BOARD CERTIFICATION EXAM STUDY GUIDES Lower Extremity Trauma
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Posted on February 11, 2023 by Dr. David Edward Marcinko MBA MEd CMP™
The “Real Deal”
A co-payment is a fixed amount ($20, for example) you pay for a covered health care service after you’ve paid your deductible.
Let’s say your health insurance plan’s allowable cost for a doctor’s office visit is $100. Your copayment for a doctor visit is $20.
If you’ve paid your deductible: You pay $20, usually at the time of the visit.
If you haven’t met your deductible: You pay $100, the full allowable amount for the visit.
Partial deductible payments incur hybrid fees.
Copayments (sometimes called “copays”) can vary for different services within the same plan, like drugs, lab tests, and visits to specialists. Generally plans with lower monthly premiums have higher copayments. Plans with higher monthly premiums usually have lower copayments.
Co-Pay Cards May Be Creating More Controversy Instead of Solutions
Instead of reducing the actual price of their excessively priced medications, many companies have opted to provide co-pay cards / coupons as an affordable solution. However, co-pay cards may only lower the cost for some consumers and patients.
But – The insurer is still left to pay the high price, which will eventually be passed back on to the patient / consumers in the form of higher health insurance deductibles. So – It doesn’t really seem like much of a solution when we all end up paying for these co-pay cards / coupons; does it?
Find out more here. (Source: Rebecca Mayer Knutsen, MM&M, 8/26/16)
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MEDICAL OFFICE CREDIT CARDS:
We stopped taking credit cards altogether. The only credit cards we take are for call-in payments of balances. We have placed ATM machines in our lobbies and we educate patients in advance of their visits that we only take cash or check. Our cash income has increased, our credit card fees have decreased, and we make $1.50 from each transaction through our ATM. Our patients have taken to the idea so much that they use the ATM for personal cash for other transactions because our fee is the lowest of any ATM. It has been a win-win-win.
–Dr. Farshid Nejad, Beverly Hills, CA [PM Magazine]
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For anyone contemplating taking credit cards for payments or copayments in your office, please be aware that some of the credit card companies require you to sign a contract. Don’t do that! If you do and you either have a problem with the company or find out that they are overcharging you, they will hold you responsible for the contract and may take you to court. There are enough credit card companies out that that do not require contracts and are highly competitive.
-Dr. Elliot Udell, DPM, Hicksville, NY [PM Magazine]
Posted on February 11, 2023 by Dr. David Edward Marcinko MBA MEd CMP™
Bridging the Medical School – Financial Services Industry & Business Education Gap
[By Ann Miller RN MHA]
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iMBA Inc., routinely presents to residents and fellows across the country on a variety of medical, financial, accounting and practice management related topics.
Whether on-site or via webinar, our educational sessions are tailored to fill the finance, economic, practice management, business and practice management educational gap and to provide physicians and allied healthcare professionals with practical advice and strategies to help make sound financial and business decisions.
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Our firm works exclusively with physicians and their advisors, and we understand the stresses and financial pitfalls that are unique to the medical profession. We are doctors who are passionate about equipping, training, and advising physicians so they can work toward achieving their professional and financial goals.
We can tailor our presentations to the needs of the program or group. Above all, we aim to empower residents and fellows with the knowledge they’ll need to succeed financially as they begin their career in private practice or in academics.
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In addition to speaking with individual programs, we speak with House Officers Associations, Fellowship & Residency Associations, Spouse Support Groups, etc. We are regularly invited to present at Grand Rounds, weekly practice management gatherings, and after-hours dinners.
Educational sessions can be done either on-site or via webinar.
Assessment
To see a list of presentations and topics, click here:
Have you visited our other topic channels? Established to facilitate idea exchange and link our community together, the value of these topics is dependent upon your input. Please take a minute to visit. And, to prevent that annoying spam, we ask that you register. It is fast, free and secure.
Conclusion
Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.
Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com
OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:
On December 19, 2022, the Department of Health and Human Services (HHS) Office of Inspector General (OIG) published Advisory Opinion (AO) No. 22-20, analyzing the utilization of nurse practitioners (NPs) in lieu of attending physicians within medical units. The OIG concluded that the arrangement utilizing NPs in certain medical units, subject to several safeguards, presented a low risk for fraud or abuse.
As noted by legal experts, this AO deviates from OIG’s typical approach to limiting arrangements involving potential remuneration from a hospital to its referring physicians. (Read more…)
Technology stocks have largely been in favor since the COVID-19 pandemic began, but re-openings in the U.S. and elsewhere as vaccines take hold have pushed investors toward value stocks, which are geared more toward the economy. But lately, stronger growth expectations are also sparking worries of higher inflation, and a potential tapping of the brakes by central banks.
Therefore, an important concept for physicians and all investors to understand is the Current Rate of Return (CCR).
So, What Exactly is CRR?
According to this principle, the current rate of a taxable return must be evaluated in reference to a similar non-taxable rate of return. This allows you to focus on your portfolio’s real (after-tax return), rather than its’ nominal, or stated return. Since most medical professionals own a combination of both vehicles, it is important to calculate the average rate of return (ARR), as demonstrated in the following matrix. Usually, this will result in the assumption of more risk, for the possibility of great return.
To compare after tax yields, with taxable yields, use the following formulas:
Tax equivalent yield = yield / (1 – MTB), while taxable yield X (1-tax rate) = tax exempt yield.
Example: if the yield on a tax exempt municipal bond was 6%, and you are in a 28% tax bracket; the equivalent taxable yield (ETY), is 8.3%, calculated in the following manner: 06 / 1.00 – .28 =.083, or, 8.3% ETY.
This means that you would need a taxable instrument paying almost 9 % to equal the 6 percent tax exempt bond.
OUR OEUVRE’ OF TEXT BOOKS IS GROWING WITH OUR INDUSTRY STATURE
We believe that by writing and sharing our experiences in standard textbook, white-paper and new media electronic format, our experts are able to address most areas of physician-focused financial planning, business or medical practice management needs in an understandable and unbiased manner.
But, we recognize that some consultants and financial advisors may appreciate reading current medical business management theory, healthcare economics, technology or financial planning information privately, prior to becoming a Certified Medical Planner® professional.
However, there is a virtual information overload out there, little of which addresses the pragmatic concerns of the modern medical provider or healthcare industry. None imparts the wisdom to become a better financial advisor or medical management consultant. All motivate the purchase of products.
Therefore, as part of the iMBA Research Library for the Certified Medical Planner® program, we highly recommend the following in-house produced books. You may even recognize some of our nationally known contributing authors and CMPs®.
Posted on February 1, 2023 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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DEFINITION:
According to Wikipedia, the Federal Open Market Committee (FOMC), a committee within the Federal Reserve System (the Fed), is charged under United States law with overseeing the nation’s open market operations (e.g., the Fed’s buying and selling of United States Treasury securities). This Federal Reserve committee makes key decisions about interest rates and the growth of the United States money supply. Under the terms of the original Federal Reserve Act, each of the Federal Reserve banks was authorized to buy and sell in the open market bonds and short term obligations of the United States Government, bank acceptances, cable transfers, and bills of exchange. Hence, the reserve banks were at times bidding against each other in the open market. In 1922, an informal committee was established to execute purchases and sales. The Banking Act of 1933 formed an official FOMC.
The FOMC is the principal organ of United States national monetary policy. The Committee sets monetary policy by specifying the short-term objective for the Fed’s open market operations, which is usually a target level for the federal funds rate (the rate that commercial banks charge between themselves for overnight loans).
The FOMC also directs operations undertaken by the Federal Reserve System in foreign exchange markets, although any intervention in foreign exchange markets is coordinated with the U.S. Treasury, which has responsibility for formulating U.S. policies regarding the exchange value of the dollar.
The Federal Reserve is set to announce today whether it will impose another interest rate hike, the central bank’s latest move in a months long fight that has eased inflation but risks plunging the U.S. into a recession.
The Fed [FOMC] has put forward a string of borrowing cost increases as it tries to slash price hikes by slowing the economy and choking off demand. The approach, however, risks tipping the U.S. economy into a downturn and putting millions out of work.
And so, at a meeting in December 2022, the Fed raised its short-term borrowing rate a half-percentage point, pulling back from three consecutive 0.75% increases and signaling confidence that sky-high inflation could be brought down to normal levels.
Economists expect the Fed to continue softening its approach with a 0.25% rate hike today? The decision comes weeks after a government report showed that inflation slowed in December, marking six consecutive months of easing price increases.
FINANCIAL ADVISER WANTED: New York’s Belfer family, which gained riches from oil, is racking up quite an investing losing streak. They lost billions in Enron’s collapse and were clients of Bernie Madoff, and now it’s come to light that they were shareholders in FTX.
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CPAs WANTED: Just as tax season kicks off, US firms are facing a national shortage of accountants, forcing them to look overseas for workers to look over your W-2. More than 300k accountants and auditors have quit in the last two years, per the WSJ.
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CMPs NEEDED: The Certified Medical Planner® program was created in response to the frustration felt by doctors in small and mid-sized practices that dealt with top financial, brokerage and accounting firms. These non-fiduciary behemoths often prescribed costly wholesale solutions that were applicable to all, but customized to few, despite ever changing needs.
Learn why brokerage sales-pitches and/or internet resources will never replace the knowledge and deep advice of a collegial Certified Medical Planner® professional.
Posted on January 23, 2023 by Dr. David Edward Marcinko MBA MEd CMP™
THE MARKETS
By Staff Reporters
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Last week, the S&P 500 dropped 0.7%, snapping a two-week winning streak, though the index rallied 1.9% Friday, thanks to a surge in tech stocks as Fed officials dialed back fears of overly aggressive policy moves. The tech-heavy NASDAQ 100 Index had its best day since November 30th to eke out a 0.7% gain for the week. At the same time, stocks from rate-sensitive industries like financials, real estate, and growth-oriented technology tend to lag during that period.
In this coming week, markets will sort through earnings results from Microsoft Corp., Tesla Inc. and International Business Machines Corp. that are poised to shape the direction of equities more broadly. Also, the Commerce Department will release its first estimate of fourth-quarter US gross domestic product, which is expected to show an acceleration.
Hospitals saw a slight financial boost in November 2022, despite continued negative operating margins throughout the year, according to a new Kaufman Hall National Hospital Flash Report, as reported in Healthcare Brew.
Lower expenses and increased outpatient revenue help buoy their performance and increase margins by 12% month over month from October 2022. But Kaufman Hall, a management consulting firm, reported that its year-to-date operating margin index reflected an actual negative figure of -0.2% in November 2022.
The findings underscore the financial challenges hospitals continue to face as they recover from the Covid-19 pandemic.
And, Erik Swanson, senior vice president of data and analytics at Kaufman Hall, wrote that the “November data, while mildly improved compared to October, solidifies what has been a difficult year for hospitals amidst labor shortages, supply chain issues, and rising interest rates.”
The monthly report, which is based on data from more than 900 hospitals, partially attributed November’s lowered expenses to a decline in patient volume and slightly shorter lengths of stay. Decreased labor costs, likely due to a drop in a reliance on contract labor, also helped lower expenses, the Kaufman analysis found.
Hospitals further saw a 10% increase year over year in outpatient revenue in November 2022, despite inpatient revenue remaining flat, according to the report. Swanson said “[h]ospital leaders should continue to develop their outpatient care capabilities amid ongoing industry uncertainty and transformation.”
Posted on January 14, 2023 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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People living in the US are finding it increasingly difficult to afford needed health services—even with employer-sponsored health insurance, a new analysis suggests.
Researchers at the NYU School of Global Public Health (GPH) examined data from the National Health Interview Survey—an annual CDC survey—that was collected from 2000 to 2020 for 230,000+ adults who received health insurance through an employer or union. Both men and women found most healthcare services to be less affordable now compared to the early 2000s, according to the finding of the NYU analysis reported in a December 2022 JAMA abstract. Women, in particular, found all types of health services to be less affordable than men.
From a nationally representative survey which is conducted annually, researchers included data from 5,545 women and 5,353 men sampled in 2020, and found that about 6% of women reported they couldn’t afford needed medical care. This compares to just 3% of slightly larger sample groups from 2000, per the analysis. By contrast, about 3% of men gave that response in 2020, compared to 2% in 2000.
Avni Gupta, a doctoral student in the public health policy and management department at NYU GPH and the lead author of the analysis, offered that “lower incomes and higher healthcare needs among women could be driving these differences in reported affordability.”
And, José Pagán, the department chair and co-author of the JAMA analysis, said people with employer-sponsored coverage—the largest source of health insurance for people living in the US—“generally think they are protected.”
“[B]ut our findings show that health-related benefits have been eroding over time,” he said; according to Healthcare Brew
Posted on January 12, 2023 by Dr. David Edward Marcinko MBA MEd CMP™
NASDAQ Winning Streak
By Staff Reporters
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Carta Inc., a financial software company valued at $7.4 billion in August 2021, told employees on Wednesday it was cutting about 10% of the workforce. The job cuts, earlier reported by TechCrunch, are more evidence of the chill that has set in for even the best-funded tech startups. Carta raised $500 million in equity last year, bringing its total fundraising haul to more than $1 billion. Carta makes software to manage equity stakes in private companies, and has been backed by firms including Andreessen Horowitz, Lightspeed Venture Partners and Silver Lake. Prominent venture capitalist Marc Andreessen sits on the company’s board.
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U.S. equities finished higher to add to gains seen this year, with the NASDAQ on a four-day winning streak. However, caution was prevalent, as the markets awaited tomorrow’s December consumer price inflation report, and as Q4 earnings season will kick off on Friday with results from some prominent names from the Financials sector.
Treasury yields were lower and the U.S. dollar was little changed, while crude oil prices and gold were higher.
The economic calendar was relatively light today, but mortgage applications snapped a two-week losing streak. The airline industry was in focus after the FAA temporarily suspended all flights across the U.S. after a computer system failure, and Wells Fargo & Company announced that it will reduce the size of its mortgage lending business.
Asia finished mixed, and Europe saw widespread gains, as the global markets awaited this week’s inflation and earnings data out of the U.S.
A Medical Practice business valuation is a set of procedures to estimate the economic value of a physician owner’s interests. Valuation is used to determine the price they are willing to pay or receive to affect a sale of the practice.
The same valuation tools are often used to resolve disputes related to estate and gift taxation, divorce litigation, allocated purchase price among business assets, establish a formula for estimating the value of partners’ ownership interest for buy-sell agreements, and other business and legal purposes.
QUERY: But, what are the most common medical practice valuation blunders to avoid? Written over a decade ago, this white paper highlights the most common mistake still seen today.
Most of the thousands of buy and sell orders executed on a typical day on the NYSE are in 100 share or multi-100 share lots. These are called round lots. Some of the inactive stocks traded at post 30, the non-horseshoe shaped post in the northwest corner of the exchange, are traded in 70 share round lots due to their inactivity. So, while a round lot is normally 700 shares, there are cases where it could be 10 shares. Any trade for less than a round lot is known as an odd lot. The execution of odd lot orders is somewhat different than round lots and needs explanation.
When a stock broker receives an odd lot order from one of his doctor customers, the order is processed in the same manner as any other order. However, when it gets to the floor, the commission broker knows that this is an order that will not be part of the regular auction market. He takes the order to the specialist in that stock and leaves the order with the specialist. One of the clerks assisting the specialist records the order and waits for the next auction to occur in that particular stock. As soon as a round lot trade occurs in that particular stock as a result of an auction at the post, which may occur seconds later, minutes later, or maybe not until the next day, the clerk makes a record of the trade price.
Every odd lot order that has been received since the last round lot trade, whether an order to buy or sell, is then executed at the just noted round lot price, the price at which the next round lot traded after receipt of the customer’s odd lot order, plus or minus the specialist’s “cut “. Just like everything else he does, the specialist doesn’t work for nothing. Generally, he will add 1/8 of a point to the price per share of every odd lot buy order and reduce the proceeds of each odd lot sale order by 1/8 per share. This is the compensation he earns for the effort of breaking round lots into odd lots. Remember, odd lots are never auctioned but, there can be no odd lot trade unless a round lot trades after receipt of the odd lot order.
Posted on January 5, 2023 by Dr. David Edward Marcinko MBA MEd CMP™
Limitless possibilities – Compassionate care
By Staff Reporters
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DEFINITION: GE HealthCare is a subsidiary of American multinational conglomerate General Electric incorporated in New York and headquartered in Chicago, Illinois. As of 2017, it is a manufacturer and distributor of diagnostic imaging agents and radio-pharmaceuticals for imaging modalities used in medical imaging procedures
TUCSON, Ariz., Dec. 06, 2022 (GLOBE NEWSWIRE) — Sheila Page, D.O., a family physician in Aledo, Texas, and president of the Association of American Physicians and Surgeons (AAPS), is featured in the winter issue of the of the Journal of American Physicians and Surgeons. She writes: “Today physicians often feel constrained to pick from among options that are not in the best interest of patients but are ‘covered’ by insurance or approved by officials.”
“An apparently free choice when there is no real alternative is a Hobson’s Choice, and physicians must understand the political structure in which this type of ‘choice’ is embedded,” Dr. Page explains.
“During the COVID pandemic, people often faced a Hobson’s Choice of taking a shot that they believed put their life, health, or fertility at risk, or be barred from their education or career,” she noted.
“Voters generally believe that they have two choices, Republican or Democrat, and that they represent extremes of political ideology. However, when they are in office, politicians behave as if they belong to the same club,” she writes.
“Physicians have accepted the Hobson’s Choice of either abiding by ridiculous regulatory burdens or refusing to treat the senior population,” she explains. They “accept the Hobson’s Choice of either standing against the oppression or keeping their ‘place at the table.'”
“The phrase ‘we need to keep our place at the table to avoid being on the menu’ entirely misses the point,” she states. “The profession is on the table already being carved up. How many times have we been told we must choose the lesser of two evils? Either choice is still evil!”
“We must identify the enemy within,” Dr. Page writes. “The medical profession must grasp the extent to which it has been manipulated by pharmaceutical, insurance, and other systems tied to medicine. We have been burdened with regulations and threats to our licenses by the same people who are selling us the solutions.”
“There is tremendous profit in the existing system, but we must nevertheless offer healing and hope, learn how to fight back effectively, and reject the Hobson’s Choice,” she concludes.
Posted on January 4, 2023 by Dr. David Edward Marcinko MBA MEd CMP™
A ME-P Reader Opinion Poll
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DEFINITION: NBER defines a recession as “a significant decline in economic activity that is spread across the economy and that lasts more than a few months.” That definition encompasses a range of economic factor but is based on three main criteria: The depth, diffusion and duration of a downturn.
Former Federal Reserve Chair Alan Greenspan recently said a US recession is the “most likely outcome” in 2023 as the central bank tightens monetary policy to curb inflation.
Posted on January 1, 2023 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
The Fed hikes interest rates, sending economy teetering toward a recession?
If everyone was an opinionated virologist in 2020, then 2022 turned us all into macro-economists. In an effort to fight historic inflation, the Fed raised its benchmark interest rate seven times this year, pushing it to a 15-year high. Chair Jerome Powell’s hawkish turn slowed the economy and was a major catalyst for the brutal sell-off in stocks, particularly in the tech sector. This year, Amazon became the first public company to lose $1 trillion in market value.
The U.S. housing market is experiencing its second-biggest home price correction of the post-World War II era. Macro Trends Advisors founding partner Mitch Roschelle attributed the massive correction to Americans’ uncertainty for the markets and their “uneasiness” regarding the economy. He explained on “Varney & Co.” that the “shoe to drop” would be if the nation starts to see a rise in unemployment, which could cause a “leg down” in the housing market.
Finis?
So what’s ahead for 2023? According to MorningBrew, Economists think that a recession is likely, but a few are holding out hope that the Fed can achieve a so-called “soft landing,” where it brings inflation down to normal levels without causing the economy to shrink. Recent months have brought cautiously hopeful news: Annual inflation has cooled from a peak of 9.1% to 7.1%, so rate hikes are expected to be much less aggressive next year.
Posted on December 30, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
By Ann Miller RN MHA CMP®
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About the Institute of Medical Business Advisors, Inc
The Institute of Medical Business Advisors, Inc provides a team of experienced, senior level consultants led by iMBA Chief Executive Officer Dr. David Edward Marcinko MBA CMP™ MBBS [Hon] and Ann Miller RN MHA CMP™ to provide ongoing contact with our clients throughout all phases of each project, with most of the communications between iMBA and the key client participants flowing through this Senior Team. iMBA Inc., and its skilled staff of certified professionals have many years of significant experience, enjoy a national reputation in the healthcare consulting field, and are supported by an unsurpassed research and support staff of CPAs, MBAs, MPHs, PhDs, CMPs™, CFPs® and JDs to maintain a thorough and extensive knowledge of the healthcare environment. The iMBA team approach emphasizes providing superior service in a timely, cost-effective manner to our clients by working together to focus on identifying and presenting solutions for our clients’ unique, individual needs.
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The iMBA Inc project team’s exclusive focus on the healthcare industry provides a unique advantage for our clients. Over the years, our industry specialization has allowed iMBA to maintain instantaneous access to a comprehensive collection of healthcare industry-focused data comprised of both historically-significant resources as well as the most recent information available. iMBA Inc’s specific, in-depth knowledge and understanding of the “value drivers” in various healthcare markets, in addition to the transaction marketplace for healthcare entities, will provide you with a level of confidence unsurpassed in the public health, health economics, management, administration, and financial planning and consulting fields. iMBA Inc’s information resources and network of healthcare industry textbook resources enhanced by our professional consultants and research staff, ensure that the iMBA project team will maintain the highest level of knowledge regarding the current and future trends of the specific specialty market related to the project, as well as the healthcare industry overall, which serves as the “foundation” for each of our client engagements.
Considered for years to be a “duopoly” over the advertising industry, they are on track to account for only 48.4% of US ad revenues this year. It’s the first time their market share has fallen below 50% since 2014, per Insider Intelligence.
Posted on December 30, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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Initial claims for state unemployment benefits rose 9,000 to a seasonally adjusted 225,000 for the week ending December 24th, the Labor Department reported, in line with the median estimate among economists polled by Reuters. Meanwhile, the number of people receiving benefits after an initial week of aid rose 41,000 to 1.710 million in the week ending December, 17th, 2022.
Meanwhile, Amazon stock closed the December 22 trading session at $83.79, which represents a 49.7% drop compared to December 31, 2021. This is the lowest closing level for the Amazon stock since March 12, 2019. Basically, the group, founded by Jeff Bezos, has completely erased all the gains during the two years when strict restrictions were put in place to limit the spread of COVID-19. It closed today at $84.18.
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Finally, U.S. stocks rose sharply, ending a two-session losing streak, though trading volumes remain subdued in the final days of the year. The heavyweight Information Technology sector led the rally, rebounding from a recent drop that has weighed on the markets this week. The equity front continued to offer little in terms of headlines, though shares of Cal-Maine Foods fell after the company missed earnings estimates.
The economic calendar introduced labor data, as jobless claims ticked slightly higher compared to the prior week.
Treasury yields were mixed, the U.S. dollar dropped, crude oil prices were lower, and gold traded higher.
Asian stocks finished mostly lower after yesterday’s downturn in the U.S., while markets in Europe were higher despite uncertainty regarding the ultimate global impact of aggressive monetary policy tightening across the world.
Posted on December 28, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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U.S. equities were mixed on the first trading session of the week following the long holiday weekend. The markets reacted to a host of economic data that was released, as home prices decreased on a seasonally adjusted basis, the trade deficit narrowed much more than expected, wholesale inventories increased, and manufacturing activity in the Dallas region contracted more than predicted.
Equity news was light, but shares of Southwest Airlines declined after the U.S. Department of Transportation said that it would examine the mass flight cancellations and delays. Additionally, Tesla’s shares fell after the company announced that it plans on running a reduced production schedule at its Shanghai factory.
Treasury yields continued to rise, and the U.S. dollar dipped, while crude oil prices were little changed, and gold was solidly higher.
Asian equities increased, led by mainland Chinese stocks, after the Chinese government announced that it would put an end to quarantine restrictions for inbound travelers effective early January.
Markets in Europe were mixed amid improved sentiment in the wake of the news.
Posted on December 27, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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Value of a $1,000 investment in Microsoft’s IPO today
Microsoft completed its initial public offering (IPO) on March 13, 1986, at a price of $21 per share. Since then, the company has grown so valuable, and its stock price has soared so high, that management opted to conduct nine stock splits over time to ensure its shares remained accessible to small investors.
Had you invested $1,000 in Microsoft at its IPO, you would have acquired 47 shares at $21 per share. Adjusting for the stock splits, you’d actually have 13,536 shares today with a cost basis of $0.0729 per share.
Given Microsoft now trades at $238.73 per share, that translates to a return of 327,401%.
In dollar terms, that $1,000 investment in 1986 would be worth a whopping $3.23 million today. But it gets better, because Microsoft has paid a dividend since 2003 — and assuming you never sold a single share along the way, you’d have also received $341,513 in dividends.
Given Microsoft continues to pay a quarterly dividend of $0.68 per share, you would still be collecting a cool $36,817 each year, or 36 times your initial $1,000 outlay. That’s the power of long-term investing.
The bargain-hunting value style is looking for shares that are under priced in relation to the company’s future potential. A value investor will invest in a company in the expectation that its shares will increase in value over time. Value investing is based essentially on quantitative criteria; asset values, cash flow, and discounted future earnings. The key properties of value shares are low Price/Earnings, Price/Sales ratios, and normally higher dividend yields.
So, on observing a company’s earnings growth, a value manager will decide whether to buy shares based on the company’s consistency or recovery prospects. The key research questions are: 1) Does the current P/E ratio warrant an investment in a slow growth company or, 2) Is the company a higher growth candidate that has dropped in price due to a temporary problem. If this is the case, will the company’s earnings growth recover, and if so, when? The key to value investing is to find bargain shares (priced low historically or for temporary and/or irrational reasons), avoiding shares that are merely cheap (priced low because the company is failing).
The buying opportunity is identified when a company undergoing some immediate problems is perceived to have good chances of recovery in the medium to long term. If there is a loss in market confidence in the company, the share price may fall, and the value investor can step in. Once the share price has achieved a suitable value, reflecting the predicted turnaround in company performance, the shareholding is sold, realizing a capital gain. A potential risk in value investing is that the company may not turn around, in which case the share price may stay static or fall.
Happy Holidays from the Institute of Medical Business Advisors, Inc
At this special time of year, we give thanks for our clients and our employees, as well as all essential workers in hospitals, health centers and medical practices across the country.
May the holiday spirit be with you and your family throughout the season and everyday We look forward to serving you in 2024.
Posted on December 24, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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he emerging Omicron subvariant XBB contributes to an increasingly high number of COVID-19 cases in the U.S., rivaling the sister strains BQ.1.1 and BQ.1, according to the latest estimates from the Centers for Disease Control and Prevention (CDC).
Recent studies have indicated that the updated bivalent COVID-19 booster performed poorly against BQ.1.1, with even a weaker antibody response against XBB.
In late November, citing its poor neutralization effect on BQ.1 and BQ.1.1., the FDA pulled the emergency use authorization granted for bebtelovimab, a COVID-19 antibody therapy developed by Eli Lilly (LLY) and AbCellera Biologics (ABCL).
The CDC estimates for the week ending Dec. 24 show that XBB has made up ~18% of COVID cases in the U.S. compared to ~11% a week ago. Meanwhile, BQ.1.1 has led to ~36% of cases unchanged from a week ago, and BQ.1 caused ~27% of cases, a decline from ~29% last week.
Posted on December 22, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
As I read Predictably Irrational by Dan Ariely, I found his ideas not only enlightening to understand my own predictable irrationality but also to think through ideas on motivation and change management for our teams. 1️⃣ Context matters – we find it hard to understand things in absolute terms so explain value in relative terms […]
Posted on December 16, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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U.S. stocks fell amid a host of monetary policy decisions globally. The markets continued to digest the economic implications of yesterday’s 50-bp rate hike from the Fed, which was followed by 50-bp increases from the European Central Bank, Bank of England, and Swiss National Bank earlier today. The economic calendar provided a host of data, as retail sales decreased more than expected, industrial production declined, and manufacturing activity in New York and Philadelphia both contracted, though jobless claims moderated much more than expected.
The equity front was relatively quiet, but Lennar Corporation posted mixed results and offered some cautious guidance, while Netflix saw pressure from a report about softer-than-expected ad-supported viewership.
Treasury yields were lower, and the U.S. dollar gained ground, while crude oil prices declined, and gold dropped. Asian and European stocks finished broadly lower, as the global markets digested mixed data and a flood of monetary policy decisions around the world.
Posted on December 13, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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The DJIA Briefly surged over 600 points this morning.
WHY DOW?
Inflation data showed the Consumer Price Index rose 0.1% on the month of November, cooler than the expected 0.3% rise. The index rose 7.1% year over year, lower than the 7.3% Econoday estimate.
In addition, the next meeting Fed meeting kicks off Tuesday with an interest rate decision on Wednesday. While the Fed has already heavily telegraphed a 50-basis-point hike, investors will be looking for further guidance on the Fed’s plans.
Finally, according to the CME’s FedWatch tool, traders place a 79% chance of a 50-basis-point rate hike.
Posted on December 13, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
This could be the revolutionary tool drug companies have been waiting for
By MIT Tech Review
Mendelian randomization could help bypass large-scale clinical trials by focusing on the genetics of patients.
The backstory:
For years, medical researchers have noted the presence of markers alongside certain traits. For instance, it’s known that a high presence of HDL is tied to a lower risk of heart attacks. But what wasn’t always known was whether the HDL caused the healthy heart, or was just correlated with it.
The breakthrough:
As Gary Taubes explains for us, researchers say that by employing innate genetic differences between people—an inborn susceptibility to alcohol, say, or to higher cholesterol levels in the arteries—they can now mimic, at much less effort and expense, the kinds of large trials that would be necessary to determine if an HDL-lowering medicine is really beneficial.
Random facts:
The new technique, called Mendelian randomization, is already being used by drug companies to make billion-dollar decisions about which drugs to pursue.
Conclusion
Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.
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Posted on December 12, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
[By Staff Reporters]
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In statistics, a confounding variable (also confounding factor, a confound, or confounder) is an extraneous variable in a statistical model that correlates (directly or inversely) with both the dependent variable and the independent variable.
IOW: It is an extraneous variable whose presence affects the variables being studied so that the results you get do not reflect the actual relationship between the variables under investigation.
Posted on December 9, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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“It was not a good investment.”
Kevin O’Leary should stick to investing in things like pimple popping toys.
The Shark Tank’s “Mr. Wonderful” admitted he was paid $15 million to act as FTX’s spokesperson. And of the ~$9.7 million he put into crypto, “it’s all at zero,” he told CNBC.
Like Tom Brady and other celebs, O’Leary hyped FTX on social media and TV over the past year; now, he’s being named in a class-action lawsuit over the exchange’s implosion.
“Physicians who don’t understand modern risk management, insurance, business, and asset protection principles are sitting ducks waiting to be taken advantage of by unscrupulous insurance agents and financial advisors; and even their own prospective employers or partners. This comprehensive volume from Dr. David Marcinko and his co-authors will go a long way toward educating physicians on these critical subjects that were never taught in medical school or residency training.” —Dr. James M. Dahle, MD, FACEP, Editor of The White Coat Investor, Salt Lake City, Utah, USA
“With time at a premium, and so much vital information packed into one well organized resource, this comprehensive textbook should be on the desk of everyone serving in the healthcare ecosystem. The time you spend reading this frank and compelling book will be richly rewarded.” —Dr. J. Wesley Boyd, MD, PhD, MA, Harvard Medical School, Boston, Massachusetts, USA
A Required Minimum Distribution (RMD) is an amount of money the IRS requires you to withdraw from most retirement accounts, beginning at age 72. Due to the Coronavirus Aid, Relief, and Economic Security (CARES) Act, RMDs were not required in 2020, but RMDs are required in 2021 and each year after. RMDs can be an important part of your retirement income strategy.
Posted on December 5, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
Colleges and Universities
TO H.R. RECRUITERS, UNIVERSITY HIRING MANAGERS & SEARCH COMMITTEES
Sooth My Academic Teaching and Classroom Withdrawal Pangs!
I’m screening for my next university Dean, Chair or teaching Professorship opportunity.
Currently, an endowed Resident-Scholar completing a text book production assignment complete with aligned case models, tests, quizzes, rubrics, curriculum teaching portfolio, and accreditation review.
Two-decades of domestic and international teaching experience and credentials in health economics, finance, investing, business, policy, risk management, IT and administration. Hundreds of peer-reviewed and trade publications [TNTC] with 30 major textbooks redacted in more than a thousand university libraries [NIH, Library of Congress and National Institute Health, etc]. Public and population health global speaker and thought leader. Wall Street experience as start-up founder, entrepreneur and CXO.
Ideal mentor for under graduate thru post-doctoral and fellowship students [PhD, DBA, MD/DO, MHA and MBA, etc].
Compensation important, but fit is paramount as servant-leader. [+] RANKED: Google Scholar and “H” Index CV available upon request.
Posted on December 4, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
Call for Manuscripts, Articles, Essays, Comments or Opinions,
Dear Medical and Financial Services Colleagues, Health Economists, CPAs, JDs, Insurance Agents and Consultants
The Medical Executive-Post (ME-P), supported by iMBA Inc., with (ISSN 13: 978-1-4665-5873-1] is currently accepting manuscripts for publication.
The ME-P is an open access, multidisciplinary, international, blind peer-reviewed and non-peer-reviewed electronic forum which publishes high-quality solicited and unsolicited research, commentary, opinions, curated news and review articles in English, in all areas of Physician Focused Financial Planning, health economics, finance, accounting, medical practice management, health law, IT, policy and administration.
Posted on December 1, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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MARKETS
Nasdaq$11,468.00+4.41%
S&P$4,080.11+3.09%
Dow$34,589.77+2.18%
10-Year3.606%-14.2 bps
Bitcoin$17,089.73+3.73%
Biogen$305.17+4.72%
*Stock data as of market close, cryptocurrency data as of 3:00am ET.
U.S. equities reversed course and finished with solid gains in the wake of remarks from Fed Chairman Jerome Powell at a gathering at the Brookings Institution in Washington. The Chairman reiterated the Fed’s plan to “stay the course” with its rate-hike campaign, but noted that smaller increases were likely ahead, as soon as next month’s meeting. Powell’s comments came just before the Fed’s release of its Beige Book report on business activity across the nation that showed a slight moderation. Preceding Friday’s key nonfarm payroll report, ADP’s private sector payroll data came in below estimates, and job openings remained robust.
In other economic news, mortgage applications snapped a two-week winning streak, Q3 GDP growth was revised higher, Chicago manufacturing unexpectedly fell further into contraction territory, and pending home sales continued to fall but at a slower pace. Moreover, the advance goods trade deficit widened surprisingly, and wholesale inventories rose more than projected. Treasury yields turned lower following Powell’s comments, and the U.S. dollar tumbled, while crude oil prices rose and gold was solidly higher. Earnings season has headed toward the finish line, with CrowdStrike Holdings topping profit and revenue estimates but missing its annual recurring revenue growth forecast, though Workday topped earnings expectations, raised its guidance, and announced a $500 million share buyback plan.
Asia finished mostly higher and stocks in Europe gained ground, with the markets digesting mixed economic data, while optimism remains that China may be set to ease some COVID-related restrictions.
This quarter’s pharmaceutical earnings were overall better than expected. Especially Merck, thanks to its Keytruda sales. The cancer drug brought in $5.4 billion last quarter, accounting for a whopping 36% of the company’s revenue for that period. But, Keytruda’s patent is expiring in 2028, and everyone is waiting to see what Merck pulls out of its hat to replace it.
Apartment rents across the US dropped in November by the most in at least five years, a sign that a key cost tracked by the Federal Reserve could be easing up. A national index of rents fell by 1%, the third straight month-over-month decline and the steepest drop in data going back to 2017, Apartment List said in a blog post recently.
As of the week ending Nov. 19th, Americans aged 65 and older make up 92% of all deaths from the virus, according to data from the Centers for Disease Control and Prevention.MORE: Latest COVID vaccine will help people ‘move on’ from the pandemic, White House’s Jha says It’s the first time senior citizens have made up more than nine out of 10 deaths since the pandemic began and a drastic increase from the roughly 58% of deaths they made up in summer 2021, an ABC News analysis showed.
Posted on November 28, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
What is PERSPECTIVE?
[By Staff reporters]
Perspective is the art of drawing solid objects on a two-dimensional surface so as to give the right impression of their height, width, depth, and position in relation to each other when viewed from a particular point.
Posted on November 26, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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What’s shrinking in size, overworked and woefully underpaid?
Did you know that only half of U.S. adults live in a household with an annual income of $52,000 to $156,000, the range it takes to be considered middle income, according to the Pew Research Center. That share is significantly lower than it was in 1971, when 61% of the nation’s adults qualified as middle income.
In 2022 — an era of historic inflation and a manic economy in which jobs are plentiful but wages are stagnant — more Americans are living paycheck to paycheck. And it’s affecting more than just their income.
“People judge whether or not they’re achieving the American dream by comparing their income and their lifestyle, or what their income can buy, to what they see around them,” says Isabel Sawhill, a senior fellow at the Brookings Institution.
On paper, middle-class household income has increased considerably in the last 50 years. Measured in 2020 dollars, the median salary of the U.S. workforce is 50% higher now ($90,131) than it was in 1971 ($59,934), primarily thanks to women’s increased participation in the workforce, says Sawhill, who’s a co-author of the Brookings report “A New Contract with the Middle Class.”
Those gains, however, pale in comparison to the 69% growth enjoyed by the wealthiest households. Elisabeth Jacobs, a deputy director at the research nonprofit Urban Institute, said in a 2021 Brookings panel that if middle incomes had grown at the same pace as the top 20% of earners over the past 50 years, a solidly middle-class family would average around $139,000 annually (post-tax).
Posted on November 24, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
By Dr. David Edward Marcinko MBA
[Editor-in-Chief]
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I first met my esteemed colleague Tony Fauci MD more than 30 years ago as a young surgical resident in Atlanta. My esteem for him has grown immensely since then. After all, he is an American physician-scientist and immunologist serving as the director of the National Institute of Allergy and Infectious Diseases and the Chief Medical Advisor to the President
And so, upon his retirement, Dr. Anthony Fauci urged Americans to get their reformulated Covid boosters in his final White House press briefing yesterday. Fauci, the nation’s top infectious disease official and the leader of the NIAID since 1984, announced recently that he’d be stepping down to “pursue the next chapter” of his career in December, 2022.
Dr. Fauci’s final plea comes as public health officials warn that a “viral jumbalaya” of respiratory infections threatens to push hospitals to the brink this coming winter.
Quote: “My final message—maybe the final message I give you from this podium—is that, please, for your own safety, for that of your family, get your updated Covid-19 shot as soon as you’re eligible, to protect yourself, your family, and your community.”
Posted on November 20, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
A Brief Review
[By Staff Reporters]
We do not have enough space to cover the subject fully. And, “important” does not necessarily indicate good or bad. But, we will try to review these three Greek Philosophers.
PLATO
Plato is important because his philosophy underpins autocratic political philosophies such as Kant, Nazism and Communism. Metaphysically he fights a war against reality claiming only a superior mind, like his, can be trusted. He had a pessimistic view of human beings.
ARISTOTLE
Aristotle is responsible for the explosion of progress since the Renaissance. His focus on identification (A is A), and reason, as the key to human knowledge and happiness has been a force for good. His heirs like Aquinas and Rand have sought to round out his discoveries. He was the optimist. If you look at the the cultural climate in the USA today, you will see a resurgence of Platonism (socialism).
And, in the face of unparalleled quality of life and prosperity, harbingers of doom capitalize in the unwillingness of many to do the work required for freedom. Identity is ignored in the attempt to avoid the requirements for happiness: Effort and thought. Hopefully the pendulum will swing back to an Aristotelian era.
SOCRATES
Socrates was the bridge between the two great minds of Plato and Aristotle, and a story teller whose skills and abundance ensured the survival of his own.
Assessment
Much as Socrates’ thought systems – so we put our coin on Plato as the premier Greek Philosopher. Without Plato, Socrates’ thought would not have survived a century past his execution; still less a millennia.
Aristotle certainly influenced Alexander, but it’s hard to credit Aristotle for Alexander’s legacy, which was largely military in nature.
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LATIN PHRASES
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Conclusion
Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.
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.
Subscribe: MEDICAL EXECUTIVE POST for curated news, essays, opinions and analysis from the public health, economics, finance, marketing, IT, business and policy management ecosystem.
Posted on November 19, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
[Emergency Request]
By Staff Reporters
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Children’s hospitals are asking the federal government to declare a public health emergency to help them deal with the surge of RSV cases. Infants are being hospitalized at seven times the rate of 2018.
DEFINITION: Respiratory syncytial virus, also called human respiratory syncytial virus and human orthopneumovirus, is a common, contagious airborne virus that causes infections of the respiratory tract. It is a negative-sense, single-stranded RNA virus.
Elizabeth Holmes, the founder and former CEO of the doomed medical startup firm Theranos, has been sentenced to 11.25 years in prison for her role in defrauding investors and consumers about the potential of her company’s blood-testing device.
Holmes’ sentence will be followed by three years of supervised release. She will be required to self-surrender at a later date, according to NBC.
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U.S. equities ended the day higher and the week mostly lower in a choppy trading session, as investors digested mixed corporate results and some disappointing economic data. Earnings were in focus with the season coming to a close, as Applied Materials handily beat the Street’s forecasts and upped its guidance, Gap posted a profit on the back of a tax benefit, making it unclear if it is comparable to forecasts, and Williams-Sonoma saw record earnings growth but fell short of predictions.
Economic reports were lackluster, as existing home sales slumped amid the persistent rise in interest rates, and the Leading Economic Index tumbled double what was expected.
Treasury yields rose following the economic data, as did the U.S. dollar, while crude oil and gold prices declined.
European stocks were higher despite geopolitical tensions remaining, and as the markets continued to digest the U.K. budget announcement. Markets in Asia finished out a volatile week mixed in a quiet trading session.
Posted on November 19, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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On World Pancreatic Cancer Day, loved ones, communities and organizations around the world unite to shine a light on pancreatic cancer and share our universal message that it’s about time we all know the symptoms!
Raise awareness on this special day as we share the facts about this disease, survivor stories and what you can do to make an impact.
Posted on November 15, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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MEDIA / INTERVIEW REQUESTS
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WHAT WE’RE LOOKING FOR
Op-eds. Cross and Re-Posts, Links and Columns. Great ideas for improving physician focused financial planning, health insurance, economics and the financial ecosystem; etc. Pitches for healthcare-focused startups and business. Write-ups of original research. Reviews of new health care products, DME and AI. Data driven analysis of health care trends. Policy proposals; etc.