EARNINGS WEEK: Four Magnificent Seven Stocks Plus 4 More “Blue Chips” Reporting

By Staff Reporters

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Busy earnings week will focus on the Magnificent Seven

Big Tech is leading the stock-market rout, but in the coming days, it has the opportunity to turn things around. Magnificent Seven members Microsoft, Meta, Alphabet, and Tesla are among the 178 S&P 500 companies scheduled to report their earnings this jam-packed week.

Other blue-chip stocks reporting include GM, Boeing, IBM, and PepsiCo.

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DAILY UPDATE: The CPI, Korion Health and the Stock Markets Rebound

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Happy Shakespeare Day

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The March Consumer Price Index, which the Bureau of Labor Statistics released last week, revealed that core inflation hit 3.8% Year over Year in March, rising for the first time in 12 months. That’s moving in the wrong direction for the Fed, whose goal is to bring inflation down to 2%.

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Here’s where the major benchmarks ended:

  • The S&P 500 index rose 43.37 points (0.9%) to 5,010.60; the Dow Jones Industrial Average® ($DJI) gained 253.58 points (0.7%) to 38,239.98; the NASDAQ Composite advanced 169.30 points (1.1%) to 15,451.31.
  • The 10-year Treasury note yield (TNX) was little changed at 4.617%.
  • The CBOE Volatility Index® (VIX) fell 1.41 to 16.39.

Chipmaker strength lifted the Philadelphia Semiconductor Index (SOX) up 1.7% Monday, partially reclaiming last week’s 9.2% tumble. Banking shares were also among the strongest sectors, while the Russell 2000® Index (RUT) advanced 1%. WTI crude futures earlier dropped to just a few cents above $82 per barrel, the lowest intraday price since late March.

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Telemedicine has a lot of potential to bridge barriers and make it convenient for people to access healthcare. But it’s limited by lack of tools. Your doctor can’t reach through the computer screen.”—Akshaya Anand, co-founder of Korion Health, on the startup’s efforts to create an electronic stethoscope for clinicians to record heart and lung movement (Maryland Today)

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DAILY UPDATE: Anti-Competitive Practices in Healthcare and the NASDAQ and S&P 500 Losing Streak!

HAPPY EARTH DAY

By Staff Reporters

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Feds Open Online Portal for Reporting AntiCompetitive Practices in Healthcare

Federal agencies want to hear from the public about monopolistic and anticompetitive behavior within the healthcare industry. Last Thursday, the Federal Trade Commission (FTC), the Department of Justice (DOJ) and the Department of Health and Human Services (HHS) unveiled HealthyCompetition.gov, an online portal where anyone can submit a healthcare competition complaint for potential investigation.

These submissions, the agencies said, can help the agencies ensure healthcare organizations provide quality care and pay their employees a fair wage.

Source: Dave Muoio, Fierce Healthcare [4/18/24]

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The S&P 500 just had its worst week in more than a year, and the NASDAQ is on a four-week losing streak. Blame skepticism that AI will meaningfully boost profits: Since the NASDAQ peaked last month, the largest US tech companies have lost more than $930 billion in market value. NVIDIA alone lost $212 billion in value on Friday, its biggest plunge since March 2020.

PS: Exxon Mobil is worth more than Tesla for the first time in more than a year.

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PODCAST: CVS Corporate History

By Eric Bricker MD

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Why the Survival and Dominance of Car Manufacturers is Far from Certain

A SPECIAL REPORT

(In case you missed it)

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#12: Vitaliy Katsenelson, Value Investor (invest like Buffett, stocks ...

By Vitaliy Katsenelson CFA

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I am going to share with you excerpts from a research paper I wrote in 2018 about Tesla and electrical vehicles (EVs), which I have turned into a small book for reader convenience (it is available for free, here). I want to share these essays with you today because we are at a pivotal moment for traditional carmakers, and these essays, which I have not updated, present an important thinking framework about the industry.

It is easier to convince shareholders and the board of directors to invest money into new factories when the demand for EVs is growing, even if you are losing money per vehicle. At least there is hope that once you get to scale and perfect new technology, the losses will turn into profits.

However, when the demand for electrical vehicles stutters and your inventory of EVs starts piling up – which is exactly what is happening right now – investing in EVs becomes very difficult (I wrote about it here).

Retreating to what you know, what has worked for almost a century, what doesn’t generate huge losses with every vehicle sold, and what your current workforce is trained for, and comfortable producing, seems like a natural decision. The decisions traditional carmakers will make over the next year or two will be very important for what their future looks like a decade or two from now.
Why the Survival and Dominance of Car Manufacturers is Far from Certain

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DAILY UPDATE: BoA “De-Banks”, Hospitals Merge and Walmart Health Grows as the NASDAQ Dives

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A group of 15 financial officers representing 13 states issued a warning to Bank of America over its alleged practices of “politicized de-banking” targeting conservatives. In a letter to Bank of America CEO Brian Moynihan, the officials said the bank’s practices threaten its own financial health and reputation with customers while simultaneously harming the U.S. economy and Americans’ civil liberties. They pointed to examples of Bank of America shuttering the accounts belonging to Christian groups and leaders and joining a net-zero climate alliance in addition to its poor viewpoint diversity rating.

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Texas and Missouri will soon have about two dozen Walmart health centers, the retail giant announced this month, adding to its 50-site roster. The company plans to open eight clinics in the Houston metro area, 10 sites in the Dallas-Fort Worth area, and four facilities in Kansas City by the end of 2024, Modern Healthcare reported.

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Hospitals reported the strongest quarter of mergers and acquisitions since 2020, according to consulting firm Kaufman Hall. Four of the 20 announced transactions in the first quarter of 2024 were “megamergers” and brought in $12 billion in revenue in that time period, per the firm’s analysis. The era of consolidation is here.

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Here’s where the major benchmarks ended:

  • The S&P 500 index fell 43.89 points (0.9%) to 4,967.23, down 3% for the week; the Dow Jones Industrial Average gained 211.02 points (0.6%) to 37,986.40, little changed for the week; the NASDAQ Composite lost 319.49 points (2.1%) to 15,282.01, down 5.5% for the week.
  • The 10-year Treasury note yield (TNX) dropped more than 2 basis points to 4.623%, still up about 10 basis points for the week.
  • The CBOE Volatility Index® (VIX) rose 0.71 to 18.71.

Nvidia (NVDA) plunged 10% to lead the chip sector lower, sending the Philadelphia Semiconductor Index (SOX) down 4.1% to a two-and-a-half-month low. Communication Services shares were also among the weakest sectors, fueled by Netflix weakness. There were several pockets of strength, however. Banking shares posted firm gains Friday behind stronger-than-expected quarterly results from some regional lenders. Utilities also advanced.

The S&P 500 has fallen 5.5% from a record close March 28, more than halfway to the 10% threshold that’s traditionally viewed as a correction. The NASDAQ Composite is down 7.1% from a record close on April 11th.

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DAILY UPDATE: Stark Laws & 23andMe as Wall Street Pulls Back

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If the practice makes a reasonable effort to collect from a patient who is experiencing financial hardship (e.g., job loss due to COVID-19), providers may be able to offer a discount (e.g., settle for 70% of the amount owed) without violating Stark Law, says Reed Tinsley, CPA, healthcare consultant in Houston, Texas. “But remember that just because even if someone doesn’t have a job, they could still have money,” he adds. “There are a lot of people out there with big savings accounts.”

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Source: Lisa A. Eramo, MA, Keith A. Reynolds, Physicians Practice [4/3/24]

  • 23andMe cofounder and CEO Anne Wojcicki wants to take the once-hot DNA company private. 23andMe said a Special Committee would evaluate the proposal in light of other options. The company’s valuation has tumbled since its stock market debut in 2021. The struggling DNA company once valued in the billions — was essentially worthless as of Wednesday.
  • But,shares soared Thursday less than three years after it began selling shares. Wojcicki told board members she is proposing to acquire the company in a potential go-private transaction, according to a filing with the Securities and Exchange Commission.

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Here’s where the major benchmarks ended:

  • The S&P 500 index fell 11.09 points (0.2%) to 5,011.12; the Dow Jones Industrial Average® ($DJI) rose 22.07 points (0.1%) to 37,775.38; the NASDAQ Composite lost 81.88 points (0.5%) to 15,601.50.
  • The 10-year Treasury note yield (TNX) gained almost 5 basis points to 4.633%.
  • The CBOE Volatility Index® (VIX) dropped 0.22 to 17.99.

Weakness in chip maker shares pushed the Philadelphia Semiconductor Index (SOX) down 1.7% to a two-month low. Biotechnology and consumer discretionary shares were also among the weakest sectors. Energy companies eroded as WTI Crude Oil (/CL) futures dropped for a third straight trading day and closed at a three-week low. 

The S&P 500 is on track for its third consecutive weekly decline, its weakest stretch since September, while the NASDAQ Composite appears headed for a fourth straight weekly slide.

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RETIREMENT: Can Doctors Afford It?

By Staff Reporters

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You’ve got a sense of your ideal retirement age. And you’ve probably made certain plans based on that timeline. But what if you’re forced to retire sooner than you expect? Aging baby-boomers, corporate medicine, the medical practice great resignation and/or the pandemic, etc?

RESIGNATION: https://medicalexecutivepost.com/2021/12/12/healthcare-industry-hit-with-the-great-resignation-retirement/

Early retirement is nothing new, but it’s clear how much the COVID-19 pandemic has affected an aging workforce. Whether due to downsizing, objections to vaccine mandates, concerns about exposure risks, other health issues, or the desire for more leisure time, the retired general population grew by 3.5 million over the past two years—compared to an annual average of 1 million between 2008 and 2019—according to the Pew Research Center.1 At the same time, a survey conducted by the National Institute on Retirement Security revealed that more than half of Americans are concerned that the COVID-19 pandemic has impacted their ability to achieve a secure retirement.2

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There’s no need to panic, but those numbers make one thing clear, says Rob Williams, managing director of financial planning, retirement income, and wealth management for the Schwab Center for Financial Research. Flexible and personalized financial planning that addresses how you’d cope if you had to retire early can help you make the best use of all your resources. 

So – Here are six steps to follow. We’ll use as an example a person who’s seeing if they could retire five years early, but the steps remain the same regardless of your individual time frame.

Step 1: Think strategically about pension and Social Security benefits

For most retirees, Social Security and (to a lesser degree) pensions are the two primary sources of regular income in retirement. You usually can collect these payments early—at age 62 for Social Security and sometimes as early as age 55 with a pension. However, taking benefits early will mean that you get smaller monthly benefits for the rest of your life. That can matter to your bottom line, even if you expect Social Security to be merely the icing on your retirement cake.

On the Social Security website, you can find a projection of what your benefits would be if you were pushed to claim them several years early. But if you’re part of a two-income couple, you may want to make an appointment at a Social Security office or with a financial professional to weigh the potential options.

For example, when you die, your spouse is eligible to receive your monthly benefit if it’s higher than his or her own. But if you claim your benefits early, thus receiving a reduced amount, you’re likewise limiting your spouse’s potential survivor benefit.

If you have a pension, your employer’s pension administrator can help estimate your monthly pension payments at various ages. Once you have these estimates, you’ll have a good idea of how much monthly income you can count on at any given point in time.

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Step 2: Pressure-test your 401(k)

In addition to weighing different strategies to maximize your Social Security and/or pension, evaluate how much income you could potentially derive from your personal retirement savings—and there’s a silver lining here if you’re forced to retire early. 

Rule of 55

Let’s say you leave your job at any time during or after the calendar year you turn 55 (or age 50 if you’re a public safety employee with a government defined-benefit plan). Under a little-known separation-of-service provision, often referred to as the “rule of 55,” you may be able take distributions (though some plans may allow only one lump-sum withdrawal) from your 401(k), 403(b), or other qualified retirement plan free of the usual 10% early-withdrawal penalties. However, be aware that you’ll still owe ordinary income taxes on the amount distributed. 

This exception applies only to the plan (including any consolidated accounts) that you were contributing to when you separated from service. It does not extend to IRAs. 

4% rule

There’s also a simple rule of thumb suggesting that if you spend 4% or less of your savings in your first year of retirement and then adjust for inflation each year following, your savings are likely to last for at least 30 years—given that you make no other changes to your withdrawals, such as a lump sum withdrawal for a one-time expense or a slight reduction in withdrawals during a down market. 

To see how much monthly income you could count on if you retired as expected in five years, multiply your current savings by 4% and divide by 12. For example, $1 million x .04 = $40,000. Divide that by 12 to get $3,333 per month in year one of retirement. (Again, you could increase that amount with inflation each year thereafter.) Then do the same calculation based on your current savings to see how much you’d have to live on if you retired today. Keep in mind that your money will have to last five years longer in this instance.

Knowing the monthly amount your current savings can generate will give you a clearer sense of whether you’ll have a shortfall—and how large or small it might be. Use our retirement savings calculator to test different saving amounts and time frames.

Step 3: Don’t forget about health insurance, doctor!

Nobody wants to spend down a big chunk of their retirement savings on unanticipated healthcare costs in the years between early retirement and Medicare eligibility at age 65. If you lose your employer-sponsored health insurance, you’ll want to find some coverage until you can apply for Medicare. 

Your options may include continuing employer-sponsored coverage through COBRA, insurance enrollment through the Health Insurance Marketplace at HealthCare.gov, or joining your spouse’s health insurance plan. You may also find discounted coverage through organizations you belong to—for example, the AARP. 

Step 4: Create a post-retirement budget

To make sure your retirement savings will cover your expenses, add up the monthly income you could get from pensions, Social Security, and your savings. Then, compare the total to your anticipated monthly expenses (including income taxes) if you were to retire five years early and are eligible, and choose to file, for Social Security and pension benefits earlier. 

Take into account various life events and expenditures you may encounter. You may not pay off your mortgage by the date you’d planned. Your spouse might still be working (which can add income but also prolong certain expenses). Or your children might not be out of college yet. 

You’re probably fine if you anticipate that your monthly expenses will be lower than your income. But if you think your expenses would be higher than your early-retirement income, some suggest that you take one or more of these measures:

  • Retire later; practice longer.
  • Save more now to fill some of the potential gap.
  • Trim your budget so there’s less of a gap down the road.
  • Consider options for medical consulting or part-time work—and begin to explore some of those opportunities now.

To the last point, finding a physician job later in life can be challenging, but certain employment agencies specialize in this area. If you can find work you like that covers a portion of your expenses, you’ll have the option of delaying Social Security and your company pension to get higher payments later—and you can avoid dipping into your retirement savings prematurely. 

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Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

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Step 5: Protect your portfolio

When you retire early, you have to walk a fine line with your portfolio’s asset allocation—investing aggressively enough that your money has the potential to grow over a long retirement, but also conservatively enough to minimize the chance of big losses, particularly at the outset.

“Risk management is especially important during the first few years of retirement or if you retire early,” Rob notes, because it can be difficult to bounce back from a loss when you’re drawing down income from your portfolio and reducing the overall number of shares you own.  

To strike a balance between growth and security, start by making sure you have enough money stashed in relatively liquid, relatively stable investments—such as money market accounts, CDs, or high-quality short-term bonds—to cover at least a year or two of living expenses. Divide the rest of your portfolio among stocks, bonds, and other fixed-income investments. And don’t hesitate to seek professional help to arrive at the right mix. 

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Many people are unaccustomed to thinking about their expenses because they simply spend what they make when working, Rob says. But one of the most valuable decisions you can make about your life in retirement is to reevaluate where your money is going now.

This serves two aims. First, it’s a reality check on the spending plan you’ve envisioned for retirement, which may be idealized (e.g., “I’ll do all the home maintenance and repairs!”). Second, it enables you to adjust your spending habits ahead of schedule—whichever schedule you end up following. This gives you more control and potentially more income. 

Step 6: Reevaluate your current spending

For example, if you’re not averse to downsizing, moving to a less expensive home could reduce your monthly mortgage, property tax, and insurance payments while freeing up equity that could also be invested to provide additional monthly income.

“When you are saving for retirement, time is on your side”. You lose that advantage when you’re forced to retire early, but having a backup plan that anticipates the possibility of an early retirement can make the unknowns you face a lot less daunting.

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References:

1Richard Fry, “Amid the Pandemic, A Rising Share Of Older U.S. Adults Are Now Retired”, Pew Research Center, 11/04/2021, https://www.pewresearch.org/fact-tank/2021/11/04/amid-the-pandemic-a-rising-share-of-older-u-s-adults-are-now-retired/.

2Tyler Bond, Don Doonan and Kelly Kenneally, “Retirement Insecurity 2021: Americans’ Views of Retirement”, Nirsonline.Org, 02/2021, https://www.nirsonline.org/wp-content/uploads/2021/02/FINAL-Retirement-Insecurity-2021-.pdf.

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StubHub! Plans to Go Public?

By Staff Reporters

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StubHub is an American ticket exchange and resale company. It provides services for buyers and sellers of tickets for sports, concerts, theater, and other live entertainment events. By 2015, it was the world’s largest ticket marketplace. While the company does not currently disclose its financials, in 2015 it had over 16 million unique visitors and nearly 10 million live events per month. StubHub was founded in 2000 by Eric Baker and Jeff Fluhr. The company was acquired by eBay for $310 million in 2007, and again acquired in 2020 by Viagogo.

StubHub reportedly plans to go public this summer?

According to The Information, the ticketing giant was last valued at $16.5 billion in 2021, but could still call off the public listing if it fails to land that figure.

The news comes amid a post-pandemic resurgence for live events, boosted by massive tours from Beyoncé and Taylor Swift. Though StubHub revenue jumped 40% in 2023 from the year before, it’s saddled with more than $2 billion in debt, which could test investors’ willingness to buy.

Rival ticketing service SeatGeek is also said to be mulling an IPO later this year.

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DAILY UPDATE: PBM Pricing Structure and UnitedHealth Cyber Fury as Stock Markets Tumble

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Pharmacy Benefits Managers often need more transparency regarding their pricing structures and the rebates they negotiate with drug manufacturers. Some argue that PBMs might receive hidden fees or undisclosed profits from drug manufacturers in exchange for favorable positioning on their formularies (lists of covered medications). This can be seen as a form of kickback, which is illegal.

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Lawmakers Express Fury Toward UnitedHealth in Change Attack Hearing on the fallout surrounding the unprecedented cyberattack on Change Healthcare in late February. Individuals representing the American Hospital Association, private cybersecurity groups and providers testified before members of the House Energy and Commerce Committee on April 16th to discuss the healthcare industry’s response to the attack and how the federal government should act.

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In March, the cyber criminal organization received $22 million in bitcoins, though UnitedHealth Group has not addressed whether the company paid the ransom. On April 15th, ransomware group RansomHub posted files on its dark web leak site comprising of personal and protected health information on patients whose data was taken in the hack. The files also include contracts and agreements between Change and its clients, marking the first time hackers have posted data from the attack.

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Source: Jakob Emerson, Becker’s Hospital Review

Stocks started the day strong yesterday but ended up slumping before the market closed as investors pulled back on tech stocks, including Nvidia. United Airlines took off after releasing a strong forecast for the year despite saying it took a $200 million hit because of Boeing’s troubles.

Here’s where the major benchmarks ended:

  • The S&P 500 index lost 29.20 points (0.6%) to 5,022.21; the Dow Jones Industrial Average declined 45.66 points (0.1%) to 37,753.31; the NASDAQ Composite dropped 181.88 points (1.2%) to 15,683.37.
  • The 10-year Treasury note yield (TNX) decreased more than 7 basis points to 4.585%.
  • The CBOE Volatility Index® (VIX) fell 0.20 to 18.20.

ASML’s slump helped send the Philadelphia Semiconductor Index (SOX) down 3.3% to its lowest level since late February. Transportation shares were also under pressure after trucking company J.B. Hunt Transport Services (JBHT) dropped 8.1% in the wake of disappointing quarterly numbers. Energy shares slipped as WTI Crude Oil (/CL) futures fell 3% to a three-week low. 

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CERTIFIED MEDICAL PLANNER™ Niche Financial Advisor Professional Designation

Think Different – Be Different  – Thrive

[By Ann Miller RN MHA]

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Dear Physician Focused Financial Advisors

Did you know that desperate doctors of all ages are turning to knowledgeable financial advisors and medical management consultants for help? Symbiotically too, generalist advisors are finding that the mutual need for knowledge and extreme niche synergy is obvious.

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planning

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But, there was no established curriculum or educational program; no corpus of knowledge or codifying terms-of-art; no academic gravitas or fiduciary accountability; and certainly no identifying professional designation that demonstrated integrated subject matter expertise for the increasingly unique healthcare focused financial advisory niche … Until Now! 

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Enter the CMPs

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Think Different

 [Think Different – Be Different – Thrive]

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So, if you are looking to supplement your knowledge, income and designations; and find other qualified professionals you may want to consider the CMP® program.

Enter the Certified Medical Planner™ charter professional designation. And, CMPs™ are FIDUCIARIES, 24/7.

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FINANCIAL ADVISORS: Finally Website Posting Their Fees?

Nevertheless – Physicians and All Investors Must be AWARE & INFORMED!

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Many financial planning websites mention fees, as required, but still remain opaque to potential clients because the advisor wants to control the discussion and understandably wishes to avoid the website shopper phenomenon.

But, physicians and all investors can still control the discussion, and still provide transparency, because posting up front pricing information doesn’t mean presenting information in a vacuum!

For example, a 1%/year fee doesn’t have to just be 1%; it can be 1%, compared to an industry average cost of X%, where the average cost of an actively managed mutual fund is Y%.

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See the source image

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Similarly, it doesn’t have to be a retainer fee of $1,000/year; it can be a retainer fee for less than the cost of a monthly cable bill! And, a financial plan doesn’t cost $1,500; it costs 8-12 hours of staff time to craft extensive, customized solutions; but saves the doctor-client so much more!

And, if services have a range of potential prices, they might be provided with some insight into the factors that impact the price. Modern young and internet savvy doctors expect this sort of information.

ASSESSMENT: Your thoughts are appreciated.

LINK: https://medicalexecutivepost.com/2015/04/06/understanding-the-failure-to-recognize-mutual-fund-fees/

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INVESTMENT BANKING UPDATE: Rules, securities markets, brokerage accounts, margin and debt review

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A Primer for Investors and Entrepreneurial Medical Professionals

Dr. David Edward Marcinko; MBA, CMP™

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Investment banking is so back. All of the biggest banks have reported their first-quarter 2024 results, and their earnings have been as good as, if not better than, expected. Higher interest rates ate into the spoils—Bank of America reported yesterday that its profit dropped 18% compared to the same period last year—but investment banking arms did well, especially since many banks increased their fees, and deal making and IPOs started to pick up again. But despite perking up, investment banking activity is still below where it used to be. Strong consumer spending also helped banks out, with credit card income rising and people and businesses continuing to need loans.

[PART 1 OF 8]

BC Dr. Marcinko

NOTE: This is an eight part ME-P series based on a weekend lecture I gave more than a decade ago to an interested group of graduate, business and medical school students. The material is a bit dated and some facts and specifics may have changed since then. But, the overall thought-leadership information of the essay remains interesting and informative. We trust you will enjoy it.

Introduction

The history, function and processes of the investment banking industry, and the rules and regulations of the securities industry and their respective markets, as well as the use of  brokerage accounts, margin and debt, will be briefly reviewed in this ME-P series.

An understanding of these concepts is required of all doctors and medical professionals as they pursue a personal investment strategy.

INVESTMENT BANKING AND SECURITIES UNDERWRITING

New economy corporate events of the past several years have provided many financial signs and symptoms that indicate a creeping securitization of the for-profit healthcare industrial complex. Similarly, fixed income medical investors should understand how Federal and State regulations impact upon personal and public debt needs. For, without investment banking firms, it would be almost impossible for private industry, medical corporations and government to raise needed capital.

Introduction

When a corporation such as a physician practice management company (PPMC), or similar entity needs, to raise capital for growth or expansion, there are two methods. Raising debt or equity. If equity is used, the corporation can market securities directly to the public by contacting its current stockholders and asking them to purchase the new securities in a  rights offering, by advertising or by hiring salespeople. Although this last example is somewhat exaggerated, it illustrates that there is a cost to selling new securities, which may be considerable if the firm itself undertakes the task.

For this reason, most corporations employ help in marketing new securities by using the services of investment bankers who sell new securities to the general public.  Although the investment banking is an exciting and vital industry, many SEC rules regulating it are not. Nevertheless, it is important for all physician executives to understand basic concepts of the industry if raising public money is ever a possibility or anticipated goal. It is also important for individual healthcare investors  to understand something about securities underwriting to reduce the likelihood of fraudulent investment schemes or ill-conceived transactions which ultimately result in monetary loss.

Fundamentals of the Investment Banking Industry

Investment bankers are not really bankers at all. The fact that the word banker appears in the name is partially responsible for the  false impressions that exist in the medical community regarding the functions they perform.

For example, they are not permitted to accept deposit, provide checking accounts, or perform other activities normally construed to be commercial banking activities. An investment bank is simply a firm that specializes in helping other corporations obtain the money they need under the most advantageous terms possible.

When it comes to the actual process of having securities issued, the corporation approaches an investment banking firm, either directly, or through a competitive selection process and asks it to act as adviser and distributor.  Investment bankers, or under writers, as they are sometimes called, are middlemen in the capital markets for corporate securities.

The medical corporation requiring the funds discuss the amount, type of security to be issued, price and other features of the security, as well as the cost to issuing the securities. All of these factors are negotiated in a process known as known as negotiated underwriting. If mutually acceptable terms are reached, the investment banking firm will be the middle man through which the securities are sold to the general public. Since such firms have many customers, they are able to sell new securities, without the costly search that individual corporations may require to sell its own security. Thus, although the firm in need of  additional capital must pay for the service, it is usually able to raise the additional capital at less expense through the use of an investment banker, than by selling the securities itself.

The agreement between the investment banker and the corporation may be one of two types. The investment bank may agree to purchase, or underwrite, the entire issue of securities and to re-offer them to the general public. This is  known as a firm commitment.

When an investment banker agrees to underwrite such a sale,  it  agrees to supply the corporation with a specified amount of money. The firm buys the securities with the intention to resell them. If it fails to sell the securities, the investment banker must still pay the agreed upon sum. Thus, the risk of selling rests with the underwriter and not with the company issuing the securities.

The alternative agreement is a best efforts agreement in which the investment banker makes his best effort to sell the securities acting on behalf of the issuer, but does not guarantee a specified amount of money will be raised.

When a corporation raises new capital through a public offering of stock, on might inquire from where does the stock come? The only source the corporation has is authorized, but previously un-issued stock. Anytime authorized, but previously un-issued stock (new stock) is issued to the public, it is known as a primary offering. If it’s the very first time the corporation is making the offering, it’s also known as the Initial Public Offering (IPO). Anytime there is a primary offering of stock, the issuing corporation is raising additional equity capital.

A secondary offering, or distribution, on the other hand, is defied as an offering of a large block of outstanding stock. Most frequently, a secondary offering is the sale of a large block of stock owned by one or more stockholders. It is stock that has previously been issued and is now being re-sold by investors. Another case would be when a corporation re-sells its treasury stock.

Prior to any further discussions of investment banking, there are several industry terms that’s should  be defined.

For example, an agent buys or sells securities for the account and risk of another party, and charges a commission. In the securities business, the terms broker and agent are used synonymously. This is not true of the insurance industry.

On the other hand, a principal is one who acts as a dealer rather than an agent or broker. A dealer buys and sells for his own account Finally, the dealer makes money by buying at one price and selling at a higher price. Thus, it is easy to understand how an investment banking firm earns money handling a best efforts offering; they make a commission on every share they sell.

  Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

The Securities Act of 1933 (Act of Full Disclosure)

When a corporation makes a public offering of its stock, it is bound by the provisions of the Securities Act of 1933, which is also known as the Act of Full Disclosure. The primary requirement of  the Act is that the corporation must file a registration statement (full disclosure) with the Securities and Exchange Commission (SEC); containing some of the following items:

  • Description of the business entity raising the money.
  • Biographical data regarding officers and directors of the issuer.
  • Listing of share holdings of officers, directors, and holders of more than 10% of the issuer’s securities (insiders).
  • Financial statements including a breakdown of existing capitalization (existing debt and equity structure).
  • Intended use of offering proceeds.
  • Legal proceedings involving the issuer, such as suits, antitrust actions or strikes.

Acting in its capacity as an adviser to the corporation, the investment banking firm files out the registration statement with the SEC. It then takes the SEC a period of time to review the information in the registration statement. This is the “cooling off period” and the issue is said to be “in registration” during this time. When the Act written in 1933, Congress thought that 20 days would be enough time from the filing date, until the effective date the sale of  securities is permitted.

In reality, it frequently takes much longer than 20 days for the SEC to complete its review. But, regardless of how long it lasts, it’s known as the cooling off period. At the end of the cooling off period, the SEC will either accept the issue or they will send a letter back to the issuer, and the underwriter, explaining that there is incomplete information in the registration statement. This letter is known as a deficiency letter. It will postpone the effectiveness of the registration statement until the deficiency is remedied. Even if initially, or eventually approved, an effective registration does not mean that the SEC has approved the issue.

For example, the following well known disclaimer statement written in bold red ink, is required to be placed in capital letters on the front cover page of every prospectus:

###

THESE SECURITIES HAVE NOT BEEN APPROVED OR DISAPPROVED BY THE SECURITIES AND EXCHANGE COMMISSION NOR HAS THE COMMISSION PASSED UPON THE ACCURACY OR ADEQUACY OF THIS PROSPECTUS. ANY REPRESENTATION TO THE CONTRARY IS A CRIMINAL OFFENSE.

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During the cooling off period, the investment bank tries to create interest in the market place for the issue. In order to do that, it distributes a preliminary prospectus, more commonly known as a “red herring”. It is known as a red herring because of the red lettering on the front page.  The statement on the very top with the date is printed in red as well as the statements on the left hand margin of the preliminary prospectus.

The cost of printing the red herring is borne by the investment bank, since they are  trying to market it.. The red herring includes information from the registration statement that will be most helpful for potential medical investors trying to make a decision. It describes the company and the securities to be issued; includes the firm’s financial statements; its current activities; the regulatory bodies to which it is subject; the nature of its competition; the management of the corporation, and what the expected proceeds will be used for. Two very important items  missing from the red herring are the public offering price and the effective date of the issue, as neither are known for certain at this point in time.

The public offering price is generally determined on the date that the securities become effective for sale (effective date). Waiting until the last minute enables the investment bankers to price the new issue in line with current market conditions. Since the investment banker uses the red herring to try to create interest in the market place, stock brokers [aka: Registered Representatives (RRs) with a Series # 7 general securities license –  After a 2 hour multiple-choice computerize test, I held this license for a decade ) will send copies of the red herring to their clients for whom they feel the issue is a suitable investment. The SEC is very strict on what can be said about an issue, in registration.

In fact, during the pre-filing period (the time when the negotiations are going on between the issuer\and underwriter), absolutely nothing can be said about it to anyone.  For example, if the regulators find out that your stock broker discussed with you  the fact that his firm was negotiating with an issuer for a possible public offering, he could be fined, or jailed.

During the cooling off period (the time when the red herring is being distributed), nothing may be sent to you; not a research report, nor a recommendation from another firm, or even the sales literature. The only thing you are permitted to receive is the red herring. The red herring is used to acquaint prospects with essential information about the offering. If you are interested in purchasing the security, then you will receive an “indication of interest”, but you can still not make a purchase or send money.

No sales may be made until the effective date; all that can be used to generate interest is the red herring.

Conclusion

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DAILY UPDATE: Tesla Lay Offs, Mammograms, Physician Pay, UnitedHealth and Tele-Health as Stock Markets Close Mixed

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Stat: 10%. That’s the percentage of Tesla employees that will be impacted by its global workforce reduction. Elon Musk sent an email to employees on Monday informing them of the layoffs, which he said were made to “reduce costs and increase productivity,” according to the WSJ. The move comes as the electric vehicle maker deals with a wider slowdown in EV sales. (the Wall Street Journal)

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UnitedHealth Group, reeling from the Change cyberattack, recorded a loss of $1.4 billion in the first quarter. Still, its EPS exceeded expectations and the stock is trading up.


The Florida Medicaid market is a big prize for insurers. Just three plans earned statewide contracts, starting in October.


And … physicians made steady pay gains last year, but increases were undercut by inflation rates. See how other specialties fared, according to a report from Medscape.

The social determinants of health can impact a woman’s chance of being up to date with her mammogram, according to a recent Centers for Disease Control and Prevention report. Women are less likely to get a mammogram if they feel socially isolated, have lost a job or don’t have reliable transportation.


And…A major House subcommittee is considering whether to issue another short-term extension on telehealth flexibilities as they continue to evaluate cost and quality issues or to enact permanent changes to virtual care reimbursement.  The American Telemedicine Association is pushing Congress to make permanent the Medicare telehealth flexibilities implemented during the COVID-19 pandemic.

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Here’s where the major benchmarks ended:

  • The S&P 500® index (SPX) declined 10.41 points (0.2%) to 5,051.41, its lowest close in almost two months; the Dow Jones Industrial Average® ($DJI) advanced 63.86 points (0.2%) to 37,798.97; the NASDAQ Composite® ($COMP) eased 19.77 points (0.1%) to 15,865.25.
  • The 10-year Treasury note yield gained almost 4 basis points to 4.667%.
  • The CBOE Volatility Index® (VIX) fell 0.83 to 18.40.

Scaled-back expectations for Fed rate cuts continued to burden interest-rate-sensitive sectors, such as banks and utilities. The KBW Regional Bank Index (KRX) lost 1.4% and ended near a five-month low. The small-cap Russell 2000® Index (RUT) dropped 0.4% and ended at a two-month low.

In other markets, the U.S. dollar index (DXY) strengthened for the fifth consecutive trading day and hit its highest level since late October, reflecting expectations rates will stay elevated. 

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WHAT IS A “CLOSED-END” MUTUAL FUND

REVIEW OF OPEN AND CLOSED MUTUAL FUNDS

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By staff reporters

A closed-end fund (CEF) or closed-ended fund is a collective investment model based on issuing a fixed number of shares which are not redeemable from the fund.

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Unlike open-end funds, new shares in a closed-end fund are not created by managers to meet demand from investors. Instead, the shares can be purchased and sold only in the market, which is the original design of the mutual fund, which predates open-end mutual funds but offers the same actively-managed pooled investments.

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Investment Adviser v. Mutual Fund Manager

“What’s the difference … and why pay fees to both?”

By Rick Kahler MS CFP®

http://www.KahlerFinancial.com

Rick Kahler MS CFPQuestions – from doctors – like these remind me that the workings of the financial services industry which I tend to take for granted but can be confusing to people outside the field.

The following analogy may help to explain.

Orchestra Analogy

Think of an orchestra. The investment adviser is the equivalent of the director/conductor and the money managers are the instrumentalists. Each one is a specialist who plays a particular type of instrument, and it takes a variety of these specialists to make up the orchestra.

Specialists

The broad specialties are the types of instruments, such as strings, brass, winds, and percussion. These are the equivalent of fund managers who specialize in asset classes like equities, bonds, real estate, commodities, and absolute returns.

Sub-Specialists

Within each specialty are a variety of subspecialists. Winds, for example, include clarinets, oboes, and saxophones—which are further divided into alto, soprano, tenor, and bass. The brass section has French horns, trumpets, and trombones. The divisions and sub-divisions go on and on. Similarly, within the various asset classes are a great many mutual fund managers who specialize in narrower subcategories.

Conductor

The task of the orchestra conductor-director is to pick, not just the best musicians, but the best mix of musicians. A group with only trumpets or every subspecialty of percussion, no matter how skilled, isn’t an orchestra. Before auditioning a single musician, the director’s first task is to clarify the purpose of the ensemble being created. A different mix of instruments will be required for a symphony, a marching band, an intimate chamber group, or a dance band. It all depends on what the audience wants.

The conductor-director needs to weigh the various musicians’ abilities against their cost and their specific specialties against the needs of the orchestra. When the right mix of players has been chosen, the director needs to pick the appropriate music, assemble the group, and rehearse. The director’s talent, experience, and leadership skills all serve to help the right players produce the right sound for their audiences.

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It takes similar coordination and skill to put together the right mix of asset classes and mutual fund managers to produce the best results for various clients, especially since there are some 17,000 mutual funds to choose from.

Fees

Just as both the orchestra director and the musicians are paid based on their skills and their work, both mutual fund managers and investment advisers are paid based on the assets they manage. Mutual fund managers earn 0.05% to 3.0%. Financial advisers earn 0.30% to 3.0%. An informed consumer could pay as low as 0.35% while an uninformed consumer could pay up to 6% a year, which would eat up most of the investment returns.

One essential responsibility for an adviser, then, is to choose mutual fund managers whose fees are low.

However, the cost of the mutual fund manager isn’t the be-all and end-all. One must also weigh performance, just as an orchestra director might pay more to get an outstanding musician who would add significant value to the performances.

Example:

For example, my firm’s overall average fee for mutual fund managers is 0.5%. We could get that as low as 0.1%, which might be impressive at first glance.

However, we would give up 0.25% to 1.00% of net return in some areas, resulting in poorer outcomes for the clients.

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INV_03_15_XMIT.indd

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Assessment

Skilled direction of an orchestra is obviously more art than science. Skilled coordination of mutual fund managers is the same. Both require knowledge, integrity, and commitment to the quality of the final product.

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Conclusion

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DAILY UPDATE: Dental and Digital Health Start-Ups as Stock Markets Collapse Again!

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Here’s where the major stock market benchmarks ended:

  • The S&P 500 index fell 61.59 points (1.2%) to 5,061.82; the Dow Jones Industrial Average lost 248.13 points (0.7%) to 37,735.11; the NASDAQ Composite® ($COMP) dropped 290.08 points (1.8%) to 15,885.02.
  • The 10-year Treasury note yield (TNX) surged almost 12 basis points to 4.618%.
  • The CBOE Volatility Index® (VIX) rose 1.92 to 19.23.

Interest-rate-sensitive sectors like real estate and utilities were among the weakest performers Monday. Technology shares were also under pressure. The small-cap Russell 2000® Index (RUT) shed 1.4% and ended at a two-month low.

In other markets, the U.S. dollar index (DXY) strengthened for the fourth consecutive trading day and hit its highest level since early November, reflecting expectations rates will stay elevated. Volatility based on the VIX jumped near 19.50, its highest level since late October.

Monday’s session also produced technical damage on the charts of benchmarks like the S&P 500, which closed under its 50-day simple moving average, currently around 5,114, for the first time since early November. The S&P 500 has dropped almost 4% from a record intraday high posted March 28th.

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And, after a tough funding year for digital health startups, the first quarter of 2024 saw a flurry of deals announced—a “positive signal” that the funding landscape is looking up, according to Adriana Krasniansky, head of research at digital health strategy group and venture fund Rock Health’s advisory arm. Overall, the number of digital health funding deals (133) that closed in Q1 was the highest in six quarters, though the average deal size ($20.6 million) was smaller, according to a Rock Health report. Total funding for digital health startups was $2.7 billion, the lowest level since 2019. An increase in the frequency of deals—even if they’re smaller—is a good sign, according to Krasniansky.

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Dental startup Tend aims to simplify the patient billing process via a partnership with health tech startup Cedar, the companies announced on April 11th, 2024. The US spends roughly $165 billion per year on dental services as of 2022, according to professional organization the American Dental Association—but the payment experience can be “opaque” and “confusing,” Matthew Fitzgerald, chief marketing officer at Tend, told Healthcare Brew. “From the outset, Tend has sought to innovate the dental experience by leveraging technology and hospitality to build a company around the patient,” Tend CEO Troy Bage said in a statement. “By partnering with Cedar, we’ll be able to streamline and simplify the payment process for all our members—further enhancing their overall experience with Tend, while unlocking new ways for us to elevate engagement.”

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Understanding the Failure to Recognize Mutual Fund Fees

 Going Granular and Deep with Obligatory “Fund Facts”

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[By Dr. David Edward Marcinko MBA CMP™]

DEM blueAn attractive investment and a polished sales pitch can often hide the underlying costs of the investment, leading some medical professionals to give up a significant portion of the long-term growth of their assets to fees. Fees absolutely matter.

In a good market investors have a propensity to ignore them and in challenging markets they are scrutinized, but in the end no matter what type of market we are in fees do make a substantial difference in your long-term investment returns.

Assessing the Worth of the Investment

The first step in assessing the worth of the investment under consideration is figuring out what the fees actually are.  If a medical professional is investing in a mutual fund, these costs are found in mutual fund company’s now obligatory “Fund Facts”.

This manuscript clearly outlines all the fees paid – including upfront fees (or commissions/loads), deferred sales charges, and any switching fees.  Fund management expense ratios are also part of the overall cost of ownership. Trading costs within the mutual fund can also impact performance.

The List of Fees Keep Coming … and Coming!

Here is a list of the traditional fees from investing in a mutual fund:

  • Front end load: It is the commission charged to purchase the fund through a broker or financial advisor. The commission reduces the amount you have available to invest. Thus if you start with $100,000 to invest and the advisor charges a 5 percent front end load, you end up actually investing $95,000.
  • Deferred Sales Charge (DSC) or back end load: Charge imposed if you sell your position in the mutual fund within a pre-specified period of time (normally five years). It is initiated at a higher start percentage (i.e. as high as 10 percent) and declines over a specific period of time.
  • Operating Fees: These are costs charged by the mutual fund including the management fee rewarded to the manager for investment services. It also includes legal, custodial, auditing and marketing.
  • Annual Administration Fee: Many mutual fund companies also charge an additional fee just for administering the account – usually under $150 per year. A 1 percent disparity in fees for a medical professional may not seem like a lot. But fees do make a considerable impact over a longer time period. [For example, a $100,000 portfolio that earns 8 percent before fees, grows to $320,714 after 20 years if the client pays a 2 percent operating fee. In comparison, if the investor opted for a fund that charges a more reasonable 1 percent fee, after 20 years, the portfolio grows to be $386,968 – a divergence of over $66,000! For many investors, this is the value of passive or index investing. In the case of an index fund, fees are generally under 0.5 percent, thus offering even more fee savings over an elongated period of time].

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[The Carousel of Fees]

Assessment

Fees and expenses can have significant impact on the performance of your investments. Always monitor the costs of an investment program to ensure that fees and expenses are reasonable for the services provided and are not consuming a disproportionate amount of the investment returns.

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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DAILY UPDATE: IRS Tax Day April 15th Exceptions as American Savings Rate is Down along with Nike, Jeep, Medicare Part C and these States?

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“Worried about an IRS audit? Avoid what’s called a red flag. That’s something the IRS always looks for. For example, say you have some money left in your bank account after paying taxes. That’s a red flag.

― Jay Leno

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HAPPY APRIL 15th 2024

Americans are saving less at their lowest pace in more than a year, and are apparently spending more than the growth of their incomes, according to an analysis by Wells Fargo that was shared with Newsweek.

In February, the personal savings rate hit 3.6 percent, “marking the lowest rate at which households saved in 14 months,” Wells Fargo economists noted in the Thursday report, adding that spending outpaced income growth for the month. The savings rate is higher than the below 3 percent level it fell to following the COVID-19 pandemic, but is nevertheless way down from the pre-pandemic rate of 6 percent.

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The deadline for most people to file a 2023 tax return with the IRS is fast approaching; returns are due by 11:59 p.m., in your time zone, on Monday, April 15th today, with some exceptions. Taxpayers in Massachusetts and Maine have until April 17th to file and pay taxes because of the Patriots’ Day and Emancipation Day holidays. There are also extensions in some areas impacted by extreme weather. Individuals and businesses impacted by the October 7th attack on Israel have also been given an extension, the IRS announced. There are extensions for certain active-duty military members and citizens living abroad.

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Nike announced plans to lay off around 1,600 employees, or about 2% of its global workforce, as part of a $2 billion cost-cutting strategy. CEO John Donahoe said performance has not been the best and took responsibility. Donahoe said, “This is a painful reality and not one that I take lightly.”

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Stellantis is the world’s fourth-largest automaker by sales, behind Toyota, Volkswagen Group, and Hyundai Motor Group. The company designs, manufactures, and sells automobiles bearing its 14 brands: Abarth, Alfa Romeo, Chrysler, Citroën, Dodge, DS, Fiat, Jeep, Lancia, Maserati, Opel, Peugeot, Ram, and Vauxhall. Their headquarters is located in Amsterdam, and they have over 300,000 employees in 130 countries.

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The Biden administration wants to make changes to private Medicare insurance plans that officials say will help seniors find plans that best suit their needs, promote access to behavioral health care and increase use of extra benefits such as fitness and dental plans. “We want to ensure that taxpayer dollars actually provide meaningful benefits to enrollees,” said Health and Human Services Secretary Xavier Becerra. If finalized, the proposed rules rolled out Monday could also give seniors faster access to some lower-cost drugs. Administration officials said the changes, which are subject to a 60-day comment period, build on recent steps taken to address what they called confusing or misleading advertisements for Medicare Advantage [Part C] plans. Just over half of those eligible for Medicare get coverage through a private insurance plan rather than traditional, government-run Medicare.

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Healthcare varies substantially by state based on dozens of factors. The same is valid for cities. Some of this is due to the availability of medical facilities. Some have to do with health habits. Some have to do with incomes and poverty levels. People who live in poor states, based on income, almost always have unhealthy populations. A new study from Renew Bariatrics shows the “Healthiest (and Unhealthiest) States in the US—2024 Rankings,” and reviews alcohol use, diabetes, drug overdoses, mental health, isolation, tobacco use, exercise, and the presence of heart disease, obesity, and cancer. These, taken together, create an index from 0 to 100, with 100 being the worst possible score. These are the most expensive states to live in.

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TAX SEASON: Planning and Preparation for Doctors

By Staff Reporters

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DEFINITION: Tax season is the period of time, generally between January 1st and April 15th of each year, when individual taxpayers prepare to report their taxable income to the federal government and, in most cases, to the government of the state in which they live.

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Some Year-End Preparation for the Upcoming Tax Filing Season

The filing season for 2023 tax returns us now upon us. A little advance preparation can prevent stressful tax time surprises for doctors and all medical professionals. Here are some important steps you can take now to set yourself up for worry-free tax filing:

  • Do one last withholding checkup. Time is running out to adjust your paycheck withholding to make sure you have paid enough tax throughout 2023. You can use the online IRS Withholding Estimator tool to make sure your numbers are on track.
  • If your name changed in 2023, report the change to the Social Security Administration as soon as possible, preferably before the end of the year.
  • Locate your bank account information, including both your account number and the bank routing number, so you can receive your tax refund by direct deposit.
  • Watch for year-end income statements, especially in late January and early February. These statements may include W-2 forms, along with 1099-NEC, 1099-MISC, 1099-INT, 1099-G and other 1099 forms. Note that some of these forms may come by mail, while others may be sent to you electronically. Keep all of the forms together and organized.
  • Organize records for tax deductions and credits. These records may include Form 1095-A (Health Insurance Marketplace Statement), tuition statements (Form 1098-T), medical bills, mortgage interest statements, and home energy improvement or clean vehicle receipts or invoices.

Waiting until the last minute to try to assemble these documents can lead to missing the filing deadline, so start early.

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DAILY UPDATE: Medicaid and Government Employee Health Insurance Changes as Stocks Tank

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Texas Governor Greg Abbott has issued a sharp warning about proposed changes to Medicaid, claiming they could “strip millions of Americans” from access to healthcare. In February 2023, the Centers for Medicare & Medicaid Services (CMS) issued a new proposed rule that would change long-standing practices for how states fund the non-federal share of Medicaid payments. In particular, the CMS is pushing for greater oversight of how states use of healthcare provider taxes to help fund their programs.

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Democratic lawmakers Sen. Richard Blumenthal and Rep. Andy Kim have partnered up with Republican Rep. Jen Kiggans to introduce legislation aiming to give army reservists and members of the National Guard that also work for the federal government options on the type of health care plans they can receive. The bill, which could impact thousands of federal employees that are also in the U.S. Army, plans to give this group of Americans the ability to decide whether they want military or civilian health care. The lawmakers said in a shared statement that their proposal will fix current regulations that limit service members who also work for the government to enroll in the cheaper Tricare Reserve Select (TRS) health plan when they also qualify for federal health plans.

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Stocks tanked last Friday after the big banks reported underwhelming earnings and the sheen from the Magnificent Seven’s AI-driven surge earlier this week wore off. Meanwhile, oil prices continue to rise near six-month highs as concern grows over geopolitical tensions in the Middle East. The tech sector was highlighted in this market, particularly due to the exceptional performance of a group of mega-cap tech giants last year nicknamed the “Magnificent Seven.” This elite group includes Apple (AAPL), Amazon (AMZN), Alphabet (GOOGL), Meta Platforms (META), Microsoft (MSFT), Nvidia (NVDA) and Tesla (TSLA).

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DAILY UPDATE: Mike Burry MD, Private Equity in Health Systems, Drug Shortages, United Health Stock Sale and the Change Healthcare Hack as the Stock Markets Re-Collapse!

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  • Medical colleague and our financial planning for physicians textbook contributor Michael Burry MD predicted a second inflation surge, and price growth re-accelerated in March,. 2024.
  • The “Big Short” investor first warned of inflation in April 2020, over two years before it peaked.
  • Burry expected a recession, rate cuts, and stimulus spending to reignite inflation.

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A growing number of drugs are in short supply around the U.S., according to pharmacists. 

In the first three months of the year, there were 323 active medication shortages, surpassing the previous high of 320 shortages in 2014, according to a survey by the American Society of Health-System Pharmacists (ASHP) and Utah Drug Information Service. It also amounts to the most shortages since the trade group started keeping track in 2001. “All drug classes are vulnerable to shortages. Some of the most worrying shortages involve generic sterile injectable medications, including cancer chemotherapy drugs and emergency medications stored in hospital crash carts and procedural areas,” ASHP said in a statement

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

Scheduling an appointment with a primary care doctor who belongs to a large health system might cause an increase in health care spending, according to a recent study. Such physicians tend to make more referrals to specialists, and emergency room visits and hospitalizations sometimes increase, according to the research out of Harvard T.H. Chan School of Public Health.

In short, physicians who work for health care systems like hospitals are more likely to recommend that patients use other services within those systems, compared with independent physicians. For the study — which was published in JAMA Health Forum, a journal of the American Medical Association — researchers analyzed the experiences of more than 4 million patients in Massachusetts.

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UnitedHealth Chairman Stephen Hemsley and other executives sold $102 million in company stock months before a federal antitrust probe became public, Bloomberg reported.

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Small physician practices are still struggling in the wake of February’s Change Healthcare cyberattack, according to an American Medical Association (AMA) survey released Wednesday.

More than half of ~1,400 respondents (55%) reported that they’ve had to use personal funds to cover their practice’s expenses due to the cyberattack’s effects on cash flow. Practices across the country have been unable to fill prescriptions or process insurance claims as Change Healthcare systems went offline, Healthcare Brew previously reported. About two-thirds of respondents said they’ve experienced restrictions to core functions, such as suspending claim payments (36%), not being able to submit claims (32%), and not being able to obtain electronic remittance advice (39%), according to the survey.

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Here’s where the major benchmarks ended:

  • The S&P 500 index fell 75.65 points (1.5%) to 5,123.41, down 1.6% for the week; the Dow Jones Industrial Averagelost 475.84 points (1.2%) to 37,983.24, down 2.4% for the week; the NASDAQ Composite® ($COMP) dropped 267.10 points (1.6%) to 16,175.09, down 0.5% for the week.
  • The 10-year Treasury note yield (TNX) fell more than 5 basis points to 4.52%, still up about 12 basis points for the week.
  • The CBOE Volatility Index® (VIX) rose 2.38 to 17.30.

Semiconductor shares were also among the weakest performers Friday as chip makers reversed Thursday’s sharp gains. The Philadelphia Semiconductor Index (SOX) dropped more than 3% and ended with its third straight weekly decline. Energy companies were also under pressure after crude oil prices retreated from the morning rally. Oil futures are still up 20% this year. The small-cap Russell 2000® Index (RUT) lost 1.9% and posted a 2.9% drop for the week.

In other markets, the U.S. dollar index (DXY) strengthened to a five-month high and gained 1.7% this week, reflecting beliefs the hotter-than-expected inflation readings earlier this week will keep interest rates elevated. Volatility based on the VIX jumped to its highest level since late October.

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PODCAST: What is the “Paradox of Thrift”

The Opposite of Consumerism During the Corona Pandemic!

Dr. David Edward Marcinko MBA CMP©

Courtesy: www.CertifiedMedicalPlanner.org

The paradox of thrift (saving) states that an increase in autonomous saving leads to a decrease in aggregate demand and thus a decrease in gross output which will in turn lower total saving. The paradox is that total saving may fall because of individuals’ attempts to increase their saving, and, broadly speaking, that increase in saving may be harmful to an economy.

Both the narrow and broad claims are paradoxical within the assumption underlying the fallacy of composition, namely that which is true of the parts must be true of the whole. The narrow claim transparently contradicts this assumption, and the broad one does so by implication, because while individual thrift is generally averred to be good for the economy, the paradox of thrift holds that collective thrift may be bad for the economy.

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DAILY UPDATE: Costco Gold, CPI, US Stamps and the Mexican Peso as Technology Stocks Rise and Private Equity Takes on Medicine

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Costco started selling gold bars to its members last August, and Wells Fargo analysts believe that the product is now bringing in between $100 million and $200 million a month. The retailer doesn’t reveal the price of the 1-ounce bullion to nonmembers online, but it’s estimated to be ~2% above the spot price gold trades at, per CNBC—and that price has soared since Costco got into the gold game. The price of gold has gone up 13% this year and reached record highs as investors pile in amid inflation worries.

The big numbers from the Consumer Price Index data released on Thursday

  • In March, inflation rose 3.5% from the year before, up from 3.2% in February.
  • The “core” CPI reading, which excludes volatile food and fuel prices, came in even higher, rising 3.8% on an annual basis. That’s the same as in February, but this time it’s serious.
  • Half of the increases came from rising gas prices and housing.

After seeing inflation fall by 3% over the course of 2023, Fed officials believed that higher inflation readings in January and February 2024 represented a hiccup in an otherwise downward trajectory. However, with the March reading also coming in hotter than anticipated, analysts say this is more than a fluke. That means hopes for a June interest rate cut are dashed. Even the US Postal Service plans to raise the price of “forever” stamps to $0.73 in July. Get yours now. And the Mexican peso is on an absolute tear, leaving the US dollar behind.

CITE: https://www.r2library.com/Resource/Title/082610254

Here’s where the major stock benchmarks ended:

  • The S&P 500® index (SPX) advanced 38.42 points (0.7%) to 5,199.06; the Dow Jones Industrial Average® ($DJI) lost 2.43 points to 38,459.08; the NASDAQ Composite gained 271.84 points (1.7%) to 16,442.20.
  • The 10-year Treasury note yield (TNX) rose nearly 2 basis points to 4.578%.
  • The CBOE Volatility Index® (VIX) fell 0.89 to 14.91.

Chip maker strength lifted the Philadelphia Semiconductor Index (SOX) more than 2% and extended the benchmark’s year-to-date gain to more than 17%. Communications services and transportation shares were also among the strongest sectors. Financial shares were mixed ahead of expected quarterly results Friday from some major banks including JPMorgan Chase (JPM), Citigroup (C), and Wells Fargo (WFC). 

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  • Big businesses such as hospital systems, insurers, and PE firms are gobbling up medical clinics.
  • Some doctors and industry experts fear corporate owners could prioritize profits ahead of patients.
  • The federal government is dialing up scrutiny of PE firms and other corporate owners in healthcare.

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QUESTION: Are Independent doctors almost a thing of the past?

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DAILY UPDATE: KPMG Fined, Aging Doctors, Water Fluoridation Outcries, Medicare Part C Down, CBO Deficit with Inflation Up as Stock Markets Crash!

MEDICAL EXECUTIVE-POST Today’s Newsletter

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NEW YORK (Reuters) -The U.S. accounting watchdog on Wednesday said it has hit KPMG Netherlands with a $25 million civil penalty, a record for the regulator, in response to “egregious” and widespread exam cheating at the foreign affiliate of the major audit firm.

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As millions of Americans approach age 66, they face the inevitable question, is it time to retire? The physician population is aging alongside the general population—more than 40% of physicians in the U.S. will be 65 years or older within the next decade. In the case of surgeons, there is little guidance on how to best ensure their competency throughout their career and at the same time maintain patient safety while preserving mature physician dignity.

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It is a scenario playing out nationwide. From Oregon to Pennsylvania, hundreds of communities have in recent years either stopped adding fluoride to their water supplies or voted to prevent its addition. Supporters of such bans argue that people should be given the freedom of choice. The broad availability of over-the-counter dental products containing the mineral makes it no longer necessary to add to public water supplies, they say. The Centers for Disease Control and Prevention says that while store-bought products reduce tooth decay, the greatest protection comes when they are used in combination with water fluoridation.

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More health systems are going to be opting out of Medicare Advantage (MA) plans, George Hill, a managing director at Deutsche Bank in Boston, predicted Monday at a “Wall Street Comes to Washington” webinar hosted by the Brookings Institution. “I think you’re going to see more large provider organizations threaten to opt out of networks, particularly as it relates to MA,” Hill said, adding that there are a number of reasons for this. “Prior authorizations are the problem, claims denials are a huge problem, delayed payments and rates are the problem — barriers in access to care in all varieties are the problem.”

CITE: https://tinyurl.com/tj8smmes

The latest budget update from the nonpartisan Congressional Budget Office (CBO) found that the federal government has spent more on paying interest on the national debt than on the military in fiscal year 2024. The CBO’s budget report for March showed that the U.S. has spent $412 billion on military programs at the Department of Defense through the first half of FY-2024, according to preliminary figures from CBO and the Treasury Department. 

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Consumer price increases remained high last month, boosted by gas, rents, and car insurance, the government said Wednesday in a report that will likely give pause to the Federal Reserve as it weighs when and by how much to cut interest rates this year. Prices outside the volatile food and energy categories rose 0.4% from February to March, the same accelerated pace as in the previous month. Measured from a year earlier, these core prices were up 3.8%, unchanged from the year-over-year rise in February. The Fed closely tracks core prices because they tend to provide a good read of where inflation is headed.

Here’s where the major benchmarks ended:

  • The S&P 500® index (SPX) dropped 49.27 points (1.0%) to 5,160.64; the Dow Jones Industrial Average lost 422.16 points (1.1%) to 38,461.51; the NASDAQ Composite® ($COMP) fell 136.28 points (0.8%) to 16,170.36.
  • The 10-year Treasury note yield (TNX) soared more than 18 basis points to 4.548%.
  • The CBOE Volatility Index® (VIX) jumped 0.82 to 15.80.

Interest-rate-sensitive sectors like banks, real estate, and utilities led Wednesday’s decliners. The KBW Regional Bank Index (KRX) tumbled 5% to its lowest point since late November. The small-cap Russell 2000® Index (RUT) lost 2.5%. Energy shares were among the few gainers as WTI Crude Oil (/CL) futures rebounded after three-straight losing sessions.

In other markets, the U.S. dollar index (DXY) jumped 1% to a five-month high amid expectations interest rates will remain elevated.

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DAILY UPDATE: Stocks Slightly Up Awaiting CPI Report

By Staff Reporters

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Boeing had yet another rough day, at one point dropping 2.5% to its lowest mark in five months after reports that the FAA is investigating a whistleblower’s claims about safety issues with the 787 Dreamliner.

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And, US stocks on Tuesday ended with small moves, weighed down by the financial sector ahead of key earnings reports later this week. Market participants also exhibited caution a day before the latest consumer inflation data. Wall Street’s three major averages opened in the green but then spent most of the day languishing in negative territory.

Finally, the tech-heavy NASDAQ Composite (COMP:IND) eventually closed 0.32% higher at 16,306.64 points, while the benchmark S&P 500 (SP500) added 0.15% to settle at 5,209.94 points. The blue-chip Dow (DJI) fell marginally by 0.02% to conclude at 38,883.67 points.

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Here’s where the major benchmarks ended:

  • The S&P 500® index (SPX) gained 7.52 points (0.1%) to 5,209.91; the Dow Jones Industrial Average® ($DJI) lost 9.13 points (0.02%) to 38,883.67; the NASDAQ Composite® ($COMP) rose 52.68 points (0.3%) to 16,306.64.
  • The 10-year Treasury note yield (TNX) fell more than 6 basis points to 4.358%.
  • The CBOE Volatility Index® (VIX) fell 0.21 to 14.98.

Financial and industrial shares led Tuesday’s decliners. Oil services stocks were also soft as WTI Crude Oil (/CL) futures dropped for a third consecutive trading session. The Philadelphia Oil Service Index (OSX) lost 0.7% and ended at its lowest point since April 1. 

In other markets, Gold (GC) futures neared $2,400 per ounce and hit a record high for the eighth consecutive trading session. Gold’s rally has been driven by factors including reports of purchases by China’s central bank as well as expectations for lower interest rates and escalating conflict in the Middle East. Bitcoin (BTC) tumbled about 3.5% and fell to less than $70,000, giving up much of Monday’s gain.

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What is Financial Portfolio “DI-WORSIFICATION”

Versus Di-Versification

BUSINESS MANAGEMENT: The term “diworsification” was coined by legendary investor Peter Lynch in his book, One up on Wall Street, to describe the over-expansion of a company into new growth projects and businesses they do not fully understand and which do not align with the company’s core competencies.

See the source image

PORTFOLIO MANAGEMENT: The term diworsification has since grown to also refer to over-diversifying an investment portfolio in such a way that it reduces the overall risk-return characteristics.

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READ: https://medicalexecutivepost.com/2014/11/12/the-negative-short-term-implications-of-diversification/

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DAILY UPDATE: U.S.A. Stock Markets Little Changed

By Staff Reporters

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Like use, investors were a little checked out yesterday, focusing on the eclipse or maybe the fact that earnings season starts later this week, and stocks were relatively flat. Diamondback Energy hit an all-time high following several other energy companies that did so last week as oil prices surge.

Here’s where the major benchmarks ended:

  • The S&P 500® index (SPX) lost 1.95 points (0.04%) to 5,202.39; the Dow Jones Industrial Average® ($DJI) eased 11.24 points (0.03%) to 38,892.80; the NASDAQ Composite® ($COMP) gained 5.44 points (0.03%) to 16,253.96.
  • The 10-year Treasury note yield rose more than 4 basis points to 4.422%.
  • The CBOE Volatility Index® (VIX) fell 0.84 to 15.19.

Bank shares were among Monday’s strongest performers, sending the KBW Regional Banking Index (KRX) up 1.5%. Consumer discretionary companies were also strong. WTI Crude Oil (/CL) futures fell sharply earlier in the session following reports Israel had removed some troops from Gaza but bounced back to end down 0.5% at around $86.47 per barrel.

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The Path to Successful Investing

By Vitaliy Katsenelson, CFA
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Something weird happened to me on Twitter a few months ago. A “follower” started lashing out at me about a stock we own. When people attack me for my views it doesn’t bother me (I wrote several chapters in Soul in the Game on this topic). I don’t let personal attacks get to me, unless people start attaching bricks to their 280 characters. 

This person’s lambasting of me was different. He was upset about the decline of a stock I had never publicly discussed in any of my newsletters or talks. This person was not a client. I didn’t know who he was; I had never met him. I was really confused why a stock my clients and I personally owned was so important to him. It’s like someone being upset about the color my wife chose to paint our kitchen.

Once gently confronted, he apologized, said he was a big fan, and explained that he had read my 13F (a form we have to file with the SEC 45 days after the quarter end, where we have to report our holdings in US stocks). He saw that the stock was one of our top holdings, and he bought it. Because I owned it, he made it a disproportionately large position.

I was truly upset about this incident. One of my principles in life is to have a net positive impact on the people I touch. If every single stock I discussed only went straight up, I wouldn’t have to worry about it. But this is not how life works.

Let me give you an example: No Shortcuts to Greatness: The Path to Successful Investing

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DAILY UPDATE: Nvidia in Medicine, IRs and the Big Banks

By Staff Reporters

SAFE SOLAR ECLIPSE DAY

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NVIDIA
is accelerating the pace of healthcare innovation! Last week they unveiled a suite of AI microservices for developers, launched cutting-edge healthcare AI tools, and deepened their collaborations with giants like Johnson & Johnson. Plus, they’re ramping up investment in clinical trials and drug design. 

Do you ever struggle with finding the best sources of information about healthcare AI? Check out my new video, where I share my favorite newsletters, websites, sub-reddits, and a list of must-follow experts. With this toolkit, you won’t miss anything important. Also, I hope you enjoyed a restful and Happy Spring Break – should you celebrate it!

Bertalan Meskó, PhD
The Medical Futurist

READ MORE: https://www.cnbc.com/2024/03/24/nvidias-ai-ambitions-in-medicine-and-health-care-are-becoming-clear.html?utm_source=The+Medical+Futurist+Newsletter&utm_campaign=f5908296a8-EMAIL_CAMPAIGN_2024_04_07_Resend&utm_medium=email&utm_term=0_efd6a3cd08-f5908296a8-399696053&mc_cid=f5908296a8&mc_eid=40fee31c25

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Last week, several Fed officials said they were in no rush to slash interest rates in 2024, which investors have been banking on this year. Meanwhile, oil prices have risen to five-month highs due to concerns about supply shocks in key areas around the world.

And, Wall Street is preparing for a crammed week, with crucial inflation data dropping on Wednesday and big banks (JPMorgan, Wells Fargo, Citigroup) inaugurating earnings season on Friday. The pressure is on companies to post beefy profits to back up their strong stock performance in Q1.

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DOCTORS FEELING WEALTHY: How Much is [Really] Enough?

By Staff Reporters

SPONSOR: http://www.MARCINKOASSOCIATES.com

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What does wealth mean to you?

In a recent survey by Edelman Financial Engines, 57% of respondents said they’d feel wealthy if they had $1 million in the bank. But for many people, like doctors, that may not be enough.

Among those with $500,000 and $3 million in assets, 53% said it would take over $3 million in the bank for them to feel wealthy, and 33% said it would take over $5 million. Given that these are amounts some people will never even come close to amassing in their lifetimes, it may be hard to wrap your head around these answers.

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RETIREMENT: The New “Magic Number” in 2024

By Staff Reporters

Since 2013 Americans believe they now need $1.46 million to retire in style

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The new magic number for retirement, found in a study by Northwestern Mutual, is 15% higher than what people thought they needed last year—and 53% higher than the amount people in 2020 pictured themselves needing to feel comfortable leaving the workforce to sit on a beach in Florida.

In fact, it’s also more than most people have socked away: On average, US adults have $88,400 saved for retirement.

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QUESTION: But what about doctors and medical professionals?

HABITS: https://medicalexecutivepost.com/2020/01/22/twenty-20-habits-of-eventual-millionaires/

DOCTORS PATH: https://medicalexecutivepost.com/2013/07/11/the-doctors-path-to-wealth/

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FINANCIAL PLANNING: Strategies for Doctors and their Advisors

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BY DR. DAVID E. MARCINKO MBA CMP®

SPONSOR: http://www.CertifiedMedicalPlanner.org

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REVIEWS:

Written by doctors and healthcare professionals, this textbook should be mandatory reading for all medical school students—highly recommended for both young and veteran physicians—and an eliminating factor for any financial advisor who has not read it. The book uses jargon like ‘innovative,’ ‘transformational,’ and ‘disruptive’—all rightly so! It is the type of definitive financial lifestyle planning book we often seek, but seldom find.
LeRoy Howard MA CMPTM,Candidate and Financial Advisor, Fayetteville, North Carolina

I taught diagnostic radiology for over a decade. The physician-focused niche information, balanced perspectives, and insider industry transparency in this book may help save your financial life.
Dr. William P. Scherer MS, Barry University, Ft. Lauderdale, Florida

This book was crafted in response to the frustration felt by doctors who dealt with top financial, brokerage, and accounting firms. These non-fiduciary behemoths often prescribed costly wholesale solutions that were applicable to all, but customized for few, despite ever-changing needs. It is a must-read to learn why brokerage sales pitches or Internet resources will never replace the knowledge and deep advice of a physician-focused financial advisor, medical consultant, or collegial Certified Medical Planner™ financial professional.
—Parin Khotari MBA,Whitman School of Management, Syracuse University, New York

In today’s healthcare environment, in order for providers to survive, they need to understand their current and future market trends, finances, operations, and impact of federal and state regulations. As a healthcare consulting professional for over 30 years supporting both the private and public sector, I recommend that providers understand and utilize the wealth of knowledge that is being conveyed in these chapters. Without this guidance providers will have a hard time navigating the supporting system which may impact their future revenue stream. I strongly endorse the contents of this book.
—Carol S. Miller BSN MBA PMP,President, Miller Consulting Group, ACT IAC Executive Committee Vice-Chair at-Large, HIMSS NCA Board Member

This is an excellent book on financial planning for physicians and health professionals. It is all inclusive yet very easy to read with much valuable information. And, I have been expanding my business knowledge with all of Dr. Marcinko’s prior books. I highly recommend this one, too. It is a fine educational tool for all doctors.
—Dr. David B. Lumsden MD MS MA,Orthopedic Surgeon, Baltimore, Maryland

There is no other comprehensive book like it to help doctors, nurses, and other medical providers accumulate and preserve the wealth that their years of education and hard work have earned them.
—Dr. Jason Dyken MD MBA,Dyken Wealth Strategies, Gulf Shores, Alabama

I plan to give a copy of this book written
by doctors and for doctors’ to all my prospects, physician, and nurse clients. It may be the definitive text on this important topic.
—Alexander Naruska CPA,Orlando, Florida

Health professionals are small business owners who need to apply their self-discipline tactics in establishing and operating successful practices. Talented trainees are leaving the medical profession because they fail to balance the cost of attendance against a realistic business and financial plan. Principles like budgeting, saving, and living below one’s means, in order to make future investments for future growth, asset protection, and retirement possible are often lacking. This textbook guides the medical professional in his/her financial planning life journey from start to finish. It ranks a place in all medical school libraries and on each of our bookshelves.
—Dr. Thomas M. DeLauro DPM,Professor and Chairman – Division of Medical Sciences, New York College of Podiatric Medicine

Physicians are notoriously excellent at diagnosing and treating medical conditions. However, they are also notoriously deficient in managing the business aspects of their medical practices. Most will earn $20-30 million in their medical lifetime, but few know how to create wealth for themselves and their families. This book will help fill the void in physicians’ financial education. I have two recommendations: 1) every physician, young and old, should read this book; and 2) read it a second time!
—Dr. Neil Baum MD,Clinical Associate Professor of Urology, Tulane Medical School, New Orleans, Louisiana

I worked with a Certified Medical Planner™ on several occasions in the past, and will do so again in the future. This book codified the vast body of knowledge that helped in all facets of my financial life and professional medical practice.
Dr. James E. Williams DABPS, Foot and Ankle Surgeon, Conyers, Georgia

This is a constantly changing field for rules, regulations, taxes, insurance, compliance, and investments. This book assists readers, and their financial advisors, in keeping up with what’s going on in the healthcare field that all doctors need to know.
Patricia Raskob CFP® EA ATA, Raskob Kambourian Financial Advisors, Tucson, Arizona

I particularly enjoyed reading the specific examples in this book which pointed out the perils of risk … something with which I am too familiar and have learned (the hard way) to avoid like the Black Death. It is a pleasure to come across this kind of wisdom, in print, that other colleagues may learn before it’s too late— many, many years down the road.
Dr. Robert S. Park MD, Robert Park and Associates Insurance, Seattle, Washington

Although this book targets physicians, I was pleased to see that it also addressed the financial planning and employment benefit needs of nurses; physical, respiratory, and occupational therapists; CRNAs, hospitalists, and other members of the health care team….highly readable, practical, and understandable.
Nurse Cecelia T. Perez RN, Hospital Operating Room Manager, Ellicott City, Maryland

Personal financial success in the PP-ACA era will be more difficult to achieve than ever before. It requires the next generation of doctors to rethink frugality, delay gratification, and redefine the very definition of success and work–life balance. And, they will surely need the subject matter medical specificity and new-wave professional guidance offered in this book. This book is a ‘must-read’ for all health care professionals, and their financial advisors, who wish to take an active role in creating a new subset of informed and pioneering professionals known as Certified Medical Planners™.
—Dr. Mark D. Dollard FACFAS, Private Practice, Tyson Corner, Virginia

As healthcare professionals, it is our Hippocratic duty to avoid preventable harm by paying attention. On the other hand, some of us are guilty of being reckless with our own financial health—delaying serious consideration of investments, taxation, retirement income, estate planning, and inheritances until the worry keeps one awake at night. So, if you have avoided planning for the future for far too long, perhaps it is time to take that first step toward preparedness. This in-depth textbook is an excellent starting point—not only because of its readability, but because of his team’s expertise and thoroughness in addressing the intricacies of modern investments—and from the point of view of not only gifted financial experts, but as healthcare providers, as well … a rare combination.
Dr. Darrell K. Pruitt DDS, Private Practice Dentist, Fort Worth, Texas

This text should be on the bookshelf of all contemporary physicians. The book is physician-focused with unique topics applicable to all medical professionals. But, it also offers helpful insights into the new tax and estate laws, fiduciary accountability for advisors and insurance agents, with investing, asset protection and risk management, and retirement planning strategies with updates for the brave new world of global payments of the Patient Protection and Affordable Care Act. Starting out by encouraging readers to examine their personal ‘money blueprint’ beliefs and habits, the book is divided into four sections offering holistic life cycle financial information and economic education directed to new, mid-career, and mature physicians.

This structure permits one to dip into the book based on personal need to find relief, rather than to overwhelm. Given the complexity of modern domestic healthcare, and the daunting challenges faced by physicians who try to stay abreast of clinical medicine and the ever-evolving laws of personal finance, this textbook could not have come at a better time.
—Dr. Philippa Kennealy MD MPH, The Entrepreneurial MD, Los Angeles, California

Physicians have economic concerns unmatched by any other profession, arriving ten years late to the start of their earning years. This textbook goes to the core of how to level the playing field quickly, and efficaciously, by a new breed of dedicated Certified Medical Planners™. With physician-focused financial advice, each chapter is a building block to your financial fortress.
Thomas McKeon, MBA, Pharmaceutical Representative, Philadelphia, Pennsylvania

An excellent resource … this textbook is written in a manner that provides physician practice owners with a comprehensive guide to financial planning and related topics for their professional practice in a way that is easily comprehended. The style in which it breaks down the intricacies of the current physician practice landscape makes it a ‘must-read’ for those physicians (and their advisors) practicing in the volatile era of healthcare reform.
—Robert James Cimasi, MHA ASA FRICS MCBA CVA CM&AA CMP™, CEO-Health Capital Consultants, LLC, St. Louis, Missouri

Rarely can one find a full compendium of information within a single source or text, but this book communicates the new financial realities we are forced to confront; it is full of opportunities for minimizing tax liability and maximizing income potential. We’re recommending it to all our medical practice management clients across the entire healthcare spectrum.
Alan Guinn, The Guinn Consultancy Group, Inc., Cookeville, Tennessee

Dr. David Edward Marcinko MBA CMP™ and his team take a seemingly endless stream of disparate concepts and integrate them into a simple, straightforward, and understandable path to success. And, he codifies them all into a step-by-step algorithm to more efficient investing, risk management, taxation, and enhanced retirement planning for doctors and nurses. His text is a vital read—and must execute—book for all healthcare professionals and physician-focused financial advisors.
Dr. O. Kent Mercado, JD, Private Practitioner and Attorney, Naperville, Illinois

Kudos. The editors and contributing authors have compiled the most comprehensive reference book for the medical community that has ever been attempted. As you review the chapters of interest and hone in on the most important concerns you may have, realize that the best minds have been harvested for you to plan well… Live well.
Martha J. Schilling; AAMS® CRPC® ETSC CSA, Shilling Group Advisors, LLC, Philadelphia, Pennsylvania

I recommend this book to any physician or medical professional that desires an honest no-sales approach to understanding the financial planning and investing world. It is worthwhile to any financial advisor interested in this space, as well.
David K. Luke, MIM MS-PFP CMP™, Net Worth Advisory Group, Sandy, Utah

Although not a substitute for a formal business education, this book will help physicians navigate effectively through the hurdles of day-to-day financial decisions with the help of an accountant, financial and legal advisor. I highly recommend it and commend Dr. Marcinko and the Institute of Medical Business Advisors, Inc. on a job well done.
Ken Yeung MBA CMP™, Tseung Kwan O Hospital, Hong Kong

I’ve seen many ghost-written handbooks, paperbacks, and vanity-published manuals on this topic throughout my career in mental healthcare. Most were poorly written, opinionated, and cheaply produced self-aggrandizing marketing drivel for those agents selling commission-based financial products and expensive advisory services. So, I was pleasantly surprised with this comprehensive peer-reviewed academic textbook, complete with citations, case examples, and real-life integrated strategies by and for medical professionals. Although a bit late for my career, I recommend it highly to all my younger colleagues … It’s credibility and specificity stand alone.
Dr. Clarice Montgomery PhD MA,Retired Clinical Psychologist

In an industry known for one-size-fits-all templates and massively customized books, products, advice, and services, the extreme healthcare specificity of this text is both refreshing and comprehensive.
Dr. James Joseph Bartley, Columbus, Georgia

My brother was my office administrator and accountant. We both feel this is the most comprehensive textbook available on financial planning for healthcare providers.
Dr. Anthony Robert Naruska DC,Winter Park, Florida

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DAILY UPDATE: Stock Markets Surge

By Staff Reporters

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Here’s where the major benchmarks ended:

  • Markets: Stocks pulled it out for a Friday win after the government dropped encouraging economic data. But all three major indexes were still down for the week, with the Dow enduring its worst of 2024.
  • Stock spotlight: Tesla took a wild ride, plunging after Reuters reported it had scrapped plans to produce its long-awaited Model 2 affordable EV only to regain some ground after Elon Musk denied it. The company then jumped after hours because Musk said it’ll debut a robotaxi on August 8.
  • The S&P 500 index gained 57.13 points (1.1%) to 5,204.34, down 1.0% for the week; the Dow Jones Industrial Average added 307.06 points (0.8%) to 38,904.04, down 2.3% for the week; the NASDAQ Composite® ($COMP) rose 199.44 points (1.2%) to 16,248.52, down 0.8% for the week.
  • The 10-year Treasury note yield (TNX) rose more than 8 basis points to 4.392%.
  • The CBOE Volatility Index® (VIX) fell 0.32 to 16.03.

Meta Platforms (META) and Netflix (NFLX), two members of the “Magnificent Seven” mega-cap group, both jumped around 3% Friday, helping lift the S&P 500 Communication Services Index ($SP500#50) 1.6% to lead top-performing sectors. Meta shares closed at a record above $527, up 49% for the year. 

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COMPUTING: Intel, Amazon and Microsoft

By Staff Reporters

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Intel revealed that its semiconductor-making unit lost $7 billion last year. The news sent the company’s stock down.

And, Amazon is laying off hundreds of employees from its cloud computing division, including the team overseeing its cashierless tech (and not just the Just Walk Out feature it’s pulling from stores), as well as people sales and marketing roles.

Finally, Microsoft and Quantinuum said they’ve had a major quantum computing breakthrough.

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DAILY UPDATE: The “Lipstick Index” and Stock Market Crash

By Staff Reporters

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Ulta and other major beauty companies that thrived during the past few years of economic instability provided good fodder for the “lipstick index”—a duct-tape economic measure that assumes people still buy small indulgences (like lipstick) during tough times, keeping the beauty industry recession-proof.

However…it’s not. Ulta’s full-year sales growth target is just 4% to 5%, which falls below Wall Street’s estimates, and Estée Lauder announced in February it was laying off 3% to 5% of its workforce after some difficult months.

And, other consumer goods powerhouses are bracing for a slowdown, too. The parent company of Calvin Klein and Tommy Hilfiger said this week that it’s preparing for a 6% to 7% revenue drop this year.

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MORE: https://medicalexecutivepost.com/2023/09/23/economic-indicators-lipstick-index-and-cosmetic-others/

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Here’s where the major benchmarks ended:

  • The S&P 500 index dropped 64.28 points (1.2%) to 5,147.21; the Dow Jones Industrial Average® ($DJI) tumbled 530.16 points (1.4%) to 38,596.98; the NASDAQ Composite® ($COMP) sank 228.38 points (1.4%) to 16,049.08.
  • The 10-year Treasury note yield (TNX) fell more than 5 basis points to 4.303.%.
  • The CBOE Volatility Index® (VIX) surged 2.07 to 16.39.

Semiconductors were among Thursday’s weakest performers as a drop of more than 8% in Advanced Micro Devices (AMD) helped send the Philadelphia Semiconductor Index (SOX) down 3% to a two-week low. Retail shares were also soft. WTI Crude Oil futures rose for the sixth consecutive day and topped $87 per barrel, marking a gain of 4.3% so far this week. Volatility based on the VIX ended at its highest level since early November. Brent Crude Oil (/BZ) futures, the global benchmark, topped $90 for the first time since October.

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HEALTHCARE PRIVATE EQUITY: Federal Regulators Launch Inquiry

By Health Capital Consultants, LLC

On March 5th, 2024, the Department of Justice’s (DOJ’s) Antitrust Division, the Federal Trade Commission (FTC), and the Department of Health and Human Services (HHS), announced the launch of a multi-agency inquiry – in the form of a request for information (RFI) and public workshop – focusing on the increasing control of private equity (PE) and other corporations over the healthcare industry.

This Health Capital Topics article discusses the agencies recent actions and how it appears to be in line with the government’s recent moves to crack down on anti-competitive actions in healthcare. (Read more…)

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Why Some Career Doctors Still DO NOT Get Rich?

SOME DIFFERENT REASONS WHY DOCTORS DON’T GET RICH

“Physicians have a significantly low propensity to accumulate substantial wealth.”

Thomas Stanley – Author “The Millionaire Next Door”

[New York Times]

How come doctors fail to get rich? Re-read the above!

http://www.MarcinkoAssociates.com

By Dr. David Edward Marcinko MBA CMP®

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SPONSOR: http://www.CertifiedMedicalPlanner.org

The Institute of Medical Business Advisors Inc identified several reasons based on observations working with medical professional and physician clients over the years.

A late start

By the time doctors finish medical school and residency they’re typically in their middle or late thirties. Many have families to feed, and substantial student loans to pay off. It will be years before they can even start accumulating wealth. Consider that physicians typically enter careers at later ages, often with larger debts from training. Some specialties may not lead a case until 10 years of practice, and many specialties have limited longevity. Peak earning years may also be shorter for health care providers than other professionals. Financial survival skills are paramount for converting the limited earnings time period to personal financial security.

Challenging socio-political environment

It is increasingly challenging to practice medicine. With the Medicare Trust Fund slated to go bust in 2019, the Center for Medicare and Medicare Service (CMS) is increasingly resorting to cutting physician reimbursements and implementing capitation and bundled value based medical payments models. The medical reimbursement effects of the PP-ACA are not yet fully discerned; but appear to continue the decline in compensation. And to illustrate this potential governmental control, in what other industry can participants debate the simple question, “who is the customer?”

Lifestyle expectations

Society expects a doctor to live like a doctor, dress like a doctor, and drive like a doctor. Meeting social expectations can be quite expensive.

Time and energy

A doctor can’t be just a doctor any more. S/he also has to deal with ever increasing regulatory mandates, paperwork requirements by state and federal agencies and capricious insurance companies. It is estimated that for every hour spent on patient care, and additional half-hour is spent on paperwork. To-date, the use of electronic medical records has exacerbated; not ameliorated this problem. The demand on their time is mind-boggling. A typical doctor works a ten- to twelve-hour day. After work and family, they simply don’t have time and energy left to do comprehensive financial planning.

Financially naïve

Doctors are smart. They’re highly trained in their area of expertise. But, that doesn’t translate into understanding about finance or economics. Because they are smart, it’s easy for them to think they can easily master and execute concepts of personal financial planning, as well. Often, they don’t.

Lack of trust and delegation

Many doctors don’t trust financial advisors working for major Wall Street banks. They have the good instinct to realize that their interests are not aligned. Not knowing there are independent advisors out there who observe a strict fiduciary standard, they tend to do everything by themselves.

In fact, Paul Larson CFP®, President-CEO of the firm LARSON Financial Group LLC, noted a disquieting trend among physician client in his firm [personal communication]. Almost 90% of them fail to take care of their own family finances in a comprehensive manner; while only 10% are succeeding.  The strategies in this chapter and book are common to their success.

Too Trusting

Another aspect of naivety, many physicians do not realize that the financial advisory industry lacks the same discipline and regulation that the average physician operates in. A primary care doctor would never even attempt a complicated surgery on a patient, but is trained to refer such patients to a specialist in the field with the proper training and experience. Financial Advisors often come from a sales background and are trained to keep a client in house even if the advisor is lacking in expertise. Also, many physicians are not trained to discern a qualified financial advisor from a sales person dressed up like a financial advisor. It is illegal to call yourself a physician in the United States unless you have the credentials to back it up; yet, anyone in the US can legally call themselves a financial advisor or a financial planner.

Your thoughts are appreciated.

Comprehensive Financial Planning Strategies for Doctors and Advisors : Best Practices from Leading Consultants and Certified Medical Planners™ book cover

SECOND OPINIONS: https://medicalexecutivepost.com/schedule-a-consultation/

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DAILY UPDATE: Iger Survives as Ulta Beauty and Stock Markets Stall

By Staff Reporters

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Ulta Beauty plunged after its CEO revealed that, despite the resilience of the beauty category, sales have slowed.

And, Walt Disney’s current rulers will continue to oversee the kingdom. The company’s board, helmed by CEO Bob Iger, defeated activist investors and Nelson Peltz who had hoped to replace current board members and steer the company in a new direction.

Here’s where the major benchmarks ended:

  • The S&P 500 index rose 5.68 points (0.1%) to 5,211.49; the Dow Jones Industrial Average lost 43.10 points (0.1%) to 39,127.14; the NASDAQ Composite® ($COMP) added 37.01 points (0.2%) to 16,277.46.
  • The 10-year Treasury note yield fell more than 1 basis point to 4.351%.
  • The CBOE Volatility Index® (VIX) declined 0.28 to 14.33.

Energy shares remained one of the market’s strongest performers behind strength in WTI Crude Oil (/CL) futures, which rose a fifth consecutive day and ended above $85 per barrel, the highest since October. The Philadelphia Oil Service Index (OSX) jumped1.6%, extending its year-to-date gain to almost 14%. 

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DAILY UPDATE: Medicare Advantage Plans Down as Stocks Crash

By Staff Reporters

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Medicare Part C papers, glasses and stethoscope.

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Humana and other managed-care stocks were down sharply in trading Tuesday after the Centers for Medicare and Medicaid Services announced an average 3.7% increase in revenue for Medicare Advantage plans in 2025. That amount is the same as the proposed increase the government had announced in January, but it came as a shock to investors who were hoping for a slight bump.

Humana  (HUM)  shares fell sharply in early Tuesday trading, while rivals UnitedHealth UNH and CVS Health  (CVS)  traded firmly in the red, as the health insurance industry received yet another blow to its 2024 profit forecasts. All three major health insurance groups have trailed the broader market this year, with Humana down nearly 25%, amid concern that profit margins will be hit by a surge in medical costs tied to a rise in elective procedures. Those procedures had been delayed by the Covid pandemic. 

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Here’s where the major benchmarks ended:

  • The S&P 500 index fell 37.96 points (0.7%) to 5,205.81; the Dow Jones Industrial Average lost 396.61 points (1.0%) to 39,170.24; the NASDAQ Composite slipped 156.38 points (1.0%) to 16,240.45.
  • The 10-year Treasury note yield was up almost 3 basis points to 4.357%.
  • The CBOE Volatility Index® (VIX) rose 0.96 to 14.61.

Retailer, biotechnology, and regional bank shares were among the weakest performers Tuesday, leading a broad market slump in which declining stocks outnumber advancers by a greater than three-to-one ratio. The small-cap Russell 2000® Index (RUT) lost 1.8% and settled at a two-week low. 

Energy companies, by contrast, extended recent strength behind an ongoing climb in WTI Crude Oil (/CL) futures, which surpassed $85 per barrel for the first time since late October. The Philadelphia Oil Service Index (OSX) advanced 2.1% and ended at a 5-½-month high. Oil prices have surged this year due to OPEC production cuts and concern over supply disruptions stemming from the Middle East conflict.

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HOSPITALS: Private Equity Ownership Quality?

PATIENT COMPLICATION RATES

By Staff Reporters

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Hospitals under private equity (PE) ownership reported higher rates of patient complications when compared to other facilities, according to a recent JAMA study—raising questions about how the business model might affect staffing and subsequent quality of care.

The surveyed Medicare beneficiaries saw a 25.4% increase in “hospital-acquired conditions,” which the Centers for Medicare and Medicaid Services defines as falls, infections, and other adverse events, when they received treatment at a PE-acquired hospital compared to those run under other forms of ownership.

On the whole, the study found that Medicare enrollees at hospitals under PE control were not only younger and less likely to additionally qualify for Medicaid but also more likely to experience complications.

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DAILY UPDATE: Truth Social and Weak Stock Markets

By Staff Reporters

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Quote: “This is a very unusual situation. The stock is pretty much divorced from fundamentals.”Jay Ritter, finance professor and IPO expert at the University of Florida, on the surging value of the newly public Trump Media. Truth Social, its only active product, has been shedding both users and cash. (CNN)

Shares of Truth Social owner Trump Media & Technology Group plunged Monday after the company disclosed that it lost more than $58 million and generated very little revenue in 2023. Former President Donald Trump is the company’s majority shareholder, and his net worth tumbled by more than $1 billion Monday as a result.

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Here’s where the major benchmarks ended:

Stocks started Q2 off soft yesterday, as investors continued to fret about inflation. Stock spotlight: Trump Media, the newly public company that owns Truth Social, plunged yesterday after revealing that it lost $58 million last year, generated just $4.1 million in revenue, and had 10 times fewer users than Threads.

  • The S&P 500 index fell 10.58 points (0.2%) to 5,243.77; the Dow Jones Industrial Average® ($DJI) shed 240.52 points (0.6%) to 39,566.85; the NASDAQ Composite® ($COMP) added 17.37 points (0.1%) to 16,396.83.
  • The 10-year Treasury note yield jumped 13 basis points to 4.323%.
  • The CBOE Volatility Index® (VIX) rose 0.64 to 13.65.

Banks were among the market’s weakest performers Monday, likely reflecting concern that elevated interest rates could pinch margins. The KBW Regional Bank Index (KRX) sank 2% after ending at a two-month high last week. The small-cap Russell 2000® Index (RUT) was also soft, dropping 1% after closing at a two-year high last week. 

Communication services and semiconductor shares turned in strong performances, as did energy, lifted by WTI Crude Oil (/CL) futures’ extending a rally to its highest level since late October. WTI Crude Oil is up almost 18% so far this year amid concern over supply disruptions stemming from the Russia-Ukraine war and Middle East conflict.

In other markets, the U.S. dollar index ($DXY) strengthened for the fourth straight day and reached its highest point since mid-November behind expectations the Fed will keep interest rates high.

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DAILY UPDATE: March Round-Up as Stocks End their Best First Quarter in Five Years

By Staff Reporters

APRIL FOOL’S DAY

April Fools’ Day customs date back to at least Renaissance Europe, but it’s likely the tradition originated long before then. Some historians have linked April Fools’ Day to the ancient Roman festival of “Hilaria,” where at the end of March, people would come together to commemorate the resurrection of the god Attis. It was a celebration of renewal in which revelers would dress up in disguises and imitate others.

It’s also possible that the medieval celebration of the Feast of Fools, where a mock bishop or pope was elected and church customs were parodied, could have inspired the day.

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Stocks had their best Q1 in five years. The S&P 500 ended Thursday—the last trading day of the quarter—up by more than 10%, marking its best start to a year since 2019.

The AI craze, record corporate profits, and optimism around cooling inflation are all contributing to the stock boom. The economy got more good news yesterday when the Stocks had their best Q1 in five years reported that several key gauges, including GDP and consumer spending, grew in Q4 of last year.

And, that’s not all: Home sales bounced back after a January slump, jobless claims fell, and advertisers raised their full-year forecast. Consumer sentiment is now at its highest level since 2021.

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DAILY UPDATE: Tesla and DJT Stock Down

By Staff Reporters

HAPPY EASTER

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Tesla had a rough quarter

The company’s stock was the worst performing in the S&P 500 in Q1, dropping 29%, amid fierce competition from Chinese electric carmakers, slowdowns from Red Sea shipping routes, arson at its German factory, Nordic labor battles, and controversies surrounding CEO Elon Musk.

Now, investors are warily watching to see what delivery numbers Tesla reports. But one group did make lots of money off the company as it lost over $230 billion in value last quarter: short sellers.

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Donald Trump’s namesake social media company burst out of the gate on its first day of trading Tuesday, opening at $70.90 and soaring as high as $79.38 as Trump fans and opportunistic traders bought up shares. But the price faded late in the session and has bounced along at lower levels ever since, ending Thursday down $4.26 at $61.96 on the NASDAQ. The stock exchange was closed Friday in observance of Good Friday.   

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DRIPS: Disadvantages, Problems and Cons

DIVIDEND REINVESTMENT PLANS

By Staff Reporters

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DEFINITION

DRIPs are merely an automated strategy in which a company’s dividends are reinvested into additional shares of that company. Instead of being paid dividends in cash, you get additional shares of ownership in the company.

There are three ways to get involved in DRIPs: directly through the company, through your broker, or through a transfer agent.

Company-run DRIPs are generally only available through large, blue-chip dividend stocks.That’s because smaller companies don’t want to take on the overhead costs of tracking all their shareholders and going through the paperwork headache of calculating how much each one gets in dividends and additional fractional shares. The company benefits from gaining an additional source of capital, but most of all in creating a more stable base of shareholders, ones who are less likely to panic and sell during a market decline. This can help decrease the volatility of a company’s shares.

As a result, more and more companies are deciding to use transfer agents, which are third-party DRIP administrators such as American Stock Transfer and Trust or Computershare.

Finally, most large discount brokers, such as Scottrade, TD Ameritrade, and E*Trade, also offer DRIPs, though with different requirements and limitations.

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The Case Against DRIP Plans

While dividend reinvestment is powerful, there are a couple reasons why you might not want to reinvest your dividends.

DRIPs Drawback 1: You may need the dividend income
The most obvious reason is that you need the income. If you’re in the “distribution” phase of your investing life, dividends are a perfect source of passive income. Income from qualified dividends is taxed at the long-term capital gains rate (currently 15% for investors who are in the 25% to 35% tax bracket for ordinary income, 0% for taxpayers in a lower bracket and 20% for those in the highest bracket). So if you’re going to be looking to your portfolio for income every month anyway, it makes sense to have that cash deposited in your account.

DRIPs Drawback 2: You may need to reallocate your positions
You might also choose to stop reinvesting your dividends for allocation reasons. Reinvesting your dividends, through DRIP plans or otherwise, will cause your stock positions to grow over time, and if you’ve owned a particular issue for a long time, it may already be a large enough percentage of your portfolio. Higher-yielding positions will grow faster, which can throw your allocations out of whack pretty quickly. So once a stock position is as big as you want it to get (for now) feel free to turn off dividend reinvestment for that position, and either enjoy the extra income or save up the cash to invest in other stocks.

DRIPs Drawback 3: You may not want to buy that stock at that time
Finally, you may also have stock-specific reasons not to reinvest dividends—if a stock is temporarily overvalued, or you simply don’t want to buy any more of it at current prices.

But bottom line, reinvesting dividends through a broker or by signing up for DRIP plans directly through the dividend-paying companies, is a surprisingly powerful tool to passively improve your investment returns.

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NOTE: Former Microsoft CEO Steve Ballmer is on pace to earn $1 billion in dividends annually from his massive 4% stake in the software company. 

  • Steve Ballmer is on pace to collect annual dividend payments of $1 billion from Microsoft.
  • He is the former CEO of Microsoft and is the largest individual shareholder of the software giant.
  • Ballmer’s Microsoft stake has surged to a value of $128 billion this year following Microsoft’s 55% stock rally.

Other dividend billionaires include: https://www.dividend.com/dividend-education/14-executives-getting-rich-off-dividends/

So yes, DRIP plans are still worth it, as long as they fit with your investing goals.

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DAILY UPDATE: Good Friday’s Impressive First Quarter Stock Market Returns

By Staff Reporters

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The stock market will be closed Friday, March 29th, for Good Friday. While Good Friday is a stock market holiday, it is not a federal holiday. As a result, the February Personal Consumption and Expenditures (PCE) Price Index will be released this Friday morning.

Yesterday, on the final trading session of March and the first quarter, the returns for major stock indexes are impressive, with the Dow Jones Industrial Average up 5% this quarter or 2,000 points and the S&P 500 and the tech-heavy NASDAQ up 11% apiece. Stock superlatives for 2024’s opening stretch are numerous, including each of the three indexes setting respective all-time highs and the benchmark S&P heading toward its best first-quarter return since 2019 and its second consecutive quarter of double-digit percentage gains since 2011-12.

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Here’s where the major benchmarks ended Thursday:

  • The S&P 500 index added 5.86 points (0.1%) to 5,254.35, up 0.4% for the week; the Dow Jones Industrial Average climbed 47.29 points (0.1%) to 39,807.37, up 0.8% for the week; the NASDAQ Composite lost 20.06 points (0.1%) to 16,379.46, down 0.3% for the week. 
  • The 10-year Treasury note yield rose one basis point to just under 4.21%.
  • The CBOE Volatility Index® (VIX) rose 0.22 to 13.00.

For the month, the S&P 500 index gained 3.1%, the Dow Jones Industrial Average rose 2.1%, and the NASDAQ Composite added 1.8%. For the quarter, the three indexes rose 10.3%, 5.6%, and 9.2%, respectively.

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FINANCE: “Prudence” in Investment Management?

SPONSOR: http://www.MARCINKOASSOCIATES.com

ON “PRUDENCE” IN FINANCE AND INVESTMENT MANAGEMENT
Courtesy: http://www.CertifiedMedicalPlanner.org

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TERMS & DEFINITIONS FOR PHYSICIANS AND ALL INVESTORS:

PRUDENT BUYER: The efficient purchaser of market balance between value and cost.

PRUDENT MAN RULE: An 1830 court case stating that a person in a fiduciary capacity (a trustee, executor, custodian, etc) must conduct him/herself faithfully and exercise sound judgment when investing monies under care. “He is to observe how men of prudence, discretion and intelligence manage their own affairs, not in regard to speculation, but in regard to the permanent distribution of their funds, considering the probable income as well as the probable safety of the capital to be invested.” Allows for mutual funds and variable annuities.

PRUDENT INVESTOR RULE: A fiduciary is required to conduct him/herself faithfully and exercise sound judgment when investing monies and take measured and reasonable investment risks in return for potential future rewards. Allows for mutual funds, stocks, bonds, variable annuities asset allocation & Modern Portfolio Theory.

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Product Details

UNIFORM PRUDENT INVESTOR ACT: https://medicalexecutivepost.com/2011/02/18/the-uniform-prudent-investor-act-versus-fiduciary-accountability/

EDITOR’S NOTE: We interviewed noted authority Ben Aikin AIF® on this topic more than a decade ago. He was ahead of his time regarding fiduciary accountability and we appreciate his insights.

Dr. David Edward Marcinko MBA CMP®

[Editor-in-Chief]

INTERVIEW: https://medicalexecutivepost.com/2009/03/01/an-interview-with-bennett-aikin-aif/

FIDUCIARY OATH: http://www.thefiduciarystandard.org/wp-content/uploads/2015/02/fiduciaryoath_individual.pdf

Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

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A Brief Historical Review of Behavioral Finance and Economics

By Related Influential Thought-Leaders

  • Dr. Brad Klontz CSAC CFP®
  • Dr. Ted Klontz PsyD
  • Dr. Eugene Schmuckler MBA MEd CTS
  • Dr. Kenneth Shubin-Stein FACP CFA
  • Dr. David Edward Marcinko MEd MBA CMP™

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doctor

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James O. Prochaska PhD, Professor of Psychology and Director of the Cancer Prevention Research Center at the University of Rhode Island, developed the Trans-Theoretic Model of Behavior Change [TTM] which has been evolving since in 1977. Nominated as one of the five most influential authors in Psychology, by the Institute for Scientific Information and the American Psychological Society, Dr. Prochaska is author of more than 300 papers on behavior change for health promotion and disease prevention.

TTM Stages of Change

In his Trans-Theoretical Model, behavior change is a “process involving progress through a series of these stages:

  • Pre-Contemplation (Not Ready) – “People are not intending to take action in the foreseeable future, and can be unaware that their behavior is problematic”
  • Contemplation (Getting Ready) – “People are beginning to recognize that their behavior is problematic, and start to look at the pros and cons of their continued actions”
  • Preparation (Ready) – “People are intending to take action in the immediate future, and may begin taking small steps toward behavior change”
  • Action – “People have made specific overt modifications in changing their problem behavior or in acquiring new healthy behaviors”
  • Maintenance – “People have been able to sustain action for a while and are working to prevent relapse”
  • Termination – “Individuals have zero temptation and they are sure they will not return to their old unhealthy habit as a way of coping”

Relapse

In addition, researchers conceptualized “relapse” (recycling) which is not a stage in itself but rather the “return from Action or Maintenance to an earlier stage.” In medical care, these stages of behavior change have applicability to anti-hypertension and lipid lowering medication use, as well as depression prevention, weight control and smoking cessation.

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Psychology

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Uniting Psychology and Financial Behavior

More recently, validating the emerging alliance between psychology (human behavior) and finance (economics) are two Americans who won the Royal Swedish Academy of Science’s 2002 Nobel Memorial Prize in Economic Science. Their research was nothing short of an explanation for the idiosyncrasies incumbent in human financial decision-making outcomes.

Enter Kahneman and Smith

Daniel Kahneman, PhD, professor of psychology at Princeton University, and Vernon L. Smith, PhD, professor of economics at George Mason University in Fairfax, Va., shared the prize for work that provided insight on everything from stock market bubbles, to regulating utilities, and countless other economic activities. In several cases, the winners tried to explain apparent financial paradoxes.

For example, Professor Kahneman made the economically puzzling discovery that most of his subjects would make a 20-minute trip to buy a calculator for $10 instead of $15, but would not make the same trip to buy a jacket for $120 instead of $125, saving the same $5.

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in vitro and in-vivo Economics

Initially, in the 1960’s, Smith set out to demonstrate how economic theory worked in the laboratory (in vitro), while Kahneman was more interested in the ways economic theory mis-predicted people in real-life (in-vivo). He tested the limits of standard economic choice theory in predicting the actions of real people, and his work formalized laboratory techniques for studying economic decision making, with a focus on trading and bargaining.

Later, Smith and Kahneman together were among the first economists to make experimental data a cornerstone of academic output. Their studies included people playing games of cooperation and trust, and simulating different types of markets in a laboratory setting. Their theories assumed that individuals make decisions systematically, based on preferences and available information, in a way that changes little over time, or in different contexts.

University of Chicago

By the late 1970’s, Richard H. Thaler, PhD, an economist at the University of Chicago also began to perform behavioral experiments further suggesting irrational wrinkles in standard financial theory and behavior, enhancing the still embryonic but increasingly popular theories of Kahneman and Smith.

Laboratory

Other economists’ laboratory experiments used ideas about competitive interactions pioneered by game theorists like John Forbes Nash Jr., PhD, who shared the Nobel in 1994, as points of reference.

Assessment

But, Kahneman and Smith often concentrated on cases where people’s actions departed from the systematic, rational strategies that Nash envisioned. Psychologically, this was all a precursor to the informal concept of life or holistic financial planning. Kahneman was awarded the Medal of Freedom, by President Barack Obama, on November 20, 2013.

READ: Behavioral Economics and Psychology DEM

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DAILY UPDATE: Independent Pharmacies Struggle as Stocks Hit New Highs

By Staff Reporters

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Independent pharmacies have struggled in recent years to stay open—and new financial constraints may mean a record number of pharmacy closures in 2024. And, nearly a third of independent pharmacies are at risk of going out of business due in part to a new rule from the Centers for Medicare and Medicaid Services (CMS) that results in lower prescription reimbursements, according to the National Community Pharmacists Association (NCPA), a trade group that represents more than 19,400 US pharmacies.

“This is an emergency,” NCPA CEO B. Douglas Hoey said in a statement. “If Congress fails to act again, thousands of local pharmacies could be closed within months and millions of patients could be stranded without a pharmacy.” The CMS rule, which went into effect on January 1st, requires payers and pharmacy benefit managers (PBMs) to apply what’s called direct and indirect remuneration (DIR) fees at the time a patient picks up a prescription.

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Here’s where the major benchmarks ended:

  • The S&P 500 index added 44.91 points (0.9%) to 5,248.49; the Dow Jones Industrial Average climbed 477.75 points (1.2%) to 39,760.08; the NASDAQ Composite added 83.82 points (0.5%) to 16,399.52. 
  • The 10-year Treasury note yield fell four basis points to just under 4.2%.
  • The CBOE Volatility Index® (VIX) dropped 0.48 to 12.76.

In addition to utility stocks, real estate, industrials, and materials were the strongest sectors. Information technology and communications were the weakest but found late-day strength to finish higher.

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