RISK MANAGEMENT & LIABILITY PROTECTION FOR PHYSICIANS

And … Their Insurance Agents and Financial Advisors

INVITE DR. MARCINKO: https://medicalexecutivepost.com/dr-david-marcinkos-

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By DR. DAVID EDWARD MARCINKO MBA CMP®

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SPONSOR: http://www.CertifiedMedicalPlanner.org

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BOOK REVIEW

It is not uncommon for practicing physicians to have more than a dozen separate insurance policies to protect their medical practice and personal assets. Yet, most doctors understand very little about their policies.BOOK REVIR

Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™explains to physicians and insurance professionals the background, theory, and practicalities of medical risk management, asset protection methods, and insurance planning.

The book presents information in a manner that is convenient and highly useful for busy medical practitioners. It discusses the medical records revolution and addresses concerns regarding cloud computing, data security, and technological threats.

The book covers modern health law and policy, including fraud and abuse, workplace-violence, Medicare compliance, HIPAA regulations, AR protection strategies with internal controls, P4P and value based care, insurance and reputation management, and how the ARA legislation is impacting physician practices. It also includes case models and examples that provide you with a real-world understanding of how to recognize and reduce personal and medical practice risks.

With time at a premium for all, and so much information packed into one well-organized resource, this book is a must-read for every physician and financial advisor that serves the health care sector. The book will help physicians make better decisions about the risks they face and will help financial advisors improve the value they provide to their clients who are doctors.

MORE = ORDER HERE: https://www.routledge.com/Risk-Management-Liability-Insurance-and-Asset-Protection-Strategies-for/Marcinko-Hetico/p/book/9781498725989

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CIGNA Healthcare Truth

By Darrell K. Pruitt DDS

QUOTE: “Employees are the biggest asset of any company, so it’s more important than ever to focus on staff well-being during uncertain times.”

Jason SadlerPresident, International Health

Cigna Healthcare

QUERIES: So, Jason Sadler, how do you think Cigna’s dentists feel about Cigna?

Do you even dare to publicly respond to that question? … I didn’t think so.

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PODCAST: Behavior Modification and the Science of Change in Healthcare

By Eric Bricker MD

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

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PODCAST: Hospital Money Challenges in 2023

By Eric Bricker MD

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

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

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DAILY UPDATE: Wall Street’s Hell Week & National Dentist’s Day

By Staff Reporters

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National Dentist’s Day falls on March 6th every year. It was established as a way to show appreciation and thanks for dentists. It’s also a way to bring awareness to dentistry so that people will know more about how to care for their teeth. It also encourages people who may have avoided going to the dentist to come in for a checkup.

MORE: https://nationaldentistsday.com/

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“WALL STREET Hell Week: Features several potential landmines for the stock market. One of them is the jobs report on Friday. Employment numbers have been on the rise, and continued strength in the labor market could lead to more interest rate hikes. Another key event this week: FOMC Chair Jerome Powell’s testimony on Capitol Hill. He’s expected to field questions on the trajectory of inflation and the looming debt-ceiling crisis.

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PODCAST: Health Insurance “Medical Policy” Explained

MEDICAL NECESSITY

By Eric Bricker MD

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

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

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HOSPITALIST DAY: March 2nd, 2023

A NATIONAL DAY OF RESPECT

SOCIETY OF HOSPITAL MEDICINE

By Staff Reporters

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SHM: National Day Thursday, March 2, 2023, is National Hospitalist Day Occurring the first Thursday in March annually, “National Hospitalist Day celebrates the fastest-growing specialty in modern medicine and hospitalists’ enduring contributions to the evolving healthcare landscape.”

HERE: https://www.hospitalmedicine.org/about/national-hospitalist-day/

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

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NATIONAL: Endometriosis Awareness Day 2023

MARCH FIRST

By Staff Reporters

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Endometriosis Awareness Day is observed on March 1st, during Endometriosis Awareness Month.

Endometriosis is an inflammatory condition that occurs in women when tissue starts growing outside the uterus. This tissue is the same as that which lines the womb internally. While there are many studies now on this condition, there is still no cure, and awareness is a huge problem. The month, and day, are dedicated to raising awareness and promoting research to find a cure for Endometriosis.

They are also aimed at addressing the stigma that comes with Endometriosis in the form of infertility.

READ:https://endometriosisassn.org/

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

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Today is RARE DISEASE DAY

By Staff Reporters

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Rare Disease Day is the globally-coordinated movement on rare diseases, working towards equity in social opportunity, healthcare, and access to diagnosis and therapies for people living with a rare disease.

Since its creation in 2008, Rare Disease Day has played a critical part in building an international rare disease community that is multi-disease, global, and diverse– but united in purpose.

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

Rare Disease Day is observed every year on 28 February (or 29 in leap years)—the rarest day of the year. It was set up and is coordinated by EURORDIS and 65+ national alliance patient organizational partners. Rare Disease Day provides an energy and focal point that enables rare diseases advocacy work to progress on the local, national and international levels.

LINK: https://www.rarediseaseday.org/#

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Necessary Pillars to Expand the Free Medical Markets

  By Jay Kempton

[Free Market Medical Association]

Download the presentation Here

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

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

Product DetailsProduct Details

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Podcasts: WHAT IS FREE-MARKET “RENT-SEEKING” BEHAVIOR IN HEALTHCARE?

What About “Rent-Seeking” in Banking and Financial Services?

By Dr. David E. Marcinko, MBA

Courtesy: www.CertifiedMedicalPlanner.org

Rent-Seeking is a public choice, and economics, theory that involves methods to increase one’s share of existing wealth without creating new wealth [no added value].

Rent-Seeking results in reduced economic efficiency through misallocation of resources, reduced wealth-creation, lost government revenue, heightened income inequality, and potential national decline.

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

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Assessment: But, what about rent-seeking behavior in the healthcare industrial complex, banking and financial services industry, today”

ESSAY: https://pnhp.org/news/the-economist-rent-seeking-in-americas-health-care-system/

MORE: https://www.the-american-interest.com/2014/06/05/health-care-rent-seeking-in-90-seconds/

MORE: https://www.marketwatch.com/story/nobel-economist-takes-aim-at-rent-seeking-banking-and-healthcare-industries-2017-03-06

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Conclusion

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

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

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

THANK YOU

8Product DetailsProduct Details

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AMAZON: Buys One Medical Parent “1 Life Healthcare”

By Staff Reporters

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According to Bloomberg — Amazon.com Inc. says it has completed its purchase of One Medical parent 1Life Healthcare Inc., sealing the $3.49 billion acquisition after the US Federal Trade Commission declined to challenge it.

The deal gives the e-commerce giant a network of primary-care doctors, Amazon’s biggest move to date into the health care industry. One Medical operates more than 200 medical offices in 26 markets in the US. Customers pay a subscription fee for access to its physicians and digital health services. 

Bloomberg just reported that the FTC, which has been probing Amazon’s market power for years, had decided not to challenge the deal. Instead the agency is issuing a letter warning Amazon and One Medical that the FTC investigation remains open. That paved the way for Amazon to finalize the acquisition. 

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

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PODCAST: Out-Patient Hospital Pricing Explained

By Eric Bricker MD

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HOSPITAL PARTNERSHIPS: CBOs and SDOH

COMMUNITY BASED ORGANIZATIONS

SOCIAL DETERMINANTS OF HEALTH

NIHCM GRANTS

By Yunyu Xiao Weil of Cornell Medicine

By Timothy Brown of UC Berkley Medicine

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This study will determine the causal effects of hospital-CBO partnerships on hospital re-admissions and mortality for the leading mental health and injury-related causes of death (suicidal ideation or suicide) and the leading physical cause of death (heart attack).

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

Findings may inform how, where, and for whom targeted hospital partnerships with CBOs can reduce hospital readmission and mortality.

Do Hospital Partnerships with Community-Based Organizations (CBOs) that Address Social Determinants of Health Reduce Hospital Readmission and Mortality?

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What is a Federally Qualified Health Center?

ABOUT F.Q.H.C.s

By Dr. David E. Marcinko MBA CMP®

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SPONSOR: http://www.CertifiedMedicalPlanner.org

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

DEFINITION:

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

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

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

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

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

Your thoughts are appreciated.

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INVITE DR. MARCINKO: https://medicalexecutivepost.com/dr-david-marcinkos-bookings/

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PRIVATE EQUITY: In Cancer Oncology Care

NIHCM GRANTS

By Ola Abdelhadi

By Richard Scheffler

University California at Berkley

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Despite increases in private equity acquisition of oncology practices, little is known about the effect on market competition, prices, and quality.

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

This research team will examine the changes in health care quality and prices following private equity acquisition of oncology practices and explore whether these acquisitions exacerbate health disparities among racial groups. This work may be relevant to policymakers and antitrust regulators assessing private equity deals.

Increasing Private Equity Investment in Cancer Care: What is the Effect on Prices and Quality of Care?

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FTC: Proposes Banning [Healthcare] Non-Compete Employment Contract Clauses

By Health Capital Consultants, LLC

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FTC Proposes Banning Non-Compete Clauses

On January 5, 2023, the Federal Trade Commission (FTC) published a proposed rule that would ban employers from imposing non-competes on their employees. The FTC asserted that this practice is widespread and often exploitative, and such actions can suppress wages, hamper innovation, and block entrepreneurs from starting their own businesses. Notably, while the proposed rule will affect all industries, not just healthcare, this proposal comes at a time when healthcare employers across the U.S. are struggling with staffing shortages.

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

This Health Capital Topics article will discuss the proposed rule, reactions from healthcare industry stakeholders, and potential implications. (Read more…)

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FINANCIAL HEALTH INSURANCE CO-PAY CARDS & DRUG COUPONS?

The “Real Deal”

A co-payment is a fixed amount ($20, for example) you pay for a covered health care service after you’ve paid your deductible.

Let’s say your health insurance plan’s allowable cost for a doctor’s office visit is $100. Your copayment for a doctor visit is $20.

  • If you’ve paid your deductible: You pay $20, usually at the time of the visit.
  • If you haven’t met your deductible: You pay $100, the full allowable amount for the visit.
  • Partial deductible payments incur hybrid fees.

Copayments (sometimes called “copays”) can vary for different services within the same plan, like drugs, lab tests, and visits to specialists. Generally plans with lower monthly premiums have higher copayments. Plans with higher monthly premiums usually have lower copayments.

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

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Invite Dr. Marcinko | The Leading Business Education Network for Doctors,  Financial Advisors and Health Industry Consultants

BY DR. DAVID E. MARCINKO MBA CMP®

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SPONSOR: http://www.CertifiedMedicalPlanner.org

Co-Pay Cards May Be Creating More Controversy Instead of Solutions

Instead of reducing the actual price of their excessively priced medications, many companies have opted to provide co-pay cards / coupons as an affordable solution. However, co-pay cards may only lower the cost for some consumers and patients.

Novartis: https://www.copay.novartispharma.com/nvscopay/#

Pfizer: https://www.pfizerpro.com/co-pay-cards-patient-savings-offers

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But – The insurer is still left to pay the high price, which will eventually be passed back on to the patient / consumers in the form of higher health insurance deductibles. So – It doesn’t really seem like much of a solution when we all end up paying for these co-pay cards / coupons; does it?

Find out more here. (Source: Rebecca Mayer Knutsen, MM&M, 8/26/16)

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MEDICAL OFFICE CREDIT CARDS:

We stopped taking credit cards altogether. The only credit cards we take are for call-in payments of balances. We have placed ATM machines in our lobbies and we educate patients in advance of their visits that we only take cash or check. Our cash income has increased, our credit card fees have decreased, and we make $1.50 from each transaction through our ATM. Our patients have taken to the idea so much that they use the ATM for personal cash for other transactions because our fee is the lowest of any ATM. It has been a win-win-win.  

Dr. Farshid Nejad, Beverly Hills, CA [PM Magazine]

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For anyone contemplating taking credit cards for payments or copayments in your office, please be aware that some of the credit card companies require you to sign a contract. Don’t do that! If you do and you either have a problem with the company or find out that they are overcharging you, they will hold you responsible for the contract and may take you to court. There are enough credit card companies out that that do not require contracts and are highly competitive. 

-Dr. Elliot Udell, DPM, Hicksville, NY [PM Magazine]

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PODCAST: JP Morgan Healthcare Conference 2023

EXPLAINED

By Eric Bricker MD

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It is a healthcare investor conference where investors meet with digital health companies, not-for-profit hospital systems, insurance carriers, biotech and med device companies.

The J.P. Morgan Healthcare Conference is invite-only. There is no large exhibition hall. The agenda is not published.

Most of the ‘action’ happens outside the conference with private meetings across the city.

Most people who attend are not invited and they just go for the private meeting opportunities.

Hear a summary of the 2023 J.P. Morgan Healthcare Conference from This Week Health‘s Bill Russell and his guest Rob, DeMichiei–the former CFO of UPMC.

Hospital systems actually have a plan to cut costs for the first time in AGES.

Insurance carriers are going to become healthcare providers themselves.

Will insurance carriers eat hospitals’ lunch? etc.

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

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ADVISORY OPINION: Allows Nurse Practitioner Support in Hospitals

NURSE PRACTITIONERS [NPs]

By Health Capital Consultants, LLC

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Advisory Opinion Allows Nurse Practitioner Support in Hospitals

On December 19, 2022, the Department of Health and Human Services (HHS) Office of Inspector General (OIG) published Advisory Opinion (AO) No. 22-20, analyzing the utilization of nurse practitioners (NPs) in lieu of attending physicians within medical units. The OIG concluded that the arrangement utilizing NPs in certain medical units, subject to several safeguards, presented a low risk for fraud or abuse.

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

As noted by legal experts, this AO deviates from OIG’s typical approach to limiting arrangements involving potential remuneration from a hospital to its referring physicians. (Read more…)

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RECESSION: Healthcare Industry Layoffs

Not even the healthcare industry is recession-proof

By Staff Reporters

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According to Kristine White of Healthcare Brew, New York City-based Memorial Sloan Kettering Cancer Center (MSK), one of the country’s top cancer treatment facilities, laid off 337 employees on Jan. 17 in response to ongoing financial challenges, according to a New York State Department of Labor filing.

The 337 employees, who worked across 14 sites and in multiple departments, represent about 1.5% of MSK’s 22,500 employees. This is a slight decrease from the expected 3% of layoffs announced in November 2022.

“This reduction was necessary to ensure that MSK can continue to invest in the future of cancer care, research, and education for the benefit of generations to come, and every effort has been made to ensure that patient care is not impacted,” spokesperson John Connolly said in a statement shared with Healthcare Brew.

The institution’s operating losses totaled $116.1 million for Q3 of 2022, compared to a loss of $8.7 million during the same period in 2021, according to a quarterly financial report released in November last year.

Factors such as increased patient activity, wages, and supply costs from inflation pushed the system’s operating expenses up by 7.5% from Q3 of 2021 to Q3 of 2022. The cancer center hired more staff in 2022 with the expectation that patient volume would increase, according to the financial report.

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

Health systems like MSK often reevaluate their biggest expense (workers) when business is down, Lori Kalic, a healthcare senior analyst at consulting firm RSM, told Healthcare Brew.

Just this year, multiple hospitals and health systems have also announced layoffs, including Tufts Medicine in Boston and Integris Health in Oklahoma, according to White.

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Medical CBD: No FDA Advocacy

By Staff Reporters

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The Food and Drug Administration said it can’t vouch for the safety of cannabidiol (CBD)—a nonpsychoactive compound found in marijuana and hemp plants—and because of that, it can’t regulate it. Instead, it’s calling on lawmakers to help supervise $12 CBD lavender sodas.The FDA said that CBD doesn’t fit the mold of the dietary supplements and food additives it typically monitors, such as ginseng and caffeine.

POT: https://contrarianedge.com/should-you-invest-in-marijuana-stocks/?uid=5f78aa3cd815b&utm_source=IMA++-+Main+Articles&utm_campaign=b43e790647-MARIJUANA_STOCKS_RESEND&utm_medium=email&utm_term=0_f1c90406d1-b43e790647-55139025

The agency claims the science is lacking on the safety of long-term CBD use, let alone on any potential perks—like preventing diabetes or aiding sleep.

No-2-Drugs: https://medicalexecutivepost.com/2022/04/20/just-say-no-to-drugs/

Derived from Hemp

Congress legalized hemp four years ago, and most CBD is derived from hemp, not marijuana. As a result, CBD got kicked off the controlled substances list and got lobbed from the Drug Enforcement Administration’s desk to the FDA’s.

Mental Health Drugs: https://medicalexecutivepost.com/2022/10/07/drugs-and-county-mental-health-programs/

Since then, the FDA’s been less active in regulating CBD than a teen in a ’90s anti-marijuana ad. That’s resulted in a chaotic and confusing marketplace, and CBD industry players were hoping the FDA would soon start reining it in.

Drug Middlemen: https://medicalexecutivepost.com/2022/03/14/drugs-money-and-the-middleman/

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INDUSTRY STATURE: Certified Medical Planner®

SPONSOR: http://www.CertifiedMedicalPlanner.org

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OUR OEUVRE’ OF TEXT BOOKS IS GROWING WITH OUR INDUSTRY STATURE

We believe that by writing and sharing our experiences in standard textbook, white-paper and new media electronic format, our experts are able to address most areas of physician-focused financial planning, business or medical practice management needs in an understandable and unbiased manner.

But, we recognize that some consultants and financial advisors may appreciate reading current medical business management theory, healthcare economics, technology or financial planning information privately, prior to becoming a Certified Medical Planner® professional.

However, there is a virtual information overload out there, little of which addresses the pragmatic concerns of the modern medical provider or healthcare industry. None imparts the wisdom to become a better financial advisor or medical management consultant. All motivate the purchase of products.

Therefore, as part of the iMBA Research Library for the Certified Medical Planner® program, we highly recommend the following in-house produced books. You may even recognize some of our nationally known contributing authors and CMPs®.

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

TEXT BOOKS AND HAND BOOKS

iMBA Inc offers links to these publications, to members, and non-members, alike:

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ENJOY THEM ALL

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COVID PANDEMIC: Official National Emergency Ending

By Staff Reporters

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President Biden plans to end both the public health and national emergencies originally declared to address the Covid pandemic in 2020 (and extended several times since) on May 11th 2023.

The White House just disclosed the plan while opposing efforts by Republican lawmakers to end the emergency declarations immediately with a bill called the Pandemic Is Over Act. The end of the emergencies will mean that many Americans will have to start paying for COVID tests, treatments, and vaccines.

It also signals a shift in how serious the government considers the pandemic to be. But, is this wise?

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PODCAST: How Doctors are Really Paid?

Learn the Incentives in Physician Compensation

BY ERIC BRICKER MD

RAND and Harvard University Researchers Recently Published a Study in the Journal of the American Medical Association Examining How Doctors are Paid by Hospital System-Owned Practices. The Study Found that only 9% of Primary Care Physician Compensation was Based on Value (Quality and Cost-Effectiveness) and only 5.3% of Specialist Compensation was Based on Value.

The Study Concluded: “The results of this cross-sectional study suggest that PCPs and specialists despite receiving value-based reimbursement incentives from payers, the compensation of health system PCPs and specialists was dominated by volume-based incentives designed to maximize health systems revenue.”

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MORE: https://medicalexecutivepost.com/2020/09/19/what-doctors-must-do-to-file-an-aetna-claim-to-get-paid/?preview_id=237387&preview_nonce=44f9028974&preview=true

RELATED: https://medicalexecutivepost.com/2008/09/12/how-doctors-get-paid/

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

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

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FAs & CPAs Wanted -BUT- Certified Medical Planners® Needed?

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Career Development, Products and Services for Medical Specificity

“The informed voice of a new generation of fiduciary advisors for healthcare”

SPONSOR: http://www.CertifiedMedicalPlanner.org 

CMP

FINANCIAL ADVISER WANTED: New York’s Belfer family, which gained riches from oil, is racking up quite an investing losing streak. They lost billions in Enron’s collapse and were clients of Bernie Madoff, and now it’s come to light that they were shareholders in FTX.

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CPAs WANTED: Just as tax season kicks off, US firms are facing a national shortage of accountants, forcing them to look overseas for workers to look over your W-2. More than 300k accountants and auditors have quit in the last two years, per the WSJ.

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CMPs NEEDED: The Certified Medical Planner® program was created in response to the frustration felt by doctors in small and mid-sized practices that dealt with top financial, brokerage and accounting firms. These non-fiduciary behemoths often prescribed costly wholesale solutions that were applicable to all, but customized to few, despite ever changing needs.

Enter the CMPs

Learn why brokerage sales-pitches and/or internet resources will never replace the knowledge and deep advice of a collegial Certified Medical Planner® professional.

Letterhead CMP

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AMAZON: Launches “RxPass” Generic Drug Subscription Program

PRIME MEMBERSHIP

By Staff Reporters

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Yesterday, Amazon announced the launch of RxPass: an add-on to Prime memberships that provides subscribers with access to 50 generic prescription drugs for a $5 monthly fee.

RxPass will launch immediately in most states (though not California and Texas, the most populous ones) and include generic drugs that treat common conditions like high blood pressure, anxiety, acid reflux, and hair loss. About 150 million US residents have a prescription for one of the drugs included in RxPass, according to Amazon.

But the service is not available to people on Medicare or Medicaid, and it doesn’t offer insulin.

RxPass is Amazon’s answer to the Mark Cuban Cost Plus Drug Company (which offers significantly more medications—1,100 of them) and is likely part of an effort to attract more users to Amazon Pharmacy. Amazon Pharmacy could use the boost—it launched in 2020 but ranked at the bottom of a list of which Prime perks drew members to the service, a Morgan Stanley survey found last summer.

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PODCAST: Medicare Advantage Plan Over Payments

A SYNOPSIS

By Eric Bricker

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PODCAST: Government Overpayments to Medicare Advantage Plans are a major problem.

CMS pays Medicare Advantage Plans per member based on a risk score. The more chronic conditions the person has, the larger the payments CMS makes to the Medicare Advantage Plan.

Medicare Advantage Plans may be overexaggerating how sick their members are in order to increase their payments from CMS.

The Department of Justice is currently suing Cigna and Elevance (Anthem) for such over exaggerations.

However there is a deeper problem… CMS itself had performed its own audits, but has not done so in 10 years. CMS identified $650M in overpayments and did nothing about them.

When the Kaiser Family Foundation (KFF) requested information on the audits, CMS refused. KFF had to sue CMS to obtain the audit information and it took 3 years for KFF to win the case.

Perhaps it is incompetence on the part of CMS or perhaps CMS does not want to reveal the audits or do anything about them due to political pressure.

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PODCAST: Medicare Traditional [A and B] v. Advantage [C] v. Part [D] v. Supplements

By Eric Bricker MD

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

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JANUARY: Cervical Cancer Awareness Month

By Staff Reporters

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Cervical Health Awareness Month

The United States Congress designated January as Cervical Health Awareness Month. More than 14,000 women in the United States are diagnosed with invasive cervical cancer each year, but the disease is preventable with vaccination and appropriate screening.

During January, NCCC and its many local chapters across the country highlight issues related to cervical cancer, HPV disease and the importance of early detection. While NCCC chapters host events throughout the year, January is a month with a special focus as chapters celebrate Cervical Health Awareness Month and work to spread the word in their communities.

NCCC and the American Sexual Health Association (ASHA) also offer a range of resources (listed below) to educate the public and healthcare providers about cervical health, from fact sheets to episodes of ASHA’s Sex+Health podcast.

READ: https://www.nccc-online.org/cervical-health-awareness-month/

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HEALTHCARE FRAUD: Predatory Senior Medicare Scams

By Staff Reporters

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As you likely know, the US spends much on healthcare ($4.3 trillion in 2021, to be exact). But did you also know that healthcare fraud makes up a not-so-small piece of that pie?

The National Health Care Anti-Fraud Association (NHCAA), a national organization that works to prevent health insurance fraud, conservatively estimates that 3% of the US’s total annual healthcare spend—a hearty $129 billion—is lost to healthcare fraud. Some government agencies estimate that percentage to be as high as 10% (that’s $430 billion), according to the NHCAA.

Overall, Medicare fraud costs the US about $60 billion each year, Nicole Liebau, national resource center director for Senior Medicare Patrol, a government-funded organization designed to help prevent Medicare fraud, told Healthcare Brew, though she added that “the exact figure is impossible to measure.”

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

While Medicare fraud isn’t new, the US saw a rise in one particular tactic during the pandemic: a durable medical equipment (DME) scheme.

How the schemes work.

In a DME scheme, scammers target Medicare patients—often after a procedure or an injury—and cold-call them to offer free equipment, said Jennifer Stewart, senior associate general counsel and senior director of fraud prevention and investigation at Blue Cross Blue Shield of Massachusetts. The scammers offer consumers items like lidocaine, wheelchairs, walkers, or braces.

The scammers have roped in doctors—who are often unaware they’re working with scammers instead of legitimate medical companies—to sign off on prescriptions that are then used to bill Medicare for the equipment, Stewart said. Sometimes patients actually receive the products, and sometimes they don’t.

“It’s really dangerous because [a prescription like lidocaine] could have reactions with other medications. The durable medical equipment isn’t sized for them, and certainly the doctor who treated their injury didn’t prescribe it […] There is a lot of patient harm involved,” Stewart said. Keep reading here.

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PODCAST: “Sage Transparency” on Hospital Prices

EMPLOYER SPONSORED HEALTH INSURANCE PLANS

By Eric Bricker MD

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

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PODCAST: Employee Engagement and Health Plans

By Eric Bricker MD

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

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MEDICARE SUPPLEMENT INSURANCE: Part G

What is it and How Does it Work?

By Staff Reporters

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Did you know that Medicare Plan G is the most popular Medicare Supplement with Baby Boomer clients? Everyone has heard of Plan F, but what is Medicare Supplement Plan G? What does Plan G cover?

Medicare Plan G coverage is very similar to Plan F, which is no longer available for people new to Medicare on or after January 1st, 2020. Plan G offers great value for beneficiaries willing to pay a small annual deductible. After that, Plan G provides full coverage for all of the gaps in Medicare. It pays for your Medicare Part A hospital deductible, co-pays, and coinsurance. It also covers the 20% that Medicare Part B doesn’t cover. Doctors and other healthcare providers must accept a Medigap Plan G if they accept Original Medicare. Plan G policies can be used across the U.S. since they do not have network limitations, and the premium costs can be very reasonable for the coverage you receive.

As you can see below, Supplement Plan G covers almost everything that F does, except for the Part B deductible.

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Medicare Plan G, also called Medigap Plan G, is an increasingly popular Supplement

Reasons:

First, Plan G covers each of the gaps in Medicare except for the annual Part B deductible. This deductible is only $226 in 2023. In fact, if you have a Plan F that has been in place for years, it can probably help you on premiums by looking at Plan G. When you shop for benefits, you can often find a Supplement Plan G that saves quite a bit in premiums over Plan F, usually substantially more than the $226 deductible that you’ll pay out.

Second, it has great coverage. For hospital stays, it covers all your hospital expenses. Most importantly, it pays the hospital deductible, which is over $1,600 in 2023. It also covers the expensive daily co-pays that you might encounter for a hospital stay that runs longer than 60 days. It provides an additional 365 days in the hospital after your Medicare benefits run out, and it covers your skilled nursing facility co-insurance, too.

What Other Medical Services Does Plan G Cover?

Medicare Supplement Plan G covers your percentage of any medical benefit that Original Medicare covers, except for the outpatient deductible. So, it helps to pay for inpatient hospital costs, such as the first three pints of blood, skilled nursing facility care, and hospice care. It also covers outpatient medical services such as doctor visits, lab work, diabetes supplies, cancer treatment, durable medical equipment, x-rays, ambulance, surgeries and much more. This means Plan G covers the coverage gaps with Original Medicare and all Plan G products must provide you with the exact same coverage.

Medicare pays first, then Plan G pays the remaining amount after you pay the once annual deductible. In addition, Plan G Medicare Supplements offer up to $50,000 in foreign travel emergency benefits (up to plan limits).

Related Article: Medicare Costs for 2023

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

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AFFORDABILITY: Healthcare on Notice for Patients

By Staff Reporters

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People living in the US are finding it increasingly difficult to afford needed health services—even with employer-sponsored health insurance, a new analysis suggests.

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

Researchers at the NYU School of Global Public Health (GPH) examined data from the National Health Interview Survey—an annual CDC survey—that was collected from 2000 to 2020 for 230,000+ adults who received health insurance through an employer or union. Both men and women found most healthcare services to be less affordable now compared to the early 2000s, according to the finding of the NYU analysis reported in a December 2022 JAMA abstract. Women, in particular, found all types of health services to be less affordable than men.

From a nationally representative survey which is conducted annually, researchers included data from 5,545 women and 5,353 men sampled in 2020, and found that about 6% of women reported they couldn’t afford needed medical care. This compares to just 3% of slightly larger sample groups from 2000, per the analysis. By contrast, about 3% of men gave that response in 2020, compared to 2% in 2000.

Avni Gupta, a doctoral student in the public health policy and management department at NYU GPH and the lead author of the analysis, offered that “lower incomes and higher healthcare needs among women could be driving these differences in reported affordability.”

And, José Pagán, the department chair and co-author of the JAMA analysis, said people with employer-sponsored coverage—the largest source of health insurance for people living in the US—“generally think they are protected.”

“[B]ut our findings show that health-related benefits have been eroding over time,” he said; according to Healthcare Brew

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The State of COVID-19 in the USA

UPDATE

By Staff Reporters

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Johns Hopkins University: https://publichealth.jhu.edu/2023/what-you-need-to-know-about-xbb15-the-latest-omicron-variant

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METAVERSE: Expert Consensus in Medicine?

By Staff Reporters

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

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

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

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

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

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MEDICAL PROVIDERS: Hobson’s Choice in Medicine

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

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TUCSON, Ariz., Dec. 06, 2022 (GLOBE NEWSWIRE) — Sheila Page, D.O., a family physician in Aledo, Texas, and president of the Association of American Physicians and Surgeons (AAPS), is featured in the winter issue of the of the Journal of American Physicians and Surgeons. She writes:  “Today physicians often feel constrained to pick from among options that are not in the best interest of patients but are ‘covered’ by insurance or approved by officials.”

“An apparently free choice when there is no real alternative is a Hobson’s Choice, and physicians must understand the political structure in which this type of ‘choice’ is embedded,” Dr. Page explains.

“During the COVID pandemic, people often faced a Hobson’s Choice of taking a shot that they believed put their life, health, or fertility at risk, or be barred from their education or career,” she noted.

“Voters generally believe that they have two choices, Republican or Democrat, and that they represent extremes of political ideology. However, when they are in office, politicians behave as if they belong to the same club,” she writes.

“Physicians have accepted the Hobson’s Choice of either abiding by ridiculous regulatory burdens or refusing to treat the senior population,” she explains. They “accept the Hobson’s Choice of either standing against the oppression or keeping their ‘place at the table.'” 

“The phrase ‘we need to keep our place at the table to avoid being on the menu’ entirely misses the point,” she states. “The profession is on the table already being carved up. How many times have we been told we must choose the lesser of two evils? Either choice is still evil!”

“We must identify the enemy within,” Dr. Page writes. “The medical profession must grasp the extent to which it has been manipulated by pharmaceutical, insurance, and other systems tied to medicine. We have been burdened with regulations and threats to our licenses by the same people who are selling us the solutions.”

“There is tremendous profit in the existing system, but we must nevertheless offer healing and hope, learn how to fight back effectively, and reject the Hobson’s Choice,” she concludes.

CITE: The Journal of American Physicians and Surgeons is published by the Association of American Physicians and Surgeons (AAPS), a national organization representing physicians in all specialties since 1943.

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

Contact Information:
Jane Orient
Executive Director
janeorientmd@gmail.com
(520)323-3110

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PODCAST: Value Based Healthcare Delivery by Dr. Michael Porter PhD

HARVARD BUSINESS SCHOOL

By Staff Reporters

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

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CENTENE CORPORATION: Medicaid Over-Billing?

By Staff Reporters

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Centene Corporation showers politicians with millions as it courts contracts and settles over-billing allegations by Samantha Young, Andy Miller, and Rebecca Grapevine (Kaiser Health News)

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Somehow KHN made Medicaid over-billing sound sexy.

This deep dive into Centene, “the nation’s largest private managed-care provider for Medicaid,” shows how the company has maintained good relationships with politicians as it looked to keep its market share and settle over-billing allegations.

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

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PODCAST: https://medicalexecutivepost.com/2021/11/12/podcast-centene-giant-medicaid-hmo/

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Omicron Sub-Variant XBB Rapidly Gaining Ground in the U.S.A.

By Staff Reporters

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he emerging Omicron subvariant XBB contributes to an increasingly high number of COVID-19 cases in the U.S., rivaling the sister strains BQ.1.1 and BQ.1, according to the latest estimates from the Centers for Disease Control and Prevention (CDC).

Recent studies have indicated that the updated bivalent COVID-19 booster performed poorly against BQ.1.1, with even a weaker antibody response against XBB.

In late November, citing its poor neutralization effect on BQ.1 and BQ.1.1., the FDA pulled the emergency use authorization granted for bebtelovimab, a COVID-19 antibody therapy developed by Eli Lilly (LLY) and AbCellera Biologics (ABCL).

The CDC estimates for the week ending Dec. 24 show that XBB has made up ~18% of COVID cases in the U.S. compared to ~11% a week ago. Meanwhile, BQ.1.1 has led to ~36% of cases unchanged from a week ago, and BQ.1 caused ~27% of cases, a decline from ~29% last week.  

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HOSPITAL FORMS: Be Aware BEFORE You Sign

By Staff Reporters

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You don’t have to sign all the forms to be treated

Part of being a patient is signing stacks of forms, most of which you barely read much less understood. This is a mistake, Charlotte O’Leary says. Look for any “blank check” clauses on intake forms—it’s the part that reads, “I will be responsible for all costs not covered by insurance.”

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

Instead, Charlotte Hilton Andersen, MS recommends crossing it out and writing, “I will be responsible for all costs that are medically necessary, that are not the responsibility of my insurer, are competitively priced, and that I am made aware of prior to treatment if they are not part of standard operating procedures.”

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DAILY UPDATE: Sovereign Wealth Funds, Mortgages and the Dimming U.S. Markets

By Staff Reporters

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Sovereign wealth funds could be selling roughly $29 billion in equities by the end of December. Meanwhile, U.S. defined benefit pension plans would need to shift up to $70 billion from equities to bonds to hit their targets, reports Bloomberg quoting the JPMorgan estimates. “The recent equity market correction and bond rally are consistent with the rebalancing hypothesis,” Bloomberg quoted Vincent Deluard, a macro strategist at StoneX. 

DEFINITION: A sovereign wealth fund, sovereign investment fund, or social wealth fund is a state-owned investment fund that invests in real and financial assets such as stocks, bonds, real estate, precious metals, or in alternative investments such as private equity fund or hedge funds. Sovereign wealth funds invest globally.

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

And, in a recent interview with CNN, Bank of America CEO Brian Moynihan said he’s concerned the housing market will continue to challenge buyers in the coming years. Moynihan pointed to sky-high mortgage rates as a big reason buyers might continue to struggle — especially first-time buyers with more limited financial resources. Moynihan also said there could be two more years of pain in the housing market before things cool off and homes become more available and affordable. And that’s a tough pill to swallow.

Finally, U.S. stocks were lower, adding to last week’s declines, as the global markets continued to grapple with the ultimate impact of aggressive monetary policy tightening around the world. Last week, the Fed, European Central Bank, Bank of England, and Swiss National Bank all increased their benchmark interest rates by 50 basis points, fostering recession concerns.

Treasury yields traded higher, and the U.S. dollar was unchanged, while crude oil gained ground, and gold was lower.

Other equity news was light, as L3Harris Technologies announced an agreement to acquire Aerojet Rocketdyne with an enterprise value of $4.7 billion, while shares of Madrigal Pharmaceuticals surged after positive trial results for its NASH and liver fibrosis treatment.

A busy week of housing data commenced, as the NAHB’s December Housing Market Index unexpectedly deteriorated.

Asia finished mostly lower as China’s COVID concerns weighed on sentiment, though European stocks were mostly higher, rebounding from last week’s decline as the global markets digest the recent rate hikes on both sides of the pond.

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HEALTH GORILLA: A New Health Data Interoperability Start-Up

By Staff Reporters

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Health Gorilla is in the business of health data interoperability and the double-backflip this startup is doing to both make clinical data an easily accessible commodity – while also making sure that access to that data adheres to the privacy rules established by the US government – takes a minute to understand, but is critically important for the future of many health tech businesses.

LINK http://www.HealthGorilla.com

And, it’s not often that 10,000-plus like-minded individuals come together for a common cause. Luckily in the healthcare space, we have HLTH – bringing together the entire health ecosystem to focus on innovation and transformation.

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

So for Health Gorilla, last month’s four-day event in Las Vegas was a most successful conference.

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TURQUOISE HEALTH? Compare Prices Before Receiving Medical Care

By Staff Reporters

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Last year, all hospitals were required to list their prices for elective services on an annual basis. Whether you have insurance or plan to pay cash – find and compare prices.

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

So, just like you wouldn’t buy a car, rent an apartment or even order food without knowing the cost, you shouldn’t pay blindly for healthcare.

Now you can compare prices before showing up for treatment.

READ MORE: https://turquoise.health/

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PODCAST: Industrial Revolution – Healthcare Revolution

SEE THE FUTURE BY LOOKING BACK

By Eric Bricer MD

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

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PODCAST: Financial Deception in Healthcare

THIRTY EXAMPLES

By Eric Bricker MD

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

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