PODCAST: Fractional Reserve Banking

By Staff Reporters

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Fractional reserve banking is a system in which only a fraction of bank deposits are backed by actual cash on hand and available for withdrawal. This is done to theoretically expand the economy by freeing capital for lending. Today, most economies’ financial systems use fractional reserve banking.

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

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LINK: https://www.youtube.com/watch?v=gd8B-zrMSYk

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Understanding the “Language” of Healthcare Finance, IT, Economics, Investing and Insurance

By Ann Miller RN MHA CMP

Courtesy: http://www.CertifiedMedicalPlanner.org

The ME-P is Doing Its’ Part with Comprehensive Dictionaries and Glossaries

Product DetailsProduct DetailsProduct Details

[Click on each icon for a larger view]

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

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PODCAST: “Real ACOs Haven’t Been Tried Yet!”

What is an Accountable Care Organization?

DEFINITION: ACOs are groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high-quality care to their patients. The goal of coordinated care is to ensure that patients get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors. When an ACO succeeds both in delivering high-quality care and spending health care dollars more wisely, the ACO will share in the savings.

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

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QUESTION: What happens when you’re a healthcare policy wonk and the pilot study for your pet program has failed miserably? 

ANSWER: You declare “Success!” in the editorial pages of the New England Journal of Medicine and demand that the program become nationwide and mandatory. I kid you not.  This is exactly what happens.

Thankfully, Anish Koka is vigilant and explains the blatant obfuscations and manipulations that the central planners engage in to have their way.

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And so, In this video, Anish and colleague Michel Accad, MD, will reveal the machinations, take the culprits to task, and discuss pertinent questions regarding health care organization: 

  • Does “capitation” reduce costs? 
  • Do employed physicians necessarily utilize fewer resources? 
  • What happens when a HMO and a traditional fee-for-service health system operate side-by-side in a community?
BMC and Accountable Care - Boston Medical Center

Enjoy!

PODCAST: http://alertandoriented.com/real-acos-havent-been-tried-yet/

Your thoughts are appreciated.

THANK YOU

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PODCAST: Hospital Debt and Tax Exempt Bonds

By Eric Bricker MD

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

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ESG Investing: Not So Hot … Anymore?

By Staff Reporters

Environmental, Social, and Corporate Governance

Florida is pulling $2 billion from BlackRock in the largest divestment ever made as part of the growing vendetta against Environmental, Social, and Governance (ESG) investing practices. Florida Governor Ron DeSantis and other Republican leaders claim that by taking ESG standards into account when making investment decisions, the firm isn’t prioritizing the bottom line. But, for a few years, things were good. In 2020 and 2021, ESG funds outperformed the market by ~4.3%.

DEFINITION: According to Wikipedia, ESG (environmental, social, and corporate governance) data reflect the externalities (costs to others) an organization is generating with respect to the environment, to society and to corporate governance. ESG data can be used by investors to assess the material risk the organization is taking and by the organization itself as metrics for strategic and managerial purposes. Investors may also use ESG data beyond assessing material risks to the organization in their evaluation of enterprise value, specifically by designing models based on assumptions that the identification, assessment and management of sustainability-related risks and opportunities in respect to all organizational stakeholders leads to higher long-term risk-adjusted return. Organizational stakeholders include but not limited to customers, suppliers, employees, leadership, and the environment.

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

Since 2020, there has been accelerating interest in overlaying ESG data with the Sustainable Development Goals (SDGs), developed based on work by United Nations beginning in the 1980s.

LINK: http://www.ESG.org

The term ESG was popularly used first in a 2004 report titled “Who Cares Wins”, which was a joint initiative of financial institutions at the invitation of UN. In less than 20 years, the ESG movement has grown from a corporate social responsibility initiative launched by the United Nations into a global phenomenon representing more than US$30 trillion in assets under management. In the year 2019 alone, capital totaling US$17.67 billion flowed into ESG-linked products, an almost 525 percent increase from 2015, according to Morningstar, Inc.. Critics claim ESG linked-products have not had and are unlikely to have the intended impact of raising the cost of capital for polluting firms, and have accused the movement of greenwashing.

PODCAST: https://medicalexecutivepost.com/2022/10/10/podcast-what-is-financial-green-washing/

Now All Mad

DeSantis ran his most recent campaign on fighting the “woke ideology” he believes is infiltrating the state. As part of the fight, Florida passed a resolution in August that said ESG standards should be ignored when investing state funds.

And he’s not the only one:

  • Other Republican-controlled states, including Missouri and Louisiana, have moved almost $1.3 billion away from BlackRock for similar reasons.
  • Texas flagged BlackRock as a financial firm that boycotts the state’s energy industry (something BlackRock has denied).

Meanwhile, Democrats aren’t happy either…they criticize BlackRock and ESG investing in general for not going far enough (and for using lax standards that let oil giants onto lists of ESG investments).

Bottom line: According to the Morning Brew, BlackRock and Florida are now cursed to yell “How could you prioritize politics over returns?” back and forth for eternity, and the debate over ESG investing is far from over. Republicans are poised to take over the House—after a campaign season that BlackRock poured record cash into—so we’re likely to see more drama play out at the federal level soon.

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What is a Rapid Learning Health System?

The RLH – From Concept to Action

[By Staff Reporters]

According to Greene, Reid and Larson, clinicians and health systems are facing widespread challenges, including changes in care delivery, escalating health care costs, and the need to keep up with rapid scientific discovery.

Re-organizing U.S. health care and changing its practices to render better, more affordable care requires transformation in how health systems generate and apply knowledge. The “rapid-learning health system” is posited as a conceptual strategy to spur such transformation – leverages and recent developments in health information technology and a growing health data infrastructure to access and apply evidence in real time, while simultaneously drawing knowledge from real-world care-delivery processes to promote innovation and health system change on the basis of rigorous research.

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TLHCS

[A Rapid Learning Health System]

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The Essay

This article describes an evolving learning health system at Group Health Cooperative, the 6 phases characterizing its approach, and examples of organization-wide applications.

Link: http://www.ncbi.nlm.nih.gov/pubmed/22868839

It is a practical model that promotes bidirectional discovery and an open mind at the system level, resulting in willingness to make changes on the basis of evidence that is both scientifically sound and practice-based.

Assessment

Rapid learning must be valued as a health system property to realize its full potential for knowledge generation and application.

Citation

Implementing the learning health system: from concept to action. Greene SM1, Reid RJ, Larson EB. Author information: Group Health Cooperative, 320 Westlake Avenue North, GHQ E2N, Seattle, WA 98109, USA. greene.sm@ghc.org

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More: http://onlinelibrary.wiley.com/doi/10.1002/hast.134/abstract

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PHYSICIAN PAYMENTS: The Financial Compensation Battle Continues

By Staff Reporters

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Paying paying doctors and medical providers for their services may seem simple on the surface, but it’s actually extremely complex. Enter two of the most commonly heard phrases in healthcare: “fee-for-service” and “value-based care,” two models insurers use to decide how much to pay providers. According to Healthcare Brew:

  1. Under a fee-for-service model, providers are paid for each individual service they perform, like a blood test or an X-ray, according to Jennifer Clawson, partner and director of value-based health systems at Boston Consulting Group. A service is provided, and the doctor gets a fixed fee for providing it. Simple enough.
  2. The value-based care model is a bit more complicated, as there are many types of value-based payments. What makes them “value-based” is that payers take patient outcomes into consideration, aka they consider the relative value. “The core of value-based care is ultimately, ‘How do I get a better outcome for less money?’” said Sam Hendler, managing director at private equity firm Thomas H. Lee Partners.

One type of value-based payment is called a bundled payment, Clawson said. Say you have a heart condition and need to get a stent put in. There are usually several providers involved in that process, e.g., a primary care doctor, cardiac surgeon, and anesthesiologist. An insurer gives the health system a set amount of money to cover everyone involved in the procedure, and the health system decides how to divvy it up.

Another type of value-based payment is called capitation, and there’s multiple types of capitation payments. It’s sort of like a bundled payment, but instead of insurers paying a set amount per procedure, they’re paying a set amount to cover an entire population of patients with a specific disease, like diabetes.

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

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CCI: Consumer Confidence Index?

By Staff Reporters

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A consumer confidence index (CCI) is an economic indicator published by various organizations in several countries.

In simple terms, increased consumer confidence indicates economic growth in which consumers are spending money, indicating higher consumption. Decreasing consumer confidence implies slowing economic growth, and so consumers are likely to decrease their spending.

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

The idea is that the more confident people feel about the economy and their jobs and incomes, the more likely they are to make purchases. Declining consumer confidence is a sign of slowing economic growth and may indicate that the economy is headed into trouble.

FOR EXAMPLE:

Consumers’ assessment of current business conditions was mixed in November, 2022.

  • 18.2% of consumers said business conditions were “good,” up from 17.7%.
  • On the other hand, more consumers, 26.7%, said business conditions were “bad,” up from 24.0%.

Consumers’ appraisal of the labor market was somewhat more favorable.

  • 45.8% of consumers said jobs were “plentiful,” up from 44.8%.
  • 13.0% of consumers said jobs were “hard to get,” unchanged from last month.

OFFICIAL: https://www.conference-board.org/topics/consumer-confidence

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Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

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AMAZON: Healthcare Act II

By Heath Capital Consultants, LLC

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The launch of Amazon Clinic comes less than two months after the announcement that Amazon Care would be shut down. Amazon Clinic, the retail giant’s virtual and in-person medical care service, was rolled out in 2019 as a pilot employee benefit for their own employees and quickly expanded to servicing non-Amazon employers across the U.S. (including large companies such as Hilton, TrueBlue, and Silicon Labs) by 2021.

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

The service combined virtual and in-person care, offering home health services, telehealth appointments, and prescription delivery. (Read more…) 

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RELATED: https://medicalexecutivepost.com/2022/09/06/more-about-the-end-of-amazon-care/

MORE: https://medicalexecutivepost.com/2022/09/05/amazons-new-move-in-health-care/

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MEDICAL DEBT: Banks and Private Equity Cash In When Patients Can’t Pay Bills

By Noam N. Levey and Aneri Pattani

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Robin Milcowitz, a Florida woman who found herself enrolled in an AccessOne loan at a Tampa hospital in 2018 after having a hysterectomy for ovarian cancer, said she was appalled by the financing arrangements.“Hospitals have found yet another way to monetize our illnesses and our need for medical help,” said Milcowitz, a graphic designer.

She was charged 11.5% interest — almost three times what she paid for a separate bank loan. “It’s immoral,” she said.

READ: https://khn.org/news/article/how-banks-and-private-equity-cash-in-when-patients-cant-pay-their-medical-bills/

MORE: https://khn.org/news/article/medical-debt-hospitals-dallas-fort-worth/

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On “Meaningful” Tchotchkes for Doctors

HDS

SPONSOR: www.CertifiedMedicalPlanner.org

According to Wikipedia, a tchotchke is a small bauble, doodad, doohickey, gewgaw, gismo knickknack, swag, thingamabob, thingamajig, toy, trinket, whatchamacallit, whosie-whatsit, widget, etc. Drug representative, various trade vendors and even prospecting financial advisors that give such cheap souvenirs to potential clients are even sometimes called “tchotchke dukes.” This industry practice is well known and wide spread.

Value-Less

Depending on context, the term has a connotation of worthlessness or disposability as well as tackiness, and has long been used in the regional speech of New York City and elsewhere.

The word may also refer to swag, in the sense of the logo pens, key rings and FOBs, t-shirts, golf balls, and other promotional freebies dispensed at trade shows, conventions, and similar large events. Most are largely value-less promotional pieces.

Valuable

Medical professionals of all types are fertile prospects for pharmaceutical representatives, insurance agents, financial advisors and like minded vendors. Most of these commissioned salesmen offer tchotchkes to their doctor clients and prospects as a reminder of their wares.

Product DetailsProduct DetailsProduct Details

Assessment

And so, wouldn’t it be interesting for these vendors to offer their doctors something of real value?  How about one of our Dictionaries of Health … in our series of three non-clinical handbooks? Affordable, memorable and valuable!

Conclusion

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

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

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What is the Elderly CPI?

The CPI-E

[By staff reporters]

We’ve written about the CPI and Chained CPI before on this ME-P.
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Q = So, what is the Elderly CPI?
A = It is experimental CPI for the elderly called the CPI-E.
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Mature Woman
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MORE:
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According to the Bureau of Labor Statistics, or BLS, the CPI-E includes households whose reference person or spouse is 62 years of age or older.
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Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™8Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™
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SUNK COSTS: The Fallacy

By Staff Reporters

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A common term in business, the sunk cost fallacy applies to our choices and activities made daily.

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

A sunk cost fallacy is a simple logical fallacy that means sticking with a losing or failed venture or activity because you have already invested considerable time, energy, money, or other things you can’t get back. It’s the idea that because you already have incurred costs, you stick with it to  “get your money’s worth.”

The sunk cost fallacy differs from other logical fallacies because it’s not a rhetorical fallacy. You may also experience a discussion with a “red herring” or “straw man” fallacy with someone. But the sunk cost fallacy is an illogical choice as a way to justify to yourself why you keep doing something.

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What is “COMPASSION FADE?”

A Cognitive Bias of the Corona Virus PandemicCourtesy: www.CertifiedMedicalPLanner.org

By Dr. David E. Marcinko MBA

Compassion Fade is a cognitive bias that predisposes people to behave more compassionately towards a small number of identifiable victims than to a large number of anonymous ones.

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

It is the psychological explanation to the known phenomenon alluded to by Joseph Stalin in his famous quote “The death of one man is a tragedy; the death of millions is a statistic”.

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LINK: https://www.publichealthpost.org/research/compassion-fade/

Assessment: Your thoughts and comments are appreciated.

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BUSINESS, FINANCE, INVESTING AND INSURANCE TEXTS FOR DOCTORS:

THANK YOU

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PODCAST: What is Public Health?

By American Journal of Public Health

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

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

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

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

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What is Leadership and Can it Be Defined?

Of Characteristics and Commonalities

[By Dr. David Edward Marcinko MBA CMP™]

[By Eugene Schmuckler PhD MBA EMd CTS]

manageIt does not matter if you are in the healthcare or financial services sector; or both.

Many psychologists and behavioral experts believe there are commonalities and characteristics applicable to all industries and sectors; including education which is a big part of what we do here at the Medical Executive Post.

Key Leadership Competencies – Definitions

And so, here is a list of key leadership competencies and definitions for your review.

  • Living by personal conviction – Means you know and are in touch with your values and beliefs, are not afraid to take a lonely or unpopular stance if necessary, are comfortable in tough situations, can be relied on in intense circumstances, are clear about where you stand, and will face difficult challenges with poise and self-assurance.
  • Possessing emotional intelligence – Means you recognize personal strengths and weaknesses; see the linkages between feelings and behaviors; manage impulsive feelings and distressing emotions; are attentive to emotional cues; show sensitivity and respect for others; challenge bias and intolerance; collaborate and share; are an open communicator; and can handle conflict, difficult people, and tense situations effectively.  Emotional intelligence may often be labeled EQ, or emotional intelligence quotient.
  • Being visionary – Means that you see the future clearly, anticipate large-scale and local changes that will affect the organization and its environment, are able to project the organization into the future and envision multiple potential scenarios/outcomes, have a broad way of looking at trends, and are able to design competitive strategies and plans based on future possibilities.
  • Communicating vision – Means that you distill complex strategies into a compelling call to march, inspire and help others see a core reason for the organization to make change, talk beyond the day-to-day tactical matters that face the organization, show confidence and optimism about the future state of the organization, and engage others to join in.
  • Earning loyalty and trust – Means you are a direct and truthful person; are willing to admit mistakes; are sincerely interested in the concerns and dreams of others; show empathy and a generally helpful orientation toward others; follow promises with actions; maintain confidences and disclose information ethically and appropriately; and conduct work in open, transparent ways.

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  • Listening like you mean it – Means you maintain a calm, easy-to-approach demeanor, are patient, open minded, and willing to hear people out; understand others and pick up the meaning of their messages; are warm, gracious and inviting; build strong rapport; see through the words that others express to the real meaning (i.e., cut to the heart of the issue); and maintain formal and informal channels of communication.
  • Giving feedback – Means you set clear expectations, bring important issues to the table in a way that helps others “hear” them, show an openness to facing difficult topics and sources of conflict, deal with problems and difficult people directly and frankly, provide timely criticism when needed, and provide feedback messages that are clear and unambiguous.
  • Mentoring others – Means you invest the time to understand the career aspirations of your direct reports, work with direct reports to create engaging mentoring plans, support staff in developing their skills, support career development in a non-possessive way (will support staff moving up and out as necessary for their advancement), find stretch assignments and other delegation opportunities that support skill development, and role model professional development by advancing your own skills.
  • Developing teams – Means you select executives who will be strong team players, actively support the concept of teaming, develop open discourse and encourage healthy debate on important issues, create compelling reasons and incentives for team members to work together, effectively set limits on the political activity that takes place outside the team framework, celebrate successes together as a unit, and commiserate as a group over disappointments.

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  • Energizing staff – Means you set a personal example of good work ethic and motivation; talk and act enthusiastically and optimistically about the future; enjoy rising to new challenges; take on your work with energy, passion and drive to finish successfully; help others recognize the importance of their work; are enjoyable to work for; and have a goal oriented, ambitious and determined working style.
  • Generating informal power – Means you understand the roles of power and influence in organizations; develop compelling arguments or points of view based on knowledge of others’ priorities; develop and sustain useful networks up, down and sideways in the organization; develop a reputation as a go-to person; and effectively affect the thoughts and opinions of others, both directly and indirectly, through others.
  • Building consensus – Means you frame issues in ways that facilitate clarity from multiple perspectives, keep issues separated from personalities, skillfully use group decision techniques (e.g., Nominal Group Technique), ensure that quieter group members are drawn into discussions, find shared values and common adversaries, and facilitate discussions rather than guide them.

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  • Making decisions effectively – Means you make decisions based on an optimal mix of ethics, values, goals, facts, alternatives and judgments; use decision tools (such as force-field analysis, cost-benefit analysis, decision trees, paired comparisons analysis) effectively and at appropriate times; and show a good sense of timing related to decision making.
  • Driving results – Means you mobilize people toward greater commitment to a vision, challenge people to set higher standards and goals, keep people focused on achieving goals, give direct and complete feedback that keeps teams and individuals on track, quickly take corrective action as necessary to keep everyone moving forward, show a bias toward action, and proactively work through performance barriers.
  • Stimulating creativity – Means you see broadly outside of the typical, are constantly open to new ideas, are effective with creative group processes (e.g., brainstorming, Nominal Group Technique, scenario building), see future trends and craft responses to them, are knowledgeable in business and societal trends, are aware of how strategies play out in the field, are well read, and make connections between industries and unrelated trends.
  • Cultivating adaptability – Means you quickly see the essence of issues and problems, effectively bring clarity to situations of ambiguity, approach work using a variety of leadership styles and techniques, track changing priorities and readily interpret their implications, balance consistency of focus against the ability to adjust course as needed, balance multiple tasks and priorities such that each gets appropriate attention, and work effectively with a broad range of people.

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Assessment

Is if often said that leaders rise to the occasion. What do you think?

Conclusion

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

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

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

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PODCAST: What is Apophenia?

Apophenia is the tendency to mistakenly perceive connections and meaning between unrelated things. The termwas coined by psychiatrist Klaus Conrad in his 1958 publication on the beginning stages of schizophrenia.

Conrad defined it as “unmotivated seeing of connections [accompanied by] a specific feeling of abnormal meaningfulness”. He described the early stages of delusional thought as self-referential, over-interpretations of actual sensory perceptions, as opposed to hallucinations.

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

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Man in the Moon refers to any of several pareidolic images of a human face, head or body that certain traditions recognize in the disc of the full moon.

Pareidolia is the tendency for incorrect perception of a stimulus as an object, pattern or meaning known to the observer, such as seeing shapes in clouds, seeing faces in inanimate objects or abstract patterns, or hearing hidden messages in music. Pareidolia is a subcategory of apophenia.

PODCAST: https://www.bing.com/videos/search?q=Apophenia%3a&ru=%2fvideos%2fsearch%3fq%3dApophenia%253a%26FORM%3dHDRSC3&view=detail&mid=7A6D44176273D21435437A6D44176273D2143543&&FORM=VDRVRV

Your thoughts and comments are appreciated.

TEXTS FOR DOCTORS

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MORE: Tax Loss Harvesting

Tax Loss Harvesting

By Vitaliy Katsenelson, CFA

DEFINITION: https://medicalexecutivepost.com/2022/11/06/tax-loss-harvesting-what-it-is/

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Tax Lost Harvesting with Examples

I enjoy writing about taxes as much as I enjoy going to the dentist. But I feel what I am about to say is important. We – including yours truly – have been mindlessly conditioned to do tax selling at the end of every year to reduce our tax bills. On the surface it makes sense. There are realized gains – why don’t we create some tax losses to offset them?

Here is the problem. With a few exceptions, which I’ll address at the end, tax-loss selling makes no logical sense. Let me give you an example.

Let’s say there is a stock, XYZ. We bought it for $50; we think it is worth $100. Fourteen months later we got lucky and it declined to $25. Assuming our estimate of its fair value hasn’t changed, we get to buy $1 of XYZ now for 25 cents instead of 50 cents.

But as of this moment we also have a $25 paper loss. The tax-loss selling thinking goes like this: Sell it today, realize the $25 loss, and then buy it in 31 days. (This is tax law; if we buy it back sooner the tax loss will be disqualified.) This $25 loss offsets the gains we took for the year. Everybody but Uncle Sam is happy.

Since I am writing about this and I’ve mentioned above I’d rather be having a root canal, you already suspect that my retort to the above thinking is a great big NO!

In the first place, we are taking the risk that XYZ’s price may go up during our 31-day wait. We really have no idea and rarely have insights as to what stocks will do in the short term. Maybe we’ll get lucky again and the price will fall further. But we’re selling something that is down, so risk in the long run is tilted against us. Also, other investors are doing tax selling at the same time we are, which puts additional pressure on the stock.

Secondly – and this is the most important point – all we are doing is pushing our taxes from this year to future years. Let’s say that six months from now the stock goes up to $100. We sell it, and… now we originate a $75, not a $50, gain. Our cost basis was reduced by the sale and consequent purchase to $25 from $50. This is what tax loss selling is – shifting the tax burden from this year to next year. Unless you have an insight into what capital gains taxes are going to be in the future, all you are doing is shifting your current tax burden into the future.

Thirdly, in our first example we owned the stock for 14 months and thus took a long-term capital loss. We sold it, waited 31 days, and bought it back. Let’s say the market comes back to its senses and the price goes up to $100 three months after we buy it back. If we sell it now, that $75 gain is a short-term gain. Short-term gains are taxed at your ordinary income tax bracket, which for most clients is higher than their capital gain tax rate. You may argue that we should wait nine months till this gain goes from short-term to long-term. We can do that, but there are costs: First, we don’t know where the stock price will be in nine months. And second, there is an opportunity cost – we cannot sell a fully priced $1 to buy another $1 that is on fire sale.

Final point. Suppose we bought a stock, the price of which has declined in concert with a decrease of its fair value; in other words, the loss is not temporary but permanent.  In this case, yes, we should sell the stock and realize the loss. 

We are focused on the long-term compounding of your wealth. Thus our strategy has a relatively low portfolio turnover. However, we always keep tax considerations in mind when making investment decisions, and try to generate long-term gains (which are more tax efficient) than short term gains. 

We understand that each client has their unique tax circumstances. For instance, your income may decline in future years and thus your tax rate, too. Or higher capital gains may put you in a different income bracket and thus disqualify you from some government healthcare program.

We are here to serve you, and we’ll do as much or as little tax-loss selling as you instruct us to do. We just want you to be aware that with few exceptions tax-loss selling does more harm than good.

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What is EISOPTROPHOBIA?

NOW YOU SEE ME – NOW I DON’T WANT TO SEE MYSELF

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By Dr. David Edward Marcinko MBA CMP®

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SPONSOR: http://www.CertifiedMedicalPlanner.org

DEFINITION: Eisoptrophobia  is the fear of mirrors or, more specifically, of seeing your own reflection in a mirror. Looking into a mirror can cause people with eisoptrophobia shame or distress.

The term is derived from the Greek “eis” and “optikos”. Even though the sufferers know their fear is irrational, they experience excessive anxiety when they look into the mirror.

ASSESSMENT: Your thoughts are appreciated.

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PODCAST: What is the Web 3.0?

By Staff Reporters

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According to Wikipedia, the Web3 (also known as Web 3.0 and sometimes stylized as web3) is an idea for a new iteration of the World Wide Web based on blockchain technology, which incorporates concepts such as decentralization and token-based economics. Some technologists and journalists have contrasted it with Web 2.0, wherein they say data and content are centralized in a small group of companies sometimes referred to as “Big Tech“. The term “Web3” was coined in 2014 by Ethereum co-founder Gavin Wood, and the idea gained interest in 2021 from cryptocurrency enthusiasts, large technology companies, and venture capital firms.

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Now, some experts argue that web3 will provide increased data security, scalability, and privacy for users and combat the influence of large technology companies.

Others have raised concerns about a decentralized web, citing the potential for low moderation and the proliferation of harmful content, the centralization of wealth to a small group of investors and individuals, or a loss of privacy due to more expansive data collection. Others, such as Elon Musk and Jack Dorsey, have argued that web3 only currently serves as a buzzword.

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PODCAST: https://www.youtube.com/watch?v=nHhAEkG1y2U

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

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BUSINESS MEDICINE: https://www.amazon.com/Business-Medical-Practice-Transformational-Doctors/dp/0826105750/ref=sr_1_9?ie=UTF8&qid=1448163039&sr=8-9&keywords=david+marcinko

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PHYSICIANS BEWARE: Traditional Financial Planning “Rules of Thumb”

DOCTORS AND MEDICAL PROFESSIONALS BEWARE?

We ARE Different

By Dr. David E. Marcinko MBA CMP®

SPONSOR: http://www.CertifiedMedicalPlanner.org

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  • While financial planning rules of thumbs are useful to people as general guidelines, they may be too oversimplified in many situations, leading to underestimating or overestimating an individual’s needs. This may be especially true for physicians and many medical professionals. Rules of thumb do not account for specific circumstances or factors occurring at a particular time, or that could change over time, which should be considered for making sound financial decisions.
  • Great Health Industry Resignation: https://medicalexecutivepost.com/2021/12/12/healthcare-industry-hit-with-the-great-resignation-retirement/

For example, in a tight job market, an emergency fund amounting to six months of household expenses does not consider the possibility of extended unemployment. I’ve always suggested 2-3 years for doctors. Venture capitalist lay-offs of physicians during the pandemic confirm this often criticized benchmark opinion of mine.

As another example, buying life insurance based on a multiple of income does not account for the specific needs of the surviving family, which include a mortgage, the need for college funding and an extended survivor income for a non-working spouse. Again a huge home mortgage, or several children or dependents, may be the financial bane of physician colleagues and life insurance.

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

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EXAMPLES: Old/New Rules

  • A home purchase should cost less than an amount equal to two and a half years of your annual income. I think physicians in practice for 3-5 years might go up to 3.5X annual income; ceteras paribus.
  • Save at least 10-15% of your take-home income for retirement. Seek to save 20% or more.
  • Have at least five times your gross salary in life insurance death benefit. Consider 10X this amount in term insurance if young, and/or with several children or other special circumstances.
  • Pay off your highest-interest credit cards first. Agreed.
  • The stock market has a long-term average return of 10%. Agreed, but appreciated risk adjusted rates of return..
  • You should have an emergency fund equal to six months’ worth of household expenses. Doctors should seek 2-3 years.
  • Your age represents the percentage of bonds you should have in your portfolio. Risk tolerance and assets may be more vital.
  • Your age subtracted from 100 represents the percentage of stocks you should have in your portfolio. Risk tolerance and assets may still be more vital.
  • A balanced portfolio is 60% stocks, 40% bonds. With historic low interest rates, cash may be a more flexible alternative than bonds; also avoid most bond mutual funds as they usually never mature.

There are also rules of thumb for determining how much net worth you will need to retire comfortably at a normal retirement age. Here is the calculation that Investopedia uses to determine your net worth:

Compensation in the Physician Specialties: Mostly Stable - NEJM  CareerCenter Resources

RULES 72, 78 and 115: https://medicalexecutivepost.com/2022/01/30/the-rules-of-72-78-and-115/

INVITATION: https://medicalexecutivepost.com/2021/05/08/invite-dr-marcinko-to-your-next-big-event/

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FINANCE: https://www.amazon.com/Comprehensive-Financial-Planning-Strategies-Advisors/dp/1482240289/ref=sr_1_1?ie=UTF8&qid=1418580820&sr=8-1&keywords=david+marcinko

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What is Hermeneutics?

To Understand … and be Understood

By Dr. David E. Marcinko MBA

Hermeneutics (/ˌhɜːrməˈnjuːtɪks/) is the theory and methodology of interpretation, originally the interpretation of biblical texts, wisdom literature, and philosophical texts.

Hermeneutics is more than interpretive principles or methods we resort to when immediate comprehension fails. Rather, hermenetics is the art of understanding and of making oneself understood.

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MORE: https://medium.com/@danpantelo/hermeneutics-why-people-interpret-things-differently-870f35436fe8

Conclusion

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

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

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PODCAST: What is a “Potemkin” Village?

“Fake It – Till You Make It”

Courtesy: www.CertifiedMedicalPlanner.org

By Dr. David E. Marcinko MBA

Originally, a Potemkin Village was any construction whose sole purpose was to provide an external façade making people believe a failing country was prosperous.

DEFINITION: https://en.wikipedia.org/wiki/Potemkin_village

The term comes from a fake portable village built to impress Empress Catherine II by her lover Grigory Potemkin, during her journey to Crimea, in 1787.

PODCAST: https://www.bing.com/videos/search?q=potemkin+village&qpvt=potemkin+village&view=detail&mid=D6C49B8CE683A2E7053ED6C49B8CE683A2E7053E&&FORM=VRDGAR&ru=%2Fvideos%2Fsearch%3Fq%3Dpotemkin%2Bvillage%26qpvt%3DPotemkin%2BVillage%26FORM%3DVDRE

The term “Potemkin” has spawned other linguistic machinations, as well:

P-NUMBERS: Are made up and appear to be valid and legitimate but are not based in reality.

P-POLITICS: Candidates who say have a certain amount of donated money but have actually received less.

LINK: https://www.amazon.com/Dictionary-Health-Economics-Finance-Marcinko/dp/0826102549/ref=sr_1_6?ie=UTF8&s=books&qid=1254413315&sr=1-6

P-HOSPITALS: Impressive, but actually sham facades, in Wuhan, China?

P-NETWORKS: Erroneous quantitative data point like “counts”, “likes” or “winks” for posts on social media forums or e-boards; etc.

LINK: https://thefuturebuzz.com/2012/06/12/social-proofiness-spotting-digital-potemkin-numbers/

Conclusion: Do you know of any other word derivations? Please opine.

THANK YOU

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PODCAST: What is Anscombe’s Quartet?

The Need for Data Visualization

Courtesy: www.CertifiedMedicalPlanner.org

Anscombe’s Quartet comprises four data sets that have nearly identical simple descriptive statistics, yet have very different distributions and appear very different when graphed. Each dataset consists of eleven (x,y) points.

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

They were constructed in 1973 by the statistician Francis Anscombe to demonstrate both the importance of graphing data before analyzing it and the effect of outliers and other influential observations on statistical properties. He described the article as being intended to counter the impression among statisticians that “numerical calculations are exact, but graphs are rough.”

So, always plot that data!

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PODCAST: https://www.bing.com/videos/search?q=Anscombe%e2%80%99s+Quartet%3a+&&view=detail&mid=68A62E7AB26B2B6EE69668A62E7AB26B2B6EE696&&FORM=VRDGAR&ru=%2Fvideos%2Fsearch%3Fq%3DAnscombe%25e2%2580%2599s%2BQuartet%253a%2B%26FORM%3DHDRSC3

Assessment: Your thoughts and comments are appreciated.

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DICTIONARIES FOR PHYSICIAN-EXECUTIVES AND MEDICAL CXOs

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PODCAST: What is the McNamara [Bio] Statistics Fallacy?

A Metaphor for the Corona Virus Pandemic!

Courtesy: www.CertifiedMedicalPlanner.org

By Dr. David E. Marcinko MBA

A belief that rational decisions can be made with quantitative data and measures alone, when in fact the things you can’t measure are often the most consequential.

Secretary McNamara, who tried to quantify every aspect of the Vietnam War.

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PODCAST: https://www.bing.com/videos/search?&q=McNamara+Fallacy&view=detail&mid=201A0081979919F8D651201A0081979919F8D651&form=VDRVSR&ru=%2Fvideos%2Fsearch%3Fq%3DMcNamara%2BFallacy%26FORM%3DHDRSC3&ajaxhist=0

QUERY: Is this also a metaphor for the “Art” and Science of Medicine and Economics?

Assessment: Your thoughts and comments are appreciated.

HEALTH DICTIONARIES FOR PHYSICIAN-EXECUTIVES AND MEDICAL CXOs

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DRIPS: Disadvantages, Problems and Cons

DIVIDEND REINVESTMENT PLANS

By Staff Reporters

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DEFINITION

DRIPs are merely an automated strategy in which a company’s dividends are reinvested into additional shares of that company. Instead of being paid dividends in cash, you get additional shares of ownership in the company.

There are three ways to get involved in DRIPs: directly through the company, through your broker, or through a transfer agent.

Company-run DRIPs are generally only available through large, blue-chip dividend stocks.That’s because smaller companies don’t want to take on the overhead costs of tracking all their shareholders and going through the paperwork headache of calculating how much each one gets in dividends and additional fractional shares. The company benefits from gaining an additional source of capital, but most of all in creating a more stable base of shareholders, ones who are less likely to panic and sell during a market decline. This can help decrease the volatility of a company’s shares.

As a result, more and more companies are deciding to use transfer agents, which are third-party DRIP administrators such as American Stock Transfer and Trust or Computershare.

Finally, most large discount brokers, such as Scottrade, TD Ameritrade, and E*Trade, also offer DRIPs, though with different requirements and limitations.

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

The Case Against DRIP Plans

While dividend reinvestment is powerful, there are a couple reasons why you might not want to reinvest your dividends.

DRIPs Drawback 1: You may need the dividend income
The most obvious reason is that you need the income. If you’re in the “distribution” phase of your investing life, dividends are a perfect source of passive income. Income from qualified dividends is taxed at the long-term capital gains rate (currently 15% for investors who are in the 25% to 35% tax bracket for ordinary income, 0% for taxpayers in a lower bracket and 20% for those in the highest bracket). So if you’re going to be looking to your portfolio for income every month anyway, it makes sense to have that cash deposited in your account.

DRIPs Drawback 2: You may need to reallocate your positions
You might also choose to stop reinvesting your dividends for allocation reasons. Reinvesting your dividends, through DRIP plans or otherwise, will cause your stock positions to grow over time, and if you’ve owned a particular issue for a long time, it may already be a large enough percentage of your portfolio. Higher-yielding positions will grow faster, which can throw your allocations out of whack pretty quickly. So once a stock position is as big as you want it to get (for now) feel free to turn off dividend reinvestment for that position, and either enjoy the extra income or save up the cash to invest in other stocks.

DRIPs Drawback 3: You may not want to buy that stock at that time
Finally, you may also have stock-specific reasons not to reinvest dividends—if a stock is temporarily overvalued, or you simply don’t want to buy any more of it at current prices.

But bottom line, reinvesting dividends through a broker or by signing up for DRIP plans directly through the dividend-paying companies, is a surprisingly powerful tool to passively improve your investment returns.

So yes, DRIP plans are still worth it, as long as they fit with your investing goals.

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The Economy TODAY!

By Staff Reporters

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It’s a big day for anyone trying to read Jerome Powell today because the October consumer price index report gets released this morning.

Economists expect to see the annual inflation rate come in at 7.9%, so anything higher is likely to spark fear that the Fed could get even more aggressive with its rate hikes.

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HOSPITALS: Another New Designation

“BIRTHING-FRIENDLY”

By Staff Reporters

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The Centers for Medicare and Medicaid Services (CMS) added a new designation to identify which hospitals are “Birthing-Friendly”—a label it will begin adding to qualifying hospitals in fall 2023.

The designation aims to reduce maternal mortality and complications in the US; maternal mortality rose by 25% in 2020, and Black women die at nearly three times the rates of white women, according to a CDC report from February. The US ranked last in maternal mortality that year compared to 10 other high-income countries, according to the Commonwealth Fund.

To earn the designation, CMS said, hospitals must participate in a statewide or national collaborative program where medical teams and public health leaders work together to improve care quality for birthing parents and babies. Hospitals that opt in qualify for an operating payment rate increase of 4.3%, a much-needed boost for hospitals struggling with profitability in the wake of the Covid-19 pandemic and inflation.

But there’s no single set of metrics that hospitals will be required to follow to earn CMS’s new designation, and any changes they make may depend on what areas need improvement. For example, hospitals could focus on reducing pregnancy complications and early births, which happen before 39 weeks, according to the CDC.

CMS’s designation—at least in its initial form—isn’t tied to outcomes. However, medical professionals said there are a variety of measures and outcomes that have been shown to make a hospital truly birthing-friendly.

When it comes to measuring maternal-care quality, one metric comes up over and over again: a hospital’s C-section rate, said Holly Loudon, chair of obstetrics, gynecology, and reproductive science at Mount Sinai West and Mount Sinai Morningside in New York City.

Keep reading here

RELATED PODCAST: https://www.kevinmd.com/2022/11/protect-black-womens-maternal-health-podcast.html

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

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What is a Financial CDO and CMO?

Collateralized Debt Obligations

versus

COLLATERALIZED MORTGAGE OBLIGATIONS

https://healthcarefinancials.files.wordpress.com/2018/06/david-edward-marcinko.png

BY DR. DAVID E. MARCINKO MBA CMP®

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SPONSOR: http://www.CertifiedMedicalPlanner.org

A collateralized debt obligation (CDO) is a type of structured asset-backed security (ABS). Originally developed as instruments for the corporate debt markets, after 2002 CDOs became vehicles for refinancing mortgage-backed securities (MBS).

Like other private label securities backed by assets, a CDO can be thought of as a promise to pay investors in a prescribed sequence, based on the cash flow the CDO collects from the pool of bonds or other assets it owns. Distinctively, CDO credit risk is typically assessed based on a probability of default (PD) derived from ratings on those bonds or assets.

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

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Collateralized Debt Obligation (CDO) - Assignment Point

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Collateralized Mortgage Obligation

A CMO is a debt security backed by mortgages. These mortgage pools are usually separated into different maturity classes called tranches (from the French word for “slice”). The securities were issued by private issuers, as well as the Federal Home Loan Mortgage Corporation (Freddie Mac). As the mortgages were usually government-guaranteed, CMOs usually carried AAA ratings until their current financial meltdown. The early versions of CMOs were known as “plain vanilla,” but recent developments gave us PACs (planned amortization certificates) and TACs (targeted amortization certificates); among too many others. They were all variations on how principal repayments in advance of maturity date were treated.

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

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CMO vs CDO | What is the difference between them? - Fintelligents

RELATED: https://medicalexecutivepost.com/2011/07/06/merrill-lynch-investigated-for-cdo-deal-involving-magnetar/

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WASH SALE RULE: Not For Cryptocurrency?

By Staff Reporters

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DEFINITION

The wash-sale rule prohibits selling an investment for a loss and replacing it with the same or a “substantially identical” investment 30 days before or after the sale. If you do have a wash sale, the IRS will not allow you to write off the investment loss which could make your taxes for the year higher than you hoped.

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

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Don’t get soaked by the wash sale

Even if you sell at a loss from a brokerage account or IRA, it still might not want to permanently exit a portfolio position. It may want to get back into an investment now at a cheaper cost with room to re-grow.

BUT – Just wait a moment, according to the IRS “wash-sale” rule.

The IRS will not count a capital loss if, within 30 days before the sale or within 30 days afterwards, the taxpayer is also buying or acquiring a “substantially identical” investment. The rule applies to investments like stocks, bonds, mutual funds, exchange traded funds and options – but not cryptocurrency.

The basic trick is just keeping track of the days. Another skill is considering what counts as “substantially identical” for the fast-moving investor who sees a buying opportunity either 30 days before or after the day of sale.

An investor could sell a stock and buy an exchange traded fund or mutual fund that contains the stock and not run afoul of the rule, Going the other way, from a mutual fund or ETF containing a stock to a direct stock purchase, also will not trigger the rule, he noted.

EXAMPLE: Suppose an investor has several investment accounts — perhaps one is a long-term account and the other is more for short-term trades. The rule applies across the account. So if one sells and the other buys within 30 days before or after, the wash-sale rule will scrap the capital loss.

Buying and selling shares of two different funds tracking the same index within the 30-day period could also cause the wash sale rule to kick in. However, a move like selling a piece of an ETF tracking the S&P 500, and then soon buying an ETF tracking the Russell 1000 Index would be OK according to a tutorial from Charles Schwab SCHW, +3.70%. “That would preserve your tax break and keep you in the market with about the same asset allocation,” an explainer said.

But while someone’s eyeing a repurchase and letting the wash-sale window close one place, they may have a chance to start the tax strategy process in a different part of their portfolio. “There’s really tax loss harvesting opportunities across a number of different asset classes this year.”

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WHAT IS THE “LUXURY PRODUCT” ECONOMIC PARADOX?

WHAT IS THE “LUXURY PRODUCT” ECONOMIC PARADOX?

By Dr. David Edward Marcinko MBA

Courtesy: http://www.CertifiedMedicalPlanner.org

The more expensive something is – the less likely you are to use it. This relationship between price and product utility is graphed as an “inverted U.”

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

So, super car Ferraris sit in garages; but Fords get driven.

ESSAY: https://medicalexecutivepost.com/2014/01/08/the-jaguar-touring-sedan-one-of-the-finest-luxury-cars-built-yesterday/

My own Jaguar touring sedan illustrates this paradox.

dem-jag

ESSAY: https://medicalexecutivepost.com/2018/09/02/my-jaguar-mechanic-vs-doctor-story/

This theory may even be valid for services; as well as products?

THINK: Plastic and cosmetic surgery?

Assessment: Your thoughts and comments are appreciated.

THANK YOU

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What is a Federally Qualified Health Center?

ABOUT F.Q.H.C.s

By Dr. David E. Marcinko MBA CMP®

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SPONSOR: http://www.CertifiedMedicalPlanner.org

I worked at several FQHCs as a medical student and intern, back in the day, both in urban and suburban settings. But, I never was sure what this entity was, exactly. Probably because I was from an under served area, myself.

DEFINITION:

A Federally Qualified Health Center (FQHC) is a reimbursement designation from the Bureau of Primary Health Care and the Centers for Medicare and Medicaid Services of the United States Department of Health and Human Services. This designation is significant for several health programs funded under the Health Center Consolidation Act (Section 330 of the Public Health Service Act).

It is a community-based organization that provides comprehensive primary care and preventive care, including health, oral, and mental health/substance abuse services to persons of all ages, regardless of their ability to pay or health insurance status.

Thus, they are a critical component of the health care safety net. FQHCs are called Community/Migrant Health Centers (C/MHC), Community Health Centers (CHC), and 330 Funded Clinics. FQHCs are automatically designated as health professional shortage facilities.

CMS: https://www.cms.gov/Center/Provider-Type/Federally-Qualified-Health-Centers-FQHC-Center

FQHC.org: https://www.fqhc.org/what-is-an-fqhc/

Your thoughts are appreciated.

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PHARMA: Will Americans Finally See Drug Prices Decrease?

By Health Capital Consultants, LLC

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According to the White House, “Americans pay two to three times as much as people in other countries for prescription drugs, and one in four Americans who take prescription drugs struggle to afford their medications. Nearly 3 in 10 American adults who take prescription drugs say that they have skipped doses, cut pills in half, or not filled prescriptions due to cost.” In an effort to combat this growing crisis, both the federal government and private companies have taken a number of steps over the past year aiming to lower drug prices. This Health Capital Topics article will review those actions and the potential unintended consequences of these actions.

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“I” Bonds: DOWN!

By Staff Reporters

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DEFINITION: https://www.treasurydirect.gov/savings-bonds/i-bonds/

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The rate for I bonds, an asset that’s tied to the rate of inflation, was lowered to 6.89% yesterday from its record high of 9.62%. But in the final days of the previous rate, investors hoarded I bonds like crazy.

Now, on Friday, the Treasury sold $979 million of I bonds, nearly as much as the entire amount sold in the three years from 2018 to 2020, per CNBC. The investors also crashed the website.

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HEALTH INSURANCE: Non-Traditional Players & Disruptors

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By Health Capital Consultants

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Non-Traditional Players Moving into the Insurance Space

In the past two months, two retail giants – Walmart and Apple – have announced plans to enter the health insurance space. This direct entry into the health insurance market by non-traditional players has been encouraged in part by health insurer-retailer partnerships, which gained traction due to rising demand for Medicare Advantage (MA) in particular and the expansion of the types of benefits that MA plans may offer.

This Health Capital Topics article will discuss reasons behind the insurer-retailer partnerships and how Walmart and Apple plan to disrupt the health insurance market.(Read more…) 

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

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MANUAL MORTGAGE UNDERWRITING FOR DOCTORS: What is it, Really?

By Staff Reporters

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Editor’s Note: FHA manual underwriting guidelines were updated in 2020 and require that, for those applicants with credit scores below 620 or a debt-to-income (DTI) ratio that exceeds 43%, mortgage applications must be manually underwritten. For a fiercely frugal doctor, or debt adverse medical professional with “poor” credit because of little to no debt, this may actually be good for them. But, it may also make it difficult for a modern automated mortgage lender to issue a loan. Our debt ridden and consumer driven society is largely causative.

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

Consumption: https://medicalexecutivepost.com/2018/09/18/are-doctors-practitioners-of-conspicuous-consumption/

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With many Lenders now making automated lending decisions, much like emerging healthcare A.I. initiatives, it can seem confusing why others are still sticking to a manual process. But, a few physicians with little to no credit/debt history, and hence a low FICO score, may actually find it a bonus.

Banking A.I.: https://www.msn.com/en-us/money/companies/this-american-bank-is-closing-the-most-branches/ar-AAT3PvQ?li=BBnbfcL

Automated Decision Making

Many mortgage lenders currently use computer-based systems to assist with their lending decisions. These systems will look at your client’s credit score, borrowing history, etc. to decide whether or not to approve a mortgage application. It can then be argued that the value of an Underwriter is decreasing; much like physicians are slowly being devalued for many emerging reasons.

ORDER: https://www.amazon.com/Business-Medical-Practice-Transformational-Doctors/dp/0826105750/ref=sr_1_9?ie=UTF8& qid=1448163039&sr=8-9&keywords=david+marcinko

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So, Why Manual Underwriting?

Now, understand that not all [minority of clients] applicants will fit into the box that automated decision making systems like. Due to this, there is a need for manual decisions to be made, that will benefit both the Lender and the Borrower (client)!

Manual underwriting allows our Underwriters to look at the bigger picture and get a balanced view on the potential physician and/or client’s ability to repay the mortgage they are applying for. This means they can have a look at the overall risk to the Society and consider what conditions can be used to meet our lending policies. By using manual underwriting in every case, this embeds sensible and responsible decision making within the Society.

A hands-on approach means a look deeper into your financial position, and consider cases where physician clients may have:

  • Low credit scores;
  • Minimal credit history;
  • Self-employed applicants;
  • Applicants in fixed term employment contracts; and
  • Many more; like really a good personal risk profile.

Manual Underwriters

It is clear to see the benefits for the Society, and physicians, retrospectively. Some benefits of manual underwriting, according to experts David Cox and Richard Groom, include;

“I like that we can look at cases that many other high street lenders wouldn’t consider. This doesn’t mean we are risk takers; we just apply common sense”.

“I enjoy the hands-on approach we apply. Every applicant is different, so why should they all be pushed through an automated system?”

“Just because something doesn’t quite fit, it shouldn’t result in a computer says no decision. It’s great to be able to look at an individual’s situation and see what changes we can make to turn the negative to a positive”.

The great thing about manual underwriting is that while our lending policy is the core of what we do, applying a manual approach means we can consider applications outside of this, where it benefits the borrower and the Society”.

MORE: https://www.bankrate.com/mortgages/manual-underwriting/

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What is CHROMETOPHOBIA?

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A great question to ponder during National Financial Planning Month!

About the “FEAR OF MONEY”

By Charles Patrick Davis, MD, PhD

Fear of money: An abnormal and persistent fear of money. Sufferers experience undue anxiety even though they realize their fear is irrational. They worry that they might mismanage money or that money might live up to its reputation as “the root of all evil.” Perhaps they remember well the ill fortune that befell the mythical King Midas. His wish that everything he touched be turned to gold was fulfilled, and even his food was transformed into gold.

The fear of money is termed chrometophobia or chrematophobia, from the Greek “chrimata” (money) and “phobos” (fear). The “chrome” in “chrometophobia” may also be related to the Greek word “chroma” (color) because of the brilliant colors of ancient coins — for example, gold, silver, bronze and copper.

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

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Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

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

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Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors : Best Practices from Leading Consultants and Certified Medical Planners™ book cover

RISK MANAGEMENT: https://www.routledge.com/Risk-Management-Liability-Insurance-and-Asset-Protection-Strategies-for/Marcinko-Hetico/p/book/9781498725989

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PHYSICIAN FINANCIAL ADVISORS: https://medicalexecutivepost.com/2021/10/11/

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PODCAST: What is a “Leveraged” ETF?

WHAT IT IS – HOW IT WORKS

Traditional ETFs: https://medicalexecutivepost.com/2008/01/07/exchange-traded-funds-etfs/

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Leveraged DEFINITION:

Leveraged ETFs have received tremendous media attention and are proving to be extremely popular with both individual and institutional investors. There are hundreds of leveraged ETFs, covering virtually every asset class and industry sector. The majority are double-leveraged, but there’s a sizeable group of triple-leveraged ETFs.

For professional investors, leveraged ETFs are useful in statistical arbitrage, short-term tactical strategies, and for use as short-term hedges without the need to roll futures. For individual investors, leveraged ETFs are alluring because of the potential for higher returns.

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

Now, some physicians and Uninformed investors might assume that the leverage returns are generated on a continuous basis, so that if an underlying index is up 5% for a month, the double-leveraged ETF will be up 10% for the same month; if the index is up 10% for 6 months, the ETF will be up 20%, and so forth. That is absolutely not the case. The leverage is determined on a daily basis and the returns for any other period usually will not be double or triple the underlying index.

In order for the leveraged funds to achieve appropriate levels of assets so they can provide their implied leverage, they have to rebalance daily. In the case of an ETF providing long 2-times leveraged exposure, they would typically attain exposure to a notional set of assets equal to 2 times their NAV.

Example: An example would be an ETF that takes in 100 units in assets that does a swap with a counterparty to provide exposure to 200 units in performing assets. The rebalancing activity of these funds will almost always be in the same direction as the market.

In essence, a leveraged ETF is essentially marked to market every night. It starts with a clean slate the next day, almost as if the previous day had not existed. This process produces daily leverage results. However, over time, the compounding of this reset can potentially vary the performance of the fund versus its underlying benchmark. This can result in either greater or lesser degrees of final leverage over individual holding periods.

PODCAST: https://www.investopedia.com/terms/l/leveraged-etf.asp

RELATED: https://smartasset.com/investing/what-is-a-leveraged-etf

ASSESSMENT: Your comments and thoughts are appreciated.

INVITATIONS: https://medicalexecutivepost.com/dr-david-marcinkos-bookings/

CONTACT: Ann Miller RN MHA

MarcinkoAdvisors@msn.com

Ph: 770-448-0769

Second Opinions: https://medicalexecutivepost.com/schedule-a-consultation/

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

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What is OBSERVATIONAL BIAS?

EVIDENCE BASED MEDICINE

By Staff Reporters

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Observer bias occurs in research when the beliefs or expectations of an observer (or investigator) can influence the data that’s collected in a study.

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

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Supporting Teachers: Reducing Observational Bias - TeacherToolkit

This causes the results of a study to be unreliable and hard to reproduce in other research settings.

READ HERE IN MEDICINE: https://www.ebmconsult.com/articles/observational-bias-statistical-analysis

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RISK MANAGEMENT: https://www.routledge.com/Risk-Management-Liability-Insurance-and-Asset-Protection-Strategies-for/Marcinko-Hetico/p/book/9781498725989

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What is GAAP?

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HOW IT WORKS

By Dr. David E. Marcinko MBA CMP®

CMP logo

SPONSOR: http://www.CertifiedMedicalPlanner.org

Generally Accepted Accounting Principles

As a new physician investor, it’s important to know the distinctions between like measurements because the market allows firms to advertise their numbers in ways not otherwise regulated. Often companies will publicize their numbers using either GAAP or non-GAAP measures. GAAP, or generally accepted accounting principles, outlines rules and conventions for reporting financial information. It is a means to standardize financial statements and ensure consistency in reporting.

When a company publicizes its earnings and includes non-GAAP figures, it means it wants to provide investors with an arguably more accurate depiction of the company’s health (for instance, by removing one-time items to smooth out earnings). However, the further a company deviates from GAAP standards, the more room is allocated for some creative accounting and manipulation.

When looking at a company that is publishing non-GAAP numbers, new physician investors should be wary of these pro forma statements, because they may differ greatly from what GAAP deems acceptable.

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

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The Core GAAP Principles

GAAP is set forth in 10 primary principles, as follows:

  1. Principle of consistency: This principle ensures that consistent standards are followed in financial reporting from period to period.
  2. Principle of permanent methods: Closely related to the previous principle is that of consistent procedures and practices being applied in accounting and financial reporting to allow comparison.
  3. Principle of non-compensation: This principle states that all aspects of an organization’s performance, whether positive or negative, are to be reported. In other words, it should not compensate (offset) a debt with an asset.
  4. Principle of prudence: All reporting of financial data is to be factual, reasonable, and not speculative.
  5. Principle of regularity: This principle means that all accountants are to consistently abide by the GAAP.
  6. Principle of sincerity: Accountants should perform and report with basic honesty and accuracy.
  7. Principle of good faith: Similar to the previous principle, this principle asserts that anyone involved in financial reporting is expected to be acting honestly and in good faith.
  8. Principle of materiality: All financial reporting should clearly disclose the organization’s genuine financial position.
  9. Principle of continuity: This principle states that all asset valuations in financial reporting are based on the assumption that the business or other entity will continue to operate going forward.
  10. Principle of periodicity: This principle refers to entities abiding by commonly accepted financial reporting periods, such as quarterly or annually.

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

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What is Medical Practice FINANCIAL RATIO ANALYSIS?

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See the source image

BY DR. DAVID E. MARCINKO MBA CMP®

CMP logo

SPONSOR: http://www.CertifiedMedicalPlanner.org

Financial ratio analysis typically involves the calculation of ratios that are financial and operational measures representative of the financial status of a clinic or medical practice enterprise.  These ratios are evaluated in terms of their relative comparison to generally established industry norms, which may be expressed as positive or negative trends for that industry sector. The ratios selected may function as several different measures of operating performance or financial condition of the subject entity.

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

Common types of financial indicators that are measured by ratio analysis include:

  • Liquidity. Liquidity ratios measure the ability of an organization to meet cash obligations as they become due, i.e., to support operational goals. Ratios above the industry mean generally indicate that the organization is in an advantageous position to better support immediate goals.  The current ratio, which quantifies the relationship between assets and liabilities, is an indicator of an organization’s ability to meet short-term obligations.  Managers use this measure to determine how quickly assets are converted into cash.
  • Activity. Activity ratios, also called efficiency ratios, indicate how efficiently the organization utilizes its resources or assets, including cash, accounts receivable, salaries, inventory, property, plant, and equipment.  Lower ratios may indicate an inefficient use of those assets.
  • Leverage. Leverage ratios, measured as the ratio of long-term debt to net fixed assets, are used to illustrate the proportion of funds, or capital, provided by shareholders (owners) and creditors to aid analysts in assessing the appropriateness of an organization’s current level of debt.  When this ratio falls equal to or below the industry norm, the organization is typically not considered to be at significant risk.
  • Profitability. Indicates the overall net effect of managerial efficiency of the enterprise. To determine the profitability of the enterprise for benchmarking purposes, the analyst should first review and make adjustments to the owner(s) compensation, if appropriate.  Adjustments for the market value of the “replacement cost” of the professional services provided by the owner are particularly important in the valuation of professional medical practices for the purpose of arriving at an ”economic level” of profit.

The selection of financial ratios for analysis and comparison to the organization’s performance requires careful attention to the homogeneity of data. Benchmarking of intra-organizational data (i.e., internal benchmarking) typically proves to be less variable across several different measurement periods.

However, the use of data from external facilities for comparison may introduce variation in measurement methodology and procedure. In the latter case, use of a standard chart of accounts for the organization or recasting the organization’s data to a standard format can effectively facilitate an appropriate comparison of the organization’s operating performance and financial status data to survey results.

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Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

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

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What is the Stock Market DEATH CROSS?

Is A Market Downside Ahead?

By Staff Reporters

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What Is a Death Cross?

The death cross is a technical chart pattern indicating the potential for a major sell-off. The death cross appears on a chart when a stock’s short-term moving average crosses below its long-term moving average. Typically, the most common moving averages used in this pattern are the 50-day and 200-day moving averages.

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What is a BEAR MARKET Relief Rally?

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

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Summary:

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What is ABSOLUTE [Intrinsic] VALUE?

A MATH AND FINANCIAL-INVESTING TERM

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By Dr. David E. Marcinko MBA CMP®

CMP logo

SPONSOR: http://www.CertifiedMedicalPlanner.org

In mathematics, the absolute value or modulus of a real number x, denoted |x|, is the non-negative value of x without regard to its sign. Namely, |x| = x if x is positive, and |x| = −x if x is negative (in which case −x is positive), and |0| = 0. For example, the absolute value of 3 is 3, and the absolute value of −3 is also 3. The absolute value of a number may be thought of as its distance from zero.

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In finance, absolute value, also known as an intrinsic value, refers to a business valuation method that uses discounted cash flow (DCF) analysis to determine a company’s financial worth. The absolute value method differs from the relative value models that examine what a company is worth compared to its competitors. Absolute value models try to determine a company’s intrinsic worth based on its projected cash flows.

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

In investing, the key issues are as follows:

  • Absolute value refers to a business valuation method that uses discounted cash flow analysis to determine a company’s financial worth.
  • Investors can determine if a stock is currently under or overvalued by comparing what a company’s share price should be given its absolute value to the stock’s current price.
  • There are some challenges with using the absolute value analysis including forecasting cash flows, predicting accurate growth rates, and evaluating appropriate discount rates.
  • Absolute value, unlike relative value, does not call for the comparison of companies in the same industry or sector.

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What is an “INSIDER” Company Shareholder?

TERMS AND DEFINITIONS PHYSICIAN INVESTORS SHOULD KNOW

By Dr. David E. Marcinko MBA CMP®

CMP logo

SPONSOR: http://www.CertifiedMedicalPlanner.org

Insider transactions shouldn’t be used primarily to make an investing decision, however an insider transaction can be an important factor in the investing decision.

In legal terms, an “insider” refers to any shareholder who owns at least 10% of a company. This can include executives in the c-suite and large hedge funds. These insiders are required to let the public know of their transactions via a Form 4 filing, which must be filed within two business days of the transaction.

SEC: https://www.sec.gov/about/forms/form4data.pdf

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

INSIDER TRANSACTIONS

When a company insider makes a new purchase, that is an indication that they expect the stock to rise.

Insider sells, on the other hand, can be made for a variety of reasons, and may not necessarily mean that the seller thinks the stock will go down.

MORE: https://smartasset.com/financial-advisor/insider-trading

EXAMPLE:

Mark Zuckerberg, CEO at Facebook (NASDAQ:FB), just made a large buy and sell of company shares on November 3, according to a new SEC filing. A Form 4 filing from the U.S. Securities and Exchange Commission states that Mark Zuckerberg exercised options to purchase 62,300 Facebook shares for $0 on November 3. They then sold their shares on the same day in the open market. They sold at prices ranging from $324.04 to $332.02 to raise a total of $25,463,482 from the stock sale.

Zuckerberg still owns a total of 232,400 shares of Facebook worth, $78,226,142.

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RISK MANAGEMENT: https://www.routledge.com/Risk-Management-Liability-Insurance-and-Asset-Protection-Strategies-for/Marcinko-Hetico/p/book/9781498725989

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What is an “INTERVAL” MUTUAL FUND?

By Staff Reporters

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An interval fund is a closed-end mutual fund that buys back shares only during specific intervals. Shares of the First Eagle Credit Opportunities Fund aren’t traded on public exchanges, and purchases or sales take place at the close of business, at the net asset value (NAV).

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

A fund’s NAV is simply the sum of its assets divided by the number of shares. A traditional open-ended mutual fund isn’t publicly traded either, and investors can buy or sell at NAV at the market close every business day. This means the manager of an open-ended fund has limited investment choices because a relatively high level of liquidity is needed to handle daily re-demptions.

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Understanding interval funds - Griffin Capital

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An interval fund sets intervals (time periods) during which shares can be sold back to the fund manager and the number of shares it is willing to redeem during any interval. This makes it possible for the manager to go for higher yields by participating in less liquid markets.

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RELATED: https://www.investopedia.com/articles/investing/120516/what-interval-fund.asp

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METAVERSE: Expert Consensus in Medicine?

By Staff Reporters

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A multi-disciplinary panel of doctors and IT experts from Asia, the United States, and Europe analyzed published articles regarding expert consensus on the Medical Internet of Things, with reference to study results in the field of metaverse technology.

READ HERE: https://reader.elsevier.com/reader/sd/pii/S2588914122000016?token=4509ACBB9748F76769BCB6562B7413EAFAA5D83509412E53E17AC36F08A581B66B0F4E7B2D31A444F80A603E8FF22792&originRegion=us-east-1&originCreation=20221015174759

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MEDICINE: https://www.amazon.com/Business-Medical-Practice-Transformational-Doctors/dp/0826105750/ref=sr_1_9?s=books&ie=UTF8&qid=1287563112&sr=1-9

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

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

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What is PRICE’S Law of Publication Participation?

What it is – How it works?

Derek Price, who was a British physicist, historian of science, and information scientist, discovered something about his peers in academia. He noticed that there were always a handful of people who dominated the publications within a subject.

Price found out the following:

Price’s law says that 50% of the work is done by the square root of the total number of participants in the work.

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

LINK: https://expressingthegeniuswithin.com/prices-law-and-how-it-applies-to-everything/

MORE: https://getpocket.com/explore/item/price-s-law-why-only-a-few-people-generate-half-of-the-results

Your comments and thoughts are appreciated.

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MEDICINE: https://www.amazon.com/Business-Medical-Practice-Transformational-Doctors/dp/0826105750/ref=sr_1_9?ie=UTF8&qid=1448163039&sr=8-9&keywords=david+marcinko

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What is Health Insurance OUT OF NETWORK Medical Care?

By Staff Reporters

What does out of network [OON] really mean?

OON – This phrase usually refers to physicians, hospitals or other medical providers who do not participate in a health insurer’s provider network.

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

This means that the provider has not signed a contract agreeing to accept the insurer’s negotiated prices.

MORE: https://www.healthinsurance.org/glossary/out-of-network-out-of-plan/

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

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BUSINESS MEDICINE: https://www.amazon.com/Business-Medical-Practice-Transformational-Doctors/dp/0826105750/ref=sr_1_9?ie=UTF8&qid=1448163039&sr=8-9&keywords=david+marcinko

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

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