BOARD CERTIFICATION EXAM STUDY GUIDES Lower Extremity Trauma
[Click on Image to Enlarge]
ME-P Free Advertising Consultation
The “Medical Executive-Post” is about connecting doctors, health care executives and modern consulting advisors. It’s about free-enterprise, business, practice, policy, personal financial planning and wealth building capitalism. We have an attitude that’s independent, outspoken, intelligent and so Next-Gen; often edgy, usually controversial. And, our consultants “got fly”, just like U. Read it! Write it! Post it! “Medical Executive-Post”. Call or email us for your FREE advertising and sales consultation TODAY [678.779.8597] Email: MarcinkoAdvisors@outlook.com
Medical & Surgical e-Consent Forms
ePodiatryConsentForms.com
iMBA Inc., OFFICES
Suite #5901 Wilbanks Drive, Norcross, Georgia, 30092 USA [1.678.779.8597]. Our location is real and we are now virtually enabled to assist new long distance clients and out-of-town colleagues.
ME-P Publishing
SEEKING INDUSTRY INFO PARTNERS?
If you want the opportunity to work with leading health care industry insiders, innovators and watchers, the “ME-P” may be right for you? We are unbiased and operate at the nexus of theoretical and applied R&D. Collaborate with us and you’ll put your brand in front of a smart & tightly focused demographic; one at the forefront of our emerging healthcare free marketplace of informed and professional “movers and shakers.” Our Ad Rate Card is available upon request [678-779-8597].
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
Stocks were decimated yesterday in the first full trading day following President Trump’s tariff announcement. It was the biggest single-day decline since the start of the Covid-19 pandemic in March 2020. Every Magnificent Seven stock was battered—Apple worst of all. And so perhaps it is a good time to discuss the concept of “Money Scripts”.
***
Money Scripts are unconscious beliefs about money that are typically only partially true, are developed in childhood, and drive adult financial behaviors. Money scripts may be the result of “financial flashpoints,” which are salient early experiences around money that have a lasting impact in adulthood. Money scripts are often passed down through the generations and social groups often share similar money scripts. And so, we argue that Money scripts are at the root of all illogical, ill-advised, self-destructive, or self-limiting financial behaviors.
In research at Kansas State University [KSU], researchers identified four distinct Money script patterns, which are associated with financial health and predict financial behaviors. These include: (a) money avoidance, (b) money worship, (c) money status, and (d) money vigilance [personal communication Brad Klontz, PsyD, CFP®, Kenneth Shubin-Stein, MD, MPH, MS, CFA and Sonya Britt, PhD, CFP®].
And so, we all like to think our financial decisions are fully rational, but the truth is that our subconscious beliefs have a dramatic impact on our money and financial decisions. These money scripts are important to know and understand. A summary is below:
Money Avoidance
Money avoidance scripts are illustrated by beliefs such as “Rich people are greedy,”“It is not okay to have more than you need,” and “I do not deserve a lot of money when others have less than me.” Money avoiders believe that money is bad or that they do not deserve money. They believe that wealthy people are corrupt and there is virtue in living with less money. They may sabotage their financial success or give money away even though they cannot afford to do so. Money avoidance scripts may be associated with lower income and lower net worth and predict financial behaviors including ignoring bank statements, overspending, financial dependence on others, financial enabling of others, and having trouble sticking to a budget.
Money Worship
Money worship is typified by beliefs such as “More money will make you happier,” “You can never have enough money,” and “Money would solve all my problems.” Money worshipers are convinced that money is the key to happiness. At the same time, they believe that one can never have enough. Money worships have lower income, lower net worth, and higher credit card debt. They are more likely to be hoarders, spend compulsively, and put work ahead of family.
Money Status
Money status scripts include “I will not buy something unless it is new,” “Your self-worth equals you net worth,” and “If something isn’t considered the ‘best’ it is not worth buying.” Money status seekers see net worth and self-worth as being synonymous. They pretend to have more money than they do and tend to overspend as a result. They often grew up in poorer families and believe that the universe should take care of their financial needs if they live a virtuous life. Money status scripts are associated with compulsive gambling, overspending, being financially dependent on others, and lying to one’s spouse about spending.
Money Vigilance
Money vigilant beliefs include “It is important to save for a rainy day,” “You should always look for the best deal, even if it takes more time,” and “I would be a nervous wreck if I did not have an emergency fund.” The money vigilants are alert, watchful and concerned about their financial welfare. They are more likely to save and less likely to buy on credit. As a result, they tend to have higher income and higher net worth. They also have a tendency to be anxious about money and are secretive about their financial status outside of their household. While money vigilance is associated with frugality and saving, excessive anxiety can keep someone from enjoying the benefits that money can provide.
Identification
When money scripts are identified, it is helpful to examine where they came from. A simple behavioral finance technique involves reflecting on the following questions:
What three lessons did you learn about money from your mother?
What three lessons did you learn about money from your father?
What is your first memory around money?
What is your most painful money memory?
What is your most joyful money memory?
What money scripts emerged for you from this experience?
How have they helped you?
How have they hurt you?
What money scripts do you need to change?
Conclusion
Ideally, from a balanced middle ground, we can see past the limitations of money scripts, our self and others who are polarized. Those who believe “Money is meant to be spent” or “Money is meant to be saved” have a world view that results in extreme positions. Labeling them as “correct” or “wrong” is not a useful way to try to shift anyone’s polarized money script beliefs.
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: CONTACT: MarcinkoAdvisors@outlook.com
Posted on April 3, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
***
***
Eidetic memory refers to the ability to vividly recall images from memory after only a few instances of exposure, with high accuracy for a short time after exposure, without using a memory aid.
Photographic memory, though often used interchangeably with eidetic memory, implies the ability to recall extensive details, like entire pages of text, with high precision. Genuine photographic memory’s existence is debated and hasn’t been conclusively proven.
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.
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.
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.
***
***
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.
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: CONTACT: MarcinkoAdvisors@outlook.com
In the latest iteration of Trump Administration healthcare cuts, the Centers for Medicare & Medicaid Services (CMS) announced on March 12th, 2025 that four Center for Medicare and Medicaid Innovation (CMMI) payment models would be sunset at the end of 2025, earlier than originally scheduled.
Cutting these models, which decision was based on “a comprehensive and data-driven review of [CMS’s] model portfolio,” are anticipated to save nearly $750 million (although the source of these savings was not detailed).
This Health Capital Topics article discusses the models being ended and the impact on healthcare stakeholders. (Read more…)
Merger risk arbitrage, while a subset of a larger strategy called event-driven arbitrage, represents a sufficient portion of the market-neutral universe to warrant separate discussion.
Merger arbitrage earned a bad reputation in the 1980s when Ivan Boesky and others like him came to regard insider trading as a valid investment strategy. That notwithstanding, merger arbitrage is a respected strategy and when executed properly, can be highly profitable. It bets on the outcomes of mergers, takeovers and other corporate events involving two stocks which may become one.
Example:
A classic example is acquisition of SDL Inc. (SDLI) by JDS Uniphase Corp (JDSU). On July 10, 2010 JDSU announced its intent to acquire SDLI by offering to exchange 3.8 shares of its own shares for one share of SDLI. At that time, the JDSU shares traded at $101 and SDLI at $320.5. It was apparent that there was almost 20 percent profit to be realized if the deal went through (3.8 JDSU shares at $101 are worth $383 while SDLI was worth just $320.5).
This apparent mispricing reflected the market’s expectation about the deal’s outcome. Since the deal was subject to the approval of the U.S. Justice Department and shareholders, there was some doubt about its successful completion.
Risk arbitrageurs who did their homework and properly estimated the probability of success bought shares of SDLI and simultaneously sold short shares of JDSU on a 3.8 to 1 ratio, thus locking in the future profit. Convergence took place about eight months later, in February 2011, when the deal was finally approved and the two stocks began trading at exact parity, eliminating the mis-pricing and allowing arbitrageurs to realize a profit.
***
***
Hedge Fund Research defines the strategy as follows:
Merger Arbitrage,also known as risk arbitrage, involves investing in securities of companies that are the subject of some form of extraordinary corporate transaction, including acquisition or merger proposals, exchange offers, cash tender offers and leveraged buy-outs. These transactions will generally involve the exchange of securities for cash, other securities or a combination of cash and other securities. Typically, a manager purchases the stock of a company being acquired or merging with another company, and sells short the stock of the acquiring company. A manager engaged in merger arbitrage transactions will derive profit (or loss) by realizing the price differential between the price of the securities purchased and the value ultimately realized when the deal is consummated. The success of this strategy usually is dependent upon the proposed merger, tender offer or exchange offer being consummated.
When a tender or exchange offer or a proposal for a merger is publicly announced, the offer price or the value of the securities of the acquiring company to be received is typically greater than the current market price of the securities of the target company. Normally, the stock of an acquisition target appreciates while the acquiring company’s stock decreases in value. If a manager determines that it is probable that the transaction will be consummated, it may purchase shares of the target company and in most instances, sell short the stock of the acquiring company. Managers may employ the use of equity options as a low-risk alternative to the outright purchase or sale of common stock. Many managers will hedge against market risk by purchasing S&P put options or put option spreads.
Posted on March 30, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
***
***
Negativity bias is not totally separate from pessimism bias, but it is subtly and importantly distinct. In fact, it works according to similar mechanics as the sunk cost fallacy in that it reflects our profound aversion to losing. We like to win, but we hate to lose even more.
And so, according to cognitive scientist Mackenzie Marcinko PhD, when we make a decision, we generally think in terms of outcomes—either positive or negative. The bias comes into play when we irrationally weigh the potential for a negative outcome as more important than that of a positive outcome.
***
***
Pessimism bias on the other hand, is a cognitive bias that causes people to overestimate the likelihood of negative things and underestimate the likelihood of positive things, especially when it comes to assuming that future events will have a bad outcome.
For example, the pessimism bias could cause someone to believe that they’re going to fail an exam, even though they’re well-prepared and are likely to get a good grade.
According to colleague Dan Ariely PhD, The pessimism bias can distort people’s thinking, including your own, in a way that leads to irrational decision-making, as well as to various issues with your mental health and emotional well being.
Posted on March 29, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
DEFINITIONS
By Staff Reporters
***
***
Paradoxes are broader concepts that may include statements, situations, or phenomena, revealing a truth through contradiction (e.g., “less is more”).
Oxymorons are combinations of two contradictory words to create a new meaning (e.g., “deafening silence”).
***
Most people tend to confuse a paradox with an oxymoron, and it’s not hard to see why. Most oxymoron examples appear to be compressed version of a paradox, in which it is used to add a dramatic effect and to emphasize contrasting thoughts. Although they may seem greatly similar in form, there are slight differences that set them apart.
A paradox consists of a statement with opposing definitions, while an oxymoron combines two contradictory terms to form a new meaning. But because an oxymoron can play out with just two words, it is often used to describe a given object or idea imaginatively.
As for a paradox, the statement itself makes you question whether something is true or false. It appears to contradict the truth, but if given a closer look, the truth is there but is merely implied.
Avram Noam Chomsky is an American professor known for his traditional work in linguistics and political activism. Sometimes called “the father of modern linguistics”, Chomsky is also one of the founders of the field of cognitive science. He is a laureate professor of linguistics at the University of Arizona and an professor emeritus at MIT.
And so, modern linguists today approach their work with scientific rigor and perspective [STEM], although they use methods that were once thought to be solely an academic discipline of the humanities.
Contrary to this humanitarian belief, according to Professor Mackenzie Hope Marcinko PhD of the University of Delaware, linguistics is now multidisciplinary. It overlaps each of the human sciences including psychology, neurology, anthropology, and sociology. Linguists conduct formal studies of sound structure, grammar and meaning, but also investigate the history of language families, and research language acquisition.
Posted on March 28, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
***
***
Dental care in America divides people into two camps: those who can afford regular preventive care and cleanings, and those who can’t.
These so-called dental deserts contribute to a deep disparity in overall health. People who live in these places are more likely to get tooth decay and develop severe health problems. They also spend more money on care, and more time seeking health assistance in an emergency.
***
***
Stat: 25 million. That’s how many US residents live in areas without enough dentists, according to a recent Harvard University study.
A growing movement against fluoride is adding to the risk of tooth decay in these “dental deserts.” (NPR)
Both median and average family net worth surged between 2019 and 2022, according to the U.S. Federal Reserve. Average net worth increased by 23% to $1,063,700, the Fed reported in October 2023, the most recent year it published the data. Median net worth, on the other hand, rose 37% over that same period to $192,900.
You might wonder why the average and median net worth figures are so different. That’s because when you take the average of something, you add together every value in a data set and then divide that figure by the number of individual values.
When calculating a median, you simply look at the middle figure within a data set. That said, an average figure can be significantly higher or lower than a median figure if there are extreme outliers – meaning a group of people with significantly more net worth than the rest of the group can bring the average higher.
Average Net Worth by Age
The average net worth of someone younger than 35 years old is $183,500, as of 2022. From there, average net worth steadily rises within each age bracket. Between 35 to 44, the average net worth is $549,600, while between 45 and 54, that number increases to $975,800. Average net worth surges above the $1 million mark between 55 to 64, reaching $1,566,900.
Average net worth again rises for those ages 65 to 74, to $1,794,600, before falling to $1,624,100 for the 75 and older group. The median net worth within every single age bracket, however, is much lower than the average net worth.
***
***
Physicians [MD/DO]Net Worth by Specialty
A 2023 Medscape report shows the top 10 specialties with the most survey respondents saying they are worth more than $5 million.
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: CONTACT: MarcinkoAdvisors@outlook.com
An important concept for all medical professionals to understand is the current rate of return (CCR).
According to this principle, the current rate of a taxable return must be evaluated in reference to a similar non-taxable rate of return. This allows you to focus on your portfolio’s real (after-tax return), rather than its’ nominal, or stated return.
Now, since most medical professionals own a combination of both vehicles, it is important to calculate the average rate of return (ARR), as demonstrated in the following matrix. Usually, this will result in the assumption of more risk, for the possibility of great return.
To compare after tax yields, with taxable yields, use the following formulas:
Tax equivalent yield = yield / (1 – MTB), while taxable yield X (1-tax rate) = tax exempt yield.
Example: if the yield on a tax exempt municipal bond was 6%, and you are in a 28% tax bracket; the equivalent taxable yield (ETY), is 8.3%, calculated in the following manner: 06 / 1.00 – .28 =.083, or, 8.3% ETY. This means that you would need a taxable instrument paying almost 9 % to equal the 6 percent tax exempt bond.
Posted on March 27, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
DEFINITION
By Staff Reporters
***
***
Restaurant Reservation Scalping
The unauthorized online restaurant reservation market works like this.
Third-party platforms directly secure or encourage scalpers to secure reservations at popular restaurants without the restaurants’ permission, and then they facilitate the sale of those reservations for a hefty fee on their websites and smart phone apps.
These reservation scalpers often use bots to quickly secure the reservations online and take them off the market, so the average human customer can’t get access to that reservation without paying an unauthorized third party.
For years, I thought of cryptocurrency as a digital replacement for traditional money. After all, Bitcoin has “coin” right in the name. But let’s be honest: if Bitcoin is a currency, then my mother’s old Beanie Baby collection is a retirement fund.
A real currency needs to be stable. It should allow you to buy a coffee today without wondering whether, by tomorrow, that same amount could buy a car—or be worth nothing at all. Bitcoin and its kin like Ethereum and Dogecoin fail this test spectacularly.
Recently I have realized that cryptocurrency might be something even bigger and stranger than currency. It is not just digital money; it’s a bet on the huge global demand for financial autonomy.
In an age where every dollar is tracked, crypto offers an escape from traditional financial oversight. That makes it attractive not just to cybercriminals and tax evaders, but also to privacy advocates, speculators, and people living under restrictive financial policies. It doesn’t replace traditional money, it sidesteps it. It allows people to move, store, create, and destroy wealth outside of conventional banking systems. Some use it for transactions. Others see it as a hedge against inflation or a bet on the future of decentralized finance. Governments and banks don’t quite know what to do with it.
Crypto exists in a financial gray zone. It’s not widely accepted for everyday purchases, yet it can hold immense value. Unlike cash, which is limited by geography, or gold, which requires secure storage, crypto can be transferred globally in seconds. That’s part of its appeal, especially in countries with strict capital controls or volatile economies.
At the heart of cryptocurrency’s identity is the way it is produced. Crypto isn’t just a speculative asset—it’s an industrialized wealth-creation system. Imagine a massive warehouse filled with powerful computers “manufacturing” cryptocurrency. These mining operations exist solely to create new “coins” and process transactions, consuming enormous amounts of electricity in the process. The larger the operation, the more crypto it produces.
This is not how traditional currencies work. Fiat currencies are managed by central banks aiming for economic stability. Crypto, by contrast, is controlled by a decentralized network of miners and participants [block-chain]. Its supply is fixed, immune to government intervention. Some see this as a weakness. Others argue it is crypto’s greatest strength.
As Bitcoin and other major cryptocurrencies become more integrated into mainstream finance, the risks evolve. Even as regulators warn about crypto’s role in illicit activity, major corporations and investment firms are offering crypto-backed products. Some politicians, including President Trump, are discussing national Bitcoin reserves. This growing legitimacy makes crypto harder to ignore. But if crypto-backed funds become widespread, a crash could ripple far beyond crypto traders. That said, crypto remains a small fraction of global finance. Unless institutional adoption grows significantly, even a major downturn likely wouldn’t trigger systemic collapse.
Crypto’s increasing presence in finance does not make it a sound retirement investment. It is still a speculation. And speculations—whether in Bitcoin, meme stocks, or dot-com startups—are high-risk and not suitable for long-term financial security. Retirement portfolios should be built on diversification, stability, and predictable returns. Crypto offers none of these.
For years, I saw crypto as a failed currency. What I now think it to be is a decentralized speculative asset, driven by a growing demand to bypass traditional financial systems. Its future remains uncertain. As regulation increases and mainstream adoption expands, its role will continue to shift. But crypto is no longer just a niche experiment. It has become a financial force that governments, institutions, and individuals must reckon with—whether they embrace it or try to control it.
Posted on March 26, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
MEDICAL EXECUTIVE-POST–TODAY’SNEWSLETTERBRIEFING
***
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.
Donald Trump has officially dropped a stablecoin. It’s called USD1, and it’s pegged 1:1 with the US dollar, according to a statement from his family company World Liberty Financial Inc, (WLFI) today. The company says the token is fully backed by short-term US government treasuries, USD deposits, and other cash equivalents. Every token equals one dollar, no exceptions. WLFI says it built the whole thing to give people a stablecoin they don’t have to second guess.
US stocks rose for a third day in a row despite souring consumer confidence — and as investors weighed whether President Trump would temper his plans for upcoming tariffs.
The benchmark S&P 500 (^GSPC) rose more than 0.1%, while the Dow Jones Industrial Average (^DJI) ticked just above the flatline. The tech-heavy NASDAQ Composite (^IXIC) rose nearly 0.5%, bolstered by a more than 3% jump from Tesla (TSLA).
Posted on March 25, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
By Wikipedia and Staff Reporters
***
***
Congestion pricing or congestion charges is a system of surcharging users of public goods that are subject to congestion through excess demand, such as through higher peak charges for use of bus services, electricity, railways, telephones, and road pricing to reduce traffic congestion; airlines and shipping companies may be charged higher fees for slots at airports and through canals at busy times. This pricing strategy regulates demand, making it possible to manage congestion without increasing supply.
According to the economic theory behind congestion pricing, the objective of this policy is to use the price mechanism to cover the social cost of an activity where users otherwise do not pay for the negative externalities they create (such as driving in a congested area during peak demand).
By setting a price on an over-consumed product, congestion pricing encourages the redistribution of the demand in space or in time, leading to more efficient outcomes.
A hostile takeover happens when an entity takes control of a company without the knowledge and against the wishes of the company’s management. A hostile takeover is an acquisition strategy requiring that the entity acquire and control more than 50% of the voting shares issued by the company.
In mergers and acquisitions (M&A), a hostile takeover is the acquisition of a target company by an acquiring company that goes directly to the target company’s shareholders, either by making a tender offer or through a proxy vote.
Ideally, an entity interested in acquiring a company should seek approval from the target company’s Board of Directors. The difference between a hostile and a friendly takeover is that, in a friendly takeover, the target company’s board of directors approve of the transaction and recommend shareholders vote in favor of the deal.
Defenses against a hostile takeover
These defense mechanisms can be preemptive or reactive, depending on how prepared the company is for the possibility of a hostile bid.
Poison pill is one of the most common defenses against a hostile takeover. Officially known as a “shareholder rights plan,” the poison pill allows existing shareholders to purchase additional shares at a discount, diluting the ownership interest of the acquiring company. The goal is to make it prohibitively expensive for the acquirer to complete the takeover.
A golden parachute is another defense strategy, which involves providing lucrative compensation packages (bonuses, severance pay, stock options, etc.) to key executives in the event they are terminated as a result of the takeover. This creates a financial disincentive for the acquiring company, as it would need to pay out these large sums upon completing the takeover.
In a Crown jewel defense, the target company sells or threatens to sell its most valuable assets—its “crown jewels”—if the takeover is completed. This reduces the attractiveness of the company to the acquirer, as the most desirable assets would no longer be part of the deal.
The Pac-Man defenses a more aggressive strategy in which the target company turns the tables by attempting to buy shares of the acquiring company, effectively launching a counter-takeover. While rare, this defense can deter hostile bids by making the takeover battle more costly and complex.
A White-Knight defense involves the target company seeking out a more favorable acquirer, or “white knight,” to make a friendly takeover bid. This allows the target company to avoid the hostile acquirer while still securing the benefits of a merger or acquisition.
The hostile takeover between Sanofi-Aventis and Genzyme Corp. occurred in 2010 when Sanofi, a French pharmaceutical company, wanted to buy Genzyme, a US biotech firm specializing in rare diseases. Genzyme resisted the offer, leading to conflict. Sanofi started a public campaign to pressure Genzyme’s shareholders into selling.
After months of negotiations, the two companies reached a deal in 2011. Sanofi agreed to pay $74 per share, with additional payments tied to Genzyme’s future performance, bringing the total deal value to around $20.1 billion. This acquisition allowed Sanofi to expand into the lucrative market for rare disease treatment.
Posted on March 22, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
***
***
While some medical practitioners and facilities can operate without Professional Liability Insurance coverage, one business related insurance that cannot / should not be avoided is Worker’s Compensation. Employers in all but seven states – so-called “monopolistic” states because they have their own state funds, are under statutory obligation to provide coverage for their employees. Historically, Worker’s Compensation pre-dates Social Security entitlements and well before the emergence of employer sponsored group benefits.
The coverage under worker’s compensation provides for lost income due to on-the-job accidents or work-related disability or death and the amount of benefits vary by state. In some instances, the coverage will reimburse the employee for medical expenses incurred with the accident.
The four general benefits covered under Worker’s Compensation are:
Medical Care – for expenses incurred usually without limitations on amount or period of care.
Disability Income – payable for both total and partial disability and is usually based on 66 2/3 percent of their wage base.
Death Benefits – generally fall into two categories; one a flat amount for “burial” insurance; and two, survivor benefits. Though varying by state, these benefits are similar to the disability payment (a percentage of weekly base wages) but may be capped as to total benefit, such as $50,000 or a period, such as 10 years
Rehabilitation Benefits – includes not only medical rehabilitation, but vocational rehabilitation, vocational counseling, retraining or educational benefits, and job placement
Traditionally, the secondary purpose of Worker’s Compensation was to reduce potential litigation because employees accepting the benefits from a Worker’s Compensation claim generally waived their right to sue their employer.
***
***
However, in our litigious society, this “protective shelter” has been severely tested and is crumbling.
Employers may provide their Worker’s Compensation three ways:
Private commercial insurance
State government funds
Self-insurance
Very few factors drive the premium structure – the occupation of the workers is the single most important determinant of premiums. An office worker may have premiums as low as $.10 per hundred of wages and a coal miner may exceed $50.00 per hundred of wages. Generally speaking, however, Worker’s Compensation premiums for the medical profession or healthcare worker are among the lowest available.
Therefore, for the medical practice, some physicians may consider self-insurance because the weekly benefits are typically below $500, thus making this decision attractive.
Alternatively, because officers and owners can elect not to be covered by Worker’s Compensation, the decision to purchase coverage from a private insurance company may afford inexpensive assurance that the benefits will be conveniently provided, and administered, by a private insurance company for their employees.
Absolute Return – the goal is to have a positive return, regardless of market direction. An absolute return strategy is not managed relative to a market index.
Accredited Investor – wealthy individual or well-capitalized institutions covered under Regulation D of the Securities Act of 1933.
Alpha – the return to a portfolio over and above that of an appropriate benchmark portfolio (the manager’s “value added”).
Arbitrage – any strategy that invests long in an asset, and short in a related asset, hoping the prices will converge.
Attribution – the process of “attributing” returns to their sources. For example, did the returns to a portfolio (over and above some benchmark) come from stock selection, industry/sector over- or under-weighting or factor weighting. Software programs are helpful in reporting an attribution.
Beta – a measure of systematic (i.e., non-diversifiable) risk. The goal is to quantify how much systematic risk is being taken by the fund manager vis-à-vis different risk factors, so that one can estimate the alpha or value-added on a risk-adjusted basis.
Correlation – a measure of how strategy returns move with one another, in a range of –1 to +1. A correlation of –1 implies that the strategies move in opposite directions. In constructing a portfolio of hedge funds, one usually wants to combine a number of non-correlated strategies (with decent expected returns) to be well diversified.
Drawdown – the percentage loss from a fund’s highest value to its lowest, over a particular time frame. A fund’s “maximum drawdown” is often looked at as a measure of potential risk.
Hurdle Rate – the return where the manager begins to earn incentive fees. If the hurdle rate is 5% and the fund earns 15% for the year, then incentive fees are applied to the 10% difference.
Leverage – one uses leverage if he borrows money to increase his position in a security. If one uses leverage and makes good investment decisions, leverage can magnify the gain. However, it can also magnify a loss.
Opportunistic – a general term that describes an aggressive strategy with a goal of making money (as opposed to holding on to the money one already has).
***
***
Pairs Trading – usually refers to a long/short strategy where one stock is bought long, and a similar stock is sold short, often within the same industry. Buying the stock of Home Depot and shorting Lowe’s in an equal amount would be an example.
Portfolio Simulation – involves testing an investment strategy by “simulating” it with a database and analytic software. Often referred to as “backtesting” a strategy. The simulated returns of the strategy are compared to those of a benchmark over a specific time frame to see if it can beat that benchmark.
Sharpe Ratio – a measure of risk-adjusted return, computed by dividing a fund’s return over the risk-free rate by the standard deviation of returns. The idea is to understand how much risk was undertaken to generate the alpha.
Short Rebate – if you borrow stock and then sell it short, you have cash in your account. The short rebate is the interest earned on that cash.
R-Squared – a measure of how closely a portfolio’s performance varies with the performance of a benchmark, and thus a measure of what portion of its performance can be explained by the performance of the overall market or index. Hedge fund investors want to know how much performance can be explained by market exposure versus manager skill.
Transportable Alpha – the alpha of one active strategy can be combined with another asset class. For example, an equity market-neutral strategy’s value-added can be “transported” to a fixed income asset class by simply buying a fixed income futures contract. The total return comes from both sources.
Value at Risk – a technique which uses the statistical analysis of historical market trends and volatilities to estimate the likelihood that a specific portfolio’s losses will exceed a certain amount.
Posted on March 21, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
Beware – Public Improvement Fees
Beware – Public Improvement Districts
By Staff Reporters
***
***
A Public Improvement Fee (PIF) is a fee that developers may require their tenants to collect on sales transactions to pay for on-site improvements. The PIF is a fee and NOT a tax; therefore, it becomes a part of the overall cost of the sale/service and is subject to sales tax
Examples of these improvements include curbs and sidewalks, parking facilities, storm management system, sanitary sewer systems, road development (within the site) and outdoor public plazas.
Public Improvement Districts (PIDs) are a financing mechanism used to fund new developments and infrastructure improvements. PIDs are relatively easy to create and can be done by the local municipality. A majority of property owners within the district may petition a local government to create the district. Bonds can then be issued to fund a development or infrastructure improvements. Through an industry analysis and view of the current political environment, PIDs are certainly a beneficial mechanism to fund projects otherwise not feasible due to constraints on city budgets. Local elected officials will want PIDs monitored and only used in proper circumstances.
Posted on March 21, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
By Health Capital Consultants, LLC
***
***
The term “value” has many different meanings and definitions to different parties. Therefore, at the outset of each valuation engagement, it is critical to define appropriately (and have all parties agree to) the standard of value to be employed in developing the valuation opinion.
The standard of value defines the type of value to be determined and answers the question “value to whom?” There are several standards of value that may be sought, including: Fair Market Value (FMV), Fair Value, Investment Value, and Liquidation Value. (Read more...)
Posted on March 20, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
***
***
A medical zebra is rare a disease, one that is so rare that most doctors have not encountered a patient with that disease. Having only read about the disease in a textbook or in the case of many recently defined diseases, not at all. It is therefore difficult for medical doctors to diagnose these individuals.
The term originates from a popular saying among clinicians, “when you hear hoof-beats, think horses, not zebras”, meaning that when diagnosing a patient, one should first exclude the most common causes for a patients symptoms, before looking for rare causes. While this is a good idea in everyday practice, one must not forget to make the effort to go “zebra hunting” when the common causes don’t explain the full clinical picture. This is especially important with the current growth of genetics and personalized medicine.
Examples:
Sutton’s law – perform first the diagnostic test expected to be most useful
Occam’s razor – select from among competing hypotheses the one that makes the fewest new assumptions
Leonard’s law of physical findings – it is obvious or it is not there
Hickam’s dictum – “Patients can have as many diseases as they damn well please”
Samuel Gee – author of Medical lectures and aphorisms (1902)
James Alexander Lindsay – author of Medical axioms, aphorisms, and clinical memoranda (1924)
Maimonides – Commentary on the aphorisms of Hippocrates and Medical aphorisms of Moses (12th century)
Sagan standard – Extraordinary claims require extraordinary evidence
Twyman’s law – Any figure that looks interesting, or different, is usually wrong.
Now, a medical aphorisms is a pithy statement denoting a general truth. They have a special niche in medical discourse and writing. The use of aphorisms in medicine dates to ancient times and continues today.
Tax avoidance—An action taken to lessen tax liability and maximize after-tax income.
Tax evasion—The failure to pay or a deliberate underpayment of taxes.
Underground economy—Money-making activities that people don’t report to the government, including both illegal and legal activities.
Voluntary compliance—A system of compliance that relies on individual citizens to report their income freely and voluntarily, calculate their tax liability correctly, and file a tax return on time.
Posted on March 19, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
***
***
Split-Dollar Life Insurance: An arrangement under which a life insurance policy’s premium, cash values, and death benefit are split between two parties—usually a corporation and a key employee or executive. Under such an arrangement an employer may own the policy and pay the premiums and give a key employee or executive the right to name the recipient of the death benefit.
***
***
Several factors will affect the cost and availability of life insurance, including age, health, and the type and amount of insurance purchased. Life insurance policies have expenses, including mortality and other charges. If a policy is surrendered prematurely, the policy holder also may pay surrender charges and have income tax implications. You should consider determining whether you are insurable before implementing a strategy involving life insurance.
Any guarantees associated with a policy are dependent on the ability of the issuing insurance company to continue making claim payments.
“Malta has quietly leveraged the rising tide of the financial transparency imperative to attract hedge funds.“
There was a time when the quaint island sought to play on the traditional terrain, offering anonymity and a “laissez-faire regulatory regime,” not to mention very low taxes, as in no capital gains taxes and no taxes on dividends; all while English speaking and USD currency denominated.
***
***
While many leading domiciles for offshore hedge funds remain in the Caribbean – notably the Cayman Islands, the British Virgin Islands, Bermuda, and the Bahamas – the island of Malta is drawing attention, especially from European funds.
Posted on March 17, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
BANK IDENTIFICATION NUMBER – DEFINED
By Staff Reporters
***
***
What Is a BIN Attack?
The BIN, or the Bank Identification Number, is the first six digits on a credit card. These are always tied to its issuing institution – usually a bank. In a BIN attack, fraudsters use these six numbers to algorithmically try to generate all the other legitimate numbers, in the hopes of generating a usable card number.
How Does a BIN Attack Work?
Fraudsters conduct BIN attacks by generating hundreds of thousands of possible credit card numbers and testing them out.
A fraudster looks up the BIN of the bank they will target. Ranging from four to six digits, this information is in the public domain and is thus easy to source.
Using dedicated software such as an auto-dialer, they generate thousands, often tens of thousands, combinations of possible existing card numbers by this issuer.
At this point, these credentials need to be tested. The fraudster identifies a suitable online shop or donation page.
They start card testing by attempting a small payment with each generated card number.
They keep track of the small percentage of card details that worked, which they are ready to use in earnest for their fraudulent pursuits.
***
***
Remember that the fraudster will start off with only six digits, yet there are many more card details required for a successful transaction. If those are entered erroneously, the transaction will decline. This includes the CVV number, the expiration date, as well as likely address verification service (AVS) failures. Card testing transactions are executed remotely in a fast fashion, so distance checks should also be a hint as well as velocity alerts.
Fraudsters may use bad merchant accounts directly for this purpose, or more frequently involve multiple online stores and services during a BIN attack, as their attempts keep getting blocked at most outlets.
When analyzing a set of financial statements to determine practice value, adjustments (normalizations) generally are needed to produce a clearer picture of likely future income and distributable cash flow. It also allows more of an “apples to apples” line item comparison. This normalization process usually consists of making three main adjustments to a medical practice’s net income (profit and loss) statement.
1. Non-Recurring Items: Estimates of future distributable cash flow should exclude non-recurring items. Proceeds from the settlement of litigation, one-time gains/losses from the selling of assets or equipment, and large write-offs that are not expected to reoccur, each represent potential nonrecurring items. The impact of nonrecurring events should be removed from the practice’s financial statements to produce a clearer picture of likely future income and cash flow.
2. Perquisites: The buyer of a medical practice may plan to spend more or less than the current doctor-owner for physician executive compensation, travel and entertainment expenses, and other perquisites of current management. When determining future distributable cash flow, income adjustments to the current level of expenditures should be made for these items.
3. Non-cash Expenses: Depreciation expense, amortization expense, and bad debt expense are all non-cash items which impact reported profitability. When determining distributable cash flow, you must analyze the link between non-cash expenses and expected cash expenditures.
The annual depreciation expense is a proxy for likely capital expenditures over time. When capital expenditures and depreciation are not similar over time, an adjustment to expected cash flow is necessary. Some practices reduce income through the use of bad debt expense rather than direct write-offs. Bad debt expense is a non-cash expense that represents an estimate of the dollar volume of write-offs that are likely to occur during a year. If bad debt expense is understated, practice profitability will be overstated.
***
***
Balance Sheet Adjustments
Adjustments also can be made to a practice’s balance sheet to remove non-operating assets and liabilities, and to restate asset and liability value at market rates (rather than cost rates). Assets and liabilities that are unrelated to the core practice being valued should be added to or subtracted from the value, depending on whether they are acquired by the buyer.
Examples include the asset value less outstanding debt of a vacant parcel of land, and marketable securities that are not needed to operate the practice. Other non-operating assets, such as the cash surrender value of officer life insurance, generally are liquidated by the seller and are not part of the business transaction.
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: CONTACT: MarcinkoAdvisors@outlook.com
Posted on March 17, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
The Power of Attorney Mistake That Could Cost You Everything
By Rick Kahler CFP®
***
***
Recently, reading a training manual on elder abuse, I was reminded of a financial risk that is often overlooked. One of the fastest and easiest ways to unravel your financial security is to have the wrong person gain control of your money.
The example in the manual mirrored a heartbreaking situation I once experienced with a long-term client. As her mental and physical health declined, this single woman moved into assisted living. Her newly designated power of attorney, a relative from out of town, took control of her financial affairs.
Almost immediately, without consulting us, the relative began making large withdrawals, closed her accounts, and transferred funds elsewhere. They challenged the financial plan, investments, and strategies we had established to safeguard the client’s financial security and provide for her long-term care. Even though their actions threatened the client’s wellbeing, we were powerless to stop them. Our only recourse was to report the behavior to the authorities.
This heartbreaking and frustrating experience underscored just how critical it is to be mindful when executing a Power of Attorney. Besides designating someone you trust, it is wise to build in safeguards to prevent even a well-meaning relative from inadvertently derailing a carefully constructed financial plan.
***
***
One such safeguard is to include a financial advisor in your POA—as long as that person is a fee-only, fiduciary advisor with an obligation to act in your best interests. In many cases, advisors are hesitant to suggest this option because they are sensitive to the potential conflict of interest and do not want to appear self-serving. An unfortunate reality is that you should be cautious if an advisor, particularly one who sells products on commission, seems eager to be added to your POA.
Including your financial advisor in your POA does not mean you designate them as your agent to manage your affairs. Instead, you include a clause naming them as the professional of record you want your designated agent to continue working with. This creates continuity and accountability. It prevents your agent from replacing your advisor with someone who may be unfamiliar with your needs and goals, unqualified, or untrustworthy.
Your advisor might also recommend adding a secondary safeguard, such as naming an attorney or accountant to oversee the selection of a successor advisor in case your current advisor is unable to continue. This additional layer of protection ensures that the financial professionals guiding your portfolio remain aligned with your best interests. Taking these extra steps can save you—and your loved ones—from significant financial stress down the road.
Including safeguards in your POA is not about mistrusting your loved ones, but about equipping them with the right resources and support to act in your best interest. Financial management is complex, and it requires expertise that most people, even those with the best intentions, may not possess.
One of the hardest parts about planning for diminished financial capacity is the emotional aspect. No one likes to imagine a time when they might not be able to manage their own money. But in reality, taking steps now to protect your financial future is the ultimate act of control. It can help ensure that your wishes are respected and the financial foundation you’ve worked so hard to build remains intact.
Remember, too, that avoiding conversations often increases financial vulnerability. If you don’t have a POA or aren’t comfortable with what you do have, now is the time to bring it up with your advisor, attorney, or a trusted family member. These safeguards are about protecting yourself. They also support those you will rely on to care for you and your financial legacy,
Posted on March 16, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
DEFINITION
***
***
According to Wikipedia, a tontine (/ˈtɒntaɪn, -iːn, ˌtɒnˈtiːn/) is an investment linked to a living person which provides an income for as long as that person is alive. Such schemes originated as plans for governments to raise capital in the 17th century and became relatively widespread in the 18th and 19th centuries.
Tontines enable subscribers to share the risk of living a long life by combining features of a group annuity with a kind of mortality lottery. Each subscriber pays a sum into a trust and thereafter receives a periodical payout. As members die, their payout entitlements devolve to the other participants, and so the value of each continuing payout increases. On the death of the final member, the trust scheme is usually wound up.
Tontines are still common in France. They can be issued by European insurers under the Directive 2002/83/EC of the European Parliament. The Pan-European Pension Regulation passed by the European Commission in 2019 also contains provisions that specifically permit next-generation pension products that abide by the “tontine principle” to be offered in the 27 EU member states.
Questionable practices by U.S. life insurers in 1906 led to the Armstrong Investigation in the United States restricting some forms of tontines. Nevertheless, in March 2017, The New York Times reported that tontines were getting fresh consideration as a way for people to get steady retirement income.
In the United States, the difference between a Ph.D and a Sc.D is that the former is awarded to most, if not all, disciplines, while a Sc.D is awarded to science or STEM (science, technology, engineering, mathematics) disciplines.
This means that, in the United States at least, a Ph.D and a Sc.D are equal to one another in terms of telling people about an individual’s mastery of a particular skill, training, and prestige. A Ph.D holder and a Sc.D holder are viewed as peers and equals by most, if not all, American universities.
Meanwhile in Europe, according to Emily Summer, the difference between a Ph.D and a Sc.D is that the former is awarded at the start of an academic career, while the Sc.D is awarded much later, after the individual has built up an impressive body of work.
Posted on March 15, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
DEFINITION
By Staff Reporters and FTC
***
***
Surveillance pricing is a broad term to describe the practice of linking pricing to individualized consumer data.
Companies employing it might use algorithms, personal information, and AI to set a price for their goods based on everything from where you live to your age to your browsing or credit history. The practice, sometimes called dynamic pricing or personalized pricing, is growing increasingly common, but isn’t completely new.
In 2012, the travel website Orbitz began directing people on Macs to higher hotels after realizing they often had more purchasing power. It stopped the practice after the Wall Street Journalreported on it.
Is surveillance pricing the same thing as surge pricing?Yes and no.
You might know about surge pricing from the last time you tried to call an Uber during a rainstorm. As demand skyrockets for a ride share, so does the price. This is one kind of surveillance pricing, but what the FTC is targeting appears more specific. The FTC said its probe concerns “when the pricing is based on surveillance of an individual’s personal characteristics and behavior.”
Is surveillance pricing bad?
The FTC opened its probe into companies using surveillance pricing because it’s worried about the risks it might pose to consumers
“Firms that harvest Americans’ personal data can put people’s privacy at risk. Now firms could be exploiting this vast trove of personal information to charge people higher prices,” FTC Chair Lina M. Khan said in a statement. “Americans deserve to know whether businesses are using detailed consumer data to deploy surveillance pricing, and the FTC’s inquiry will shed light on this shadowy ecosystem of pricing middlemen.”
The FTC is looking into four major areas of the practice: types of products being offered, data collection, customer and sales information, and impacts on consumers and prices.
Many Americans, it fears, don’t know when their data is being harvested and how it is affecting what they pay. “Consumers may now be subjected to surveillance pricing when they shop for anything, big or small, online or in person: a house, a car, even their weekly groceries,” the FTC said.
The FTC sent the orders for more information to Accenture, Bloomreach, Chase, Mastercard, McKinsey & Co., Pros, Revionics, and Task.
“Advancements in machine learning make it cheaper for these systems to collect and process large volumes of personal data, which can open the door for price changes based on information like your precise location, your shopping habits, or your web browsing history,” the FTC wrote.
Posted on March 14, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
BREAKING NEWS
By Staff Reporters
***
***
The Consumer Price Index (CPI) for February found that the cost of goods and services rose 0.2% on the month. The annual rate of inflation was also up 2.8% — slightly less than expected.
Here’s a breakdown of several price changes for February:
Food: increase 0.2%
Energy: increase 0.2%
Electricity: increase 1.0%
New vehicles: decrease 0.1%
Used vehicles: increase 0.9%
Apparel: increase 0.6%
Shelter: increase 0.3%
Transportation: decrease 0.8%
Medical care services: increase 0.3%
The Bureau of Labor Statistics reported that according to its indexes, over the month the cost of medical care rose 0.3%, physicians’ services were 0.4% higher, hospital services added 0.1%, and prescription-drug costs were unchanged.
Posted on March 14, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
Over Heard in the Doctor’s Lounge
By Staff Reporters
***
***
Statistics is a discipline that deals with data, facts, and figures from which meaningful information is inferred. It involves gathering, summarizing, and analyzing data to understand trends and patterns. Statistics can be divided into two main types: descriptive statistics, which summarize data, and inferential statistics, which make predictions or inferences about a population based on a sample
But, reading statistical income information can be full of pitfalls. One needs to look at the mean and median. Both give useful information. By comparing the two, one can ascertain if there are outliers that affect the results.
Example:
If a sample of 10 physicians has one earning $1,000,000 and the other nine earning $100,000, the average (mean) income is $190,000; but the median income is $100,000.
Just using this information alone, one can tell there are some outliers that could affect the results.
–Dr. Edmond F. Mertzenich, DPM MBA [Rockford, IL]
***
***
Example:
“Lies, damned lies, and statistics” is a phrase describing the persuasive power of statistics to bolster weak arguments, “one of the best, and best-known” critiques of applied statistics. It is also sometimes colloquially used to doubt statistics used to prove an opponent’s point.
Posted on March 14, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
By Dr. David Edward Marcinko MBA MEdCMP®
***
***
Your Executor or personal representative is named in your Will and is responsible for management of assets subject to probate. A basic checklist of the duties of the personal representative looks like this:
Gather all estate assets;
Collect all amounts owed the decedent;
Notify creditors and paying all valid debts;
Selling assets as needed to pay expenses or as directed by the Will;
Distribute assets to beneficiaries;
File decedents final federal income tax return;
File an estate tax return if the estate is large enough; and
File inventories and annual returns with the probate court, if required.
The position requires a lot of responsibility and involves many duties and a considerable commitment of time. The personal representative must petition the probate court for formal appointment.
Selection of your personal representative should not be made lightly, or as a favor to a friend. It requires a lot of work and very often for little or no pay. Friends and family typically will not charge the estate for their time and work. Outside advisers like attorneys and accountants will not hesitate to bill for their work effort. A few items for your selection criteria should be:
Longevity – the person should have a likelihood of being able to serve after your death;
Skill in managing legal and financial affairs;
Familiarity with your estate and wishes;
Integrity and loyalty; and
Impartiality and absence of conflicts of interest.
Alternatives to family or friends might be a corporate executor, such as a bank, an attorney, or other adviser. Similar criteria should be used in the selection of a trustee.
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
Posted on March 13, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
***
***
Wikipedia suggests that Rhetoric is the art of persuasion . It is one of the three ancient arts of discourse (trivium) along with grammar and logic/dialectic.
As an academic discipline within the humanities, rhetoric aims to study the techniques that speakers or writers use to inform, persuade, and motivate their audiences.
And, according to Professor Mackenzie Hope Marcinko PhD, rhetoric also provides heuristics for understanding, discovering, and developing arguments for particular situations.
Posted on March 13, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
BEHAVIORAL ECONOMICS
By Staff Reporters
***
***
Prospect theory is a psychological and behavioral economics theory developed by Daniel Kahneman and Amos Tversky in 1979. It explains how people make decisions when faced with alternatives involving risk, probability, and uncertainty. According to this theory, decisions are influenced by perceived losses or gains.
Example:
Amanda, a DO client, was just informed by her financial advisor that she needed to re-launch her 403-b retirement plan. Since she was leery about investing, she quietly wondered why she couldn’t DIY. Little does her FA know that she doesn’t intend to follow his advice, anyway! So, what went wrong?
The answer may be that her advisor didn’t deploy a behavioral economics framework to support her decision-making. One such framework is the “prospect theory” model that boils client decision-making into a “three step heuristic.”
Prospect theory makes the unspoken biases that we all have more explicit. By identifying all the background assumptions and preferences that clients [patients] bring to the office, decision-making can be crafted so that everyone [family, doctor and patient] or [FA, client and spouse] is on the same page. Briefly, the three steps are:
1. Simplify choices by focusing on the key differences between investment [treatment] options such as stock, bonds, cash, and index funds.
2. Understanding that clients [patients] prefer greater certainty when it comes to pursuing financial [health] gains and are willing to accept uncertainty when trying to avoid a loss [illness].
3. Cognitive processes lead clients and patients to overestimate the value of their choices thanks to survivor bias, cognitive dissonance, appeals to authority and hindsight biases.
Assessment
Much like healthcare today, the current mass-customized approaches to the financial services industry falls short of recognizing more personalized advisory approaches like prospect theory and assisted client-centered investment decision-making.
Posted on March 13, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
DEFINITION
By Staff Reporters
***
***
1035 Exchange
DEFINITION: A method of exchanging insurance-related assets without triggering a taxable event. Cash-value life insurance policies and annuity contracts are two products that may qualify for a 1035 exchange.
***
A 1035 exchange is a feature in the tax code that permits individuals to transfer funds from an existing life insurance endowment, or annuity policy to a new one without tax consequences.
These transactions are not subject to tax deductions or tax credits but rather tax deferrals, meaning that individuals would only pay taxes on any earnings once they receive money from the policy later.
Without this provision, policyholders would have to close their previous accounts and be subjected to both taxes and surrender charges before they could open a new account.
Posted on March 13, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters and IRS
***
***
Straddles: A straddle is any set of offsetting positions on personal property. For example, a straddle may consist of a purchased option to buy and a purchased option to sell on the same number of shares of the security, with the same exercise price and period.
Personal property.
This is any actively traded property. It includes stock options and contracts to buy stock but generally does not include stock.
Straddle rules for stock.
Although stock is generally excluded from the definition of personal property when applying the straddle rules, it is included in the following two situations.
The stock is of a type that is actively traded, and at least one of the offsetting positions is a position on that stock or substantially similar or related property.
The stock is in a corporation formed or availed of to take positions in personal property that offset positions taken by any shareholder.
Note
For positions established before October 22, 2004, condition 1 above does not apply. Instead, personal property includes stock if condition 2 above applies or the stock was part of a straddle in which at least one of the offsetting positions was:
An option to buy or sell the stock or substantially identical stock or securities,
A securities futures contract on the stock or substantially identical stock or securities, or
A position on substantially similar or related property (other than stock).
Position
A position is an interest in personal property. A position can be a forward or futures contract or an option.
An interest in a loan denominated in a foreign currency is treated as a position in that currency. For the straddle rules, foreign currency for which there is an active inter bank market is considered to be actively traded personal property.
Offsetting position
This is a position that substantially reduces any risk of loss you may have from holding another position. However, if a position is part of a straddle that is not an identified straddle, do not treat it as offsetting to a position that is part of an identified straddle.
Presumed offsetting positions
Two or more positions will be presumed to be offsetting if:
The positions are established in the same personal property (or in a contract for this property), and the value of one or more positions varies inversely with the value of one or more of the other positions;
The positions are in the same personal property, even if this property is in a substantially changed form, and the positions’ values vary inversely as described in the first condition;
The positions are in debt instruments with a similar maturity, and the positions’ values vary inversely as described in the first condition;
The positions are sold or marketed as offsetting positions, whether or not the positions are called a straddle, spread, butterfly, or any similar name; or
The aggregate margin requirement for the positions is lower than the sum of the margin requirements for each position if held separately.
Related persons
To determine if two or more positions are offsetting, you will be treated as holding any position your spouse holds during the same period. If you take into account part or all of the gain or loss for a position held by a flow-through entity, such as a partnership or trust, you are also considered to hold that position.
Posted on March 12, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
The IRS 1099-k Tax Form
By Staff Reporters and IRS
***
***
Third party payment platforms are required to send you a 1099-K tax form if you made more than $5,000 on the platform in 2024. This reporting change will give the IRS a clearer picture of how much you earned in untaxed income this year to help ensure you pay your taxes properly. For the 2025 tax year, the threshold will drop to $2,500.
The IRS originally rolled out a plan to implement new reporting requirements for anyone earning over $600 via payment apps in 2023. After two years of delays, the tax agency has decided to implement a phased rollout, lifting the reporting threshold to $5,000 for the 2024 tax year.
If you earn freelance or self-employment income, you’re likely no stranger to 1099 tax forms. You’re required to report any net earnings over $400 to the IRS when you file your tax return, even if you don’t receive a 1099. The 1099-K tax change places a reporting requirement on payment apps so the IRS can keep better tabs on income earnings that might otherwise go unreported.
Posted on March 12, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
Drugs: (List of Schedule I-V Controlled Drugs)
By Staff Reporters
***
***
Any discussion on narcotics, prescription drugs, or other controlled substances is usually peppered with the word schedule. One substance may be Schedule I, while another is Schedule II, III, IV, or V.
Drugs, substances, and certain chemicals used to make drugs are classified into five (5) distinct categories or schedules depending upon the drug’s acceptable medical use and the drug’s abuse or dependency potential. The abuse rate is a determinate factor in the scheduling of the drug; for example, Schedule I drugs have a high potential for abuse and the potential to create severe psychological and/or physical dependence. As the drug schedule changes — Schedule II, Schedule III, etc., so does the abuse potential — Schedule V drugs represents the least potential for abuse.
A Listing of drugs and their schedule are located at Controlled Substance Act (CSA) Scheduling or CSA Scheduling by Alphabetical Order. These lists describes the basic or parent chemical and do not necessarily describe the salts, isomers and salts of isomers, esters, ethers and derivatives which may also be classified as controlled substances. These lists are intended as general references and are not comprehensive listings of all controlled substances.
Please note that a substance need not be listed as a controlled substance to be treated as a Schedule I substance for criminal prosecution. A controlled substance analogue is a substance which is intended for human consumption and is structurally or pharmacologically substantially similar to or is represented as being similar to a Schedule I or Schedule II substance and is not an approved medication in the United States.
Schedule I Schedule I drugs, substances, or chemicals are defined as drugs with no currently accepted medical use and a high potential for abuse. Some examples of Schedule I drugs are: heroin, lysergic acid diethylamide (LSD), marijuana (cannabis), 3,4-methylenedioxymethamphetamine (ecstasy), methaqualone, and peyote.
Schedule II Schedule II drugs, substances, or chemicals are defined as drugs with a high potential for abuse, with use potentially leading to severe psychological or physical dependence. These drugs are also considered dangerous. Some examples of Schedule II drugs are: combination products with less than 15 milligrams of hydrocodone per dosage unit (Vicodin), cocaine, methamphetamine, methadone, hydromorphone (Dilaudid), meperidine (Demerol), oxycodone (OxyContin), fentanyl, Dexedrine, Adderall, and Ritalin
Schedule III Schedule III drugs, substances, or chemicals are defined as drugs with a moderate to low potential for physical and psychological dependence. Schedule III drugs abuse potential is less than Schedule I and Schedule II drugs but more than Schedule IV. Some examples of Schedule III drugs are: products containing less than 90 milligrams of codeine per dosage unit (Tylenol with codeine), ketamine, anabolic steroids, testosterone
Schedule IV Schedule IV drugs, substances, or chemicals are defined as drugs with a low potential for abuse and low risk of dependence. Some examples of Schedule IV drugs are: Xanax, Soma, Darvon, Darvocet, Valium, Ativan, Talwin, Ambien, Tramadol
Schedule V Schedule V drugs, substances, or chemicals are defined as drugs with lower potential for abuse than Schedule IV and consist of preparations containing limited quantities of certain narcotics. Schedule V drugs are generally used for antidiarrheal, antitussive, and analgesic purposes. Some examples of Schedule V drugs are: cough preparations with less than 200 milligrams of codeine or per 100 milliliters (Robitussin AC), Lomotil, Motofen, Lyrica, Parepectolin
Posted on March 12, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
MEDICAL EXECUTIVE-POST–TODAY’SNEWSLETTERBRIEFING
***
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.
Stocks inched up overnight after Monday’s ugly plunge to six-month lows, but positive catalysts were scattered and the rocky economy has begun affecting earnings forecasts. Delta Airlines (DAL) lowered its outlook yesterday amid what it called “macro uncertainty,” raising concerns it could be first on a crowded runway.
One theme as stocks plunged recently was that despite the suffering was that earnings outlooks remained strong. The latest FactSet forecasts for first quarter and 2025 S&P 500 earnings growth are 7.3% and 11.6%, respectively. Both are down from December 31st, though, and further setbacks in expectations could hurt confidence. Oracle (ORCL) missed analysts’ estimates late Monday. “The longer the tariff turmoil and related uncertainty about trade policy lasts, the more likely economic and earnings growth may take a hit,” said Jeffrey Kleintop, chief global investment strategist at Schwab.
Job openings data later yesterday morning and the Consumer Price Index (CPI) tomorrow could help set the tone, though economic growth seems to have replaced inflation as the prime concern. Yesterday’s steep losses reflected less confidence in either the administration or the Federal Reserve potentially stepping in to rescue a slumping economy. Growth fears have pummeled the Magnificent Seven, with six of them among the bottom 350 in S&P 500 index (SPX) year-to-date performance.
For now, the S&P 500 (^GSPC) avoided correction territory but still fell about 0.8% to trade at just under 5,600. The Dow Jones Industrial Average (^DJI) shed roughly 500 points, or 1.1%, dragged down by shares of Verizon (VZ). The tech-heavy NASDAQ Composite (^IXIC) reversed gains in the last few minutes of trading to fall about 0.2%. All three indexes closed at their lowest levels since September.
Visualize: How private equity tangled banks in a web of debt, from the Financial Times.
Monetarism is the belief that changes in the money supply are the main determinant of changes in inflation, associated especially with Milton Friedman, an American economist. Cases of hyperinflation have indeed been associated with the rapid printing of money. But when governments adopted monetarist policies in the late 1970s and early 1980s, they found money supply hard to control and also struggled to decide which measure of money supply was best to target. Monetarist policies were abandoned in favor of inflation targeting.
Monetary financing is the direct financing of government spending by the central bank. This happened during the hyperinflation in Germany in 1923 and was thus regarded as anathema for a long period afterwards. As a result, some commentators viewed quantitative easing after the financial crisis of 2007-09 with great suspicion. Technically, however, QE is not monetary financing, because central banks only buy government bonds in the secondary market and because they pay interest on reserves (the money they create).
Monetary policy The use, normally by the central bank, of interest rates and other tools to try to influence the economy. Interest rates are raised when the bank is trying to control inflation and lowered when inflation is low and it is trying to revive the economy. The financial crisis of 2007-09 led central banks to face the zero lower bound. This prompted many of them to use a new tool, quantitative easing, which was designed to bring down long-term rates or bond yields.
Posted on March 11, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
***
***
Inattentional Blindness: Is a psychological phenomenon where individuals fail to notice unexpected stimuli in their visual field when their attention is focused on a specific task or object.
This occurs because the brain prioritizes processing information relevant to the task at hand, leading to a temporary inability to perceive other, potentially significant details in the environment. Experiments, such as the famous “invisible gorilla” study, illustrate how people can completely miss prominent objects or events when their attention is directed elsewhere.
And, according to colleague Dan Ariely PhD, inattentional blindness highlights the limitations of human perception and attention, emphasizing that what we see is often influenced by where we focus our cognitive resources.
If you have ever filed a homeowners insurance claim, you know it can feel more like an endurance test than a straightforward process. While insurers are legally required to honor valid claims, they have strong financial incentives to delay, underpay, or deny them whenever possible.
Over the years, I’ve learned this the hard way. The most recent lesson started when a hailstorm hit my home in June 2023. I promptly filed an insurance claim. I also made up a story that leaving someone more qualified than me in charge would free me from a part-time job as a contractor, so I relied on a roofing contractor to handle the whole claim, including the gutter and siding damage. That was my first mistake.
About 15 months later, my roof and gutters were replaced, but the siding repairs and painting remained undone. Every time the insurance company reassigned my claim to a new adjuster, I had to start over. When I called the contractor after a period of inactivity, they said the adjuster had ghosted them, so they’d given up—and I still owed them the full roofing bill.
At that point, I had two choices: pay out of pocket for the unfinished work or escalate. I chose the latter. I filed a complaint with the state insurance division, contacted my agent, reached out to the last adjuster, hired my own painter, and withheld final payment to the contractor. I also made it clear that I was prepared to take legal action if necessary. That was not a bluff.
Within a week, things started moving. Seven days later, the insurance company reinspected my home and sent a check covering all but $3,000 of the painting costs. After nearly two years of delays and excuses, progress finally happened when I took matters into my own hands.
Delay is a common insurer tactic. They’ll repeatedly ask for more documentation, take months to respond, or swap adjusters to force you to restart the process—all in hopes that you’ll give up or accept a lower payout.
Another common tactic is the lowball offer. Insurers often rely on software that underestimates damages or send adjusters unfamiliar with actual repair costs. Accepting their first offer without question can be a costly mistake. It’s wise to get independent repair estimates or even hire a public adjuster who works for you rather than the insurance company.
Insurers also deny claims based on fine print, arguing that damage was pre-existing, caused by poor maintenance, or excluded under some obscure clause. Knowing your policy inside out and keeping pre-loss photos can help you counter these claims.
Another trick? Steering homeowners toward “preferred” contractors who work at discounted rates and may prioritize the insurer’s interests over yours. Getting independent estimates ensures repairs are done properly.
For homeowners stuck in an insurance battle, persistence is key. Withholding final payment until work is complete, filing a complaint with the state insurance division, and even considering small claims court can help push a claim forward. If the dispute is within your state’s small claims limit—often between $10,000 and $25,000—filing may push the insurer to settle.
Assuming my contractor would handle everything was my biggest mistake, and it cost me nearly two years of frustration. Even though progress happened quickly once I took control, my claim isn’t over. I suspect I will be filing legal action in small claims court against the insurance company, contractor, and insurance agent.
If you need to navigate an insurance claim, be persistent and attentive. Keeping records, pushing back on delays, and escalating when necessary can mean the difference between being shortchanged and getting the settlement you deserve.
I was having lunch with a close friend of mine. He mentioned that he had accumulated a significant sum of money and did not know what to do with it. It was sitting in bonds, and inflation was eating its purchasing power at a very rapid rate.
He is a dentist and had originally thought about expanding his business, but a shortage of labor and surging wages turned expanding into a risky and low-return investment. He complained that the stock market was extremely expensive. I agreed.*
He said that the only thing left was residential real estate. I pushed back. “What do you think will happen to the affordability of houses if – and most likely when – interest rates go up? Inflation is now 6%. I don’t know where it will be in a year or two, but what if it becomes a staple of the economy? Interest rates will not be where they are today. Even at 5% interest rates [I know, a number unimaginable today] houses become unaffordable to a significant portion of the population. Yes, borrowers’ incomes will be higher in nominal terms, but the impact of the doubling of interest rates on the cost of mortgages will be devastating to affordability.”
He rejoined, “But look at what happened to housing over the last twenty years. Housing prices have consistently increased, even despite the financial crisis.”
I agreed, but I qualified his statement: “Over the past twenty, actually thirty, years interest rates declined. I honestly don’t know where interest rates will be in the future. But probabilistically, knowing what we know now, the chances that they are going to be higher, much higher, are more likely than their staying low. Especially if you think that inflation will persist.”
We quickly shifted our conversation toward more meaningful topics, like kids.
It seems that every year I think we have finally reached the peak of crazy, only to be proven wrong the next year. The stock market and thus index funds, just like real estate, have only gone one way – up. Index funds became the blunt instrument of choice in an always-rising market. So far, this choice has paid off nicely.
The market is the most expensive it has ever been, and thus future returns of the market and index funds will be unexciting. (I am being gentle here.)
You don’t have to be a stock market junkie to notice the pervasive feeling of euphoria. But euphoria is a temporary, not a permanent emotion; and at least when it comes to the stock market, it is usually supplanted by despair. Market appreciation that was driven by expanding valuations was not a gift but a loan – the type of loan that must always be paid back with a high rate of interest.
I don’t know what straw will break the feeble back of this market or what will cause the music to stop (there, you got two analogies for the price of none). We are in an environment where there are very few good options. If you do nothing, your savings will be eaten away by inflation. If you do something, you find that most assets, including the stock market as a whole, are incredibly overvalued.
We are doing the only sensible thing that you can do today. We spend very little time thinking about straws or what will cause the music to stop or how overvalued the market is. We are focusing all our energy on patiently building a portfolio of high-quality, cash-generative, significantly undervalued businesses that have pricing power.
This has admittedly been less rewarding than taking risky bets on unimaginably expensive assets. It may lack the excitement of sinking money into the darlings you see in the news every day, but we hope that our stocks will look like rare gems when the euphoria condenses into despair. As we keep repeating in every letter, the market is insanely overvalued. Our portfolio is anything but – we don’t own “the market”.
*A question may arise:Why did I not tell my dentist friend to pick individual stocks? He runs a busy dental practice and wouldn’t have the time or the training to pick stocks.
Why didn’t I offer him our services? IMA manages all my and my family’s liquid assets, but I have a rule that I never (ever!) break – I don’t manage my friends’ money. I’ll help them as much as possible with free advice but will never have a professional relationship with them. I intentionally create a separation between my personal and professional lives. After a difficult day in the market, I want to be able to go for beers with friends and leave the market at the office.
Also, this simplifies my relationships with my friends. There is no ambiguity in our friendship.
Posted on March 9, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
***
***
A Morton’s fork is a type of false dilemma in which contradictory observations lead to the same conclusion.
Morton’s Fork:Claims its origin from John Morton, the Archbishop of Canterbury, a public policymaker who used convoluted and contradictory logic to establish tax laws in the mid-15th century.
He contended that whoever lived humbly must be saving much money and hence would be able to pay higher taxes; and those that lived lavish lives were obviously rich, so they could also pay higher taxes.
In other words: a Hobsons Choice between two equally unpleasant alternatives.
Posted on March 9, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
DEFINITION
By Staff Reporters
***
***
FACILITY CHARGEDEFINED
Classic: Service fee submitted for payment by a healthcare facility, such as a clinic, hospital or ambulatory care center.
Modern: Facility fees are expenses charged by hospitals to cover their overhead – the funding needed to keep the lights on, machines running, and doors open, etc. People who receive outpatient care at hospital-owned buildings are charged a facility fee, in addition to treatment costs and fees charged, individually, by doctors.
Examples: How to Fight Facility Fees:
Check with your health agent or insurer. Many insurers don’t cover facility fees or cover only a portion.
Talk to your doctor. It’s hard to tell whether a facility is hospital-run or whether your doctor works for a health system.
Posted on March 9, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
DENTAL ADA DEGREES
By Colgate and Staff Reporters
***
***
DDS vs. DMD Degree
DDS and DMD are the acronyms of the degrees dentists earn after finishing dental school. DDS means Doctor of Dental Surgery, and DMD can mean either Doctor of Medicine in Dentistry or Doctor of Dental Medicine. While the names are different, the American Dental Association (ADA) explains that they represent the same education. Some universities may grant dental graduates with a DDS, and others grant a DMD, but both degrees have the same requirements.
According to the ADA, the Baltimore College of Dental Surgery established the first Doctor of Dental Surgery degrees in 1840. When Harvard University started its dental school in 1867, their degrees were called Dentariae Medicinae Doctorate (Doctor of Medicine in Dentistry) because Harvard uses Latin names for their degrees. Even though these degrees are based on the same educational requirements, they still have different names.
Difference Between a DDS and a DMD Degree?
Today, many universities award a DMD degree. Dentists with either a DDS or a DMD are educated to practice general dentistry. All dentists receive a rigorous education. First, dental schools typically require a four-year undergraduate education. Afterward, graduates go to dental school for another four years of classroom training, clinical training, and dental laboratory training.
Dental students spend the first two years of dental school studying biomedical sciences courses like anatomy, biochemistry, pathology, and pharmacology. The last two years are focused on clinical and laboratory training.
After graduating from dental school, dentists must pass a national written examination called the National Board Dental Examination, followed by a regional clinical board examination. Dentists must also pass a jurisprudence examination about state laws before being given a license to practice dentistry in that state.
Post Graduate Education After a DDS or DMD
Most dentists stick with practicing general dentistry. However, some choose to specialize in a particular area of dentistry after earning their degree. Training programs range from two to six years, depending upon the specialty area. There are several dental specialties, including endodontics, orthodontics, periodontics, prosthodontics, oral surgery, and pediatric dentistry. The ADA can help you find a dentist with a specialty that fits you best.
Dentists receive a rigorous education and have to pass several exams to be able to practice. Whether they have a DDS or DMD after their name, you should choose a dentist based on their skills, types of services provided, communication, and professionalism.
RISK MANAGEMENT, LIABILITY INSURANCE AND ASSET PROTECTION ABBREVIATIONS
[Glossary of Important Acronyms]
Much has been written and much has been opined on the topic of medical risk management, insurance, asset protection and professional liability for physicians and healthcare providers in this textbook; and elsewhere.
But occasionally, we all still get lost in a wide array of abbreviations, acronyms, and initialisms that are constantly changing in this ecosystem.
And so, this glossary serves as a ready reference for those who want to know about these medical risk management definitions in a quick and ready fashion.
Acronyms and Abbreviations
AAASC American Association of Ambulatory Surgery Centers
AAHP American Association of Health Plans
ABN advance beneficiary notice
ABQAUR American Board of Quality Assurance and Utilization Review
ACE acute care episode
ACHCE American College of Health Care Executives
ACS American College of Surgeons
ADA Americans with Disabilities Act
ADC average daily census
ADL activities of daily living
ADT Admission/Discharge/Transfer
AHA American Hospital Association
AHIMA American Health Information Management Association
AHRQ Agency for Healthcare Research and Quality
AI average inventory
AIMR Association for Investment Management and Research
AIR assumed interest rate
ALE annualized loss expectancy
ALF assisted living facility
ALOS average length of stay
AMA American Medical Association
AMBAC AMBAC Indemnity Corporation
AMGA American Medical Group Association
ANSI American National Standards Institute
AP accounts payable
APA American Psychiatric Association
APC ambulatory payment classification
APG ambulatory payment group
APR annual percentage rate
AR accounts receivable
ASA American Society of Appraisers
ASC ambulatory surgery centers; also Accredited Standards Committee
ASHA American Surgical Hospital Association
ASO administrative services only
ASTC ancillary service technical component
ATM asynchronous transfer mode
AVG ambulatory visit group
BANTA best alternative to negotiated agreement
BBA Balanced Budget Act of 1997
BBRA Balanced Budget Refinement Act [1999]
BCP business continuity planning
BEA break-even analysis
BEP break-even point
BIPA Benefits Improvement and Protection Act [2000]
BLS Bureau of Labor Statistics
BPD border protection device
BS balance sheet
BSA Bank Secrecy Act
BVS business valuation standard
CA certificate authority
CAC Carrier Advisory Committee
CAS cost accounting standards
CASB Cost Accounting Standards Board
CC common criteria [for IT Security Evaluation —ISO/IEC 15408]; complication or comorbidity [for MS-DRGs]
CCA certified cost accountant
CCC cash conversion cycle
CCEVS common criteria evaluation and validation scheme
CCHIT Certification Commission for Healthcare Information Technology
CCU critical care unit
CDC Centers for Disease Control and Prevention
CDH consumer-directed healthcare
CDHP consumer-directed healthcare plan
CDPM Clinical Data Project Manager
CDSS clinical decision support system
CEO Chief Executive Officer
CF conversion factor
CFA Chartered Financial Analyst
CFO Chief Financial Officer
CFR Code of Federal Regulations
CHAMP Children’s Health and Medicare Protection Act of 2007
CHAMPUS Civilian Health and Medical Program of the Uniformed Services
CHE Certified Healthcare Executive
CHIPS Center for Healthcare Industry Performance Studies
CIA Corporate Integrity Agreement
CIO Chief Information Officer
CIP Customer Identification Program
CIS computer information systems
CLIA Clinical Laboratory Improvement Act
CLT capitation liability theory
CME continuing medical education
CMI case mix index
CMIO Chief Medical Information Officer
CMIS contribution margin income statement
CMN Certificate of Medical Necessity
CMP Certified Medical Planner ™
CMS Centers for Medicare and Medicaid Services [formerly HCFA]
COD cash on delivery
COGME Council of Graduate Medical Education
COH cash on hand
COLA cost of living allowance
CON Certificate of Need
COO Chief Operating Officer
COSO Committee of Sponsoring Organizations
COTS commercial off-the-shelf
CPHQ Certified Physician in Healthcare Quality
CPIM Certificate in Production and Inventory Management
CPI-U Consumer Price Index—urban
CPM critical (clinical) path method
CPOE computerized physician order entry [system]
CPR computer-based patient record
CPT current procedural terminology
CQI continuous quality improvement
CRL Certification Revocation List
CRM customer relationship management
CRVS California Relative Value Studies
CSO Chief Security Officer
CT scan computed tomography scan [also called CAT scan]
CUSIP Committee on Uniform Security Identification Procedures
Candid CIO: Will Weider, CIO of Ministry Health Care and Affinity Health System, offers his perspectives on administration issues in this blog.
Christina’s Considerations: Christina Thielst is a hospital and healthcare administrator and entrepreneur with a deep desire for continually improving the health of the community being served. This is her blog.
Healing Hospitals — Formerly Ask a Hospital President: F. Nicholas “Nick” Jacobs has more than 20 years experience in hospital management, with an acknowledged reputation for innovation and consumer-centered leadership.
Hospital Impact: Part of the Fierce network of health sites, this site is becoming popular among healthcare administrators for its news updates, tips and opinions on health care matters.
Leading the Way to Medical Excellence: the president of McLeod Health non-profit institutions provides weekly insights into his facilities and health care in general.
Let’s Talk Health Care: Bruce Bullen, Interim Chief Executive Officer at Harvard Pilgrim in Massachusetts, provides and open and ongoing conversation about health care administration.
Life as a Healthcare CIO: Dr. John Halamka records his experiences with infrastructure, applications, policies, management, and governance as he supports 3,000 doctors, 18,000 faculty and about three million patients.
Managed Care Matters: Joe Paduda shares his knowledge on managed care for group health, health policy, health research, and medical news for insurers, employers, and healthcare providers.
More than Medicine: Tom Quinn, president and CEO of Community General Hospital in Syracuse, New York, began his career as a hospital kitchen worker. His perspective on administration reflects his knowledge on how hospitals work from every angle.
Running a Hospital: A CEO of a large Boston hospital shares thoughts on hospitals, medicine and health care issues.
St. Joseph Medical Center: Chief Executive Officer at St. Joseph Medical Center in Missouri, Mr. Kashman, provides personal insight into administrative matters and general topics.
Todd’s Perspective: Todd Linden, president and CEO of Grinnell Regional Medical Center, offers insights into medical administration and guest bloggers provide insight into various departments.
Wachter’s World: This blog focuses on hospitals, hospitalists, quality, safety, policy and much more from Robert M. Wachter, MD, Professor and Associate Chairman of the Department of Medicine at the University of California, San Francisco.
Legal Matters
Drug and Device Law: This blog contains an attorney’s personal views (and those of several other Dechert attorneys) on topics that arise in the defense of pharmaceutical and medical device product liability litigation.
Drug Injury Watch: Learn more about drug injury lawsuits from an attorney who represents patients and their families.
FDA Law Blog: Hyman, Phelps & McNamara, P.C. is the largest dedicated food and drug law firm in the country. Their knowledge about laws and regulations governing drugs, medical devices, foods, dietary supplements, and cosmetics is helpful to anyone interested in these topics.
Health Care Law Blog: Bob Coffield’s expertise lies in helping businesses and health care providers weave through a variety of state and federal health care regulations and assisting them in business transactions.
Health Plan Law: This site contains information about group health plans, claims administration and related ERISA fiduciary issues. This site also contains tutorials.
HealthBlawg: this is David Harlow’s popular health care law blog, offering expert insights and easy-to-understand analysis.
Healthcare Law Blog: Holland & Hart’s healthcare practice provides insight into this arena, including HIPAA, Stark law, the Anti-kickback Statute and more.
HIPAA Blog: Join in on this discussion of medical privacy issues often buried in “political arcana.”
HIPAA, HiTech & HIT: This updated blog brings insight into legal issues, developments and other pertinent information that relates to the creation, use and exchange of electronic health records.
HIT Blawg: This blog is focused on national health information technology legal trends and current news on this topic.
Home Care Law Blog: Learn more about legal and policy issues in the home health care, private duty and hospice industries from Gilliland & Markette LLP.
Med Law Blog: This law blog focuses on topics that range from compliance to contracts and from employee benefits to HIPAA and HIT.
Physician Law: This blog provides and easy way to stay on top of current news, updates and useful tips relating to legal issues that affect physicians and non-institutional providers.
eHealth and Health IT
Chilmark Research: This blog provides perspectives on key IT trends in the healthcare sector.
davidrothman.net: David is the Information Services Specialist at the Community General Hospital Medical Library, but he also provides great ideas for 2.0 tools and tips for healthcare industry professionals on this blog.
e-CareManagement blog: Vince Kuraitis, owner of Better Health Technologies, LLC, has a passion for disease management and care coordination that dates back to 1995.
e-HealthExpert: A non-profit organization provides a free and open forum to support the development of expertise in the field of eHealth, Healthcare Information Systems, and Health IT (Clinical IT).
eHealth: John Sharp is an IT Manager for a major medical center in Northeast Ohio, with a focus on ehealth, personal health records, Web 2.0 technologies, Windows Sharepoint Services and project management.
Found In Cache: If you would prefer a professional’s take on social media matters, Web sites and all things technological, then follow Ed Bennett, a technology expert for a Maryland medical care system.
Future Health IT: A health IT and EPR advocate from the UK provides a format to discuss the future of health care and IT.
Informaticopia: This UK blogger provides eclectic news and views on health informatics and elearning.
MedGadget: Stay ahead of the gadget curve with this site, which offers information about the newest health care gadgets on the market as well as emerging medical technologies.
Neil Versel’s Healthcare IT Blog: A healthcare journalist’s provides his views on the major segment of the industry he covers — and, he provides a ton of links to other sites as well.
Schwartz Healthcare IT Blog: A variety of authors from Schwartz Communications provide insights into ways to use IT effectively within healthcare facilities.
The Health IT Channel: For a different perspective on IT and EHR as well as other health care issues, watch a few videos at this site.
The Healthcare IT Guy: The CEO of Netspective, a Java/.NET consultancy that specializes in healthcare IT with an emphasis on e-health, EMRs, data integration, and legacy modernization, supplies tips and information for physicians and healthcare administration.
ACKNOWLEDGEMENTS: To Mackenzie H. Marcinko PhD of iMBA Inc., Perry D’Alessio CPA CMP™ [Hon] New York, NY; and Daniel B. Moisand CFP®, Principal for Moisand Fitzgerald Tamayo, Melbourne, FL.
Support our online development, and advance our onground research initiatives in free market economics, as we seek to showcase the brightest Next-Gen minds.
THE ME-P DISCLAIMER: Posts, comments and opinions do not necessarily represent iMBA, Inc., but become our property after submission. Copyright © 2006 to-date. iMBA, Inc allows colleges, universities, medical and financial professionals and related clinics, hospitals and non-profit healthcare organizations to distribute our proprietary essays, photos, videos, audios and other documents; etc. However, please review copyright and usage information for each individual asset before submission to us, and/or placement on your publication or web site. Attestation references, citations and/or back-links are required. All other assets are property of the individual copyright holder.
The Leading Business Education Network for Doctors, Financial Advisors and Health Industry Consultants 