PHARMACY BENEFITS MANAGER: The Business Model Explained?

Posted on August 12, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By A.I. and Dr. David Edward Marcinko MBA MEd CMP™

SPONSOR: http://www.CertifiedMedicalPlanner.org

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Business Model Defined

Doctors and dentists earn money by treating patients. CPAs and Attorneys have clients, and retail stores buy items low and sell them at higher prices. This is called a business model.

More formally, a business model identifies the products or services the business plans to sell, the target market, and any anticipated expenses, in order to outline how to generate a profit. Business models are important for both new and established businesses. They help companies attract investment, recruit talent, and motivate management and staff.

Businesses should regularly update their business model, or they’ll fail to anticipate trends and challenges ahead. Business models also help investors to evaluate companies that interest them and employees to understand the future of a company they may aspire to join.

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The Business Model of Pharmacy Benefits Managers

In the United States, health insurance providers often hire a third party to handle price negotiations, insurance claims, and distribution of prescription drugs. Providers that use such pharmacy benefit managers include commercial health plans, self-insured employer plans, Medicare Part D [drug] plans, the Federal Employees Health Benefits Program, and state government employee plans. PBMs are designed to aggregate the collective buying power of en-rollees through their client health plans, enabling plan sponsors and individuals to obtain lower prices for their prescription drugs. PBMs negotiate price discounts from retail pharmacies, rebates from pharmaceutical manufacturers, and mail-service pharmacies which home-deliver prescriptions without consulting face-to-face with a pharmacist.

PBMs DEFINED: https://medicalexecutivepost.com/2019/01/18/on-pbms-pharmacy-benefits-management/

Pharmacy benefit management companies can make revenue in several ways.

First, they collect administrative and service fees from the original insurance plan.

Then, they can also collect rebates from the manufacturer.

Traditional PBMs do not disclose the negotiated net price of the prescription drugs, allowing them to resell drugs at a public list price (also known as a sticker price), which is higher than the net price they negotiate with the manufacturer. This practice is known as “spread pricing”. The industry argues that savings are trade secrets. Pharmacies and insurance companies are often prohibited by PBMs from discussing costs and reimbursements. This leads to lack of transparency.

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Therefore, states are often unaware of how much money they lose due to spread pricing, and the extent to which drug rebates are passed on to en-rollees of Medicare plans. In response, states like Ohio, West Virginia, and Louisiana have taken action to regulate PBMs within their Medicaid programs.

For instance, they have created new contracts that require all discounts and rebates to be reported to the states. In return, Medicaid pays PBMs a flat administrative fee.

PBM PODCAST: https://medicalexecutivepost.com/2023/08/26/podcast-cvs-replaces-its-pbm/

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SPEAKING: Dr. Marcinko will be speaking and lecturing, signing and opining, teaching and preaching, storming and performing at many locations throughout the USA this year! His tour of witty and serious pontifications may be scheduled on a planned or ad-hoc basis; for public or private meetings and gatherings; formally, informally, or over lunch or dinner. All medical societies, financial advisory firms or Broker-Dealers are encouraged to submit an RFP for speaking engagements: CONTACT: Ann Miller RN MHA at MarcinkoAdvisors@outlook.com -OR- http://www.MarcinkoAssociates.com

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Ophthalmologist V. Optometrist V. Optician V. Ocularist

Posted on August 11, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

A.I. and Staff Reporters

SPONSOR: http://www.CertifiedMedicalPlanner.org

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Difference-between-Optometrist-and-Ophthalmologist

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An ophthalmologist is a physician [MD, DO] who undergoes sub-specialty training in medical and surgical eye care. Following a medical degree, a doctor specializing in ophthalmology must pursue additional postgraduate residency training specific to that field. In the United States, following graduation from medical school, one must complete a four-year residency in ophthalmology to become an ophthalmologist. Following residency, additional specialty training (or fellowship) may be sought in a particular aspect of eye pathology.

Ophthalmologists prescribe medications to treat ailments, such as eye diseases, implement laser therapy, and perform surgery when needed. Ophthalmologists provide both primary and specialty eye care—medical and surgical. Most ophthalmologists participate in academic research on eye diseases at some point in their training and many include research as part of their career. Ophthalmology has always been at the forefront of medical research with a long history of advancement and innovation in eye care.

Optometrist

Optometrists focus on regular vision care and primary health care for the eye. After college, they spend 4 years in a professional program and get a doctor of optometry degree. But they don’t go to medical school. Some optometrists get additional clinical training or complete a specialty fellowship after optometry school. They:

  • Perform eye exams and vision tests
  • Prescribe and fit eyeglasses and contact lenses
  • Monitor eye conditions related to diseases like diabetes
  • Manage and treat conditions like dry eye and glaucoma
  • Provide low-vision aids and vision therapy

There are specialties among optometrists. They include:

Pediatric optometry. These providers work with babies, toddlers, and children, using special techniques to test their vision.

Neuro-optometry. If you have vision problems that result from a brain injury, this is the type of optometrist you might visit.

Low-vision optometry. If you have low vision—that means you can’t see well enough to perform your daily activities and your sight can’t be corrected by glasses or contact lenses, medicine, or surgery—low-vision optometrists offer devices and strategies that can improve your quality of life.

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Optician

An optician is an eye care specialist who helps you choose the right eyeglasses, contact lenses or other vision correction devices. They can’t diagnose or treat conditions that affect your eyes or vision. They’ll work with you to get the right corrective lenses after your optometrist or ophthalmologist gives you a prescription.

Ocularist

An ocularist is an eye care specialist who provides care for people needing prosthetic eyes due to injury, infection or congenital disease (present at birth). Losing or damaging an eye can be a traumatic experience, and the need for a prosthetic can be overwhelming. Ocularists offer long-term care. They collaborate with your healthcare team to create or restore a more natural facial appearance with the goal of enhancing your health-related quality of life.

A former term for this medical branch is oculism.

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PHARMACEUTICALS: Trump Tariff Plans

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

By A.I. and Staff Reporters

SPONSOR: http://www.CertifiedMedicalPlanner.org

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Trump says pharma tariffs could be as high as 250%

The president revealed that he plans to formally announce tariffs on the pharmaceutical industry “within the next week or so” in an attempt to force drug manufacturing to the US, he told CNBC several days ago.

PBMs: https://medicalexecutivepost.com/2019/01/18/on-pbms-pharmacy-benefits-management/

It would start with a “small” tariff, Trump said, before rising to 150% in a year to a year and a half, and eventually to 250%.

Pharma companies have argued that tariffs could drive up costs and threaten their ability to fund research for new medicines.

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PROSPECT THEORY: In Client Empowerment and Financial Decision Making

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

By Dr. David Edward Marcinko MBA MEd

SPONSOR: http://www.MarcinkoAssociates.com

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PROSPECT THEORY

In the early 1980s, Daniel Kahneman and Amos Tverskey proved in numerous experiments that the reality of decision making differed greatly from the assumptions held by economists. They published their findings in Prospect Theory: An analysis of decision making under risk, which quickly became one of the most cited papers in all of economics.

KAHNEMAN: https://medicalexecutivepost.com/2024/03/28/rip-daniel-kahneman-phd/

To understand the importance of their breakthrough, we first need to take a step back and explain a few things. Up until that point, economists were working under a normative model of decision making. A normative model is a prescriptive approach that concerns itself with how people should make optimal decisions. Basically, if everyone was rational, this is how they should act.

INVESTING PSYCHOLOGY: https://medicalexecutivepost.com/2025/02/21/investing-psychology/

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REAL-LIFE EXAMPLE

Amanda, an RN client, was just informed by her financial advisor that she needed to re-launch her 403-b retirement plan. Since she was leery about investing, she quietly wondered why she couldn’t DIY. Little does her Financial Advisor know that she doesn’t intend to follow his advice, anyway! So, what went wrong?

The answer may be that her advisor didn’t deploy a behavioral economics framework to support her decision-making. One such framework is the “prospect theory” model that boils client decision-making into a “three step heuristic.”
 
According to colleague Eugene Schmuckler PhD MBA MEd CTS, Prospect theory makes the unspoken biases that we all have more explicit. By identifying all the background assumptions and preferences that clients [patients] bring to the office, decision-making can be crafted so that everyone [family, doctor and patient] or [FA, client and spouse] is on the same page.

INVESTING MIND TRAPS: https://medicalexecutivepost.com/2025/06/12/psychology-common-finance-and-investing-mind-traps/

Briefly, the three steps are:

1. Simplify choices by focusing on the key differences between investment [treatment] options such as stock, bonds, cash, and index funds. 

2. Understanding that clients [patients] prefer greater certainty when it comes to pursuing financial [health] gains and are willing to accept uncertainty when trying to avoid a loss [illness].

3. Cognitive processes lead clients and patients to overestimate the value of their choices thanks to survivor bias, cognitive dissonance, appeals to authority and hindsight biases.

 CITE: Jaan E. Sidorov MD [Harrisburg, PA] 

Assessment

Much like in healthcare today, the current mass-customized approaches to the financial services industry fall short of recognizing more personalized advisory approaches like prospect theory and assisted client-centered investment decision-making.  

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SPEAKING: Dr. Marcinko will be speaking and lecturing, signing and opining, teaching and preaching, storming and performing at many locations throughout the USA this year! His tour of witty and serious pontifications may be scheduled on a planned or ad-hoc basis; for public or private meetings and gatherings; formally, informally, or over lunch or dinner. All medical societies, financial advisory firms or Broker-Dealers are encouraged to submit an RFP for speaking engagements: CONTACT: Ann Miller RN MHA at MarcinkoAdvisors@outlook.com -OR- http://www.MarcinkoAssociates.com

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HOSPITALS: Understanding Different Types

Posted on August 6, 2025 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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HOSPITAL TYPES DEFINED FOR MODERNITY

Acute Care Inpatient Hospital

An acute care inpatient hospital is a health care organization or “anchor hospital” in which a patient is treated for an acute (immediate and severe) episode of illness or the subsequent treatment of injuries related to an accident or trauma, or during recovery from surgery. Specialized personnel using complex and sophisticated technical equipment and materials usually render acute professional care in a hospital setting. Unlike chronic care, acute care is often necessary for only a short time. Measures of acute health care utilization are represented by three separate rates:

  1. Rate of admissions per 1000 patients.
  2. Average length of stay per admission.
  3. Total days of care per 1000 patients.

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Psychiatric Hospital

A psychiatric hospital (behavioral health, mental hospital, or asylum) specializes in the treatment of patients with mental illness or drug-related illness or dependencies. Psychiatric wards differ only in that they are a unit of a larger hospital.

Specialty Hospital

A specialty hospital is a type of health care organization that has a limited focus to provide treatment for only certain illnesses such as cardiac care, orthopedic or plastic surgery, elder care, radiology / oncology services, neurological care, or pain management cases. These organizations are often owned by doctors who refer patients to them. In recent years, single-specialty hospitals have emerged in various locations in the United States. Instead of offering a full range of inpatient services, these hospitals focus on providing services relating to a single medical specialty or cluster of specialties.


Long-Term Care Hospital

A long-term care hospital is an entity that provides assistance and patient care for the activities of daily living (ADLs), including reminders and standby help for those with physical, mental, or emotional problems. This includes physical disability or other medical problems for 3 months or more (90 days). The criteria of five ADLs may also be used to determine the need for help with the following: meal preparation, shopping, light housework, money management, and telephoning. Other important considerations include taking medications, doing laundry, and getting around
outside.

Rural Hospital

The parameters of a rural hospital are determined based on distance. A rural hospital is defined as a hospital serving a geographic area 10 or more miles from the nexus of a population center of 30,000 or more.

More specifically, a rural hospital means an entity characterized by one of the following:

  1. Type A rural hospital—small and remote, has fewer than 50 beds, and is more than 30
    miles from the nearest hospital
  2. Type B rural hospital—small and rural, has fewer than 50 beds, and is 30 miles or less from
    the nearest hospital
  3. Type C rural hospital—considered rural and has 50 or more beds

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SPEAKING: Dr. Marcinko will be speaking and lecturing, signing and opining, teaching and preaching, storming and performing at many locations throughout the USA this year! His tour of witty and serious pontifications may be scheduled on a planned or ad-hoc basis; for public or private meetings and gatherings; formally, informally, or over lunch or dinner. All medical societies, financial advisory firms or Broker-Dealers are encouraged to submit an RFP for speaking engagements: CONTACT: Ann Miller RN MHA at MarcinkoAdvisors@outlook.com -OR- http://www.MarcinkoAssociates.com

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PROPOSED: 2026 Physician Fee Schedule Payment Increases

Posted on July 31, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

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On July 14, 2025, the Centers for Medicare & Medicaid Services (CMS) released its proposed Medicare Physician Fee Schedule (MPFS) for calendar year (CY) 2026.

In addition to the agency’s suggested increase to physician payments, the proposed rule also announces a new payment model and more tele-health flexibilities.

According to CMS, the “proposed rule is one of several proposed rules that reflect a broader Administration-wide strategy to create a health care system that results in better quality, efficiency, empowerment, and innovation for all Medicare beneficiaries.” (Read more…)

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PODIATRIST: Types, Specialization and Salary

Posted on July 28, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

THE FOOT & ANKLE DOCTORS

By A.I.

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Podiatry offers a promising career with a balanced mix of specialization and income. By understanding the factors that influence salaries—such as location, experience, and practice type—a doctor can strategically enhance his/er earning potential. Staying informed about healthcare policies and market trends is crucial for maximizing income.

With an aging population and advancements in technology, the demand for podiatrists is expected to grow, making it a rewarding field both professionally and financially. Investing in specialized training and adapting to policy changes will help doctors remain competitive and successful in the evolving healthcare landscape.

MORE: https://medicalexecutivepost.com/2024/12/03/12-investing-mistakes-of-physicians/

Frequently Asked Questions

What is a podiatrist?

A podiatrist is a healthcare professional specialized in diagnosing and treating conditions related to the feet and ankles. Their responsibilities include performing surgeries, prescribing orthotics, and providing preventive care.

MORE: https://medicalexecutivepost.com/2024/03/20/is-a-podiatrist-a-physician/

What education is required to become a podiatrist?

To become a podiatrist, one must complete a Doctor of Podiatric Medicine (DPM) degree, which typically takes four years after earning a bachelor’s degree. Following this, a residency program lasting 2-3 years is required for practical training.

What factors influence the salary of a podiatrist?

Geographic location, level of experience, specialization, and type of practice significantly affect a podiatrist’s salary. Areas with a higher cost of living or demand for services usually offer higher salaries.

How does the salary of a podiatrist compare to other medical professions?

Podiatrists generally earn more than general practitioners but less than specialty surgeons. This disparity is due to differences in training length, specialization, and practice complexity among these professions.

Can the salary of a podiatrist increase over time?

Yes, a podiatrist’s salary can increase with additional experience, further specialization, and strategic practice location choices. Continuing education and staying updated on healthcare policies can also enhance earning potential.

What impact do healthcare policies have on podiatrist salaries?

Healthcare policies, including changes in insurance reimbursement rates and government health initiatives, can affect podiatrist salaries. Adapting to these policy shifts is crucial for maximizing earning potential in the field.

What are the future trends in podiatry salaries?

Future trends suggest potential salary growth due to increasing demand from an aging population, technological advancements, and geographic disparities in healthcare access. Keeping informed about these trends can help podiatrists plan their careers strategically.

MORE: https://medicalexecutivepost.com/2011/09/22/is-the-mutual-fund-company-invesco-dis-respecting-podiatrists/

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EDUCATION: Books

SPEAKING: Dr. Marcinko will be speaking and lecturing, signing and opining, teaching and preaching, storming and performing at many locations throughout the USA this year! His tour of witty and serious pontifications may be scheduled on a planned or ad-hoc basis; for public or private meetings and gatherings; formally, informally, or over lunch or dinner. All medical societies, hospitals, financial advisory firms, RIAs, or Broker-Dealers are encouraged to submit an RFP for speaking engagements: CONTACT: Ann Miller RN MHA at MarcinkoAdvisors@outlook.com -OR- http://www.MarcinkoAssociates.com

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CMS Proposes Updates to the OPPS

Posted on July 26, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By Health Capital Consultants, LLC

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On July 15, 2025, the Centers for Medicare & Medicaid Services (CMS) released the proposed rule for the Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System for calendar year (CY) 2026.

Among other items, the agency proposes increasing payments to all outpatient providers, eliminating the Inpatient Only (IPO) List, and changing quality reporting programs.

This Health Capital Topics article reviews the proposed updates and changes to outpatient reimbursement. (Read more…) 

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Commodities, Stocks and Bonds

Posted on July 24, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By A.I.

SPONSOR: http://www.CertifiedMedicalPlanner.org

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  • Stocks: Investors were pleased to hear about the trade deal with Japan yesterday and reports of an agreement with the EU coming soon kept the stock rally alive through market close. The S&P 500 notched its 12th new closing record this year, and the NASDAQ ended the day above 21,000 for the first time.
  • Bonds: Treasury yields rose a bit after an auction of 20-year notes was met with strong demand, indicating investor appetite for longer-term US debt.
  • Commodities: Oil inched higher while gold edged lower as investors hedge their bets in anticipation of more trade deals before the August 1st deadline.

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DAILY UPDATE: Both ACA Premiums and Stock Markets Rise

Posted on July 24, 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“

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

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SPONSORED BY: Marcinko & Associates, Inc.

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Daily Update Provided By Staff Reporters Since 2007.
How May We Serve You?
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CITE: https://www.r2library.com/Resource

What’s up

  • Krispy Kreme and GoPro got caught up in the new meme stock craze—the donut maker jumped 4.60%, while the wearable camera company leaped 12.41%.
  • Nintendo rose 2.36% after the company’s new Switch 2 console sold 1.6 million units in June, making it the fastest-selling console in US history.
  • GE Vernova gained 14.58% thanks to an impressive beat-and-raise earnings report for the power equipment manufacturer.
  • USANA Health Sciences soared 12.37% after the nutritional supplement maker crushed earnings estimates.
  • Cal-Maine Foods, the biggest egg producer in the country, added 13.80% after profiting from the high cost of eggs over the previous quarter.
  • Lamb Weston sizzled 16.31% higher as shareholders applauded the french fry giant’s strong earnings report and new cost-cutting program.

What’s down

  • Texas Instruments tumbled 13.34% after the semiconductor company revealed a disappointing third-quarter earnings forecast.
  • Enphase Energy plunged 14.16% thanks to weak earnings guidance, with the solar company’s management blaming tariffs for squeezing its margins.
  • SAP lost 5.03% after the enterprise software company missed Q2 revenue estimates.
  • Fiserv may have beaten analyst forecasts last quarter, but the fintech still sank 13.85% due to weaker-than-expected financial guidance.
  • Going down: Otis Worldwide dropped 12.38% after the elevator manufacturer lowered its fiscal guidance due to weak demand.

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

Insurers selling plans on ACA exchanges are expected to hike premiums next year as subsidies on them are set to expire, with the average person expected to be paying 75% more, according to an analysis from the nonpartisan research group KFF.

CITE: https://tinyurl.com/tj8smmes

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

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Psychiatrist V. Psychologist V. Psychotherapist

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

DEFINITIONS
By A. I. and Staff Reporters

SPONSOR: http://www.CertifiedMedicalPlanner.org

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The terms “psychologist” and “psychiatrist” are often used interchangeably to describe anyone who provides therapy services, but the two professions and the services they provide differ in terms of content and scope. A major difference between the two types of experts is that psychiatrists can prescribe medication [Rx].

  • As physicians [MD/DO] psychiatrists are trained to recognize the ways biological processes affect mental functioning.
  • Psychologists are oriented to how thoughts, feelings, and social factors influence mental functioning.

PSYCHIATRIST

Psychiatrists are medical or osteopathic doctors who are able to prescribe psychotropic medications, which they do in conjunction with providing psychotherapy though medical and pharmacological interventions are often their focus.

PSYCHOLOGIST

Though many psychologists hold doctorate degrees, they are not medical doctors, and most cannot prescribe medications. Rather, they solely provide psycho-therapy, which may involve cognitive and behavioral interventions, psycho-dynamic or psycho-analytic approaches.

NOTE PROTECTED TITLE: The title of “psychologist” can only be used by an individual who has completed the required education, training, and state license requirements. Informal titles, such as “counselor” or “therapist,” are often used as well. Other mental health care professionals, such as licensed social workers, can claim those titles, but not the title of “psychologist.”

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HEALTH CARE SPENDING: Projected to Exceed $8.5 Trillion by 2033

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

By Health Capital Consultants LLC

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On June 25th, 2025, the Centers for Medicare & Medicaid Services (CMS) released its forecast on U.S. healthcare spending through 2033. The analysis, published in Health Affairs, estimated healthcare spending growth in 2024 and projected the growth into 2033. CMS found that overall healthcare spending growth has decreased slightly but is still elevated compared to pre-pandemic levels, and is expected to continue to moderately grow.

This Health Capital Topics article examines the factors underlying the forecasts. (Read more…) 

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VILLAGES HEALTH SYSTEM: Files Chapter 11 Bankruptcy

Posted on July 9, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By A.I.

BREAKING NEWS!

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The Villages Health System, LLC, a health care provider operating in The Villages, Florida, filed for Chapter 11 bankruptcy protection on July 3rd, 2025, in the United States Bankruptcy Court for the Middle District of Florida.

“The bankruptcy petition indicates significant financial challenges, with assets estimated between $50 million and $100 million and liabilities between $100 million and $500 million. The United States of America is listed as the largest creditor with a contingent, unliquidated claim of approximately $361 million. The filing indicates that funds will be available for distribution to unsecured creditors,”

RK Consultants reported on X, the former Twitter. 

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OREGON BANS: Corporate Control of Physicians

Posted on July 6, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By Health Capital Consultants LLC

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On June 9th, 2025, Oregon’s governor signed into law the country’s strictest corporate practice of medicine (CPOM) prohibition. Senate Bill (SB) 951 will severely curtail the involvement of private equity firms and other corporations in the state’s medical practices.

This Health Capital Topics reviews the bill and discusses the implications on the healthcare industry. (Read more…)

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UNHAPPY HOSPITALS: One Big Beautiful Bill Act!

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

SPONSOR: http://www.CertifiedMedicalPlanner.org

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One Big Beautiful Bill Act (OBBBA; OBBB; BBB), or the Big Beautiful Bill, is a budget reconciliation bill in the 119th US Congress.

Hospitals are not happy with the health care provisions of the bill, which would reduce the support they receive from states to care for Medicaid enrollees and leave them with more uncompensated care costs for treating uninsured patients.

“The real-life consequences of these nearly $1 trillion in Medicaid cuts – the largest ever proposed by Congress – will result in irreparable harm to our health care system, reducing access to care for all Americans and severely undermining the ability of hospitals and health systems to care for our most vulnerable patients,” said Rick Pollack, CEO of the American Hospital Association.

The association said it is “deeply disappointed” with the bill, even though it contains a $50 billion fund to help rural hospitals contend with the Medicaid cuts, which hospitals say is not nearly enough to make up for the shortfall.

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“BIG BEAUTIFUL BILL”: Not So for Healthcare?

Posted on June 30, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By Health Capital Consultants; LLC

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On May 22, 2025, the U.S. House of Representatives moved President Trump’s budget proposal forward, sending to the Senate a budget reconciliation bill (with a one-vote margin) – the One Big Beautiful Bill Act of 2025 – that renews expiring tax cuts and enacts new ones at a cost of almost $4 trillion. These costs would largely be paid for by cuts to other programs, including to federal healthcare programs, which cuts will have significant ramifications for the healthcare industry.

This Health Capital Topics article reviews the current status of the budget bill and healthcare industry implications. (Read more…)

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FINANCIAL COACHING: For Physicians!

Posted on June 28, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By Staff Reporters

SPONSOR: http://www.MarcinkoAssociates.com

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DEAR COLLEAGUES

If you are just starting out managing your finances and don’t know where to begin, a financial coach may be a good option for you. They are helpful for someone who wants to become proficient in the basics of finance, from learning how to budget or save money to building an emergency fund or creating a plan for paying off debt. If you have short-term money goals, like saving for a big purchase or just practicing better money habits, a financial coach can help you reach them by working with you to create a plan and holding you accountable. Even more for physicians and most all medical professionals.

Pros and Cons of Working with a Financial Coach
A financial coach can have a positive impact on your financial well–being and your life in a number of ways:

  • Financial coaches see the bigger picture of how you relate to money. They can help you develop better habits, resulting in positive personal growth.
  • By providing education and encouragement, they can reduce financial stress, confusion, and what it is about money that overwhelms you.
  • Through accountability and support, they can help you accomplish your goals and help you feel more confident in your finances.
  • Available 24/7/365.
  • Modest fees.

At you service.
Dr. David Edward Marcinko MBA MEd CMP

CONTACT: MarcinkoAdvisors@outlook.com

LINK: https://medicalexecutivepost.com/2025/01/23/personal-coaching-dr-marcinko-at-your-service/

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DAILY UPDATE: Health Insurance Options as Bull Market Edges Upward

Posted on June 28, 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“

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

http://www.MedicalBusinessAdvisors.com

SPONSORED BY: Marcinko & Associates, Inc.

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http://www.MarcinkoAssociates.com

Daily Update Provided By Staff Reporters Since 2007.
How May We Serve You?
© Copyright Institute of Medical Business Advisors, Inc. All rights reserved. 2025

REFER A COLLEAGUE: MarcinkoAdvisors@outlook.com

SPONSORSHIPS AVAILABLE: https://medicalexecutivepost.com/sponsors/

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

A June 11th report from global professional services firm Alvarez & Marsal (A&M) predicts that more beneficiaries might soon ditch insurance coverage for options like short-term, limited duration plans or healthcare sharing ministries (HCSMs), which aren’t regulated like health insurance and aren’t required to comply with ACA protections like covering maternity care or pre-existing conditions.

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

🟢 What’s up

  • Nvidia extended its winning streak to five days, rising another 1.73% as the AI trade continues to recover.
  • EchoStar climbed 13.16% after the parent company of Dish TV disclosed that President Trump did in fact prod the FCC to make a deal.
  • Cyngn soared another 20.07% following a big day of gains after the company that makes self-driving tech for industrial vehicles announced a partnership with Nvidia.
  • Strong earnings from Nike (more on that later) propelled sporting goods stocks higher today. ON Holdings rose 1.74%, while Dick’s Sporting Goods climbed 3.59%.
  • Domestic power producers popped on reports that Trump is planning to issue an executive order increasing energy production to meet AI demand. Vistra gained 2.44%, GE Vernova climbed 2.54%, and Vertiv added 2.71%.

What’s down

  • Coinbase Global ended its winning streak, tumbling 5.77% after GENIUS Act hype propelled the crypto stock skyward all week long. Traders took profits in Circle as well, pushing the stablecoin stock down 15.54%.
  • Chinese EV maker Li Auto fell 1.93% on its weaker-than-expected deliveries forecast for the second quarter.
  • Fellow Chinese EV maker Xiaomi stunned markets with reports that it received 240,000 orders for its new SUV within 18 hours of its debut, but shares still sank 4%.
  • Pony.ai lost 6.31% on a report that Uber is considering helping its founder Travis Kalanick fund his acquisition of the US subsidiary of the Chinese autonomous vehicle company.
  • Gold miners tumbled while the price of the precious metal fell as investors took a risk-on stance. Newmont lost 4.11%, Barrick Mining fell 3.44%, and Kinross Gold shed 6.18%.
  • Today’s trade deal reopens the door for Chinese rare earth imports, bad news for US producers like MP Materials (down 8.59%) and USA Rare Earth (down 12.14%).

CITE: https://tinyurl.com/tj8smmes

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

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HEALTHCARE INSURANCE: Marketplace Consumer Fraud

Posted on June 23, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By AI

SPONSOR: http://www.CertifiedMedicalPlanner.org

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Consumer Fraud in the Health Insurance Marketplace

Don’t be a Victim of Consumer Fraud in the Health Care Marketplace 

Beware of…

People asking for money to enroll you in Marketplace or “Obamacare” insurance. Legitimate enrollment agents will NOT ask for money.

High-pressure visits, mail solicitations, e-mails, and phone calls from people pretending to work for the government. No one should threaten you with legal action if you do not sign up for a plan. Always ask for identification if someone comes to your door.

People you did not contact who request personal information. They may be trying to steal your identity. No one from the government will call or email you to sell you an insurance plan or ask for personal identifying information. Be careful when giving out personal information, such as credit card, banking, or Social Security numbers.

Sham websites. Always look for official government seals, logos or website addresses.

Note: If you are a Medicare beneficiary, you do NOT need to buy insurance in the new Health Insurance Marketplace.

Report Marketplace Consumer Fraud: 1-800-318-2596

For more information about using the Marketplace, visit HealthCare.gov . This is the official Marketplace website.

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CORRELATION: Diversification in Finance and Investments

Posted on June 17, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By Staff Reporters

SPONSOR: http://www.MarcinkoAssociates.com

DEFINITION

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Correlation measures the relationship between two investments–the higher the correlation, the more likely they are to move in the same direction for a given set of economic or market events. Correlation, in the finance and investment industries, is a statistic that measures the degree to which two securities move in relation to each other. Correlations are used in advanced portfolio management, computed as the correlation coefficient which has a value that must fall between -1.0 and +1.0.

So if two securities are highly positively correlated, they will move in the same direction the vast majority of the time. Negatively correlated investments do the opposite–as one security rises, the other falls, and vice versa. No correlation means there is no relationship between the movement of two securities–the performance of one security has no bearing on the performance of the other.

CAUSATION: https://medicalexecutivepost.com/2024/06/05/correlation-is-not-causation/

Correlation is an important concept for portfolio diversification--combining assets with low or negative correlations can improve risk-adjusted performance over time by providing a diversity of payouts under the same financial conditions.

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MARCINKO ASSOCIATES: How our Second Investment Portfolio Opinions are Different?

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

SPONSOR: http://www.MarcinkoAssociates.com

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We make second investment portfolio opinions affordable

Approximately 1 million allopathic physicians, 150,000 dentists, 200,000 osteopaths, 15,000 podiatrists and 6 million nurses often find it difficult to get an unbiased and fiduciary second opinion on their retirement or brokerage accounts. By offering second opinions for a flat fee, the monetary barriers that prevented colleagues from receiving a second opinion in the past have been removed.

We make second investment portfolio opinions convenient

Here’s how we work: you book an initial appointment with us, answer a few preliminary questions and email us your portfolio information. We then provide a second opinion. It is then up to you to incorporate or not.

INVESTMENT ADVISORY: https://medicalexecutivepost.com/2025/05/04/investment-advisory-portfolio-second-opinions-for-physician-colleagues/

We make second investment portfolio opinions timely

Financial markets, jobs and colleague age change like the weather. It is not always okay to wait a week, year or more, to seek a professional second financial portfolio opinion. You need to receive an opinion now. That’s where we come in. We are standing by, ready to take your email [MarcinkoAdvisors@outlook.com] and schedule a free initial consultation within two or three days, or less.

ASSET ALLOCATION: https://medicalexecutivepost.com/2024/10/23/musings-on-a-famous-portfolio-asset-allocation-study-3/

We make second investment portfolio opinions accurate

Fiduciary and non-sales orientated second opinions have the power to change financial lives in the long term. We’ve seen it happen many times. What characterizes a good second opinion? Three things: the opinion must be individualized to your investment portfolio[s], informed and results-oriented. That’s the informed fiduciary approach we take. We are colleagues and look forward to working with you.

PORTFOLIO MANAGEMENT: https://medicalexecutivepost.com/2025/05/27/physicians-personal-portfolio-management/

CONTACT: Ann Miller RN MHA CPHQ: Email: MarcinkoAdvisors@outlook.com

Invite Dr. Marcinko

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CMMI’s Evolving Strategy: Initial Indications from Recent Actions

Posted on June 10, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By Health Capital Consultants, LLC

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On May 13th, 2025, the CMS Center for Medicare & Medicaid Innovation (CMMI) introduced a new strategic plan for its models going forward. After ending four payment models early and canceling two not-yet-implemented models in March 2025, the agency had promised to release a new strategy. Nearly two weeks later, CMMI released that strategy, as well as a preliminary evaluation of, and changes to, one of its core payment models.

This Health Capital Topics article will review CMMI’s recent actions and what initial indications these actions provide. (Read more…) 

LTC: https://medicalexecutivepost.com/2025/06/05/cms-proposes-increasing-inpatient-long-term-care-payments-2/

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CMS Proposes Increasing Inpatient & Long Term Care Payments

Posted on June 5, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By Health Capital Consultants, LLC

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On April 11th, 2025, the Centers for Medicare & Medicaid Services (CMS) released its proposed rules for the payment and policy updates for the Medicare inpatient prospective payment system (IPPS) and long-term care hospital prospective payment system (LTCH PPS) for fiscal year (FY) 2026.

This Health Capital Topics article will discuss the proposed rule and the implications for stakeholders. (Read more…)

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2025 MEDICARE: Agent & Broker Pay Day Changes

OAK Street: https://medicalexecutivepost.com/2025/05/16/oak-street-health-agrees-to-pay-60m-to-resolve-alleged-false-claims-act-liability-for-paying-kickbacks-to-insurance-agents-in-medicare-advantage-patient-recruitment-scheme/

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The Shift to Value-Based Care: Evidence of Progress

Posted on June 3, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By Health Capital Consultants, LLC

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A recent joint report by the National Association of Accountable Care Organizations (NAACOS) and Innovaccer Inc., a healthcare artificial intelligence (AI) company, found tangible evidence that the U.S. healthcare delivery system is indeed moving toward value-based care (VBC).

Fifteen years after the passage of the Patient Protection and Affordable Care Act (ACA), which promoted VBC through the advent of ACOs and other alternative payment models, there is finally evidence that providers are actually moving in that direction.

This Health Capital Topics article reviews the joint report on “The State and Science of Value-based Care 2025.” (Read more…)

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PARADOX VBC: https://medicalexecutivepost.com/2024/10/25/paradox-value-based-care/

VBC: https://medicalexecutivepost.com/2018/12/07/the-state-of-value-based-care-vbc/

RN CAPITATION: https://medicalexecutivepost.com/2024/07/07/on-nursing-capitation-reimbursement/

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ABOUT: Marcinko Associates; Inc.

Posted on May 31, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By Dr. David Edward Marcinko; MBA MEd CMP™

PRACTICE MANAGEMENT AND FINANCIAL PLANNING ADVICE FOR MEDICAL PROFESSIONALS

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At http://www.MarcinkoAssociates.com, we follow Fiduciary Standards for your protection:

Embrace the legal fiduciary obligation to place Medical colleague clients’ interests first

Deliver comprehensive financial planning and practice management advice for medical professionals

Provide fee-only advice; not fee-based advice

Do not accept commissions or assets under management

Be transparent on client costs, fees, and terms at all times

Provide transparency on portfolios and investment suggestions

Remain independent from any bank, broker dealer, insurance provider, RIA or custodian

Measure client performance returns using independent third parties

Do not create products to sell or price any public securities

Do not physically hold or possess any client assets, securities, or money for management

Investment and financial planning advice only!

OUR EDUCATION: Books

SPEAKING: Dr. Marcinko will be speaking and lecturing, signing and opining, teaching and preaching, storming and performing at many locations throughout the USA this year! His tour of witty and serious pontifications may be scheduled on a planned or ad-hoc basis; for public or private meetings and gatherings; formally, informally, or over lunch or dinner. All medical societies, financial advisory firms or Broker-Dealers are encouraged to submit a RFP for speaking engagements: MarcinkoAdvisors@outlook.com 

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FINANCIAL LIFE PLANNING? For Physicians and Medical Professionals

Posted on May 29, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

SPONSOR: http://www.MarcinkoAssociates.com

By Dr. David Edward Marcinko; MBA MEd CMP™

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SPONSOR: http://www.CertifiedMedicalPlanner.org

Life planning and behavioral finance as proposed for physicians and integrated by the Institute of Medical Business Advisors Inc., is unique in that it emanates from a holistic union of personal financial planning, human physiology and medical practice management, solely for the healthcare space.  Unlike pure life planning, pure financial planning, or pure management theory, it is both a quantitative and qualitative “hard and soft” science, with an ambitious economic, psychological and managerial niche value proposition never before proposed and codified, while still representing an evolving philosophy. Its’ first-mover practitioners are called Certified Medical Planners™.

Life planning, in general, has many detractors and defenders. Formally, it has been defined by Mitch Anthony, Gene R. Lawrence, AAMS, CFP© and Roy T. Diliberto, ChFC, CFP© of the Financial Life Institute, in the following trinitarian way.

Financial Life Planning is an approach to financial planning that places the history, transitions, goals, and principles of the client at the center of the planning process.  For the financial advisor or planner, the life of the client becomes the axis around which financial planning develops and evolves.

Financial Life Planning is about coming to the right answers by asking the right questions. This involves broadening the conversation beyond investment selection and asset management to exploring life issues as they relate to money.

Financial Life Planning is a process that helps advisors move their practice from financial transaction thinking, to life transition thinking. The first step is aimed to help clients “see” the connection between their financial lives and the challenges and opportunities inherent in each life transition.

But, for informed physicians, life planning’s quasi-professional and informal approach to the largely isolate disciplines of financial planning and medical practice management is inadequate. Today’s practice environment is incredibly complex, as compressed economic stress from HMOs managed care, financial insecurity from insurance companies, ACOs and VBC, Washington DC and Wall Street; liability fears from attorneys, criminal scrutiny from government agencies, and IT mischief from malicious electronic medical record [eMR] hackers. And economic bench marking from hospital employers; lost confidence from patients; and the Patient Protection and Affordable Care Act [PP-ACA] more than a decade ago. All promote “burnout” and converge to inspire a robust new financial planning approach for physicians and most all medical professionals. 

The iMBA Inc., approach to financial planning, as championed by the Certified Medical Planner™ professional certification designation program, integrates the traditional concepts of financial life planning, with the increasing complex business concepts of medical practice management. The former topics are presented in this textbook, the later in our recent companion text: The Business of Medical Practice [Transformational Health 2.0 Skills for Doctors].

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For example, views of medical practice, personal lifestyle, investing and retirement, both what they are and how they may look in the future, are rapidly changing as the retail mentality of medicine is replaced with a wholesale and governmental philosophy. Or, how views on maximizing current practice income might be more profitably sacrificed for the potential of greater wealth upon eventual practice sale and disposition. 

Or, how the ultimate fear represented by Yale University economist Robert J. Shiller, in The New Financial Order: Risk in the 21st Century, warns that the risk for choosing the wrong profession or specialty, might render physicians obsolete by technological changes, managed care systems or fiscally unsound demographics. OR, if a medical degree is even needed for future physicians?

Say, what medical license?

Dr. Shirley Svorny, chair of the economics department at California State University, Northridge, holds a PhD in economics from UCLA. She is an expert on the regulation of health care professionals who participated in health policy summits organized by Cato and the Texas Public Policy Foundation. She argues that medical licensure not only fails to protect patients from incompetent physicians, but, by raising barriers to entry, makes health care more expensive and less accessible. Institutional oversight and a sophisticated network of private accrediting and certification organizations, all motivated by the need to protect reputations and avoid legal liability, offer whatever consumer protections exist today.

Yet, the opportunity to revise the future at any age through personal re-engineering, exists for all of us, and allows a joint exploration of the meaning and purpose in life. To allow this deeper and more realistic approach, the informed transformation advisor and the doctor client, must build relationships based on trust, greater self-knowledge and true medical business management and personal financial planning acumen.

[A] The iMBA Philosophy

As you read this ME-P website, we hope you will embrace the opportunity to receive the focused and best thinking of some very smart people. Hopefully, along the way you will self-saturate with concrete information that proves valuable in your own medical practice and personal money journey. Maybe, you will even learn something that is so valuable and so powerful, that future reflection will reveal it to be of critical importance to your life.  The contributing authors certainly hope so.

At the Institute of Medical Business Advisors, and thru the Certified Medical Planner™ program, we suggest that such an epiphany can be realized only if you have extraordinary clarity regarding your personal, economic and [financial advisory or medical] practice goals, your money, and your relationship with it. Money is, after only, no more or less than what we make of it. 

Ultimately, your relationship with it, and to others, is the most important component of how well it will serve you. 

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EDUCATION: Books

SPEAKING: Dr. Marcinko will be speaking and lecturing, signing and opining, teaching and preaching, storming and performing at many locations throughout the USA this year! His tour of witty and serious pontifications may be scheduled on a planned or ad-hoc basis; for public or private meetings and gatherings; formally, informally, or over lunch or dinner. All medical societies, financial advisory firms or Broker-Dealers are encouraged to submit a RFP for speaking engagements: CONTACT: MarcinkoAdvisors@outlook.com 

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Physician V. Doctor V. Provider V. Prescriber V. Medical Others

Posted on May 22, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

HEALTHCARE DEFINITIONS

By Staff Reporters

SPONSOR: http://www.CertifiedMedicalPlanner.org

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When you visit health clinic or hospital for a medical appointment, you’ll be seen by a doctor, healthcare provider and/or medical prescriber. But what do these words really mean?

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Doctors / Physicians

Doctor of Medicine (MD), Doctor of Podiatric Medicine (DPM), Doctor of Osteopathy (DO, or Doctor of Dental Surgery (DDS/DMD). Doctors, also known as physicians, have extensive prescription privileges across various specialties. They can diagnose medical conditions, prescribe medication, and oversee the overall management of patient care. Doctors include general practitioners, specialists such as cardiologists or dermatologists, and surgeons. Their prescription authority encompasses a wide range of medications to address acute and chronic health conditions, ranging from antibiotics to specialized treatments for complex diseases.

MORE: https://medicalexecutivepost.com/2023/06/17/the-md-versus-do-degree/

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Medical Providers

A medical provider is a general term that encompasses a wide range of education levels, skill-sets, and specializations. A provider could be a Physician Assistant (PA), Nurse Practitioner (NP), Clinical Nurse Specialist (CNS), Doctor of Medicine (MD), Doctor of Podiatric Medicine (DPM), Dentist (DDSDMD) or Doctor of Osteopathy (DO).

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Medical Drug Prescribers

Generally, psychologists and therapists do not have prescription privileges. They focus on psychotherapy and counseling rather than medication management. However, some jurisdictions may grant limited prescription rights to psychologists who undergo additional training and certification. Like psychologists, therapists typically do not have prescription privileges. They focus on providing counseling and psychotherapy to address mental health issues and emotional concerns.

PHARMACISTS: https://medicalexecutivepost.com/2025/02/12/pharmd-doctor-of-pharmacy/

Psychiatrists are medical doctors (MD/DO) who specialize in the diagnosis and treatment of mental health disorders. They have full prescription privileges and can prescribe a wide range of medications to manage psychiatric conditions.

In most cases, physical therapists do not have the authority to prescribe medication. They primarily focus on rehabilitation and physical interventions to improve mobility and function.

MORE: https://medicalexecutivepost.com/2025/02/23/doctorate-physical-therapy/

Nurse practitioners are advanced practice nurses with the authority to diagnose, treat, and prescribe medication independently in many states and countries. They undergo extensive education and training, which allows them to provide a wide range of healthcare services, including medication management.

Similar to nurse practitioners, psychiatric nurse practitioners have the authority to prescribe medication for mental health conditions. They specialize in psychiatric and mental health care, offering comprehensive treatment that may include medication management.

Chiropractors primarily focus on diagnosing and treating musculoskeletal disorders through manual adjustments and therapies. They do not have surgical or prescription privileges in most jurisdictions.

Optometrists are trained to diagnose and treat vision problems, including prescribing corrective lenses and medications for certain eye conditions such as infections or inflammation.

Registered nurses typically do not have prescription privileges. They work under the direction of physicians and nurse practitioners, assisting with patient care but not prescribing medication themselves.

Dentists have limited prescription privileges related to dental care, such as antibiotics or pain medications for dental procedures. However, they do not have the authority to prescribe general medications outside of their scope of practice.

Nutritionists typically do not have prescription privileges. They specialize in providing dietary advice and counseling to promote health and well-being through nutrition but do not prescribe medication.

Depending on their scope of practice and legal regulations in their jurisdiction, nurse midwives may have limited prescription privileges for certain medications related to prenatal care, childbirth, and postpartum care.

MORE: http://www.HealthDictionarySeries.org

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CLEVELAND CLINIC: Controversial New Health Insurance Co-Payment Policy

Posted on May 17, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By Staff Reporters

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Health Insurance Co-Payments Upfront or Lose Your Appointment

Definition: A co-payment is a fixed amount you pay each time you get a particular type of healthcare service, and co-pays will generally be quite a bit smaller than deductibles. However, deductibles and co–pays are both fixed amounts, as opposed to coinsurance, which is a percentage of the claim.

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EMPLOYER’S: Pay for Health Insurance Paradox

On some health plans, certain services are covered with a co-pay before you’ve met the deductible, while other health insurance plans have co-pays only after you’ve met your deductible. And, the pre-deductible versus post-deductible co-pay rules often vary based on the type of medical service you’re receiving.

PRE-PAID PLANS: https://medicalexecutivepost.com/2025/04/17/health-insurance-pre-paid-plans/

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Starting in June 2025, Cleveland Clinic patients who can’t pay their co-pay on the spot will have non-emergency appointments rescheduled or cancelled. This new policy could make it harder for low-income people who prefer to be billed to see a clinic doctor, and create delays that could lead to medical emergencies down the road.

For example, a delay in care can mean six to eight more weeks of a tumor growing or a blood clot developing or an infection brewing.

Source: Julie Washington, cleveland.com [5/13/25]

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OAK STREET HEALTH: Agrees to Pay $60M to Resolve Alleged False Claims Act Liability for Paying Kickbacks to Insurance Agents in Medicare Advantage Patient Recruitment Scheme

Posted on May 16, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By Staff Reporters

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Oak Street Health, headquartered in Chicago and a wholly-owned subsidiary of CVS Health since 2023, has agreed to pay $60 million to resolve allegations that it violated the False Claims Act by paying kickbacks to third-party insurance agents in exchange for recruiting seniors to Oak Street Health’s primary care clinics.

Part C: https://medicalexecutivepost.com/2024/05/03/eschew-medicare-advantage-part-c-plans-now/

The Anti-Kickback Statute prohibits anyone from offering or paying, directly or indirectly, any remuneration — which includes money or any other thing of value — to induce referrals of patients or to provide recommendations of items or services covered by Medicare, Medicaid and other federally funded programs. Under the Medicare Advantage (MA) Program, also known as Part C, Medicare beneficiaries have the option to obtain their health care through privately-operated insurance plans known as MA plans. Some MA Plans contract with health care providers, including Oak Street Health, to provide their plan members with primary care services.

Medicare Advantage Rates: https://medicalexecutivepost.com/2025/04/28/medicare-advantage-plan-rates-substantially-increased-for-2026/

The United States alleged that, in 2020, Oak Street Health developed a program to increase patient membership called the Client Awareness Program. Under the Program, third-party insurance agents contacted seniors eligible for or enrolled in Medicare Advantage and delivered marketing messages designed to generate interest in Oak Street Health. Agents then referred interested seniors to an Oak Street Health employee via a three-way phone call, otherwise known as a “warm transfer,” and/or an electronic submission.

MEDICARE PART C: Humana Used A.I. Tool from UnitedHealth to Deny Medicare Advantage Claims

In exchange, Oak Street Health paid agents typically $200 per beneficiary referred or recommended. These payments incentivized agents to base their referrals and recommendations on the financial motivations of Oak Street Health rather than the best interests of seniors. The settlement resolves allegations that, from September 2020 through December 2022, Oak Street Health knowingly submitted, and caused the submission of, false claims to Medicare arising from kickbacks to agents that violated the Anti-Kickback Statute.

US Department of Justice: https://www.justice.gov/archives/opa/pr/oak-street-health-agrees-pay-60m-resolve-alleged-false-claims-act-liability-paying-kickbacks

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SPINAL CORD: Injury Awareness Day 2025

Posted on May 14, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By Staff Reporters

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History of Spinal Cord Injury Awareness Day

The first mention of spinal cord injuries was in the ancient Egyptian Edwin Smith’s papyrus from 2,500 B.C. The ancient Egyptian physicians described the injury as “untreatable.”

The first treatment for spinal cord injuries occurred in ancient India, where Hindu doctors used traction techniques to straighten the spine. The Greeks also employed the same technique as the Hindus. For example, Hippocrates — born in the 5th century B.C. — developed traction devices that helped straighten patients’ spines. It wasn’t until the second century A.D. that Galen, a Greek physician, discovered the relation between spinal cord injuries and loss of autonomic function and sensation.

Paul of Aegina, born in 625 A.D., became the first physician to pioneer surgical techniques for spinal cord injuries. He employed laminectomy to relieve pressure on the spine and recommended using a windlass to reduce the dislocation. The notion and treatment remained the same until the latter half of the 20th century; physicians continued to believe that spinal cord injuries were incurable. Although during the Renaissance, Leonardo da Vinci and Andreas Vesalius, made contributions to S.C.I. through their accurate depiction of the human spine and nerves.

In 1981, the Canadians Albert Aguayo and Sam David ended the millennia-long belief that S.C.I. is incurable. Through experiments on rats, they showed that axons could regenerate in the central nervous system in the right environment. The introduction of imaging, surgery, medical care, and rehabilitation medicine in the mid-20th century helped improve the care for spinal cord injuries and increased the life expectancy of those living with the condition.

CHIROPRACTORS: https://medicalexecutivepost.com/2014/10/14/career-advice-for-those-interested-in-chiropracty/

Finally, the creation of emergency medical transport services in the 1970s contributed to these improvements in S.C.I. treatment.

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UNITEDHEALTH GROUP CEO: Quits and Suspends Annual Forecast

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

By Staff Reporters

BREAKING NEWS

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UnitedHealth Group just announced the exit of CEO Andrew Witty and suspended its 2025 forecast due to surging medical costs, sending its shares down more than 10%. Chairman Stephen Hemsley will become CEO, effective immediately.

Medicare Advantage: https://medicalexecutivepost.com/2024/10/11/medicare-advantage-part-c-plans-face-headwinds/

The fourth-largest U.S company big revenue in 2024, Minnetonka-based UnitedHealth has experienced a turbulent year that saw the shock killing of United Healthcare CEO Brian Thompson in New York City, and a cyberattack that affecting an estimated 190 million people and cost the company an estimated $3.1 billion dollars.

UnitedHealth: https://medicalexecutivepost.com/2025/04/17/unitedhealth-stock-dives/

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OMADA: Digital Health Company Files for IPO

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

By Staff Reporters

SPONSOR: http://www.MarcinkoAssociates.com

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Virtual chronic care provider Omada Health has filed to go public in the United States, the latest in a string of healthcare listings expected this year. Omada did not disclose the details as to how much it plans to raise from its IPO.

IPO: https://medicalexecutivepost.com/2025/03/02/ipo-road-show-with-pros-and-cons/

The San Francisco, California-based company, which last raised $192 million in a Series E funding round in 2022, reported a 38% increase in revenue to $169.8 million for 2024, according to its IPO paperwork. For the first quarter of 2025, the company posted a 56.6% year-on-year jump in revenue to $55 million. Omada has applied to list its common stock on the NASDAQ under the symbol “OMDA”.

Healthcare IPOs on U.S. exchanges have fetched $7.1 billion in 2024, compared with $2.8 billion a year earlier, according to data compiled by LSEG.

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MEDICAL DEMAND: Health Care Elasticity

Posted on May 5, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

DEFINITION

By Staff Reporters

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Classic: Despite a wide variety of empirical methods and data sources, the demand for health care is consistently found to be price inelastic

Modern: If you are sick, you will not be very price sensitive. There are exceptions to this rule (e.g., elective surgery such as plastic surgery, purchases of eyeglasses) but most studies find that patients are fairly insensitive to changes in health care prices.

Examples: For instance, the RAND Health Insurance Experiment found that the price elasticity of medical expenditures is -0.2.

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The Medical Executive-Post is a  news and information aggregator and social media professional network for medical and financial service professionals. Feel free to submit education content to the site as well as links, text posts, images, opinions and videos which are then voted up or down by other members. Comments and dialog are especially welcomed. Daily posts are organized by subject. ME-P administrators moderate the activity. Moderation may also conducted by community-specific moderators who are unpaid volunteers.

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2 Fast 2 Furious: HHS Cuts on the Horizon

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

By Health Capital Consultants LLC

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During the first 90 days of the Republican Party’s government trifecta (controlling the White House, Senate, and House of Representatives), both the Trump Administration and Congress have laid the groundwork for seismic change to the U.S. healthcare industry.

In an attempt to track the latest actions of the federal government’s legislative and executive branches affecting the healthcare industry since the first installment in our February issue, this Health Capital Topics article summarizes recent events in Washington and the impact of these changes on providers and patients. (Read more…)

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NATIONAL NURSES IN BUSINESS ASSOCIATION: Empowering Nurses Through Entrepreneurship

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

By Staff Reporters

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The National Nurses in Business Association (NNBA) is the premier nursing organization for nurse entrepreneurs, and a springboard for nurses transitioning from employees to entrepreneurs and business owners. The NNBA is an invaluable resource for existing nurse business owners seeking to expand, and maximize their business success.

Members’ resumes include thousands of nurse owned businesses, local, national and international awards, and millions of dollars in revenue. The experience, knowledge and impact of the NNBA community is amazing, as well as the support provided to fellow nurse entrepreneurs and aspiring entrepreneurs.

As the forerunner of the nurse entrepreneur movement, the NNBA provides valuable business information customized for nurses on how to start, plan, expand and grow your nurse owned business. They provide expert guidance, marketing and promotional opportunities, and continuing education in professional growth and career development.

MORE: https://nursesbusiness.com/

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DAILY UPDATE: Meta, Eli Lilly, Microsoft, Amazon, Apple and the Roaring Markets

Posted on May 2, 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“

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

http://www.MedicalBusinessAdvisors.com

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Meta Platforms jumped 4.23% after the big tech giant reported that its advertising revenue came in at $41.39 billion, beating analyst projections of $40.44 billion, thanks to higher ad price growth than expected. Daily active users rose to 3.43 billion, up from 3.35 billion last quarter, while nearly 1 billion people use its digital AI assistant every month. Management expects Q2 sales to come in between $42.5 billion and $45.5 billion, in-line with analyst forecasts of $44.03 billion.

  • EPS: $6.43 per share, crushing estimates of $5.28
  • Revenue: $42.31 billion, above the $41.10 expected

Microsoft leaped 7.63% after reporting its profit jumped a staggering 18% from a year earlier. That wasn’t the only good news: Revenue from Microsoft’s Azure cloud software grew 33% year over year, higher than the 31% expected by analysts. But perhaps the best news of all was management’s upbeat guidance—Microsoft projected revenue between $73.15 billion and $74.25 billion for the current quarter, well above expectations of $72.26 billion.

  • EPS: $3.46 per share, beating forecasts of $3.22
  • Revenue: $70.07 billion, above the $68.42 billion projected

Eli Lilly dropped 11.66% today, despite the fact that the pharmaceutical giant reported that sales skyrocketed 45% year over year thanks to its lucrative GLP-1 drugs, Zepbound and Mounjaro. Two things spooked investors today: The company lowered its profit outlook well below its preview estimate due its acquisition of a cancer drug from Scorpion Therapeutics, and CVS Health dropped Zepbound from its preferred drug list in lieu of arch-rival Novo Nordisk’s Wegovy this morning.—LB

  • EPS: $3.34 adjusted, beating the $3.02 expected
  • Revenue: $12.73 billion, compared to the $12.67 projected

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🟢 What’s up

  • Kohls popped 7.76% after the retailer fired its brand-new CEO for unethical behavior.
  • CVS Health not only beat earnings expectations but raised its fiscal guidance, pushing shares of the pharmacy chain up 4.11%.
  • Wayfair rose 3.65% on surprisingly strong earnings for an online furniture seller that analysts were convinced would be hit hard by tariffs.
  • Roblox gained 2.91% as people checked out of reality and hit the metaverse in higher numbers than ever.
  • CoreWeave popped 7.31% thanks to key customer Microsoft’s strong capex guidance.
  • Carrier Global climbed 11.61% after the air conditioning company boosted its fiscal forecast. Turns out everyone needs AC regardless of economic uncertainty.
  • People also need straight teeth: Dental products manufacturer Align Technology rose 1.98% on solid earnings.
  • Quanta Services gained 9.99% after the construction engineering company beat Wall Street estimates on both the top and bottom line.

What’s down

  • Qualcomm may have beaten earnings expectations, but shares fell 8.92% after investors were disappointed by the chipmaker’s lower guidance.
  • GM was in the same boat: Earnings beat forecasts, but poor guidance and warnings that tariffs could cost the company up to $5 billion this year pushed shares 0.42% lower.
  • Robinhood Markets enjoyed a 50% increase in revenue last quarter as traders played the volatile market, but the stock still sank 5.07%.
  • Moderna fell 5.29% after the vaccine maker missed revenue expectations and said it’s planning another $1.5 billion in cost cuts.
  • Church & Dwight, maker of household goods like Arm & Hammer Baking Soda, missed revenue forecasts last quarter and sank 6.87%.
  • Becton Dickinson & Co. lost 18.13% after the medical device maker warned of the adverse effects of, what else, tariffs.

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

Amazon plans to invest about $4 billion into its rural delivery network across the US.

Apple is in hot water after a judge ruled it violated a court order to reform the App Store.

The Department of Justice sued several big health insurers, alleging they used illegal kickbacks to nudge members into Medicare programs.

CITE: https://tinyurl.com/tj8smmes

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

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HEALTHCARE LEADERSHIP ON THE BRINK: Executives Eyeing the Exits

Posted on May 1, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By Health Capital Consultants LLC

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While the healthcare industry has been dealing with high employee turnover since the start of the COVID-19 pandemic, that turnover was largely among clinical staff.

However, a recent survey found that significant healthcare leadership turnover may also be on the horizon. AMN Healthcare subsidiary B.E. Smith found that nearly half of healthcare executives plan to leave their organization in the next year.

This Health Capital Topics article reviews the survey and the reasons behind the intended exits. (Read more…) 

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MEDICARE ADVANTAGE PLANS: Rates Substantially Increased for 2026

Posted on April 28, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By Health Capital Consultants LLC

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On April 7, 2025, the Centers for Medicare & Medicaid Services (CMS) published their 2026 Rate Announcement for Medicare Advantage (MA) and Medicare Part D Prescription Drug Plans.

For 2026, the payment rate to MA plans will increase 5.06%, the largest increase in the past ten years, and up significantly from the 2.2% rate increase proposed by the Biden Administration.

This Health Capital Topics article will review the Rate Announcement. (Read more…)

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ECONOMIC COMPETITION MODELS: In Medicine and Health Care

Posted on April 26, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By Staff Reporters

SPONSOR: http://www.CertifiedMedicalPlanner.org

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HEALTH CARE ECONOMIC COMPETITION MODELS

In a discussion of competitive healthcare economic models, assumptions must include normal demand quantities, many fully informed patients and the fact that physicians cannot directly influence demand for medical care. These assumptions, although fluid, also preclude that patient buyers are large enough to have any influence over price and result in the following”:

  • In a “pure monopoly”, there is only one provider with a unique service. The doctor   is a “price maker” and charges whatever s/he wishes.
  • In an “oligopoly”, there are a few physicians who provide similar services. For example, when it becomes clear to Dr. Smith and Dr. Jones that neither can win their price war, oli-gopolists return prices to prior, but still inflated levels!  
  • In “monopolistic competition”, there are many providers with differentiated services. For example, should Dr. Jones decide to have evening hours, she may charge a premium for her fees if Dr. Jones doe not follow suit.
  • Finally, when “pure competition” occurs, there are many physicians, providing providing similar and substitutable services. Marketing and advertising does not affect fees, and prices are determined by supply and demand. The doctors become “price takers” by accepting fees arrived at by practicing competitively.

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Feel free to submit education content to the site as well as links, text posts, images, opinions and videos which are then voted up or down by other members. Comments and dialog are especially welcomed.

Daily posts are organized by subject. ME-P administrators moderate the activity. Moderation may also conducted by community-specific moderators who are unpaid volunteers.

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AOMB: Assignment of Medical Benefits

Posted on April 16, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By Staff Reporters

SPONSOR: http://www.CertifiedMedicalPlanner.org

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Classic: An arrangement by which a patient requests that their health benefit payments be made directly to a designated person or facility, such as a physician or hospital. It is a legally binding agreement between patient and Insurance company asking them to send your reimbursement checks directly to your doctor.
 
Modern: To accept assignment means that the provider agrees to accept what ever the insurance company allows or approves as payment in full for the claim. The patient signs paperwork requiring his health insurance provider to pay his physician or hospital directly.
 
EXAMPLES:
 
CMS: The approved amount, also known as the Medicare-approved amount, is the fee that Medicare sets as how much a provider or supplier should be paid for a particular service or item. Original Medicare calls this “assignment.”
 
Tardiness: When a medical office accepts an assignment of benefits, the insured patients may have to wait several months for their insurance reimbursement to arrive.

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DAILY UPDATE: UnitedHealth Group Members Appear Sicker as Stock Markets Edge Up

Posted on April 15, 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“

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

http://www.MedicalBusinessAdvisors.com

SPONSORED BY: Marcinko & Associates, Inc.

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Daily Update Provided By Staff Reporters Since 2007.
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A recent study published in the Annals of Internal Medicine found that in 2021, UnitedHealth Group received just under $14 billion in extra Medicare Advantage payments after using a code that made its members appear sicker. It’s another tough break for the plan and provider that has faced allegations of illegally taking additional money from patients and taxpayers, especially after its CEO was fatally shot in early December.

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

US stocks edged higher on Monday as investors focused on tech’s temporary reprieve from President Trump’s tariffs.

The S&P 500 (^GSPC) trimmed bigger gains to rise a healthy 0.8%. The tech-heavy NASDAQ (^IXIC) also closed off its session high, up 0.6%. The Dow Jones Industrial Average (^DJI) was up around 0.7%, or more than 300 points.

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MEDICAL PRACTICE: As a Financial Asset Class?

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

SPONSOR: http://www.MarcinkoAssociates.com

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By Dr. David Edward Marcinko; MBA MEd CMP™

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What Is an Alternative Investment?

An alternative investment is a financial asset that does not fall into one of the conventional investment categories. Conventional categories include stocks, bonds, and cash. Alternative investments can include private equity or venture capital, hedge funds, managed futures, art and antiques, commodities, and derivatives contracts. Real estate is also often classified as an alternative investment.

QUESTION: But what about a medical, podiatric or dental practice?

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An Alternate Asset Class Surrogate?

A medical practice is much like an alternative investment [AI], or alternate asset class in, two respects.

  • First, it provides the work environment that generates personal income which has been considered generous, to date. 
  • Second, it has inherent appreciation and sales value that can be part of an exit (retirement) or succession planning transfer strategy.

Conclusion

So, unlike the emerging thought that offers Social Security payments as a surrogate for an asset classes; or a federally insured AAA bond – a medical practice might also be considered by some folks as an asset class within a well diversified modern investment portfolio.

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SPEAKING: Dr. Marcinko will be speaking and lecturing, signing and opining, teaching and preaching, storming and performing at many locations throughout the USA this year! His tour of witty and serious pontifications may be scheduled on a planned or ad-hoc basis; for public or private meetings and gatherings; formally, informally, or over lunch or dinner. All medical societies, financial advisory firms or Broker-Dealers are encouraged to submit a RFP for speaking engagements: MarcinkoAdvisors@outlook.com 

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FINANCIAL MODELING TERMS: All Physicians Should Review and Know

Posted on April 10, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By Staff Reporters

SPONSOR: http://www.CertifiedMedicalPlanner.org

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Financial Modeling is one of the most highly valued, but thinly understood, skills in financial analysis. The objective of financial modeling is to combine accounting, finance, and business metrics to create a forecast of a company’s future results.

According to Jeff Schmidt, a financial model is simply a spreadsheet, usually built in Microsoft Excel, that forecasts a business’s financial performance into the future. The forecast is typically based on the company’s historical performance and assumptions about the future and requires preparing an income statement, balance sheet, cash flow statement, and supporting schedules (known as a three-statement model, one of many types of approaches to financial statement modeling). From there, more advanced types of models can be built such as discounted cash flow analysis (DCF model), leveraged buyout (LBO), mergers and acquisitions (M&A), and sensitivity analysis

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DEFINED TERMS

Discounted Cash Flow (DCF): A valuation method used to estimate the value of an investment based on its expected future cash flows, adjusted for the time value of money. It’s like deciding whether a treasure chest is worth diving for now, based on the gold coins you’ll be able to cash in later.

Sensitivity Analysis: This involves changing one variable at a time to see how it affects an outcome. Imagine tweaking your coffee-to-water ratio each morning to achieve the perfect brew strength.

Budget – A budget is the amount of money a department, function, or business can spend in a given period of time. Usually, but not always, finance does this annually for the upcoming year.

Rolling Forecast – A rolling forecast maintains a consistent view over a period of time (often 12 months). When one period closes, finance adds one more period to the forecast.

Topside – A topside adjustment is an overlay to a forecast. This is typically completed by the corporate or headquarter team. As individual teams submit a forecast, the consolidated result might not make sense or align with expectations. When this occurs, the high-level teams use a topside adjustment to streamline or adjust the consolidated view.

Monte Carlo Simulation: Picture yourself at the casino, but instead of gambling your savings away, you’re using this technique to predict different outcomes of your business decisions based on random variables. It’s like playing financial roulette with the odds in your favor.

What-If Analysis: Ever daydream about what would happen if you took that leap of faith with your business? This tool allows you to explore various scenarios without risking a dime. It’s like trying on outfits in a virtual dressing room before making a purchase.

Leveraged Buyout (LBO) Model: This is a bit like orchestrating a heist, but legally. It’s about acquiring a company using borrowed money, with plans to pay off the debts with the company’s own cash flows. High stakes, high rewards.

Mergers and Acquisitions (M&A) Model: Picture two puzzle pieces coming together. This model evaluates how combining companies can create a new, more valuable entity. It’s the corporate version of a matchmaker.

Three Statement Model: The holy trinity of financial modeling, linking the income statement, balance sheet, and cash flow statement. It’s like weaving a tapestry where each thread is crucial to the overall picture.

Capital Asset Pricing Model (CAPM): A formula that calculates the expected return on an investment, considering its risk compared to the market. It’s like choosing the best roller coaster in the park, balancing thrill and safety.

Cash Flow Forecasting: This is your financial weather forecast, predicting the cash flow climate of your business. It helps you plan for sunny days and save for the rainy ones.

Cost of Capital: The price of financing your business, whether through debt or equity. It’s like the interest rate on your growth engine, pushing you to maximize every dollar invested.

Debt Schedule: A timeline of your business’s debts, showing when and how much you owe. It’s your roadmap to becoming debt-free, one milestone at a time.

Equity Valuation: Determining the value of a company’s shares. It’s like assessing the worth of a rare gemstone, ensuring investors pay a fair price for a piece of the treasure.

Financial Leverage: Using debt to amplify returns on investment. It’s like using a lever to lift a heavy object, increasing force but also risk.

Forecast Model: A crystal ball for your finances, projecting future performance based on past and present data. It’s your guide through the financial wilderness, helping you navigate with confidence.

Operating Model: A detailed blueprint of how a business generates value, mapping out operational activities and their financial impact. It’s like laying out the inner workings of a clock, ensuring every gear turns smoothly.

Revenue Growth Model: This tracks potential increases in sales over time, charting a course for expansion. It’s like plotting your ascent up a mountain, anticipating the effort required to reach the summit.

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ACO REACH: A New Model

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

ACCOUNTABLE CARE ORGANIZATIONS

Realizing Equity, Access, and Community Health

By Staff Reporters

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Model Overview

The ACO REACH Model provides novel tools and resources for health care providers to work together in an ACO to improve the quality of care for people with Traditional Medicare. REACH ACOs are comprised of different types of providers, including primary and specialty care physicians.

The ACO REACH Model makes important changes to the previous Global and Professional Direct Contracting (GPDC) Model which include:  

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  1. Promote Provider Leadership and Governance. The ACO REACH Model includes policies to ensure doctors and other health care providers continue to play a primary role in accountable care. At least 75% control of each ACO’s governing body generally must be held by participating providers or their designated representatives, compared to 25% during the first two Performance Years of the GPDC Model. In addition, the ACO REACH Model goes beyond prior ACO initiatives by requiring at least two beneficiary advocates on the governing board (at least one Medicare beneficiary and at least one consumer advocate), both of whom must hold voting rights. 
     
  2. Protect Beneficiaries and the Model with More Participant Vetting, Monitoring and Greater Transparency. CMS will ask for additional information on applicants’ ownership, leadership, and governing board to gain better visibility into ownership interests and affiliations to ensure participants’ interests align with CMS’s vision. We will employ increased up-front screening of applicants, robust monitoring of participants, and greater transparency into the model’s progress during implementation, even before final evaluation results, and will share more information on the participants and their work to improve care. Last, CMS will also explore stronger protections against inappropriate coding and risk score growth. 

MORE: https://www.cms.gov/priorities/innovation/innovation-models/aco-reach

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PHYSICIAN PAYMENT INCREASE: Excluded by Continuing Resolution

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

By Health Capital Consultants, LLC

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Continuing Resolution Excludes Physician Payment Increase Again

On March 15th, 2025, President Donald Trump signed a continuing resolution (CR) that avoided a government shutdown and funds the federal government for the rest of the fiscal year, i.e., through September 30th, 2025.

Perhaps more notable than what was included in the spending bill was what was once again excluded. While the COVID-era tele-health waivers were temporarily extended, Medicare physician payment rates were not addressed, meaning physicians will continue experiencing a 2.93% pay cut for 2025.

This Health Capital Topics article discusses the healthcare provisions included in and excluded from the CR, and the impacts on healthcare providers. (Read more…)

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OBTAIN: An Unbiased Second Financial Planning Opinion

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

By Ann Miller RN MHA CPHQ CMP™

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Finally … Fiduciary second investing and financial planning opinions right here!

Telephonic or electronic advice for medical professionals that is:

  • Objective, affordable, medically focused and financially personalized
  • Rendered by a pre-screened financial consultant for doctors and medical professionals
  • Offered on a pay-as-you-go basis, by phone or secure e-mail transmission

The iMBA Discussion Forum™ is a physician-to-financial advisor telephone or e-mail portal that connects independent financial professionals to doctors, nurses or healthcare executives desiring affordable and unbiased financial planning advice.

Medical professionals and healthcare executives can now receive direct access to pre-screened iMBA professionals in the areas of Investing, Financial Planning, Asset Allocation, Portfolio Management, Insurance, Mortgage and Lending, Human Resources, Retirement Planning and Employee Benefits. To assist our medical professional and healthcare executive members, we can be contracted with per-minute or per-project fees, and contacted by client phone, email or secure instant messaging.

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http://www.MARCINKOASSOCIATES.com

E-mail CONTACT: MarcinkoAdvisors@outlook.com

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Thank You

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MEDICARE: Four Payment Models Ended Early

Posted on March 31, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By Health Capital Consultants, LLC

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Four Medicare Payment Models Ended Early

In the latest iteration of Trump Administration healthcare cuts, the Centers for Medicare & Medicaid Services (CMS) announced on March 12th, 2025 that four Center for Medicare and Medicaid Innovation (CMMI) payment models would be sunset at the end of 2025, earlier than originally scheduled.

Cutting these models, which decision was based on “a comprehensive and data-driven review of [CMS’s] model portfolio,” are anticipated to save nearly $750 million (although the source of these savings was not detailed).

This Health Capital Topics article discusses the models being ended and the impact on healthcare stakeholders. (Read more…)

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HOSPITAL: Finances Hold Steady in 2025

Posted on March 29, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By Health Capital Consultants, LLC

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Hospital Finances Held Steady in First Month of 2025

In the first month of 2025, hospital revenue and expenses both increased, balancing each other out and resulting in continued steady financial performance for hospitals, according to Kaufman Hall’s January 2025 National Hospital Flash Report.

Revenues grew more quickly in the inpatient setting, as more patients were treated in the hospital and emergency department than in outpatient settings. While expense increases were largely driven by drug costs, the rate of that growth has significantly slowed.

This Health Capital Topics article reviews the report and the current state of hospital operations. (Read more…) 

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CELEBRATE: National Physicians Week 2025

Posted on March 29, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

EDITOR-IN-CHIEF

By Dr. David Edward Marcinko; FACFAS MBA MEd

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NATIONAL PHYSICIANS WEEK

National Physicians Week sets out March 25-31 to honor the healers dedicated to the art of medicine. In 2017, National Physicians Week highlighted the shortage of physicians in the United States against a growing landscape of minorities joining the ranks.

#NationalPhysiciansWeek

“In hindsight, I am proud of what we have accomplished in a short period of time, including raising the recognition of our group and spotlighting the years of sacrifice by those in our profession to serve our patients. We are poised to initiate actionable efforts to engage and educate our physician community.”

Cite: Dr. Kimberly Funches Jackson, President

Today in 2025, let’s explore the invaluable contributions of physicians, celebrate their hard work during National Physicians Week, and highlight the essential role that locum doctors play in enhancing healthcare delivery.

A Week to Honor All Physicians

National Physicians Week is a celebration of the remarkable work that doctors do every single day. From diagnosing complex conditions to providing life-saving treatments, physicians dedicate themselves to improving the health and well-being of their patients. It’s a week for healthcare professionals, patients, and communities to come together and show appreciation for the doctors who make a difference in our lives.

Physicians work long hours, face immense pressure, and make critical decisions daily. Their contributions go beyond the walls of the hospital, as many are also involved in research, teaching, and community outreach.

So, this week, it’s important to acknowledge not only their professional expertise but also the compassion and resilience they exhibit in their work.

EDUCATION: Books

SPEAKING: Dr. Marcinko will be speaking and lecturing, signing and opining, teaching and preaching, storming and performing at many locations throughout the USA this year! His tour of witty and serious pontifications may be scheduled on a planned or ad-hoc basis; for public or private meetings and gatherings; formally, informally, or over lunch or dinner. All medical societies, financial advisory firms or Broker-Dealers are encouraged to submit a RFP for speaking engagements: CONTACT: MarcinkoAdvisors@outlook.com 

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