BOARD CERTIFICATION EXAM STUDY GUIDES Lower Extremity Trauma
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As a doctor and attorney, it is only logical for me to be the medical guardian for my adult learning and physically challenged cousin. So, I am here in Miami, Floridanearly every month for his physician appointments as well as social service visits. But, we also make sure we attend exciting and fun activities, as well!
In fact, last weekend was no exception as we went to the Sabrina Cohen Foundation for theirAdaptive Beach Daysevent during Brain Awareness Month every June.
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TheCohen Foundationprovides adaptive services for physically impaired people to participate in water activities, particularly in the ocean and beach activities. Miss Cohen was injured 19 years ago in a terrible accident and had a spinal cord injury. Instead of feeling sorry for herself, she created a foundation where she helps others enjoy life and activities outdoors. She received a 2 1/2 million dollar grant from the city of Miami and has a permanent site on the Beach in Miami. And, she provides services and activities for many people and is trying to take her foundation nationwide.
ME-P NOTE: The Illinois’s 11th Congressional District is in the state of Illinois. It includes parts of Cook, DuPage, Kendall, Kane and Will counties, as well some suburbs of Chicago and rural areas. So, please drop us a line and consider learning about and supporting Dr. Kent, regardless of your congressional district, affiliation and/or U.S. state.He is a political centrist and surely a rising new national star.
Posted on June 12, 2023 by Dr. David Edward Marcinko MBA MEd CMP™
By Health Capital Consultants, LLC
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On April 26, 2023, the California-based healthcare giant Kaiser Permanente announced a $5 billion “mega deal” to acquire Pennsylvania health system Geisinger Health. Kaiser also announced the formation of a new nonprofit health system, to be called Risant Health. Geisinger Health will be the first health system under the umbrella of Risant Health, although Kaiser aims to add approximately five more systems to the entity.
This Health Capital Topics article will review this mega deal and discuss what this transaction may mean for hospitals and health systems. (Read more…)
Posted on June 10, 2023 by Dr. David Edward Marcinko MBA MEd CMP™
Understanding the Cost of Capital
[By Calvin W. Wiese; MBA, CPA]
[By David Edward Marcinko MBA]
[Staff Writers]
It is critical to understand and to measure the total cost of capital. Lack of understanding and appreciation of the total cost of capital is widespread, particularly among not-for-profit hospital executives.
Capital Structure Defined
The capital structure includes long-term debt and equity; total capital is the sum of these two. Each of these components has cost associated with it. For the long-term debt portion, this cost is explicit: it is the interest rate plus associated costs of placement and servicing. For the equity portion, the cost is not explicit and is widely misunderstood.
Capital Structure of Hospitals
In many cases, hospital capital structures include significant amounts of equity that has accumulated over many years of favorable operations. Too many physician and healthcare executives wrongly attribute zero cost to the equity portion of their capital structure. Although it is correct that generally accepted accounting principles continue to assign a zero cost to equity, there is opportunity cost associated with equity that needs to be considered. This cost is the opportunity available to utilize that capital in alternative ways.
Cost of Capital
In general, the cost attributed to equity is the return expected by the equity markets on hospital equity. This can be observed by evaluating the equity prices of hospital companies whose equity is traded on public stock exchanges. Usually the equity prices will imply cost of equity in the range of 10% to 14%; at least prior to the recent Wall Street meltdown.
Cost of Equity Exceeds Long-Term Debt
Almost always, the cost of equity implied by hospital equity prices traded on public stock exchanges will substantially exceed the cost of long-term debt. Thus, while many hospital executives will view the cost of equity to be substantially less than the cost of debt (i.e., to be zero), in nearly all cases, the appropriate cost of equity will be substantially greater than the cost of debt.
Weighted Average Cost of Capital
Hospitals need to measure their weighted average cost of capital. WACC is the cost of long-term debt multiplied by the ratio of long-term debt to total capital plus the cost of equity multiplied by the ratio of equity to total capital (where total capital is the sum of long-term debt and equity).
Assessment
WACC is then used as the basis for capital charges associated with all capital investments. Capital investments should be expected to generate positive returns after applying this capital charge based on the WACC.
Conclusion
Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.
Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com
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Congress is actively considering several bills related to site-neutral payment that has hospitals across the U.S. significantly concerned. The proposed legislation would lower the price that Medicare pays hospitals for common outpatient services, such as x-rays and general checkups, and match what it pays outpatient facilities such as physician offices. Facilities that are owned by hospitals (known as hospital outpatient departments, or HOPDs) earn more than twice what an independent outpatient facility earns for providing the same services.
This Health Capital Topics article will review the changes that are being considered by Congress, as well as the responses from stakeholders. (Read more…)
Posted on June 8, 2023 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters and MGMA Survey
Physician Compensation is Rising but Not Keeping Pace with Inflation
Despite physician and advanced practice provider productivity continuing its post-pandemic recovery, compensation gains are being outstripped by the most severe inflationary growth in decades, according to a new report. Provider compensation increased across the board, with primary care physicians (PCPs) receiving the biggest increase last year. Growth in median total compensation for primary care doctors doubled from 2021 to 2022—from pay growth of 2.13% to 4.41%. But these gains were eclipsed by the rate of inflation at 7% and 6.5%, respectively.
Surgical and non-surgical specialists saw their change in median total compensation cool slightly in 2022, dropping from 3.89% for surgical specialists in 2021 to 2.54% in 2022, and from 3.12% for non-surgical physicians in 2021 to 2.36% in 2022, according to the Medical Group Management Association’s 2023 provider compensation and production report.
The Biden administration is confident it will succeed in the courts against Merck & Co’s lawsuit filed on Tuesday, the White House said, defending the Medicare health insurance program’s authority to seek deals on medicine prices. “We are confident we will succeed in the courts: there is nothing in the Constitution that prevents Medicare from negotiating lower drug prices,” White House spokeswoman Karine Jean-Pierre said in a statement.
Behind negative returns for shares of UnitedHealth and Merck, as noted above, UnitedHealth’s shares were off $14.28, or 2.9%, while those of Merck have dropped $3.23, or 2.9%. A $1 move in any one of the 30 components of the Dow results in a 6.59-point swing. In summary:
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Here is where the major benchmarks ended yesterday:
The S&P 500® Index was up 10.04 points (0.2%) at 4283.84; the Dow Jones industrial average was up 10.48 at 33,573.34; the NASDAQ Composite was up about 47 points (0.36%) at 13,276.42.
The 10-year Treasury yield was little changed at 3.687%.
Posted on May 31, 2023 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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Workers appear to value paid time off even more than having employer-funded health insurance, a recent study found. The Pew Research Center report called “How Americans view their jobs” found 62% of the 5,900 people surveyed felt it’s “extremely” important to have paid time off for vacations or minor illness, with a further 27% saying it’s “very” important. That’s higher than the 51% who said employer-funded health insurance was extremely important, with 28% saying it’s very important.
And, here is where the major market benchmarks ended yesterday:
The S&P 500 Index was up 0.07 point at 4205.52; the Dow Jones industrial average was down 50.56 (0.2%) at 33,042.78; the NASDAQ Composite was up 41.74 (0.32%) at 13,017.43.
The 10-year Treasury yield was down about 13 basis points at 3.694%.
CBOE’s Volatility Index was little changed at 17.46.
Oilfield services companies and others in energy were among the weakest performers as crude oil futures dropped more than 4% to less than $70 a barrel, reflecting ample supply.
Consumer staples and health care were also weak. The U.S. dollar index was down slightly after rising earlier to its highest level since mid-March.
Posted on May 31, 2023 by Dr. David Edward Marcinko MBA MEd CMP™
A”Surprise Billing” Maven
By Staff Reporters
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Envision, a $10 billion physician and ambulatory surgery firm owned by private equity giant Kohlberg Kravis Roberts, filed for Chapter 11 bankruptcy on May 15th 2023. It was the largest healthcare bankruptcy in US history.
Envision claimed to employ 25 thousand clinicians- emergency physicians, anesthesiologists, hospitalists, intensivists, and advanced practice nurses and contracted with 780 hospitals. Envision’s ER physicians delivered 12 million visits in 2021, not quite 10% of the US total hospital ED visits.
Posted on May 24, 2023 by Dr. David Edward Marcinko MBA MEd CMP™
By Anonymous
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The HHS OIG Fall 2022 report was recently released to Congress. On page 20, there are many referrals to seven inappropriate payments to a variety of Medicare “Advantage” Plans. Topping the list is Humana. The OIG claims that Humana in the time period studied falsified records to receive $34.4M worth of payments they received from CMS for risk diagnosis code risk assessments. If even half this amount is true, it is unconscionable that Humana is not severely fined, their executives terminated and subjected to criminal proceedings, and they should be banned from the Medicare program for ten years. This is no different from how other healthcare providers are criminalized, so the question is, why is the insurance industry treated different and preferentially when they commit fraud?
These OIG studies are great reads, but up until now, they have done nothing to stop the insurance industry’s abusive practices of denying “clean claims”, denying claims after prior authorization, ignoring CCI edits, “losing” charts sent for review and then claiming higher error rates to Congress, paying providers often less than 50% of Medicare, and this the last draw… falsifying data so they can be paid more from CMS. When will this madness stop? When will providers have the gumption to actually act out the famous quote, “I’m mad as hell and I’m not going take it anymore!” (from the movie Network), and Peter Finch it!
Posted on May 23, 2023 by Dr. David Edward Marcinko MBA MEd CMP™
MENTAL HEATH AMERICA
By Staff Reporters
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MENTAL HEALTH PARITY ACT
Atlanta, GA – Governor Brian P. Kemp, joined by First Lady Marty Kemp and their three daughters, Lt. Governor Geoff Duncan, Speaker David Ralston, members of the House and Senate, and mental health advocates, to sign the Mental Health Parity Act (HB1013) into law.
You may view his remarks from the bill signing ceremony below, and you can watch the full ceremony here.
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Mental Health Rights
People living with mental health conditions are people. They have people they love, activities they enjoy, and dreams for their lives. As people, they deserve to be treated with dignity, and under the law they have rights and protections.
Unfortunately, it has long been the case that individuals with mental health conditions are among the most abused and discriminated against in our country. From leaving people to languish in overcrowded state hospitals to lobotomies and forced sterilization, the treatment of those with mental health conditions is a dark stain on our history as a nation.
While we have come a long way, abuse and discrimination continue to be serious problems today. The shackling or restraining of children, keeping people out of work, and denying access to services are just a few examples of the way we continue to fail the 1 in 5 Americans that has a diagnosable mental health disorder.
This is not just a small issue for a small group of people: half of all Americans will experience a diagnosable mental health condition in their lifetime. If it is not us being directly impacted, it is likely that it will be our family members, friends, or loved ones– whether we know it or not. Beyond struggles in education or employment, we see the loss of human dignity and even human life for the people we love and care about when we do not work to address abuses in the system.
For Mental Health America, the fight against abuse and discrimination is essential to our history and continues to guide our work. MHA’s symbol, which sits in our national office, is the Bell of Hope cast from the chains and shackles that were used to restrain individuals in old state hospitals. As an organization, MHA is committed to the principles of human and civil rights inherent to the concept of equal justice under the law.
Posted on May 23, 2023 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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Here is where the major benchmarks ended yesterday:
The S&P 500® Index was up 0.65 point at 4192.63; the Dow Jones industrial average was down 140.05 (0.4%) at 33,286.58; the NASDAQ Composite was up 62.88 (0.5%) at 12,720.78.
The 10-year Treasury yield was up about 3 basis points at 3.721%.
CBOE’s Volatility Index was up 0.38 at 17.19.
The NASDAQ-100 Index ended at a 13-month high, driven by gains in large tech companies. Lenders were also particularly strong, with the KBW Regional Banking Index up nearly 3%. Oilfield services companies also rose as crude oil futures ticked higher. Consumer staples was among the weaker sectors.
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Debt ceiling negotiations could result in less funding for state and local health officials to combat STDs. Remote work is making it easier for some family caregivers to fill care gaps. An RSV vaccine for pregnant women is another step closer to approval. Congress will question CIGNA over its practice of rejecting medical claims by the hundreds of thousands every month.
Posted on May 17, 2023 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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The Federal Trade Commission said on Tuesday [yesterday] it will try to block an effort by bio-pharmaceutical leader Amgen Inc. from purchasing Horizon Therapeutics for $28.3 billion, charging the move could force insurance companies to favor their products. The FTC said the coupling of Amgen and Horizon could have allowed Amgen to leverage its portfolio of top-selling drugs to entrench a monopoly position in treatments for thyroid eye disease and chronic refractory gout. The watchdog agency said Amgen could force insurance companies and pharmacy benefit managers, or PBMs, into favoring Horizon’s two monopoly products. It said Tepezza is used to treat thyroid eye disease, while Krystexxa is used to treat chronic refractory gout. The agency said neither of the treatments has competition in the pharmaceutical marketplace.
And, the CME FedWatch Tool shows an 82% probability of the Fed leaving rates where they are, versus an 18% chance of another rate hike. As for rate cuts, Liz Ann Sonders of Schwab said they remain unlikely “unless the banking crisis significantly worsens and/or the economy or labor market sinks notably.” “Otherwise, the most likely outcome is for the Fed to pause and hold,” she added.
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So, here is where the major benchmarks ended yesterday:
The S&P 500® Index was down 26.38 points (0.64%) at 4,109.90; the Dow Jones Industrial Average was down 336.46 (1.01%) at 33,012.14; the NASDAQ Composite was down 22.16 (0.18%) at 12,343.05.
The 10-year Treasury yield was up about 4 basis points at 3.541%.
CBOE’s Volatility Index was up 90 basis points at 18.02.
The energy sector was one of the weakest performers Tuesday, as WTI Crude Oil futures dipped. The Dow Jones U.S. Oil & Gas Total Stock Market Index was down more than 2%, while the S&P Global Oil Index shed 2.5%. Real estate and utilities also lagged. Communication services and tech were the strongest performers.
Posted on May 16, 2023 by Dr. David Edward Marcinko MBA MEd CMP™
By Anonymous
GoodRx Holdings, Inc. is an American healthcare company that operates a telemedicine platform and a free-to-use website and mobile app that track prescription drug prices in the United States and provide free drug coupons for discounts on medications. GoodRx checks more than 75,000 pharmacies in the United States
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Good Rx makes money by perpetuating the, artificially set, high sticker prices of medications and receiving a portion of Pharmacy Benefits Manager [PBM] fees.
How it Works
GoodRx taps into PBM network for their “discounts” off of sticker price (e.g. Express Scripts, Optum Rx, Navitus … etc)
Consumer pays the newly “discounted” drug price.
Pharmacy pays PBM fee.
PBM pays GoodRx portion of the fee.
Good Rx adjusted EBITDA in 2019: $160 Million
Good Rx 2020 revenue is up 48% first half of 2020 – $257M
Posted on May 12, 2023 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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Happy 203rd birthday to Florence Nightingale, the founder of modern nursing. She rose to fame during the Crimean War, when her hygiene standards substantially reduced the mortality rate at army hospitals. The healthcare industry still relies on some of her ideas, such as using data as a tool to improve hospital care. The “lady with the lamp” is still lighting the path forward.
Posted on May 11, 2023 by Dr. David Edward Marcinko MBA MEd CMP™
By Health Capital Consultants, LLC
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On January 30th, 2023, President Joseph Biden announced that the public health emergency (PHE) and national emergency declaration related to the COVID-19 pandemic will finally end on May 11, 2023, after being in place for over three years.
And so, this Health Capital Topics article will discuss the changes that will take place after both declarations cease, and the implications for stakeholders. (Read more…)
Posted on May 11, 2023 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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Because the inflation data came in roughly as expected, Wall Street sees the door still open for the Federal Reserve to leave interest rates alone at its next meeting in June. That would be the first time it hasn’t raised rates at a meeting in more than a year, and a pause would offer some breathing room for the economy and financial markets.
Today is the last day of the US Covid-19 public health emergency, which has been in place since Jan. 31st, 2020. With it comes the end of certain Covid-era rules, though some telehealth protections have been extended through the end of 2024. Here’s to all the medical professionals who got us through, and a remembrance for the millions who lost their lives to Covid.
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Brightline, a California-based mental health startup, laid off 20% of its staff this week following a data breach. North Carolina is the latest state to consider changes to the prior authorization process that advocates say delays care. A board member at Geisinger claims that consolidation prompted the healthcare provider to sell to Kaiser Permanente. Texas Gov. Greg Abbottsaid the state should address mental health issues in the wake of a shopping mall mass shooting, but did not call for gun control reform.
Finally, here is where the major benchmarks ended yesterday:
The S&P 500 Index was up 18.47 points (0.5%) at 4137.64; the Dow Jones industrial average was down 30.48 (0.1%) at 33,531.33; the NASDAQ Composite was up 126.89 (1.0%) at 12,306.44.
The 10-year Treasury yield was down about 8 basis points at 3.441%.
CBOE’s Volatility Index was down 0.80 at 16.91.
Oilfield services providers and other energy companies were among the laggards Wednesday, pressured by a more-than 1% drop in WTI crude oil futures.
Financial sector stocks struggling to escape the effects of the bank volatility earlier this spring helped push the KWB Regional Bank Index back near a 2½-year low reached last week.
Posted on May 10, 2023 by Dr. David Edward Marcinko MBA MEd CMP™
By Health Capital Consultants, Inc
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On February 22, 2023, UnitedHealth Group’s (UHG’s) Optum division, the health insurance giant’s care delivery arm, acquired Crystal Run Healthcare, a New York based physician group of almost 400 physicians, nurse practitioners, and other providers
This significant move is just the latest in UHG’s concerted effort over the past few years to acquire outpatient providers, surgery centers, and physician groups. This Health Capital Topics article will briefly survey some of the insurer’s recent acquisitions and initiatives to expand their physician services network. (Read more…)
Posted on May 6, 2023 by Dr. David Edward Marcinko MBA MEd CMP™
The Invisible Hand of Capitalism?
By Vitaliy Katsenelson CFA
Just as the well-meaning economist of the Soviet Union didn’t know the correct price of sugar, nor do the good-intentioned economists of our global central banks know where interest rates should be.
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Assessment
Even more important, they can’t predict the consequences of their actions.
Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.
Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com
OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:
Posted on May 6, 2023 by Dr. David Edward Marcinko MBA MEd CMP™
By Ann Miller RN MHACMP™
INTRODUCING OUR NEXT GENERATION e-BOOK LIBRARYFROM iMBA, Inc.
An e-book is an electronic or digital book that can be read on a computer or a handheld device.
Our new e-books consists of text, images, and are fixed to a specific spot on the page.
And, our e-books are a data files similar in content and structure to a word-processing document that comes in a PDF format. To use our e-books, you need to purchase and download it to a device that has a .pdf file reader app, such as ADOBE® or similar on a smartphone, tablet or computer. A PDF, also known as a portable document format, is the format most people are familiar with and used in our e-books. PDFs are known for their ease of use and ability to hold custom layouts. They are the most commonly used e-Book formats, especially by professionals and adult-learners.
You can then access the e-book and read it, or highlight pages and even take side notes.
e-Books Save Money
With no manufacturing, printing, binding or shipping costs, e-Books are cheaper than traditional hard or paper back books.The price of each specialized and highly niche focused e-Book [50-100 pages] is only $25, whereas similar paperback printed books of this type generally cost $145, or more!
Posted on May 5, 2023 by Dr. David Edward Marcinko MBA MEd CMP™
SDOH
By Staff Reporters
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READ: Social determinants of health aren’t just for patients. Health systems looking to promote health equity within their communities can start internally, by looking at their own workforce; according to HealthcareBrew.
Posted on May 4, 2023 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
MAY THE FOURTH BE WITH YOU
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Many pharma companies reported earnings in the last week, and the common thread is crashing Covid-related sales.
For example, AstraZeneca’s Covid medication sales dropped $1.5b in Q1, Merck’s Covid antiviral sales fell 88% from the same quarter in 2022, and Roche’s diagnostics division sales fell 28% from Q1 2022, thanks to low Covid-test demand. Clearly, pharma companies have to figure out how to pivot their strategies in a post-Covid world.
The CDCwill not continue to track Covid-19 community spread as the country enters the endemic stage of the pandemic.
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The Food and Drug Administration approved Wednesday the first-ever vaccine to combat severe respiratory syncytial virus, or RSV. Arexvy, the new vaccine developed by GlaxoSmithKline, was approved for adults 60 and older and was 82% effective at preventing lower respiratory tract illness caused by RSV, according to trial data. It was also 94% effective in those who had at least one underlying medical condition.
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The Federal Reserve voted unanimously to raise interest rates by a quarter point yesterday, the tenth rate hike since the central bank started its battle against inflation last March. The move comes amid ongoing fragility in the banking sector triggered partly by higher interest rates, and following the collapse of three regional banks. Markets had anticipated the rate hike, and remained fairly muted after the Fed’s announcement.
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Finally, here’s where the major indexes ended up:
The S&P 500® Index was down 28.83 points at 4090.75; the Dow Jones industrial average was down 270.29 (0.8%) at 33,414.24; the NASDAQ Composite was down 55.18 (0.5%) at 12,025.33.
The 10-year Treasury yield was down about 7 basis points at 3.367%.
CBOE’s Volatility Index was up 0.52 at 18.30.
Energy companies were among the market’s weakest performers as crude oil continued a recent decline, with WTI crude futures falling more than 4% under $70 a barrel—a nearly six-week low.
Semiconductor and financial shares were also weak. The U.S. dollar index dropped sharply in the wake of the Fed announcement before rebounding.
Posted on May 3, 2023 by Dr. David Edward Marcinko MBA MEd CMP™
FOR MEDICAL AND HEALTHCARE ENTREPRENEURS AND INNOVATORS
By Dr. David Edward Marcinko MBA MEdCMP®
I was asked by business schools and medical colleagues – and their bankers, CPAs and advisors – to speak about this topic several times last year before the pandemic.
Now, with the specter of M-4-A etc; it certainly is a vital concern to all young entrepreneurs, doctors & medical professionals whether live, audio recorded or in podcast form. And so, here is a written transcript of a recent presentation for your review.
Now, with the specter of tele-health, tele-medicine, M-4-A etc; it certainly is a vital concern to all young doctors & medical professionals whether live, audio recorded or in podcast form. And so, here is a written transcript of a recent presentation for your review.
Posted on April 30, 2023 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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Eli Lilly (NYSE: LLY) investors continued to be in a good mood about their stock on Friday. Following the estimates-beating first quarter reported by the big pharmaceutical company the previous morning, they traded the shares up by 1.4% on the final trading day of the week. That eclipsed the 0.8% gain of the S&P 500 index.
Researchers at MIT have created a new type of tabletop printer that spits out vaccine doses on demand in the form of thumbnail-size microneedle patches. Once scaled, this mobile technology could produce hundreds of doses per day, revolutionizing pandemic response. And in a boon for warmer or more remote parts of the world, the vaccine patches can be stored at room temperature for months before they’re slapped on—no refrigeration or professional administering required.
Posted on April 27, 2023 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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The two tech giants posted earnings that showed they’re both on solid footing, despite investors’ concerns that growth would slow to a trickle. For Alphabet, Google search advertising revenue grew again after a quarter in the red. And Microsoft’s all-important cloud division posted better-than-expected sales. Both companies stated AI could impact their businesses, but they differed in their predictions: Microsoft characterized AI as a much more disruptive force than Google did.
Get ready for earnings calls from pharmaceutical companies: Eli Lilly, AstraZeneca, AbbVie, and more quarterly calls this week. Investors will watch AbbVie’s sales numbers, as Amgen introduced the first biosimilar version of AbbVie’s blockbuster arthritis drug, Humira, in January. In its last call, AbbVie executives said they expected to lose $7.9 billion in Humira sales in 2023
The S&P 500 Index was down 15.64 points (0.4%) at 4055.99; the Dow Jones industrial average was down 228.96 (0.7%) at 33,301.87; the NASDAQ Composite was up 55.19 (0.5%) at 11,854.35.
The 10-year Treasury yield was up about 4 basis points at 3.439%.
Posted on April 27, 2023 by Dr. David Edward Marcinko MBA MEd CMP™
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By Kevin Pho MD
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“Teaching medical students entrepreneurial and business skills is invaluable as the need for leadership in medicine grows in every single sector. Many physicians already engage in managerial and entrepreneurial-like practices without labeling these skills. By formalizing these skills into medical education, physicians will be able to take their ambitions and ideas about how to best run existing health care institutions and translate them into innovations for the future of the field.”
Sofia Yunez is a medical student.
She shares her story and discusses her KevinMD article, “To be effective leaders, physicians need to be trained as entrepreneurs and encouraged to innovate.”
Posted on April 26, 2023 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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DEFINITION: Startups areyoung companies or ventures that are founded to develop a unique or innovative product, service, or platform, and bring it to market. They are typically in the early stages of their development and face high uncertainty and failure rates. They are usually self-funded by the founders or seek external funding from investors or loans. They aim to grow large beyond the solo founder and disrupt existing industries or create new one.
SVB was relatively small—it had 40,000 customers compared to JPMorgan Chase’s 66 million—but it claimed to bank nearly half of all US tech and life sciences startups last year, including household names like Etsy, Roblox, and Roku. The cultural cachet of having a relationship with SVB as a venture-backed startup was like sporting a New Yorker tote at Whole Foods.
But the reason its loss will leave such a gaping hole in the startup community isn’t that it was cool to name-drop at a networking event. Because the bank was created in 1983 specifically to cater to venture-backed startups, it helped them in ways that most banks can’t—or won’t.
SVB chill loans: According to the MorningBrew, SVB would offer loans to startups more readily than large banks, basing the loans on a company’s ability to raise venture capital funds, not to turn a profit. SVB was also known for being flexible—even if startups breached their loan terms. “They were the easiest money for an unprofitable, early stage to mid-stage tech company,” Irving Investors founder Jeremy Abelson told The Information. And, even small startups received hand-holding services, such as guidance on how to set up their financial infrastructure. Its bankers personally called startups when they secured their first rounds of funding, according to The Information.
Startups now have to deal with big banks
Several founders who previously banked with SVB told Bloomberg that they’re moving their money to Chase and Bank of America, banks considered “too big to fail.”
Startups’ experience at big banks won’t be like their time at SVB. Not only is Jamie Dimon unlikely to call a startup to congratulate them on their Series A, but big banks are also expected to be more tight-fisted with their loans. The Office of the Comptroller of the Currency, a regulator that oversees large US banks, disapproves of loans to companies that are further out than one year from profitability, according to Crunchbase.
The loss of SVB is therefore expected to have a chilling effect on loans to venture-backed startups, aka “venture debt,” which SVB handed out more of than any other bank.
Posted on April 26, 2023 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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DEFINITION: Financial technology (abbreviated fintech or FinTech) is the technology and innovation that aims to compete with traditional financial methods in the delivery of financial services. Artificial intelligence, Blockchain, Cloud computing, and big Data are regarded as the “ABCD” (four key areas) of FinTech. The Fintech industry is an emerging industry that uses technology to improve activities in finance. The use of smartphones for mobile banking, investing, borrowing services,and cryptocurrency are examples of technologies aiming to make financial services more accessible to the general public.
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Financial technology companies consist of both startups and established financial institutions and technology companies trying to replace or enhance the usage of financial services provided by existing financial companies.
Posted on April 26, 2023 by Dr. David Edward Marcinko MBA MEd CMP™
THE EIGHT [8] GIFTS
By Staff Reporters
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Much like the False Claims Act, the Anti-Kickback Statute (AKS) remains a frequent tool used by the Department of Justice to investigate the healthcare industry. Unlike the False Claims Act, the AKS imposes criminal penalties on violators.
The leaders of a physicians’ practice may be held liable for what others in the practice do, even if the leader did not know precisely what was going on. It has been called the “crime of doing nothing.”
1. Providing free dinners or lunches to physicians
2. Travel expenses paid to physicians
3. Entering into consulting or research agreements with physicians under which payments are made but minimal (or zero) work is done in return
4. Other gifts, such as electronics or tickets to sporting events
5. Laboratory pays a specimen processing fee to physicians above the fair value for those fees
6. Physician retention or recruitment agreements, when those agreements provide for payments above fair market value or are made with the intent to induce Medicare referrals
7. Agreements for speaking or teaching where the payments are above fair market value or made with the intent to induce referrals
8. Discount schemes that do not meet the safe harbor requirements
Source: Sara Kropf and Logan Lutton, Physicans Practice
Posted on April 25, 2023 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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Physicians Who Accept Medicare, Medicaid at All-time Low of 65%
Reduced Medicare and Medicaid payments are having more physicians considering reducing those patient bases, according to Medscape’s “Physician Compensation Report” for 2023. Sixty-five percent of physicians surveyed said they would continue treating current Medicare or Medicaid patients and take on new ones, according to the report. Medscape said it is the lowest percentage it has seen in its annual compensation reports. Five years ago, 71 percent of physicians said they would continue treating current Medicare or Medicaid patients and take on new ones.
For the report, Medscape collected responses from 10,011 physicians across more than 29 specialties. The data was collected between Oct. 7, 2022, and Jan. 17, 2023. Eight percent of physicians surveyed said they would not take on new Medicare patients, and 5 percent said they would not take new Medicaid patients. Four percent said they will stop treating some or all of their current Medicare patients and will not take on new ones, and 3 percent said the same about Medicaid patients. Twenty-two percent said they have not yet decided how they will move forward regarding Medicare and Medicaid patients, according to the report.
Source: Andrew Cass, Becker’s Payer Issues [4/18/23]
Women earn as much as or more than their husbands in just under half of US opposite-sex marriages, a significant advancement for economic equality from past decades, according to a new Pew Research study.
Sixteen percent of wives in opposite-sex marriages are the sole or primary breadwinners in their home (“primary” meaning they make more than 60% of the household’s income). This share is triple the 5% of women breadwinners from 50 years ago.
In 29% of marriages, both spouses bring home about the same income.
But, according to MorningBrew, in marriages where both partners have the same income, women spend about four-and-a-half more hours per week on chores and care giving than men.
And when women become the house’s primary income earner, little really changes about how much time either partner spends on chores, Pew found. But in this scenario, men report almost five more hours of leisure time per week than men in egalitarian households
Posted on April 20, 2023 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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Meta Platforms, the billionaire’s social media empire, will reportedly cut thousands more jobs. And the bloodbath is not over, according to the latest reports. Meta plans to eliminate thousands more jobs. According to Bloomberg News, an internal memo has been sent to managers, asking them to prepare for tough new announcements. The job cuts, which total 4,000, are expected to affect Facebook, WhatsApp and Instagram. They would also affect Reality Labs, the division that houses the group’s Metaverse projects — Quest virtual-reality headsets. In 2021 and 2022, Reality Labs, which is supposed to build the company’s next big thing, recorded a cumulative loss of nearly $24 billion, including $13.7 billion just last year.
And, Walt Disney Company plans to cut thousands of jobs next week, in another lay-off round that includes about 15% of the staff in its entertainment division, according to people familiar with the plans. Disney Entertainment will bear a significant chunk of the job cuts – with approximately 15% of the division’s staffers set to exit next week, according to a report. Disney has more than 200,000 employees across its various businesses.
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And now, the Markets:
The S&P 500 Index fell 0.35 point to 4154.52; the Dow Jones industrial average was down 79.62 (0.2%) at 33,897.01; the NASDAQ Composite was up 3.81 at 12,157.23.
The 10-year Treasury yield was up about 2 basis points at 3.60%.
CBOE’s Volatility Index was down 0.37 at 16.46.
Transportation was one of the top gainers among S&P 500 sectors yesterday, thanks in part to strength in United Airlines (UAL) and other top carriers. Real estate and financials were also higher, while oilfield services stocks were among the weakest performers due to a sharp drop in crude oil prices. WTI futures fell below $80, their lowest level in nearly three weeks.
Oil prices rallied at the start of this month after members of OPEC+ announced a production cut.
National Healthcare Decisions Day (NHDD) exists to inspire, educate and empower the public and providers about the importance of advance care planning. NHDD is an initiative to encourage patients to express their wishes regarding healthcare and for providers and facilities to respect those wishes, whatever they may be.
NHDD was founded in 2008 by Nathan Kottkamp, a Virginia-based health care lawyer, to provide clear, concise, and consistent information on healthcare decision-making to both the public and providers/facilities through the widespread availability and dissemination of simple, free, and uniform tools (not just forms) to guide the process.
NHDD is a series of independent events held across the country, supported by a national media and public education campaign. In all respects, NHDD is inclusive and brings a variety of players in the larger healthcare, legal, and religious community together to work on a common project, to the benefit of patients, families, and providers. A key goal of NHDD is to demystify healthcare decision-making and make the topic of advance care planning inescapable. Among other things, NHDD helps people understand that advance healthcare decision-making includes much more than living wills; it is a process that should focus first on conversation and choosing an agent.
As of June 2016, The Conversation Project has been responsible for the management, finances, and structure of NHDD. NHDD’s founder, Nathan Kottkamp, continues to be involved in NHDD and provides leadership by ensuring the maintenance of NHDD’s high quality resources and support for the community.
DEFINITION: What is advance care planning for financial advisors and lawyers?
Advance care planning involves discussing and preparing for future decisions about your medical care if you become seriously ill or unable to communicate your wishes with your estate planning attorney or financial advisor. Having meaningful conversations with your loved ones is the most important part of advance care planning. Many people also choose to put their preferences in writing by completing legal documents called advance directives.
What are advance directives?
Advance directives are legal documents that provide instructions for medical care and only go into effect if you cannot communicate your own wishes.
The two most common advance directives for health care are the living will and the durable power of attorney for health care.
Living will: A living will is a legal document that tells doctors how you want to be treated if you cannot make your own decisions about emergency treatment. In a living will, you can say which common medical treatments or care you would want, which ones you would want to avoid, and under which conditions each of your choices applies. Learn more about preparing a living will.
Durable power of attorneyfor health care: A durable power of attorney for health care is a legal document that names your health care proxy, a person who can make health care decisions for you if you are unable to communicate these yourself. Your proxy, also known as a representative, surrogate, or agent, should be familiar with your values and wishes. A proxy can be chosen in addition to or instead of a living will. Having a health care proxy helps you plan for situations that cannot be foreseen, such as a serious car accident or stroke. Learn more about choosing a health care proxy.
Think of your advance directives as living documents that you review at least once each year and update if a major life event occurs such as retirement, moving out of state, or a significant change in your health.
Advance care planning is not just for people who are very old or ill. At any age, a medical crisis could leave you unable to communicate your own health care decisions. Planning now for your future health care can help ensure you get the medical care you want and that someone you trust will be there to make decisions for you.
Advance care planning for people with dementia. Many people do not realize that Alzheimer’s disease and related dementias are terminal conditions and ultimately result in death. People in the later stages of dementia often lose their ability to do the simplest tasks. If you have dementia, advance care planning can give you a sense of control over an uncertain future and enable you to participate directly in decision-making about your future care. If you are a loved one of someone with dementia, encourage these discussions as early as possible. In the later stages of dementia, you may wish to discuss decisions with other family members, your loved one’s health care provider, or a trusted friend to feel more supported when deciding the types of care and treatments the person would want.
What happens if you do not have an advance directive?
If you do not have an advance directive and you are unable to make decisions on your own, the state laws where you live will determine who may make medical decisions on your behalf. This is typically your spouse, your parents if they are available, or your children if they are adults. If you are unmarried and have not named your partner as your proxy, it’s possible they could be excluded from decision-making. If you have no family members, some states allow a close friend who is familiar with your values to help. Or they may assign a physician to represent your best interests. To find out the laws in your state, contact your state legal aid office or state bar association.
Will an advance directive guarantee your wishes are followed?
An advance directive is legally recognized but not legally binding. This means that your health care provider and proxy will do their best to respect your advance directives, but there may be circumstances in which they cannot follow your wishes exactly. For example, you may be in a complex medical situation where it is unclear what you would want. This is another key reason why having conversations about your preferences is so important. Talking with your loved ones ahead of time may help them better navigate unanticipated issues.
There is the possibility that a health care provider refuses to follow your advance directives. This might happen if the decision goes against:
The health care provider’s conscience
The health care institution’s policy
Accepted health care standards
In these situations, the health care provider must inform your health care proxy immediately and consider transferring your care to another provider.
Other advance care planning forms and orders from doctors
You might want to prepare documents to express your wishes about a single medical issue or something else not already covered in your advance directives, such as an emergency. For these types of situations, you can talk with a doctor about establishing the following orders:
Do not resuscitate (DNR) order: A DNR becomes part of your medical chart to inform medical staff in a hospital or nursing facility that you do not want CPR or other life-support measures to be attempted if your heartbeat and breathing stop. Sometimes this document is referred to as a do not attempt resuscitation (DNR) order or an allow natural death (AND) order. Even though a living will might state that CPR is not wanted, it is helpful to have a DNR order as part of your medical file if you go to a hospital. Posting a DNR next to your hospital bed might avoid confusion in an emergency. Without a DNR order, medical staff will attempt every effort to restore your breathing and the normal rhythm of your heart.
Do not intubate (DNI) order: A similar document, a DNI informs medical staff in a hospital or nursing facility that you do not want to be on a ventilator.
Do not hospitalize (DNH) order: A DNH indicates to long-term care providers, such as nursing home staff, that you prefer not to be sent to a hospital for treatment at the end of life.
Out-of-hospital DNR order: An out-of-hospital DNR alerts emergency medical personnel to your wishes regarding measures to restore your heartbeat or breathing if you are not in a hospital.
Physician orders for life-sustaining treatment (POLST) and medical orders for life-sustaining treatment (MOLST) forms:These forms provide guidance about your medical care that health care professionals can act on immediately in an emergency. They serve as a medical order in addition to your advance directive. Typically, you create a POLST or MOLST when you are near the end of life or critically ill and understand the specific decisions that might need to be made on your behalf. These forms may also be called portable medical orders or physician orders for scope of treatment (POST). Check with your state department of health to find out if these forms are available where you live.
At enrollment, Medicare in the future could offer three advancedirectives with goals of care: DirectiveA: CONSENT to treat — inpatient medical treatment DirectiveB: CONSENT to comfort — home bound holistic care DirectiveC: CHOOSE against medical advice — outpatient palliative resources.
Posted on April 14, 2023 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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A 2020 analysis of Doximity’s physician compensation data found that men physicians make an estimated $2 million more than women over the course of their careers.
Men physicians outearned women physicians by at least 10% across all specialties, except pediatric cardiology (9.2%) and nuclear medicine (3%).
Specialties with the largest gender pay gaps were: oral and maxillofacial surgery ($568,789 vs. $395,687), pediatric pulmonology ($282,272 vs. $227,958), allergy and immunology ($329,634 vs. $268,938), urology ($515,850 vs. $424,733), and ophthalmology ($468,515 vs. $387,295).
Specialities with the smallest gender pay gaps were: nuclear medicine ($394,231 vs. $382,431), pediatric cardiology ($334,384 vs. $303,622), pediatric gastroenterology ($293,771 vs. $264,135) hematology ($358,736 vs. $320,938), and medicine/pediatrics ($283,034 vs. $253,019).
Posted on April 10, 2023 by Dr. David Edward Marcinko MBA MEd CMP™
NOW AVAILABLE
By Staff Reporters via CMS
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Open Payments is a national disclosure program that promotes a transparent and accountable healthcare system. Open Payments houses a publicly accessible database of payments that reporting entities, including drug and medical device companies, make to certain healthcare providers, which are referred to as covered recipients.
Pre-publication review and dispute for the Program Year 2022 Open Payments data opened on April 1st and is available through May 15th, 2023. Disputes must be initiated by May 15th, 2023 in order to be reflected in the June 2023 data publication.
Posted on April 7, 2023 by Dr. David Edward Marcinko MBA MEd CMP™
Happy 75th Birthday
By Staff Reporters
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It’s World Health Day and the 75th birthday of the World Health Organization (WHO). Thanks to the WHO, we have almost eradicated diseases like polio and smallpox, and the organization led the largest-ever response to a global health crisis against the Covid-19 pandemic.
So, why not Celebrate this WorldHealthDay by taking care of yourself? It doesn’t have to be tough or uninteresting to eat a well-balanced, nutrient-dense diet, reduce alcohol intake or go for a walk or other exercise. And, stick around for next year!
Posted on April 6, 2023 by Dr. David Edward Marcinko MBA MEd CMP™
“Sameach Pesach”
Holy [Maundy] Thursday
By Staff Reporters
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Markets: The NASDAQ extended its losing streak for a third day yesterday amidst a mixed showing for stocks overall. Among the tech stocks having a rough day was cybersecurity giant Zscaler, as investors got new data suggesting the labor market may be cooling (setting off recession jitters again).
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This week’s economic numbers “all point to a softening economy,” but not necessarily a “soft landing,” says Kevin Gordon, senior investment strategist at the Schwab Center for Financial Research. An economic slowdown that averts recession “is what the Fed is looking for, but the market is saying today—with both stock prices and bond yields lower—that recession fears are outweighing hopes for a soft landing,” Kevin says.
The S&P 500® Index fell 10.22 points (0.3%) to 4090.38; the Dow Jones industrial average rose 80.34 (0.2%) to 33482.72; the NASDAQ Composite fell 129.47 (1.1%) to 11996.86.
The 10-year Treasury yield fell about 3 basis points to 3.309%.
CBOEs Volatility Index was up 0.12 at 19.12.
Among S&P 500 sectors, consumer discretionary and industrial stocks led declines. One bright spot was the healthcare sector, which jumped nearly 2%, helped by gains in Johnson & Johnson (JNJ) and Eli Lilly (LLY). Recession concerns weighed particularly heavily on small-cap stocks, as the Russell 2000 index dropped near a two-week low. WTI crude futures fell slightly but remained above $80 a barrel and near two-month highs.
Gold futures extended this week’s rally and ended at a 13-month high.
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