BOARD CERTIFICATION EXAM STUDY GUIDES Lower Extremity Trauma
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Posted on July 20, 2023 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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The healthcare industry cut 97% more jobs in the first half of 2023 compared to the same period in 2022, according to a July 6 report from executive outplacement firm Challenger, Gray, & Christmas.
The report mentioned an unnamed hospital that closed last month due to a cyberattack, which likely contributed to the healthcare job cuts. In June, St. Margaret’s Health in Spring Valley, Illinois, closed, and was the first hospital to publicly attribute a cyberattack to its closure, NBC News reported.
Market and economic conditions were cited as the reasons for the majority of job cuts across all US industries; the report didn’t detail the reasons for healthcare job cuts specifically, except for the NBC News Report.
Posted on July 19, 2023 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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(Bloomberg) — Novartis AG raised its profit outlook and announced plans to buy back as much as $15 billion in shares as it prepares to spin off its Sandoz generics unit. Operating profit excluding some items will likely grow by low double digits this year, the Swiss drug maker said in a statement, raising its forecast for a second time from a prior estimate of high single-digits gains. The stock rose as much as 4% in Zurich trading.
Shares of U.S. telecom giantVerizon (NYSE: VZ) fell 7.5% in trading on Monday after a series of articles in The Wall Street Journal highlighted the lead in cable sheathing that telecom companies used decades ago. Some analysts downgraded the stock, but the market sold before more details were available from the company.
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Here is where the major market benchmarks ended:
U.S. stocks extended a rally as better-than-expected bank results boosted the S&P 500 and NASDAQ to fresh 15-month highs.
The S&P 500 Index was up 32.19 points (0.7%) at 4,554.98; the Dow Jones industrial average was up 366.58 points (1.1%) at 34,951.93; the NASDAQ Composite was up 108.69 points (0.8%) at 14,353.64.
The 10-year Treasury note yield (TNX) was little changed at 3.793%.
CBOE’s Volatility Index (VIX) was down 0.16 at 13.32.
Financial stocks were among the strongest performers Tuesday, sending the KBW Regional Banking Index (KRX) up over 4%. Oilfield services shares were also strong as crude oil futures gained over 2%. The small-cap Russell 2000 (RUT) gained over 1% and posted a five-month high.
Posted on July 17, 2023 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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A near-$10 trillion rally for global stocks this year will face a make-or-break moment as hundreds of companies report earnings over the next few weeks.
S&P 500 firms are expected to post a 9% drop in profits in the second quarter, making it the worst season since 2020, according to data compiled by Bloomberg Intelligence.
In Europe, it may be even worse, with a projected 12% slump. But with the bar already low — and some indicators suggesting an earnings recovery next year — strategists are split on how the markets will react.
Posted on July 16, 2023 by Dr. David Edward Marcinko MBA MEd CMP™
Supplemental Security Income
By Staff Reporters
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Stocks popped 2% this week, as investors expect the Fed to soon pause or dial back interest rates after the release of the June inflation report. Central bankers have raised rates from zero to over 5% since March of last year, a move that led the S&P 500 to shed 20% in 2022.
And yet, No SSI for you!
DEFINITION: Supplemental Security Income (SSI) is a means-tested program that provides cash payments to disabled children, disabled adults, and individuals aged 65 or older who are citizens or nationals of the USA. SSI was created by the Social Security Amendments of 1972 and is incorporated in Title 16 of the Social Security Act The program is administered by the Social Security Administration (SSA) and began operations in 1974.
Individuals or their helpers may start the application for SSI benefits by completing a short form on SSA’s website. SSA staff will schedule an appointment for the individual or helper within 1–2 weeks and complete the process.
SSI was created to replace federal-state adult assistance programs that served the same purpose, but were administered by the state agencies and received criticism for lacking consistent eligibility criteria. The restructuring of these programs was intended to standardize the eligibility requirements and level of benefits. Although administered by SSA, SSI is funded from the U.S. Treasury general funds, not the SS Trust Fund. As of July 2022, the program provides benefits to approximately five million Americans.
The Social Security Administration gives, and the Social Security Administration takes away — at least when it comes to beneficiaries who qualify for Supplemental Security Income (SSI) payments.
July is one of the months when the agency doesn’t issue an SSI check. Because of a quirk in the payment schedule, SSI beneficiaries get two payments in March, June, September and December, while no payments are deposited in January, April, July and October.
Posted on July 15, 2023 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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The biggest U.S. banks presented a picture of a resilient economy on Friday, with consumers and businesses continuing to spend and borrow even after a lightning-fast rise in interest rates.
JPMorgan Chase’s profit soared 67% in the second quarter from a year earlier and Wells Fargo’s jumped 57%, lifted by the income they earned lending out money at higher rates. Citigroup’s net interest income was a bright spot, though profit fell 36%. All three banks beat analysts’ expectations for profit and revenue.
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Here is where the major benchmarks ended:
The S&P 500 Index was down 4.62 points (0.1%) at 4,505.42, up 2.4% for the week; the Dow Jones Industrial Average (DJIA) was up 113.89 points (0.3%) at 34,509.03, up 2.3% for the week; the NASDAQ Composite was down 24.87 points (0.2%) at 14,113.70, up 3.3% for the week.
The 10-year Treasury note yield (TNX) was up about 7 basis points at 3.828%.
CBOE’s Volatility Index (VIX) was down 0.29 at 13.32.
Energy shares were among the weakest performers Friday after crude oil futures retreated nearly 2% from 2½-month highs posted Thursday. Regional banks were also lower despite stronger-than-expected quarterly results from their larger peers.
Health care and Consumer Staples were among the strongest performers. The U.S. dollar gained slightly but remained near a 17-month low against the euro.
Posted on July 12, 2023 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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American consumers are on track to run out of cash later this year, Bill Gross has warned.
Consumer spending is a key driver of economic growth. If it drops, a recession might be the result.
“Bond King” Gross said the government’s aggressive spending during the pandemic is still buoying the economy.
American consumers are propping up the economy by spending their pandemic savings, but they’re likely to run out of cash later this year, Gross warned.
“It’s fiscal policy not just monetary policy — stupid,” the billionaire investor tweeted. His point was that government spending and tax rates, along with interest rates and money supply, affect economic growth and inflation.
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Used Auto Prices Down
Used car prices in America saw the largest monthly slump since the height of the pandemic in June.
That’s good news on inflation, which could fall below 3% in June, the analyst said.
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Here is where the major benchmarks ended: yesterday
The S&P 500® Index (SPX) was up 29.73 points (0.7%) at 4,439.26; the Dow Jones Industrial Average (DJIA) was up 317.02 points (0.9%) at 34,261.42; the NASDAQ Composite (COMP) was up 75.22 points (0.6%) at 13,760.70.
The 10-year Treasury note yield (TNX) was down about 3 basis points at 3.978%.
CBOE’s Volatility Index (VIX) was down 0.23 at 14.84.
Energy companies led sector gainers Tuesday as crude oil futures extended a rally, with the benchmark WTI contract rising more than 2.5% and touching a 2½-month high on signs of lower Russian production.
The Philadelphia Oil Service Index (OSX) jumped more than 3% to a four-month high. Retail and transportation shares were also among the strongest sectors, while the health care and semiconductor sectors slipped.
Posted on July 11, 2023 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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Markets: Investors shook off last week’s post-holiday blues with all three major indexes snapping three-day losing streaks yesterday, embracing a new outlook as they wait for more economic data and a new earnings season to start this week.
CAVA rose as analysts got their first chance to comment on the lunch spot since its IPO and were largely bullish on the bowl-maker—it’s already nearly doubled since its market debut last month.
Posted on July 9, 2023 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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Consider this ME-P as a PSA for anyone getting married and/or preparing to send a million thank-you notes: The price of a USPS first-class “Forever” postage stamp is rising from 63 cents to 66 cents, effective tomorrow.
You don’t hear much about stamp inflation, but it’s been soaring. The price of stamps has jumped 32% since early 2019, when they cost just 50 cents. Then again, the USPS has to make up for emptier mailboxes somehow. Volume for first-class mail (which includes letters) has plunged 51% since 2006.
WHY?
Can you say e-mail, twitter, social media and text-messages, etc?
Posted on July 7, 2023 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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The U.S. is expected to have added tens of thousands of jobs in June, continuing to defy high interest rates and stubborn inflation, But any signs of slower job and wage growth last month could signal the labor market may be cooling down.
Economists surveyed by Bloomberg project that 225,000 jobs were added to the economy in June while the unemployment rate is expected to have slipped to 3.6% – down from 3.7% the previous month. And a projected 4.2% average hourly wage bump over the previous June would be the smallest yearly uptick since 2021.
Posted on July 7, 2023 by Dr. David Edward Marcinko MBA MEd CMP™
By Ann Miller RN MHACMP™
INTRODUCING OUR NEXT GENERATION e-BOOK LIBRARYFROM iMBA, Inc.
An e-book is an electronic or digital book that can be read on a computer or a handheld device.
Our new e-books consists of text, images, and are fixed to a specific spot on the page.
And, our e-books are a data files similar in content and structure to a word-processing document that comes in a PDF format. To use our e-books, you need to purchase and download it to a device that has a .pdf file reader app, such as ADOBE® or similar on a smartphone, tablet or computer. A PDF, also known as a portable document format, is the format most people are familiar with and used in our e-books. PDFs are known for their ease of use and ability to hold custom layouts. They are the most commonly used e-Book formats, especially by professionals and adult-learners.
You can then access the e-book and read it, or highlight pages and even take side notes.
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Posted on July 6, 2023 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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[AP]:Meta is poised to unveil a new app that appears to mimic Twitter — a direct challenge to the social media platform owned by Elon Musk. A listing for the app, called Threads, just appeared on Apple’s App Store, indicating it would debut as early as today. It is billed as a “text-based conversation app” that is linked to Instagram, with the listing teasing a Twitter-like micro-blogging experience.
“Threads is where communities come together to discuss everything from the topics you care about today to what’ll be trending tomorrow,” it said.
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Here is where the major benchmarks ended:
The S&P 500 Index was down 8.77 points (0.2%) at 4,446.82; the Dow Jones Industrial Average was down 129.83 points (0.4%) at 34,288.64; the NASDAQ Composite was down 25.12 points (0.2%) at 13,791.65.
The 10-year Treasury yield (TNX) was up about 7 basis points at 3.932%.
The CBOE Volatility Index (VIX) was up 0.49 at 14.19.
Chemical makers and other materials sector companies were among the weakest performers Wednesday. Semiconductor shares were also lower, as were many energy-company shares despite a 3% surge in crude oil futures. U
Utility stocks were among the strongest performers.
Posted on June 30, 2023 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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Three charged with insider trading related to Trump’s SPAC deal
The DOJ arrested three Florida investors, alleging they made more than $22 million in illegal profits through trading stock in the SPAC that took former President Trump’s social media company public.
The men are accused of trading shares in Digital World Acquisition Corporation based on nonpublic knowledge and making bank in October 2021 when news it planned to acquire Truth Social made its stock soar. Neither the former president nor his family members are implicated.
Posted on June 26, 2023 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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Last week, the NASDAQ snapped its eight-week winning streak, but it’s still on pace for its best and has nearly erased its total losses from 2022. Over in the media world, everyone (Disney, Warner Bros. Discovery, Paramount Global) is struggling except Netflix.
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But, the U.S. dollar rose to a 15-month high against the ruble this Monday after dramatic weekend events in Russia, which saw an aborted mutiny by heavily armed mercenaries. The dollar index also found some safe-haven support on lingering worries that the protracted monetary tightening cycles from major central banks would further hurt the global economic outlook.
Posted on June 24, 2023 by Dr. David Edward Marcinko MBA MEd CMP™
By Ann Miller RN MHA CPHQ CMP
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INVESTMENT ADVISORY & PORTFOLIO OPINIONS, MEDICAL START-UPS, ESTABLISHED PRACTICE VALUATIONS, BUSINESS MANAGEMENT AND EXPERT WITNESS CONSULTING
“FROM CHAOS-TO-CALM”
If you’re looking at this ME-P tab, chances are you are fed up, burned out, seeking practice management techniques or a better work-life balance; looking for a new non-clinical career, thinking of finance, investing, retirement, or all of the above. Perhaps you are just looking to regain the joy and meaning in your medical or professional career?
And so, we can help. From informal coaching and mentoring – to second opinions and more formal business, legal and/or financial consulting. Regardless, the need is real.
Posted on June 19, 2023 by Dr. David Edward Marcinko MBA MEd CMP™
FREEDOM DAY
By Staff Reporters
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The U.S. bond market, and both the NASDAQ and New York Stock Exchange (NYSE) are closed on June 19th in observance of Juneteenth.
Juneteenth became a federal and public U.S. holiday in 2021, when it was officially recognized by President Joe Biden.
Juneteenth is a banking holiday observed by the Federal Reserve. That means most major banks like Bank of America (BAC), Chase and Wells Fargo (CBEAX) will be closed. TD Bank, which remained open last Juneteenth, will also be closed today.
Posted on June 16, 2023 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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Stocks climbed again yesterday—and it wasn’t just tech companies carrying the team this time. The DJIA was the best-performing major index, showing how the current market rally is spreading beyond the A.I. frenzy. But the Artificial Intelligence frenzy is still frenzied. Microsoft, seen as the de facto AI leader, hit a record high.
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On Wall Street yesterday, CAVAwent public in the sixth-biggest US IPO of the year. Shares of the Mediterranean fast-casual chain popped 99%, giving it a market value of $4.9 billion at market close. Cava’s successful debut could inspire other restaurant brands, such as Panera and Fogo De Chão, to accelerate their plans to go public and wake up a slow IPO market.
Posted on June 16, 2023 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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The number of Americans applying for unemployment benefits remained elevated last week, a possible sign that the Federal Reserve’s interest rate hikes over the past year may taking hold in what’s proved to be a resilient job market. U.S. applications for jobless claims were 262,000 for the week ending June 10th, the Labor Department reported Thursday, more than analysts were expecting. This week’s number mirrors last week’s, which was revised up by 1,000. The claims numbers for the past two weeks are the highest since October of 2021. The four-week moving average of claims, which flattens some of the week-to-week fluctuations, rose by by more than 9,000 to 246,750. That’s the highest level since November of 2021.
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Here is where the major benchmarks ended:
The S&P 500 Index was up 53.25 points (1.2%) at 4,425.84; the Dow Jones industrial average was up 428.73 (1.3%) at 34,408.06; the NASDAQ Composite was up 156.34 (1.2%) at 13,782.82.
The 10-year Treasury note yield (TNX) was down about 8 basis points at 3.718%.
CBOE’s Volatility Index (VIX) was up 0.61 at 14.49.
Energy was the best performing sector Thursday as WTI crude oil futures rose more than 3%, putting them back above $70 per barrel, thanks to improving demand from China. Health care and retail stocks were also strong.
The euro surged above $1.09, its strongest level against the U.S. dollar in over a month, after the European Central Bank earlier Thursday hiked its benchmark deposit rate a quarter point to 3.5%, saying inflation is still too high.
Posted on June 15, 2023 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
UnitedHealth Group expects to spend more of its members’ premiums on medical care in the second quarter, driven by a rise in outpatient care for Americans 65 and older in Medicare plans, CFO John Rex said Tuesday at a Goldman Sachs investor conference. Speaking at a Goldman Sachs healthcare conference, Tim Noel, CEO of UnitedHealth’s Medicare and retirement business, pointed to elevated demand for outpatient procedures from Medicare patients, per Reuters.
“We’re seeing that more seniors are just more comfortable accessing services for things that they might have pushed off a bit like knees and hips,” Noel reportedly said at the conference. The elevated demand is expected to increase the company’s second-quarter costs and premiums look set to lag spending on claims. As a result, UnitedHealth said it expects its medical loss ratio for full-year 2023 to be in the upper end of its prior outlook.
But, following the news, RBC Capital analyst Ben Hendrix reiterated UnitedHealth with an Outperform and maintained its $592 price target. Mizuho analyst Ann Hynes also reiterated UnitedHealth with a Buy and a $600 price target.
The S&P 500 Index was up 3.58 points (0.1%) at 4,372.59; the Dow Jones Industrial Average (DJIA) was down 232.79 (0.7%) at 33,979.33; the NASDAQ Composite was up 53.16 (0.4%) at 13,626.48.
The 10-year Treasury note yield (TNX) was down about 4 basis points at 3.80%.
Cboe’s Volatility Index (VIX) was down 0.74 at 13.87.
Regional banks and retail were among the weakest sectors Wednesday. The KBW Regional Banking Index (KRX) tumbled from a 14-month high earlier in the day, ending down nearly 3%. Small-caps stocks also took a hit, as the Russell 2000 Index (RUT) fell 1.2%. The U.S. Dollar Index (DXY) rebounded sharply from a four-week low, boosted by the indications rates will stay higher for longer.
Posted on June 13, 2023 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
Markets: With investors keeping their fingers crossed that the Fed will pause its rate hikes when it meets tomorrow, the S&P 500 climbed to its highest in over a year yesterday, buoyed in part by Apple closing at a record high for the first time since January 2022.
Stock spotlight: The NASDAQ index has been on fire lately, but NASDAQ’s own stock fell after it announced plans to buy financial software-maker Adenza for $10.5 billion—its biggest purchase ever—as the company works to diversify its business beyond stock exchanges.
As a doctor and attorney, it is only logical for me to be the medical guardian for my adult learning and physically challenged cousin. So, I am here in Miami, Floridanearly every month for his physician appointments as well as social service visits. But, we also make sure we attend exciting and fun activities, as well!
In fact, last weekend was no exception as we went to the Sabrina Cohen Foundation for theirAdaptive Beach Daysevent during Brain Awareness Month every June.
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TheCohen Foundationprovides adaptive services for physically impaired people to participate in water activities, particularly in the ocean and beach activities. Miss Cohen was injured 19 years ago in a terrible accident and had a spinal cord injury. Instead of feeling sorry for herself, she created a foundation where she helps others enjoy life and activities outdoors. She received a 2 1/2 million dollar grant from the city of Miami and has a permanent site on the Beach in Miami. And, she provides services and activities for many people and is trying to take her foundation nationwide.
ME-P NOTE: The Illinois’s 11th Congressional District is in the state of Illinois. It includes parts of Cook, DuPage, Kendall, Kane and Will counties, as well some suburbs of Chicago and rural areas. So, please drop us a line and consider learning about and supporting Dr. Kent, regardless of your congressional district, affiliation and/or U.S. state.He is a political centrist and surely a rising new national star.
Posted on June 10, 2023 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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Republicans in the U.S. House of Representatives just unveiled a series of new tax breaks aimed at businesses and families while proposing to reverse some of President Joe Biden’s legislative victories, including credits to spur the sale of clean-burning electric vehicles.
Under the proposed legislation, married couples filing jointly would receive a $4,000 “deduction bonus” for two years that the committee said would potentially help up to 107 million families who take the standard deduction.
The legislation also would significantly increase the way businesses could claim depreciation deductions, raising the threshold to a permanent $2.5 million from the current $1 million that was contained in the Republicans’ broad 2017 tax cut package.
Other provisions include an expansion of tax benefits for small start-up enterprises to “S Corporations,” while eliminating some “red tape” that small businesses experience related to contract workers.
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The Closing Friday Markets
Markets: Stocks celebrated the summer Friday by jumping up yesterday, giving the S&P 500, which recently reentered bull market territory, its fourth positive week in a row. And, Tesla enjoyed its eleventh consecutive trading day in the green, matching its longest hot streak.
The S&P 500 Index was up 4.93 points (0.11%) at 4,298.86; the Dow Jones Industrial Average (DJIA) was up 43.17 points (0.13%) at 33,876.78; the NASDAQ Composite (COMPX) was up 20.62 points (0.16%) at 13,259.14.
The 10-year Treasury note yield (TNX) was little changed at 3.740%.
CBOE’s Volatility Index (VIX) was up 10 points at 13.75.
The Technology, Consumer Discretionary, and Communication Services sectors—home to market heavyweights such as Alphabet (GOOGL), Apple (AAPL), Meta (META), Microsoft (MSFT), NVIDIA (NVDA), and Tesla (TSLA)—were the strongest performers Friday. Energy was among the weaker sectors, as crude oil futures fell 1.5% to just above $70. The small-company-focused Russell 2000 (RUT) lagged, falling about 0.9%.
Posted on June 9, 2023 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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About one in three physicians reported that they’ve been sued for medical malpractice during their career, a new study from the American Medical Association (AMA) found.
The study analyzed 14,000 responses from AMA Physician Practice Benchmark Surveys between 2016 and 2022. The longer a physician works in the industry, the higher their risk of getting a malpractice claim.
In summary, almost half of physicians over the age of 54 have been sued in their career, versus 9.5% of physicians younger than 40 years old. Specialty and gender influenced the likelihood of being sued. For example, general surgeons and ob-gyns, as well as men physicians, had the highest risk, per the AMA report.
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This is exactly why we produced a major 800 page textbook for all our medical colleagues: Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors Best Practices from Leading Consultants and Certified Medical Planners™
Posted on June 4, 2023 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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The US kept adding jobs according to new data from the Bureau of Labor Statistics. The economy gained 339,000 pay-rolled employees in May, more than in each of the preceding three months and way more than the 190,000 Dow Jones predicted (to be fair, expert estimates low-balled 13 of the last 16 job reports, according to CNBC. This growth happened despite climbing interest rates, inflation, recent bank failures, and a nerve-racking debt ceiling standoff that threatened to destroy the economy And, Wall Street interpreted the data as a big green “buy” sign. For example:
Stocksleaped up last week as investors celebrated the deal to lift the debt ceiling being showed that the economy is still going strong. In fact, Lululemon stretched toward the heavens after beating earnings expectations thanks to a 24% year over year jump in sales.
But not all indications pointed to the hot streak continuing indefinitely.
The unemployment rate inched, wage growth slowed, and workers appear less self-assured in the labor market:
The self-employed lost 369,000 people from its ranks in May, a possible sign that folks might be ditching the self-employment for the security of a traditional employer.
And, recent data shows the quit rate has declined from an all-time high in late 2021, bringing an end to the pandemic job-hopping trend dubbed the Great Resignation.
Ultimately, the Fed will have to use the conflicting and mixed economic indicators to decide whether to further crank up interest rates at their next meeting. The Federal Reserve has been hinting that it might cease raising interest rates, and investors seem convinced the central bank will follow through and at least “skip” a hike this month even though the labor market is still radiating heat.
NOTE: The US debt-ceiling bill just passed, June 1, 2023. So, here are some budgeting rules for doctors and medical professionals.
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Budgeting is probably one of the greatest tools in building wealth. However, it is also one of the greatest weaknesses among physicians who tend to live a certain lifestyle. This includes living in an exclusive neighborhood, driving an expensive car, wearing imported suits and a fine watch, all of which do not lend themselves to expense budgeting. Only one in ten medical professionals has a personal budget. Fear, or a lack of knowledge, is a major cause of procrastination.
The following guidelines will assist in this microeconomic endeavor:
Set reasonable goals and estimate annual income. Do not keep large amounts of cash at home, or in the office. Deposit it in a money market account for safety and interest.
Do not pay bills early, do not have more taxes withheld from your salary than you owe, and develop spending estimates and budget fixed expenses first. Fixed expenses are usually contractual, and may include housing, utilities, food, telephone, social security, medical, debt repayment, homeowner’ or renter’s insurance, auto, life and disability insurance, and maintenance, etc.
Make variable expenses a priority. Variable expenses are not usually contractual, and may include clothing, education, recreational, travel, vacation, gas, entertainment, gifts, furnishings, savings, investments, etc.
Trim variable expenses by 10-15 percent, and fixed expenses, when possible. Ultimately, all fixed expenses get paid and become variable in the long run.
Use carve-out or set-asides for big ticket items and differentiate “wants from needs.”
Know the difference between saving and investing. Savers tend to be risk adverse and investors understand risk and takes steps to mitigate it.
Determine shortfalls or excesses with the budget period.
Track actual expenses.
Calculate both income and expenses as a percentage of the total, and determine if there is a better way to allocate resources. Then, review the budget on a monthly basis to determine if there is a variance. Determine if the variance was avoidable, unavoidable, or a result of inaccurate assumptions, and take needed corrective action.
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Verify Your Budget and Follow a Financial Plan
The process of establishing a budget relies heavily on guesswork, and the use of software or “apps”, that seamlessly track expenditures and help your budget and your financial plan become more of reality. Most doctors underestimate their true expenses, so lumping and best guesses on expense usually prove very inaccurate. Personal financial software and mobile phone applications make the verification of budgets easier. Once your personal accounts are setup, free apps like MINT.com will let give you a detailed report on where your money is going and the adjustments you must make. Few professions make larger contributions to the Internal Revenue Service than physicians and the medical profession. It is very important to categorize different budget categories not only to be proactive about your expenses, but also to accurately reflect the effect your different expenditures have on your real savings capability. All expense dollars are not equal.
For example, a mortgage payment, which is mostly interest expense in the early years, is likewise mostly tax deductible. Spending money on your family vacation is typically not tax deductible. Itemized deductions, which are deductions that a US taxpayer can claim on their tax return in order to reduce their Adjustable Gross Income (AGI), may include such costs as property taxes, vehicle registration fees, income taxes, mortgage expense, investment interest, charitable contributions, medical expenses (to the extent the expenses exceed 10% of the taxpayers AGI) and more.
Employing a qualifiedcertified medical planneR® that utilizes a cash-flow based financial planning software program may help the physician identify their actual after-tax projected cash flow and more accurately plan their future.
Posted on May 29, 2023 by Dr. David Edward Marcinko MBA MEd CMP™
COLLEGE 529 SAVINGS PLAN DAY
By Staff Reporters
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May 29th is observed across the U.S. as 529 Day or 529 College Savings day. It was introduced to increase awareness of these plans and encourage families to start saving toward future education expenses.
Posted on May 25, 2023 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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Thousands of clients of Maxim Healthcare Services are about to receive a payment of up to $5,000 in compensation for a data breach. According to information obtained by The Sun, the private medical personnel company based in Columbia, Maryland; agreed to pay 2020 data breach claims filed in a class action lawsuit by residents of the state of California.
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Gold futures tallied a third consecutive session decline settling at their lowest in nearly a week as further strength in the U.S. dollar pressured prices for the precious metal. Gold gave up early gains that had been driven by uncertainty surrounding a U.S. debt-ceiling deal in Congress.
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And, here is where the major benchmarks ended yesterday:
The S&P 500 Index was down 30.34 points (0.7%) at 4115.24; the Dow Jones industrial average was down 255.59 (0.8%) at 32,799.92; the NASDAQ Composite was down 76.08 (0.6%) at 12,484.16.
The 10-year Treasury yield was up about 4 basis points at 3.742%.
CBOEs Volatility Index was up 1.52 at 20.04.
Technology and regional bank stocks were among the weakest sectors, with the Philadelphia Semiconductor Index down more than 2%. Energy was one of the few gainers among S&P 500 sectors as crude oil futures climbed to a three-week high of near $74 a barrel. The U.S. dollar index rose a third straight day to a two-month high.
Posted on May 23, 2023 by Dr. David Edward Marcinko MBA MEd CMP™
MENTAL HEATH AMERICA
By Staff Reporters
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MENTAL HEALTH PARITY ACT
Atlanta, GA – Governor Brian P. Kemp, joined by First Lady Marty Kemp and their three daughters, Lt. Governor Geoff Duncan, Speaker David Ralston, members of the House and Senate, and mental health advocates, to sign the Mental Health Parity Act (HB1013) into law.
You may view his remarks from the bill signing ceremony below, and you can watch the full ceremony here.
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Mental Health Rights
People living with mental health conditions are people. They have people they love, activities they enjoy, and dreams for their lives. As people, they deserve to be treated with dignity, and under the law they have rights and protections.
Unfortunately, it has long been the case that individuals with mental health conditions are among the most abused and discriminated against in our country. From leaving people to languish in overcrowded state hospitals to lobotomies and forced sterilization, the treatment of those with mental health conditions is a dark stain on our history as a nation.
While we have come a long way, abuse and discrimination continue to be serious problems today. The shackling or restraining of children, keeping people out of work, and denying access to services are just a few examples of the way we continue to fail the 1 in 5 Americans that has a diagnosable mental health disorder.
This is not just a small issue for a small group of people: half of all Americans will experience a diagnosable mental health condition in their lifetime. If it is not us being directly impacted, it is likely that it will be our family members, friends, or loved ones– whether we know it or not. Beyond struggles in education or employment, we see the loss of human dignity and even human life for the people we love and care about when we do not work to address abuses in the system.
For Mental Health America, the fight against abuse and discrimination is essential to our history and continues to guide our work. MHA’s symbol, which sits in our national office, is the Bell of Hope cast from the chains and shackles that were used to restrain individuals in old state hospitals. As an organization, MHA is committed to the principles of human and civil rights inherent to the concept of equal justice under the law.
Posted on May 23, 2023 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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Last week, investors shrugged off debt ceiling worries to send the S&P and the NASDAQ to their best weekly performance since March. Tech stocks have posted impressive gains this year thanks to the hype around artificial intelligence:
Four giants that have made a big deal about investing in AI—Meta, Alphabet, Microsoft, and Nvidia—have surged in 2023 and now account for ~15% of the S&P 500’s market capitalization, according to Barron’s.
Posted on May 11, 2023 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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Because the inflation data came in roughly as expected, Wall Street sees the door still open for the Federal Reserve to leave interest rates alone at its next meeting in June. That would be the first time it hasn’t raised rates at a meeting in more than a year, and a pause would offer some breathing room for the economy and financial markets.
Today is the last day of the US Covid-19 public health emergency, which has been in place since Jan. 31st, 2020. With it comes the end of certain Covid-era rules, though some telehealth protections have been extended through the end of 2024. Here’s to all the medical professionals who got us through, and a remembrance for the millions who lost their lives to Covid.
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Brightline, a California-based mental health startup, laid off 20% of its staff this week following a data breach. North Carolina is the latest state to consider changes to the prior authorization process that advocates say delays care. A board member at Geisinger claims that consolidation prompted the healthcare provider to sell to Kaiser Permanente. Texas Gov. Greg Abbottsaid the state should address mental health issues in the wake of a shopping mall mass shooting, but did not call for gun control reform.
Finally, here is where the major benchmarks ended yesterday:
The S&P 500 Index was up 18.47 points (0.5%) at 4137.64; the Dow Jones industrial average was down 30.48 (0.1%) at 33,531.33; the NASDAQ Composite was up 126.89 (1.0%) at 12,306.44.
The 10-year Treasury yield was down about 8 basis points at 3.441%.
CBOE’s Volatility Index was down 0.80 at 16.91.
Oilfield services providers and other energy companies were among the laggards Wednesday, pressured by a more-than 1% drop in WTI crude oil futures.
Financial sector stocks struggling to escape the effects of the bank volatility earlier this spring helped push the KWB Regional Bank Index back near a 2½-year low reached last week.
Posted on May 6, 2023 by Dr. David Edward Marcinko MBA MEd CMP™
By Ann Miller RN MHACMP™
INTRODUCING OUR NEXT GENERATION e-BOOK LIBRARYFROM iMBA, Inc.
An e-book is an electronic or digital book that can be read on a computer or a handheld device.
Our new e-books consists of text, images, and are fixed to a specific spot on the page.
And, our e-books are a data files similar in content and structure to a word-processing document that comes in a PDF format. To use our e-books, you need to purchase and download it to a device that has a .pdf file reader app, such as ADOBE® or similar on a smartphone, tablet or computer. A PDF, also known as a portable document format, is the format most people are familiar with and used in our e-books. PDFs are known for their ease of use and ability to hold custom layouts. They are the most commonly used e-Book formats, especially by professionals and adult-learners.
You can then access the e-book and read it, or highlight pages and even take side notes.
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Posted on May 6, 2023 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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Dr. Rochelle Walensky, the head of the Centers for Disease Control and Prevention, submitted her resignation yesterday, saying the waning of the COVID-19 pandemic was a good time to make a transition.
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The World Health Organization just reported that COVID-19 no longer qualifies as a global emergency, marking a symbolic end to the devastating coronavirus pandemic that triggered once-unthinkable lock-downs, upended economies and killed millions of people worldwide.
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Here’s where the major indexes ended:
The S&P 500® Index was up 75.03 points (1.9%) at 4136.25; the Dow Jones industrial average was up 546.64 (1.7%) at 33,674.38; the NASDAQ Composite was up 269.01 (2.3%) at 12,235.41.
The 10-year Treasury yield was up about 8 basis points at 3.431%.
CBOE’s Volatility Index was down 2.89 at 17.20.
Financial shares were a bright spot Friday, with the KBW Regional Banking Index up over 4% after sinking near a 2½-year low Thursday. Energy stocks were also strong as crude oil futures rallied over 4% and pushed back above $70 a barrel. Small-cap stocks also gained, with the Russell 2000 up more than 2%.
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* UNC Health might be able to expand its footprint faster, pending state approval. * A new chatbot called Pi is helping people with their emotional well-being. * The FDA approved the first RSV vaccine, which comes from GSK.
Under law, financial advisors and planners must provide you with a form ADV Part II or a brochure that covers the same information. Even if a brochure is provided, ask for the ADV. While it is acceptable, even desirable, for the brochure to be easier to read than the ADV, the ADV is what is filed with the appropriate state or SEC. If the brochure reads more like a slick sales brochure or the information in the brochure glosses over the items on the ADV to a high degree, one should consider eliminating the advisor from consideration.
Registering with a state or SEC gives an advisor a fiduciary duty to the client. This is a high standard under the law.
There are several types of advisors who are exempt from registering and filing an ADV.
First, there are registered representatives (brokers). Brokers have a fiduciary responsibility to their firms regardless of whether they are statutory employees or independent contractors. Not the client.
Second are attorneys and accountants whose advice is “incidental” to their legal or accounting practices. But, why would one hire someone whose advice is “incidental” to his primary profession? A top-notch advisor is a full-time professional and should be registered. One should insist that their advisor be registered.
The ADV will describe the advisor’s background and employment history, including any prior disciplinary issues. It will describe the ownership of the firm and outline how the firm and advisor are compensated. Any referral arrangements will be described. If an advisor has an interest in any of the investments to be recommended, it must be listed as well as the fee schedule. There is also a description of the types of investments recommended and the types of research information that is used.
ASSESSMENT: A review of the ADV should result in an alignment of what the advisor said during the interview and what is filed with the regulators. If there is a clear discrepancy, choose another advisor. If it is unclear, discuss the issue with the advisor.
Your thoughts and comments are appreciated.
SEC Headquarters 100 F Street, NE Washington, DC 20549 (202) 942-8088
Posted on May 2, 2023 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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Companies, mostly in tech and media, have laid off thousands of employees, so far this year. For example:
Amazon announced in early January that it’s eliminating 18,000 roles in total, including layoffs that were announced in November 2022. The company announced last month that it was laying off an additional 9,000 people.
Payments company PayPal is cutting 7% of its staff, which amounts to about 2,000 employees, President and CEO Dan Schulman said on Jan. 31st.
E-commerce company eBay announced in an SEC filing on Feb. 7 that it’s laying off 500 people, or 4% of its workforce.
And, Jenny Craig is saddled with $250 million in debt and has been looking for a buyer, Bloomberg Law reported in March. The weight loss industry is going through changes, as the obesity drug business has exploded in popularity. The medications, which mimic hormones found in the body to support weight loss, have recently grown in popularity thanks to reported use by celebrities and posts from everyday people on social media about successful weight loss.
Finally, General Motors terminated “several hundred” contract employees who worked at its Global Technical Center in Warren, Michigan, and other locations this weekend in its bid to shave $2 billion from its budget by the end of next year. The cuts come nearly a month after 5,000 salaried employees agreed to a voluntary separation package that GM said would help it achieve close to 50% of its cost-cutting target this year alone and prevent further involuntary cuts.
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Happy Tuesday! Today marks the first day of Mental Health Awareness Month. One in five US adults experiences mental illness each year, but fewer than half of them get care, according to the National Alliance on Mental Illness.
The MARKETS
The S&P 500® Index was down 1.61 points at 4167.87; the Dow Jones industrial average was down 46.46 (0.1%) at 34,051.70; the NASDAQ Composite was down 13.99 (0.1%) at 12,212.60.
The 10-year Treasury yield was up about 13 basis points at 3.585%.
Posted on May 1, 2023 by Dr. David Edward Marcinko MBA MEd CMP™
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By Staff Reporters
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According to Wikipedia, May Day is a European festival of ancient origins marking the beginning of summer, usually celebrated on 1 May, around halfway between the spring equinox and summer solstice. Festivities may also be held the night before, known as May Eve.
But in 1889, it was chosen as the date for International Workers’ Day by the Second International, to commemorate the Haymarket affair in Chicago and the struggle for an eight-hour working day. As a result, International Workers’ Day is also called “May Day”, but the two are unrelated.
Posted on May 1, 2023 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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Big banks including JPMorgan Chase & Co. and PNC Financial Services Group Inc. submitted bids for First Republic Bank to the Federal Deposit Insurance Corp., which is preparing to seize and sell the troubled lender, according to people familiar with the matter. The winning bidder could be announced soon.
Posted on April 30, 2023 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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Eli Lilly (NYSE: LLY) investors continued to be in a good mood about their stock on Friday. Following the estimates-beating first quarter reported by the big pharmaceutical company the previous morning, they traded the shares up by 1.4% on the final trading day of the week. That eclipsed the 0.8% gain of the S&P 500 index.
Researchers at MIT have created a new type of tabletop printer that spits out vaccine doses on demand in the form of thumbnail-size microneedle patches. Once scaled, this mobile technology could produce hundreds of doses per day, revolutionizing pandemic response. And in a boon for warmer or more remote parts of the world, the vaccine patches can be stored at room temperature for months before they’re slapped on—no refrigeration or professional administering required.
Posted on April 26, 2023 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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The CARES Act, a COVID relief law that was enacted in March of 2020, made it easier to pull money from one’s 401(k) or IRA It allowed people to take up to $100,000 out of their accounts and have three years to pay it back without the normal 10% early withdrawal penalty and tax payment. For Americans who needed cash quickly, their 401(k) was a tempting well to dip into that wouldn’t have been otherwise available.
In the spring of 2020, nearly 20% of all withdrawals from 401(k)’s, between April 6th and June 26th were related to COVID, according to CNBC. CNBC reported that at Fidelity Investments, the largest provider of 401(k) plans in the U.S., more than 700,000 people took from their 401(k) or their 403(b) plan. The median amount was about $5,000, while more than 18,000 people asked for the full $100,000 amount.
And Vanguard’s How America Saves report from 2021 found that more than 7% of people withdrew from their 401(k) or a 401(b) — similar to a 401(k) but available to not-for-profit companies — in 2020.
The S&P 500 Index was down 65.41 (1.6%) at 4071.63; the Dow Jones industrial average was down 344.57 (1.0%) at 33,530.83; the NASDAQ Composite was down 238.05 (2.0%) at 11,799.16.
The 10-year Treasury yield was down about 12 basis points at 3.394%.
CBOEs Volatility Index was up 1.99 at 18.92.
Transportation stocks also had a rough day after United Parcel Service’s (UPS) shares dropped some 10% after its results missed analysts’ forecasts. Energy companies were lower after WTI crude oil futures dropped under $77 a barrel for the first time this month. Small-cap companies, which are considered to have greater recession exposure than larger businesses, were also under pressure, with the Russell 2000 index falling more than 2% and nearing a five-week low.
Posted on April 26, 2023 by Dr. David Edward Marcinko MBA MEd CMP™
THE EIGHT [8] GIFTS
By Staff Reporters
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Much like the False Claims Act, the Anti-Kickback Statute (AKS) remains a frequent tool used by the Department of Justice to investigate the healthcare industry. Unlike the False Claims Act, the AKS imposes criminal penalties on violators.
The leaders of a physicians’ practice may be held liable for what others in the practice do, even if the leader did not know precisely what was going on. It has been called the “crime of doing nothing.”
1. Providing free dinners or lunches to physicians
2. Travel expenses paid to physicians
3. Entering into consulting or research agreements with physicians under which payments are made but minimal (or zero) work is done in return
4. Other gifts, such as electronics or tickets to sporting events
5. Laboratory pays a specimen processing fee to physicians above the fair value for those fees
6. Physician retention or recruitment agreements, when those agreements provide for payments above fair market value or are made with the intent to induce Medicare referrals
7. Agreements for speaking or teaching where the payments are above fair market value or made with the intent to induce referrals
8. Discount schemes that do not meet the safe harbor requirements
Source: Sara Kropf and Logan Lutton, Physicans Practice
Posted on April 25, 2023 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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1. Regional banks’ plight was Morgan Stanley’s perk. The bank saw nearly $20 billion in new client assets in the wake of the banking crisis that rocked smaller banks like First Republic. Why the bank became a “destination of choice” amid the crisis.
2. Taylor Swift was the only one asking the right question on FTX. The mega star didn’t sign a $100 million sponsorship deal with the crypto exchange because, unlike seemingly everyone in Silicon Valley, she did some form of due diligence.
4. It’s starting to get scary in the housing market. Foreclosure filings were up 22% in Q1 compared to last year, and repossessions are headed in the wrong direction as well.
Finally, Fintel reports that on April 21, 2023, Goldman Sachs maintained coverage of Tesla (NASDAQ:TSLA) with a Buy recommendation. As of April 6th, 2023, the average one-year price target for Tesla is $203.14. The forecasts range from a low of $24.58 to a high of $315.00. The average price target represents an increase of 24.63% from its latest reported closing price of $162.99. The projected annual revenue for Tesla is $118,517MM, an increase of 37.75%. The projected annual non-GAAP EPS is $5.70.
The S&P 500® Index was up 3.52 points (0.1%) at 4137.04; the Dow Jones industrial average was up 66.44 (0.2%) at 33,875.40; the NASDAQ Composite was down 35.25 (0.3%) at 12,037.20.
The 10-year Treasury yield was down about 7 basis points at 3.50%.
CBOEs Volatility Index was up 0.12 at 16.89.
Real estate and financials were among Monday’s weakest-performing sectors, while energy companies led gainers thanks to a jump of about 1% in crude oil futures. The U.S. dollar index fell to about 101.37, its weakest level since mid-April, while Treasury yields eased slightly.
Posted on April 25, 2023 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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Physicians Who Accept Medicare, Medicaid at All-time Low of 65%
Reduced Medicare and Medicaid payments are having more physicians considering reducing those patient bases, according to Medscape’s “Physician Compensation Report” for 2023. Sixty-five percent of physicians surveyed said they would continue treating current Medicare or Medicaid patients and take on new ones, according to the report. Medscape said it is the lowest percentage it has seen in its annual compensation reports. Five years ago, 71 percent of physicians said they would continue treating current Medicare or Medicaid patients and take on new ones.
For the report, Medscape collected responses from 10,011 physicians across more than 29 specialties. The data was collected between Oct. 7, 2022, and Jan. 17, 2023. Eight percent of physicians surveyed said they would not take on new Medicare patients, and 5 percent said they would not take new Medicaid patients. Four percent said they will stop treating some or all of their current Medicare patients and will not take on new ones, and 3 percent said the same about Medicaid patients. Twenty-two percent said they have not yet decided how they will move forward regarding Medicare and Medicaid patients, according to the report.
Source: Andrew Cass, Becker’s Payer Issues [4/18/23]
Posted on April 18, 2023 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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Tax deadline — April 18, 2023 — is today.
Did you know that the probability of being audited by the IRS is generally low, with less than 1% of tax returns receiving a second look? The average chance of being audited is 1 in 333, or 0.3%. But, certain factors can increase the likelihood of being audited, such as earning a lot of money or claiming complex deductions.
For example, the audit rate among filers with income of $10 million or more is 6.66%, while the audit rate for filers with incomes between $25,000 and $500,000 is roughly 0.5%. If selected for an audit, the taxpayer must demonstrate that the information on their tax return is correct
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The following is a round-up of yesterday’s market activity:
The S&P 500 Index was up 13.68 points (0.3%) at 4151.32; the Dow Jones industrial average was up 100.71 (0.3%) at 33,987.18; the NASDAQ Composite was up 34.26 (0.3%) at 12,157.72.
The 10-year Treasury yield was up about 8 basis points at 3.3.60%.
CBOE’s Volatility Index was down 0.13 at 16.94.
Among S&P 500 sectors, real estate stocks led advancers, while financials and industrials were also higher. Small-caps rose, with the Russell 2000 up about 1%. Communication services companies were among the weakest performers, and energy companies slumped as crude oil futures dropped nearly 2%.
The U.S. dollar index strengthened slightly, and equity market volatility remained subdued, with the VIX extending a decline to the lowest levels since late 2021.
National Healthcare Decisions Day (NHDD) exists to inspire, educate and empower the public and providers about the importance of advance care planning. NHDD is an initiative to encourage patients to express their wishes regarding healthcare and for providers and facilities to respect those wishes, whatever they may be.
NHDD was founded in 2008 by Nathan Kottkamp, a Virginia-based health care lawyer, to provide clear, concise, and consistent information on healthcare decision-making to both the public and providers/facilities through the widespread availability and dissemination of simple, free, and uniform tools (not just forms) to guide the process.
NHDD is a series of independent events held across the country, supported by a national media and public education campaign. In all respects, NHDD is inclusive and brings a variety of players in the larger healthcare, legal, and religious community together to work on a common project, to the benefit of patients, families, and providers. A key goal of NHDD is to demystify healthcare decision-making and make the topic of advance care planning inescapable. Among other things, NHDD helps people understand that advance healthcare decision-making includes much more than living wills; it is a process that should focus first on conversation and choosing an agent.
As of June 2016, The Conversation Project has been responsible for the management, finances, and structure of NHDD. NHDD’s founder, Nathan Kottkamp, continues to be involved in NHDD and provides leadership by ensuring the maintenance of NHDD’s high quality resources and support for the community.
DEFINITION: What is advance care planning for financial advisors and lawyers?
Advance care planning involves discussing and preparing for future decisions about your medical care if you become seriously ill or unable to communicate your wishes with your estate planning attorney or financial advisor. Having meaningful conversations with your loved ones is the most important part of advance care planning. Many people also choose to put their preferences in writing by completing legal documents called advance directives.
What are advance directives?
Advance directives are legal documents that provide instructions for medical care and only go into effect if you cannot communicate your own wishes.
The two most common advance directives for health care are the living will and the durable power of attorney for health care.
Living will: A living will is a legal document that tells doctors how you want to be treated if you cannot make your own decisions about emergency treatment. In a living will, you can say which common medical treatments or care you would want, which ones you would want to avoid, and under which conditions each of your choices applies. Learn more about preparing a living will.
Durable power of attorneyfor health care: A durable power of attorney for health care is a legal document that names your health care proxy, a person who can make health care decisions for you if you are unable to communicate these yourself. Your proxy, also known as a representative, surrogate, or agent, should be familiar with your values and wishes. A proxy can be chosen in addition to or instead of a living will. Having a health care proxy helps you plan for situations that cannot be foreseen, such as a serious car accident or stroke. Learn more about choosing a health care proxy.
Think of your advance directives as living documents that you review at least once each year and update if a major life event occurs such as retirement, moving out of state, or a significant change in your health.
Advance care planning is not just for people who are very old or ill. At any age, a medical crisis could leave you unable to communicate your own health care decisions. Planning now for your future health care can help ensure you get the medical care you want and that someone you trust will be there to make decisions for you.
Advance care planning for people with dementia. Many people do not realize that Alzheimer’s disease and related dementias are terminal conditions and ultimately result in death. People in the later stages of dementia often lose their ability to do the simplest tasks. If you have dementia, advance care planning can give you a sense of control over an uncertain future and enable you to participate directly in decision-making about your future care. If you are a loved one of someone with dementia, encourage these discussions as early as possible. In the later stages of dementia, you may wish to discuss decisions with other family members, your loved one’s health care provider, or a trusted friend to feel more supported when deciding the types of care and treatments the person would want.
What happens if you do not have an advance directive?
If you do not have an advance directive and you are unable to make decisions on your own, the state laws where you live will determine who may make medical decisions on your behalf. This is typically your spouse, your parents if they are available, or your children if they are adults. If you are unmarried and have not named your partner as your proxy, it’s possible they could be excluded from decision-making. If you have no family members, some states allow a close friend who is familiar with your values to help. Or they may assign a physician to represent your best interests. To find out the laws in your state, contact your state legal aid office or state bar association.
Will an advance directive guarantee your wishes are followed?
An advance directive is legally recognized but not legally binding. This means that your health care provider and proxy will do their best to respect your advance directives, but there may be circumstances in which they cannot follow your wishes exactly. For example, you may be in a complex medical situation where it is unclear what you would want. This is another key reason why having conversations about your preferences is so important. Talking with your loved ones ahead of time may help them better navigate unanticipated issues.
There is the possibility that a health care provider refuses to follow your advance directives. This might happen if the decision goes against:
The health care provider’s conscience
The health care institution’s policy
Accepted health care standards
In these situations, the health care provider must inform your health care proxy immediately and consider transferring your care to another provider.
Other advance care planning forms and orders from doctors
You might want to prepare documents to express your wishes about a single medical issue or something else not already covered in your advance directives, such as an emergency. For these types of situations, you can talk with a doctor about establishing the following orders:
Do not resuscitate (DNR) order: A DNR becomes part of your medical chart to inform medical staff in a hospital or nursing facility that you do not want CPR or other life-support measures to be attempted if your heartbeat and breathing stop. Sometimes this document is referred to as a do not attempt resuscitation (DNR) order or an allow natural death (AND) order. Even though a living will might state that CPR is not wanted, it is helpful to have a DNR order as part of your medical file if you go to a hospital. Posting a DNR next to your hospital bed might avoid confusion in an emergency. Without a DNR order, medical staff will attempt every effort to restore your breathing and the normal rhythm of your heart.
Do not intubate (DNI) order: A similar document, a DNI informs medical staff in a hospital or nursing facility that you do not want to be on a ventilator.
Do not hospitalize (DNH) order: A DNH indicates to long-term care providers, such as nursing home staff, that you prefer not to be sent to a hospital for treatment at the end of life.
Out-of-hospital DNR order: An out-of-hospital DNR alerts emergency medical personnel to your wishes regarding measures to restore your heartbeat or breathing if you are not in a hospital.
Physician orders for life-sustaining treatment (POLST) and medical orders for life-sustaining treatment (MOLST) forms:These forms provide guidance about your medical care that health care professionals can act on immediately in an emergency. They serve as a medical order in addition to your advance directive. Typically, you create a POLST or MOLST when you are near the end of life or critically ill and understand the specific decisions that might need to be made on your behalf. These forms may also be called portable medical orders or physician orders for scope of treatment (POST). Check with your state department of health to find out if these forms are available where you live.
At enrollment, Medicare in the future could offer three advancedirectives with goals of care: DirectiveA: CONSENT to treat — inpatient medical treatment DirectiveB: CONSENT to comfort — home bound holistic care DirectiveC: CHOOSE against medical advice — outpatient palliative resources.
Posted on April 15, 2023 by Dr. David Edward Marcinko MBA MEd CMP™
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