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Did you know that at MARCINKO & Associates, all medical colleagues throughout the United States may contact us when they are considering the sale, purchase, strategic operating improvement, merger, acquisition and/or other financial business or related personal financial planning transaction?

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Our difference is “hard” knowledge and insider financial guidance that helps medical colleagues, nurses, private practitioners, clinics, ambulatory surgery, radiology and outpatient wound care centers realize their ultimate economic goals. This typically includes managerial and cost accounting, financial ratio analysis, fair market valuation business appraisals, business plan creation and personal financial planning.

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Our “expert witness” business litigation support service and divorce mediation, arbitration, asset division, settlement and second opinion offerings are always available, as well.

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And, our “soft” skill professional career guidance and mentoring center includes executive coaching, consulting and mentoring advisory programs for stressed, conflicted or burned-out physicians and medical practitioners.

COACHING: Careers

Most importantly, our professional fees are reasonable and always transparent.

MARCINKO & Associates also serves universities, medical, business, graduate and nursing schools; physicians, dentists, podiatrists, optometrists and legal societies. This includes accountants, financial service providers, wealth and hedge fund managers, emerging entities, hospitals, CEOs and their BODs, the press, media and related organizations.

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Contact us for an educational white-paper on most any topic.

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Now, please review our website to learn more.

And, always retain us when needed.

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DAVID EDWARD MARCINKO

email: MarcinkoAdvisors@msn.com

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HOSPITAL Revenue Metrics Review

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

By Staff Reporters

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The emphasis on hospital revenue metrics at hospitals may be a sign of misplaced prioritization away from patients and their well-being. For example:

Orthopedic Surgeons Generated the $2.75 Million in Hospital Revenue Per Orthopedist Per Year.
Interventional Cardiologists Generated $2.45 Million in Hospital Revenue Per Cardiologist Per Year.
General Surgeons Generated $2.17 Million in Hospital Revenue Per Surgeon Per Year.
Family Practice Doctors Generated $1.5 Million in Hospital Revenue Per Doctor Per Year.

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DAILY UPDATE: United Health Owned Insurance Fined and CFPB Hides Medical Debt as Nvidia Leads Stock Markets Down

Posted on January 8, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

MEDICAL EXECUTIVE-POST – TODAY’S NEWSLETTER BRIEFING

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

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Three UnitedHealth-owned insurance companies must pay over $165 million for misleading thousands of customers in Massachusetts into paying for additional health insurance, a state judge has ruled.

Nvidia stock (NVDA) tumbled more than 6% Tuesday, a day after shares closed at a record high in anticipation of CEO Jensen Huang’s keynote at the tech industry’s annual CES trade show in Las Vegas.

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

Dow ends down nearly 180 points, NASDAQ tumbles 1.9% as Treasury yields surge after job-openings, ISM services data

The Biden administration’s Consumer Financial Protection Bureau (CFPB) issued a new rule Tuesday that will hide an estimated $49 billion in medical debt from credit reports. The rule, which is slated to affect 15 million Americans, prohibits the inclusion of medical bills on credit reports and bars creditors from using medical information in making lending decisions. The policy specifically targets national credit-reporting companies Equifax, Experian and Transunion, which provide detailed evaluations of consumer finances to banks, employers and landlords.

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DAILY UPDATE: Medicare Advantage Bonus Payments as Stocks Rise and Technology Pops

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

MEDICAL EXECUTIVE-POST – TODAY’S NEWSLETTER BRIEFING

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

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Health plans made billions in Medicare Advantage bonus payments. A yearlong investigation reveals how. (the Wall Street Journal)

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

The 10-year Treasury note yield ($TNX) is higher by ~3 basis points to 4.63%.

The U.S. Dollar Index ($DXY) is lower by 0.69 to 108.26.

WTI Crude Oil (/CL) is trading higher by 0.68% to $74.46 per barrel.

Gold prices have traded in a range of $2,624.60 to $2,663.80 and were last seen trading lower by 0.39% to $2,644.40/oz.

Natural Gas prices have traded in a range of $3.502-3.726 and were last seen trading higher by 7.30% to $3.599/MMBtu.

Bitcoin (/BTC) is trading higher by 3.83% to $102,114.50 today.

US stocks largely rose on Monday as chip names popped and investors awaited the release of key monthly jobs data later this week.

The S&P 500 (^GSPC) was up about 0.5%, while the Dow Jones Industrial Average (^DJI) fell about 0.1% after being higher for most of the session. The tech-heavy NASDAQ Composite (^IXIC) led the gains, adding about 1.2%, after a tech-led rally on Friday.

Chip stocks rallied after a record revenue and a strong sales forecast from Nvidia (NVDA) server partner Foxconn (2317.TW, HNHPF), which boosted optimism for AI-fueled growth. Shares of Nvidia climbed more than 3%, as the stock closed at a record high. Meanwhile peer Micron Technology (MU) rose over 10%.

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DAILY UPDATE: Dental and Medical Record Data Breaches as Stocks Jump!

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

MEDICAL EXECUTIVE-POST – TODAY’S NEWSLETTER BRIEFING

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

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

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Nvidia stock (NVDA) led gains among the “Magnificent Seven” tech stocks to start the new year after a group-wide sell-off in the last days of 2024. Shares of the AI chip-maker rose 4.5% Friday after gaining roughly 3% the prior day.

Stat: 18. That’s how many dental data breaches there were in the US in 2024. (Becker’s Dental + DSO Review)

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

Quote: “If your credit card gets compromised, your bank will alert you, cancel it and send you get a new one. But your medical records have a long lifespan. They can be misused without detection for long periods of time, because it’s harder to identify malicious activity. That makes them very valuable.”—Geetha Thamilarasu, associate professor at the University of Washington Bothell, on why hackers want healthcare information (the Wall Street Journal)

That upswing followed a 4% dip between Christmas Eve and New Year’s Eve as megacap tech stocks dropped across the board in the absence of a “Santa Claus” rally, where the stock market typically enjoys a surge between December 24th and January 2nd. Tesla (TSLA) stock plunged nearly 13% over that time frame, while Amazon (AMZN) and Microsoft (MSFT) dropped more than 4%. Meanwhile, Meta (META) and Google (GOOG) fell just under 4%, and Apple (AAPL) dropped 3%.

Even with its December decline, Nvidia shares still ended 2024 up more than 150%. Wall Street analysts have remained bullish on the stock, estimating shares will rise to roughly $173 over the next year from their current level of $138, according to Yahoo Finance data.

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ANTHEM Splits with SCRIPPS Health

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

By Staff Reporters

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Anthem Blue Cross and Scripps Health will part ways impacting thousands of patients.

Scripps Health and Anthem Blue Cross officially just parted ways on January 1st, 2025, leaving about 125,000 patients uncertain of what their healthcare and insurance will look like in 2025.

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Filed under: "Ask-an-Advisor", "Doctors Only", Accounting, Alerts Sign-Up, Drugs and Pharma, Ethics, Health Economics, Health Insurance, Health Law & Policy, Healthcare Finance | Tagged: Anthem, Anthem Blue Cross, Health Insurance, healthcare, patients, Scripps, Scripps Health | Leave a comment »

DAILY UPDATE: Veterans Scammed as 3 Major Markets Drop

Posted on December 28, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

MEDICAL EXECUTIVE-POST – TODAY’S NEWSLETTER BRIEFING

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

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

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Read: Health insurers reportedly took billions of dollars from Medicare to cover veterans who didn’t use services. (the Wall Street Journal)

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US stocks closed the holiday week on a downbeat note as Wall Street slogged to the finish of a largely triumphant year.

The S&P 500 (^GSPC) lost 1.1%, while the tech-heavy NASDAQ Composite (^IXIC) shed 1.5% Friday at the close. The Dow Jones Industrial Average (^DJI) gave up 0.8%. Meanwhile, the 10-year Treasury yield (^TNX) hovered near seven-month highs around 4.6%.

After stacking impressive gains this year, some of the biggest names in tech lost ground as investors took profits, rebalance portfolios, or reassessed their lofty valuations. Tesla (TSLA) lost 5%. Nvidia (NVDA) gave up c2%, while Amazon (AMZN) decreased by 1%.

Wall Street has just three trading days remaining in a 2024 full of big gains, but markets have been unable to mount a “Santa Claus” rally into the end of the year.

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

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DAILY UPDATE: Medicare Tele-Health Out as DJIA Finishes Up a Tad

Posted on December 27, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

MEDICAL EXECUTIVE-POST – TODAY’S NEWSLETTER BRIEFING

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

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Absent Congressional action, beginning January 1sy, 2025, the statutory limitations that were in place for Medicare telehealth services prior to the COVID-19 PHE will retake effect for most telehealth services.

This means most telehealth visits will not be covered by Medicare in 2025, unless Congress acts by the end of December 2024.

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(Reuters) -The Dow Jones Industrial Average closed fractionally higher on Thursday, stretching its winning streak to five sessions despite light trading volumes and rising U.S. Treasury yields weighing on some of the dominant technology megacaps.

While the NASDAQ Composite and the S&P 500 were broadly unchanged, the indexes both finished slightly in negative territory. This snapped the NASDAQ’s four-session run of higher closes, and ended the S&P 500’s own run at three sessions.

On a day of few catalysts, investors responded to yields on U.S. government bonds inching higher, including the yield on the benchmark 10-year Treasury note hitting its highest since early May at 4.64% earlier in the session. And, a strong auction of seven-year notes early in the afternoon though helped yields come off slightly, with the 10-year note at 4.58% in late-afternoon trade.

Higher yields are traditionally seen as negative for growth stocks, as it raises the cost of their borrowing to fund expansion. With markets increasingly dominated by the megacap technology stocks known as the Magnificent Seven, crimping their performance – especially in lieu of other market catalysts – will put downward pressure on benchmark indexes.

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

The S&P 500 slipped 2.45 points, or 0.04%, to 6,037.59 points, while the NASDAQ Composite lost 10.77 points, or 0.05%, to 20,020.36. The Dow Jones Industrial Average rose 28.77 points, or 0.07%, to 43,325.80.

Six of the megacaps fell, with Tesla leading decliners with a 1.8% fall. The outlier was Apple, rising 0.3% and continuing to edge closer to becoming the first company in the world to hit a market value of $4 trillion.

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

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e-BOOKS: For Doctors, Financial Advisors, CPAs, Insurance Agents, Medical Consultants and Health Law Attorneys

Posted on December 21, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

By Ann Miller RN MHA CMP™

INTRODUCING OUR NEXT GENERATION e-BOOK LIBRARY FROM 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!

Payable thru PayPal [3% courtesy surcharge applies].

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DAILY UPDATE: Healthcare Satisfaction Poll as Stock Markets Close Flat

Posted on December 20, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

MEDICAL EXECUTIVE-POST – TODAY’S NEWSLETTER BRIEFING

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

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

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Americans aren’t satisfied with healthcare.

Gallup’s annual Health and Healthcare poll released on December 6th found that the US adult rating of healthcare quality is the lowest it’s been since 2001, with 54% of respondents saying they believe the healthcare system has “major problems” and 16% saying it’s in a “state of crisis.” In 2001, 53% viewed healthcare positively.

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

US stocks closed little changed as a rebound from the previous day’s sell-off flopped with a hawkish outlook from the Federal Reserve on its path for interest rates looming over markets.

The Dow Jones Industrial Average (^DJI) ended a 10-day losing streak, its longest in 50 years, as it closed just above the flat line on Thursday. Meanwhile, the S&P 500 (^GSPC) and tech-heavy NASDAQ Composite (^IXIC) both fell about 0.1%.

The 10-year Treasury yield (^TNX) continued its trek higher on Thursday, rising roughly seven basis points to hit 4.57% for its highest levels since May.

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

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PARADOX: Demographic-Economics

Posted on December 19, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

By Staff Reporters

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Demographic-Economics Paradox Definition: A nations or sub-populations with higher GDP per capita are observed to have fewer children, even though a richer population can support more children. Dr. Herwig Birg has called this inverse relationship between income and fertility a “demo-economic paradox”.

Cite: https://www.researchgate.net/profile/Herwig-Birg

Why? Evolutionary biology predicts that more successful individuals (and by analogy countries) should seek to develop optimum conditions for their life and reproduction.

However, in the last half of the 20th century it has become clear that the economic success of developed countries is being counterbalanced by a demographic failure, a sub-replacement fertility that may prove destructive for their future economies and societies.

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DAILY UPDATE: Undo Medical Debt, Native American Medical Debt as Stock Markets Plummet and Plunge

Posted on December 19, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

MEDICAL EXECUTIVE-POST – TODAY’S NEWSLETTER BRIEFING

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

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

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Stat: 23,000. That’s about how many Connecticut residents will get at least part of their medical debt eliminated, thanks to a state partnership with nonprofit organization Undue Medical Debt. (NBC Connecticut)

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

The stock market plunged on Wednesday after the Federal Reserve scaled back its expectations for interest rate cuts next year.

The Dow Jones Industrial Average fell about 1,100 points, or 2.5%, the largest drop for the index since August. The dip marked the 10th consecutive day of losses for the Dow, its longest losing streak since 1974.

The S&P 500 fell nearly 3%, while the tech-heavy NASDAQ plummeted about 3.5%.

https://www.amazon.com/Business-Medical-Practice-Transformational-Doctors/dp/0826105750/ref=sr_1_9?ie=UTF8u0026amp;qid=1448163039u0026amp;sr=8-9u0026amp;keywords=david+marcinko

Native American patients are reportedly often billed for healthcare services the government is supposed to pay for, according to an investigation. (KFF Health News)

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

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Filed under: Financial Planning, Funding Basics, Glossary Terms, Health Economics, Health Insurance, Health Law & Policy, Healthcare Finance, Information Technology, Investing, Marcinko Associates, Recommended Books, Sponsors | Tagged: Apple, DJIA, DOW, Marcinko, markets plummet, markets plunge, NASA, NASDAQ, S&P 500, Science, textbooks, TNX, universe, VIX, WSJ | Leave a comment »

DAILY UPDATE: PBMs and Healthcare A.I. as All Major Market Indexes Drop

Posted on December 18, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

MEDICAL EXECUTIVE-POST – TODAY’S NEWSLETTER BRIEFING

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

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

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Stat: 97%. That’s how many healthcare leaders think A.I. will become important in healthcare over the next five years.

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Pharmacy benefit managers (PBMs) are once again under pressure from federal leaders. A group of Democratic and Republican congresspeople proposed legislation that would attempt to prevent pharmacies from also owning PBMs. The three largest PBMs—CVS Health’s Caremark, Cigna’s Express Scripts, and UnitedHealth Group’s Optum Rx—currently operate pharmacies and administer more than 80% of the prescriptions in the US, and officials have linked this practice to drug price increases.

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

US stocks fell across the board on Tuesday, with the Dow logging its biggest losing streak in 46 years. The Dow Jones Industrial Average (^DJI) finished the session down roughly 0.6%, registering its ninth straight day of losses. The last 9-day losing streak for the Dow was Feb. 1978. Prior to that, the index suffered an 11-day losing streak in 1974 and another in 1971.

The other major indexes dropped in tandem on Tuesday, with the benchmark S&P 500 (^GSPC) falling around 0.4% and the NASDAQ Composite (^IXIC) losing about 0.3% after the tech-heavy index closed at a record high on Monday.

http://www.CertifiedMedicalPlanner.org

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

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Filed under: "Ask-an-Advisor", "Doctors Only", Accounting, Drugs and Pharma, Ethics, Financial Planning, Funding Basics, Glossary Terms, Health Economics, Health Insurance, Health Law & Policy, Healthcare Finance, Information Technology, Investing, Marcinko Associates, Recommended Books, Sponsors | Tagged: AI, artificial intelligence, Artificial Intelligence Medicine, Caremark, Cigna, CVs, DJIA, DOW, drug prices, health, healthcare, Healthcare AI, Marcinko, NASDAQ, Optum Rx, PBM, PBMs, pharma, Pharmacy Benefits Managers, S&P 500, Technology, textbooks, TNX, UnitedHealth, VIX, WSJ | Leave a comment »

INCENTIVE BIAS? In Medicine and with Physicians?

Posted on December 12, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

DEFINITION

By Staff Reporters

SPONSOR: http://www.MarcinkoAssociates.com

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Incentives: It is broadly accepted that incenting someone to do something is effective, whether it be paying office staff a commissions to sell more healthcare products, or giving bonuses to office employees if they work efficiently to see more HMO patients. Some experts even suggest there are five specific components1 that should be built into an overall physician incentive program:

Appropriate financial incentives.
Managed-care efficiency incentives.
Group citizenship.
Patient satisfaction.
Group profitability.

What is not well understood is that the incentives cause a sub-conscious distortion of decision-making ability in the incented person. This distortion causes the affected person – whether it is yourself or someone else – to truly believe in a certain decision, even if it is the wrong choice when viewed objectively. Service professionals, including financial advisors and lawyers, are affected by this bias, and it causes them to honestly offer recommendations that may be inappropriate, and that they would recognize as being inappropriate if they did not have this bias.

According to colleague Dan Ariely PhD, the existence of this bias makes it important for each one of us to examine our incentive biases and take extra care when advising physician clients, or to make sure we are appropriately considering non-incented alternatives.

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MARCINKO ASSOCIATES: Physician Wealth Advisors and Practice Management Consultants

Posted on December 11, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

FIDUCIARY MEDICAL COLLEAGUES – FEE ONLY – NO PRODUCT OR SALES COMMISSIONS

SPONSOR: http://www.MarcinkoAssociates.com

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DEAR MEDICAL COLLEAGUES

Achieving your financial, wealth and medical practice management goals is important, but handling everything on your own can be overwhelming. That’s where we come in. At D. E. Marcinko & Associates, our team of dual degree experienced physician advisors and medical consultants is here to guide you every step of the way. We believe in providing unbiased, high-quality financial and business advice.

For example, we offer a one-time written financial plan with oral evaluation for a flat fee with no ongoing sales or assets under management fees or commissions. Together, we can create a personalized financial plan tailored to your unique goals, empowering you to make confident, informed decisions as you navigate your financial future.

Other Services Include:

Estate Planning We have a network of qualified legal professionals that we can refer you to for state specific estate planning needs.
Tax Strategy We can work alongside your CPA for tax planning purposes. If needed, we can refer you to a qualified tax professional.
Investment Analysis If you have investments, we review your accounts to make sure they are aligned with your long-term goals.
401-k Allocations We evaluate your 401(k) allocations and provide recommendations that align with your goals.
Education Savings We help you explore the various ways to plan and save for education expenses.
Insurance & Risk Management We assess your insurance coverage to ensure it adequately protects you against potential risks; as well as evaluate and provide expert litigation witnesses, as needed.
Medical Practice Management We evaluate your current or potential medical practice to determine value and/or private equity offers or physician practice management formats [PPMC] for new, mid-career or retiring physicians, nurses and dentists.

D. E. Marcinko & Associates is unique and fully committed to all phases of a medical professionals personal and business life cycle. We are at your service 24/7: Email MarcinkoAdvisors@outlook.com

ANN MILLER RN MHA CMP™

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USA: Contact

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Why are CERTIFIED MEDICAL PLANNER® Textbooks So DARN Popular?

Posted on December 10, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

The Big Surprise

[By Dr. David Edward Marcinko MBA MEd CMP®]

OK – I was a Certified Financial Planner® before my academic team launched the Certified Medical Planner™ online and on-ground chartered education and board certification designation program a few years ago. I am now CFP reformed and in remission.

MORE: Enter CPMs

Enter the Certified Medical Planner™ Chartered Designation

Today, we are of course, gratified that Certified Medical Planner™ mark notoriety is growing organically in the healthcare, as well as financial services, industry.

Even uber-blogger Mike Kitces MSFS, MTAX, CFP, CLU, ChFC, RHU, REBC, CASL has taken note of us in his musings on the Nerd’s Eye View website. And, the reality is that there are a growing number of CFP educational programs at the post-CFP niche market level.

But, none for healthcare industrial complex: for doctors … by doctors!

Popularity of our Text Books

However, it is our modern, innovative and proprietary Certified Medical Planner™ textbooks and dictionaries that have exploded in the academic marketplace.

In fact, they are now redacted in thousands of medical, graduate, law and B-schools and libraries, as well as colleges and universities throughout the nation. This includes the Library of Congress, National Institute of Health and the Library of Congress.

What Gives?

We have been told that this textbook popularity and publishing success is because of their balanced and peer-reviewed nature; something not very widespread in the financial services industry that is prone to gross and overstated advertising, salesmanship and marketing hyperbole. And, for this we are very gratified.

But, is there another reason our books are so popular?

A bit of networking and research suggests that interested folks may be eschewing the actual course work in favor of just the high quality textbooks! UGH!

Another reason may be that our books and curricula are kept fresh and updated on our corporate website: http://www.MedicalBusinessAdvisors.com

Assessment

So, what do you think? Matriculation with the professional mark versus self study without the designation mark. Please opine.

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.

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Subscribe: MEDICAL EXECUTIVE POST for curated news, essays, opinions and analysis from the public health, economics, finance, marketing, IT, business and policy management ecosystem.

DOCTORS:

“Insurance & Risk Management Strategies for Doctors” https://tinyurl.com/ydx9kd93

“Fiduciary Financial Planning for Physicians” https://tinyurl.com/y7f5pnox

“Business of Medical Practice 2.0” https://tinyurl.com/yb3x6wr8

HOSPITALS:

“Financial Management Strategies for Hospitals” https://tinyurl.com/yagu567d

“Operational Strategies for Clinics and Hospitals” https://tinyurl.com/y9avbrq5

Adult Learners and Students:

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Filed under: "Advisors Only", Book Reviews, Career Development, CMP Program, Glossary Terms, Health Economics, Health Insurance, Investing, Marcinko Associates | Tagged: Certified Medical Planner Textbooks, CMP, CMP Program, Marcinko | Leave a comment »

VALUATION OF HOSPITALS: Reimbursement Environment

Posted on December 7, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

By Health Capital Consultants, LLC

The U.S. government is the largest payor of medical costs, through Medicare and Medicaid, and has a strong influence on reimbursement to hospitals. In 2022, Medicare and Medicaid accounted for an estimated $944.3 billion and $805.7 billion in healthcare spending, respectively. The prevalence of these public payors in the healthcare marketplace often results in their acting as a price setter, and being used as a benchmark for private reimbursement rates.

This third installment of the series discusses the reimbursement environment in which hospitals operate. (Read more…)

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2025 MEDICARE: Agent & Broker Pay Day Changes

Posted on December 7, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

How insurance agents will be compensated for helping seniors?

By Staff Reporters

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Health insurance agents offering support to seniors signing up for healthcare coverage will be compensated differently starting in 2025. For example:

The government will pay $100 more per enrollment to agents who sign seniors up for Medicare Advantage Plans or Medicare Part D for the first time — a significant increase from the proposed $31 pay increase for agents.

And, Medicare is ending sales incentives for agents who currently receive bonuses, including volume-based bonuses, for signing people up for Medicare Advantage Plans, Medigap Supplement Plans or Part D. Medicare is also putting a stop to agents and brokers collecting “administrative fees” above the fixed compensation cap the government has put in place.

The hope is that providing agents with fair initial compensation will no longer incentivize them to steer seniors towards plans that may not be a good fit.

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

PS: Medicare open enrollment ended December 7th, 2024. New plans commence January 1st, 2025

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Filed under: "Ask-an-Advisor", Drugs and Pharma, Ethics, Health Economics, Health Insurance, Health Law & Policy, Healthcare Finance | Tagged: Health Insurance, healthcare, insurance, insurance agent, insurance agent compensation, medicare, Medicare Advantage, medicare agent compensation, medicare agent pay, Medicare C, open enrollment, Part C, Part D | Leave a comment »

ANTHEM BX/BS WEBSITE: Corporate Leaders Page Gone?

Posted on December 6, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

By Staff Reporters

BREAKING NEWS!

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The internet web page listing the corporate leadership team behind Anthem Blue Cross Blue Shield (BCBS), one of America’s biggest health insurers, has disappeared from the company’s website.

The disappearance of the page listing the provider’s 25 highest-ranking employees was highlighted in a post shared to the r/antiwork subreddit on Reddit by the user u/wendysdriv

MORE: https://www.msn.com/en-us/money/companies/blue-cross-blue-shields-corporate-about-us-page-vanishes-from-website/ar-AA1voh7N

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OPPS: Final Rule Issued by CMS

Posted on December 6, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

By Health Capital Consultants, LLC

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On November 1, 2024, CMS released its Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System Final Rule for calendar year 2025. The rule finalizes payment updates, revises current programs, and establishes new standards to address the ongoing maternal health crisis.

This Health Capital Topics article discusses the key OPPS changes and updates included in the Final Rule. (Read more…)

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DAILY UPDATE: Anthem Health Insurance Cost Cutting as Markets Pause

Posted on December 6, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

MEDICAL EXECUTIVE-POST – TODAY’S NEWSLETTER BRIEFING

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

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

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Health insurance companies are under scrutiny for proposed changes to anesthesia billing policies, raising concerns about patient safety and fair compensation for medical professionals. Anthem, a major health insurer, recently announced a controversial policy limiting payments for anesthesia services in Connecticut, Missouri, and New York. The policy would only cover part of the documented anesthesia time during a patient’s surgery, a decision strongly opposed by the American Society of Anesthesiologists (ASA).

Breaking News: Anthem health insurance company is backing off of a controversial plan to limit coverage of anesthesia in at least one state, according to Connecticut’s comptroller.

WEEKLY UPDATE: SCHEDULE

December 6: November nonfarm payrolls, University of Michigan preliminary December Consumer Sentiment.

December 9: October final wholesale inventories, November consumer inflation expectations, and expected earnings from Toll Brothers (TOL) and MongoDB (MDB).

December 10: Third quarter productivity and unit labor costs and expected earnings from AutoZone (AZO).

December 11: November Consumer Price Index and expected earnings from Adobe (ADBE).

December 12: November Producer Price Index and expected earnings from Broadcom (AVGO), Ciena (CIEN), and Costco (COST).

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

Here’s where the major benchmarks ended:

The SPX fell 11.38 points (–0.19%) to 6,075.11; the Dow Jones Industrial Average^® ($DJI) lost 248.33 points (–0.55%) to 44,765.71; and the NASDAQ Composite^® ($COMP) declined 34.85 points (–0.18%) to 19,700.26.
The 10-year Treasury note yield was unchanged at 4.18%.
The CBOE Volatility Index^® (VIX)inched up to 13.46.

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

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INSURANCE: Long Term Care Economics

Posted on December 5, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

LTC

By Anonymous Insurance Agent

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Some retired people live on a fixed income and many of them live right on the edge of their financial capability. At some time in their life, they may have to make a choice regarding many purchases. In this case, we will illustrate “choice” using a couple’s purchase of Long-Term-Care Insurance [LTCI].

Of course, economics is the study of choice; wants, needs and scarcity, etc. In our case, if they decide to make the purchase they commit to a lifetime of premium payments. The financial tradeoff is this; if they make the commitment to purchase LTCI, they must give up something else.

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

Example: In order to maintain a monthly premium of $100 ($1,200per year), an elderly patient, retired layman or couple must essentially relegate about $30,000 of financial assets to generate the $100 necessary to make an average premium payment (assumes a 7% rate of return with 4% withdrawal rate) or [4% X $30,000 = $1,200 year]. Thus, if the monthly premium cost is $500 per month, the elder must give up the use of $150,000 of retirement asset just to generate enough cash flow to pay for the LTC insurance.

The married elder couple has to make the decision among lifestyle (dinners, vacations, gifts to children, prescription drugs, medical care or food and shelter) versus paying an insurance premium to provide for nursing home coverage for a need, which may be very real, but will not occur until sometime in the ambiguous future.

And so, when faced with such a tough economics, neither of which delivers peace of mind or a respectable solution; many will simply decide that, in either case, they may already end up impoverished.

Thus, many will often opt for the better lifestyle now … while they can enjoy it … together.

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DAILY UPDATE: UnitedHealthcare CEO Shot but Stocks Rise as Paul Atkins Nominated for SEC Chairman

Posted on December 5, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

MEDICAL EXECUTIVE-POST – TODAY’S NEWSLETTER BRIEFING

***

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

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

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

SPONSORED BY: Marcinko & Associates, Inc.

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The CEO of UnitedHealthcare, Brian Thompson, was fatally shot in the chest on Wednesday morning outside the Hilton hotel in Midtown, the New York Post reported, citing police sources. WPIX reported Thompson, 50, was shot just before 7 a.m. near a hotel on 54th Street between 6th and 7th Avenues.

The 10-year U.S. Treasury yield (TNX) climbed four basis points to nearly 4.27%.
The U.S. Dollar Index ($DXY) rose slightly to 106.58.
The CBOE Volatility Index^® (VIX) was steady near 13.18, still close to four-month lows.
WTI Crude Oil (/CL) added 0.2% to $70.09 per barrel.
Bitcoin (BTC) rose 0.1% to $95,702.

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

President-elect Donald Trump officially announced the nomination of Paul Atkins as the next chair of the Securities and Exchange Commission on Wednesday. Atkins, currently the CEO at Patomak Global Partners, served as SEC chair under the George W. Bush administration from 2002 to 2008. Unlike his potential predecessor Gary Gensler, who is set to leave office in January 2025, Atkins is seen as a pro-cryptocurrency official and currently serves on the advisory board for digital securities issuance platform Securitize.

https://www.amazon.com/Comprehensive-Financial-Planning-Strategies-Advisors/dp/1482240289/ref=sr_1_1?ie=UTF8u0026amp;qid=1418580820u0026amp;sr=8-1u0026amp;keywords=david+marcinko

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

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Filed under: Alerts Sign-Up, Drugs and Pharma, Ethics, Health Insurance, Information Technology, Investing, Managed Care, Marcinko Associates, Recommended Books, Sponsors | Tagged: Bitcoin, Brain Thompson, crypto, cryptocurrency, DJIA, DOW, Marcinko, NASA, NASDAQ, Paul Atkins, S&P 500, SEC, SEC chair, textbooks, TNX, UHC, UHC CEO shot, UnitedHealthcare, VIX, WPIX, WSJ, WTI bitcoin | Leave a comment »

MPFS Final Rule Cuts Physician Payments [Will it Last?]

Posted on December 4, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

By Health Capital Consultants, LLC

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On November 1, 2024, the Centers for Medicare & Medicaid Services (CMS) released its finalized Medicare Physician Fee Schedule (MPFS) for calendar year (CY) 2025, aiming “to strengthen primary care, expand access to preventive services, and further access to whole-person care.” While the finalized fee schedule cuts payments to physicians, Congress is considering legislation to override the cut.

This Health Capital Topics article discusses the provisions contained in the MPFS final rule, as well as the proposed “doc fix” legislation. (Read more…)

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Filed under: "Ask-an-Advisor", Accounting, Career Development, Experts Invited, Funding Basics, Health Economics, Health Insurance, Healthcare Finance, iMBA, Inc. | Tagged: Centers for Medicare & Medicaid Services, CMS, Health Capital Consultants LLC, Health Capital Topics, Jessica Bailey-Wheaton, MPFS, physician payments, TODD A. ZIGRANG | Leave a comment »

Record-Breaking Savings for ACOs in 2023

Posted on December 1, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

ACCOUNTABLE CARE ORGANIZATIONS

By Health Capital Consultants, LLC

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On October 29, 2024, CMS announced Performance Year (PY) 2023 results for accountable care organizations (ACOs) participating its Medicare Shared Savings Program (MSSP). Notably, MSSP ACOs garnered the largest net savings in MSSP’s history – more than $2.1 billion.

This Health Capital Topics article discusses MSSP performance in 2023 and how this may inform value-based care going forward. (Read more…)

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AMA: 41 Senators Sign Letter to Stop Medicare Cuts

Posted on November 30, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

By Staff Reporters

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In a sign of legislative momentum, 41 senators are supporting efforts to prevent a pending 2.8 percent cut in Medicare physician payments that will go into effect January 1st. The bipartisan letter led by Sens. John Boozman, R-Ark., and Peter Welch, D-Vt., to Senate leaders says the cuts would interfere with the ability of physicians to provide high-quality care. “These continued payment cuts undermine the ability of independent clinical practices – especially in rural and under served areas – to care for their communities,” the letter said.

The Senate letter follows one from the American Medical Association (AMA) and 127 other state medical associations and national medical societies asking Congress to use these last few congressional days to prevent the scheduled cuts. The letter to congressional leaders also urges Congress to provide a positive payment update for 2025. All 50 state medical societies – and DC— as well as 77 national medical societies signed.

Source: AMA

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

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Filed under: "Doctors Only", Accounting, Health Economics, Health Insurance, Health Law & Policy, Healthcare Finance, Taxation | Tagged: AMA, American Medical Associaion, CPT, CPTs, health, Health Insurance, healthcare, insurance, medicare, medicare cuts, RVUs, senators | Leave a comment »

DAILY UPDATE: Semaglutide Drugs, CMS, Emory & UnitedHealthcare as Stock Markets Rise High

Posted on November 27, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

MEDICAL EXECUTIVE-POST – TODAY’S NEWSLETTER BRIEFING

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

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

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

SPONSORED BY: Marcinko & Associates, Inc.

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In breaking news, the Biden administration is attempting to cover anti-obesity drugs for weight loss under Medicare and Medicaid. A recent study finds 137 million people are eligible for semaglutide drugs nationwide.

Another insurer can claim victory against CMS after UnitedHealthcare prevailed in its star ratings lawsuit on Friday. The feds will now have to recalculate the scores.

And ... Emory Healthcare is looking to expand value-based care for more than 350,000 patients through a population health partnership with tech company Guidehealth.

STOCKS UP

Uncrustables taste almost as good as today’s gains: J.M. Smucker rose 5.70% thanks to a beat-and-raise quarter for the company.

Walmart gained 2.02% on a report that Target is losing its high-end customers to the low-price retailer. Target sank 3.03%.
Semiconductor stock Semtech rose another 18.10% after announcing stronger-than-expected earnings last night.

STOCKS DOWN

Amgen’s new drug did help patients lose up to 20% of their weight in a given year, but that wasn’t enough to impress shareholders, who kicked shares down 4.76%.
Kohl’s plummeted 17.01% after the retailer met revenue expectations but missed on earnings last quarter. It definitely doesn’t help that the CEO announced his retirement last night.
Abercrombie & Fitch’s turnaround is well underway, and the company beat earnings forecasts last quarter and projected strong holiday sales. But it still fell short of shareholder expectations, and the stock sank 5.10% today.
Best Buy rounded out retailer earnings today, dropping 4.89% after missing revenue expectations last quarter and cutting its full-year guidance.
Zoom Communications changed its name, but that wasn’t enough to save the company from a 6.31% decline today thanks to its tepid fiscal outlook.

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

Here’s where the major benchmarks ended:

The S&P 500^® index (SPX)rose 34.26 points (0.57%) to 6,021.63; the Dow Jones Industrial Average^® ($DJI) added 123.74 points (0.28%) to 44,860.31; and the NASDAQ Composite^® ($COMP) gained 119.46 points (0.63%) to 19,174.30.
The 10-year Treasury note yield climbed four basis points to 4.3% after Trump’s tariff comments, but shorter-term yields fell after the Fed minutes, keeping the yield curve slightly out of inversion.
The CBOE Volatility Index^® (VIX)dropped to 14.19, near a two-week low.

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

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Filed under: "Ask-an-Advisor", "Doctors Only", Drugs and Pharma, Ethics, Financial Planning, Health Economics, Health Insurance, Health Law & Policy, Healthcare Finance, Industry Indignation Index, Information Technology, Investing, Marcinko Associates, Recommended Books, Sponsors | Tagged: Biden, CMS, DJIA, DOW, Emory Healthcare, guidehealth, Marcinko, NASA, NASDAQ, S&P 500, Science, semaglutide, textbooks, TNX, UnitedHealthcasre, VIX, weightloss, WSJ | Leave a comment »

DAILY UPDATE: Health Insurance Affordability as Stock Markets Broadly Rise

Posted on November 26, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

MEDICAL EXECUTIVE-POST – TODAY’S NEWSLETTER BRIEFING

***

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

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

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The Commonwealth Fund’s 2024 biennial health insurance survey, released November 21, found that though 79% of US adults had continuous health insurance for 12 months, 23% were under insured, meaning they have health insurance and still can’t afford care. About 56% of those surveyed had adequate insurance coverage all year.

STOCKS UP

Rocket Lab rocketed (sorry) 3.44% to a new record high after launching not one, but two different rockets in two different hemispheres in a single day.
Bath & Body Works soared 16.51% on a strong beat-and-raise quarter.
Robinhood jumped 3.27% after Morgan Stanley analysts doubled their price target for the investing app.
Super Micro Computer surged yet another 15.87%, more than doubling in the last seven days, and shareholders cheered its comeback.
Hims & Hers Health climbed 23.77% on the news that the new head of the FDA may be an ally.
Flying taxi company Vertical Aerospace popped 45.51% after announcing an additional $50 million in funding from one of its biggest shareholders.

STOCKS DOWN

Defense contractor stocks got a double whammy today: Hopes of a ceasefire between Israel and Hezbollah, combined with Elon Musk’s declaration on X that buying manned military aircraft is wasteful. Lockheed Martin fell 3.76%, Northrop Grumman dropped 2.39%, and Raytheon Technologies parent company RTX Corp. fell 1.74%.
Speaking of Musk, Tesla sank 3.96% after California announced it may exclude the automaker from incentives that encourage drivers to buy EVs in the state.
Pipeline operator Oneok lost 4.72% on the news that it will acquire the remaining portion of EnLink Midstream that it doesn’t already own.
After rallying last week thanks to its inclusion in the S&P 500, Texas Pacific Land sank 6.71% today as investors took profits.

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Here’s where the major benchmarks ended:

The SPX rose 18.03 points (0.30%) to 5,987.37; the $DJI added 440.06 points (0.99%) to 44,736.57; and the NASDAQ Composite^® ($COMP) gained 51.18 points (0.27%) to 19,054.84.
The 10-year Treasury note yield fell 15 basis points to 4.27%.
The CBOE Volatility Index^®(VIX)dropped to 14.74, the lowest since November 14.

ORDER: 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

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

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Valuation of Hospitals [Technological Environment]

Posted on November 25, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

By Health Capital Consultants, LLC

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Technological advancements have accelerated the shift of healthcare services from inpatient to outpatient settings, creating both opportunities and challenges for hospitals. For instance, minimally invasive procedures often serve as alternatives to traditional, more invasive surgeries. Additionally, the integration of telehealth and artificial intelligence (AI) has the potential to enhance access to and quality of care while reducing expenditures and administrative burdens.

This final installment of a five-part series on the valuation of hospitals examines the technological advancements transforming the industry. (Read more…)

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MEDICAL ECONOMICS: Healthcare Inflation

Posted on November 23, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

By Staff Reporters

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Inflation has hit record levels this year as demand for goods and services far outpaced supply, and many companies are still trying to bounce back from the shutdowns of early 2020. Health systems, which have razor-thin operating margins even in the best of times, aren’t an exception.

“In the past, we’ve always said that healthcare was kind of recession-proof because demand for healthcare keeps going, regardless of what’s happening in the economy,” said Tina Wheeler, leader of consulting firm Deloitte’s US healthcare practice.

But in the last year, inflation hovered around 8% for much of the year, while medical-care prices increased by only 4.8%, according to Wheeler. Since medical costs are negotiated between hospitals and payers years in advance, hospitals can’t just raise their prices now to keep up with the pace of inflation, said Gerard Brogan Jr., senior vice president and chief revenue officer at Northwell Health.

READ: https://medicalexecutivepost.com/2022/11/10/the-cpi-and-stock-markets/

Here’s how badly hospitals could be hurting:

Inflation could cause an additional $370 billion more in healthcare spending than the expected baseline increase by 2027, according to McKinsey.
The national health expenditure could grow at a rate of 7.1% over the next five years, compared to the expected economic growth rate of 4.7%, according to McKinsey.
By the end of 2021, total hospital expenses per adjusted discharge were up 20.1% compared to 2019, according to the trade group American Hospital Association.

Rising interest rates also hurt hospitals since their main access to capital is through issuing tax-exempt bonds, Wheeler said. The rising cost of capital limits hospitals’ ability to fund projects, like opening a new oncology center to treat patients, for example. Keep reading here

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AMA: Bye-Bye Medicare Billing Codes?

Posted on November 22, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

By Staff Reporters

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Robert F Kennedy Jr, who was selected by Donald Trump to run the U.S. health and human services department, is working on plans to rid the American Medical Association from its role in drawing up Medicare’s billing codes, which sets doctors’ fees for more than 10,000 procedures, Oliver Barnes of The Financial Times reports.

The plan would result in an upheaval of a system that has been in place for decades. Publicly traded companies in the healthcare space include CVS Health (CVS), Centene (CNC), Cigna (CI), Elevance Health (ELV), Humana (HUM), Molina Healthcare (MOH) and UnitedHealth (UNH).

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CHARGE MASTER: Medical Bills Paradox

Posted on November 20, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

By Dr. David Edward Marcinko MBA MEd CMP™

SPONSOR: http://www.CertifiedMedicalPlanner.org

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CHARGE MASTER MEDICAL BILLS

Classic Definition: A comprehensive review of a physician, clinic, facility, medical provider or hospital’s charges to ensure Medicare billing compliance through complete and accurate HCPCS/CPT and UB-92 revenue code assignments for all items including supplies and pharmaceuticals. The charge master captures the costs of each procedure, service, supply, prescription drug, and diagnostic test provided at the hospital, as well as any fees associated with services, such as equipment fees and room charges

Modern Circumstance: A charge master quizlet (charge description master [CDM]) document that contains a computer-generated list of procedures, services, and supplies with charges for each. Charge master rates are essentially the health care market equivalent of Manufacturer’s Suggested Retail Price (MSRP) in the car buying market. Poor charge master maintenance can lead to overpayments or underpayments. It can also lead to claim rejections from insurance companies, poor patient experience, or compliance violations.

Paradox Examples:

Superbills: An encounter form that is the financial record source document used by healthcare providers and other personnel to record treated diagnoses and services rendered to the patient during the current encounter. It is also called a superbill.
Payment rates: Almost no one actually pays the publicized charge master rates. The vast majority of health care consumers are represented by a payer of some kind, such as a commercial health insurance company, Medicaid, or Medicare. Commercial insurers negotiate the actual prices they pay during the process of contracting with providers. Medicare and Medicaid establish their own payment levels independent of hospitals’ charge master lists – Medicare through the federal government and Medicaid through state governments.
Cash pay: The sad irony of the charge master is that the uninsured are the most likely to be billed charge master rates because they are not represented by a third-party payer.
Problematic features: Other items also impede the ability of payers to have a comprehensive and accurate understanding of hospitals’ financial positions. For example, nonprofit hospitals are required to report charity care, bad debt expenses, community benefit initiatives, and uncompensated care. When these expenses are reported at the charge master level, expenses can be paradoxically overstated, potentially making a hospital’s financial position look worse than it actually is.

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WHAT TRUMP’S ELECTION WIN COULD MEAN FOR HEALTH CARE

Posted on November 19, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

By Dr. Bertalan Meskó, MD PhD

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Regarding AI, the emphasis will shift away from the regulatory environment towards technology companies making their own decisions. Trump also promised to repeal Biden’s executive order on AI because it “hinders AI Innovation”.

Regarding health care, Trump said he would let Robert F. Kennedy “go wild” on health. Being a vaccine doubter and having made many unscientific claims about health, this could be a huge risk to digital health and the FDA’s job on regulating technologies. READ MORE

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NOVEMBER: National Alzheimer’s Awareness Month

Posted on November 17, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

By Dr. David Edward Marcinko MBA MEd

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The number of people living with Alzheimer’s disease is growing. The ripple effect is straining families, communities, and the healthcare system, yet talking about the disease on a personal level can be difficult.

November is Alzheimer’s Awareness Month because it can happen in any family, and because it’s worth talking about the challenges of living with or caring for someone with this disease.

You may notice splashes of teal and purple sprouting up this November, as both colors are associated with Alzheimer’s awareness. Teal is the color of the Alzheimer’s Foundation of America, chosen for its calming effect. Purple is the signature color of the Alzheimer’s Foundation, which stands for strength in the fight against Alzheimer’s disease.

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DAILY UPDATE: Healthcare Private Equity Prominent as Stocks Go Down

Posted on November 15, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

MEDICAL EXECUTIVE-POST – TODAY’S NEWSLETTER BRIEFING

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Private equity (PE) dollars have become prominent in the US healthcare industry in recent decades, with PE firms now owning roughly 8% of all private hospitals in the country, according to nonprofit Private Equity Stakeholder Project. But studies have illustrated the financial model’s potential adverse effects, such one published in JAMA in December 2023 that found PE-owned hospitals are 25.4% more likely to report patient complications. Others have found that PE-owned healthcare companies represented more than one-fifth of healthcare company bankruptcies in 2023 and that PE-owned hospitals see their assets drop an average of 24% following an acquisition.

STOCKS UP

Tapestry, parent company of luxury brands like Coach and Kate Spade, and Capri, parent company of luxury brands like Versace and Jimmy Choo, have announced they will mutually terminate their planned merger. Tapestry popped 12.80%, while Capri rose 4.43%.

Speaking of luxury brands, Burberry soared 18.04% after its CEO announced a turnaround plan designed to halt the company’s recent decline.
Semiconductor maker ASML plummeted last month on a profit warning, but rose 2.90% today on reassurances that it’s still on track to meet its 2030 revenue forecasts.

STOCKS DOWN

Super Micro Computer fell yet another 11.41% as it nears the November 16 deadline to report fiscal year earnings or be delisted from the Nasdaq.
Trump Media & Technology Group dropped 6.71% as investors digested news that company insiders are shedding shares, as well as in reaction to a number of President-elect Trump’s cabinet appointments.
Hims & Hers Health tumbled 24.46% on the news that Amazon is getting into the telehealth game, offering Prime members fixed prices on treatments for hair loss and erectile dysfunction.
Ibotta is a cashback rewards company, but its shareholders may want their cash back. The company beat on top and bottom line estimates last quarter, but the win wasn’t good enough, and shares sank 12.55%.

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

Here’s where the major benchmarks ended:

The S&P 500^® index (SPX) fell 36.21 points (–0.60%) to 5,949.17; the Dow Jones Industrial Average^® ($DJI) lost 207.33 points (–0.47%) to 43,750.86; and the NASDAQ Composite^® ($COMP) dropped 123.07 points (–0.64%) to 19,107.65.
The 10-year Treasury note yield fell three basis points to 4.42%.
The CBOE Volatility Index^® (VIX) edged up to 14.17.

Where the Candidates Stand on Healthcare

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

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NOVEMBER: Lung Cancer Awareness Month

Posted on November 14, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

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November is Lung Cancer Awareness Month, which according to the CDC, is the third most common cancer in the US. There are about one in five lung cancer deaths each year across the country, and November is dedicated to increasing screening, reducing smoking, and finding new treatments.

MORE: https://www.lung.org/

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PHYSICIAN: Pay Cuts in 2025

Posted on November 12, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

By Staff Reporters

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Doctors, Facing Another Pay Cut, Call for Permanent Medicare Payment Reform

The Centers for Medicare and Medicaid Services (CMS) is moving forward with a 2.9% cut to physician payments in 2025 despite protest from major industry groups. CMS has finalized the calendar year 2025 Medicare Physician Fee Schedule rule that sets payment rates for next year and also outlines new policies focused on primary care, preserved telehealth flexibilities, and a strengthened Medicare Shared Savings Program (MSSP).

But, provider groups were quick to condemn CMS’ decision to go ahead with the pay cut, which was proposed in the draft rule released in July. In a statement, Bruce Scott, MD, president of the American Medical Association (AMA), pointed out that that while physicians are receiving a 2.8% payment cut next year, medical practice costs for physicians will increase by 3.5% in 2025. After adjusted for inflation, Medicare reimbursement to physicians has decreased 29% since 2001, the AMA says.

Source: Heather Landi, Fierce Healthcare [11/2/24]

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PRIMARY MEDICAL CARE: The Paradox

Posted on November 11, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

BY DR. DAVID EDWARD MARCINKO MBA MEd CMP™

Sponsor: http://www.CertifiedMedicalPlanner.org

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Classic Definition: Despite rising costs, health care often is of poor quality. Evidence from a classic medical improvement outcomes study assessed care of patients with several chronic diseases. This study found that patients’ functional health status outcomes are similar to care rendered by specialists and generalists but that generalists use far fewer resources. Similar outcome at lower cost represents higher value.

Modern Circumstance: Current solutions to improving care quality may do more harm than good if they focus more on diseases than on people. Efforts to improve the parts (evidence-based care of specific diseases) may not necessarily improve the whole (the health of people and populations).

Expanding access to specialty care, for example, has been proposed as both a source of and a solution for deficiencies in quality of care. Primary care is touted as an essential building block of a high-value health care system even as it is undermined by systems attempting to improve the quality, effectiveness, and value of their health care..

Paradox Example: The above contradictions plague improvement efforts in health care systems around the world, particularly the United States The paradox is that compared with specialty care or with systems dominated by specialty medical care, primary care is associated with the following: (1) poorer quality care for individual diseases, yet (2) similar functional health status at lower cost for people with chronic disease, and (3) better quality, better health, greater health equity and lower costs for whole peoples and populations.

And so, this contradiction plagues improvement efforts in health care systems around the world, particularly the United States.

Cite: Kurt Stange MD PhD and Robert Ferrer MD MPH

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HEALTHCARE: Where the Presidential Candidates Stand

Posted on November 6, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

By Health Capital Consultants, LLC

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With the Presidential Election just weeks away, healthcare has once again come front and center of national political discourse, as voters rank healthcare as an important issue, and Vice President Kamala Harris and former President Donald Trump tout their respective healthcare agendas.

While details related to future healthcare proposals have been light, both candidates do have political track records that can be examined for clues as to their priorities should they become president.

This Health Capital Topics article explores where the candidates stand on various issues related to healthcare. (Read more…)

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METAVERSE MEDICINE: A Paradigm Shift?

Posted on November 5, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

By Dr. David Edward Marcinko MBA MEd

SPONSOR: http://www.MarcinkoAssociates.com

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In what some are calling the next iteration of the internet, the metaverse is an unfamiliar digital world where you could be an avatar navigating computer-generated places and interacting with others in real time. In this space, the constraints of our physical, bricks and mortar world and travel habits fade. And new opportunities and challenges emerge.

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

For example:

Google in healthcare: The search giant has repeatedly successfully transferred its in-depth knowledge of algorithms in the field of medicine, particularly since it acquired DeepMind.

Apple in healthcare: Apple will keep on working on expanding the health features of its devices, Apple Watch and iPhones included.

Microsoft in healthcare: Microsoft’s cloud solutions provide integrated capabilities that make it easier to improve the healthcare experience.

Amazon in healthcare: Amazon will make further use of its vast knowledge of online shopping trends and behavior and will keep on providing what people need, from medicine to wearables.

IBM in healthcare: IBM has a lot to offer in federated learning, blockchain, and quantum computing.

Nvidia in healthcare: NVIDIA seems incredibly focused on its approach to healthcare. We can expect NVIDIA to be a leader in the use of artificial intelligence in healthcare.

Facebook in healthcare: The Metaverse developed by Facebook/Meta has incredible potential to revolutionize healthcare.

All this technology has huge potential because it uses both virtual reality (VR) and augmented reality (AR) technology to work in virtual spaces: All signs point to the metaverse being widely used as a disruptive change in healthcare, from better surgical precision to therapeutic uses to social-distance accommodations and more.

But along with these improvements come new problems that will change what we know about modern healthcare. The metaverse is a paradigm shift in healthcare that everyone involved needs to be aware of. This is because it changes how medical infrastructure is built, how startup costs are covered, and how data security and privacy are handled.

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GDP: Private Domestic Health Care Investments

Posted on November 5, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

By Dr. David Edward Marcinko MBA MEd CMP™

SPONSOR: http://www.MarcinkoAssociates.com

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SPONSOR: http://www.CertifiedMedicalPlanner.org

GROSS PRIVATE DOMESTIC HEALTH CARE INVESTMENTS

Classic: Investment purchases and private expenditures of healthcare firms, the value of related construction, and the change in inventory during the year.

Modern: Gross Revenue Per Day is the average amount charged by a hospital for one day of inpatient care (gross inpatient revenue divided by patient-census days).

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

Examples:

Gross Revenue Per Discharge: The average amount charged by a hospital to treat an inpatient from admission to discharge (gross inpatient revenue divided by discharges).
Gross Revenue Per Visit: The average amount charged by a hospital for an outpatient visit (gross outpatient revenue divided by outpatient visits).

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DAILY UPDATE: CVS Splits as Stocks Down in Slow Session

Posted on November 5, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

MEDICAL EXECUTIVE-POST – TODAY’S NEWSLETTER BRIEFING

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

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Among consideration for CVS is splitting up its assets: CVS Pharmacy, pharmacy benefit manager CVS Caremark, and insurance arm Aetna. The company has reportedly been in talks with bankers about the move, Reuters reported early this month.

STOCKS UP

Just as Nvidia will replace Intel, Sherwin Williams will replace Dow Inc. on the Dow (how embarrassing, getting kicked off an index you share a name with). Sherwin Williams popped 4.59%, while Dow Inc. fell 2.08%.
Chewy is also getting added to an index, replacing Stericycle on the MidCap 400. Shares rose 6.34%.
Peloton pedaled 3.59% higher on a double upgrade from Bank of America analysts, who like the bike company’s higher profit outlook and hiring of new CEO Peter Stern from Ford.
Yum! China, the company that operates Pizza Hut and KFC restaurants in China, climbed 7.12% after announcing that new store openings translated into better-than-expected revenue and earnings last quarter.

STOCKS DOWN

Nuclear energy stocks took a big hit today after the Federal Energy Regulatory Commission ruled that Talen Energy could not increase the amount of energy its nuclear plant in Susquehanna, PA, produces in order to power an Amazon data center. Talen fell 2.23%, Vistra Corp sank 3.18%, and Constellation Energy plummeted 12.46%.

Clinical data from a Viking Therapeutics trial shows its weight-loss pill is effective. Shares soared then sank 13.36% as investors took profits.
The New York Times dropped 7.71% thanks to slower subscriber growth last quarter.

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

Here’s where the major benchmarks ended:

The S&P 500^® index (SPX) dipped 16.11 points (–0.28%) to 5,712.69; the $DJI dropped 257.59 points (–0.61%) to 41,794.60; and the $COMP lost 59.93 points (–0.33%) to 18,179.98.
The 10-year Treasury note yield (TNX) fell five basis points to 4.31%.
The CBOE Volatility Index^® (VIX)edged up to 22.11, still below last week’s peaks.

https://www.amazon.com/Comprehensive-Financial-Planning-Strategies-Advisors/dp/1482240289/ref=sr_1_1?ie=UTF8u0026amp;qid=1418580820u0026amp;sr=8-1u0026amp;keywords=david+marcinko

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PHYSICIANS: Career Change Conundrum

Posted on November 3, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

By Dr. David Edward Marcinko MBA MEd CMP™

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Half of Physicians Plan to Change Career Paths

The Physicians Foundation conducted a survey on physician practice patterns and perspectives a few years ago. Here are some key findings from the report:

• 31% of physicians identify as independent practice owners or partners.
• Almost half (47%) of physicians plan to change career paths.
• 78% of physicians sometimes, often or always experience feelings of burnout.
• Nearly a quarter of physician time is spent on non-clinical paperwork.

This result is not good for Medicine.

Cite: The Physicians Foundation, September 2018

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Filed under: "Doctors Only", Career Development, Ethics, Health Insurance, Health Law & Policy, iMBA, iMBA, Inc., Industry Indignation Index, LifeStyle, Marcinko Associates | Tagged: doctor burnout, doctor career change, doctor careers, doctors, iMBA, institute medical advisors, Marcinko, medical executive post, physician burn out, physician career change, physician careers, physicians, Physicians Foundation | Leave a comment »

Recent Court Actions Provide Insight into Future of Fraud & Abuse Laws

Posted on November 3, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

By Health Capital Consultants, LLC

Two recent court actions may serve as harbingers for the future of healthcare fraud and abuse laws. In September 2024, a federal judge in the Southern District of West Virginia ordered parties in a qui tam False Claims Act and Stark Law case to brief the court on the implications of Loper Bright Enterprises v. Raimondo on the interpretation of the Stark Law to the case at hand.

That same month, a federal judge in the Middle District of Florida dismissed a qui tam lawsuit on a novel theory that the False Claims Act’s whistleblower provisions are unconstitutional.

This Health Capital Topics article discusses these cases and the potential impact on federal fraud and abuse laws. (Read more…)

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Filed under: "Doctors Only", Accounting, Career Development, Experts Invited, Funding Basics, Glossary Terms, Health Economics, Health Insurance, Health Law & Policy, Healthcare Finance, iMBA, Inc. | Tagged: false claiims act, fraud and abuse, health abuse, Health Capital Consultants LLC, health fraud, qui tam, Stark laws | Leave a comment »

IN & OUT OF NETWORK: Medical Care

Posted on November 2, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

By Dr. David Edward Marcinko MBA MEd CMP™

SPONSOR: http://www.CertifiedMedicalPlanner.org

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What does in-network mean?

In-network refers to a health care provider that has a contract with your health plan to provide health care services to its plan members at a pre-negotiated rate. Because of this relationship, you pay a lower cost-sharing when you receive services from an in-network doctor.

What does out-of-network mean?

Out-of-network refers to a health care provider who does not have a contract with your health insurance plan. If you use an out-of-network provider, health care services could cost more since the provider doesn’t have a pre-negotiated rate with your health plan. Or, depending on your health plan, the health care services may not be covered at all.

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

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OUT OF NETWORK [OON] MEDICAL CARE

Classic: Any medical provider, supplier or facility that is in-network is one that has contracted with your health insurer to provide services;as above.

Modern: Depending on your plan, if you visit an out-of-network provider, it may not be covered or might be only partially covered. When making appointments with various doctors and service providers, you may notice some are listed as “in-network” while others are “out-of-network.”

THINK: Medicare Advantage {Part C] Plans

Example: You can expect a higher deductible and out-of-pocket limit at out-of-network providers. Your coinsurance and co-payment may also be higher for out-of-network providers.

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Filed under: Accounting, CMP Program, Glossary Terms, Health Economics, Health Insurance, Health Law & Policy, Healthcare Finance, iMBA, Inc., Managed Care, Touring with Marcinko | Tagged: health, Health Insurance, healthcare, HMO, iMBA, in network, insurance, Marcinko, medicare, Medicare Advantage, Medicare C, OON, out of network, PPO | Leave a comment »

EMPLOYER’S: Pay for Health Insurance Paradox

Posted on November 1, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

By Dr. David Edward Marcinko MBA MEd CMP™

SPONSOR: http://www.CertifiedMedicalPlanner.org

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Classic Definition: Employers write checks that cover most health insurance premiums for employees and their dependents. But as the late Princeton health economist Uwe Reinhardt PhD once explained, employer-sponsored insurance is like a pickpocket taking money out of your wallet at a bar and buying you a drink. You appreciate the cocktail until you realize you paid for it yourself.

Modern Circumstance: With health coverage, employers write the check to the insurer, but employees bear the cost of the premium — the entire premium, not just the portion listed as their contribution on their pay stub. The premium money that goes to the insurance company is cash that employers would otherwise deposit in employees’ accounts like the rest of their salary.

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

Paradox Example: The fallacy paradox is in thinking an employer’s contribution comes out of profits. In fact, higher health insurance premiums mean lower wages for workers. Since 1999, health insurance premiums have increased 147 percent and employer profits have increased 148 percent. But in that time, average wages have hardly moved, increasing just 7 percent. Clearly workers’ wages, not corporate profits, have been paying for higher health insurance premiums. Health care costs are one — though not the only — reason wages have stagnated over the last few decades. With health insurance costs rising faster than growth in the economy, more labor costs go to benefits like health insurance and less to take-home pay. Yet the paradox that employees don’t pay for their own health insurance is widespread:

The first reason is that individuals cannot be sure what causes their wages to change or remain stagnant for decades.
The second reason is that employers want Americans to believe that they pay for their workers’ health insurance.
The third reason is that there are those who profit from the employment-based system: drug companies, device manufacturers, specialty physicians and high-income individuals.

And so, they all want you to believe companies are being magnanimous in giving you insurance, but they are not!

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Filed under: "Ask-an-Advisor", Accounting, CMP Program, Drugs and Pharma, Ethics, Experts Invited, Glossary Terms, Health Economics, Health Insurance, Health Law & Policy, Healthcare Finance, iMBA, iMBA, Inc., Insurance Matters, Marcinko Associates | Tagged: certified medical planner, CMP, health, Health Insurance, health insurance paradox, healthcare, iMBA, Institute Medical Business Advisors, insurance, Marcinko, medical executive post, medicare, paradox, Uwe Reinhardt PhD | Leave a comment »

DAILY UPDATE: Health-Care’s Future as Stocks Climb

Posted on October 29, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

MEDICAL EXECUTIVE-POST – TODAY’S NEWSLETTER BRIEFING

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

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Healthcare’s future as HSBC Innovation Banking collaborated with LINUS and HLTH to help prepare the healthcare ecosystem for the future. The Health 2035 report goes in depth with discussions between visionaries in the ecosystem and studies of young physicians’ forecasts for what the state of care will be in the year 2035. Download the report.

Stocks Up

Trump Media & Technology Group soared 21.59% following a major rally at Madison Square Garden, an appearance on Joe Rogan’s podcast, and rising chances of winning the election. Fun fact: After this latest stock surge, Trump Media is now worth almost as much as social media network X.
Nio surged 10.46% thanks to an upgrade from Macquerie, whose analysts believe that the EV startup could see strong growth from new vehicle launches next year.
Spotify has earned a spot on Wells Fargo’s top pick playlist, with analysts confident the stock could rise over 20%. Shares rose 1.27%.
Lower oil prices hurt energy stock, but are a big boost for companies that spend a lot on fuel. Carnival Corp rose 4.83%, Royal Caribbean Cruises climbed 1.35%, and American Airlines popped 3.42%.

Stocks Down

Philips floundered 15.95% after the Dutch consumer goods manufacturer missed on earnings and lowered its full-year forecast.
Boeing continued to fall yet another 2.79%, this time on the news that it is raising $19 billion through a stock offering in the hopes that it fends off a credit rating downgrade.
Oil stocks took a beating thanks to a big decline for crude prices. Diamondback Energy fell 3.36%, APA Corp. dropped 4.51%, Exxon Mobil sank 0.49%, and BP lost 1.48%.

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

Here’s where the major benchmarks ended:

The S&P 500^® index (SPX)rose15.40points (0.27%) to 5,823.52; the Dow Jones Industrial Average^® ($DJI) added 273.17 points (0.65%) to 42,387.57; and the NASDAQ Composite^® ($COMP) gained 48.58 points (0.26%) to 18,567.19.
The 10-year Treasury note yield (TNX) climbed six basis points to 4.29%, the highest close since July 9.
The VIX fell to 19.53.