. Viewed from this angle, it should not surprise us that many Americans think the rich are galloping ever further ahead.

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DAILY UPDATE: Evergrande and the FanDuel-Flutter as Stocks End Mixed Awaiting the FOMC

By Staff Reporters

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Embattled China Evergrande ordered to liquidate by Hong Kong court

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China Evergrande, which owes $300 billion, ordered to liquidate. Yesterday, a Hong Kong court ordered the debt-burdened real estate firm to wind up its business—though it’s not clear if mainland Chinese authorities will enforce it. As one of the largest developers to struggle with debt, the company, which defaulted in 2021, has become a symbol of the real estate bust in China, which has so many homes sitting vacant that an ex-official admitted even its population of 1.4 billion could not fill them. Now, investors around the world will be watching the liquidation process to see how foreign investors fare as a test of how China’s system treats international businesses.

FanDuel parent Flutter lists on New York Stock Exchange. Rob Gronkowski visited the NYSE trading floor yesterday to celebrate the kickoff of the company selling shares in New York, which—for now—is a secondary listing to the European company’s primary London Stock Exchange listing. The move steps up its competition with DraftKings. And with US sports betting booming thanks to legal changes, the FanDuel parent wants to go all in and is proposing making the NYSE its primary trading venue, which would be a blow to the London exchange.

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

Here’s where the major benchmarks ended:

  • The S&P 500® index (SPX) fell 2.96 points (0.1%) to 4,924.97; the Dow Jones Industrial Average gained 133.86 points (0.4%) to 38,467.31; the NASDAQ Composite® (COMP) lost 118.15 points (0.8%) to 15,509.90.
  • The 10-year Treasury note yield (TNX) tumbled about 3 basis points to 4.059%.
  • The CBOE Volatility Index® (VIX) dropped 0.29 to 13.31.

Chipmaker shares were among the market’s weakest performers, with the Philadelphia Semiconductor Index (SOX) sinking 1.6%. The small-cap Russell 2000® Index (RUT) lost 0.8%, giving back part of Monday’s 1.7% gain. Energy and financial companies were among the strongest sectors.

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DAILY UPDATE: Stock Markets Blast Off Again!

By Staff Reporters

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Markets: Stocks had a strong start to the week, with the S&P 500 and the Dow once again hitting new records. That’s mostly thanks to a boom in Big Tech as investors anticipate a slew of high-profile earnings (not to mention a Fed meeting) this week. Microsoft, Meta, and Uber all reached all-time highs.

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Here’s where the major benchmarks ended today:

  • The S&P 500 index rose 36.96 points (0.8%) to 4,927.93; the Dow Jones Industrial Average gained 224.02 points (0.6%) to 38,333.45; the NASDAQ Composite® (COMP) added 172.68 points (1.1%) to 15,628.04.
  • The 10-year Treasury note yield (TNX) dropped about 8 basis points to 4.08%.
  • The CBOE Volatility Index® (VIX) rose 0.37 to 13.63.

Consumer discretionary and banks were among the market’s strongest sectors Monday, and small caps were also strong. The Russell 2000® Index (RUT), a small-cap benchmark, outpaced its large-cap counterparts with a gain of 1.7%, ending near a four-week high. Energy shares took pressure after WTI Crude Oil futures (/CL) reversed an initial rally to a two-month high and ended with a loss of more than 1%.

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2024: Healthcare Industry Future Outlook

By Health Capital Consultants, LLC

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2024 Healthcare Industry Outlook

Nearly one year removed from the end of the COVID-19 public health emergency, the healthcare industry expects a number of new opportunities in 2024, despite lingering challenges exposed by the pandemic. For example, healthcare organizations anticipate issues related to workforce shortages and legislative challenges; however, the industry also expects that opportunities emanating from technological advancements will allow them to grow and transform.

This Health Capital Topics article reviews anticipated U.S. healthcare industry activity for 2024 as well as trends that may drive change in the industry. (Read more…)

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PODCAST: Hospital Medicare Break-Even Plans

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By Eric Bricker MD

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DAILY UPDATE: U.S. GDP and Microsoft

By Staff Reporters

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The US GDP grew 3.3% in Q4, per the Commerce Department, annihilating Wall Street’s expectations of 2% growth. For the year, the US economy expanded 2.5% in 2023, up from 1.9% in 2022. That also outpaced Wall Street’s estimates from the beginning of the year. The growth was driven by strong consumer spending made possible by rising wages and a sturdy job market, even as the country dealt with inflation. That, too, improved in Q4: Prices increased 2.7% on an annual basis, down from a 5.9% increase the year prior. The GDP smash adds more fuel to the expectation that the Fed will cut interest rates this year.

The cuts across Xbox and Activision Blizzard account for 8% of Microsoft’s video game division. The tech giant closed on its $69 billion acquisition of Call of Duty-maker Activision Blizzard in October and has since made several leadership changes. CEO Bobby Kotick stepped down in December, and now Blizzard President Mike Ybarra has decided to leave, according to an internal memo obtained by The Verge. An upcoming survival game has also been canceled. The cuts come as several gaming-related companies, including Twitch, Discord, Unity, and Riot Games, have conducted layoffs.

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DAILY UPDATE: Stocks End Mixed

By Staff Reporters

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Here’s where the major benchmarks ended:

  • The S&P 500® index (SPX) fell 3.19 points (0.1%) to 4,890.97, up 1.1% for the week; the Dow Jones Industrial Average gained 60.30 points (0.2%) to 38,109.43, up 0.6% for the week; the NASDAQ Composite® (COMP) dropped 55.13 points (0.4%) to 15,455.36, still up 0.9% for the week.
  • The 10-year Treasury note yield (TNX) rose about 1 basis point to 4.143%.
  • The CBOE Volatility Index® (VIX) fell 0.19 to 13.26.

Energy shares extended a strong week as WTI Crude Oil futures (/CL) rallied further, reaching a two-month high just under $78 per barrel. Regional banks were also among the market’s strongest performers Friday. Small-cap stocks gained modestly to end a firm week with the Russell 2000® Index (RUT) posting a weekly gain of about 1.8%.

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Physician Payments in 2025

By Staff Reporters

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American Medical Association (AMA) leaders lauded the Medicare Payment Advisory Commission (MedPAC) this month for backing increased physician payment rates for 2025.

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AMA President Jesse Ehrenfeld praised MedPAC, a nonpartisan independent legislative agency that advises Congress on the Medicare program, for endorsing a draft recommendation that urges lawmakers to increase physician payment rates to reflect inflation. He cast the move as “a critical first step toward the necessary work of reforming the broken Medicare payment system.”

“Long-term reforms from Congress are overdue to close the unsustainable gap between what Medicare pays physicians and the actual costs of delivering high-quality care. When adjusted for inflation in practice costs, Medicare physician pay declined 26% from 2001 to 2023,” he said in a statement.

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DAILY UPDATE: Stock Markets Close at Record Highs

By Staff Reporters

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Here’s where the major benchmarks ended:

  • The S&P 500 index rose 25.61 points (0.5%) to 4,894.16, a record high close; the Dow Jones Industrial Average® (DJI) gained 242.74 points (0.6%) to 38,049.13, also a record high; the NASDAQ Composite rose 28.58 points (0.2%) to 15,510.50.
  • The 10-year Treasury note yield (TNX) fell about 5 basis points to 4.13%.
  • The CBOE Volatility Index® (VIX) rose 0.31 to 13.45.

Energy companies were among the market’s strongest performers Thursday, boosted by a rally in WTI crude oil (/CL) futures, which surged 2.8% and ended near a two-month high above $77 per barrel amid concerns conflict in the Middle East and the Russia-Ukraine war may disrupt global oil supplies.

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PODCAST: Doctors Subconsciously Influenced By Pharmaceutical Companies?

Dr. Eric Bricker MD

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DAILY UPDATE: Mobile Payment Fraud Up as Economy Grows and Stock Markets Extend Gains

By Staff Reporters

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Alarmed by a surge in fraud draining bank accounts through popular mobile payment apps like Venmo, Cash App and Zelle, Manhattan District Attorney Alvin Bragg, Jr., has sent scathing letters to the CEOs of each company, demanding immediate action to protect consumers.

In the letters, Bragg described the crimes as involving an unauthorized user gaining access to unlocked devices, then stealing significant sums of money from bank accounts by making purchases with the mobile payment apps and using financial information from them to open new accounts.

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And, the U.S. economy expanded at a 3.3% annualized pace in the final quarter of 2023, the Commerce Department said on Thursday.

Why it matters: It’s much stronger growth than economists expected and caps a year of economic resilience as the nation avoided a projected recession.

Here’s where the major benchmarks ended:

  • The S&P 500 index rose3.95 points (0.1%) to 4,868.55; the Dow Jones Industrial Average® (DJI) lost 99.06 points (0.3%) to 37,806.39; the NASDAQ Composite gained 55.97 points (0.4%) to 15,481.92.
  • The 10-year Treasury note yield (TNX) increased about 4 basis points to 4.18%.
  • The CBOE Volatility Index® (VIX) rose 0.59 to 13.14.

Tech-related strength helped boost the NASDAQ-100® (NXD), which includes the NASDAQ’s largest non-financial companies, by 0.6% to a record close. Energy shares were also strong behind continued gains in WTI Crude Oil (/CL) futures, which rose 1.4% and settled near a two-month -high after the Energy Information Administration reported a 7.5% drop in U.S. oil production last week, reflecting disruptions from winter storms. Small-cap shares lagged as the Russell 2000® Index (RUT) fell 0.7%.

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DAILY UPDATE: R.I.P. Medical Debt as Stock Markets End Mixed

By Staff Reporters

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New York City intends to wipe out more than $2 billion in medical debt for up to 500,000 residents, tackling a top cause of personal bankruptcy, Mayor Eric Adams just announced yesterday.

The city is working with RIP Medical Debt, a nonprofit that buys medical debt in bulk from hospitals and debt collectors for pennies on the dollar. The group targets the debt of people with low incomes or financial hardships and then forgives the amounts.

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Here’s where the major benchmarks ended:

  • The S&P 500 index rose 14.17 points (0.3%) to 4,864.60; the Dow Jones Industrial Average lost 96.36 points (0.3%) to 37,905.45; the NASDAQ Composite® (COMP) rose 65.66 points (0.4%) to 15,425.94.
  • The 10-year Treasury note yield (TNX) gained about 4 basis points to 4.138%.
  • The CBOE Volatility Index® (VIX) fell 0.64 to 12.55.

Shares of banks and retailers were among the market’s weakest areas Tuesday, while consumer staples were among the upside leaders. Oilfield services companies were also strong, as strong quarterly results from Halliburton (HAL) helped offset a slide in crude oil futures. In other markets, the U.S. dollar index (DXY) hit its strongest level since mid-December, partly reflecting the Bank of Japan’s decision to keep short-term interest rates unchanged.

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FEDERAL HEALTH PROGRAMS: Defined

By Staff Reporters

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Theranos founder and ex-CEO Elizabeth Holmes was just banned from US federal health care programs for nine decades, according to the US the health department. Holmes was sentenced in November 2022 to 11 years in prison following a trial that determined she knew her blood-testing startup, which was founded in 2003 and which claimed to be able to test for a range of diseases and risks with one finger prick, produced inaccurate and faulty results. Before government probes, Theranos raised hundreds of millions of dollars, named prominent former U.S. officials to its board, and explored a partnership with the U.S. military to use its tests on the battlefield.

So, just what is a Federal Health Care Program?

Federal Health Care Program means any plan or program that provides health benefits, whether directly, through insurance, or otherwise, which is funded directly, in whole or in part, by the United States Government, including, but not limited to, Medicare, Medicaid/MediCal, managed Medicare/Medicaid/MediCal, TriCare/VA/CHAMPUS, SCHIP, Federal Employees Health Benefit Plan, Indian Health Services, Health Services for Peace Corp Volunteers, Railroad Retirement Benefits Black Lung Program, Services Provided to Federal Prisoners, and Pre- Existing Condition Insurance Plans (PCIPs).

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BUYING: Home Economics

By Staff Reporters

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A report released last month by the National Association of Realtors (NAR) confirms what many Americans suspect: home affordability is down. Due to rising interest rates and low inventory, NAR found that the average income of a home buyer between July 2022 and June 2023 was $107,000, up from $88,000 the year prior—one of the highest levels since NAR started tracking in 1981.

But the housing market continues to churn. The organization found…

  • More and more home buyers are single women. The share of single women buying homes is almost double that of men. They’re also slightly older—a single woman buying her first home is 38 on average, while a single man is 33 years old.
  • Buyers are older. The average first-time home buyer is 35, up from 29 in the 1980s, but it’s older people who are buying up the three-bedrooms after selling their starter homes: NAR found that the median age of a repeat home buyer last year was 58. In 1981, it was 36 years old.

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Can this Doctor RETIRE?

AFFORDABILITY IN 2024

By Staff Reporters

SPONSOR: http://www.MARCINKOASSOCIATES.com

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CAN THIS DOCTOR RETIRE – HE ASKS?

I’m a late career entry and 55 year old burned out doctor who wants out. Can I retire in 2 years with a pension of $6,100 a month (net). I have $825,000 in my 401(k) and 457 plan and a mortgage of $95,000 at 5.30%. I am not planning to move and will retire in place.

SOME THOUGHTS AND ANSWERS?

Congratulations on you solid retirement fund on top of a pending pension. 

The first step you should take is to create a detailed budget for your retirement years. Consider expected living costs, healthcare expenses, travel and any other major expenses. Many folks make the mistake of setting up a monthly budget, but keep out significant milestones that are often costly, such as paying for a child’s college education or wedding.

Next, you should figure out your plan for housing. Mortgage payments, upkeep and taxes are important considerations. There was no mention of mortgage equity. 

Another factor to take into account is state and Federal tax projections. If the 401(k) funds are all pre-tax dollars, any distributions will be taxable and there may be penalties if funds are withdrawn prior to 59 ½ years old. That will impact your retirement plan if you’re preparing to retire at 57-58.

It also sounds like you haven’t taken into account your Social Security allowance. It’s possible that your pension is one that comes with a government pension offset which would explain why you didn’t include it. On the other hand, maybe you’re thinking it’s far out enough that it doesn’t factor into your calculations?

Finally, you may want to look for a fee-only financial advisor that is paid directly by the client and doesn’t receive commissions for recommending financial products. So, advice is less biased. And get a fiduciary advisor which means they are required to put your best interests ahead of their own. 

Also, someone with medical niche specificity. Good Luck!

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NOTE: This is not an offer to buy or sell any security or interest. All investing involves risk, including loss of principal. Working with an adviser may come with potential downsides such as payment of fees (which will reduce returns). There are no guarantees that working with an adviser will yield positive returns. The existence of a fiduciary duty does not prevent the rise of potential conflicts of interest.

Refer a Colleague: MarcinkoAdvisors@msn.com

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ADVERSE: Medical Events

By Dr. David Edward Marcinko MBA

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Aggregated experience from the Doctors Company and other malpractice insurers has shown that adverse medical events tend to fall into three categories:

A. Medical and/or System Error 
Error is defined by the National Quality Forum Consensus report titled Standardizing a Patient Safety Taxonomy as “the failure to perform a task satisfactorily against customary standards and the failure cannot be attributed to causes beyond the patient or provider.” When the investigation (including a sentinel event root cause analysis) is complete and the cause is determined to be medical and/or system error, a disclosure meeting should take place with the patient or family.

B. Known Risk/Complication or Unforeseeable Event 
The key factor in this category is pre-ventability. Disclosure communications following unpreventable complications or unforeseeable events need to be forthright, open, and compassionate, though they differ qualitatively from apologies after preventable errors.

  1. Review the known facts surrounding the adverse outcome.
  2. Determine if the event was preventable.
  3. Review your process of informed consent to determine if the known risk or complication was discussed.
  4. Proceed to the disclosure meeting with the patient or family. Focus on discussing the cause(s) of the known risk or complication. Review the informed consent if appropriate.

C. Unexplained Change in Patient Status or New Diagnosis of Late-Stage Disease 

  1. The main challenge in communicating after a Category C event is the avoidance of a premature conclusion that a severe and surprising outcome must be due to a negligent error. It is especially important in these circumstances to limit the information conveyed to the confirmed details and to provide ongoing updates as new information becomes available. These cases are particularly vulnerable to retraction and correction cycles that render all subsequent communications with the patient and family questionable.
  2. Conduct an internal review of the medical records to determine exactly what happened and to determine if the status change was preventable or if the new diagnosis could have or should have been made earlier.
  3. If appropriate, initiate an external expert review. Peer reviews of the medical care with the outcome blinded can lend unique insight into these events.
  4. If a sentinel event occurred, a root cause analysis is appropriate.
  5. Proceed to the disclosure meeting. Review the findings of your medical record review and investigation. Explain the implications of the change in the patient’s health status and how this will affect his or her subsequent disease management. Discuss the prognosis and management of the newly diagnosed late-stage disease.

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Disruptive Behavior and Bullies in Medicine

“Micro-Aggressors” in Healthcare

[By staff reporters] http://www.CertifiedMedicalPlanner.org

Every workplace has “micro-aggressors” or/or bullies that exhibit disruptive behavior.

But, when the workplace is a hospital, it’s not just an employee problem.

Definition

Microaggression is a term coined by psychiatrist and Harvard University  professor Chester M. Pierce in 1970 to describe insults and dismissals he said he had regularly witnessed non-black Americans inflict on African Americans.

In 1973, MIT economist Mary Rowe extended the term to include similar aggression directed at women; eventually, the term came to encompass the casual degradation of any socially marginalized group, such as the poor and the disabled.

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Case Report

In one reported case, the worker, felt threatened: His superior came at him “with clenched fists, piercing eyes, beet-red face, popping veins, and screaming and swearing.” He thought he was about to be hit. Instead, his angry co-worker stormed out of the room.

But, it wasn’t just any room: It was in a hospital, adjacent to a surgical area. The screamer was a cardiac surgeon, and the threatened employee was a perfusionist, a person who operates a heart/lung machine during open heart surgery. In 2008, the Indiana Supreme Court ruling in Raess v. Doescherupheld a $325,000 settlement for the perfusionist, who said he was traumatized.

PHYSICIAN COACH: https://marcinkoassociates.com/process-what-we-do/

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™

 Harvard Medical School

Boston Children’s Hospital – Psychiatrist

Yale University

PODCAST: The United Health Group Financial Giant

By Eric Bricker MD

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PODCAST: Hospitals Post Laboratory Test Prices on EMRs

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COMPETITION: Apple, MSFT & Google

Chat-Bots

By Staff Reporters

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Microsoft just unseated Apple yesterday as the world’s most valuable publicly traded company…and then gave the throne right back. The AI-fueled stock rally that Microsoft has enjoyed for months finally buoyed the software company’s market capitalization to $2.9 trillion Thursday-Firday morning, briefly edging past Apple’s $2.89 trillion. Apple had been the most valuable company in the world for a year and a half, and on-and-off for more than a decade.

Apple was back on top by midday, but Microsoft’s momentary reign—the fourth time it’s briefly overtaken Apple since 2018—indicates that the tables may be turning between these longtime rivals.

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Employees in its streaming divisions, Google cut about a thousand roles across its Assistant and core engineering teams, The Verge reported. The company is also reportedly removing 17 “underutilized” features from its voice-activated Google Assistant software, which launched in 2016 to compete with Apple’s Siri and Amazon’s Alexa. Google announced last year that it would integrate its generative AI chatbot, Bard, into Assistant.

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BANKS: JPMorgan Chase, BoA, Wells Fargo and CitiGroup Report

By Staff Reporters

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JPMorgan Chase’s profit fell in the fourth quarter as the lender set aside nearly $3 billion to help refill a government deposit insurance fund. JPMorgan and several major banks are required to pay a bulk of the $16 billion to replenish the Federal Deposit Insurance Corporation’s deposit insurance fund (DIF), which was drained after Silicon Valley Bank and Signature Bank failed last year.

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Bank of America’s fourth-quarter profit shrank as the lender took $3.7 billion in combined charges to refill a government deposit insurance fund and phase out a loan index. Its net interest income (NII) – the difference between what banks earn from loans and pay to depositors – fell 5% to $13.9 billion as the company spent more to keep customer deposits and demand for loans stayed subdued amid high interest rates.

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Wells Fargo press release (NYSE:WFC): Q4 Non-GAAP EPS of $1.29 beats by $0.20. Revenue of $20.48B (+2.2% Y/Y) beats by $100M. Shares -1% PM. Fourth quarter 2023 results included: ◦ $(1.9) billion, or ($0.40) per share, of expense from an FDIC special assessment ◦ $(969) million, or ($0.20) per share, of severance expense for planned actions ◦ $621 million or $0.17 per share, of discrete tax benefits related to the resolution of prior period tax matters ◦ Provision for credit losses in fourth quarter 2023 included an increase in the allowance for credit losses driven by credit card and commercial real estate loans, partially offset by a lower allowance for auto loans. The change in allowance for credit losses also included higher net loan charge-offs for commercial real estate office and credit card loans

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Citigroup (C) is in the middle of a complicated restructuring. It made it clear Wednesday that its fourth quarter earnings report Friday will be complicated, too.

The giant New York-based bank said in a regulatory document it will take more than $3 billion in one-time reserves and expenses as part of those fourth quarter results. They include everything from a $1.3 billion reserve build for currency exposure in Argentina and Russia to $780 million in charges related to severance costs and other aspects of a wide-ranging restructuring of the bank led by CEO Jane Fraser.

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PRIVATE HOSPITAL EQUITY: Adverse Events Rise?

By Staff Reporters

DEFINITION: Adverse events are medical errors that healthcare facilities could and should have avoided. The National Quality Forum (NQF) defines these errors, which are also called serious reportable events. There are 29 adverse events listed as reportable errors. The events may result in patient death or serious disability. The department manages aggregate data on adverse events and posts quarterly reports on this website.

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

NEVER EVENTS: https://medicalexecutivepost.com/2007/12/20/new-never-events-policy/

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A hospital’s acquisition by a private equity firm is linked to a rise in adverse events despite the pool of lower-risk patients they tend to admit, according to a Medicare Part A claims analysis just published in the Journal of the American Medical Association [JAMA], and according to Dave Muoio of Fierce Healthcare.

JAMA: https://jamanetwork.com/journals/jama/article-abstract/2813379

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PODCAST: Impact of Education on Employee Health Care

HEALTH INSURANCE DEMOGRAPHICS

By Eric Bricker MD

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DAILY UPDATE: Crypto-Currency, ETFs and the Stock Markets

By Staff Reporters

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SPONSOR: http://www.MarcinkoAssociates.com

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The Markets as of 10:00am ET. Here’s what these numbers mean.
Markets: One week into 2024, stocks and bonds are off to their worst start in 21 years as investors maybe got a bit ahead of their skis in anticipating Fed rate cuts.

This week, Wall Street will be focused on fresh inflation data and the beginning of Q4 earnings season.

                        

Bitcoin ETF cleared for launch? The first spot bitcoin ETF—could be approved by regulators this week in what would be a watershed moment for Wall Street’s embrace of digital tokens. The hype around these proposed funds, which would allow regular investors to gain exposure to bitcoin without buying it directly, drove bitcoin’s price up 162% over the past year.

Here is where the major benchmarks ended:

  • The S&P 500 Index was up 84.15 points (1.9%) at 4,495.70; the Dow Jones Industrial Average (DJI) was up 489.83 points (1.4%) at 34,827.70; the NASDAQ Composite (COMP) was up 326.64 points (2.4%) at 14,094.38.
  • The 10-year Treasury note yield (TNX) was down about 18 basis points at 4.453%.
  • CBOE’s Volatility Index (VIX) was down 0.60 at 14.16.

The small-cap focused Russell 2000 Index (RUT), which has lagged large-cap benchmarks for most of the year, jumped more than 5% Tuesday. Small-caps are often seen as being more exposed to the economic cycle and had suffered because of concerns that high interest rates could push the economy into recession.

Other interest rate-sensitive sectors, such as real estate, materials, and utilities, also saw outsize gains.

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IMPLICATION OF WITHDRAWALS IN A MODERATE INTEREST RATE ENVIRONMENT

  A SPECIAL ME-P REPORT

A Retrospective Review … and Implications for Modernity

[Copyright Manning & Napier Advisors, Inc.]

Dr. Jeff Coons

By Jeff Coons PhD CFA

By Dr. David Edward Marcinko MBA CMP

SPONSOR: http://www.CertifiedMedicalPlanner.org

The general trend of declining interest rates experienced over the last several decades, part of a long-term trend Manning & Napier Advisors, Inc. and others have focused on since the early 1980’s, created new challenges for managing investment portfolios with regular and significant cash withdrawals.

Historical Review

This continuing report, first prepared 25 years ago, will provide an analysis of the investment implications of withdrawals in light of the secular shift in the economic and market conditions today. This analysis and historical review aims to guide decisions as to the appropriate level of withdrawals from an account in the more current moderate interest rate environment of 2014; and estimated thru to 2023.

The Questions

Declining interest rates restrict the ability to generate income from high quality investments, so a greater proportion of a given withdrawal requirement must come from the potential price appreciation of the securities.  Of course, the inherently volatile nature of the financial markets makes price appreciation the less predictable of the sources of total return available to fund withdrawal needs.

The natural questions that arise from this observation include:

  • What withdrawal rate inhibits the ability to pursue long-term capital growth as a primary investment objective?
  • What withdrawal rate may create a significant risk of a sustained deterioration of capital?
  • What is a reasonable range of withdrawal rates given the relatively low interest rate environment that we face? 

The answer to the first question can be derived from interest rates and dividend yields.  With a dividend yield of 1.0%-2.0% on stocks (e.g., the yield on the S&P 500 Index as of December 2000 was 1.2%) and yields on intermediate-term and long-term fixed income securities between 5.0% and 6.0% (e.g., as of December 2000, a one-year Treasury Bill had a yield of 5.4% and a thirty-year Treasury bond had a yield of 5.5%), growth-oriented portfolios should generally produce a level of income adequate to allow 2.5%-3.5% withdrawals on an annual basis.

Thus, rates of withdrawal of less than 3.5% generally should not inhibit the pursuit of long-term capital growth as a primary investment objective.

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Portfolio analysis

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Management Approach

To establish the high end of the achievable withdrawals under a management approach pursuing long-term capital growth, consider some historical evidence.

Assume that withdrawals are taken from each of three portfolios (i.e., 100% stocks, 80% stocks/20% bonds, and 50% stocks/50% bonds using data from Ibbotson Associates, Inc.) starting at the beginning of 1973.  How many years did it take to regain the original capital of the portfolio?

As can be seen in the following table, it took between 4-8 years for these portfolios to recover from the 1973-74 bear market with a 5.0% withdrawal rate.  If withdrawals are at a 7.5% rate per year, over ten years elapsed before the original capital was restored.

Finally, with a 10.0% withdrawal rate, it took between 13-15 years to restore the capital.  While the 1973-74 bear market was severe, it is not the worst bear market that can be used to illustrate the risk of significant withdrawals taken when the portfolio’s market value is depressed.

The clear conclusion is that withdrawals of greater than 5.0% are a potential impediment to pursuing long-term capital growth, given the long periods required to restore capital for the various growth-oriented asset mixes offered in this analysis.

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When Was Original (12/72) Capital Restored?
  1. 0% W/D
 

  1. 5% W/D
 

  1. 0% W/D
 100% Stock  9/80(7.75 years) 6/83(10.5 years) 6/86(14.5 years)
80% Stock/ 20% Bond  9/80(7.75 years) 3/83(10.25 years) 6/86(14.5 years)
50% Stock/ 50% Bond  12/76(4.0 years) 3/83(10.25 years) 3/87(15.25 years)

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Another key issue to remember is that the withdrawal rates above are a percentage of current market value, so the dollar value of the cash withdrawn from the account is assumed to decline in a bear market.  However, most of us think of our withdrawal needs in terms of dollars instead of percentages (e.g., $50,000 from a $1,000,000 account, which translates to 5%).

If we attempt to maintain the dollar value of withdrawals in bear market periods, the percentage of current market value being withdrawn actually increases, and the impact on the portfolio far exceeds the example provided above.

SAMPLE:

To demonstrate, consider maintaining withdrawals of $50,000, $75,000 and $100,000 on an account with a $1,000,000 market value as of 12/72 (see table below).

In the case of a $50,000 annual withdrawal, approximately 8-10 years elapse before the original $1,000,000 market value is restored.  If the withdrawals are $75,000 per year, 13 years elapse for the 50/50 asset mix and almost 19 years pass for the 80/20 asset mix before the $1,000,000 is restored.  For the 100% stock portfolio, nearly 25 years elapse before the original $1,000,000 is restored.

Finally, for $100,000 withdrawals off of a $1,000,000 market value in 1972, all capital in the account is depleted within 10-15 years given these withdrawals.  Thus, the risk of significant cash withdrawals having a detrimental impact on the ability to preserve and grow capital is much more pronounced when withdrawals remain high in dollar terms.

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When Was Original Capital ($1,000,000 in 12/72) Restored?
$50,000 W/D  $75,000 W/D  $100,000 W/D
 100% Stock  3/83(10.25 years) 9/97(24.75 years) Capital Depleted9/83
80% Stock/ 20% Bond  12/80(8.0 years) 9/91(18.75 years) Capital Depleted3/85
50% Stock/ 50% Bond  9/80(7.75 years) 3/86(13.25 years) Capital Depleted9/87

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So far, the major point we have established is that a withdrawal rate of 2.5%-3.5% may be achievable without hampering the pursuit of long-term capital growth, but withdrawals of 5% or greater may have a significant impact on the ability to manage for growth.  Therefore, accounts expected to experience withdrawals of 4%-5% (or greater) should be managed with a goal of satisfying these withdrawal needs on a regular basis first, with the pursuit of capital growth taking secondary importance.

However, the analysis provided above also implies that there is a rate of withdrawals that forces us to focus on capital preservation, because depletion of capital is a likely outcome.  For withdrawals in the range of 10.0%, the example above shows that the risk of depletion of capital is significant at these high annual levels, especially if the withdrawals are on a dollar basis and not adjusted by the decline of current market value in a bear market.

In fact, with long-term U.S. government bond yields at approximately 5.0%-6.0%, annual withdrawals greater than 7.5% are likely to be too high to allow a manager to effectively pursue long-term capital growth without a high degree of risk to the capital of the account.  That is, since attempts to provide returns above the current Treasury yields imply risk of volatility, and volatility can lead to the examples provided above, withdrawals at 7.5% or more and maintained on a dollar basis imply a high likelihood that original capital will be depleted over a 15-20 year period.

In general, the current level of yields in the market imply that management of a portfolio requiring over 7.5% per year in withdrawals faces a strong possibility of depleting capital under any scenario, and so portfolio management should focus on dampening market volatility so as to extend the life of the capital for as long as possible as it is drawn down.

Final Questions

The final question[s] (i.e., the appropriate level of withdrawals) is driven by both the client’s need for the assets and the parameters outlined above:

  1. Withdrawals less than 3.5% of current market value should not inhibit the pursuit of long-term capital growth as a primary objective.
  2. Withdrawal rates between 3.6% and 7.4% require a primary focus on satisfying withdrawal needs over the market cycle, possibly with a secondary goal of long-term capital growth to protect future withdrawal needs.
  3. Withdrawal rates greater than 7.5% are likely to result in a depletion of capital, so the goal should be to manage the drawdown of capital by dampening year-to-year volatility of the portfolio.

While we all would like to achieve capital growth, the ability to pursue growth-oriented strategies depends on the flexibility to moderate withdrawals, if required by market conditions, and on the overall reliance on these assets.

As another example, an endowment can control its withdrawals to some extent, but there is a level beyond which the belt cannot be tightened without harming the services being funded.

Yet another example comes from a physician-executive or someone living primarily on an IRA account, especially after becoming accustomed to the high (and falling) interest rate/high asset return environment of the last fifteen years.  Aggressively pursuing capital growth in the face of large withdrawals may result in exposure to significant risk of depletion of the IRA assets when other sources of income are unavailable.

If, on the other hand, the IRA was a small part of the wealth available in retirement, then there is some flexibility to work towards long-term capital growth.

Financial Planning MDs 2015

Implications for defined benefit retirement plans

A defined benefit retirement plan may have an outside source of funding to help restore capital (i.e., contributions from the employer), but defined contribution and Taft-Hartley plans have much less of a safety net.  As a result, the risk taken to pursue growth in the face of significant withdrawals must take into account the nature of the assets and the problems associated with a deterioration of capital in the account.

Assessment

And so, withdrawals can have a significant impact on the ability of a manager to preserve capital and pursue long-term capital growth.  However, while lessening the level of withdrawals will help provide flexibility for the manager to pursue these goals, the need for the assets may require that withdrawals are maintained at a certain level.  Once withdrawals are minimized, the manager should focus on investment goals that correspond with this minimum level.

If withdrawals are below 3% of current market value, pursuit of long-term capital growth can be a primary objective.  Withdrawals between 4% and 7.5% of market value on an annual basis require a focus on working towards satisfying these annual needs.  Long-term capital growth, in this case, should be a secondary goal.

Finally, if withdrawals are above a 7.5% annual rate, then the investment management approach should focus on preserving capital and dampening market volatility so as to work towards allowing the assets to last as long as possible as they are drawn down.

NOTE: The 10-year Treasury rate’s just fell below 3.91% after Fed, ECB nominees; today.

Conclusion

This historical review paper provides a retrospective review of IRs and implications for modernity.

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