BOARD CERTIFICATION EXAM STUDY GUIDES Lower Extremity Trauma
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Posted on July 11, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
A Very Brief Review
By Dr. Mark Matthews with Dr. David Marcinko MBA
As most medical and healthcare executives and consultants are aware, there are a few tools and techniques that are unique to the world of Lean process improvement and management.
These include: Kaizen Events, The 5-S Technique, Standard Work, Visual Controls and Human Factors Engineering.
We will review the first two techniques in this ME-P. Of course, the last three are reviewed in much greater detail in our new book complete with checklists, figures, tables, drawings, graphs and other illustrations.
Kaizen Events
Kaizen is one of the most powerful tools in the Lean methodology. These events involve intense work sessions aimed at making concrete decisions in a short time period without the need for much data collection. Kaizen events are fairly narrow in scope, ideally concentrating on making one or two decisions at the most.
For example, there may be competing improvement ideas that require more exploration. Using a Kaizen event can provide the necessary structure to make the decision needed to move forward with implementation. The steps in a typical Kaizen Event often include:
Determine and define the objectives
Determine the current state of the process
Determine the requirements of the process
Create a plan for implementation
Implement the improvements
Check the effectiveness of the improvements
Document and standardize the improved process
Continue the cycle
The 5-S Technique
This technique was developed to allow employees to visually control their work area around visual management techniques. The principles involved in visual management include:
Improving workspace efficiency and productivity
Helping people share workstations by providing standard layouts
Reducing the time required to look for needed supplies or tools
Improving the work environment
Each “S” in 5S stands for a step in the process:
Sort – classify every item in the designated area as either needed or not needed
Set (Straighten) – put “everything in its place”
Shine (Sweep) – clean all work environments for order and organization
Standardize – document what goes where, who will clean and who will inspect and on what schedule
Sustain-design a system for monitoring process, providing feedback, and rewarding good outcomes
Assessment
Prior to conducting a 5S event, a significant amount of planning is vital. It is important to scope the target area as something that is manageable, draw a physical map of the area under consideration [hospital, ED, OR, clinic, office, etc], and assemble a list of current items in that area. This is usually accomplished by taking photographs (both before and after) of the area.
Conclusion
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Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, urls and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.
Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com
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Posted on June 28, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Writers
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Venture capitalists who are in a rut should stop talking about how hard it is to raise a $100 million fund. Instead, raise a $5 million fund.
Rather, they should stop trying to invest $5 million at a time (with an 18-month window before going public). A better strategy is to start doing smaller investments with longer time horizons.
Posted on June 17, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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Dr. Anthony Fauci, the leader of the U.S. government’s Covid pandemic response effort tested positive for the coronavirus. Fauci, who is fully vaccinated against Covid, is experiencing mild symptoms. “Dr. Fauci will isolate and continue to work from home,” a statement said. “He has not recently been in close contact with President [Joe] Biden or other senior government officials.”
The yen fell after Japan’s central bank kept its ultra-low interest rates on hold even as policy makers around the world hike cost of borrowing to tackle rising prices. The Bank of Japan (BOJ) also says it will continue its program of buying huge amounts of government bonds. This week central banks in the US, UK and Switzerland raised interest rates as they try to curb inflation. After the announcement, the US dollar climbed to 134.64 yen, not far from the 24-year peak of 135.6 earlier this week. So far this year the dollar has climbed by 15% against the yen, as the gap between interest rates in Japan and much of the rest of the world continues to grow.
Markets: Stocks took a big tumble over recession concerns, and blue-chip companies such as Home Depot, Intel, Walgreens, and JPMorgan touched 52-week lows.
Global economy: European central banks including the Bank of England, the Swiss National Bank, and the National Bank of Hungary increased interest rates yesterday to tame inflation.
Posted on June 9, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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Global venture capital investment was a healthy $39 billion in May, according to Crunchbase. But, the figure declined for the second month in a row, reaching the lowest point since December 2020. In monthly terms, VC investments declined by nearly 16%. In yearly terms, it fell by 20%.
Nobel laureate and economist Robert Shiller said the US has a good chance of entering a recession. He told Bloomberg the odds of a recession in the next few years are 50%, which is “much higher than normal.” Shiller predicted in 2005 that the housing bubble would burst and also warned a new one may be forming. And, Ray Dalio said the FMOC will cut interest rates to combat stagflation in a recent Market Insider interview. “We are in a tighttening mode … the pain of that will become great.”
Additionally, former EY Global Chairman and CEO Mark Weinberger warned that inflation will not go down in the near future, causing the economy to “turn for the worse.”
Gemini, a crypto exchange and custodian founded by Cameron and Tyler Winklevoss faced a loss in February in the form of a $36 million breach. And now the company is being sued over its alleged failure to protect its customers.
The Stock Markets have been a bit dull recently. The S&P 500 has been directionless trading within a roughly 100-point range for the past two weeks. The only energy in the market seems to belong to Exxon Mobil which notched a record close; first since 2014.
Posted on May 20, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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ArkInvestment Management’s Cathie Wood says “exploding” inventories at major retailers like Walmart Inc. and Target Corp. paired with declining US consumer sentiment portend slower inflation on the horizon. The money manager was responding on Thursday to a tweet quoting world’s richest man Elon Musk saying the recent inflation surge was due to government pandemic stimulus, even as money velocity held constant.
Home sales slowed for the third consecutive month in April as mortgage rates surged, driving up borrowing costs for would-be buyers as home prices soared to new highs. Existing home sales fell 2.4% last month from March to a seasonally adjusted annual rate of 5.61 million, the National Association of Realtors said Thursday.
And, in April, the median U.S.rent hit a record high for the 14th month in a row of $1,827, according to Realtor.com, a residential real estate information service. “If recent trends continue, we expect the typical U.S. asking rent to eclipse $2,000 by August,” it said. April rent increased 16.7% from a year earlier. That’s the third straight month in which year-over-year rent growth has dipped, down from 17.1% in January. Higher rents are taking money away from renters’ budgets for regular expenses and savings, Realtor.com said. Rent represents the biggest strain on renters’ overall finances, according to a Realtor.com survey.
Incidentally, a number of American corporate giants, including Walmart, Target, Bank of America, Charles Schwab, and Intel, hit 52-week lows yesterday.
Posted on May 19, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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Target Corp. is on pace for its worst stock drop since 1987’s Black Monday crash after becoming the second big retailer in two days to trim its profit forecast. A surge in costs during the first quarter shows little sign of easing, said Chief Executive Officer Brian Cornell. Operating profit will amount to only about 6% of sales this year, 2 percentage points below the previous forecast, Target said Wednesday. And the company’s first-quarter adjusted profit missed the lowest of 23 analyst estimates compiled by Bloomberg.
Netflix continues to hemorrhage subscribers, as the streaming service laid off 150 more employees representing 2% of its workforce. In a statement, a company rep clarified “the changes are primarily driven by business needs rather than individual performance.”
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And, socks plunged as deepening concern about the economic impact of high inflation and rising interest rates drove the Dow Jones Industrial Average to its worst day since March 2020.
The Dow closed with a loss of 1,161 points, dropping 3.6 percent Wednesday for its steepest one-day drop since the onset of the coronavirus pandemic. The S&P 500 closed 4 percent lower and the NASDAQ closed 4.7 percent lower Wednesday.
A failure by the CBOE Volatility Index [VIX] sometimes referred to as Wall Street’s fear gauge, to push above the mid-30 range was seen as one sign that investors hadn’t made the sort of “capitulation” that often clears the way for a sustained rebound. However, some positive market internals on the upside during Friday’s and Tuesday’s bounce have some analysts looking for some near-term upside, which could continue to confound market bears.
More Americans were considered “equity rich” in the first quarter of 2022 — meaning that they owed no more than 50% of their home’s total value — amid a rise in home prices, according to new data from ATTOM Data Solutions. The number of equity-rich homeowners grew to 44.9% of mortgage holders in the first quarter, up from 41.9% in the fourth quarter of 2021 and 31.9% in the first quarter of 2021, according to the company’s first-quarter 2022 U.S. Home Equity and Underwater Report.
Finally, Litecoin (LTC-USD) is getting ready for its newest upgrade on Thursday, May 19th. The MimbleWimble (MWEB) upgrade will turn the Litecoin crypto into a more fungible, private currency. Privacy coins like Monero (XMR-USD) and Zcash (ZEC-USD) have been hot investments in recent weeks
Posted on May 10, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
Altered and Poorly Written Rx for Vicodin
By Dr. David Edward Marcinko MBA
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Poorly-written Rx for vicodin
Drug: Rx Vicodin
Disp: # 10
Sig: Take I, as needed for pain.
Refills: 1 2 3 4 or 5
AM2685591
David Edward Marcinko, MBBS DPMMBA
The patient abuser may change drug quantity numbers, copy or remember the doctors’ DEA number, or take extra Rx pads. For this reason, a physician’s Rx pad should contain his/her name, address and telephone number. The doctor’s DEA number should not be pre-printed on the pad, for fear of mis-use.
Example:
Increase the quantity 10, to 100, by adding a zero, so that the additional capsules can be used, sold or bartered with on the street.
Change the directions to take 2 capsules, rather than 1 in order to produce greater euphoria.
Increase the Rx refills, from one to two, by extending the underline, or checking an additional quantity box.
Pre-printed DEA number can be stolen, sold or reused.
Pre-printed (not original) physician signature can be reproduced and widely distributed for more prescriptions.
Altered Rx for vicodin
Drug: Rx Vicodin
Disp: # 100
Sig: Take II, as needed for pain.
Refills: 1 2 3 4 or 5
AM2675591
David Edward Marcinko, MDBBS DPM MBA
The doctor drug addict, or a doc in need of funds, may write for more narcotic agent than needed, and receive the additional pills back from the patient-shill for personal consumption, sell them on the street himself for money, or receive a monetary kickback from the patient-shill.
A pharmacist may also indirectly alter a prescription using the above methods, or simply short-change the patient with fewer narcotic capsules than the prescription intends. This is more difficult to do with pills or tablets in the out patient setting, but easy to do in the in-patient setting when liquid IV drugs are used, by dilution and placing less than the full amount in IV bottles or bags. The harm to patients, of course, may be fatal.
Well-written Rx for vicodin
Drug: Rx Vicodin
Disp: # 10 (ten) capsules
Sig: Take one or two capsules, po, prn pain.
Refills: 1 2 3 4 or 5
AM2685591
David Edward Marcinko, MBBS DPM MBA
Example:
Drug quantity can-not be changed.
Directions can-not be changed. Route of administration (by mouth) indicated.
Rx refills clearly indicated.
Handwritten, not pre-printed, DEA number.
Original physician signature, only.
Doctor Rx prescription abuse foibles are legendary in the DEA and include a Maryland podiatrist who wrote prescriptions for more than 1,235 Mepergan Fortis capsules ostensibly for his wife following minor foot surgery. Or, the Florida physician who prescribed more than 2,150 Vicodin capsules for a patient with whom he was having an extra-marital affair in order that his consort not disclose the fling to his wife. Or, the osteopath from New Jersey who wrote more than 100 narcotic prescriptions every 8 hour day, for more than a year, to any patient standing in a line in front of his office. And, finally the California dentist whose excuse for writing more than 1,845 narcotic tablet prescriptions in a six month period for the same patient was that they would be needed in his next reincarnation. Yes, all of these incidents are laughable if not for their serious consequences to the involved individuals, and society, alike. The bastards!
Fortunately, unlike drug local domestic drug kingpins or international narco-traffickers who ply their trade virtually undetected, these naive white-collared nerds, always get caught by the Drug Enforcement Agency. Their Rx abuse tactics are so amateurish!
Posted on May 9, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
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By Dr. David Edwarrd Marcinko MBA
Rx DRUG ABUSE
Traditional medicinal agents come in a variety of ways, known as dispensing vehicles. Drugs may be in liquid, pill or inject able form, they may be compounded in capsules, caplets, gelatin tablets, powders or suppositories, or they may come in creams or ointments for the eye, anus and vagina. They may be ingested into the stomach, placed and dissolved under the tongue, put into the eyes, popped, injected or smeared and transported through the human skin from patches.
A valid drug prescription is a written order, by a doctor, to a pharmacist. In this country, prescriptions are written by physicians, podiatrists, osteopaths, dentists. and some optometrists, physician assistants and nurse practitioners. In addition to the name of the patient and that of the medical prescriber, the prescription contains the name of the drug (not necessarily a narcotic), its quantity, instructions to the pharmacist, and directions to the patient. Narcotic prescriptions may not be prescribed to a drug addict to prevent withdrawal symptoms, as there must be some other therapeutic purpose for such an order.
The art of medicinal prescription writing, and pharmaceutical compounding, has declined in modern medicine for several reasons. Most drugs are made by pharmaceutical companies, and the role of the pharmacist, in most cases, consists only of compounding and error prevention. Many drugs are even automatically dispensed, and tracked, in the hospital setting with bar coding technology and modern inventory tracking mechanisms. Also, the practice of writing long and complicated prescriptions, containing many active ingredients, adjuvants, correctives, and elegant vehicles, has been abandoned in favor of using pure compounds.
Drugs may be prescribed by their official names, which were first given by the United States Pharmacopeia (USP), in 1920, or by the National Formulary (NF), since 1906. Unofficial or generic names may be used, known as New and Non-Official Drugs (NND) or by the United States Adopted Names (USAN), or by the manufactures trade name. For example, the generic narcotic meperidine or pithidine, is also known by the trade named, demerol. The designation USAN does not imply endorsement by the American Medical Association (AMA) Council on Drugs (CODs), or by the USP.
Of course, there is an advantage and disadvantages to prescribing drugs by their trade name, or generic names. Advantages of generics include economies of scale for both the patient and pharmacist, and although the active ingredient in generics are identical to trade drugs, they are often less expensive since research and development costs are absent, and various binders, colorizing agents, preservatives or dispersing agents are of an inferior quality, and hence cheaper for the patient. Appearance, size and taste issues are common. For the pharmacist, generics are cheaper since a multiplicity of very similar drugs need not be shelved.
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For example, the tablet or capsular form of many drugs contains inactive ingredients, such as: ammonio methacrylate copolymer, hydroxypropyl methylcellulose, lactose, magnesium stearate, povidone, redironoxide, stearyl alcohol, talc, titanium dioxide, triacetin, yellowironoxide, yellowironoxide with FD&C blue No.2 (80 mgstrengthtablet only), FD&C blue No.2 and other ingredients. And yes, I’ve seen an addict do into shock, or die from acute anaphylaxis, after taking drugs containing ingredient he was highly allergic to.
Shock is a life-threatening condition where blood pressure falls too low to sustain life. It occurs when low blood volume (due to severe bleeding, excessive fluid loss or inadequate fluid uptake), inadequate pumping action of the heart or excessive dilation of the blood vessel walls (vasodilation) causes low blood pressure. This in turn results in inadequate blood supply to body cells, which can quickly die or be irreversibly damaged.
Anaphylactic shock is the severest form of allergy that is a medical emergency. It is a Type I reaction according to the Gell and Coombs medical classification, and is often severe and sometimes fatal systemic reaction in a susceptible individual upon exposure to a specific antigen (such as wasp venom or penicillin) following previous sensitization, or drug use. Characterized especially by respiratory symptoms, fainting, itching, itching and swelling of the throat or other mucous membranes and a sudden decline in blood pressure! The victim literally cannot breathe and drowns in its own congested and fluid filled lungs
So, patients in need of routine drugs for acute or chronic conditions like arthritis, high blood pressure, asthma, acne, hay fever, performance enhancing steroids or, so called life style drugs, like Viagra for a limp woody, or hair growth stimulator Rogaine, may get a good deal by going to Canada or Mexico for generics. But for important drugs, like nitroglycerine fro your heart, blood thinner coumadin, birth control pills or various anti-cancer agents, stick with brand names.
The main disadvantage of trade drugs is increased cost, due to R & D, patents, trademarks, marketing and company advertising expenses. Of course, trade drug are first to market, and hence may be beneficial as a new treatment modality, or injurious if significant side affects or other complications arise.
Today, the prime source for drug information is probably the well known, Physicians Desk Reference (PDR). Now, in its 58th edition, the PDR® provides the latest information on prescription, but not illegal street drugs. It is considered the standard reference that can be found in virtually every physician’s office, hospital and pharmacy in the United States. The current edition is over 3,000 pages long, and is where you can find data on more than 4,000 drugs, by brand and generic name, manufacturer and product categories. The PDR also provides usage information and warnings, drug interactions, plus full-size, full-color photos cross-referenced to specific drugs. For the layman, it also includes: phonetic spelling for each listing, a key to controlled substances, adverse reactions and contraindications, pregnancy ratings, dosages and all other FDA-required information. Of course, on the street, or in Mexico, none of this information matters.
Latin abbreviations, sometimes still used by doctors on prescription blanks include:
Rx = take thou (receipe)
po = by mouth (para orbis)
prn = as needed (pro re’nata)
hs = at bed time (hora somnae)
BID = twice daily
TID = three times daily
QID = four times daily
M = Mix
Traditionally, a medical prescription is written in a certain order, well known to drug abusers, and DEA agents, and consist of six basic parts:
Superscription: This is the Rx, or recipe. In Latin it means take thou.
Inscription: Represents the ingredients and amounts.
Subscription: Represent the description for drug dispensing, and may be represented by the letter M, for mix.
Signature: Often abbreviated as Sig, and contains the directions for patient use.
Refill Status: Indicates the number of refills allowed.
DEA Number: This is nine-character alpha-numeric sequence, used by all licensed physicians who prescribe narcotic agents. An example is AM2685591. The second letter is the first letter of the doctor’s last name, (ie, Marcinko) and the first two digits add up to the third (ie, 2+6=8).
Finally, in addition to the basic parts of a prescription, it should have the patient’s name, and physician signature written in ink, followed by degree designation, such as MD, DPM, DO or DDS, etc.
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Perhaps the most egregious narcotic prescribing habits recently encountered by DEA agents have been by doctors of all degrees and medical designations. Reasons are generally two-fold. First, the doctor may become a drug addict himself, either by accident or through initial legitimate therapeutic use, and over-prescribe the narcotics. Or, increasing office costs, and decreased reimbursement fee reductions of many managed medical care have so economically destabilized the medical community, that economically impoverished doctors desperately sell prescriptions to finance their personal lifestyles, automobiles, clothes, fancy vacations or own addictions.
For example, a staggering medical student loan debt burden of $100,000-$250,000 is not unusual for new practitioners. In fact, the federal Health Education Assistance Loan (HEAL) program reported that for the Year 2001, it squeezed significant repayment settlements from its Top 5 list of deadbeat doctor debtors. This included a $303,000 settlement from a New York dentist, $186,000 from a Florida osteopath, $158,000 from a New Jersey podiatrist, $128,000 from a Virginia podiatrist, and $120 from a Virginia dentist. The agency also excluded 303 practitioners from Medicare, Medicaid and other federal healthcare programs and had their cases referred for non-payment of debt.
These facts indicate that the current healthcare reimbursement climate has caused more pain and tumult to doctors than the pubic realizes. Older medical practitioners are retiring prematurely, mature providers are frustrated and in despair, and young physicians have no concept of the economic servitude to which they are about to be subjected. Frustration is high and physician suicides have been documented. Many doctors get divorced at the start of their careers. Even the U.S. Inspector General has declared healthcare providers to be public enemy #2,behind international narco-traffickers, for their federal drug, fraud and abuse initiatives. Still, the statistic above lends itself to narcotic drug prescription abuse, either on the part of the doctor or patient, since only these two parties that can directly alter a prescription for illicit drug use, as illustrated by this poorly written prescription for a narcotic pain killer, vicodin.
During this period, the standard deviation of quarterly real gross domestic product (GDP) declined by half and the standard deviation of inflation declined by two-thirds, according to figures reported by former U.S. Federal Reserve Chair Ben Bernanke. The Great Moderation can be summed up as a multi-decade period of low inflation and positive economic growth.
But, what about health economics, writ large? And, the actual practice of medicine by physicians in the trenches. Consider this historical review.
GOLDEN AGE OF MEDICINE
The ‘golden age of medicine’ – the first half of the 20th century, reaching its zenith with Jonas Salk’s 1955 polio vaccine – was a time of profound advances in surgical techniques, immunization, drug discovery, and the control of infectious disease; however, when the burden of disease shifted to lifestyle-driven, chronic, non-communicable diseases, the golden era slipped away. Although modifiable lifestyle practices now account for some 80% of premature mortality, medicine remains loathe to embrace lifestyle interventions as medicine Here, we argue that a 21st century golden age of medicine can be realized; the path to this era requires a transformation of medical school recruitment and training in ways that prioritize a broad view of lifestyle medicine. Moving beyond the basic principles of modifiable lifestyle practices as therapeutic interventions, each person/community should be viewed as a biological manifestation of accumulated experiences (and choices) made within the dynamic social, political, economic and cultural ecosystems that comprise their total life history. This requires an understanding that powerful forces operate within these ecosystems; marketing and neoliberal forces push an exclusive ‘personal responsibility’ view of health – blaming the individual, and deflecting from the large-scale influences that maintain health inequalities and threaten planetary health. The latter term denotes the interconnections between the sustainable vitality of person and place at all scales. We emphasize that barriers to planetary health and the clinical application of lifestyle medicine – including authoritarianism and social dominance orientation – are maintaining an unhealthy status quo.
To listen to all those desperate to reform health care, you get the impression that physicians are pretty horrible people. We are all sexist, greedy, money grubbing tyrants who will perform unnecessary tests and procedures just to make money. We don’t care about quality or cost. We are killing off 250,000 patients every year with our ignored “errors.”
We purposely keep our patients in pain, or we addict them to narcotics just to shut them up. We are constantly told by lawyers that lawsuits are necessary to protect patients from doctors. We provide unsafe drugs just because the drug reps give us free pens and coffee cups. The government must step in to clean up the mess.
On April 5, 2022, the Internal Revenue Service (IRS) proposed a rule change to its eligibility requirements for families to receive premium tax credits toward purchasing high-quality health coverage on the insurance marketplaces established by the Patient Protection and Affordable Care Act (ACA). This proposed change comes on the heels of two Biden Administration executive orders calling for improvements to the ACA and Medicaid. This Health Capital Topics article will discuss the proposed solution to a decade-long problem and how it will affect millions of Americans. (Read more…)
Posted on April 28, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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Markets: The NASDAQ stayed flat at its lowest level this year.Spotify shares sank to a record low. Facebook is having a rough go, but it’s not the only one. Netflix stock plunged nearly 70% this year after hitting a ceiling on subscriber growth. At one point, it was worth more than Disney; now, it’s not even half as valuable. Even Google is googling “ways to make more money.” Its parent company, Alphabet, reported a slowdown in growth last quarter because, like Facebook, YouTube’s also being been dinged by TikTok and Apple’s privacy changes: The video platform’s revenue came in more than $500 million below expectations.
Energy: Russia’s halted oil shipments to Poland and Bulgaria yesterday.
Posted on April 22, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
April 22nd, 2022
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By Dr. David Edward Marcinko MBA
Founding Editor-in-Chief
Go Green!
At this Medical Executive-Post, we are trying to go GREEN! Our green mindset permeates brightly whenever we conduct business. However, green is more than just a color, it’s a way of working and living that honors our environment and helps preserve it for future generations. And so, below is a list of our environment-friendly green initiatives.
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Initiatives
We have the ability to remotely monitor our phone and internet systems. Not only is this a cost savings for our colleagues, members, visitors, customers and us, it reduces fuel usage by keeping third-party vendor delivery service fleets off the road.
Inbound technicians have an 85% first-call resolution rate. Our folks ask the right questions and take the time to solve issues without scheduling an in-person or vendor service call.
We telephone re-use jacks and cables, when possible.
We recycle all paper, plastic and glass in our office.
We use an eFax service, cutting down on paper usage.
We have a paperless billing system.
We have a virtual library of “how to” resources for all of our ME-P products and services.
We sent our old phone systems to a re-cycler who uses the parts for plastic.
Posted on April 17, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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Russia: Shut its stock market all week in a bid to curb panic-selling after the invasion of Ukraine. The ruble cratered to trade below 1 cent as Western sanctions effectively weaponized the financial system.
Posted on April 14, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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DEFINITION: A rate of return (RoR) is the net gain or loss of an investment over a specified time period, expressed as a percentage of the investment’s initial cost. When calculating the rate of return, you are determining the percentage change from the beginning of the period until the end.
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And so, according to Greg McBride CFA, before you invest your money, you’re likely wondering how much you’re going to earn. This is known as the rate of return. The rate of return is expressed as a percentage of the total amount you invested. If you invest $1,000 and get back your original investment plus an additional $100 in interest, you’ve earned a 10 percent return.
However, numbers don’t always tell the full story. You’ll also need to think about how long you plan to keep the money invested, how your investment options have performed historically and how inflation will impact your bottom line.
Key return on investment statistics
When you’re trying to get the best return on your investment, you’ll likely start combing through loads of data. A good place to start is looking at the past decade of returns on some of the most common investments:
As our private iMBA Inc clients, ME-P subscribers, textbook and dictionary purchasers, seminar attendees and most ME-P readers know, Ken Arrow is my favorite economist. Why?
About Kenneth J. Arrow, PhD
Well, in 1972, Nobel Laureate Kenneth J. Arrow, PhD shocked Academe’ by identifying health economics as a separate and distinct field. Yet, the seemingly disparate insurance, asset allocation, econometric, statistical and portfolio management principles that he studied have been transparent to most financial professionals and wealth management advisors for years; at least until now.
Nevertheless, to informed cognoscenti, they served as predecessors to the modern healthcare advisory era. In 2004, Arrow was selected as one of eight recipients of the National Medal of Science for his innovative views. And, we envisioned the ME-P at that time to present these increasingly integrated topics to our audience.
Healthcare Economics Today
Today – as 2022 passes – savvy medical professionals, management consultants and financial advisors are realizing that the healthcare industrial complex is in flux; along with the Russian war, domestic inflation and this dynamic may be reflected in the overall flagging economy.
Like many laymen seeking employment, for example, physicians are frantically searching for new ways to improve office revenues and grow personal assets, because of the economic dislocation that is Managed Care, Medi Care and Obama Care [ACA], the depressed business cycle, etc.
Moreover, the largest transfer of wealth in US history is – or was – taking place as our lay elders and mature doctors sell their practices or inherit parents’ estates. Increasingly, the artificial academic boundary between the traditional domestic economy, financial planning and contemporaneous medical practice management is blurring.
I’m Not a Cassandra
Yet, I am no gloom and doom Cassandra like I have been accused, of late. I am not cut from the same cloth as a Jason Zweig, Jeremy Grantham or Nouriel Roubini PhD, for example.
However, I do subscribe to the philosophy of Hope for the Best – Plan for the Worst.
And so dear colleagues, I ask you, “Are the latest swings in the economic, healthcare and financial headlines making you wonder when it will ever stop?”
The short answer is: “It will never stop” because what’s been happening isn’t any “new normal”; it’s just the old normal playing out before a new audience; sans the war.
What audience?
The next-generation of investors, FAs, management consultants and the medical professionals of Health 2.0.
How do I know all this?
History tells me so! Just read this work, and opine otherwise, or reach a different conclusion.
Evidence from the American Financial Scene, circa 1861-1935
The work was created by L. Merle Hostetler in 1936, while he was at Cleveland College of Western Reserve University (now known as Case Western Reserve University). I learned of him while in B-School, back in the day.
At some point after it was printed, he added the years 1936-1938. Mr. Hostetler became a Financial Economist at the Federal Reserve Bank of Cleveland in 1943. In 1953 he was made Director of Research. He resigned from the Bank in 1962 to work for Union Commerce Bank in Cleveland. He died in 1990.
The volume appears to be self published and consists of a chart, approximately 85′ long, fan-folded into 40 pages with additional years attached to the last page. It also includes a “topical index” to the chart and some questions of technical interest which can be answered by the chart.
And so, as with Sir John Templeton’s [whose son is an MD] four most dangerous words in investing (It’s different this time), Hostetler effectively illustrates that it wasn’t so different in his era, and maybe—just maybe—it isn’t so different today for all these conjoined fields.
Conclusion
Your thoughts and comments on this ME-P are appreciated. While not exactly a “sacred cow,” there is a current theory that investors will experience higher volatility and lower global returns for the foreseeable future.
In fact, it has gained widespread acceptance, from the above noted Cassandra’s and others, as problems in Europe persist and threats of a double-dip recession loom. But, how true is this notion; really?
Is Hostetler correct, or not; and why?
Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.
Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com
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Posted on March 8, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
BY JONATHAN MASER.N.
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Being an entrepreneur is not necessarily easy, and many people that try to become entrepreneurs wind up failing. It’s important to recognize the risk of failure before you decide to walk down this path. Being an entrepreneur is very rewarding, and you can find success if you can do things right.
Keep reading to learn about common entrepreneurial mistakes that you can avoid to give yourself a better chance of realizing your entrepreneurial goals.
Posted on March 4, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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Stocks fell and oil prices eased back after another bumpy day of trading on Wall Street as markets remained anxious about the broader impact of Russia’s invasion of Ukraine.
Okta shares were down 8.06% while Snowflake plummeted 15.37%.
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INTEL: Intel stock (NASDAQ: INTC) fell 2.5% after Morgan Stanley and Bank of America Securities cut their targets to $47, according to StreetInsider. The stock fell to a low of $47.62, not far from its 52-week low of $43.63. Morgan Stanley (NYSE:MS) analyst Joseph Moore also downgraded the stock to underweight from equal weight while BofA’s Vivek Arya maintained his under perform rating.
INDEXES: Major indexes veered up and down for much of the day before a late-day slide pushed them into the red. The S&P 500 shed a 0.7% gain to close 0.5% lower, while the Dow Jones Industrial Average fell 0.3%. The NASDAQ composite fell 1.6%, weighed down by technology stocks, which accounted for a big share of the market’s decline.
The Dow is down 0.9% for the week, on track for its fourth negative week in a row. The S&P 500 is down about 0.5% for the week, while the NASDAQ Composite is down more than 1%.
BUYBACKS: In the third quarter of 2021, Apple, Inc. (NASDAQ: AAPL) led all S&P 500 companies with $20.4 billion in buybacks. Alphabet, Inc. (NASDAQ: GOOG) (NASDAQ: GOOGL) was a distant second with $15 billion in buybacks, followed by Meta Platforms Inc (NASDAQ: FB) with $12.6 billion.
Over the last decade, no company has come close to Apple in the buyback department. Apple has bought back $487.6 billion in stock since 2012. Microsoft Corporation (NASDAQ: MSFT) is a very distant second with $147.1 billion in buybacks, followed by JPMorgan Chase & Co (NYSE: JPM) with $146.2 billion.
Why Buybacks Matter: It should come as no surprise to investors that all three of the stocks that have been most aggressive in buying back shares over the last 10 years have outperformed the SPDR S&P 500 ETF (NYSE: SPY) total return by a wide margin in that period.
BONDS: Bond yields were mostly steady. The yield on the 10-year Treasury slipped to 1.85% from 1.86% late Wednesday.
When trying to decide whether to buy a used car or a new one, it’s typically financially wiser to buy used. But if you want to buy new, you should plan to drive the car for 10 years or more.
Better yet – do not buy a new vehicle.
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The 20/4/10 rule for buying a vehicle
If you have to borrow when buying a car, to avoid spending more than you can afford you should put down at least 20%, keep the loan limited to no more than four years (to avoid interest), and spend no more than 10% of your gross income on transportation costs (which includes the car payment, parking, gas, and insurance).
Book Dr. David E. Marcinko MBA MBBSfor your Next Medical, Pharma or Financial Services Seminar orPersonal and Corporate Coaching Sessions
Dr. Marcinko enjoys personal coaching and public speaking and gives as many talks each year as possible, at a variety of medical society and financial services conferences around the country and world.
These include lectures and visiting professorships at major academic centers, keynote lectures for hospitals, economic seminars and health systems, endnote lectures at city and statewide financial coalitions, and annual engagements for a variety of internal and external yearly meetings.
After an understandable slowdown in 2020, due to the onset of the COVID-19 pandemic, merger & acquisition (M&A) activity in the healthcare industry accelerated in 2021, and the industry is expected to continue the high number of deals and high deal volume in 2022.
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This Health Capital Topics article will review the U.S. healthcare industry’s M&A activity in 2021, and discuss what these trends may mean for 2022. (Read more…)
Posted on February 24, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
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By Staff Reporters
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OIL: Brent crude, the world benchmark, briefly climbed above $100 a barrel for the first time since 2014. US crude jumped 3.3% to $95.15 a barrel.
U.S. stock indexes: All closed sharply lower with the DJIA narrowly avoiding a slip into correction, as U.S. officials warned that Russian troops were poised to attack, and are attacking, the Ukraine raising anxieties among investors who are also wrangling with changing monetary policy and surging inflation.
How did stock indexes trade? The Dow Jones Industrial Average fell 464.85 points, or 1.4%, to end at 33,131.76. A finish below 33,119.69 would mark a 10% decline from the Dow’s Jan. 4 record close, meeting the commonly used definition of a correction. The S&P 500 index fell 79.26 points, or 1.8%, to around 4,225.50, deepening its stumble into correction territory. The NASDAQ Composite Index declined 344.03 points, or 2.6%, at 13,037.49, with 12,845.95 representing the level that would represent a bear market for the technology-laden index.
Asia: Hong Kong’s Hang Seng Index declined 3.2%. Korea’s Kospi dropped 2.7%. Japan’s Nikkei 225 lost 2.4% after coming back from a holiday. China’s Shanghai Composite moved 0.9% lower.
Posted on February 23, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
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By Staff Reporters
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MARKETS: The S&P 500 fell into a correction for the first time in two years, joining the NASDAQ Composite, as Russia sent troops into pro-Russian regions in Ukraine. The S&P 500 index ended down 1% at 4,304.76, below the correction level at 4,316.91, which would represent a 10% drop from its January 3rd record close. A correction is commonly defined by market technicians as a fall of at least 10% (but not greater than 20%) from a recent peak. The last time the S&P 500 entered a correction was February 27th 2020, when the market was being whipsawed by fears about the outbreak of the COVID pandemic.
And, this bearish market isn’t sparing 2021 winners like Home Depot, which fell the most in nearly two years after supply-chain bottlenecks squeezed its margins. HD was the Dow’s biggest gainer last year.
IRS: According to a news release issued by the IRS, taxpayers now have the option to verify their identities during live, virtual interviews with agents. The agency stresses that no bio-metric data will be required for those interviews.
However, taxpayers once again have the option to verify their identity using ID.me’s facial recognition services. Addressing privacy concerns, the IRS says new requirements are in place to ensure that images provided will be deleted upon verification. That would apply to any new IRS accounts created and those where selfies have already been collected.
Posted on February 22, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
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By Staff Reporters
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Markets: The domestic markets were closed yesterday as stocks around the world tumbled.
Crypto: Bitcoin was trading at $36,649 at 2:30 a.m. ET, falling nearly 6.5% in the last 24 hours, according to data from CoinDesk. The world’s most valuable cryptocurrency fell below $40,000 over the weekend, and has continued to slide as the Ukraine crisis intensifies. The currency has lost almost half its value since its November high of $68,990 due to geopolitical tensions, the prospect of interest rate hikes by the US Federal Reserve and curbs by some major economies on digital assets. Bitcoin’s peers have also been faring poorly. Ethereum, the world’s second most valuable cryptocurrency, fell over 8% in the last 24 hours and was trading at $2,520.
Putin: Russian President Vladimir Putin dramatically escalated the Ukrainian conflict. He recognized two separatist regions in eastern Ukraine as independent and ordered Russian troops to enter those areas, which may provide the pretext for an invasion of other parts of the country. Western leaders condemned the move as a violation of international law and the US said it will impose sanctions on those regions.
Posted on February 16, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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MARKETS: The Dow jumped 422 points, or 1.2%. The S&P 500 surged 1.5% and the NASDAQ was 2.5% higher.
OIL: US oil futures tumbled 3.7% to just under $92 a barrel. That’s despite the fact that Russia stressed that major military exercises would continue.
CPI: The Producer Price Index rose 1% last month, marking a significant acceleration from December’s 0.2% jump.
Meta: As Varietyreports, the company has agreed to pay $90 million to settle a 2012 class action lawsuit accusing it of violating users’ privacy. Facebook allegedly overstepped its bounds in 2010 and 2011 by using tracking cookies that monitored browsing after users signed out despite promises to the contrary.
MODERNA: Moderna Inc (NASDAQ: MRNA) shares were down more than 40% since the start of the year and continues to trend lower. Vaccine stocks are facing selling pressure as the COVID-19 omicron variant fades, but Moderna investors have been expressing concerns about recent stock sales from CEO Stéphane Bancel, as well as the presumed deletion of his Twitter account.
Posted on February 6, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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It’s February – American Heart Month – a time when the nation spotlights heart disease, the No. 1 killer of Americans.
President Lyndon B. Johnson, among the millions of people in the country who’d had heart attacks, issued the first proclamation in 1964. Since then, U.S. presidents have annually declared February American Heart Month.
Throughout the month, the American Heart Association’s “Heart to Heart: Why Losing One Woman Is Too Many” campaign will raise awareness about how 1 in 3 women are diagnosed with heart disease annually.
The first Friday of American Heart Month, Feb. 5, is also National Wear Red Day as part of the AHA’s Go Red for Women initiative. Coast to coast, landmarks, news anchors and neighborhoods go red to raise awareness and support for the fight against heart disease. For more information on the event and other activities during the month, visit goredforwomen.org.
This year, the federally designated event is even more important due to the impact of the coronavirus on the public’s heart health, including potential harmful effects on the heart and vascular system, according to recent research.
Also, during the COVID-19 pandemic, many people have delayed or avoided going to hospitals for heart attacks and strokes – netting poorer outcomes and prompting the AHA to create “Don’t Die of Doubt,” a national awareness campaign that reminds people that hospitals are the safest place to go when you have symptoms.
And while in lock-down, more people have engaged in unhealthy lifestyle behaviors, such as eating poorly, drinking more alcohol and limiting physical activity, that can contribute to heart disease.
Meanwhile, heart disease continues to be the greatest health threat to Americans and is still the leading cause of death worldwide, according to the AHA’s Heart Disease and Stroke Statistics – 2021 Update.
The update, published in the association’s flagship journal Circulation, reports that nearly 18.6 million people across the globe died of cardiovascular disease in 2019, the latest year for which worldwide statistics are calculated. That’s a 17.1% increase over the past decade. And 523.2 million cases of cardiovascular disease were reported in 2019, a 26.6% increase over 2010.
During American Heart Month, the AHA and other organizations reinforce the importance of heart health, the need for more research and efforts to ensure that millions of people live longer and healthier.
In most cases, heart disease is preventable when people adopt a healthy lifestyle, which includes not smoking, maintaining a healthy weight, controlling blood sugar and cholesterol, treating high blood pressure, getting at least 150 minutes of moderate-intensity physical activity a week and getting regular checkups.
Posted on February 4, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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A recent Johns Hopkins analysis of 676 U.S. health systems found that these 4 health systems contributed to healthcare overuse the most:
• St. Dominic Health Services in Jackson, Mississippi • USMD Health System in Irving, Texas • Community Medical Centers in Clovis, California • Care New England Health System in Providence, Rhode Island
Posted on January 31, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
By Ann Miller RN MHACMP®
Executive Director
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ME-P Free Advertising Consultation
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Posted on January 26, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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Maestro Health: Top 5 Ranked Risk Areas
Maestro Health surveyed 600 U.S.-based HR professionals. Survey respondents anticipate their company’s medical costs will increase. The top areas at risk are:
• Decreases in annual physicals/screenings: 62% • Increased pharmaceutical costs: 49% • Unvaccinated employees: 47% • More elective surgeries: 46% • Increased urgent care costs: 45%
The business cycle is also known as the economic cycle and reflects the expansion or contraction in economic activity. Understanding the business cycle and the indicators used to determine its phases may influence investment or economic business decisions and financial or medical planning expectations. Although often depicted as the regular rising and falling of an episodic curve, the business cycle is very irregular in terms of amplitude and duration.
Moreover, many elements move together during the cycle and individual elements seldom carry enough momentum to cause the cycle to move. However, elements may have a domino effect on one another, and this is ultimately drives the cycle. We can also have a large positive cycle, coincident with a smaller but still negative cycle, as seen in the current healthcare climate of today.
First Phase: Trough to Recovery (production driven)
Scenario: A depressed GNP leads to declining industrial production and capacity utilization. Decreased workloads result in improved labor productivity and reduced labor (unit) costs until actual producer (wholesale) prices decline.
Second Phase: Recovery to Expansion (consumer driven)
Scenario: CPI declines (due to reduced wholesale prices) and consumer real income rises, improving consumer sentiment and actual demand for consumer goods.
Third Phase: Expansion to Peak (production driven)
Scenario: GNP rises leading to increased industrial production and capacity utilization. But, labor productivity declines and unit labor costs and producer (wholesale) prices rise.
Fourth Phase: Peak to Contraction (consumer driven)
Scenario: CPI rises making consumer real income and sentiment erode until consumer demand, and ultimately purchases, shrink dramatically. Recessions may occur and economists have an alphabet used to describe them.
For example, with a V, the drop and recovery is quick. For U, the economy moves up more sluggishly from the bottom. A W is what you would expect: repeated recoveries and declines. An L shaper recession describes a prolonged dry economic spell or even depression.
NOTE: Historically, contractions have had a shorter duration than expansions.
Bull and Bear Markets for Medical Professionals
A bull market is generally one of rising stock prices, while a bear market is the opposite. There are usually two bulls for every one bear market over the long term.
More specifically, a bear market is defined as a drop of twenty percent or more in a market index from its high, and can vary in duration and severity. While a bull market has no such threshold requirement to exist, other than they exist between these two periods of sharp decline.
Whither the Bear?
As a doctor, your action plan in a bear market depends on many variables, with perhaps your age being the most important:
In your 30s:
Pay off debts, school or practice loans.
Invest in safe money market mutual funds, cash or CDs.
Start retirement plan or 401-K account.
In your 40s:
Increase your pension plan or 401-K contributions.
Stay weighted more toward equity investments.
Review your goals, risk tolerance and portfolio.
In your 50s:
Position assets for ready cash instruments.
Diversify into stock, bonds and cash.
Retirement:
Maintain 3 years of ready cash living expenses.
Reduce, but still maintain your exposure to equities.
ASSESSMENT: So, where are we right now in the economic business cycle? Your thoughts are appreciated.
Whether you do contract work or have your own small business, tax deductions for the self-employed physician consultant and/or medical executive or nurse consultant, etc., can add up to substantial tax savings.
With self-employment comes freedom, responsibility, and a lot of expense. While most self-employed people celebrate the first two, they cringe at the latter, especially at tax time. They might not be aware of some of the tax write-offs to which they are entitled.
When it comes time to file your returns, don’t hesitate to claim the benefits you get for being the boss. As a self-employed success story, you’ve earned them.
FORM 1099NEC: Form 1099 NEC is one of several IRS tax forms used in the United States to prepare and file an information return to report various types of income other than wages, salaries, and tips. The term information return is used in contrast to the term tax return although the latter term is sometimes used colloquially to describe both kinds of returns.
“Many times an overlooked deduction is educational expenses. If one is taking courses or buying research material to be more effective in their work, this can be deductible.”
Individual Retirement Plans (IRAs)
One of the best tax write-offs for the self-employed physician consultant is a retirement plan. A person with no employees can set up an individual 401 (k). “You can contribute $19,500 in 2021 as a 401(k) deferral, plus 25 percent of net income.”
If you have employees, consider a SIMPLE (Savings Incentive Match Plan for Employees) IRA—an IRA-based plan that gives small employers a simplified method to make contributions to their employees’ retirement. As of 2021, an employee may defer up to $13,500 and employees over 50 may contribute an additional $3,000.
“A third retirement plan is Simplified Employee Pension IRA (SEP IRA).” The employer may contribute the lesser of 25 percent of income or $58,000 in 2021. If the employer has eligible employees, an equal percentage of their income must be contributed.
Recall that retirement plans are “absolutely the No. 1 tax deduction. The government is helping fund retirement.”
Business use of home or dwelling
Now, most self-employed taxpayers’ businesses start as home-based businesses. These people need to know portions of business costs are deductible and so “It is very important that you keep track of expenses relating to your housing costs.”
If your gross income from your business exceeds your total expenses, then you can deduct all of your expenses related to the business use of your home. If your gross income is less than your total expenses, your deduction will be limited to the difference between your gross income and the sum of all business expenses you would pay if the business was not in your home. Those expenses could include telephone lines, the Internet, and other costs to do business.
You must also have a home office that is truly used for work and the Internal Revenue Service may require you to document this.
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Deducting automobile expenses
If you travel for business, even short distances within your own city, you may deduct the dollar value of business miles traveled on your tax return. The taxpayer may file the actual expense s/he incurred, or use the standard mileage rate prescribed by the IRS, which is 56 cents as of 2021. The IRS allowable mileage rates should be checked every year as they can change.
“If you decide to use actual car expenses, be sure to include payments, depreciation, registration, insurance, garage rent, licenses, repairs and maintenance, and parking and toll fees.” AND, “If you decide to use the standard mileage rate, it would be in your best interest to keep a log—daily, weekly or monthly—of miles driven to distinguish personal use from business use.”
Depreciation of property and equipment
Some self-employed people may purchase property and equipment for a business. If they expect that property to last longer than one year, it should be depreciated on the tax return.
Claims regarding property, according to the IRS, must meet the following criteria: You must own the property and it must be used or held to generate income. The property should have an estimated useful life, meaning you should be able to guess how long you can generate income with it. It may not have a useful life of one year or less, and may not be purchased and disposed of in the same year.
Certain repairs on property used for business may also be deducted.
Educational expenses
Any educational expense is potentially tax-deductible.
“Many times an overlooked deduction is educational expenses. “If one is taking courses or buying research material to be more effective in their work, this can be deductible.”
Think about any books, web courses, local college courses, or other classes or materials that you have purchased to improve your job or business. It’s easy to forget a work-related webinar or business e-book that was purchased online, so remember to save e-receipts.
Also recall that subscriptions to trade or professional publications and donations to business organizations, both of which are frequently necessary for the continuation and growth of your business.
Other areas to explore
Other deductions that can be easily missed are advertising and promotional expenses, banking fees, and air, bus, or train fare. Restaurant meals and other entertainment costs may be written off as long as they are necessary business expenses.
And, consider health insurance premiums, which in most cases represent a credit rather than a tax deduction. “A credit goes directly against one’s taxes, rather than a reduction of income.”
Regardless of which expenses you discover that you may write off, the most important thing is to keep accurate records throughout the year. Save receipts, including e-mail receipts, and file or log them so you have easy access to them at tax time. Not only does keeping receipts, mileage logs, and other expense records make filing taxes easier, but it also facilitates a system that allows you to track changes from year to year.
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Long-term tax-saving strategies
Don’t just look at last-minute write-offs when considering self-employment tax deductions. Think about laying down some long-term strategies for money savings from year to year—particularly if you are a high earner.
“Accountants typically tell you what you have to pay but they don’t always tell you strategies to reduce your payments.”
To reduce your gross taxable income, consider setting up a defined-benefit pension plan. This plan is based on your age and income: The older you are and the higher your earnings, the more you are allowed to contribute. An alternative plan is an age-weighted profit-sharing plan, which is similar and can benefit those who have several employees.
Another strategy for high-earning business owners who own their own building through a limited liability company or similar business structure is to pay themselves rent. This rent is used to pay down the mortgage, but it is also considered a business expense for tax purposes.
Self-employed professionals required to have liability insurance should consider setting up their own insurance company. A captive insurance company is one that insures the risks of the business—or businesses, in the case of a cooperative. Its premiums can be tax-deductible.
But, if money accumulates and claims are minimal, the money taken out is taxable under capital gains. This is not a retirement strategy, but that it can save you money by allowing you to “pay yourself” instead of an insurance company and still deduct the premiums.
Assessment
With any of these more complicated, long-term strategies, consult with a business attorney, CPA/EA or financial planner to ensure you have the best plan possible for your business.
Posted on January 24, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
Stock Markets: The S&P is off to its worst start to a year since 2016. The NASDAQ is in a correction. And the week ahead features a busy earnings slate and a Federal Reserve meeting.
CovisPandemic: Tony Dr. Fauci said he is “confident as you can be” that the Omicron wave in the US will peak by mid-February. In a growing number of states, that peak has already come and gone and cases are plunging in states like New York and Florida. Other states, such as Oklahoma, Idaho, and Wyoming, are still reporting an uptick in new Covid cases.
Crypto-Currency: Crypto investors, meanwhile, wish they got the weekend off like stock traders, because bitcoin, ethereum, and other digital tokens continued to sink.
Federal Reserve: Federal Reserve officials will get together on Tuesday and Wednesday against the backdrop of quaking markets. Investors will want to hear an update on Chair Jerome Powell’s views on inflation. This Fed meeting will likely be the last before an anticipated interest rate hike in March. And, a blizzard of companies will report including nearly half of the Dow’s 30 giants (American Express, 3M, IBM, and more) and tech heavyweights such as Apple, Microsoft, and Tesla.
Tax Season: The income tax filing season opens today and government officials warn it could be bumpy due to a depleted IRS. The Treasury says to file early, file online, and request your refund via direct deposit to avoid the severe headaches.
Posted on January 18, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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Markets: The stock market was closed for Martin Luther King Jr. Day. Maybe a day off is just what the market needs to score its first winning week of 2022. But … For many stocks, 2022 was a real bear of a year. More than 220 US-listed companies with a market cap of $10+ billion are down at least 20% from their peaks. And things are even worse in the tech-heavy NASDAQ, where 39% of companies have dropped at least half from their all-time highs.
Economy: A combo of Omicron disruptions, higher inflation, and shortages of everything has caused forecasters to lower their projections for economic growth this quarter. Analysts surveyed by the WSJ dropped their Q1 forecast to 3% annual growth from 4.2% back in October.
China: World shares were mixed after China reported that its economy expanded at an 8.1% annual pace in 2021, though growth slowed to half that level in the last quarter. And, Paris, Frankfurt, Tokyo and Shanghai advanced while Hong Kong and Seoul declined.
Posted on January 16, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
The 2-Ps [80/20] Rule
[By staff reporters]
Pareto’s law is either of the following closely related ideas: Pareto principle or law of the vital few, stating that 80% of the effects come from 20% of the causes Pareto distribution
Pareto distribution
The Pareto distribution, named after the Italian civil engineer, economist, and sociologist Vilfredo Pareto, is a power law probability distribution that is used in description of social, scientific, geophysical, actuarial, and many other types of observable phenomena. en.wikipedia.org
Posted on January 16, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
Mitigations for the Digital Health Era
By Shahid N. Shah MS
There has been a tremendous explosion of information technology (IT) in healthcare caused by billions of dollars of government incentives for usage of digital healthcare tools. But, IT systems face threats with significant adverse impacts on institutional assets, patients, and partners if sensitive data is ever compromised. Every health enterprise is required to confidentiality, integrity and availability of its information assets (this is called “information assurance” or IA). Confidentiality means private or confidential information must not be disclosed to unauthorized persons. Integrity means that the information can be changed only in an authorized manner so as to maintain the correctness of the information. Availability defines the characteristic that information systems work as intended and all services are available to its users whenever necessary.
It is well known that healthcare organizations face and have been mitigating many risks such as investment risk, budgetary risk, program management risk, safety risk, and inventory risk for many years. What’s new in the last decade or so is that organizations must now manage risks related to information systems because operating systems [OSs] are also at risk. IT is now just as a critical an asset as most other infrastructure managed by health systems. It is important that information security risks are given the same or more importance and priority as given to other organizational risks.
As health records move from paper native to digital native, it’s vital that organizations have information risk management programs and security procedures that woven into the culture of the organization. For this to happen, basic requirements of information security must be defined and implemented as part of both the operational and management processes. A framework that provides guidance on how to perform these activities, and the co-ordination required between these activities is needed.
INTRODUCTION
The Risk Management Framework (RMF), supported by the National Institute of Standards and Technology (NIST) provides this framework. The NIST 800 series publications provide a structured approach to achieve risk management. It provides broad guidance and not necessarily all the prescriptions, which means it can be tailored to meet the organization’s specific needs and providing the flexibility needed for the different organizations. Using the NIST RMF helps organizations with risk management not only in a repeatable manner, but also with greater efficiency and effectiveness. Healthcare information assurance is complex and without a framework that takes into account a broad risk management approach, it is difficult to consider all the intricacies involved.
NIST Risk Management Framework
The NIST Risk Management Framework consists of a six step process designed to guide organizations in managing the risks in their information systems. The various steps as defined in the NIST specifications are the following:
Categorize the information system and the information processed, stored, and transmitted by that system based on an impact analysis.
Select an initial set of baseline security controls for the information system based on the security categorization; tailoring and supplementing the security control baseline as needed based on an organizational assessment of risk and local conditions
Implement the security controls and describe how the controls are employed within the information system and its environment of operation.
Assess the security controls using appropriate assessment procedures to determine the extent to which the controls are implemented correctly, operating as intended, and producing the desired outcome with respect to meeting the security requirements for the system.
Authorize information system operation based on a determination of the risk to organizational operations and assets, individuals, other organizations, and the Nation resulting from the operation of the information system and the decision that this risk is acceptable.
Monitor the security controls in the information system on an ongoing basis including assessing control effectiveness, documenting changes to the system or its environment of operation, conducting security impact analyses of the associated changes, and reporting the security state of the system to designated organizational officials.
All information systems process, store and transmit information. What is the possible impact if a worst case scenario occurs that causes endangers this information? A structured way to find out the potential impact on the confidentiality, integrity and availability of information can be done through the first step of NIST RMP, the categorization of information systems. The NIST SP 800-60 provides such guidance. The potential impact is assigned qualitative values – low, moderate, or high. Based on these impact levels for each of the information type contained in the system, the high water mark level is calculated, that helps in selecting the appropriate controls in the subsequent steps.
Organizations need to mitigate risks adequately by selecting an appropriate set of controls that would work effectively. In the selection of security controls step, the set of controls are chosen based on the categorization of the information system, the high water mark and the goals of the organizations. These baseline controls are selected from NIST SP 800-53 specification, one of three sets of baseline controls, corresponding to low, moderate, high impact rating of the information system. These baseline controls can be modified to meet specific business needs and organization goals. These tailored controls can be supplemented with additional controls, if needed, to meet unique organizational policies and environment factors and its security requirements and its risk appetite. The minimum assurance requirements need to be specified here.
All the activities necessary for having the selected controls in place, is done in the implementation of security controls step. The implementation of the selected security controls will have an impact on the organization risks and its effects. NIST SP 800-70 can be used as guidance for the implementation. An implementation strategy has to be planned and the actions have to be defined and the implementation plan needs to be reviewed and approved, before the implementation is done.
Once the controls are implemented, then the assessment of security controls is done to find out whether the controls have been correctly implemented, working as intended, and giving the desired output with respect to the security requirements. In short, whether the applied security controls are indeed the right ones, done in the right way, giving the right outcome. NIST SP 800-53,, NIST 800-53A, NIST 800-115 can provide the necessary guidance, here.
IS authorization
The authorization of information systems is an official management decision, authorizing that the information system can be made operational, with the identified risks mitigated and the residual risks accepted, and is accountable for any adverse impacts on the confidentiality, integrity and availability of information systems. If the authorizing personnel find that the risks are not mitigated and hence can compromise the sensitive information, they can deny authorizing the information system. NIST SP 800-37 provides guidance on authorization. The authorizing personnel are to be involved actively throughout the risk management process.
Risk management is not one-time process, that once it is done, it is forgotten. It is a continuous process, to be integrated with day-to-day activities. One of the key aspects of any risk management is the monitoring of security controls to check whether the controls are performing as intended. The main focus of monitoring security controls is to know whether the controls are still effective over a period time, given the changes that occur in the information systems — the changes in hardware, software and firmware, the changes in environment factors, operating conditions etc. NIST SP 800-37 provides guidance about this. And if the security controls are found to be ineffective, the cycle starts again, with either re-categorization or selecting another set of baseline controls, or assessing the effectiveness of the controls once more etc.
And, in all the steps in risk management framework, one of the important aspects is communication. Appropriate documents needed to be generated in all the steps, reviewed and kept up-to-date.
Assessment
Organizational risk management provides great benefits to the organization because it helps to prioritize the resources, increase interoperability, and reduce costs incurred due to the adverse effects. It helps to prevent unauthorized access to personally identifiable information which will lead to security breaches.
Posted on January 11, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
BY ERIC BRICKER MD
With 43 Million Americans Having Lost Their Job at Some Point During the Pandemic and About 1/2 Those Jobs Providing Health Insurance… the 1st Group–People Who Do Not Have Health Insurance–Needs to Be Aware of How These Programs Work.
In this Video You Will Learn the Patient Assistance Program Process for:
1) 2 of the Most Common Types of Insulin
2) The Highest-Revenue Medication in America: Humira
**Note: At the Time of the Video’s Recording, the Unemployment Rate in the US was 15%. As of November 2021, the Unemployment Rate is 4.2%.
Posted on January 10, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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Markets: Stocks are off to a sputtering start in 2022, and they could be in for more upheaval this week with a big inflation report due, Fed Chair Jerome Powell’s confirmation hearing on Capitol Hill, and the beginning of earnings season.
NASDAQ: Last week, the tech-heavy NASDAQ fell 4.5% for its worst week since February 2021. And the ARK Innovation ETF, which is full of high-growth tech companies, plunged 11%.
Bonds: Over in the bond market, yields (or the return you can get from buying a bond) are surging. On Friday, the yield for the 10-year Treasury note hit its highest level since January 2020. Now, While rising yields are generally a bullish sign for the economy, they also make riskier assets—like expensive tech stocks—less attractive compared to other names that may get a boost from higher interest rates. The Dow, for example, with its many financial services companies, lost just 0.29% last week.
Good News: Billionaire investor Chamath Palihapitiya said US stocks could rebound rapidly after the recent sell-off. He said there’s “a ton” of money waiting on the sidelines in products such as money market accounts.
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By Dr. Mark Matthews with Dr. David Marcinko MBA
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