CLEVELAND CLINIC: Controversial New Health Insurance Co-Payment Policy

Posted on May 17, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By Staff Reporters

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Health Insurance Co-Payments Upfront or Lose Your Appointment

Definition: A co-payment is a fixed amount you pay each time you get a particular type of healthcare service, and co-pays will generally be quite a bit smaller than deductibles. However, deductibles and co–pays are both fixed amounts, as opposed to coinsurance, which is a percentage of the claim.

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EMPLOYER’S: Pay for Health Insurance Paradox

On some health plans, certain services are covered with a co-pay before you’ve met the deductible, while other health insurance plans have co-pays only after you’ve met your deductible. And, the pre-deductible versus post-deductible co-pay rules often vary based on the type of medical service you’re receiving.

PRE-PAID PLANS: https://medicalexecutivepost.com/2025/04/17/health-insurance-pre-paid-plans/

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Starting in June 2025, Cleveland Clinic patients who can’t pay their co-pay on the spot will have non-emergency appointments rescheduled or cancelled. This new policy could make it harder for low-income people who prefer to be billed to see a clinic doctor, and create delays that could lead to medical emergencies down the road.

For example, a delay in care can mean six to eight more weeks of a tumor growing or a blood clot developing or an infection brewing.

Source: Julie Washington, cleveland.com [5/13/25]

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PARADOX: Warren Buffett and Berkshire Hathaway (BRK)

Posted on May 11, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By Vitaliy Katsenelson CFA

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I am back from what has become over the past two decades an annual pilgrimage to Omaha. 

What’s fascinating about this trip is that it has everything and nothing to do with Warren Buffett. The main event that draws everyone to Omaha – the Berkshire Hathaway (BRK) annual meeting – is actually the least important part. I could have watched the shareholder meeting livestreamed on YouTube from the comfort of my living room couch.

The emergence of the Berkshire phenomenon reminds me of China’s manufacturing evolution. China initially attracted capital because of its cheap labor. But over time, China took this capital and plowed it into infrastructure. Factories were built next to each other, each specializing in certain areas. A specialized ecosystem emerged. 

Today, Chinese labor is no longer cheap. It’s been replaced by automation, and now China is a powerhouse for manufacturing anything and everything.

The transformation that the BRK weekend has undergone followed a similar progression. Initially, the only way to absorb Buffett and Munger’s wisdom was to come to Omaha, as the event was not streamed. But then something interesting happened. The BRK weekend attracted people who shared the same value system, and friendships were formed. A variety of smaller events began to be scheduled throughout the same weekend across Omaha, and an equally specialized ecosystem emerged.

The shareholder meeting began to be streamed about ten years ago, but that has had no impact on attendance. This is one reason why I think Buffett is at peace with the idea of no longer presiding at the meeting – people will still come to Omaha the weekend before Mother’s Day.
The BRK weekend now features dozens of excellent events. 

I spoke at several, including an investing panel at Creighton University, alongside the wonderful Bob Robotti, a die-hard value investor who runs Robotti & Co. I’ve known Bob for years – at 72, he exhibits the same enthusiasm for stocks as someone decades younger – and this panel was an excellent example of what the BRK Omaha ecosystem has produced.

Bob and I have very different approaches to value investing. He loves cyclical businesses, while I generally shun them. Bob mentioned that he’d buy a very cheap business run by a mediocre manager, while I would not touch it with a ten-foot pole. 

There is absolutely nothing wrong with either approach; indeed, there is an important lesson in it. Your investment philosophy and process have to fit your personality and your EQ. In my case, I get nervous (and thus irrational) when I own companies run by imbeciles who don’t have either skin or soul in the game. But the great thing about the BRK weekend is that I learn from Bob every time I spend time with him. He’s a thoughtful and genuinely kind human being. 

From the outside, the BRK weekend may seem like a place where people simply want to learn how to get and stay rich. But this gathering transcends value investing and capitalism and genuinely celebrates human values. People (like me) bring their kids to this event. And just like at the main event, at the Q&A breakfast I hosted for my readers, many questions centered on life rather than investing.

My first Omaha reader meetup fit around a small restaurant table. This year, to my surprise, 450 people packed into a venue with standing-room only. I answered questions on every imaginable topic for just over two hours, and by the end I was exhausted. 

This gave me even greater admiration for Buffett, who is four decades my senior, yet still fielded questions for four solid hours. I was delighted to hear Warren give a similar answer to one I had given the day before when asked what advice he’d give to graduating students: 
“Don’t worry too much about starting salaries and be very careful who you work for because you will take on the habits of the people around you.” 

(Incidentally, we are going to host our next Q&A Breakfast on May 1, 2026. You can sign up for it here. It’s free, but I suggest you sign up early, as it fills up fast.)

I also participated (as I have for over a decade) in an investing panel at YPO (Young President Organization) in the beautiful Holland Performance Art Center with Tom Gaynor, CEO of Markel (often described as a baby Berkshire Hathaway) and Lawrence Cunningham. Lawrence authored perhaps the most important book about Buffett, The Essays of Warren Buffett, masterfully editing Warren’s annual letters into a cohesive volume. This year’s panel was one of those occasions where I found myself listening intently to my fellow panelists instead of speaking more.

Lawrence has met Greg Abel – Buffett’s designated successor – and feels optimistic about him. He’s probably right – this was one of Buffett’s most crucial decisions, which he did not make lightly. Yet I can’t imagine sitting for four hours listening to Greg Abel. I am sure he is a brilliant CEO, but he’s neither Buffett nor Munger – few individuals possess so much worldly wisdom and communicate it with such clarity and humor.

This brings me to the point of this note: the dramatic (yet not unexpected) announcement that Buffett is stepping down as CEO of BRK at the end of the year.

Before I comment on this, let me tell you a story. Imagine you have been watching a soap opera for 17 years. You arrive dutifully every year to watch every episode in person. And then you miss the last five minutes of the explosive finale before it goes off the air. This is what happened to me when Buffett announced his retirement as CEO.

A few minutes before noon, while Buffett was answering a question I’d heard before and appeared to be winding down, I suggested we slip out early for lunch to avoid the crowds. When we came back, I discovered that the meeting had gone on until 1 pm, and just before it ended, Buffett announced that he would step down at the end of the year. Seventeen years of watching Warren speak and I missed the most dramatic moment of all, followed by a five-minute standing ovation.

I think Buffett has engineered his exit brilliantly. He will still remain chairman, and even before the announcement he was not managing BRK’s day-to-day operations. As a collection of hundreds of companies that often have absolutely nothing in common with each other, BRK is already highly decentralized. Buffett’s main contribution has been capital allocation.

Giving up the CEO title while he’s still alive means Buffett has brought in his replacement in an orderly way and created a smooth transition. But I have a feeling that on January 1, 2026, when Greg Abel officially becomes CEO, nothing will really change, and Warren will continue doing what he’s been doing for as long as he can. If Buffett is able – he’ll be 95 – he’ll still drive to the office and stop by McDonald’s for a breakfast sandwich (there’s a lot of wisdom in finding pleasure in little things). His son Howard Buffett will become chairman after Warren, with his only job being to preserve the culture.
I’ve been asked what I think of BRK stock. We bought the stock during the pandemic. It has done better than I expected, in part because of the strong performance of Apple, which was BRK’s largest holding. But BRK today is an unexciting investment at its current price. In all honesty, it is a conglomerate with some good and some merely okay businesses.

As a consumer, I get a (small) glimpse into how BRK businesses are being run by visiting Dairy Queen. BRK owns DQ, and I love their soft-serve ice cream (though I only eat it when I travel). My favorite part of research!

DQ has (or maybe had) a strong brand and operates on a capital-light model as a franchisor. But most stores I have visited looked like they have been neglected and need fresh paint. To be sure, I understand the limitations of this “analysis,” and DQ overall amounts to a rounding error on BRK’s financials. But little things often reveal much about big things.

BRK’s big businesses, from what I can glean through their financials, are not particularly well managed – GEICO and BNSF (railroad) have definitely been undermanaged lately. BNSF is not nearly as efficient as its competitors that embraced precision railroading, and until recently GEICO was losing market share to Progressive. 

BRK’s reinsurance business, a significant source of BRK’s profitability, is run by the extraordinary Ajit Jain. Ajit is in his 70s and unfortunately it seems he is not in great health. Is his replacement going to shoot the lights out, like he did? We don’t know. But Ajit is probably more important to BRK today than Buffett.

BRK is not going to melt into oblivion after Buffett is gone, but its best days are behind it. As Buffett has acknowledged, just its size alone makes it very difficult for BRK to grow. Truth be told, even if Buffett were thirty years younger and continued to run BRK, I am not sure the results would be much different than what I think the future holds with Abel at the helm. 

Buffett and Charlie Munger had a tremendous impact on me as an investor and human being. I am incredibly thankful to both. I hope Warren is there next year, but, in either case, I will be.

As value investors say, “next year in Omaha”.

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Lessons from History’s Technology Booms

Posted on May 6, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By Vitaliy Katsenelson CFA

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The technology at the core of the mania is different every time. What doesn’t change over time is human emotion – the fear of missing out and then the fear of loss.

AI has a feel of “this time is different.” Optimism rarely erupts about the same technology twice; this is why history doesn’t repeat but rhymes. The technology at the core of the mania is different every time. What doesn’t change over time is human emotion – the fear of missing out and then the fear of loss, in that order. 

Humans are an optimistic bunch. We need it; it’s essential to our survival and progress; but eventually, we take our optimism too far. The graveyard of financial ruins is full of these stories.

I have beat the dotcoms and Nifty Fifties to death, so let’s go to back another century. My friend the brilliant Edward Chancellor wrote about the railroad boom and bust in England in the 1800s. Here he is, edited for brevity:

The first railway to use steam locomotives opened in 1825 and was designed to carry coal, not passengers. Railway promoters simply did not appreciate the potential demand for high-speed travel. The successful launch of the Liverpool and Manchester Railway in 1830, however, demonstrated the commercial viability of passenger travel. By the early 1840s, Britain’s railway network stretched to more than 2,000 miles. Railway companies were delivering acceptable, if not spectacular, returns for investors.

Then railway fever suddenly gripped the nation. Enthusiasts touted rail transport not just for its economic benefits, but for its benign effects on human civilization. One journal envisaged a day when the “whole world will have become one great family speaking one language, governed in unity by like laws, and adoring one God.” In the two years after 1843, the index of rail stocks doubled.

Investment peaked at around 7% of Britain’s national income. Railway enthusiasts predicted that rail would soon replace all the country’s roads and that “horse and foot transit shall be nearly extinct.”

In 1845, Britain’s railways carried nearly 34 million passengers. If the 8,000 miles of newly authorized railways were to deliver their expected 10% return, then the industry’s total revenue and passenger traffic would have to climb five fold or more – all within the space of just five years. “This should have alarmed observers by itself … But they were deluded by the collective psychology of the Mania”, writes Odlyzko. 

In 1847 a severe financial crisis broke out, induced in part by the diversion of large amounts of capital into unprofitable railway schemes. It turned out that the revenue projections provided by so-called “traffic takers” were wildly overoptimistic. Railway engineers underestimated costs. The vogue for constructing direct lines between large urban centers proved mistaken, as most traffic turned out to be local. As a result, Britain’s rail network was plagued with overcapacity. By the end of the decade, the index of railway stocks was down 65% from its 1845 peak. 

The railroad bubble in England is just one example; there are hundreds of similar stories across market history. They all share this theme:

A new technology appears on the horizon. In the early stages, investment is rational, but then at some point excitement, imagination, and optimism take over, leading to overinvestment (usually creating a financial bubble). Investors make a lot of money until most lose it all. When the dust settles, only a few companies survive.

This AI boom reminds me of the telecom sector in the 1990s. The internet was going to change the world, and it did, but first we had tremendous overcapacity in global fiber and telecom equipment.

One could say that telecommunications companies overestimated demand for broadband and underestimated changes in technology, and that would be true. But there was a more nuanced dynamic at play, what economists call the fallacy of composition.

What’s true for one participant isn’t necessarily true for the group.

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NATIONAL NURSES IN BUSINESS ASSOCIATION: Empowering Nurses Through Entrepreneurship

Posted on May 2, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By Staff Reporters

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The National Nurses in Business Association (NNBA) is the premier nursing organization for nurse entrepreneurs, and a springboard for nurses transitioning from employees to entrepreneurs and business owners. The NNBA is an invaluable resource for existing nurse business owners seeking to expand, and maximize their business success.

Members’ resumes include thousands of nurse owned businesses, local, national and international awards, and millions of dollars in revenue. The experience, knowledge and impact of the NNBA community is amazing, as well as the support provided to fellow nurse entrepreneurs and aspiring entrepreneurs.

As the forerunner of the nurse entrepreneur movement, the NNBA provides valuable business information customized for nurses on how to start, plan, expand and grow your nurse owned business. They provide expert guidance, marketing and promotional opportunities, and continuing education in professional growth and career development.

MORE: https://nursesbusiness.com/

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QUANTUM COMPUTING: Healthcare and Banking Affected [B-QTUM Index Fund]

Posted on April 30, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

FUNDAMENTAL INDUSTRY CHANGES

By Staff Reporters

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Index Funds

An index mutual fund or ETF (exchange-traded fund) tracks the performance of a specific market benchmark—or “index,” like the popular S&P 500 Index—as closely as possible. That’s why you may hear people refer to indexing as a “passive” investment strategy.

Instead of hand-selecting which stocks or bonds the fund will hold, the fund’s manager buys all (or a representative sample) of the stocks or bonds in the index it tracks.

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Quantum Computing

Unlike traditional computers that use bits, quantum computers utilize qubits. These qubits are capable of being in a state of superposition, where they can represent both 0 and 1 simultaneously, enabling the processing of multiple calculations at once. This could allow quantum computers to outperform classical computers in solving certain complex problems. However, the field is still overcoming challenges such as qubit stability and decoherence; especially in these three areas:

  • Quantum computing could fundamentally alter healthcare by accelerating drug discovery and improving individualized medicine. Rapid analysis of enormous volumes of biological data allows quantum computers to find trends that might guide the creation of more potent treatments. In addition to accelerating drug development, this will enable customized treatments tailored to unique genetic profiles.
  • Faster and more accurate financial models produced by quantum computing will transform the banking sector. Through real-time analysis of intricate financial systems, it can help investors to control risk and make better decisions. More precise market forecasts will help maximize portfolio management and trading strategies.
  • Through greatly enhanced medical diagnosis and patient care, quantum computing can transform the healthcare industry. Quantum computers can remarkably accurately find trends and possible health hazards by analyzing enormous volumes of medical data in a fraction of the time. Early diagnosis and more customized treatment alternatives follow from this.

B–QTUM Index Fund

Index Description: The BlueStar® Machine Learning and Quantum Computing Index (BQTUM) tracks liquid companies in the global quantum computing and machine learning industries, including products and services related to quantum computing or machine learning, such as the development or use of quantum computers or computing chips, superconducting materials, applications built on quantum computers, embedded artificial intelligence chips, or software specializing in the perception, collection, visualization, or management of big data.

Citation and Disclosure: https://www.defianceetfs.com/qtum/

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DAILY UPDATE: Coca-Cola and Pfizer as Stock Markets Rise

Posted on April 30, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

MEDICAL EXECUTIVE-POST – TODAY’S NEWSLETTER BRIEFING

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

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

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Coca-Cola rose 0.84% after the beverage behemoth beat earnings expectations. Not only that, it also doubled down on its forward-looking guidance, saying that revenue will grow 5% to 6% while comparable earnings per share will jump 2% to 3% in 2025. Tariff mania may raise some costs, but the company said it would be “manageable,” putting it a step ahead of arch-rival PepsiCo.

Pfizer jumped 3.28% today after the pharma giant announced that it expects to cut costs by about $7.7 billion by the end of 2027 thanks to advances in AI and automation. Despite lower sales in Q1, the company managed to keep its 2025 revenue guidance of $61 billion to $64 billion intact. While that forecast takes into account the $150 million blow from tariffs, it does not include any future tariffs (which President Trump has threatened to slap on the pharma industry).—LB

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What’s up

  • Meta Platforms gained 0.85% after the social media giant announced it will launch a standalone AI app to compete with ChatGPT. Expect more details in its earnings call tomorrow.
  • JetBlue Airways may have pulled guidance, but investors like the airline’s lower-than-expected loss last quarter so pushed shares 2.70% higher.
  • SoFi Technologies rose 0.53% after it crushed analyst expectations on both the top and bottom line.
  • Speaking of fintech, PayPal climbed 2.14% thanks in no small part to a 20% pop in Venmo revenue.
  • Honeywell International gained 5.40% thanks to strong earnings and sales for the manufacturing conglomerate.
  • Deutsche Bank climbed 4.08% after Germany’s largest lender reported a 39% increase in profit last quarter.
  • Sherwin-Williams may have missed on revenue last quarter, but the paint company beat earnings estimates and kept its forward guidance intact, so shareholders pushed it up 4.80%.
  • Royal Caribbean eked out a 0.02% despite reporting record bookings and boosting its profit outlook, a rare move these days amid tariff uncertainty.
  • Leggett & Platt may not be a household name, but it sells household goods—and the bedding company’s solid earnings and strong fiscal guidance sent shares 31.73% higher.

What’s down

  • General Motors fell 0.64% after the automaker beat on top and bottom line estimates but warned that it will have to pull its forward guidance and suspend stock buybacks.
  • Spotify dropped 3.04% despite active monthly users rising 10% last quarter. The problem, believe it or not, was lower guidance.
  • Regeneron lost 6.87% thanks to disappointing sales for its hit eye drug Eylea.
  • NXP Semiconductors may have beaten analyst estimates last quarter, but management’s lower-than-expected earnings guidance disappointed investors, and pushed shares 6.94% lower.
  • Wolfspeed tumbled 15.98% after the chipmaker’s impressive short squeeze rally fizzled out.

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

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DAILY UPDATE: Stocks Mixed and End Flat

Posted on April 29, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

MEDICAL EXECUTIVE-POST – TODAY’S NEWSLETTER BRIEFING

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

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

A Partner of the Institute of Medical Business Advisors , Inc.

http://www.MedicalBusinessAdvisors.com

SPONSORED BY: Marcinko & Associates, Inc.

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http://www.MarcinkoAssociates.com

Daily Update Provided By Staff Reporters Since 2007.
How May We Serve You?
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What’s up

  • Plug Power soared 25.68% on the news that the hydrogen fuel cell manufacturer has signed a deal that allows it to issue $525 million in secured debentures.
  • Tesla eked out a 0.33% gain as investors took profits following the EV company’s strong week in spite of terrible earnings.
  • IBM rose 1.61% after the tech company pledged to invest $150 billion in US manufacturing over the next five years.
  • Peloton climbed 4.93% thanks to an upgrade from Truist analysts, who said the home workout company has cleaned up the “BS.”
  • MGM Resorts International gained 1.71% after reporting an impressive 34% increase in revenue last quarter thanks to its BetMGM platform.
  • ADMA Biologics popped 12.12% on FDA approval of its new production process that draws 20% more usable material from donated plasma than current methods.

What’s down

  • Nvidia sank 2.05% on the news that China’s Huawei Technologies is preparing to test a new semiconductor that could rival Nvidia’s most powerful tech.
  • Coinbase fell 2.08% on a double downgrade from Compass Point analysts, who cited a decline in retail trading activity.
  • DraftKings dropped 1.51% after Mizuho analysts lowered their price target on the company, cutting their expectations for the gambling stock’s EBITDA.

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MEDICARE ADVANTAGE PLANS: Rates Substantially Increased for 2026

Posted on April 28, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By Health Capital Consultants LLC

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On April 7, 2025, the Centers for Medicare & Medicaid Services (CMS) published their 2026 Rate Announcement for Medicare Advantage (MA) and Medicare Part D Prescription Drug Plans.

For 2026, the payment rate to MA plans will increase 5.06%, the largest increase in the past ten years, and up significantly from the 2.2% rate increase proposed by the Biden Administration.

This Health Capital Topics article will review the Rate Announcement. (Read more…)

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STOCKS: Bounce Back Like a House

Posted on April 28, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By Staff Reporters

SPONSOR: http://www.MarcinkoAssociates.com

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Much like a springy inflatable structure often resembling a four-sided building and used by children for jumping for sport and fun, stocks staged a much-needed bounce-house back week on hopes that the trade war would de-escalate, with the S&P 500 climbing for four straight days to close 4.6% higher.

Whether the rally continues this week may depend on the Magnificent Seven earnings on tap—each of those Big Tech stocks has fallen at least 6.5% this year, shedding a combined $2.5 trillion in market value, per the Wall Street Journal.

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EARNINGS REPORTS: Out This Week

Posted on April 28, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

BREAKING NEWS

By Staff Reporters

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This Week is Full of Data

On the economic side, things kick off on Tuesday with the S&P Case-Shiller home price index, and the job openings and labor turnover survey.

Then Wednesday brings the banga-bing, banga-boom: GDP, the ADP employment report, and of course, PCE.

On Thursday we get initial jobless claims and the ISM manufacturing index, followed by Friday’s US jobs report.

Company Earnings Reports

Monday: Domino’s Pizza, Waste Management, Nucor, and NXP Semiconductors

Tuesday: Visa, Coca-Cola, Novartis, AstraZeneca, HSBC, Pfizer, Honeywell, Spotify, Snap, American Tower, Altria, Starbucks, Mondelez International, Sherwin-Williams, UPS, BP, PayPal, Royal Caribbean Cruises, Universal Music Group, Hilton, Porsche, Adidas, GM, Corning, Kraft Heinz, JetBlue Airways, and Paccar

Wednesday: Microsoft, Meta, Samsung, Qualcomm, Caterpillar, Airbus, UBS, GSK, Barclays, Volkswagen, Robinhood, Humana, eBay, Norwegian Cruise Line, Albemarle, Wingstop, and Etsy

Thursday: Apple, Amazon, Eli Lilly, Mastercard, McDonald’s, Amgen, MicroStrategy, CVS Health, Airbnb, Dominion Energy, Roblox, Block, Hershey, Live Nation Entertainment, Kellanova, Estee Lauder, Reddit, Duolingo, Twilio, Juniper Networks, Moderna, United States Steel, Roku, Wayfair, and Harley-Davidson

Friday: ExxonMobil, Chevron, Shell, Eaton, Cigna Group, T. Rowe Price, Apollo, ING, and Wendy’s

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FOURTH MARKET: Private Security Transactions

Posted on April 27, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

DEFINITIONS

By Staff Reporters

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The Fourth Market?

The fourth market is defined as private transactions made directly between large medical investors, institutions such as banks, mutual funds, and insurance companies, without the use of a securities firm. In other words, fourth market trading is usually one institution swapping securities in its portfolio with another large institution.

From the stock broker’s viewpoint, there is one problem with the fourth market. Since no broker/dealer is involved, no registered representative is involved and there is no commission to be earned. These trades are reported on a system called Instinet.

This is advantageous to larger medical foundations or institutional investors.

What Is Instinet?

Instinet is a global financial securities service that operates an electronic securities order matching, trading, and information system which allows members, primarily institutional traders, and investors, to display bids and offer quotes for stocks, and conduct transactions with each other.

Instinet is an example of a dark pool of liquidity, a private exchange for trading securities that is not accessible by the investing public. The name implies a lack of transparency. and it facilitates block trading by institutional investors who do not wish to impact the markets with their large orders.

According to the SEC, there were 74 registered Alternative Trading Systems, or dark pools, as of February 2024.

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NEWS IN BRIEF: Financial, Investing, Economics and IT

Posted on April 26, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

BREAKING NEWS

By Staff Reporters

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  • Spot bitcoin ETFs saw their highest inflows since January over the last few days, sparking a crypto rally.
  • The Federal Reserve withdrew its guidance for banks about engaging in crypto-related business.
  • California is now the fourth-largest economy in the world.
  • OpenAI expects its revenue to reach $125 billion in 2029, up from $3.7 billion last year.
  • The median pay for CEOs rose to a record $16.8 million in 2024.
  • Meta Platforms is laying off staff working in its virtual reality division.
  • Apple announced it’s shifting its iPhone production from China to India.

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Alphabet & Intel

Posted on April 24, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By Staff Reporters

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Alphabet has been declared a monopoly for the second time in under a year. Analysts will have plenty of questions about the repercussions of the most recent ruling, but don’t expect a breakup of Google’s many businesses just yet.

And, the best business unit of them all these days is YouTube, which has seen a stunning surge in popularity lately that the search company will likely try to capitalize on, while it continues to tinker with its Gemini AI model. Consensus: $2.02 EPS, $89.25 billion in revenue.

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Intel seems like a bit of an also-ran in the AI race these days, with shares down over 40% in the last 12 months. But to bulls, that just means the stock is cheap, while the company itself has plenty of opportunities for growth ahead, including partnerships with Nvidia and TSMC.

And, don’t forget that Intel’s status as a dark horse lets it slip below the tariff radar—the domestic chip producer dodged the latest round of restrictions that hit Nvidia and AMD. Shareholders will be hoping to hear more good news ahead. Consensus: $0.09 EPS, $12.31 billion in revenue.

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The Medical Executive-Post is a  news and information aggregator and social media professional network for medical and financial service professionals. Feel free to submit education content to the site as well as links, text posts, images, opinions and videos which are then voted up or down by other members. Comments and dialog are especially welcomed. Daily posts are organized by subject. ME-P administrators moderate the activity. Moderation may also conducted by community-specific moderators who are unpaid volunteers.

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ANNUITIES: Three Types of Insurance Products

Posted on April 23, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By Staff Reporters

SPONSOR: http://www.MarcinkoAssociates.com

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An annuity is a contract between you and an insurance company.  When you purchase an annuity, you make a lump-sum contribution or a series of contributions, generally each month.  In return, the insurance company makes periodic payments to you beginning immediately or at a pre-determined date in the future.  These periodic payments may last for a finite period, such as 20 years, or an indefinite period, such as until both you and your spouse are deceased.  Annuities may also include a death benefit that will pay your beneficiary a specified minimum amount, such as the total amount of your contributions.

The growth of earnings in your annuity is typically tax-deferred; this could be beneficial as you may be in a lower tax bracket when you begin taking distributions from the annuity. 

Warning: A word of caution: Annuities are intended as long-term investments. If you withdraw your money early from an annuity, you may pay substantial surrender charges to the insurance company as well as tax penalties to the IRS and state.

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There are three basic types of annuities — fixed, indexed, and variable

1. With a fixed annuity, the insurance company agrees to pay you no less than a specified (fixed) rate of interest during the time that your account is growing. The insurance company also agrees that the periodic payments will be a specified (fixed) amount per dollar in your account.

2. With an indexed annuity, your return is based on changes in an index, such as the S&P. Indexed annuity contracts also state that the contract value will be no less than a specified minimum, regardless of index performance.

3. A variable annuity allows you to choose from among a range of different investment options, typically mutual funds. The rate of return and the amount of the periodic payments you eventually receive will vary depending on the performance of the investment options you select. 

READ: SEC’s publication, Variable Annuities: What You Should Know.

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The Medical Executive-Post is a  news and information aggregator and social media professional network for medical and financial service professionals.

Feel free to submit education content to the site as well as links, text posts, images, opinions and videos which are then voted up or down by other members. Comments and dialog are especially welcomed.

Daily posts are organized by subject. ME-P administrators moderate the activity. Moderation may also conducted by community-specific moderators who are unpaid volunteers.

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VEHICLE INVOICE PRICE: Defined

Posted on April 22, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

OFTEN CONFUSING TO ALL

By Staff Reporters

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A vehicle typically has two prices: the manufacturer’s suggested retail price (MSRP) and the invoice price. The MSRP is the sticker price, while the invoice price is what the dealer paid the manufacturer for the vehicle. The MSRP includes a hefty profit, so that’s what dealers want you to focus on. However, your goal should be to get the invoice price and focus on that for your negotiations.

However, finding invoice pricing on new cars can be difficult when going through the dealer. Dealers don’t want their invoice price on a vehicle to be public knowledge because that gives customers more leverage when it comes to negotiations. Just like any company, car dealers are in the business to make money. They can’t make money if they give you a huge discount on a car.

What is a Vehicle Invoice Price?

When it comes to the car buying process, there are several other terms and types of pricing you should understand. One of them is the vehicle invoice price. This is also known as the dealer cost, or what a car manufacturer charges the dealer for that specific vehicle. Freight charges are typically included in this total.

However, the numbers on the invoice may not be the true price the dealer paid for the vehicle, because it has hidden profits already built-in. Dealers are often given manufacturer rebates, allowances, discounts, and other incentives for selling a car. The invoice price on a vehicle may range from several hundred to several thousand dollars below its sticker price, which is why service will help you determine what the real numbers look like.

So, once you determine the car invoice price, you have added leverage when it comes to negotiating the best price possible with the auto dealer.

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INTRA-DAY: Stock Markets Crash!

Posted on April 21, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

BREAKING NEWS

Artificial Intelligence Enhanced

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Markets drop as tariff concerns shake the market

Key takeaways (1:30 EST)

  • The Dow Jones Industrial Average experienced a significant drop of more than 1,100 points, reflecting investor anxiety over tariff policies finance. The S&P was down 150 and the NASDAQ was down 550.
  • This decline is part of a broader trend affecting the S&P 500 and NASDAQ, as geopolitical tensions and economic uncertainties weigh heavily on market sentiment finance.yahoo.com .
  • Investors are closely monitoring developments regarding trade policies and their potential impact on the economy, leading to heightened volatility in the stock market

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The DOCTOR EFFECT

Posted on April 21, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

Dr. David Edward Marcinko; MBA MEd CMP™

Medical Colleagues Beware the Advisors

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SPONSOR: http://www.MarcinkoAssociates.com

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

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

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

Bread for the advisor – Crumbs for the client!

And so, Marcinko Associates formed a cadre’ of technology focused and highly educated multi-degreed doctors, nurses, financial advisors, attorneys, accountants, psychologists and educational visionaries who decided there must be a better way for their healthcare colleagues to receive financial planning advice, products and related advisory services within a culture of fiduciary responsibility.

We trust you agree with this specific niche knowledge, and collegial consulting philosophy, as illustrated thru our firm and these two books.

EDUCATION: Books

SPEAKING: Dr. Marcinko will be speaking and lecturing, signing and opining, teaching and preaching, storming and performing at many locations throughout the USA this year! His tour of witty and serious pontifications may be scheduled on a planned or ad-hoc basis; for public or private meetings and gatherings; formally, informally, or over lunch or dinner. All medical societies, financial advisory firms or Broker-Dealers are encouraged to submit a RFP for speaking engagements: MarcinkoAdvisors@outlook.com 

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STOCKS: Basic Definitions

Posted on April 18, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By Staff Reporters

SPONSOR: http://www.MarcinkoAssociates.com

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When you buy a share of stock, you are taking ownership in a company.  Collectively, the company is owned by all the shareholders, and each share represents a claim on assets and earnings.  If the company distributes profits to its shareholders, you should receive a proportionate share of the earnings.

Stocks are often categorized by the size of the company, or their market capitalization.  The market capitalization is determined by multiplying the number of outstanding shares by the current share price.  The most common market cap classes are small-cap (valued from $100 million to $1 billion), mid-cap ($1 billion to $10 billion), and large cap ($10 billion to $100 billion).

Stocks are also categorized by their sector, or the type of business the company conducts.  Common sectors include utilities, consumer staples, energy, communications, financial, health care, transportation, and technology.

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Stocks are often viewed as being in one of two categories — growth or value.

  • Growth stocks are ones that are associated with high quality, successful companies that are expected to continue growing at a better-than-average rate as compared to the rest of the market.
  • Value stocks are ones that have generally solid fundamentals, but are currently out of favor with the market.  This may be due to the company being relatively new and unproven in the market, or because the company has recently experienced a decline due to the company’s sector being affected negatively.  An example of this would be if the federal government was to levy a new tax on all cell phones, thus negatively affecting all cell phone company stocks.

History has shown that, over time, stocks have provided a better return than bonds, real estate, and other savings vehicles.  As a result, stocks may be the ideal investment for investors with long-term goals.

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UNITEDHEALTH: Stock Dives

Posted on April 17, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By Staff Reporters

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UnitedHealth stock nosedived 20% in morning trading, falling by $116 per share from Wednesday’s $585 close to $469. The Minnesota-based firm is on track for its steepest daily loss since Aug. 6, 1998.

The losses came after UnitedHealth’s first-quarter financial report was worse than analysts expected across each of the three major quarterly yardsticks: revenue, earnings per share and future earnings outlook.

Furthermore, after the opening bell, the Dow Jones Industrial Average tumbled 1.3%, or around 500 points. The S&P 500 moved up 0.4%, while the tech-heavy NASDAQ composite gained 0.5%.

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Very Few Stocks UP but Many Stocks DOWN

Posted on April 17, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By Staff Reporters

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🟢 What’s up

  • Hertz Global soared 56.44% on the news that Bill Ackman’s Pershing Square Capital has taken a $46.5 million stake in the rental car company.
  • Travelers Cos. rose 1.13% in spite of massive losses from California wildfires, which didn’t hurt the insurer’s bottom line as badly as Wall Street feared.
  • Abbott Laboratories gained 2.77% after the pharma company missed sales estimates but still beat earnings forecasts.
  • Gold miners continue to climb as gold keeps hitting new highs. Newmont rose 2.51%, while Gold Fields gained 3.35%.

What’s down

  • Tesla sank 4.94% after the company’s share of EV sales in California fell below 50% in the first quarter, while export controls threaten plans to produce Cybercabs in the US.
  • United Airlines fell 0.01% despite reporting its “best first-quarter financial results in five years,” according to management. The airline took the unique measure of providing two different financial outlooks for the year ahead: one for a stable economy, and one for a recession.
  • Lyft shed just 0.46% on the news that the ride-hailing company is acquiring European taxi app Free Now for $199 million.
  • Interactive Brokers Group reported a 47% increase in trading volume last quarter that helped it beat revenue expectations, but the brokerage still tumbled 8.95% after missing profit forecasts.
  • Palantir gave up some of its recent gains following its big NATO announcement, sinking 5.78% today as investors collected profits.
  • JB Hunt Transport Services’ management team warned that the logistics company sits squarely in the crosshairs of the trade war, pushing shares down 7.68%.
  • Omnicom Group tumbled 7.28% after the advertising firm missed revenue estimates thanks to economic uncertainty.

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Stocks UP and Stocks DOWN

Posted on April 16, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By Staff Reporters

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Investors were apparently tired of all the volatility yesterday, leading to a relatively calm day where indexes ever-so-slightly slipped. But it was a big day for Netflix after the Wall Street Journal reported that the streaming giant has plans to double its revenue and reach a $1 trillion valuation by 2030.

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🟢 What’s up

  • Hewlett Packard Enterprise popped 5.11% after Elliott Investment Management took a $1.5 billion stake in the tech company.
  • Rocket Lab rocketed (sorry) 10.14% higher after the space stock inked deals with both the US Air Force and the UK Ministry of Defense.
  • Netflix rose 4.83% on a report from the Wall Street Journal that the streaming giant plans to hit a $1 trillion market capitalization and double its revenue by 2030. The company announces earnings on Thursday.
  • Bank of America and Citigroup both posted strong Q1 earnings that beat analyst forecasts (more on that below). BofA climbed 3.60%, while Citi rose 1.76%.
  • Palantir rose another 6.24% a day after NATO agreed to purchase its AI-powered warfighting system.

What’s down

  • Albertsons tumbled 7.49% after the grocer’s full-year guidance came in below expectations.
  • Allegro Microsystems sank 9.68% on the news that ON Semiconductor has withdrawn its offer to acquire the chipmaker.
  • Applied Digital plummeted 35.94% after the digital infrastructure company missed analyst revenue estimates, despite sales climbing 22% last quarter.
  • #recessionindicator: Coty sank 8.57% after the beauty retailer was double downgraded by Bank of America analysts, citing a slowdown in makeup spending.

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STOCK MARKET: Update

Posted on April 15, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By Staff Reporters

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Stocks kept the good vibes going for a second trading day yesterday with tech companies like Apple rising as investors reacted to the weekend’s news that smartphones and computers would be temporarily exempt from “reciprocal” tariffs—at least until new semiconductor tariffs are imposed.

Car companies also jumped after President Trump suggested he wanted to “help” as automakers try to transition their production to the US in the face of 25% auto tariffs.

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US STOCKS: Market Update

Posted on April 14, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By Staff Reporters

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US Markets

After one of the most volatile weeks in Wall Street history, the S&P 500 closed 5.7% higher for its best week since 2023. But investors are taking little comfort with the rebound in stocks.

A declining dollar fell to a three-year low against the euro on Friday and spiking bond yields have some observers warning of a monumental, structural shift away from the US as a safe haven due to the recent tariff turmoil.

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BENEFICIARY DESIGNATIONS: Top 10 Tips for Medical Professionals

Posted on April 14, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By Staff Reporters

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Beneficiary designations can provide a relatively easy way to transfer an account or insurance policy upon your death. However, if you’re not careful, missing or outdated beneficiary designations can easily cause your estate plan to go awry.

Where you can find them

Here’s a sampling of where you’ll find beneficiary designations:

  • Employer-sponsored retirement plans [401(k), 403(b), etc.]
  • IRAs
  • Life insurance policies
  • Annuities
  • Transfer-on-death (TOD) investment accounts
  • Pay-on-death (POD) bank accounts
  • Stock options and restricted stock
  • Executive deferred compensation plans
  • In several states, so-called “lady bird” deeds for real estate

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10 tips about beneficiary designations

Because beneficiary designations are so important, keep these things in mind in your estate planning:

  1. Remember to name beneficiaries. If you don’t name a beneficiary, one of the following could occur:
    • The account or policy may have to go through probate. This process often results in unnecessary delays, additional costs, and unfavorable income tax treatment.
    • The agreement that controls the account or policy may provide for “default” beneficiaries. This could be helpful, but it’s possible the default beneficiaries may not be whom you intended.
  2. Name both primary and contingent beneficiaries. It’s a good practice to name a “back up” or contingent beneficiary in case the primary beneficiary dies before you. Depending on your situation, you may have only a primary beneficiary. In that case, consider whether it may make sense to name a charity (or charities) as the contingent beneficiary.
  3. Update for life events. Review your beneficiary designations regularly and update them as needed based on major life events, such as births, deaths, marriages, and divorces.
  4. Read the instructions. Beneficiary designation forms are not all alike. Don’t just fill in names — be sure to read the form carefully. If necessary, you can draft your own customized beneficiary designation, but you should do this only with the guidance of an experienced attorney or tax advisor.
  5. Coordinate with your will and trust. Whenever you change your will or trust, be sure to talk with your attorney about your beneficiary designations. Because these designations operate independently of your other estate planning documents, it’s important to understand how the different parts of your plan work as a whole.
  6. Think twice before naming individual beneficiaries for particular assets. For example, you may establish three accounts of equal value initially and name a different child as beneficiary of each account. Over the years, the accounts may grow or be depleted unevenly, so the three children end up receiving different amounts — which is not what you originally intended.
  7. Avoid naming your estate as beneficiary. If you designate a beneficiary on your 401(k), for example, it won’t have to go through probate court to be distributed to the beneficiary. If you name your estate as beneficiary, the account will have to go through probate. For IRAs and qualified retirement plans, there may also be unfavorable income tax consequences.
  8. Use caution when naming a trust as beneficiary. Consult your attorney or CPA before naming a trust as beneficiary for IRAs, qualified retirement plans, or annuities. There are situations where it makes sense to name a trust — for example if:
    • Your beneficiaries are minor children
    • You’re in a second marriage
    • You want to control access to funds
  9. Be aware of tax consequences. Many assets that transfer by beneficiary designation come with special tax consequences. It’s helpful to work with an experienced tax advisor to help provide planning ideas for your particular situation.
  10. Use disclaimers when necessary — but be careful. Sometimes a beneficiary may actually want to decline (disclaim) assets on which they’re designated as beneficiary. Keep in mind that disclaimers involve complex legal and tax issues and require careful consultation with your attorney and CPA.

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CONVERTIBLE ARBITRAGE: Defined

Posted on April 13, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By Staff Reporters

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Convertible Arbitrage

Convertible arbitrage is the oldest market-neutral strategy. Designed to capitalize on the relative mispricing between a convertible security (e.g. convertible bond or preferred stock) and the underlying equity, convertible arbitrage was employed as early as the 1950s.

Since then, convertible arbitrage has evolved into a sophisticated, model-intensive strategy, designed to capture the difference between the income earned by a convertible security (which is held long) and the dividend of the underlying stock (which is sold short). The resulting net positive income of the hedged position is independent of any market fluctuations. The trick is to assemble a portfolio wherein the long and short positions, responding to equity fluctuations, interest rate shifts, credit spreads and other market events offset each other.

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Hedge Fund Research (HFR) New York, offers the following description of the strategy

Convertible Arbitrage involves taking long positions in convertible securities and hedging those positions by selling short the underlying common stock. A manager will, in an effort to capitalize on relative pricing inefficiencies, purchase long positions in convertible securities, generally convertible bonds, convertible preferred stock or warrants, and hedge a portion of the equity risk by selling short the underlying common stock. Timing may be linked to a specific event relative to the underlying company, or a belief that a relative mispricing exists between the corresponding securities. Convertible securities and warrants are priced as a function of the price of the underlying stock, expected future volatility of returns, risk free interest rates, call provisions, supply and demand for specific issues and, in the case of convertible bonds, the issue-specific corporate/Treasury yield spread. Thus, there is ample room for relative mis-valuations.

Because a large part of this strategy’s gain is generated by cash flow, it is a relatively low-risk strategy. 

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CREDIT CARDS: Mistakes All Doctors Must Avoid

Posted on April 13, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By Staff Reporters

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Credit Card Mistakes to Avoid

No number has as far-reaching an impact on your money as your credit scores. Here are some credit card obstacles all physicians, nurses and medical professionals should dodge on the road to financial security

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  • Don’t pay for a credit card repair service.
  • Don’t miss a payment.
  • Don’t max out your card.
  • Don’t take a cash-advance.
  • Don’t skip using your cards.
  • Don’t chase interest rates.
  • Don’t apply for several credit cards all at once.
  • Don’t co-sign a loan.
  • Don’t spread our car or mortgage payments.


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MEDICAL PRACTICE: As a Financial Asset Class?

Posted on April 13, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

SPONSOR: http://www.MarcinkoAssociates.com

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By Dr. David Edward Marcinko; MBA MEd CMP™

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What Is an Alternative Investment?

An alternative investment is a financial asset that does not fall into one of the conventional investment categories. Conventional categories include stocks, bonds, and cash. Alternative investments can include private equity or venture capital, hedge funds, managed futures, art and antiques, commodities, and derivatives contracts. Real estate is also often classified as an alternative investment.

QUESTION: But what about a medical, podiatric or dental practice?

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An Alternate Asset Class Surrogate?

A medical practice is much like an alternative investment [AI], or alternate asset class in, two respects.

  • First, it provides the work environment that generates personal income which has been considered generous, to date. 
  • Second, it has inherent appreciation and sales value that can be part of an exit (retirement) or succession planning transfer strategy.

Conclusion

So, unlike the emerging thought that offers Social Security payments as a surrogate for an asset classes; or a federally insured AAA bond – a medical practice might also be considered by some folks as an asset class within a well diversified modern investment portfolio.

EDUCATION: Books

SPEAKING: Dr. Marcinko will be speaking and lecturing, signing and opining, teaching and preaching, storming and performing at many locations throughout the USA this year! His tour of witty and serious pontifications may be scheduled on a planned or ad-hoc basis; for public or private meetings and gatherings; formally, informally, or over lunch or dinner. All medical societies, financial advisory firms or Broker-Dealers are encouraged to submit a RFP for speaking engagements: MarcinkoAdvisors@outlook.com 

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PHYSICIAN: Financial Education Lacking in Medical School

Posted on April 12, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

FRANKLY SPEAKING MY MIND!

By Dr. David Edward Marcinko MBA MEd CMP™

SPONSOR: http://www.CertifiedMedicalPlanner.org

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SPONSOR: http://www.MarcinkoAssociates.com

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The vast majority of physicians and medical professionals major in one of the hard science while in college; biology, engineering, chemistry, mathematics, computer science or physics; etc. Few take undergraduate courses in finance, business management, securities analysis, accounting or economics; although this paradigm is changing with modernity. These course are not particularly difficult for the pre-medical baccalaureate major, they are just not on the radar screen for time compressed and highly competitive students; nor are they needed for medical or nursing school admission, or the many related allied health professional schools.

In fact, William C. Roberts MD, originally from Emory University in Atlanta, and former editor for the Baylor University Medical Center Proceedings and The American Journal of Cardiology, opined just a decade ago:

“Of the 125 medical schools in the USA, only one of them to my knowledge offers a class related to saving or investing money.”

And so, it is important to review some basic principles of economics, finance and accounting as they relate to financial planning in thees two textbooks; and this ME-P.

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SPECIAL PURPOSE VEHICLE: Defined

Posted on April 12, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By dcpalter

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What is an SPV and When Do You Need One?

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A special purpose vehicle (SPV), or a special purpose entity (SPE), is a legal entity that a parent company creates to hold separate assets from the parent’s balance sheet.

Its purpose is to isolate the parent company from any potential credit or financial risk that may arise from the SPV and is often used to pursue riskier projects, securitize debt, or transfer assets.
Since an SPV is separate from the parent company, it isn’t affected by the parent’s performance, and the parent isn’t typically affected by the performance of the SPV. If the parent goes bankrupt and is no longer in existence, the SPV can carry on.

This makes an SPV bankruptcy remote. This also means that the parent company is unaffected by the loss if the SPV fails.

MORE: https://www.wallstreetoasis.com/resources/skills/strategy/special-purpose-vehicle-spv

Related: https://medicalexecutivepost.com/2024/07/26/spac-v-direct-listing-v-ipo/

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PHYSICIAN RETIREES: Home Ownership V. Home Renting

Posted on April 12, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

THE “FIVE-FIVE” FINANCIAL RULE

By Staff Reporters

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Many of the pros of home ownership will appeal to medical retirees for whom their home is their castle and who appreciate being settled both financially and geographically:

  • 1. Building equity in your home: Each mortgage payment you make brings you closer to owning your house free and clear with no payments. If you can buy a new home or condo outright by selling your current home, you can still build equity in your new home over time.
  • 2. Predictability: If you have a fixed-rate mortgage, your mortgage payments will remain consistent for years and you don’t have to worry about a landlord ever making you move.
  • 3. Tax benefits: You can deduct mortgage interest and property taxes up to certain limits.
  • 4. Customization: You don’t need a landlord’s permission to alter and improve your home.
  • 5. Home appreciation: Homes generally increase in value, so you can increase your net worth by owning a property.

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Renting also has five significant upsides, particularly for physician retirees who want greater freedom to travel and to make bigger moves — potentially across the country or even abroad:

  • 1. Extreme flexibility: You can leave your property after giving notice and go wherever you want much more easily than with an illiquid home you’d have to sell first.
  • 2. Lower upfront costs: You only have to pay first and last month’s rent and a security deposit to move into a rental, not make a large home down payment.
  • 3. No maintenance concerns: If something breaks, your landlord is responsible for the cost of fixing it and the actual repairs. You don’t have to build up an emergency fund for maintenance.
  • 4. Predictable expenses: For the duration of your lease, your monthly housing costs including utilities will remain consistent, even if the cost of energy goes up, for example.
  • 5. Lack of worry: If you’re in a rental apartment, you won’t have to concern yourself with shoveling snow, mowing grass or other matters of upkeep.

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DAILY UPDATE: Dow & S&P 500 Post Best Week Since 2023

Posted on April 12, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

MEDICAL EXECUTIVE-POST – TODAY’S NEWSLETTER BRIEFING

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

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

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US stocks turned higher on Friday to cap a chaotic week on Wall Street, as investors weighed the latest tariff-related developments in the trade war between the US and China.

The S&P 500 (^GSPC) rose 1.8% after seesawing earlier in the session. The tech-heavy NASDAQ Composite (^IXIC) climbed 2.1%. The Dow Jones Industrial Average (^DJI) advanced 1.5%, about 600 points.

Trump’s fast-moving tariff policy has whiplashed stocks this week with historic gains during Wednesday’s session but sharp losses on Thursday.

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

In the end, the S&P 500 and Dow had their best weeks since 2023, while the NASDAQ’s 7% weekly gain was its best since 2022.

CITE: https://tinyurl.com/tj8smmes

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

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ROTH: Conversion Considerations for Physicians

Posted on April 11, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

Why would a doctor consider a Roth IRA conversion?

By Staff Reporters

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A Roth conversion involves transferring funds from a traditional retirement account—such as a 401(k), 403(b), or individual retirement account (IRA) funded with pre-tax dollars—into a Roth IRA.

The biggest benefit lies in the tax treatment of the converted funds. Once the funds are in the Roth IRA, future growth of those assets is tax-free. Withdrawals in retirement are also tax-free, assuming they meet certain criteria. As with any strategy, there are important considerations to keep in mind.

When you convert funds to a Roth IRA, the amount converted is taxable income in that tax year. For example, if you convert $100,000 from a traditional IRA to a Roth IRA, that $100,000 will be added to your taxable income in the conversion year.

Converting large amounts can result in a significant tax bill and may push you into a higher tax bracket. Even so, using retirement funds to pay taxes may make sense for those looking to convert large IRAs to reduce their future required minimum distributions (RMDs).

The timing of your Roth conversion matters too. Generally, it’s a good idea to convert when your income is lower—for example, after you’ve retired and before you begin drawing Social Security. You may also choose to convert over the course of several years to spread out the tax impacts. But if you can get comfortable with these considerations, a Roth conversion can provide you with benefits beyond tax-free growth and withdrawals.

Some of these benefits are:

  • Tax diversification. Having both traditional and Roth accounts allows you to manage your tax liability in retirement. For example, if your income in a given year is higher than expected, you can withdraw from the Roth IRA without increasing your taxable income.
  • No RMDs. Traditional IRAs and 401(k)s require you to begin taking RMDs at age 73. Roth IRAs have no RMD requirement during your lifetime. With a Roth account, you have more control over your retirement withdrawals and can leave the funds to grow for your heirs.
  • Benefits for heirs. Roth IRAs can be passed on to beneficiaries, who can inherit the account income tax-free. This means your heirs can enjoy the tax-free growth and withdrawals if the Roth IRA has been held for five years or more—a significant advantage, especially if your beneficiaries are in a higher tax bracket.

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DAILY UPDATE: Stocks Crushed Again!

Posted on April 11, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

MEDICAL EXECUTIVE-POST – TODAY’S NEWSLETTER BRIEFING

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

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

A Partner of the Institute of Medical Business Advisors , Inc.

http://www.MedicalBusinessAdvisors.com

SPONSORED BY: Marcinko & Associates, Inc.

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US stocks got crushed on Thursday, pulling back from the previous day’s historic rally amid concerns that President Trump’s broad trade offensive has become a direct confrontation with China.

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

The S&P 500 (GSPC) dropped almost 3.5%, while the tech-heavy NASDAQ Composite (IXIC) tumbled 4.3%. The Dow Jones Industrial Average (^DJI) fell about 1,000 points, or 2.5%. The 10-year Treasury yield (^TNX), in high focus amid bond market whiplash, ended the day flat around 4.39%.

CITE: https://tinyurl.com/tj8smmes

The major averages sank to session lows after the White House confirmed updated tariff figures released on Thursday brings the total increased levies on Chinese goods to 145%, not 125% as previously stated.

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

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FINANCIAL MODELING TERMS: All Physicians Should Review and Know

Posted on April 10, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By Staff Reporters

SPONSOR: http://www.CertifiedMedicalPlanner.org

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Financial Modeling is one of the most highly valued, but thinly understood, skills in financial analysis. The objective of financial modeling is to combine accounting, finance, and business metrics to create a forecast of a company’s future results.

According to Jeff Schmidt, a financial model is simply a spreadsheet, usually built in Microsoft Excel, that forecasts a business’s financial performance into the future. The forecast is typically based on the company’s historical performance and assumptions about the future and requires preparing an income statement, balance sheet, cash flow statement, and supporting schedules (known as a three-statement model, one of many types of approaches to financial statement modeling). From there, more advanced types of models can be built such as discounted cash flow analysis (DCF model), leveraged buyout (LBO), mergers and acquisitions (M&A), and sensitivity analysis

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DEFINED TERMS

Discounted Cash Flow (DCF): A valuation method used to estimate the value of an investment based on its expected future cash flows, adjusted for the time value of money. It’s like deciding whether a treasure chest is worth diving for now, based on the gold coins you’ll be able to cash in later.

Sensitivity Analysis: This involves changing one variable at a time to see how it affects an outcome. Imagine tweaking your coffee-to-water ratio each morning to achieve the perfect brew strength.

Budget – A budget is the amount of money a department, function, or business can spend in a given period of time. Usually, but not always, finance does this annually for the upcoming year.

Rolling Forecast – A rolling forecast maintains a consistent view over a period of time (often 12 months). When one period closes, finance adds one more period to the forecast.

Topside – A topside adjustment is an overlay to a forecast. This is typically completed by the corporate or headquarter team. As individual teams submit a forecast, the consolidated result might not make sense or align with expectations. When this occurs, the high-level teams use a topside adjustment to streamline or adjust the consolidated view.

Monte Carlo Simulation: Picture yourself at the casino, but instead of gambling your savings away, you’re using this technique to predict different outcomes of your business decisions based on random variables. It’s like playing financial roulette with the odds in your favor.

What-If Analysis: Ever daydream about what would happen if you took that leap of faith with your business? This tool allows you to explore various scenarios without risking a dime. It’s like trying on outfits in a virtual dressing room before making a purchase.

Leveraged Buyout (LBO) Model: This is a bit like orchestrating a heist, but legally. It’s about acquiring a company using borrowed money, with plans to pay off the debts with the company’s own cash flows. High stakes, high rewards.

Mergers and Acquisitions (M&A) Model: Picture two puzzle pieces coming together. This model evaluates how combining companies can create a new, more valuable entity. It’s the corporate version of a matchmaker.

Three Statement Model: The holy trinity of financial modeling, linking the income statement, balance sheet, and cash flow statement. It’s like weaving a tapestry where each thread is crucial to the overall picture.

Capital Asset Pricing Model (CAPM): A formula that calculates the expected return on an investment, considering its risk compared to the market. It’s like choosing the best roller coaster in the park, balancing thrill and safety.

Cash Flow Forecasting: This is your financial weather forecast, predicting the cash flow climate of your business. It helps you plan for sunny days and save for the rainy ones.

Cost of Capital: The price of financing your business, whether through debt or equity. It’s like the interest rate on your growth engine, pushing you to maximize every dollar invested.

Debt Schedule: A timeline of your business’s debts, showing when and how much you owe. It’s your roadmap to becoming debt-free, one milestone at a time.

Equity Valuation: Determining the value of a company’s shares. It’s like assessing the worth of a rare gemstone, ensuring investors pay a fair price for a piece of the treasure.

Financial Leverage: Using debt to amplify returns on investment. It’s like using a lever to lift a heavy object, increasing force but also risk.

Forecast Model: A crystal ball for your finances, projecting future performance based on past and present data. It’s your guide through the financial wilderness, helping you navigate with confidence.

Operating Model: A detailed blueprint of how a business generates value, mapping out operational activities and their financial impact. It’s like laying out the inner workings of a clock, ensuring every gear turns smoothly.

Revenue Growth Model: This tracks potential increases in sales over time, charting a course for expansion. It’s like plotting your ascent up a mountain, anticipating the effort required to reach the summit.

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TREASURY NOTES: Panic Attack Mode?

Posted on April 10, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By Staff Reporters

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Treasury notes are typically considered one of the world’s safest safe-haven assets—the US has always repaid bondholders on their investment, plus yield (interest). That’s why you can usually count on the bond market to rally when the stock market craters. And, vice-versa. But not this time:

  • The benchmark 10-year bond yield, which moves inversely to bond prices, had its steepest spike this week since the 2008 financial crisis. The 10-year yield is more closely watched than the 30-year yield (which also spiked) in part because it influences home and auto loan rates.
  • A Treasury auction of 3-year bonds on Tuesday was met with the softest demand since December 2023. That helped drive the bond sell-off on fears of a pullback among international investors, who hold $8.5 trillion in US Treasuries (Japan and China lead the pack).

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REPUTATIONAL BANKRUPTCY: Of the American Dollar

Posted on April 9, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By Vitaliy Katsenelson CFA

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The Reputational Bankruptcy of the American Dollar
I am in an unenviable position. The policy coming out of the White House has a significant impact on economics, more than ever before in my career. If I say anything positive about that policy, I’ll be put in the MAGA camp. If I criticize it, I’ll be accused of suffering from Trump derangement syndrome. I am hired by you to make the best investment decisions possible. Rather than see me as engaged in political commentary, I’d ask that you view my remarks as purely analytical.

Let me give you this analogy. I live in Denver. Let’s imagine I am a huge Broncos fan, and the Broncos are playing the Chicago Bears. If I am betting a significant amount of money on this game, I should put my affinity for the Broncos and hatred of the Chicago Bears aside and analyze data and facts. The Broncos are either going to win or lose; my wanting them to win has zero impact on the outcome. The same applies to my analysis here. My motto in life is Seneca’s saying, “Time discovers truth.” I just try to discover it before time does.

When it comes to politics, I also have a significant advantage. I was not born in this country. From a young age, I was brainwashed about communism, not about team Republican versus team Democrat. The failure of the Soviet Union de-brainwashed me fast concerning the virtues of communism and converted me into a believer in free markets.

As a result, I never bought into either party’s ideology, and thus in the last four presidential elections I voted for a Republican, an independent, a Democrat, and wrote in my youngest daughter, Mia Sarah (not in that order). In my articles I have criticized the policies of both Biden (student loan forgiveness, unions) and Trump (Bitcoin reserve).

I remind myself that in times like these you have to be a nuanced thinker. Some of Trump’s policies are terrific, others … not so much (I am being diplomatic here).

Scott Fitzgerald once said “The test of a first-rate intelligence is the ability to hold two opposed ideas in mind at the same time, and still retain the ability to function.” In 2025 we are taking this “first-rate intelligence” test daily.

What will happen to the US dollar? The US dollar will likely continue to get weaker, which is inflationary for the US. Let me start with some easily identifiable reasons:

We have too much debt. We ran 6-7% budget deficits while our economy was growing and unemployment was at record lows. Now we have $36 trillion in debt. Our interest expenses exceed our defense spending, and these costs will continue to climb. If/when we go into recession, we may see something we have not seen in a long time – higher interest rates. Our budget deficits will balloon to between 9–12%, and the debt market, realizing that inflation (i.e., money printing) is inevitable, will say, “Pay up!”

New competition from Bitcoin. President Trump’s approval of Bitcoin as a potential reserve currency is one of the most self-serving and anti-American things I’ve seen any president do. The US dollar is the world’s reserve currency. We still have little competition for that title. China could be a contender, but it is not a democracy and has capital controls. This policy has no upside for America, only downside.

A stronger Europe. Ironically, we may inadvertently create a stronger Europe by threatening to abandon NATO. I don’t want to insult European clients (or my European friends), but the following analogy describes the US-Europe relationship on some level: Europe gradually evolved into a trust fund kid (when it came to security) and the US turned into its sugar daddy. The trust fund kid was incredibly dependent on the sugar daddy. It criticized its parent for being a barbarian and money-driven, but it relied heavily on that parent to protect it from bullies.

President Trump cut off Europe’s allowance by threatening that the US might not protect Europe from Russia. This has forced Europe to spend more money on defense. Outside of Germany (which has little debt), few European economies can afford that. This may force Europe (or at least some European countries) to become more pragmatic – to cut social programs and bureaucracy. If this leads to a stronger Europe both economically and militarily, the euro will be competing with the US dollar. This is a big if.

Our new foreign policy.

When people describe President Trump’s foreign policy as “transactional,” they’re highlighting a fundamental shift in how America engages with the world – one with profound implications for our global standing, national interests, and the US dollar. The shift affects both types of capital – financial and reputational.

Reputational capital isn’t at risk in ‘one-shot’ transactions like house selling. Imagine you’re selling your primary residence and moving elsewhere. Do you disclose every flaw, or let the buyer figure things out? Your incentive is to maximize short-term profits. You’ll likely never meet this buyer again, and therefore there are incentives not to care what they’ll think of you afterward. You’ll be transactional, seeking the highest price possible for your biggest asset. This exemplifies a ‘one-shot’ system where future interactions aren’t expected.

Contrast this with a relationship- and trust-based system. Now imagine you are a homebuilder in a small town. Your suppliers only extend credit if you have a reputation for paying on time. Your employees do quality work only if you treat them fairly. Your buyers tell friends about their experience with you. The incentives naturally create a relational approach. In this trust-based system, incentives skew toward maximizing long-term profits, where reputational capital becomes the glue creating continuity.

Reputational capital radiates predictability – you know how someone will behave based on their history – but operating with low or negative reputational capital is difficult and expensive. People won’t enter long-term contracts with you or will demand external guarantees. Many potential partners will simply refuse to deal with you.

Building reputational capital works like adding pennies to a jar – each good deed incrementally adds to your standing. Yet reputational capital can collapse instantly by removing the jar’s bottom. A single breach of trust doesn’t just remove one penny; it can wipe out your entire balance and plunge you into reputational bankruptcy. The math is brutally asymmetric: good deeds might add a point or two, while bad deeds subtract by factors of 50 or 100.

This doesn’t mean transactions shouldn’t be profitable. If you’re accumulating reputational capital while consistently losing money, you’re probably in the wrong business. Each deal should be evaluated considering both long-term financial and reputational capital.

Individual transactions can sacrifice some profit but cannot afford to lose reputational capital. A “one-shot” transactional approach used in a trust-system environment may provide greater short-term profitability, but if this success comes at the expense of reputational capital, the long-term consequences for America’s global position could be devastating.

This brings us to our current foreign policy.

Relationships between nations are a trust-based system. I’d argue it’s a super-relational system because it’s multigenerational, lasting beyond the life of any one human. Reputational capital is paramount here.

Part of the US’s strength has been the soft power – the reputational capital – it exerted. We had a lot of friends, which helped us to be more effective in dealing with our foes. We keep telling ourselves that America is an “exceptional” nation. This exceptionalism didn’t just come from our financial and military might – it accumulated based on our reputational capital.

Though we don’t always succeed, we are a people who try to do the right thing. Our exceptionalism has been earned through our actions. We are the country that helped rebuild Europe and gave it six decades to repay lend-lease. We toppled communism.

I don’t know the nuances of the Ukraine mineral deal, but initially it had the optics of extortion. Though I think the renegotiated and signed version appears to be fair to both sides, forcing repayment while Ukraine is dodging Russian missiles made the US look transactional.

Actions by President Trump over the last month have undermined our reputation. We are quickly becoming a “one-shot” transactional player in a trust-based environment. Imposing tariffs on Canada on a whim to try to get it to become the 51st state erodes American reputational capital. So does not ruling out America invading Greenland. This puts us on the same moral plane as Russia invading Ukraine.

The conversation about tariffs has many nuances. For instance, I don’t know anyone who opposes reciprocal tariffs – they seem fair and don’t consume any reputational capital. But tariffs that are used as weapons in a trade war in order to annex another country erode reputational capital. Threatening to leave NATO and not protect countries that don’t spend enough on their defense diminishes reputational capital. Maybe the only way to get European countries to spend on defense was to threaten not to defend them – you can agree or disagree with the rationale behind each of Trump’s decisions, but what can’t be argued is that they undermined our reputational capital.

As we lose soft power, our influence will diminish, and thus so will perceptions of our power. The world will start looking at us not from the perspective of the continuity of generations but of presidential cycles. The word of the American president will have an expiration date of the next presidential or mid-term election.

There are two negotiation styles – Warren Buffett’s and Donald Trump’s. Both have their advantages and disadvantages. Buffett will give you one offer and one offer only. Once the deal is agreed to, even just verbally, that is the deal. Critics would say that there is downside to that predictability, as foes know how you are going to respond. Donald Trump’s style is to be unpredictable, which has its own advantages when you deal with foes – it keeps opponents guessing. But it destroys trust with your allies.

In a world of fiat currencies, all currency is a financial and reputational promise. President Trump, with the help of DOGE (and maybe even tariffs) may increase our financial strength. I hope he does, but it will likely come at a very high cost to our reputational capital, and therefore US global influence and the US dollar will continue its decline.

How are we positioned for this?

About half of our portfolio is foreign companies whose sales are not in dollars. They will benefit from a weaker dollar. We also have exposure to oil, which is priced in the US dollar and usually appreciates when the dollar weakens.

A weaker dollar means our imports will become more expensive, which is inflationary. We own many companies with pricing power and also companies that have claims on someone else’s revenues. Take Uber for example: they get about 20% of each ride. If the cost of the ride goes up, so does their dollar take.

Why does President Trump keep pushing crypto?

In July 2019, Trump said the following: “I am not a fan of Bitcoin and other cryptocurrencies, which are not money, and whose value is highly volatile and based on thin air.” Five years later he promised to establish the US Crypto Reserve, and in 2025 he did.

What changed? There is no logical reason for an American president to endorse crypto. None. Here is the honest answer: Crypto bros made mega-contributions to his campaign.

To top it off, three days before he took office he issued $TRUMP – a shitcoin. Believe it or not, “shitcoin” is a technical term in the crypto community (any coin other than Bitcoin is called a shitcoin by Bitcoin “maximalists”, folks who believe Bitcoin is the one and only digital currency). The future sitting president literally issued – I don’t want to call it a currency, so I guess shitcoin is the right name – that will at some point decline to zero in value. In other words, he’ll fleece his loyal followers who purchase $TRUMP of billions of dollars.

I previously referenced both reputational capital and soft power. These types of acts by a sitting president subtract from both.

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STOCK MARKET: Panic Buying Apple A18 Processor iPhones

Posted on April 9, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By Staff Reporters

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Just after midnight, President Trump’s “reciprocal” tariffs went into effect against 86 countries. Analysts have estimated that the new US average effective tariff rate is north of 20%, the highest in more than 100 years. Ahead of the tariff deadline, markets swung violently, mostly way down: According to Bloomberg’s Cameron Crise, yesterday was the fourth straight trading day when the S&P 500’s trading range was 5% or more. That’s only happened in 1987, 2008, and 2020.

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The Apple A18 and Apple A18 Pro are a pair of 64-bit ARM-based system on a chip (SoC) designed by Apple Inc., part of the Apple silicon series. They are used in the iPhone 16 and iPhone 16 Pro lineups and the iPhone 16e, and built on a second generation 3 nm process by TSMC.

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Yesterday, for several hours on Tuesday, it looked like stocks were going to regain some of the ground lost during the market’s very bad week. But after the Trump administration made it clear that its increased tariffs on China would go into effect, all three indexes plunged. Apple, which makes most of its iPhones in China, was hit harder than many of its Big Tech peers.

So shoppers are thinking it’s better to have an Apple A18 processor and not need it, than to need it and not have it. Apple customers are scrambling to buy new iPhones out of fear that the company could raise prices to offset President Trump’s tariffs.

Employees at locations throughout the US said they’re being bombarded with questions about potential price hikes and have witnessed customers panic-buying phones. Though Apple declined to comment to Bloomberg, its retail stores reportedly saw higher sales over the last weekend than in previous years.

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IPOs: Delayed

Posted on April 7, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By Staff Reporters

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Initial Public Offering Defined

IPO stands for initial public offering. It is when a company takes a portion of their shares and makes them available for the general public to buy on the open market. It is a way for the company to raise money by selling those shares to the general public. You can usually access shares from an IPO by working directly with an investment bank.

Paused IPOs

Private companies StubHub and Klarna each paused their imminent plans to go public.

Klarna, which was set to IPO on this Monday, was expected to jump-start the frozen IPO market this year with an expected ~$15 billion valuation.

StubHub, meanwhile, reportedly wants to wait for the market to calm down before resuming its plans to go public.

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BLACK MONDAY REDEUX: Interesting Day or Financial Crisis?

Posted on April 7, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

BILL ACKMAN versus JIM KRAMER

By Staff Reporters

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Interesting Day?

Markets: Last week’s market bloodbath will go down in the history books. The S&P 500’s 10% plunge on Thursday and Friday, after President Trump announced massive tariffs, ranks among the steepest two-day decline in the last 70 years, on par with Black Monday in 1987, the post-Lehman Brothers rout in 2008, and the Covid plunge in March 2020. More than $6 trillion was wiped out from stocks over two days, and the NASDAQ entered a bear market, down 20% from a previous high.

Trading restarted at 9:30 am ET for what Bill Ackman predicts will be “one of the more interesting days in our country’s economic history.”

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Monday Crash?

On the other hand, CNBC host and market commentator Jim Cramer just warned that America is in store for another “Black Monday” market crash similar to the record 1987 collapse if President Trump doesn’t curtail his tariff plan.

Cramer — who noted that the 1987 crash saw the Dow Jones Industrial Average fall by 22.6% in a single day — said the bloodbath could be repeated after the brutal two-day sell-off following the announcement of Trump’s sweeping tariffs against nearly 90 countries.

If the president doesn’t try to reach out and reward these countries and companies that play by the rules, then the 1987 scenario … the one where we went down three days and then down 22% on Monday, has the most cogency,” Cramer said on his show Saturday, referencing the worst single-day fall in the history of the Dow.

QUESTION: Who is correct; Ackman or Cramer?

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Registered Investment Advisor VERSUS Hedge Fund Manager

Posted on April 7, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

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By Staff Reporters

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A hedge fund is a limited partnership of private investors whose money is pooled and managed by professional fund managers. These managers use a wide range of strategies, including leverage (borrowed money) and the trading of nontraditional assets, to earn above-average investment returns. A hedge fund investment is often considered a risky, alternative investment choice and usually requires a high minimum investment or net worth. Hedge funds typically target wealthy investors.

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The Hedge Fund manager I am considering is a Registered Investment Adviser [RIA]

QUESTION: What is a Registered Investment Advisor?

If the fund manager is an entity, then any individual you deal with will be a registered investment adviser representative. If the fund manager is an individual, then that individual is a registered investment adviser. In either case, the designation implies several steps have been taken.

In order to become a registered investment adviser, an individual must register for and pass the Series 65 Uniform Investment Adviser Law Exam, a three-hour, 130-question computer-based exam administered by the North American Securities Administrators Association. Topics covered include economics and analysis, investment vehicles, investment recommendations and strategies, and ethics and legal guidelines. A passing score is 70 percent or higher.

Once an individual has passed the Series 65, he or she must then apply via Form ADV to become a registered investment adviser. This application is made to either a state authority or to the SEC, depending on the adviser’s assets under management. If assets under management exceed $30 million, then the adviser must register with the SEC.

Form ADV consists of two parts. Part I provides general information to the regulatory authority. Part II is designed to be distributed to potential clients, and includes disclosure of a decent amount of information about the adviser. If the manager is a registered investment adviser, then you should expect to receive as part of the offering documentation either a current copy of Part II of the adviser’s Form ADV or a brochure that contains all the current information in Part II of Form ADV.

In addition to filing Form ADV and paying a small fee, the registered investment adviser becomes subject to extra administrative/regulatory burden as well as capital adequacy requirements that state the Adviser must maintain certain net worth levels.

By and large, because of the extra administrative burden as well as restrictions on certain activities, hedge fund managers attempt to avoid registering as investment advisers. Whether such managers can or cannot avoid such registration is largely dependent upon the state in which the manager operates. In California, for instance, hedge fund managers must register as investment advisers. In New York, such registration is not necessary. Not surprisingly, hedge fund managers located in California are rare, while they are quite plentiful in New York. 

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MEDICAL DEVICES: Special Considerations

Posted on April 6, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By Staff Reporters

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INFORMATION TECHNOLOGY CONSIDERATIONS FOR MEDICAL DEVICES

In 2013, the Food and Drug Administration (FDA) issued its first cybersecurity safety communication, followed in 2014 by final guidance. It struck a reasonable balance between new regulations (almost none) and guidance (in the form of non-binding recommendations).

In 2015, the Federal Trade Commission (FTC) released a staff report entitled Internet of Things: Privacy & Security in a Connected World, in which it recommend that Internet of Things (IoT) style devices, which of course include medical and clinical devices, need to maintain a good security posture. It’s worth noting that the FDA, FTC, and other government regulators are centering on a few key guidelines. The following recommendations come directly from the FTC report.

Companies should build security into their devices at the outset, rather than as an afterthought. As part of the security by design process, companies should consider:

  • Conducting a privacy or security risk assessment
  • Minimizing the data they collect and retain
  • Testing their security measures before launching their products
  • Companies should train all employees about good security, and ensure that security issues are addressed at the appropriate level of responsibility within the organization
  • Companies should retain service providers that are capable of maintaining reasonable security and provide reasonable oversight for these service providers.
  • When companies identify significant risks within their systems, they should implement a defense-in-depth approach, in which they consider implementing security measures at several levels.
  • Companies should consider implementing reasonable access control measures to limit the ability of an unauthorized person to access a consumer’s device, data, or even the consumer’s network.
  • Companies should continue to monitor products throughout the life cycle and, to the extent feasible, patch known vulnerabilities

According to colleague Shahid N. Shah MS, the FTC report and FDA guidelines are remarkably consistent. When thinking of cybersecurity and data privacy, engineers tend to think about authentication, authorization, and encryption. Those are the relatively easy topics. For safety-critical devices, however, things are much more difficult and need to encompass a larger surface of questions, including but not limited to:

  • Asset Inventory: Is the device discoverable, and can it associate itself with standard IT inventory systems so that revision management, software updates, and monitoring can be automated?
  • Cyber Insurance: Does the device have enough security documentation to allow it to be insured by standard cyber insurance riders?
  • Patching: How is the firmware, operating system (OS), or application going to be patched by IT staff within hospitals (or the home for remote devices)?
  • Internal Threats: Has the device been designed to circumvent insider (hospital staff, network participants, etc.) threats?
  • External Threats: Has the device been designed to lock down the device from external threats?
  • Embedded OS Security: Is the device sufficiently hardened at the operating system level, such that no extraneous software components, which increase the attack surface, are present?
  • Firmware and Hardware Security: Are the firmware and hardware components sourced from reputable suppliers and free of state-sponsored spying?
  • Application Security: Is the Microsoft Security Development Lifecycle (SDL) or similar software security assurance process integrated into the engineering process?
  • Network Security: Have all network protocols not in use by the device been turned off so that they are not broadcasting?
  • Data Privacy: What data segmentation, logging, and auditing is being done to ensure appropriate data privacy?
  • HIPAA Compliance: Have proper steps been followed to ensure Health Insurance Portability and Accountability Act (HIPAA) compliance?
  • FISMA Compliance: If you’re selling to the federal government, have proper steps, such as use of Federal Information Processing Standard (FIPS) certified encryption, been followed to ensure Federal Information Security Management Act (FISMA) compliance?
  • Data Loss Prevention (DLP): Is there monitoring in place to ensure data leakage outside of the device doesn’t occur?
  • Vulnerabilities: Have common vulnerabilities such as the Open Web Application Security Project (OWASP) Top 10 been reviewed?
  • Data Sharing: Are proper data sharing agreements in place to allow sharing of data across devices and networks?
  • Password Management: Are passwords hardcoded into the device or made configurable?
  • Configuration Protection: Are configuration files properly check-summed and protected against malicious changes?

ASSESSMENT

It is vital to perform a security assessment on a healthcare practice to understand the environment, identify risks and perform risk mitigation. A one-time security assessment with risk mitigation is not sufficient in 2025. This is a continuous process that needs to be performed religiously to maintain a secure and compliant practice.

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HEDGE FUND: Wrap Fees?

Posted on April 5, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

Staff Reporters

SPONSOR: http://www.CertifiedMedicalPlanner.org

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A hedge fund is a limited partnership of private investors whose money is pooled and managed by professional fund managers. These managers use a wide range of strategies, including leverage (borrowed money) and the trading of nontraditional assets, to earn above-average investment returns. A hedge fund investment is often considered a risky, alternative investment choice and usually requires a high minimum investment or net worth. Hedge funds typically target wealthy investors.

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My stock broker is telling me about a “wrap-fee” program involving a hedge fund manager.

QUESTION: What is a Wrap Fee?

A wrap fee program is a service that provides investment advice and portfolio management to clients for one all-inclusive fee. The fee pays for the services provided to the client, including but not limited to securities transactions, portfolio management, research, brokerage, and administrative services. Wrap fee programs also provide an understanding of a client’s financial goals and objectives; research and selection of assets; implementation of investment decisions; account statements, and access to real-time financial data.

The Investment Advisers Act of 1940 regulates investment advisors when they offer these wrap fee programs and requires them to provide comprehensive disclosure documents before investing. This act helps ensure clients have access to all important information that affects their investment decisions.

QUESTION: Why do I need my stock broker? Can I just go directly to the hedge fund manager?

Yes, you can, but you may find a different fee arrangement when you reach the hedge fund manager, and you may be participating in an unethical transaction. When hedge fund managers set up separate accounts for wrap-fee clients, they agree to take a set fee in exchange for managing this money. They also enter into agreements with one or more brokers to help market this aspect of their money management business. A portion of the wrap fee you pay goes to the broker, and a portion goes to the manager. Incentive compensation is not generally used.

When approached directly, hedge fund managers will typically offer only the hedge fund, complete with incentive compensation and pooled investment features. However, if the hedge fund manager is willing to set up a separate account, it is possible that the investor will find the set fee much less than what he or she would have paid in a wrap fee account through a broker.

Finally, the very large caveat to all this is that the ethics of a hedge fund manager who steals clients from brokers with whom he has a marketing relationship ought to be called into question. And when it comes to hedge funds, the ethics of the manager are of paramount importance.

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FINANCIAL RATIOS: Profitability for Doctors

Posted on April 4, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By CFI Team and Staff Reporters

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Profitability Ratios

Profitability ratios measure a company’s ability to generate income relative to revenue, balance sheet assets, operating costs, and equity. Common profitability financial ratios include the following:

The gross margin ratio compares the gross profit of a company to its net sales to show how much profit a company makes after paying its cost of goods sold:

Gross margin ratio = Gross profit / Net sales

The operating margin ratio, sometimes known as the return on sales ratio, compares the operating income of a company to its net sales to determine operating efficiency:

Operating margin ratio = Operating income / Net sales

The return on assets ratio measures how efficiently a company is using its assets to generate profit:

Return on assets ratio = Net income / Total assets

The return on equity ratio measures how efficiently a company is using its equity to generate profit:

Return on equity ratio = Net income / Shareholder’s equity

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DAILY UPDATE: DJIA Plummets 1,700 Points While NASDAQ & S&P 500 Plunge for Biggest Drop Since 2025

Posted on April 4, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

MEDICAL EXECUTIVE-POST – TODAY’S NEWSLETTER BRIEFING

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

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

A Partner of the Institute of Medical Business Advisors , Inc.

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Daily Update Provided By Staff Reporters Since 2007.
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Roughly $2.5 trillion was erased from the S&P 500 Index on Thursday amid worries that President Donald Trump’s sweeping new round of tariffs could plunge the economy into a recession. The damage was heaviest in companies whose supply chains are most dependent on overseas manufacturing. Apple Inc., which makes the majority of its US-sold devices in China, fell 9.3%. Lululemon Athletica Inc. and Nike Inc., among companies with manufacturing ties to Vietnam, were both down more than 9%. Target Corp. and Dollar Tree Inc., retailers whose stores are filled with products sourced outside of the US, dropped more than 10%.

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The tech-heavy NASDAQ Composite (^IXIC) led the sell-off, plummeting 6%. The S&P 500 (^GSPC) sank nearly 5%, while the Dow Jones Industrial Average (^DJI) tumbled 4%. The Dow’s 1,700-point drop was the fifth-worst in its history.

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

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TRADITIONAL INVESTMENT PORTFOLIO DIVERSIFICATION MODEL: Routed by Larry Fink CEO of BlackRock?

Posted on April 3, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

BREAKING NEWS – MARKET VOLATILITY

By Staff Reporters

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US stocks nosedived on Thursday, with the Dow tumbling more than 1,200 points as President Trump’s surprisingly steep “Liberation Day” tariffs sent shock waves through markets worldwide. The tech-heavy NASDAQ Composite (IXIC) led the sell-off, plummeting over 4%. The S&P 500 (GSPC) dove 3.7%, while the Dow Jones Industrial Average (^DJI) tumbled roughly 3%. [ongoing story].

So, does the traditional 60 stock / 40 bond strategy still work or do we need another portfolio model?

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The 60/40 strategy evolved out of American economist Harry Markowitz’s groundbreaking 1950s work on modern portfolio theory, which holds that investors should diversify their holdings with a mix of high-risk, high-return assets and low-risk, low-return assets based on their individual circumstances.

While a portfolio with a mix of 40% bonds and 60% equities may bring lower returns than all-stock holdings, the diversification generally brings lower variance in the returns—meaning more reliability—as long as there isn’t a strong correlation between stock and bond returns (ideally the correlation is negative, with bond returns rising while stock returns fall).

CORRELATION: https://medicalexecutivepost.com/2024/10/27/correlation-diversification-in-finance-and-investments/

For 60/40 to work, bonds must be less volatile than stocks and economic growth and inflation have to move up and down in tandem. Typically, the same economic growth that powers rallies in equities also pushes up inflation—and bond returns down. Conversely, in a recession stocks drop and inflation is low, pushing up bond prices.

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  • But, the traditional 60/40 portfolio may “no longer fully represent true diversification,” BlackRock CEO Larry Fink writes in a new letter to investors.
  • Instead, the “future standard portfolio” may move toward 50/30/20 with stocks, bonds and private assets like real estate, infrastructure and private credit, Fink writes.
  • Here’s what experts say individual investors may want to consider before dabbling in private investments.

It may be time to rethink the traditional 60/40 investment portfolio, according to BlackRock CEO Larry Fink. In a new letter to investors, Fink writes the traditional allocation comprised of 60% stocks and 40% bonds that dates back to the 1950s “may no longer fully represent true diversification.“

DI-WORSIFICATION: https://medicalexecutivepost.com/2024/04/09/what-is-financial-portfolio-di-worsification-2/

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SPEAKING: Dr. Marcinko will be speaking and lecturing, signing and opining, teaching and preaching, storming and performing at many locations throughout the USA this year! His tour of witty and serious pontifications may be scheduled on a planned or ad-hoc basis; for public or private meetings and gatherings; formally, informally, or over lunch or dinner. All medical societies, financial advisory firms or Broker-Dealers are encouraged to submit a RFP for speaking engagements: MarcinkoAdvisors@outlook.com 

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PHYSICIAN PAYMENT INCREASE: Excluded by Continuing Resolution

Posted on April 2, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By Health Capital Consultants, LLC

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Continuing Resolution Excludes Physician Payment Increase Again

On March 15th, 2025, President Donald Trump signed a continuing resolution (CR) that avoided a government shutdown and funds the federal government for the rest of the fiscal year, i.e., through September 30th, 2025.

Perhaps more notable than what was included in the spending bill was what was once again excluded. While the COVID-era tele-health waivers were temporarily extended, Medicare physician payment rates were not addressed, meaning physicians will continue experiencing a 2.93% pay cut for 2025.

This Health Capital Topics article discusses the healthcare provisions included in and excluded from the CR, and the impacts on healthcare providers. (Read more…)

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HEDGE FUNDS: In Individual Retirement Accounts?

Posted on April 2, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By Staff Reporters

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QUESTION: What is a Hedge Fund?

A hedge fund is a limited partnership of private investors whose money is pooled and managed by professional fund managers. These managers use a wide range of strategies, including leverage (borrowed money) and the trading of nontraditional assets, to earn above-average investment returns. A hedge fund investment is often considered a risky, alternative investment choice and usually requires a high minimum investment or net worth. Hedge funds typically target wealthy investors.

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QUESTION: Can I invest my Individual Retirement Account [IRA] in a Hedge Fund?

This is up to the manager, but there is no legal restriction on a hedge fund accepting individual retirement account (IRA) assets. IRA accounts are not well suited for funds that make extensive use of leverage, however. In such cases, the fund is likely to generate significant amounts of unrelated business taxable income (UBTI) – profits of the fund attributable to the use of leverage. The holder of an IRA account must pay taxes on UBTI, even if the UBTI was generated in an IRA account.

But, today’s hedge funds may or may not use leverage. Many hedge funds are not hedged at all, but rather are just specialized versions of regular long stock portfolios. If such funds do not use much leverage, IRA investors will not encounter much difficulty with UBTI and should not hesitate in considering these funds.

In considering whether to accept IRA money, hedge fund managers must consider several factors. If the only type of retirement money accepted by the hedge funds is IRA money, then the manager has no limit on how much retirement money the fund can accept. If, however, there are other types of retirement money invested in the fund, such as pension funds, IRA money will be counted towards a total of 25 percent of fund assets that can be invested in retirement accounts before the fund becomes subject to the Employment Retirement Income Security Act of 1974 (ERISA). Funds subject to ERISA regulations face a heavy administrative burden and more restrictions than most fund managers like.

Finally, IRA distributions from a hedge fund are subject to the standard 20 percent withholding unless the funds are directly rolled over to other qualified plans.

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ACCOUNTABLE CARE ORGANIZATION: A Financially Toxic Contract Example for Physicians

Posted on April 1, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

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By. Dr. David Edward Marcinko; MBA MEd CMP®

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WARNING – DISASTROUS ACO EXAMPLE – WARNING

GIVEN CASH FLOW MODEL

Suppose that in a new Accountable Care Organization [ACO] contract, a certain medical practice was awarded a new global payment or capitation styled contract that increased revenues by $100,000 for the next fiscal year. The practice had a gross margin of 35% that was not expected to change because of the new business. However, $10,000 was added to medical overhead expenses for another assistant and all Account’s Receivable (AR) are paid at the end of the year, upon completion of the contract.

Cost of Medical Services Provided (COMSP):

The Costs of Medical Services Provided (COMSP) for the ACO business contract represents the amount of money needed to service the patients provided by the contract.  Since gross margin is 35% of revenues, the COMSP is 65% or $65,000.  Adding the extra overhead results in $75,000 of new spending money (cash flow) needed to treat the patients. Therefore, divide the $75,000 total by the number of days the contract extends (one year) and realize the new contract requires about $ 205.50 per day of free cash flows.

Assumptions

Financial cash flow forecasting from operating activities allows a reasonable projection of future cash needs and enables the doctor to err on the side of fiscal prudence. It is an inexact science, by definition, and entails the following assumptions:

  • All income tax, salaries and Accounts Payable (AP) are paid at once.
  • Durable medical equipment inventory and pre-paid advertising remain constant.
  • Gains/losses on sale of equipment and depreciation expenses remain stable.
  • Gross margins remain constant.
  • The office is efficient so major new marginal costs will not be incurred.

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Physician Reactions:

Since many physicians are still not entirely comfortable with global reimbursement, fixed payments, capitation or ACO reimbursement contracts; practices may be loath to turn away short-term business in the ACA era.  Physician-executives must then determine other methods to generate the additional cash, which include the following general suggestions:

1. Extend Account’s Payable

Discuss your cash flow difficulties with vendors and emphasize their short-term nature. A doctor and her practice still has considerable cache’ value, especially in local communities, and many vendors are willing to work them to retain their business

2. Reduce Accounts Receivable

According to most cost surveys, about 30% of multi-specialty group’s accounts receivable (ARs) are unpaid at 120 days. In addition, multi-specialty groups are able to collect on only about 69% of charges. The rest was written off as bad debt expenses or as a result of discounted payments from Medicare and other managed care companies. In a study by Wisconsin based Zimmerman and Associates, the percentages of ARs unpaid at more than 90 days is now at an all time high of more than 40%. Therefore, multi-specialty groups should aim to keep the percentage of ARs unpaid for more than 120 days, down to less than 20% of the total practice. The safest place to be for a single specialty physician is probably in the 30-35% range as anything over that is just not affordable.

The slowest paid specialties (ARs greater than 120 days) are: multi-specialty group practices; family practices; cardiology groups; anesthesiology groups; and gastroenterologists, respectively. So work hard to get your money, faster. Factoring, or selling the ARs to a third party for an immediate discounted amount is not usually recommended.

3. Borrow with Short-Term Bridge Loans

Obtain a line of credit from your local bank, credit union or other private sources, if possible in an economically constrained environment. Beware the time value of money, personal loan guarantees, and onerous usury rates. Also, beware that lenders can reduce or eliminate credit lines to a medical practice, often at the most inopportune time.

4. Cut Expenses

While this is often possible, it has to be done without demoralizing the practice’s staff.

5.  Reduce Supply Inventories

If prudently possible; remember things like minimal shipping fees, loss of revenue if you run short, etc.

6. Taxes

Do not stop paying withholding taxes in favor of cash flow because it is illegal.

Hyper-Growth Model:

Now, let us again suppose that the practice has attracted nine more similar medical contracts. If we multiple the above example tenfold, the serious nature of potential cash flow problem becomes apparent. In other words, the practice has increased revenues to one million dollars, with the same 35% margin, 65% COMSP and $100,000 increase in operating overhead expenses. 

Using identical mathematical calculations, we determine that $750,000 / 365days equals $2,055.00 per day of needed new free cash flows!  Hence, indiscriminate growth without careful contract evaluation and cash flow analysis is a prescription for potential financial disaster.

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