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.

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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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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.

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

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DAILY UPDATE: Walgreens’s Dividend Dives as Stocks Post Down Week

By Staff Reporters

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SPONSOR: http://www.MarcinkoAssociates.com

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DEFINITION: A stock dividend is a payment to shareholders that consists of additional shares rather than cash. The distributions are paid in fractions per existing share. For example, if a company issues a stock dividend of 5%, it will pay 0.05 shares for every share owned by a shareholder. The owner of 100 shares would get five additional shares.

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Stat: 3.9%. That’s Walgreens’s new dividend yield after the pharmacy chain cut its quarterly dividend of 7.0%. The company said that it was using the money to “strengthen [its] long-term balance sheet and cash position.” Walgreens stock fell 11% the day after the announcement. (CNBC)

Here is where the major benchmarks ended:

  • The S&P 500 index was up 8.56 points (0.2%) at 4,697.24, down 1.6% for the week; the Dow Jones Industrial Average® (DJI) was up 25.77 points (0.1%) at 37,466.11, down 0.6% for the week; the NASDAQ Composite® (COMP) was up 13.77 points (0.1%) at 14,524.07, down 3.2% for the week.
  • The 10-year Treasury note yield (TNX) was up about 6 basis points at 4.051%.
  • The CBOE® Volatility Index (VIX) was down 0.77 at 13.36.

Consumer staples and real estate ranked among the market’s weakest performers Friday, and technology shares remained under pressure with tech bellwether Apple (AAPL) extending this week’s nearly-6% slide and ending near a two-month low. Financial shares were one of the stronger sectors with the Philadelphia KBW Bank Index (BKX) rising 1.6% to a 10-month high. Small-cap stocks remained in the red with the Russell 2000® Index (RUT) ending the week down 3.7%. 

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PODCAST: Hospital Cost to Charge Ratios Explained

By Eric Bricker MD

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Medical Cost Accounting: https://medicalexecutivepost.com/2022/08/30/understanding-medical-cost-accounting/

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PODCAST: Why Hospitals Cry “Poor”

By Eric Bricker MD

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DAILY UPDATE: ChristianaCare Settles FCA Lawsuit as Stock Markets Celebrate 2023 but Start Off Rocky in 2024

By Staff Reporters

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ChristianaCare agreed to pay $47.1 million to resolve illegal kickback allegations flagged by its former chief compliance officer.

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Markets: The stock market was closed yesterday to give investors time to celebrate New Year’s Day 2024. As the just passed old year, 2023, provided plenty of reasons to pop bottles and celebrate:

For example, global stock markets had their best year since 2019, and all three major US indexes finished the year higher than they started it, with tech company gains pushing the NASDAQ up the most. Even among tech giants, Nvidia was a standout, boosted by A.I. suddenly being everywhere.

But, all major markets are down as of this posting time, today.

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HELPING DOCTORS ACHIEVE: New Year Resolutions

COACHING AND MENTORING

Physician Goal Setting [Business V. Personal Approach] in 2024

By Marcinko Associates, Inc.

SPONSOR: http://www.MarcinkoAssociates.com
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CORPORATE APPROACH

The year-end physician, nurse and/or medical employee reviews in general aren’t very effective at motivating employees in ACOs, and VBC organizations, etc.

And, according to a Gallup [non-medical worker] poll, only 14% of employees “strongly agreed” that a performance review inspired them to improve. But in recent years, some workplaces have changed how they conduct performance reviews—or abandoned them altogether especially in technology.

  • A decade ago, Microsoft disbanded its version of stack ranking, the practice pioneered by General Electric CEO Jack Welch in the 1980s in which the company would rank every employee. Experts say it hurts morale and can create a toxic work culture.
  • Netflix has around 10,000 employees but has eschewed the year-end review for informal conversations during the year.
  • Google revamped its system last May by reducing performance reviews from twice to once a year.
  • Apple dropped performance reviews completely.

Healthcare business and corporate employees want feedback, even physicians, but it has to be useful.

PERSONAL APPROACH

Now that you’ve set your personal goals on your landmark date (New Year 2024), how you pursue it will go a long way toward whether you achieve it. There are generally two ways to tackle the goals you’ve set for yourself—and one yields more success than the other.

  • Avoidance goals: While this works well when it comes to your ex-medical partner or spouse, it’s not how you want to attack resolutions. Avoidance goals include “stop eating sweets” or “watch less TV.”
  • Approach goals: Instead of avoiding a behavior, you create a new one. Your goals would be “eating more vegetables” or “reading more books” to replace the habits you want to shake.

And, a recent study found that approach goals are more likely to be accomplished (59%) than avoidance goals (47%) across a wide range of potential resolutions. Good luck with that!

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HAPPY NEW YEAR: From All of Us at the ME-P

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EDUCATION: https://marcinkoassociates.com/textbooks-academic-catalog/

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 From us all to you and yours.
Here’s to making a difference and paying it forward today, in 2024, and beyond. 

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DEFLATION: Another Holiday Surprise?

By Staff Reporters

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Deflation could be arriving this holiday season. Walmart CEO Doug McMillon recently said deflation may be on the horizon, citing a decline in the prices of grocery items such as chicken and eggs. McMillion said that although some items like beef remain expensive, he expects prices on other staples to come down in the coming months.

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It’s the latest welcome news for everyone feeling the squeeze from inflation and rising interest rates.

  • Target Chief Growth Officer Christina Hennington said earlier this week that the average price of basics fell three percentage points between Q2 and Q3.
  • JCPenney announced last month that it planned to keep prices for Black Friday the same or lower than last year.

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DAILY UPDATE: Holiday Spending Solid as Stock Market Rally Continues

By Staff Reporters

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Consumer spending grew solidly this holiday season, rebuking concerns of a slowdown and reinforcing positive signals about the U.S. economy as it approaches the end of a tumultuous year.

Buying among shoppers rose 3.1% over the holidays compared to the same period last year, according to data released on Tuesday by Mastercard SpendingPulse, which measures in-store and online purchases from November 1st to December 24th across all forms of payment. The data is not adjusted for inflation.

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Here’s where the major benchmarks ended: 

  • The S&P 500 index was up 20.12 points to 4,774.75 up 0.42%; the Dow Jones Industrial Average was up 159.36 points at 37,54533, up 0.2% ; the NASDAQ Composite® (COMP) was up 81.6 points to 15,074.57 up 0.54% to start the week.  
  • The 10-year Treasury note yield (TNX) was down 1 basis point to 3.895%.
  • The CBOE® Volatility Index (VIX) was down 0.38% to 12.98.

Small-cap stocks continued to outpace their larger cousins, a common theme lately. The Russell 2000® Index rose Tuesday following six weeks of gains. Financials and real estate sectors were among strongest S&P 500 performers during the session, and the Russell 2000 has a heavy exposure to financials. In other markets, the U.S. Dollar Index (DXY) extended its recent slide and now trades at five-month lows, reflecting ideas that potentially lower interest rates may prompt investors to seek higher returns elsewhere.

With just three trading days left in 2023, the S&P 500 and other major equity benchmarks are poised to turn in a strong year that may more than make up for 2022’s losses. With Tuesday’s gains factored in, the SPX is closing in on its all-time high close just below 4,800 posted in early 2022. Through Tuesday, the S&P 500 was up more than 24% for the year, after tumbling 19.4% in 2022. The Dow Jones Industrial Average and the NASDAQ Composite were up 13% and 44%, respectively, after losing 8.8% and 33% in 2022.

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HEALTHCARE: Spending Grew in 2022

By Health Capital Consultants, LLC

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On December 13, 2023, the Centers for Medicare & Medicaid Services (CMS) released its annual report on healthcare spending in the U.S., highlighting the growth in private insurance and Medicaid spending in 2022, which was offset by the declines in supplemental federal funding as a result of the COVID-19 pandemic.

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This Health Capital Topics article reviews the notable healthcare spending findings in CMS’s report. (Read more…) 

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HOLIDAY BONUS: Wall Street is Down

By Staff Reporters

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For the second straight year, Wall Street bankers should prepare for smaller bonuses this holiday season, according to a report from consulting firm Johnson Associates. Cash bonuses for investment bankers in particular could shrivel up to 25% compared to 2022. Now, bonuses often account for a huge share of bankers’ total compensation. In some cases, they can be double their salary. That adds up to tens of billions of dollars in Wall Street’s bonus pot, which hit an all-time high in 2021.

But two years later, the economy looks a lot different.

For example, IPOs have slowed, interest rates are up, and we’re down a few banks. Investment bankers aren’t the only ones feeling the effects:

  • Regional bankers are likely to see bonuses fall 10%–20%.
  • Workers in asset management and sales could get 5%–10% less this year.
  • The only groups expected to receive bonus bumps this year are wealth managers and retail or commercial bankers at major global banks. Goldman Sachs is also reportedly considering bigger (but still unspecified) bonuses to keep top traders.

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EDITOR’S CORNER: Fierce Health-Care’s 10 Most-Read Stories of 2023

By Heather Landi

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READ HERE: http://tinyurl.com/484773vm

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EMPLOYEE LAYOFFS: A Different Type of Holiday “Window Dressing”

END-OF-YEAR FINANCE

By Staff Reporters

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We’ve discussed end of year mutual fund “window-dressing” before on this ME-P. Essentially, with mutual funds, window dressing refers to the superficial changes a fund might make to its portfolio of holdings to appear more attractive to current and prospective investors. At a glance, a potential investor might be drawn in with what appears to be good performance. 

For example, a mutual fund management team might choose to sell losing stocks and buy winning ones at or around the end of a quarter. This strategy hides weak performance and gives investors a perception of impressive returns. 

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Window dressing in stocks is an example from another part of the world of finance, as public companies sometimes use window dressing when reporting earnings. Depending on the specifics, this practice can range from “creative accounting” to something bordering on or actually qualifying as fraud.

For example, some economics researchers cite rounding as a manipulative form of window dressing. A firm might round $5.99 million in quarterly earnings up to $6 million because the round number can be more psychologically attractive.

MORE: https://medicalexecutivepost.com/2023/12/02/what-is-mutual-fund-window-dressing/

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The GM-owned self-driving car company Cruise will lay off 24% of its staff (~900 employees) as well as nine executives following a serious autonomous taxi crash in San Francisco in October 2023 and the vehicles’ subsequent banning in the state of California.

Cruise’s staff reduction appears mostly due to the safety concerns around the company’s robo-taxis, but it comes after a deluge of other high-profile companies made major cuts just before the holidays:

  • Etsy. The online marketplace said it was laying off 11% of its staff. CEO Josh Silverman blamed the macroeconomic environment and previous over-hiring despite gross merchandise sales remaining flat since 2021.
  • Hasbro. The toymaker laid off 1,100 workers (roughly 20% of its staff) after a period of less-than-stellar toy sales following a pandemic surge. This most recent layoff is in addition to the 800 jobs it cut earlier this year.
  • Spotify. The streaming giant announced its third round of 2023 layoffs earlier this month. The company cut 1,500 jobs, which equates to about 17% of staff.
  • Why do companies do this?

Pre-holiday layoffs might seem especially cruel, but sadly, they aren’t uncommon. December job cuts are the quickest way for companies to pad the balance sheet and EOY reports before they show them to shareholders. Plus, it means they’ll have to give out fewer end-of-year bonuses.

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DAILY UPDATE: Three Arrows Capital is Down as Stock Markets Rebound

By Staff Reporters

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Almost $1 billion in assets belonging to the founders of cryptocurrency hedge fund Three Arrows Capital have been frozen by a British Virgin Islands court, according to the firm’s liquidator. The court issued an order preventing co-founders Su Zhu and Kyle Davies, as well as Davies’ wife Kelly Chen, from transferring or selling assets worth up to $1.14 billion, the liquidator Teneo said in an emailed statement, adding that it estimates creditors are owed roughly $3.3 billion. 

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Here is where the major benchmarks ended:

Here’s where the major benchmarks ended:

  • The S&P 500® index (SPX) was up 48.40 points (1.0%) at 4,746.75; the Dow Jones Industrial Average was up 322.35 points (0.9%) at 37,404.35; the NASDAQ Composite®(COMP) was up 185.92 points (1.3%) at 14,963.87.
  • The 10-year Treasury note yield (TNX) was up about 1 basis point at 3.89%.
  • The CBOE® Volatility Index (VIX) was down 0.02 at 13.65, after earlier rising to 14.49.

Among market sectors, Micron Technology’s gain helped send the Philadelphia Semiconductor Index (SOX) up 2.8%. Retail and transportation shares were also among the strongest performers.

The Russell 2000® Index (RUT), which is largely small cap focused, rose 1.7% and is on track for a sixth consecutive weekly gain.

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Of Gray Rhinos & Other Financial Threats!

Rick Kahler MS CFP

By Rick Kahler MS CFP®

“There he is,” our South African guide whispered excitedly. About 200 feet away stood a black rhino, the rarest and most aggressive of the rhinos. The rhino focused his full attention on us as he repeatedly took a few steps and stopped. After several minutes, he moved so a bush blocked our view of him. “Ok, he is using the bush as a cover and is probably going to charge. We need to leave. Start walking backward and keep your eyes in the direction where you saw the rhino.”

As I started backing up as fast as I could, the guide barked in his loudest whisper, “Don’t run! If he charges drop to the ground; he won’t trample you.” I can’t say I was comforted by this bit of information.

This experience taught me a rhino on the horizon represents a real and present danger.

Ignoring it can result in paying a heavy price

At this year’s FPA Retreat, one of the speakers was Michele Wucker, author of The Gray Rhino: How to Recognize and Respond to the Obvious Dangers We Ignore. She said that when it comes to financial planning and investments, rhinos loom everywhere. Wucker described these dangers as different from elephants and black swans.

The elephant in the room is something we see but no one is going to do anything about. It’s not going anywhere, and we will construct our life to accommodate it. Common financial elephants that I see are adult children financially dependent upon enabling parents, a financially controlling spouse with a history of poor financial decisions, or a family member addicted to spending,

A black swan is unpredictable, something we don’t even see. It can be the loss of a job, the sudden death of a breadwinner, or the collapse of a highly rated financial institution.

The grey rhino is something you know is stalking you. You know it is coming, but you don’t know when. The trick to avoiding a rhino is recognizing and acting on the obvious dangers we ignore.

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Ex-Cathedra black swan

[Black Swan]

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There are a lot of grey rhinos in the financial world

Here are a few common ones:

1. The next stock market crash. I guarantee you the stock market will crash at some time in the future. The best plan I know is to prepare yourself to do nothing, so you don’t panic and sell.
2. Death. It is certainly inevitable, yet the majority of Americans don’t have a will.
3. Health costs. At some point in your life you will need health care, and good health care is, and will always be, expensive.
4. House and vehicle repairs. Normal wear and tear should come as no surprise.

Yet another critter lurks around the financial landscape: the bat. Where I live, bats show up every evening at dusk, without fail. Financial bats are equally predictable.

These are future events or expenses that we know are coming, such as:

1. College. Subtract each minor child’s age from 18. That’s the number of years you have to save to fund their college education.
2. Retirement. Subtract your age from the age at which you want to quit working. This is how many years you have to accumulate enough wealth to replace your salary.
3. Taxes. We even know the day and the hour on this one.
4. Birthday and Christmas gifts. These come every year, just as reliably as the bats.

Assessment

What’s the best way to cope with this financial zoo? I suggest emulating another animal—the lowly ant from Aesop’s fable. Unlike the happy-go-lucky grasshopper, the ant put away resources so it was prepared for future hardships.

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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HAPPY HOLIDAYS: A New Covid Virus Variant!

By Staff Reporters

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READ HERE: N.1 is the Covid variant that’s spiking just in time to disrupt the holidays.

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HOLIDAY: Tip Etiquette 2023?

GRATUITIES

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DAILY UPDATE: First Day of Winter as FedEx and the Stock Markets Crash!

HAPPY WINTER SOLSTICE

By Staff Reporters

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Astronomical winter begins at the winter solstice, which is the shortest day of the year. This means days get longer during winter—very slowly at first, but at ever-larger daily intervals as the March Equinox approaches, heralding the start of spring.

Locations closer to the poles experience larger differences in day length throughout the year, so winter days are shorter there. In Toronto, the shortest day is just under 8 hours and 56 minutes long; in Miami, roughly 2000 kilometers or 1200 miles farther south, it lasts about 10 hours and 32 minutes.

Places within the polar circles experience polar night during all or part of the winter season when the Sun does not rise at all.

Here is where the major benchmarks ended:

Here’s where the major benchmarks ended:

  • The S&P 500 index (SPX) was down 70.02 points (1.5%) at 4,698.35; the Dow Jones Industrial Average (DJI) was down 475.92 points (1.3%) at 37,082.00; the NASDAQ Composite® (COMP) was down 225.28 points (1.5%) at 14,777.94.
  • The 10-year Treasury note yield (TNX) was down about 6 basis points at 3.858%.
  • The CBOE® Volatility Index (VIX) was up 1.14 at 13.67.

Shares of semiconductors and banks were among the weakest performers Wednesday, giving back some recent gains after ranking among upside leaders during the recent rally.

Transportation shares also slumped behind weakness in FedEx. The Dow Jones Transportation Index (DJT) fell 1.5% and ended at its lowest level in a week. 

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PODCAST: FFS MedicalPayment As a Public Health Threat?

FEE FOR SERVICE

By Eric Bricker MD

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DAILY UPDATE: Goldman Sachs Speaks as the Stock Markets Rise

By Staff Reporters

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The Federal Reserve’s pivot last week to an easier monetary policy made many investors more bullish toward stocks. You can count Goldman Sachs among them. It has raised its year-end 2024 target for the S&P to 5,100 from 4,700. The new forecast represents an 8% increase from 4,740 on Dec. 18. Goldman has a three-month target of 4,800 and a six-month target of 4,900.

Here is where the major benchmarks ended:

Here’s where the major benchmarks ended:

  • The S&P 500 index was up 21.37 points (0.5%) at 4,740.56; the Dow Jones Industrial Average was up 0.86 points at 37,306.02; the NASDAQ Composite was up 90.89 points (0.6%) at 14,904.81.
  • The 10-year Treasury note yield (TNX) was up about 2 basis points at 3.946%.
  • The CBOE® Volatility Index (VIX) was up 0.25 at 12.53.

Energy shares were among Monday’s strongest performers behind a rally in WTI Crude Oil futures (/CL), which jumped 1.7% to end at a two-week high amid concern over supply disruptions following attacks on ships in the Red Sea.

Communication services and consumer staples were also firm. Financials gave back some of last week’s sharp gains, with the KBW Bank Index (BKX) down nearly 1%.

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DAILY UPDATE: The “Magnificent Seven” Technology Stocks PLUS Uber

By Staff Reporters

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  • Markets: The Magnificent Seven technology mega-cap stocks—Microsoft, Apple, Alphabet, Nvidia, Tesla, Meta, and Amazon—have surged 75% this year, while the other 493 companies in the S&P 500 have gained 12%. The Magnificent Seven now account for nearly 30% of the entire index’s value, per the WSJ.
  • Stock spotlight: Speaking of the S&P 500, it’s getting a prominent new member—Uber will join the index today. With a market cap of $127 billion, Uber is the most valuable company that hadn’t yet been included in the S&P 500, and it celebrated by notching a 52-week high last week.
  • CITE: https://www.r2library.com/Resource

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PODCAST: US Primary Medical Care V. Other Industrialized Nations

By Eric Bricker MD

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MICRO-CERTIFICATIONS: Physician Insider Knowledge for Financial Advisor Success?

Micro-Credentials on the Rise

KNOWLEDGE RICHES IN NICHES

DR. DAVID EDWARD MARCINKO MBA CMP

SPONSOR: http://www.CertifiedMedicalPlanner.org

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Do you ever wish you could acquire specific information for your career activities without having to complete a university Master’s Degree or finish our entire Certified Medical Planner™ professional designation program? Well, Micro-Certifications from the Institute of Medical Business Advisors, Inc., might be the answer. Read on to learn how our three Micro-Certifications offer new opportunities for professional growth in the medical practice, business management, health economics and financial planning, investing and advisory space for physicians, nurses and healthcare professionals.

Micro-Certification Basics

Stock-Brokers, Financial Advisors, Investment Advisors, Accountants, Consultants, Financial Analyists and Financial Planners need to enhance their knowledge skills to better serve the changing and challenging healthcare professional ecosystem. But, it can be difficult to learn and demonstrate mastery of these new skills to employers, clients, physicians or medical prospects. This makes professional advancement difficult. That’s where Micro-Certification and Micro-Credentialing enters the online educational space. It is the process of earning a Micro-Certification, which is like a mini-degree or mini-credential, in a very specific topical area.

Micro-Certification Requirements

Once you’ve completed all of the requirements for our Micro-Certification, you will be awarded proof that you’ve earned it. This might take the form of a paper or digital certificate, which may be a hard document or electronic image, transcript, file, or other official evidence that you’ve completed the necessary work.

Uses of Micro-Certifications

Micro-Certifications may be used to demonstrate to physicians prospective medical clients that you’ve mastered a certain knowledge set. Because of this, Micro-Certifications are useful for those financial service professionals seeking medical clients, employment or career advancement opportunities.

Examples of iMBA, Inc., Micro-Certifications

Here are the three most popular Micro-Certification course from the Institute of Medical Business Advisors, Inc:

  • 1. Health Insurance and Managed Care: To keep up with the ever-changing field of health care physician advice, you must learn new medical practice business models in order to attract and assist physicians and nurse clients. By bringing together the most up-to-date business and medical prctice models [Medicare, Medicaid, PP-ACA, POSs, EPOs, HMOs, PPOs, IPA’s, PPMCs, Accountable Care Organizations, Concierge Medicine, Value Based Care, Physician Pay-for-Performance Initiatives, Hospitalists, Retail and Whole-Sale Medicine, Health Savings Accounts and Medical Unions, etc], this iMBA Inc., Mini-Certification offers a wealth of essential information that will help you understand the ever-changing practices in the next generation of health insurance and managed medical care.
  • 2. Health Economics and Finance: Medical economics, finance, managerial and cost accounting is an integral component of the health care industrial complex. It is broad-based and covers many other industries: insurance, mathematics and statistics, public and population health, provider recruitment and retention, health policy, forecasting, aging and long-term care, and Venture Capital are all commingled arenas. It is essential knowledge that all financial services professionals seeking to serve in the healthcare advisory niche space should possess.
  • 3. Health Information Technology and Security: There is a myth that all physician focused financial advisors understand Health Information Technology [HIT]. In truth, it is often economically misused or financially misunderstood. Moreover, an emerging national HIT architecture often puts the financial advisor or financial planner in a position of maximum uncertainty and minimum productivity regarding issues like: Electronic Medical Records [EMRs] or Electronic Health Records [EHRs], mobile health, tele-health or tele-medicine, Artificial Intelligence [AI], benefits managers and human resource professionals.

Other Topics include: economics, finance, investing, marketing, advertising, sales, start-ups, business plan creation, financial planning and entrepreneurship, etc.

How to Start Learning and Earning Recognition for Your Knowledge

Now that you’re familiar with Micro-Credentialing, you might consider earning a Micro-Certification with us. We offer 3 official Micro-Certificates by completing a one month online course, with a live instructor consisting of twelve asynchronous lessons/online classes [3/wk X 4/weeks = 12 classes]. The earned official completion certificate can be used to demonstrate mastery of a specific skill set and shared with current or future employers, current clients or medical niche financial advisory prospects.

Mini-Certification Tuition, Books and Related Fees

The tuition for each Mini-Certification live online course is $1,250 with the purchase of one required dictionary handbook. Other additional guides, white-papers, videos, files and e-content are all supplied without charge. Alternative courses may be developed in the future subject to demand and may change without notice.

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Contact: For more information, or to speak with an academic representative, please contact Ann Miller RN MHA CMP™ at: MarcinkoAdvisors@msn.com [24/7] -OR- 770-448-0769[9:00 – 5:00 EST].

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DAILY UPDATE: Mental Health and NASDAQ Technology Stocks

By Staff Reporters

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“We kept hearing nightmare stories about Americans not getting the treatment that they needed because insurance companies were denying them care. But we didn’t have enough data to show just how extensive and deep the problem was.”—

Bill Smith, founder of mental health advocacy coalition Inseparable, on patients with mental health diagnoses not receiving care (NPR)

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The NASDAQ closed at an all-time high yesterday, breaking the record it set in November 2021, as technology stocks continued to rally on the news that the Fed may cut interest rates next year.

DocuSign shot up following reports that the $11 billion company whose tech lets you use your signature without a pen could be up for sale.

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

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DEAR COLLEAGUES: Are You a Financial Advisor’s “Customer” or “Client”?

By Dr. David Edward Marcinko MBA CMP

SPONSOR: http://www.MarcinkoAssociates.com

First – a little “insider expert” background on the confusion. It exists largely because of the influence that large financial institutions (who earn revenue through the sale of financial products) have on legislators.

The Investment Advisors Act of 1940 requires that anyone giving investment advice must be acting in a fiduciary capacity. The intent was to separate the financial salespeople, who had significant conflicts of interest, from the investment advisors, who had few to none. If you know very little about financial products, would you rather be educated as the customer of a commissioned salesperson or the client of a fee-for-service advisor? Hands down, you’d want the fee-for-service advisor.

Of course, the financial institutions selling products understood this. They were able to influence the drafting of the 1940 Investment Advisors Act, to exclude “any broker or dealer whose performance of such [advisory] services is solely incidental to the conduct of his business as a broker or dealer.” So if salespeople just happen to give some financial advice that is “incidental” to the sale of a product, they and their companies are not held to the fiduciary standard. Our U.S. Congress allows financial companies to advertise as if they are fiduciaries while their sales forces are not held to a fiduciary standard.

Now, according to Rick Kahler CFP®, the same conflict arises in some professional designations, like the Certified Financial Planner® designation conferred by the CFP® Board. The designation initially certified the completion of training in financial planning. In 2008 the Board added a fiduciary requirement to the designation.

However, CFP®’s are only held to a fiduciary requirement when they are doing what the CFP® Board defines as financial planning. If a CFP® professional is giving advice to a client, the fiduciary standard applies. Yet the same professional can sell the same client an annuity with high fees and high commissions, even if the product may not be in the client’s best interest, as long as no “financial planning” is part of the transaction. The result is significant confusion for consumers.

The bottom line is this: when you look for financial advice or financial products, don’t assume the advisor is looking out for you. It’s your responsibility to find out whether any financial professional owes you a fiduciary duty.

So, I suggest you ask directly, “Am I a customer or a client?” The answer is almost always “a client,” as most financial services salespeople honestly don’t know the difference. After you explain that difference, ask them to verify their fiduciary duty in writing. That five-minute solution may have a lasting impact on your financial well-being.

Better yet, consider speaking to your fiduciary focused and fee-only Certified Medical Planner® professional colleagues at D.E. Marcinko & Associates.

“By Doctors – For Doctors”

CMP: http://www.CertifiedMedicalPlanner.org***

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2024: FOMC Interest Rate Cuts?

By Staff Reporters

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The Dow hit an all-time high yesterday after the Federal Reserve hinted at plans to make multiple rate cuts next year. Not having such a good day was Pfizer, which touched a 10-year low after releasing disappointing projections for 2024 because people just aren’t buying Covid products like they used to.

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

Fed rate cuts may come in threes next year

The Federal Reserve had investors popping bottles yesterday, not just because it made the expected move of holding interest rates steady for now but also for signaling that there may be multiple interest rate cuts in 2024. Most Fed officials penciled in three quarter-percentage-point cuts in their projections. Fed Chair Jerome Powell said inflation had “eased” but still did his best to keep everyone from getting too excited, saying, “No one is declaring victory. That would be premature.” Even so, markets started pricing in even more aggressive cuts than the projections.

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PODCAST: Health Insurance is Sold; NOT Bought

BUILD A HEALTHCARE SALES MACHINE

By Eric Bricker MD

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FTC Lawsuit Targets Private Equity & U.S. Anesthesia Partners

By Health Capital Consultants, LLC

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FTC Lawsuit Targets Private Equity

On September 21, 2023, the Federal Trade Commission (FTC) sued U.S. Anesthesia Partners (USAP), a Texas-based anesthesia provider, and Welsh, Carson, Anderson & Stowe (Welch Carson), a private equity firm. The FTC alleged that the two companies executed an anti-competitive scheme for multiple years to consolidate anesthesiology practices in Texas, boost their profits, and drive up the price of anesthesia services rendered to patients.

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

This Health Capital Topics article will discuss the lawsuit and how it appears to fit in with the FTC’s recent moves to crack down on anti-competitive actions in healthcare. (Read more…)

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The Perfect Holiday Gift [The “Business of Medical Practice”]

Third Edition of Classic Text Now Available

[Transformational Health 2.0 Skills for Savvy Doctors]

By Ann Miller RN MHA [Executive-Director]

Product Details

For the first time anywhere, we offer our loyal ME-P readers and subscribers an exclusive first look at the new book: The “Business of Medical Practice” from the Institute of Medical Business Advisors Inc, in Atlanta, GA www.MedicalBusinessAdvisors.com

Synopsis

Now in its 3rd edition, the book explores a variety of issues and seeks to answer these questions:

  • Does Health 2.0 enhance or detract from traditional medical care delivery, and can private practice business models survive?
  • How does transparent business information and reimbursement data impact the modern competitive healthcare scene?
  • How are medical practices, clinics, and physicians evolving as a result of rapid health- and non-health-related technology change?
  • Does transparent quality information affect the private practice ecosystem?

A Tool for all Stakeholders

Answering these questions and more, this newly updated and revised edition is an essential tool for doctors, nurses, and healthcare administrators; management and business consultants; accountants; and medical, dental, business, and healthcare administration graduate, doctoral students and virtually all stakeholders of the healthcare industrial complex.

Management and Operational Strategies for Private Practice

Written in plain language using nontechnical jargon, the text presents a progressive discussion of management and operation strategies. It incorporates prose, news reports, and regulatory and academic perspectives with Health 2.0 examples, and blog and internet links, as well as charts, tables, diagrams, and Web site references, resulting in an all-encompassing resource. It integrates various medical practice business disciplines-from finance and economics to marketing to the strategic management sciences-to improve patient outcomes and achieve best practices in the healthcare administration field. With contributions by a world-class team of expert authors, the third edition covers brand-new information, including:

  • The impact of Web 2.0 technologies on the healthcare industry
  • Internal office controls for preventing fraud and abuse
  • Physician compensation with pay-for-performance trend analysis
  • Healthcare marketing, advertising, CRM, and public relations
  • eMRs, mobile IT systems, medical devices, and cloud computing
  • and much more!

Front Matter: Front Matter BoMP – 3

Assessment

Please send any question/and or comments directly to us at: MarcinkoAdvisors@msn.com

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:

HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
BLOG: www.MedicalExecutivePost.com
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors

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DAILY UPDATE: Economy Modest, Sickle Cell CRISPR Therapy Approved and Stock Markets Rise

By Staff Reporters

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SPONSOR: http://www.MarcinkoAssociates.com

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According to the Organization for Economic Cooperation and Development’s November economic outlook report, global growth is on track to stay modest this year and into 2024. And, while gross domestic product growth has been stronger than anticipated in 2023 so far, it’s now “moderating on the back of tighter financial conditions, weak trade growth and lower business and consumer confidence,” the report’s authors noted. The OECD anticipates global GDP growth of 2.9% in 2023, and a dip to 2.7% in 2024. 2025 looks better, with predicted global growth of 3%.

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The Food and Drug Administration on Friday approved a powerful treatment for sickle cell disease, a devastating illness that affects more than 100,000 Americans, the majority of whom are Black. The therapy, called Casgevy, from Vertex Pharmaceuticals and CRISPR Therapeutics, is the first medicine to be approved in the United States.

CRISPR: https://medicalexecutivepost.com/2022/08/06/crispr-play-by-play-of-an-experiment/

Here is where the major benchmarks ended:

The S&P 500® Index (SPX) was up 0.41% at 4,604.46, up marginally for the week; the Dow Jones Industrial Average (DJI) was up 130 points (0.36%) at 36,247.87, up marginally for the week; the NASDAQ Composite® (COMP) was up 63.98 points (0.45%) at 14,403.97, up 0.7% for the week.The 10-year Treasury note yield (TNX) was up 10 basis points at 4.235%. The CBOE Volatility Index (VIX) was down 5.44% at 12.35.

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DAILY UPDATE: Deflation Pending as Stock Markets Gain

By Staff Reporters

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After grappling with high inflation for more than two years, American consumers are now seeing an economic trend that many might only dimly remember: falling prices — but only on certain types of products. 

Deflation is impacting so-called durable goods, or products that are meant to last more than three years, Wall Street Journal reporter David Harrison told CBS News. As Harrison noted in his reporting, durable goods have dropped on a year-over-year basis for five straight months and dropped 2.6% in October from their September 2022 peak.

These items are products such as used cars, furniture and appliances, which saw big run-ups in prices during the pandemic. Used cars in particular were a pain point for U.S. households, with pre-owned cars seeing their prices jump more than fifty percent in the first two years of the pandemic.

Here is where the major benchmarks ended:

  • The S&P 500 Index was up 36.25 points (0.8%) at 4,585.59; the Dow Jones Industrial Average was up 62.95 points (0.2%) at 36,117.38; the NASDAQ Composite was up 193.28 points (1.4%) at 14,339.99.
  • The 10-year Treasury note yield (TNX) was up about 2 basis points at 4.144%.
  • The CBOE® Volatility Index (VIX) was up 0.09 at 13.06.

Tech sector strength was highlighted by the Philadelphia Semiconductor Index (SOX), which gained nearly 3%. Financial shares were also among the strongest performers, as the KBW Regional Banking Index (KRX) rose 2% and ended at a four-month high. In other markets, WTI crude oil futures (/CL) posted the market’s first gain in six days after earlier dropping to its lowest level since late June.

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GEMINI: Google’s Large Language Model Released

LLM

By Staff Reporters

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Gemini: Google's Latest AI Challenging GPT-4 - YouTube
  • About a year after OpenAI’s launch of ChatGPT brought the simmering artificial intelligence race to a boil, Google’s highly anticipated AI model, Gemini, has finally joined the competition. Released yesterday, Gemini is a large language model (LLM) that Google CEO Sundar Pichai and executives at the company’s DeepMind AI division say will revolutionize generative technology for business and daily life.

The tech is a family of three models that Google is slowly looping into its suite of services:

  • Gemini Nano is mainly for mobile devices. As of yesterday, Google Pixel 8 Pro owners could enlist Gemini Nano to summarize audio recordings or draft automatic message replies.
  • Gemini Pro is a midsize offering designed for more complex tasks. Pro now powers Google’s chatbot, Bard, but the AI tech isn’t available to Google Cloud customers until Dec. 13.
  • Gemini Ultra, the powerhouse version geared toward data centers and large companies, will launch next year and underpin “Bard Advanced,” a new chatbot that will be able to simultaneously process text, images, audio, and video, according to Google’s prerecorded demonstrations.

If Gemini can do what Google promises, it could chip away at OpenAI’s lead in the LLM space.

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DAILY UPDATE: Apple Market Cap Up as Major Stock Indexes Ease

By Staff Reporters

MEDICARE ANNUAL ENROLLMENT ENDS

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SPONSOR: http://www.MarcinkoAssociates.com

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Apple regains a $3 trillion market cap and is on track to end the year as the world’s most valuable company for the 5th time in a row.

Today marks the 82nd anniversary of the attack on Pearl Harbor that drew the US into WWII.

Here’s where the major benchmarks ended:

  • The S&P 500® index (SPX) was down 17.84 points (0.4%) at 4,549.34; the Dow Jones Industrial Average® (DJI) was down 70.13 points (0.2%) at 36,054.43; the NASDAQ Composite® (COMP) was down 83.20 points (0.6%) at 14,146.71.
  • The 10-year Treasury note yield (TNX) was down about 5 basis points at 4.117%.
  • The CBOE® Volatility Index (VIX) was up 0.10 at 12.95.

Energy shares were again among the market’s weakest performers as crude oil futures extended a slump, closing below $70 per barrel for the first time since late June on concerns over slowing global demand. And, Liz Ann Sonders of Schwab said a “somewhat stealthy” rotation continued under the market’s surface, with the S&P 500® Equal Weight (SPXEW) and Russell 2000®(RUT) indexes outperforming both the S&P 500 and NASDAQ over the past month or so. She also noted a defensive tone to Wednesday’ trading, illustrated by strength in utilities and weakness in technology.

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

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VALUATION OF MSOs: Introduction and Competitive Environment

MANAGEMENT SERVICE ORGANIZATION

By Health Capital Consultants, LLC

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Valuation of MSOs: Introduction & Competitive Environment

DEFINITION: A management services organization is an outside entity that can help with the non-medical parts of running a medical practice, out-patient facility or clinic; etc.

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

Management service organizations (MSOs) can be defined as “a healthcare specific administrative and management engine that provides a host of administrative and management functions necessary to be successful in the ever changing healthcare environment.” MSOs are primarily utilized by non-physicians as a vehicle to legally owning an entity that provides administrative support to a medical practice’s operations.

Most states only allow medical practices to be owned by physicians, which can limit the number of investors in a medical practice, as well as the financial value of the practice. (Read more…) 

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PODCAST: “Open Enrollment” Best Practices

By Eric Bricker MD

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JEROME POWELL: Speaks On “Premature” Interest Rate Cuts

By Staff Reporters

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What Is Money Factor for SMB? : On Auto Monthly Lease Payment

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With the Fed’s aggressive rate hikes to curb inflation looking like they’ve finally come to an end thanks to encouraging data on prices falling, investors are starting to look forward to when the central bankers start slashing rates again.

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

But Jerome Powell sought to pour some cold water on the rate cut hype cycle during a speech at Spelman College in Atlanta, Georgia yesterday, saying that it was too soon “to speculate on when policy might ease.” However, investors still think he’ll come around: Markets are putting the odds that the Fed will cut rates in March above 50% and are totally convinced it’ll happen by May, according to Bloomberg.

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MEDICARE [dis] ADVANTAGE Plans?

By Staff Reporters

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Leading hospital trade groups are accusing some Medicare Advantage plans, including giant UnitedHealthcare, of flaunting coverage requirements recently codified by CMS. The American Hospital Association is now petitioning the Biden administration to crack down.


However … the Medicare Advantage market is booming but investment in cancer care continues to lag.

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MPFS Final Rule Cuts Physician Payments

Medicare Physician Fee Schedule

By Health Capital Consultants

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DEFINITION: The Centers for Medicare and Medicaid Services (CMS) uses the Medicare Physician Fee Schedule (MPFS) to reimburse physician services. The MPFS is funded by Part B and is composed of resource costs associated with physician work, practice expense and professional liability insurance.

Under the MPFS, each of these three elements is assigned a Relative Value Unit (RVU) for each Current Procedural Terminology (CPT®) code. These RVUs are then adjusted based on the Geographical Practice Cost Index associated with various geographic areas for different medical costs and wage differentials. The conversion factor is the national dollar amount that is multiplied by the total geographically adjusted RVU to determine the Medicare-allowed payment amount for a particular physician service.

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

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MPFS Final Rule Cuts Physician Payments

On November 2nd, 2023, the Centers for Medicare & Medicaid Services (CMS) released its finalized Medicare Physician Fee Schedule (MPFS) for calendar year (CY) 2024. While the finalized fee schedule cuts payments to physicians, there are a number of other (more positive) provisions in the final rule.

This Health Capital Topics article explores the various changes and updates included in the MPFS final rule. (Read more…)

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HEALTHCARE Innovation and Practice Management on the Move

By Staff Reporters

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Online therapy company Talkspace will provide free virtual mental health services to more than 400,000 adolescents and teens in New York City after inking a deal with the city. The new program, dubbed TeenSpace, will connect teens to a licensed therapist through phone, video and text.

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The Patient-Centered Outcomes Research Institute (PCORI) has announced funding awards of $80.5 million to support four new studies focused on disparities in maternal health. They will take into account clinical and social factors that contribute to inequities and will compare interventions in various settings.


And … Ayble Health, a digital health platform for patients with chronic gastrointestinal conditions, is working with the Mayo Clinic Complex Care Program to offer a hybrid care model that matches patients with the appropriate virtual and in-person care based on acuity and need.

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MARCINKO & Associates, Inc.

WHAT WE DO AND HOW WE ASSIST MEDICAL COLLEAGUES

Hard Business Advice AND Personal Lifestyle Coaching

http://www.MARCINKOASSOCIATES.com

By Ann Miller RN MHA CMP™

At Marcinko & Associates our clients traditionally include physicians [MD, MBBS and DO], dentists [DDS and DMD], podiatrists [DPM], Registered Nurses [RNs], Certified Registered Nurse Anesthetists [CRNA], Physician Assistants [PA] and Nurse Practitioners [NP]. A growing cohort of clients include medical technologists, physical, speech and occupational therapists, etc.

The above are naturally segregated into three career tranches: 1. New practitioners, 2] Mid-Career practitioners and 3] Mature practitioners. We serve them all and are fully prepared for any special needs situation that may arise in any tranche [death, divorce, adverse risk event and/or bankruptcy, etc].

Marcinko & Associates understands the complexity of financial and non-financial deal terms because we are also doctors. Our “hard” knowledge of your business comes from being actual healthcare facility owners, operators and medical practitioners [with additional professional licenses and expertise] enabling us to effectively analyze your business, take corrective measures and present your healthcare entity in the best possible and accurate light.

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But, if you’re looking at this website, chances are you are fed up, burned out, seeking practice management techniques or a better work-life balance. Or, you are looking for a new non-clinical career, thinking of finance, investing, retirement, or all of the above. Perhaps you are just looking to regain the joy and meaning in your medical or professional career? This is known as “soft” psychology, coaching, personal consulting or fraternal advice.

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Regardless, of your “soft” personal or “hard” corporate needs, our transparent Fees for Service [FFS] model is moderated for all colleagues based on the acuity and urgency of their engagements. Reduced rates and/or limited charity work may also be possible.

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http://www.DavidEdwardMarcinko.com

CONTACT US TODAYTHRIVE TOMORROW!

Suite #5901 Wilbanks Drive

Norcross, Georgia USA 30092-1141

email: MarcinkoAdvisors@msn.com

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NURSING: Emerging Trends and Innovation

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