BOARD CERTIFICATION EXAM STUDY GUIDES Lower Extremity Trauma
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Posted on October 9, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
By Steve Febus
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Hospital Finance 101: Understanding the Cost of Full-Service Healthcare in Pullman, WA Program by: Steve Febus, Pullman Regional Hospital Chief Financial Officer.
Posted on October 9, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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The Fed is poised to raise interest rates just one more time in November before stopping, according to Ed Yardeni. That’s because there is a growing risk that financial markets are on the verge of instability due to a soaring US dollar.
“The soaring dollar has been associated in the past with creating financial crisis on a global basis,” Yardeni just told told Bloomberg.
Posted on October 8, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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U.S. stocks traded noticeably lower on the heels of the September nonfarm payroll report, but was still able to post weekly gains following the strong rebound on Monday and Tuesday. The labor data showed job growth rose more than predicted, while the unemployment rate unexpectedly declined, and the labor force participation rate surprisingly dipped. The report seemed to dampen recently increased optimism that the Fed could decelerate its aggressive monetary policy tightening campaign.
In other economic news, wholesale inventories were unrevised at a solid gain, and data on consumer credit showed consumer borrowing was well above expectations.
Treasury yields rose following the labor report, and the U.S. dollar continued to rebound from a stumble earlier in the week.
Crude oil prices climbed following the decision from OPEC+ to cut oil production and gold traded lower.
Asian stocks finished out the week broadly lower, and European stocks trimmed a weekly gain as volatility remained in the currency and bond markets across the globe.
Posted on October 6, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
By Eric Bricker MD
1) Fee-for-Services Motivates Hospitals to Increase Costs. 2) Medicare and Commercial Insurance Companies Have Not Changed That Motivation with ‘Value-Based’ Payments. 3) Hospital Prices Have NO Connection to the Underlying Cost of a Test or Procedure. 4) Most Don’t Even Know What the Underlying Test or Procedure Cost Is in the First Place.
Posted on October 5, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
Implications for Staffing Modern Mental Health Facilities
[By Carol Miller RN MBA]
Community Mental Health Centers are also referred to as County Mental Health Centers and treat patients usually with no or limited insurance in a domiciliary setting versus an inpatient state or community facility.
And, both children and adults are eligible to receive such assistance.
These programs provide a wide range of psychiatric and counseling services to the residents in their community as well
as other types of assistance. But, what type of mental healthcare staff, and providers, are involved with these facilities?
Staffing
Staffing levels at community mental health facilities depend on the size and funding of each clinic, and vary in number, qualifications, and mix. Many personnel hold or are working on Master’s degrees and various professional certifications.
Typical staffing would include:
Administrative or Mental Health Director ¾ This individual, working under general policy directives, is responsible for planning, organizing, coordinating, and directing delivery of a community’s comprehensive mental health programs and services. This would include the development and implementation of goals, objectives, policies, procedures, budget, standard compliance, and work standards for mental health services. The Director is responsible not only for the services offered under the program, but also for extensive coordination with other county departments, public and private organizations, citizen groups, and the Board of Supervisors.
Case management staff ¾ These personnel are responsible for compiling all the services related to the treatment program.
Psychiatrists ¾ These individuals may work for a mental health center full or part time, and be Board-eligible or Board-certified in Psychiatry.
Psychologists ¾ These individuals will hold Ph.D., Psy.D. or Ed.D. qualifications and be licensed as clinical psychologists in the state.
Licensed Independent Social Worker (LISW) ¾ These individuals will have expertise in such services as family counseling, child psychology, geriatric dementia, psychological testing, and so on.
Licensed Marriage and Family Therapist (LMFT) — These individuals are specialized in various fields and provide an array of counseling services to patients, dependent on the nature of their problem.
Clinical Nurse Specialists ¾ These personnel are certified in psychiatric nursing by a national nursing organization such as the American Nurses Association to practice within the scope of these services and are licensed in the state.
Support staff ¾ These staff members would include an administrative assistant to the Director, medical billers, transcriptionist, and possibly a receptionist.
Substance Abuse Counselor or Licensed Professional Clinical Mental Health Counselor (LPC or LPCC) — An individual who takes a holistic approach where they exam a person’s external environmental and societal influences while also monitoring inner emotion, physical and behavioral health.
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Counselor Qualifications
A licensed mental health counselor has met or exceeded the following professional qualifications:
earned a Master’s degree in counseling or a closely related mental health discipline;
completed a minimum of two years post-Master’s clinical work under the supervision of a licensed or certified mental health professional; and
passed a state-developed or national licensure or certification examination.
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Specifically, the 88 mostly primary care doctors of Tryon Medical Partners sued Atrium Health, the hospital system that owned them, in order to leave and become independent in 2018.
Some of their grievances against the hospital system were: 1. The hospital replaced the nurses in their clinics with medical assistants. 2. The hospital increased the number of patients they needed to see per day and decreased their visit times.
Atrium agreed to let the doctors separate in exchange for dropping the lawsuit.
Just one year later Tryon Medical Partners began to offer Direct Primary Care to local employers and have signed up 30 companies.
The program has been a huge success because an independent primary care practice can work to provide better care at lower costs. Conversely, physicians associated with a hospital system are incentivized to increase healthcare costs.
Posted on October 4, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
Fed Official Says Inflation Fight Will Take Time, Despite Signs of Progress
Bringing inflation down from 40-year highs is likely to take time and will require a slowdown in economic growth and reduced demand for workers by employers, a Federal Reserve official said yesterday.
Those efforts are showing tentative signs of progress, said Fed governor Philip Jefferson, in his first public remarks since taking office in May. But Mr. Jefferson also said he remains concerned that higher prices could change consumer expectations around inflation in a way that makes further price increases self-fulfilling.
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Posted on October 4, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
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By Darrell Pruitt DDS
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“Small- and medium-sized businesses with two to 200 employees suffered the most attacks during the period, accounting for 46%, or 2,300 ransomware attacks total, according to the report.” That’s us, Doc. Patterson and Schein won’t admit it, but if you don’t put patients’ information on a computer, you and your patients are completely safe from ransomware.
“US organizations hit by almost half of all ransomware since 2020 – American exceptionalism extends to ransomware as organizations based in the U.S. suffered the greatest number of attacks, ahead of Canada and the U.K.”
By Matt Kapko: Cybersecurity Dive, Sept. 28, 2022.
Paper’s security – “Report: 90% of companies affected by ransomware in 2022 – An annual SpyCloud survey found that 90% of organizations were impacted by ransomware over the past twelve months, an alarming increase from last year’s 72.5%.”
On August 30, 2022, the Centers for Medicare & Medicaid Services (CMS) released the financial and quality performance results for the Medicare Shared Savings Program (MSSP) Performance Year (PY) 2021.
The results revealed net savings of $1.66 billion for Medicare, marking the fifth consecutive year of savings. In total, 58% of MSSP accountable care organizations (ACOs) achieved savings as a result of their performance. This Health Capital Topics article will discuss the 2021 performance results, which are being released on the eve of seismic changes to the MSSP. (Read more…)
Posted on September 29, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
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By Michael A. Gayed, CFA
Portfolio Manager of the ATAC Rotation Funds
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Bob Farrell is a legendary Wall Street trader and market analyst. He’s perhaps best-known for his “10 rules” of investing that he developed based on his 50-year career in the industry. One of the more popular rules says that “when all the experts and forecasts agree, something else is going to happen.”Right now, almost everyone is expecting a recession driven by high inflation, rising interest rates and geopolitical risks. The S&P 500 is still more than 10% off of its highs, while the NASDAQ 100 is down by more than 20%. Many feel as if more downside is ahead, but what if they’re wrong? What if the bottom is already in? What if the worst is over?
My take? I have no idea. I believe there’s still a bigger and more traditional classic “risk-off” period coming where stocks decline and Treasuries rally in price (which is what historically happens during periods of heightened equity volatility), but the path to get there is what drives investor sentiment. And like everyone else in this business, I can’t tell the future. All I can do is identify conditions in a rules-based fashion that favor an outcome.The important thing to remember here is that the market isn’t the economy. The financial markets are often leading indicators of where investors feel things are going. The actual data is only showing how conditions are or were.
Take the 2020 COVID recession, for example. Once the government announced its multi-trillion dollar stimulus program, stock prices shot higher even though the worst of the economic pain had yet to be experienced.Today, some of the data isn’t even indicating imminent danger.
High yield spreads tend to blow out ahead of a recession. They’re currently not at the levels reached during 2016, 2018 or 2020. Investors often view the 10-year/2-year Treasury yield spread as the “recession indicator”. This number did briefly turn negative earlier this year, but has remained in positive territory ever since. While both of these numbers have teased the idea of higher risk conditions ahead, neither has done so in convincing fashion yet.Also consider that the markets tend to be very sensitive to what the Fed does. If the central bank ever decides that recession risk is too high and it hits the pause button on the rate hiking cycle, it could be off to the races again for equity prices. Risk asset prices have the ability to react favorably to looser monetary conditions. Any pivot in that direction could give a big boost to investor sentiment.
If the bear market is over, the ATAC Rotation Fund (ATACX), the ATAC U.S. Rotation ETF (RORO) and the ATAC Credit Rotation ETF (JOJO) could be primed to benefit.We believe all three funds use proven market signals to determine whether they should be positioned either offensively or defensively. Since investors often flock to safety in times of market volatility, the three funds use Treasuries as the “risk-off” or defensive asset class. Admittedly, Treasuries haven’t acted as they historically do relative to equities when in high volatility states. But that doesn’t mean things won’t revert back to historical behavior in the small sample of the here and now.When the signals suggest that conditions are more favorable, the funds can go “risk-on”.
In the case of RORO and ATACX, that could include some combination of large-cap stocks, small-caps and emerging markets. JOJO remains in the fixed income markets and targets junk bonds in this scenario.RORO and ATACX also use leverage, which offers higher return potential. Why? Because leveraging equities when risk-on helps to, over time, counter the impact of being in Treasuries when stocks continue to move higher and with hindsight, risk-off positioning there wasn’t warranted.
Of course this is a double-edged sword, since in a year like this year, the leveraged risk-on position in stocks earlier in the year led to a sizeable decline for both ATACX and RORO. However, over multiple roll of the die, it is that leverage which gives investors the opportunity to capture above average returns in more traditional markets when combined with occasional risk-off periods where Treasuries perform well.High volatility markets don’t need to be feared.
We believe strategies that add and remove market risk based on what the market is telling us give investors the opportunity to earn superior risk-adjusted returns while lowering downside risk. If the markets are ready to begin the next leg higher, the ATAC funds stand ready to benefit while (hopefully) Treasuries get back to doing what they normally would in true risk-off periods .
I was having lunch with a close friend of mine. He mentioned that he had accumulated a significant sum of money and did not know what to do with it. It was sitting in bonds, and inflation was eating its purchasing power at a very rapid rate.
He is a dentist and had originally thought about expanding his business, but a shortage of labor and surging wages turned expanding into a risky and low-return investment. He complained that the stock market was extremely expensive. I agreed.*
On September 13, 2022, Representatives Ami Berra (D-CA-7) and Larry Bucshon (R-IN-8) introduced the Supporting Medicare Providers Act of 2022 (H.R. 8800), which aims to infuse the Medicare Physician Fee Schedule (MPFS) with a 4.42% funding increase for 2023. With a bipartisan coalition of 12 co-sponsors, the bill would have the practical effect of negating the impending 4.42% cut to the MPFS conversion factor. This Health Capital Topics article will review the bill, discuss its support, and examine its potential implications. (Read more…)
The Federal Reserve now owns $2.6 trillion in mortgages. That means about 24 percent of all outstanding residential mortgages in this whole big country reside in the central bank.
I was interviewed on PBS Newshour about the insanity that is happening in the NFT (non-fungible token) market. You can watch it here. If you read my “I Kid You Not Crazy” article, then you know everything I have to say about NFTs and cryptocurrency. I can sum up my thoughts on NFTs in one sentence: NFTs, just like cryptocurrencies, are a technology of the future, but a speculative bubble induced by excess global liquidity in the present.
Posted on September 22, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
By Eric Bricker MD
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Dr. Sachin MD MBA Jain wrote an outstanding article on Value Based Care in the April 12, 2022 issue of Forbes stating that the Patient Must Come First in Value Based Care.
The popularity of special purpose acquisition companies (SPACs) has been soaring in recent years. There are 35 times as many SPACs operating in 2020 as in 2010, and these companies seem poised for greater exponential growth in the future.
While many experts are predicting a continued, rapid increase in SPACs, this article will also examine the factors that could possibly slow SPAC growth and diminish their future prospects. SPACs span several market areas, including biotechnology and healthcare; this article will review SPAC trends generally as well as healthcare SPACs in particular. (Read more…)
Personal health sensors and apps equip patients with personalised data so that they can become more proactive in managing their health. But what is still mostly the norm is that these sensitive data are governed by the companies providing these services; and they often profit out of it, oblivious to patients.
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But even though NFTs are still in their infancy, the technology might evolve in the future to become more compelling for patients to favor the agency it provides over their data.
Posted on September 20, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
By Jules Murtha
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Here’s What Doctors Need to Know
The Supreme Court of the United States (SCOTUS) has ruled that doctors must show intent to mis-prescribe opioids in order to face criminal charges.
Despite the drop in opioid prescriptions in recent years, opioid overdoses and deaths are on the rise, largely because of street drugs.
The CDC’s position is that physicians can better serve patients by focusing on when to initiate and continue opioid treatment, what type and dosage of opioid to use, and how to address risk of drug abuse when prescribing opioids.
Posted on September 20, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
An Audio-Video Presentation
[Submitted via Darrell Pruitt DDS]
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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.
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During the pandemic, I engaged in telemedicine with my patients out of necessity. This platform was already destined to become part of the medical landscape even prior to the pandemic. COVID-19 accelerated the process. The appeal is obvious. Patients can have medical visits from their own homes without driving to the office, parking, checking in, finding their way to the office, biding time in the waiting room and then driving out afterwards. And patients could consult physicians from far distances, even across state lines. Most of the time invested in traditional office visits occurs before and after the actual visits. So much time wasted! Indeed, telemedicine has answered the prayers of time management enthusiasts.
Posted on September 18, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
By Paige Minemyer
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The AMA and 2 State Medical Societies Join Class-Action Suit Against CIGNA
The American Medical Association (AMA) has joined a class-action lawsuit against Cigna, alleging the insurer underpaid for claims filed by providers in the contracted MultiPlan network. MultiPlan is the country’s largest third-party network, and Cigna contracts with it to access providers. According to the lawsuit, which was initially filed in June, Cigna reimbursed for claims from providers in MultiPlan’s network at its non-participating providers rate rather than at the rate expected for a MultiPlan contract.
As such, the insurer “significantly underpaid claims, and put patients at risk of balance billing,” the plaintiffs claim. “It also breached its fiduciary duties, including its duty to honor written plan terms and its duty of loyalty, because its conduct serves Cigna’s own economic self-interest and elevates Cigna’s interests above the interests of plan member patients,” according to the lawsuit.
On August 16, 2022, one week after Congress passed the Inflation Reduction Act of 2022 (IRA), President Joseph Biden signed the bill into law. The broad bill, which covers healthcare, taxes, and climate change, had been passed around Congress in assorted versions with varying support for months, but under the specter of a record 40-year-high inflation rate, congressional Democrats ultimately came together to pass the IRA; no Republicans voted for the bill.
The IRA aims, among other things, to fight against ever-increasing healthcare costs, by lowering prescription drug prices and extending federal health insurance subsidies. (Read more…)
Posted on September 15, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
FOR TOP MANAGERS AND BODs
By Dr. Jeffery Funk
Did you know that far more MBAs and bachelor-degree holders were among top managers and board of directors among startups filing for IPOs between 1990 and 2018 than were other degree holders?
About 55% of them had an MBA for their highest degree vs. 20% for bachelors, 7% for PhD, 3% for MD, 12% for MS, and 3% for JD. The high percentage of MBAs and bachelor-degree holders reflects the move away from #science-based #technologies such as semiconductors, and electronic, communications, and medical equipment that once dominated Silicon Valley (hence the name), and towards Internet commerce, content, and services over last 25 years.
In fact, most PhDs among top managers and board of directors at IPO time studied life sciences and were employed in #biotech#startups, a sector that continues to thrive. Creating successful science-based startups in other sectors continues to be a big challenge, one that may be partially overcome by #AI in near future.
As for which #universities train these people, Harvard, Stanford, Berkeley and MIT had the most graduates in many categories, representing almost 20% of PhDs for instance.
Posted on September 14, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
By Dan McCarthy
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Like everyone’s desire to work, venture funding sank to a new low during the dog days of summer. In August, global venture funding fell to $25.2 billion, per Crunchbase, less than half of the ~$53 billion invested one year prior, and the lowest monthly venture-funding total in two years. It’s down ~10% from the previous month.
Even so…The ongoing pullback didn’t stop several companies—including Adam Neumann’s, uh, controversial, comeback project Flow—from locking down significant investment rounds in August. Here are three rounds that stood out to us…all of which happen to play in the clean-energy space:
Terrapower, a nuclear tech developer founded by Bill Gates,raised $750 million. Gates co-led the round with SK Group, which plowed $250 million into the company. In addition to nuclear power generation, the company is also researching nuclear medicine techniques.
Longroad Energy, a renewable energy developer based in Boston, raised $500 million. The company said that the funding would catalyze a shift toward an owned-and-operated business model and enable it to grow the capacity of its wind, solar, and storage assets from 1.5 gigawatts (GW) to 8.5 GW in the next five years.
Lunar, a home-electrification startup founded by a former Tesla Energy exec, debuted with $300 million in funding, with residential solar bigwig Sunrun and SK Group (hello again) as investors. Later this year, Lunar plans to begin releasing hardware and software products that make it easier for homes to generate, use, and store carbon-free energy.
Monthly venture funding has been trending down since it hit a record high of $69.4 billion last November, as rising rates, inflation, and general economic uncertainty have turned the investing temperature from “deep summer” to “that first really cold day of winter where you neglect to wear a proper coat.” But it’s time for two of our most common refrains on this subject: 1) $25 billion in monthly VC funding is still a lot of money 2) VCs are sitting on a record high of more than half a trillion dollars in dry powder. Those reserves are unlikely to be emptied in 2022, but there is a lot of committed capital on hand for startups to vie for.
Posted on September 12, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
By Pete Quinones
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John joins Pete to talk about ways to use entrepreneurship, cryptocurrency and alliances to prevent the medical tyranny that is being thrust upon the world.
Cityblock Health has raised $400 million in its latest funding round. This brings the value of the startup to a whopping $5.7 billion. The company focuses on delivering care to patients in marginalized groups, aiming to provide care for 10 million patients by the end of the decade. Two key parts of the company’s strategy is integrating community support into care plans and connecting members with resources and specialized providers.
According to a spokesperson for Cityblock Health, “We can confirm that Cityblock has raised a new round of capital as we continue to accelerate our plans to empower more people across the country more quickly. Millions of marginalized and lower-income people across the U.S., including those who receive their healthcare through Medicaid plans, continue to lack sufficient access to integrated, community-based health services. We are leveraging this investment to reach more people and have an even greater impact.”
Posted on September 8, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
Welcome to The Common Bridge
By Richard Helppie
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Hello, welcome to the Common Bridge.
We’ve got a great topic for you today. It’s all about taxes and the IRS and with us today, two experts from Plante Moran. Welcome, Rachel Keller and Brett Bissonnette, welcome to the Common Bridge. The Common Bridge, of course, is available@substack.com. Please go to substack.com. Enter the Common Bridge in your search engine. Subscribe if you wish, either a paid subscription or a free subscription.
Of course, the Common Bridge is available on all of your podcast outlets. Look for us there and on YouTube TV. And of course, with our friends over at Mission Control radio on your radio garden app. We all listen to debates and commentary about law and policy and especially taxes. And every law, every policy and of course tax regulation require mechanisms to ensure compliance.
Well, our President Joseph R. Biden has stated that the IRS needs to be properly funded in order to carry out its mission on our very complex tax code. Taxpayers have been puzzled by missing records, slow refund late fees for things they paid and other matters including slowness in the support that they get directly from the IRS. So today, we’re going to chat with these two experts who are in the field today actively advising people from all stripes about tax law and tax regulation. They spent a lot of their time interacting with the IRS and making sure that their clients are in compliance with the tax law. So we anticipate some education and maybe some policy ideas.
From Plante Moran, we welcome Rachel Keller and Brett Bissonnette — Welcome to the Common Bridge.
-Richard Helppie
EDITOR’S NOTE: Richard D. Helppie Former: CEO and Founder Superior Consultant Company, Inc. [SUPC-NASD]
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