BOARD CERTIFICATION EXAM STUDY GUIDES Lower Extremity Trauma
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Patient satisfaction occurs when patient perceptions exceed their expectations. They get an intangible “something extra” from their visit, above what they paid for. When patient expectations match their perceptions, mutual obligations are fulfilled, making both practitioner and patient “break-even”.
The clinical result, within a relevant range, is only part of the patient’s perceptions. Numerous sub-conscious impressions comprise the remainder. We’ve all had patients love us despite a less than optimal result. We’ve all had patients angrily leave the practice over some non-clinical matter like a trivial billing dispute. A patient’s perception of any health care service is colored by a vast array of prior experiences that set up current expectations. The patient is pleased to the extent that his current perceptions exceed his/her pre existing expectations. This encompasses far more than the clinical result (within a relevant range), and includes such non-treatment issues as the demeanor of the staff, condition of the physical premises, psychological comfort during the visit, etc.
Remember, all patients talk about you anyway. In the past, a happy patient told four others about what a nice doctor you are. Today, patients post website comments or blogs immediately after their visits. They are more likely to complete treatment and follow instructions, thus obtaining a better medical outcome, and, generating additional fees for the practice. They pay quicker, cause less bad-debt and help create a pleasant environment for us to work in.
An unhappy patient vehemently tells nine others, onground or online, what a nasty greedy rip-off artist you are. Sad, but true! They are not as likely to complete treatment, thus incurring a less than optimal result, and generate fewer fees. They pay slower, if at all, create a stressed environment and detrimentally affect the attitude of other patients in the office.
Try to eliminate problems that might cause negative perceptions (i.e., a filthy restroom) and implement controls that help assure positive perceptions. Patient satisfaction is a soft managerial science. It is a numbers game. Most patients don’t pre-define what would be “acceptable” from this encounter, but have vaguely defined ranges of prior expectations anyway, gleaned from a lifetime of health care related experience. Any variance between these this “acceptable” range of expectations and each trivial encounter invokes some degree positive or negative feeling in the patient.
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The total perception of the office experience is an aggregate of multiple trivial, often subliminal, observations. Patient satisfaction is an intangible and amorphous process complicated by:
Inter patient variables: Significant differences between patients in their “expectations”. Intra patient variables: A single patient can perceive the same thing or situation differently at different times, depending on uncontrollable variables like mood, or, context of occurrence which may (sometimes and/or partially) be controllable by the practice. Luck of the draw” in physical variables: Does Sally or Mary escort the patient to the exam room? Was it the blue or green exam room? Did the last patient to use the rest room, five minutes ago, leave a disgusting mess? Heterogeneous staff variables: Even with appropriate training, people are not machines and have their own quirks.
ASSESSMENT
By proactively anticipating the entire visit, from the patient’s perspective, the practitioner can structure and arrange things such that most patients have, mostly positive perceptions, most of the time. This can be done despite all the potential hetero-genicity of the above factors. Patient satisfaction can be improved in any office, and can be done by anyone.
CONCLUSION
Because patient satisfaction is a multi-faceted amorphous subject, there are multiple correct approaches to the subject and no “cook book” recipe on how to proceed. Try and get the big picture. Identify the worst areas and fix them. Identify the best areas and reinforce them. Proceed slowly. It can be done one facet at a time. Adapt things to your own managerial style and personality. Be completely open to suggestion and change.
Finally, be aware that patient relationship and satisfaction implementation strategies frequently overlap.
SPEAKING: Dr. Marcinko will be speaking and lecturing, signing and opining, teaching and preaching, storming and performing at many locations throughout the USA this year! His tour of witty and serious pontifications may be scheduled on a planned or ad-hoc basis; for public or private meetings and gatherings; formally, informally, or over lunch or dinner. All medical societies, financial advisory firms or Broker-Dealers are encouraged to submit a RFP for speaking engagements: MarcinkoAdvisors@outlook.com
Posted on April 3, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
MEDICAL EXECUTIVE-POST–TODAY’SNEWSLETTERBRIEFING
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Essays, Opinions and Curated News in Health Economics, Investing, Business, Management and Financial Planning for Physician Entrepreneurs and their Savvy Advisors and Consultants
“Serving Almost One Million Doctors, Financial Advisors and Medical Management Consultants Daily“
A Partner of the Institute of Medical Business Advisors , Inc.
Stocks looked like a very concerning EKG recently, fluctuating throughout as investors weighed today’s tariff announcement. The Newsmax meme stock kept on surging, stacking a 180% gain on top of Monday’s 735% spike to skyrocket over 900% since the conservative media outlet went public earlier this week.
U.S. stocks whipped through another dizzying day Wednesday in the final hours before President Donald Trump’s unveiling of the tariffs promised as part of his “Liberation Day,” which could drastically remake the global economy. The S&P 500 rose 0.7%, but only after careening between an earlier loss of 1.1% and a later gain of 1.1%. It’s had a pattern this week of opening with sharp drops only to finish the day higher.
The Dow Jones Industrial Average added 235 points, or 0.6%, and the NASDAQ composite climbed 0.9%. Both also veered from sharply lower in the morning to sharply higher in the afternoon before doubling back.
Mass layoffs at health agencies begin. The purge of thousands of Health and Human Services (HHS) employees announced last week by Secretary Robert F. Kennedy Jr. started yesterday, with senior leaders at the FDA, CDC, and other departments saying they had been pushed out. Among those removed were the FDA’s chief tobacco regulator, its top veterinarian, and medical officers in charge of new drug approvals.
f you like to use Zelle to send money to others, you need to find a new solution. On April 1st, the digital payment app shut down.
Visualize: How private equity tangled banks in a web of debt, from the Financial Times.
Posted on April 2, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
By Ann Miller RN MHA CPHQ CMP™
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The iMBA Discussion Forum™ is a physician-to-financial advisor telephone or e-mail portal that connects independent financial professionals to doctors, nurses or healthcare executives desiring affordable and unbiased financial planning advice.
Medical professionals and healthcare executives can now receive direct access to pre-screened iMBA professionals in the areas of Investing, Financial Planning, Asset Allocation, Portfolio Management, Insurance, Mortgage and Lending, Human Resources, Retirement Planning and Employee Benefits. To assist our medical professional and healthcare executive members, we can be contracted with per-minute or per-project fees, and contacted by client phone, email or secure instant messaging.
A hedge fund is a limited partnership of private investors whose money is pooled and managed by professional fund managers. These managers use a wide range of strategies, including leverage (borrowed money) and the trading of nontraditional assets, to earn above-average investment returns. A hedge fund investment is often considered a risky, alternative investment choice and usually requires a high minimum investment or net worth. Hedge funds typically target wealthy investors.
QUESTION:Can I invest my Individual Retirement Account [IRA] in a Hedge Fund?
This is up to the manager, but there is no legal restriction on a hedge fund accepting individual retirement account (IRA) assets. IRA accounts are not well suited for funds that make extensive use of leverage, however. In such cases, the fund is likely to generate significant amounts of unrelated business taxable income (UBTI) – profits of the fund attributable to the use of leverage. The holder of an IRA account must pay taxes on UBTI, even if the UBTI was generated in an IRA account.
But, today’s hedge funds may or may not use leverage. Many hedge funds are not hedged at all, but rather are just specialized versions of regular long stock portfolios. If such funds do not use much leverage, IRA investors will not encounter much difficulty with UBTI and should not hesitate in considering these funds.
In considering whether to accept IRA money, hedge fund managers must consider several factors. If the only type of retirement money accepted by the hedge funds is IRA money, then the manager has no limit on how much retirement money the fund can accept. If, however, there are other types of retirement money invested in the fund, such as pension funds, IRA money will be counted towards a total of 25 percent of fund assets that can be invested in retirement accounts before the fund becomes subject to the Employment Retirement Income Security Act of 1974 (ERISA). Funds subject to ERISA regulations face a heavy administrative burden and more restrictions than most fund managers like.
Finally, IRA distributions from a hedge fund are subject to the standard 20 percent withholding unless the funds are directly rolled over to other qualified plans.
Posted on April 2, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
MEDICAL EXECUTIVE-POST–TODAY’SNEWSLETTERBRIEFING
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Essays, Opinions and Curated News in Health Economics, Investing, Business, Management and Financial Planning for Physician Entrepreneurs and their Savvy Advisors and Consultants
“Serving Almost One Million Doctors, Financial Advisors and Medical Management Consultants Daily“
A Partner of the Institute of Medical Business Advisors , Inc.
The CEO of a Texashealth insurance company was fired after admitting before a DOGE panel of state lawmakers that he hired private investigators to spy on customers and obtain sensitive details about their lives. Mark Sanders was dismissed from his duties as chief executive of Austin-based Superior HealthPlan after he testified before the Texas House Delivery of Government Efficiency Committee in a hearing on Medicaid procurement last week.
US stocks closed mixed on Tuesday as investors cautiously counted down to President Trump’s highly anticipated “Liberation Day” rollout of sweeping new reciprocal tariffs. The S&P 500 (^GSPC) rose about 0.4%, extending the gains the benchmark index secured on Monday, while the Dow Jones Industrial Average (^DJI) fell just below the flatline. The tech-heavy NASDAQ Composite (^IXIC) rebounded to close up around 0.9%.
Suppose that in a new Accountable Care Organization [ACO] contract, a certain medical practice was awarded a new global payment or capitation styled contract that increased revenues by $100,000 for the next fiscal year. The practice had a gross margin of 35% that was not expected to change because of the new business. However, $10,000 was added to medical overhead expenses for another assistant and all Account’s Receivable (AR) are paid at the end of the year, upon completion of the contract.
Cost of Medical Services Provided (COMSP):
The Costs of Medical Services Provided (COMSP) for the ACO business contract represents the amount of money needed to service the patients provided by the contract. Since gross margin is 35% of revenues, the COMSP is 65% or $65,000. Adding the extra overhead results in $75,000 of new spending money (cash flow) needed to treat the patients. Therefore, divide the $75,000 total by the number of days the contract extends (one year) and realize the new contract requires about $ 205.50 per day of free cash flows.
Assumptions
Financial cash flow forecasting from operating activities allows a reasonable projection of future cash needs and enables the doctor to err on the side of fiscal prudence. It is an inexact science, by definition, and entails the following assumptions:
All income tax, salaries and Accounts Payable (AP) are paid at once.
Durable medical equipment inventory and pre-paid advertising remain constant.
Gains/losses on sale of equipment and depreciation expenses remain stable.
Gross margins remain constant.
The office is efficient so major new marginal costs will not be incurred.
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Physician Reactions:
Since many physicians are still not entirely comfortable with global reimbursement, fixed payments, capitation or ACO reimbursement contracts; practices may be loath to turn away short-term business in the ACA era. Physician-executives must then determine other methods to generate the additional cash, which include the following general suggestions:
1. Extend Account’s Payable
Discuss your cash flow difficulties with vendors and emphasize their short-term nature. A doctor and her practice still has considerable cache’ value, especially in local communities, and many vendors are willing to work them to retain their business
2. Reduce Accounts Receivable
According to most cost surveys, about 30% of multi-specialty group’s accounts receivable (ARs) are unpaid at 120 days. In addition, multi-specialty groups are able to collect on only about 69% of charges. The rest was written off as bad debt expenses or as a result of discounted payments from Medicare and other managed care companies. In a study by Wisconsin based Zimmerman and Associates, the percentages of ARs unpaid at more than 90 days is now at an all time high of more than 40%. Therefore, multi-specialty groups should aim to keep the percentage of ARs unpaid for more than 120 days, down to less than 20% of the total practice. The safest place to be for a single specialty physician is probably in the 30-35% range as anything over that is just not affordable.
The slowest paid specialties (ARs greater than 120 days) are: multi-specialty group practices; family practices; cardiology groups; anesthesiology groups; and gastroenterologists, respectively. So work hard to get your money, faster. Factoring, or selling the ARs to a third party for an immediate discounted amount is not usually recommended.
3. Borrow with Short-Term Bridge Loans
Obtain a line of credit from your local bank, credit union or other private sources, if possible in an economically constrained environment. Beware the time value of money, personal loan guarantees, and onerous usury rates. Also, beware that lenders can reduce or eliminate credit lines to a medical practice, often at the most inopportune time.
4. Cut Expenses
While this is often possible, it has to be done without demoralizing the practice’s staff.
5. Reduce Supply Inventories
If prudently possible; remember things like minimal shipping fees, loss of revenue if you run short, etc.
6. Taxes
Do not stop paying withholding taxes in favor of cash flow because it is illegal.
Hyper-Growth Model:
Now, let us again suppose that the practice has attracted nine more similar medical contracts. If we multiple the above example tenfold, the serious nature of potential cash flow problem becomes apparent. In other words, the practice has increased revenues to one million dollars, with the same 35% margin, 65% COMSP and $100,000 increase in operating overhead expenses.
Using identical mathematical calculations, we determine that $750,000 / 365days equals $2,055.00 per day of needed new free cash flows! Hence, indiscriminate growth without careful contract evaluation and cash flow analysis is a prescription for potential financial disaster.
SPEAKING: Dr. Marcinko will be speaking and lecturing, signing and opining, teaching and preaching, storming and performing at many locations throughout the USA this year! His tour of witty and serious pontifications may be scheduled on a planned or ad-hoc basis; for public or private meetings and gatherings; formally, informally, or over lunch or dinner. All medical societies, financial advisory firms or Broker-Dealers are encouraged to submit a RFP for speaking engagements: CONTACT: MarcinkoAdvisors@outlook.com
Posted on April 1, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
MEDICAL EXECUTIVE-POST–TODAY’SNEWSLETTERBRIEFING
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Essays, Opinions and Curated News in Health Economics, Investing, Business, Management and Financial Planning for Physician Entrepreneurs and their Savvy Advisors and Consultants
“Serving Almost One Million Doctors, Financial Advisors and Medical Management Consultants Daily“
A Partner of the Institute of Medical Business Advisors , Inc.
US stocks rebounded Monday to cap a volatile month and quarter as trade-war worries mount in the run-up to President Trump’s tariff bonanza later in the week.
The tech-heavy NASDAQ Composite (^IXIC) closed down about 0.1%, while the S&P 500 (^GSPC) recuperated losses of as much as 1.7% to close up nearly 0.6%. The Dow Jones Industrial Average (^DJI) erased early morning losses to gain 1%, or about 400 points.
Markets wrapped up March on a woeful note after a rough month and quarter beset by Trump’s fast-evolving tariff policy. Last week was the fifth in six weeks that the NASDQ Composite and S&P 500 ended the week in the red. The benchmark index is down over 4.5% to start the year while the NASDAQ has lost over 10%, finishing with their worst quarters since 2022.
Some of the biggest-name megacaps have led the decline. NVIDIA (NVDA) fell Monday as it has neared a 20% loss so far this year, while TESLA (TSLA) has lost more than 35%.
Merger risk arbitrage, while a subset of a larger strategy called event-driven arbitrage, represents a sufficient portion of the market-neutral universe to warrant separate discussion.
Merger arbitrage earned a bad reputation in the 1980s when Ivan Boesky and others like him came to regard insider trading as a valid investment strategy. That notwithstanding, merger arbitrage is a respected strategy and when executed properly, can be highly profitable. It bets on the outcomes of mergers, takeovers and other corporate events involving two stocks which may become one.
Example:
A classic example is acquisition of SDL Inc. (SDLI) by JDS Uniphase Corp (JDSU). On July 10, 2010 JDSU announced its intent to acquire SDLI by offering to exchange 3.8 shares of its own shares for one share of SDLI. At that time, the JDSU shares traded at $101 and SDLI at $320.5. It was apparent that there was almost 20 percent profit to be realized if the deal went through (3.8 JDSU shares at $101 are worth $383 while SDLI was worth just $320.5).
This apparent mispricing reflected the market’s expectation about the deal’s outcome. Since the deal was subject to the approval of the U.S. Justice Department and shareholders, there was some doubt about its successful completion.
Risk arbitrageurs who did their homework and properly estimated the probability of success bought shares of SDLI and simultaneously sold short shares of JDSU on a 3.8 to 1 ratio, thus locking in the future profit. Convergence took place about eight months later, in February 2011, when the deal was finally approved and the two stocks began trading at exact parity, eliminating the mis-pricing and allowing arbitrageurs to realize a profit.
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Hedge Fund Research defines the strategy as follows:
Merger Arbitrage,also known as risk arbitrage, involves investing in securities of companies that are the subject of some form of extraordinary corporate transaction, including acquisition or merger proposals, exchange offers, cash tender offers and leveraged buy-outs. These transactions will generally involve the exchange of securities for cash, other securities or a combination of cash and other securities. Typically, a manager purchases the stock of a company being acquired or merging with another company, and sells short the stock of the acquiring company. A manager engaged in merger arbitrage transactions will derive profit (or loss) by realizing the price differential between the price of the securities purchased and the value ultimately realized when the deal is consummated. The success of this strategy usually is dependent upon the proposed merger, tender offer or exchange offer being consummated.
When a tender or exchange offer or a proposal for a merger is publicly announced, the offer price or the value of the securities of the acquiring company to be received is typically greater than the current market price of the securities of the target company. Normally, the stock of an acquisition target appreciates while the acquiring company’s stock decreases in value. If a manager determines that it is probable that the transaction will be consummated, it may purchase shares of the target company and in most instances, sell short the stock of the acquiring company. Managers may employ the use of equity options as a low-risk alternative to the outright purchase or sale of common stock. Many managers will hedge against market risk by purchasing S&P put options or put option spreads.
Posted on March 29, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
MEDICAL EXECUTIVE-POST–TODAY’SNEWSLETTERBRIEFING
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Essays, Opinions and Curated News in Health Economics, Investing, Business, Management and Financial Planning for Physician Entrepreneurs and their Savvy Advisors and Consultants
“Serving Almost One Million Doctors, Financial Advisors and Medical Management Consultants Daily“
A Partner of the Institute of Medical Business Advisors , Inc.
Dr. Jay Bhattacharya is officially the new NIH director. The Senate voted to confirm the Stanford University professor’s appointment on March 26 in a 53–47 vote. Marty MakaryMD was also confirmed as FDA commissioner in the same hearing in a 56–44 vote. The appointments come as additional “healthcare disruptors,” alongside Robert F. Kennedy Jr.’s confirmation as HHS secretary and Mehmet Oz’s nomination as head of the Centers for Medicare and Medicaid Services. The nominees have faced backlash from the medical community following their controversial stances on topics like vaccinations and alternative medical practices.
The Dow Jones Industrial Average (^DJI) dropped more than 700 points or nearly 1.7%, while the benchmark S&P 500 (^GSPC) fell almost 2%. The NASDAQ Composite (^IXIC) dropped 2.7% as tech stocks led the declines.
As noted above, the major averages fell on Friday after the release of a hotter-than-expected Personal Consumption Expenditures index reading, which includes the Federal Reserve’s preferred inflation gauge of “core” PCE. The reading showed prices increased more than expected last month, rising 0.4% month over month and 2.8% year over year, continuing a stubborn plateau on the path to the Fed’s 2% target.
Visualize: How private equity tangled banks in a web of debt, from the Financial Times.
Both median and average family net worth surged between 2019 and 2022, according to the U.S. Federal Reserve. Average net worth increased by 23% to $1,063,700, the Fed reported in October 2023, the most recent year it published the data. Median net worth, on the other hand, rose 37% over that same period to $192,900.
You might wonder why the average and median net worth figures are so different. That’s because when you take the average of something, you add together every value in a data set and then divide that figure by the number of individual values.
When calculating a median, you simply look at the middle figure within a data set. That said, an average figure can be significantly higher or lower than a median figure if there are extreme outliers – meaning a group of people with significantly more net worth than the rest of the group can bring the average higher.
Average Net Worth by Age
The average net worth of someone younger than 35 years old is $183,500, as of 2022. From there, average net worth steadily rises within each age bracket. Between 35 to 44, the average net worth is $549,600, while between 45 and 54, that number increases to $975,800. Average net worth surges above the $1 million mark between 55 to 64, reaching $1,566,900.
Average net worth again rises for those ages 65 to 74, to $1,794,600, before falling to $1,624,100 for the 75 and older group. The median net worth within every single age bracket, however, is much lower than the average net worth.
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Physicians [MD/DO]Net Worth by Specialty
A 2023 Medscape report shows the top 10 specialties with the most survey respondents saying they are worth more than $5 million.
SPEAKING: Dr. Marcinko will be speaking and lecturing, signing and opining, teaching and preaching, storming and performing at many locations throughout the USA this year! His tour of witty and serious pontifications may be scheduled on a planned or ad-hoc basis; for public or private meetings and gatherings; formally, informally, or over lunch or dinner. All medical societies, financial advisory firms or Broker-Dealers are encouraged to submit a RFP for speaking engagements: CONTACT: MarcinkoAdvisors@outlook.com
Posted on March 28, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
MEDICAL EXECUTIVE-POST–TODAY’SNEWSLETTERBRIEFING
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Essays, Opinions and Curated News in Health Economics, Investing, Business, Management and Financial Planning for Physician Entrepreneurs and their Savvy Advisors and Consultants
“Serving Almost One Million Doctors, Financial Advisors and Medical Management Consultants Daily“
A Partner of the Institute of Medical Business Advisors , Inc.
Health and Human Services Secretary Robert F. Kennedy Jr. is expected to announce 10,000 employees will be cut, the Wall Street Journal reported today—the latest round of layoffs in the Trump administration’s push to slash the size of the federal workforce.
US stocks slid lower on Thursday after President Trump pushed ahead with hefty new tariffs on auto imports, stoking concerns about a potential full-on trade war and global economic harm. The S&P 500 (^GSPC) and the Dow Jones Industrial Average (^DJI) fell just over 0.3% on the heels of a losing day for the major gauges. The tech-heavy NASDAQ Composite (^IXIC) led the losses, falling more than 0.5%.
An important concept for all medical professionals to understand is the current rate of return (CCR).
According to this principle, the current rate of a taxable return must be evaluated in reference to a similar non-taxable rate of return. This allows you to focus on your portfolio’s real (after-tax return), rather than its’ nominal, or stated return.
Now, since most medical professionals own a combination of both vehicles, it is important to calculate the average rate of return (ARR), as demonstrated in the following matrix. Usually, this will result in the assumption of more risk, for the possibility of great return.
To compare after tax yields, with taxable yields, use the following formulas:
Tax equivalent yield = yield / (1 – MTB), while taxable yield X (1-tax rate) = tax exempt yield.
Example: if the yield on a tax exempt municipal bond was 6%, and you are in a 28% tax bracket; the equivalent taxable yield (ETY), is 8.3%, calculated in the following manner: 06 / 1.00 – .28 =.083, or, 8.3% ETY. This means that you would need a taxable instrument paying almost 9 % to equal the 6 percent tax exempt bond.
Posted on March 27, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
MEDICAL EXECUTIVE-POST–TODAY’SNEWSLETTERBRIEFING
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Essays, Opinions and Curated News in Health Economics, Investing, Business, Management and Financial Planning for Physician Entrepreneurs and their Savvy Advisors and Consultants
“Serving Almost One Million Doctors, Financial Advisors and Medical Management Consultants Daily“
A Partner of the Institute of Medical Business Advisors , Inc.
Over the next decade, advances in artificial intelligence will mean that humans will no longer be needed “for most things” in the world, says Bill Gates. That’s what the Microsoft co-founder and billionaire philanthropist told comedian Jimmy Fallon during an interview on NBC’s “The Tonight Show” in February. At the moment, expertise remains “rare,” Gates explained, pointing to human specialists we still rely on in many fields, including “a great doctor” or “a great teacher.”
US stocks closed sharply loser Wednesday as President Trump prepared to unveil new tariffs on US auto imports. The benchmark S&P 500 (^GSPC) was down more than 1.1%, while the Dow Jones Industrial Average (^DJI) fell about 0.4%. The tech-heavy NASDAQ Composite (^IXIC) led the losses, sliding over 2%. Tech leaders Nvidia (NVDA) and Tesla (TSLA) both closed down more than 5%.
It’s a shocking fall for 23andMe that once boasted a $6 billion valuation in 2021—despite never making a profit. As of Friday, it was worth $50 million, and on Monday, shares for the consumer genetic testing pioneer fell 50% to 88 cents, Reuters reported.
Visualize: How private equity tangled banks in a web of debt, from the Financial Times.
Posted on March 26, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
MEDICAL EXECUTIVE-POST–TODAY’SNEWSLETTERBRIEFING
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Essays, Opinions and Curated News in Health Economics, Investing, Business, Management and Financial Planning for Physician Entrepreneurs and their Savvy Advisors and Consultants
“Serving Almost One Million Doctors, Financial Advisors and Medical Management Consultants Daily“
A Partner of the Institute of Medical Business Advisors , Inc.
Donald Trump has officially dropped a stablecoin. It’s called USD1, and it’s pegged 1:1 with the US dollar, according to a statement from his family company World Liberty Financial Inc, (WLFI) today. The company says the token is fully backed by short-term US government treasuries, USD deposits, and other cash equivalents. Every token equals one dollar, no exceptions. WLFI says it built the whole thing to give people a stablecoin they don’t have to second guess.
US stocks rose for a third day in a row despite souring consumer confidence — and as investors weighed whether President Trump would temper his plans for upcoming tariffs.
The benchmark S&P 500 (^GSPC) rose more than 0.1%, while the Dow Jones Industrial Average (^DJI) ticked just above the flatline. The tech-heavy NASDAQ Composite (^IXIC) rose nearly 0.5%, bolstered by a more than 3% jump from Tesla (TSLA).
Posted on March 25, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
MEDICAL EXECUTIVE-POST–TODAY’SNEWSLETTERBRIEFING
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Essays, Opinions and Curated News in Health Economics, Investing, Business, Management and Financial Planning for Physician Entrepreneurs and their Savvy Advisors and Consultants
“Serving Almost One Million Doctors, Financial Advisors and Medical Management Consultants Daily“
A Partner of the Institute of Medical Business Advisors , Inc.
US stocks closed near session highs on Monday as investors welcomed reports that the next wave of President Trump’s tariffs will be narrower than expected.
The S&P 500 (^GSPC) rose almost 1.8% on the heels of the broad benchmark snapping a four-week losing streak. The Dow Jones Industrial Average (^DJI) advanced 1.4%, while contracts on the tech-heavy NASDAQ Composite (^IXIC) led the gains, up 2.3%.
A hostile takeover happens when an entity takes control of a company without the knowledge and against the wishes of the company’s management. A hostile takeover is an acquisition strategy requiring that the entity acquire and control more than 50% of the voting shares issued by the company.
In mergers and acquisitions (M&A), a hostile takeover is the acquisition of a target company by an acquiring company that goes directly to the target company’s shareholders, either by making a tender offer or through a proxy vote.
Ideally, an entity interested in acquiring a company should seek approval from the target company’s Board of Directors. The difference between a hostile and a friendly takeover is that, in a friendly takeover, the target company’s board of directors approve of the transaction and recommend shareholders vote in favor of the deal.
Defenses against a hostile takeover
These defense mechanisms can be preemptive or reactive, depending on how prepared the company is for the possibility of a hostile bid.
Poison pill is one of the most common defenses against a hostile takeover. Officially known as a “shareholder rights plan,” the poison pill allows existing shareholders to purchase additional shares at a discount, diluting the ownership interest of the acquiring company. The goal is to make it prohibitively expensive for the acquirer to complete the takeover.
A golden parachute is another defense strategy, which involves providing lucrative compensation packages (bonuses, severance pay, stock options, etc.) to key executives in the event they are terminated as a result of the takeover. This creates a financial disincentive for the acquiring company, as it would need to pay out these large sums upon completing the takeover.
In a Crown jewel defense, the target company sells or threatens to sell its most valuable assets—its “crown jewels”—if the takeover is completed. This reduces the attractiveness of the company to the acquirer, as the most desirable assets would no longer be part of the deal.
The Pac-Man defenses a more aggressive strategy in which the target company turns the tables by attempting to buy shares of the acquiring company, effectively launching a counter-takeover. While rare, this defense can deter hostile bids by making the takeover battle more costly and complex.
A White-Knight defense involves the target company seeking out a more favorable acquirer, or “white knight,” to make a friendly takeover bid. This allows the target company to avoid the hostile acquirer while still securing the benefits of a merger or acquisition.
The hostile takeover between Sanofi-Aventis and Genzyme Corp. occurred in 2010 when Sanofi, a French pharmaceutical company, wanted to buy Genzyme, a US biotech firm specializing in rare diseases. Genzyme resisted the offer, leading to conflict. Sanofi started a public campaign to pressure Genzyme’s shareholders into selling.
After months of negotiations, the two companies reached a deal in 2011. Sanofi agreed to pay $74 per share, with additional payments tied to Genzyme’s future performance, bringing the total deal value to around $20.1 billion. This acquisition allowed Sanofi to expand into the lucrative market for rare disease treatment.
Posted on March 24, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
MEDICAL EXECUTIVE-POST–TODAY’SNEWSLETTERBRIEFING
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Essays, Opinions and Curated News in Health Economics, Investing, Business, Management and Financial Planning for Physician Entrepreneurs and their Savvy Advisors and Consultants
“Serving Almost One Million Doctors, Financial Advisors and Medical Management Consultants Daily“
A Partner of the Institute of Medical Business Advisors , Inc.
Futures attached to the benchmark S&P 500 (ES=F) rose 0.6%, with NASDAQ 100 (NQ=F) futures up 0.7%. Futures tied to the Dow Jones Industrial Average (YM=F) advanced around 0.4%.
Posted on March 22, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
MEDICAL EXECUTIVE-POST–TODAY’SNEWSLETTERBRIEFING
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Essays, Opinions and Curated News in Health Economics, Investing, Business, Management and Financial Planning for Physician Entrepreneurs and their Savvy Advisors and Consultants
“Serving Almost One Million Doctors, Financial Advisors and Medical Management Consultants Daily“
A Partner of the Institute of Medical Business Advisors , Inc.
The S&P 500 edged up 0.1%. The index finished with a 0.5% gain for the week. It’s still down 4.8% so far this month. The Dow Jones Industrial Average eked out a 0.1% gain, while the NASDAQ composite rose 0.5%.
It appears Medicare coverage for tele-health is here to stay—at least for the next six months. When the House of Representatives and Senate passed a budget on March 11t and 14th, respectively, they not only avoided a government shutdown, but also extended a resolution for Medicare to cover non-behavioral health tele-health appointments until September 30th.
Visualize: How private equity tangled banks in a web of debt, from the Financial Times.
Posted on March 21, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
MEDICAL EXECUTIVE-POST–TODAY’SNEWSLETTERBRIEFING
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Essays, Opinions and Curated News in Health Economics, Investing, Business, Management and Financial Planning for Physician Entrepreneurs and their Savvy Advisors and Consultants
“Serving Almost One Million Doctors, Financial Advisors and Medical Management Consultants Daily“
A Partner of the Institute of Medical Business Advisors , Inc.
U.S. stock indexes edged lower Thursday following another reminder that big, unsettling policy changes are underway because of President Donald Trump, along with more signals suggesting the U.S. economy remains solid for now.
The S&P 500 slipped 0.2% after flipping between modest gains and losses through the day. The Dow Jones Industrial Average dipped by 11 points, or less than 0.1 %, and the NASDAQ composite fell 0.3%.
Tax avoidance—An action taken to lessen tax liability and maximize after-tax income.
Tax evasion—The failure to pay or a deliberate underpayment of taxes.
Underground economy—Money-making activities that people don’t report to the government, including both illegal and legal activities.
Voluntary compliance—A system of compliance that relies on individual citizens to report their income freely and voluntarily, calculate their tax liability correctly, and file a tax return on time.
Posted on March 20, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
MEDICAL EXECUTIVE-POST–TODAY’SNEWSLETTERBRIEFING
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Essays, Opinions and Curated News in Health Economics, Investing, Business, Management and Financial Planning for Physician Entrepreneurs and their Savvy Advisors and Consultants
“Serving Almost One Million Doctors, Financial Advisors and Medical Management Consultants Daily“
A Partner of the Institute of Medical Business Advisors , Inc.
Stat: $1.2 billion. That’s how much San Diego-based Scripps Health plans to spend building a new hospital in San Marcos, California. (Becker’s Hospital Review)
Read: What WHO Director-General Tedros Adhanom Ghebreyesus said about USAID cuts. (Stat)
Pharm fresh: Check out in-depth strategies designed to help increase engagement between pharma reps and primary care clinicians. It’s all right here in Pri-Med’s research. Read the report.
Shares of Charles Schwab Corp. SCHW+1.51% rallied 1.51% to $78.73 Wednesday, on what proved to be an all-around favorable trading session for the stock market, with the S&P 500 IndexSPX+1.08% rising 1.08% to 5,675.29 and the Dow Jones Industrial AverageDJIA+0.92% rising 0.92% to 41,964.63.
Posted on March 19, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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Split-Dollar Life Insurance: An arrangement under which a life insurance policy’s premium, cash values, and death benefit are split between two parties—usually a corporation and a key employee or executive. Under such an arrangement an employer may own the policy and pay the premiums and give a key employee or executive the right to name the recipient of the death benefit.
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Several factors will affect the cost and availability of life insurance, including age, health, and the type and amount of insurance purchased. Life insurance policies have expenses, including mortality and other charges. If a policy is surrendered prematurely, the policy holder also may pay surrender charges and have income tax implications. You should consider determining whether you are insurable before implementing a strategy involving life insurance.
Any guarantees associated with a policy are dependent on the ability of the issuing insurance company to continue making claim payments.
9. We act with honesty, integrity and are always straightforward. 8. We strive to be innovative, creative, iconoclastic, and flexible. 7. We admit and learn from mistakes and don’t repeat them. 6. We work hard always as competitors are trying to catch up. 5. We treat others with dignity and respect. 4. We are the onus of consulting advice for the well being of others. 3. We fight complacency as former success is in the past. 2. The best management styles are timeless, not timely. 1. Our clients are colleagues and always come first.
SPEAKING: Dr. David Edward Marcinko MBA MEd will be speaking and lecturing, signing and opining, teaching and preaching, storming and performing at many locations throughout the USA this year! His tour of witty and serious pontifications may be scheduled on a planned or ad-hoc basis; for public or private meetings and gatherings; formally, informally, or over lunch or dinner. All medical societies, financial advisory firms or Broker-Dealers are encouraged to submit a RFP for speaking engagements.
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CONTACT: Ann Miller RN MHA at: MarcinkoAdvisors@outlook.com
Posted on March 19, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
MEDICAL EXECUTIVE-POST–TODAY’SNEWSLETTERBRIEFING
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Essays, Opinions and Curated News in Health Economics, Investing, Business, Management and Financial Planning for Physician Entrepreneurs and their Savvy Advisors and Consultants
“Serving Almost One Million Doctors, Financial Advisors and Medical Management Consultants Daily“
A Partner of the Institute of Medical Business Advisors , Inc.
US stocks pulled back on Tuesday, led by a nearly 2% decline in the NASDAQ, following two days of gains as investors concerned about an economic slowdown looked to the Federal Reserve’s policy meeting for insights.
The tech-heavy NASDAQ Composite (^IXIC) plummeted about 1.7% as Nvidia (NVDA) shares fell roughly 3% as its annual GTC event failed to impress investors. Other “Magnificent Seven” names also dragged down the tech-heavy index. Notably, those stocks are having their worst quarter in more than two years.
The Dow Jones Industrial Average (^DJI) and S&P 500 (^GSPC) also moved to the downside on Tuesday, dropping about 0.6% and 1.1%, respectively.
SO – HOW MUCH IS A “FINANCIAL ADVISOR” REALLY WORTH?
This blog holds a rather uncomplimentary opinion of financial advisors, and the financial services and brokerage industry as a whole; deserved, or not? The entire site hints at this attitude as well, in favor of a going it alone or ME, Inc investing when possible. Nevertheless, it is reasonable to wonder how much boost in net-returns might an educated and informed, fee transparent and honest, fiduciary focused “financial advisor” add to a clients’ investment portfolio; all things being equal [ceteris paribus].
And, can it be quantified?
Well, according to Vanguard Brokerage Services®, perhaps as much as 3%? In a decade long paper from the Valley Forge, PA based mutual fund and ETF giant, Vanguard said financial advisors can generate returns through a framework focused on five wealth management principles:
• Being an effective behavioral coach: Helping clients maintain a long-term perspective and a disciplined approach is arguably one of the most important elements of financial advice. (Potential value added: up to 1.50%).
• Applying an asset location strategy: The allocation of assets between taxable and tax-advantaged accounts is one tool an advisor can employ that can add value each year. (Potential value added: from 0% to 0.75%).
• Employing cost-effective investments: This component of every advisor’s tool kit is based on simple math: Gross return less costs equals net return. (Potential value added: up to 0.45%).
• Maintaining the proper allocation through rebalancing: Over time, as investments produce various returns, a portfolio will likely drift from its target allocation. An advisor can add value by ensuring the portfolio’s risk/return characteristics stay consistent with a client’s preferences. (Potential value added: up to 0.35%).
• Implementing a spending strategy: As the retiree population grows, an advisor can help clients make important decisions about how to spend from their portfolios. (Potential value added: up to 0.70%).
Source: Financial Advisor Magazine, page 20, April 2014.
Assessment
However, Vanguard notes that while it’s possible all of these principles could add up to 3% in net returns for clients, it’s more likely to be an intermittent number than an annual one because some of the best opportunities to add value happen during extreme market lows and highs when angst or giddiness [fear and greed] can cause investors to bail on their well-thought-out investment plans.
And, is the study applicable to doctors and allied healthcare providers? Doe Vanguard have a vested interest in the topic. What about fee based versus fee-only financial advice?
Conclusion
Finally, recognize the plethora of other financial planning life-cycle topics addressed in this ME-P were not included in the Vanguard investment portfolio-only study a decade ago.
And what about today with contemporaneous internet advising, chat-rooms, linkedin, robo-advisors, reddit and the like?
Posted on March 18, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
MEDICAL EXECUTIVE-POST–TODAY’SNEWSLETTERBRIEFING
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Essays, Opinions and Curated News in Health Economics, Investing, Business, Management and Financial Planning for Physician Entrepreneurs and their Savvy Advisors and Consultants
“Serving Almost One Million Doctors, Financial Advisors and Medical Management Consultants Daily“
A Partner of the Institute of Medical Business Advisors , Inc.
A group of current and former employees of JPMorgan Chase (NYSE:JPM) has filed a lawsuit alleging that the company, through its prescription drug plan run by CVS Health (NYSE:CVS), overpaid for medicines, resulting in higher expenses for its workers, according to Bloomberg News.
The S&P 500 (^GSPC) gained about 0.6% to rebound for a second day in row, while the Dow Jones Industrial Average (^DJI) gained more than 350 points, or more than 0.8%. The tech-heavy NASDAQ Composite (^IXIC) rose 0.3% as “Magnificent 7” stocks, including Nvidia (NVDA) and Tesla (TSLA), faltered.
Posted on March 17, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
BANK IDENTIFICATION NUMBER – DEFINED
By Staff Reporters
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What Is a BIN Attack?
The BIN, or the Bank Identification Number, is the first six digits on a credit card. These are always tied to its issuing institution – usually a bank. In a BIN attack, fraudsters use these six numbers to algorithmically try to generate all the other legitimate numbers, in the hopes of generating a usable card number.
How Does a BIN Attack Work?
Fraudsters conduct BIN attacks by generating hundreds of thousands of possible credit card numbers and testing them out.
A fraudster looks up the BIN of the bank they will target. Ranging from four to six digits, this information is in the public domain and is thus easy to source.
Using dedicated software such as an auto-dialer, they generate thousands, often tens of thousands, combinations of possible existing card numbers by this issuer.
At this point, these credentials need to be tested. The fraudster identifies a suitable online shop or donation page.
They start card testing by attempting a small payment with each generated card number.
They keep track of the small percentage of card details that worked, which they are ready to use in earnest for their fraudulent pursuits.
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Remember that the fraudster will start off with only six digits, yet there are many more card details required for a successful transaction. If those are entered erroneously, the transaction will decline. This includes the CVV number, the expiration date, as well as likely address verification service (AVS) failures. Card testing transactions are executed remotely in a fast fashion, so distance checks should also be a hint as well as velocity alerts.
Fraudsters may use bad merchant accounts directly for this purpose, or more frequently involve multiple online stores and services during a BIN attack, as their attempts keep getting blocked at most outlets.
When analyzing a set of financial statements to determine practice value, adjustments (normalizations) generally are needed to produce a clearer picture of likely future income and distributable cash flow. It also allows more of an “apples to apples” line item comparison. This normalization process usually consists of making three main adjustments to a medical practice’s net income (profit and loss) statement.
1. Non-Recurring Items: Estimates of future distributable cash flow should exclude non-recurring items. Proceeds from the settlement of litigation, one-time gains/losses from the selling of assets or equipment, and large write-offs that are not expected to reoccur, each represent potential nonrecurring items. The impact of nonrecurring events should be removed from the practice’s financial statements to produce a clearer picture of likely future income and cash flow.
2. Perquisites: The buyer of a medical practice may plan to spend more or less than the current doctor-owner for physician executive compensation, travel and entertainment expenses, and other perquisites of current management. When determining future distributable cash flow, income adjustments to the current level of expenditures should be made for these items.
3. Non-cash Expenses: Depreciation expense, amortization expense, and bad debt expense are all non-cash items which impact reported profitability. When determining distributable cash flow, you must analyze the link between non-cash expenses and expected cash expenditures.
The annual depreciation expense is a proxy for likely capital expenditures over time. When capital expenditures and depreciation are not similar over time, an adjustment to expected cash flow is necessary. Some practices reduce income through the use of bad debt expense rather than direct write-offs. Bad debt expense is a non-cash expense that represents an estimate of the dollar volume of write-offs that are likely to occur during a year. If bad debt expense is understated, practice profitability will be overstated.
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Balance Sheet Adjustments
Adjustments also can be made to a practice’s balance sheet to remove non-operating assets and liabilities, and to restate asset and liability value at market rates (rather than cost rates). Assets and liabilities that are unrelated to the core practice being valued should be added to or subtracted from the value, depending on whether they are acquired by the buyer.
Examples include the asset value less outstanding debt of a vacant parcel of land, and marketable securities that are not needed to operate the practice. Other non-operating assets, such as the cash surrender value of officer life insurance, generally are liquidated by the seller and are not part of the business transaction.
SPEAKING: Dr. Marcinko will be speaking and lecturing, signing and opining, teaching and preaching, storming and performing at many locations throughout the USA this year! His tour of witty and serious pontifications may be scheduled on a planned or ad-hoc basis; for public or private meetings and gatherings; formally, informally, or over lunch or dinner. All medical societies, financial advisory firms or Broker-Dealers are encouraged to submit a RFP for speaking engagements: CONTACT: MarcinkoAdvisors@outlook.com
Posted on March 15, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
MEDICAL EXECUTIVE-POST–TODAY’SNEWSLETTERBRIEFING
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Essays, Opinions and Curated News in Health Economics, Investing, Business, Management and Financial Planning for Physician Entrepreneurs and their Savvy Advisors and Consultants
“Serving Almost One Million Doctors, Financial Advisors and Medical Management Consultants Daily“
A Partner of the Institute of Medical Business Advisors , Inc.
At least eight agencies are investigating a recent fire at a Bayer executive’s New Jersey home as a possible arson, authorities said. The fire happened around 7:30 a.m. March 4th “at an occupied residence on East Lane in Madison,” the Morris County Prosecutor’s Office told CNN yesterday.
US stocks bounced back sharply on Friday to cap a volatile week on Wall Street as the risk of a government shutdown eased while investors stayed on watch for the next move in an escalating trade war. The S&P 500 (^GSPC) climbed more than 2.1% after the benchmark index sank on Thursday to close in correction territory. The NASDAQ Composite (^IXIC) jumped over 2.6% as tech stocks soared. The Dow Jones Industrial Average (^DJI) moved up more than 600 points, or 1.6%.
Yesterday March 14th was Pi Day! (Yes, the mathematical constant, although we fully support celebrating with actual pie.) Put simply, Pi—aka π—is the ratio of a circle’s circumference to its diameter. It also sneaks its way into medicine. For one, it’s part of Poiseuille’s Law, an equation that helps explain how fluid flows through tubes, including arteries and IV lines. So, whether you’re crunching numbers or crunching on a slice, Pi is definitely worth celebrating
And, today is the Ides of March!
Visualize: How private equity tangled banks in a web of debt, from the Financial Times.
Posted on March 14, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
MEDICAL EXECUTIVE-POST–TODAY’SNEWSLETTERBRIEFING
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Essays, Opinions and Curated News in Health Economics, Investing, Business, Management and Financial Planning for Physician Entrepreneurs and their Savvy Advisors and Consultants
“Serving Almost One Million Doctors, Financial Advisors and Medical Management Consultants Daily“
A Partner of the Institute of Medical Business Advisors , Inc.
An executive for insurance giant State Farm was fired this week after he was recorded on an undercover video making comments about the insurer’s premium increases in response to Southern California wildfires. Haden Kirkpatrick, who worked as State Farm’s vice president for innovation and venture capital, was surreptitiously recorded on a video published by O’Keefe Media Group. The Los Angeles Times reported that he claims he was fired over the recording.
US stocks fell on Thursday, with the S&P 500 (^GSPC) officially entering into correction territory, as economic concerns grew and investors digested the latest inflation data, President Trump’s trade offensive, and a looming US government shutdown.
The S&P 500 (^GSPC) dropped 1.4% to officially enter a correction, as it is now more than 10% off its February record high. The tech-heavy NASDAQ Composite (^IXIC), which itself entered into a correction last week, shed nearly 2% on the heels of a rebound for both gauges. The Dow Jones Industrial Average (^DJI) slid 1.3%, or nearly 550 points.
Posted on March 13, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
MEDICAL EXECUTIVE-POST–TODAY’SNEWSLETTERBRIEFING
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Essays, Opinions and Curated News in Health Economics, Investing, Business, Management and Financial Planning for Physician Entrepreneurs and their Savvy Advisors and Consultants
“Serving Almost One Million Doctors, Financial Advisors and Medical Management Consultants Daily“
A Partner of the Institute of Medical Business Advisors , Inc.
Stock markets mostly rose Wednesday on both sides of the Atlantic as investors shrugged off Washington’s latest tariffs to focus on cooling US inflation and a Ukraine ceasefire plan.
Markets have worried that the tariffs could spark a surge in US inflation and drive a stake into the chances that the Federal Reserve cuts interest rates further. But government data released Wednesday showed US consumer inflation had slowed slightly to 2.8 percent in February — the first full month of Trump’s White House return.
That was slightly better than analysts expected. Core inflation, which excludes volatile food and energy prices, dipped to an annual rate of 3.1 percent. “The inflation data are a bright spot in the Federal Reserve’s battle against rising prices. They reinforce the expectation of three rate cuts later in 2025,” said Jochen Stanzl, chief market analyst at CMC Markets.
“Sentiment on Wall Street is so negative that these positive inflation figures could spark a broader recovery in stock prices,” he added.
Wall Street’s main stock indices mostly closed higher with the tech-heavy NASDAQ Composite rising 1.2 percent. But the Dow dipped into the red, losing 0.2 percent.
Posted on March 12, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
MEDICAL EXECUTIVE-POST–TODAY’SNEWSLETTERBRIEFING
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Essays, Opinions and Curated News in Health Economics, Investing, Business, Management and Financial Planning for Physician Entrepreneurs and their Savvy Advisors and Consultants
“Serving Almost One Million Doctors, Financial Advisors and Medical Management Consultants Daily“
A Partner of the Institute of Medical Business Advisors , Inc.
Stocks inched up overnight after Monday’s ugly plunge to six-month lows, but positive catalysts were scattered and the rocky economy has begun affecting earnings forecasts. Delta Airlines (DAL) lowered its outlook yesterday amid what it called “macro uncertainty,” raising concerns it could be first on a crowded runway.
One theme as stocks plunged recently was that despite the suffering was that earnings outlooks remained strong. The latest FactSet forecasts for first quarter and 2025 S&P 500 earnings growth are 7.3% and 11.6%, respectively. Both are down from December 31st, though, and further setbacks in expectations could hurt confidence. Oracle (ORCL) missed analysts’ estimates late Monday. “The longer the tariff turmoil and related uncertainty about trade policy lasts, the more likely economic and earnings growth may take a hit,” said Jeffrey Kleintop, chief global investment strategist at Schwab.
Job openings data later yesterday morning and the Consumer Price Index (CPI) tomorrow could help set the tone, though economic growth seems to have replaced inflation as the prime concern. Yesterday’s steep losses reflected less confidence in either the administration or the Federal Reserve potentially stepping in to rescue a slumping economy. Growth fears have pummeled the Magnificent Seven, with six of them among the bottom 350 in S&P 500 index (SPX) year-to-date performance.
For now, the S&P 500 (^GSPC) avoided correction territory but still fell about 0.8% to trade at just under 5,600. The Dow Jones Industrial Average (^DJI) shed roughly 500 points, or 1.1%, dragged down by shares of Verizon (VZ). The tech-heavy NASDAQ Composite (^IXIC) reversed gains in the last few minutes of trading to fall about 0.2%. All three indexes closed at their lowest levels since September.
Visualize: How private equity tangled banks in a web of debt, from the Financial Times.
Monetarism is the belief that changes in the money supply are the main determinant of changes in inflation, associated especially with Milton Friedman, an American economist. Cases of hyperinflation have indeed been associated with the rapid printing of money. But when governments adopted monetarist policies in the late 1970s and early 1980s, they found money supply hard to control and also struggled to decide which measure of money supply was best to target. Monetarist policies were abandoned in favor of inflation targeting.
Monetary financing is the direct financing of government spending by the central bank. This happened during the hyperinflation in Germany in 1923 and was thus regarded as anathema for a long period afterwards. As a result, some commentators viewed quantitative easing after the financial crisis of 2007-09 with great suspicion. Technically, however, QE is not monetary financing, because central banks only buy government bonds in the secondary market and because they pay interest on reserves (the money they create).
Monetary policy The use, normally by the central bank, of interest rates and other tools to try to influence the economy. Interest rates are raised when the bank is trying to control inflation and lowered when inflation is low and it is trying to revive the economy. The financial crisis of 2007-09 led central banks to face the zero lower bound. This prompted many of them to use a new tool, quantitative easing, which was designed to bring down long-term rates or bond yields.
Posted on March 11, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
MEDICAL EXECUTIVE-POST–TODAY’SNEWSLETTERBRIEFING
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Essays, Opinions and Curated News in Health Economics, Investing, Business, Management and Financial Planning for Physician Entrepreneurs and their Savvy Advisors and Consultants
“Serving Almost One Million Doctors, Financial Advisors and Medical Management Consultants Daily“
A Partner of the Institute of Medical Business Advisors , Inc.
US stocks plunged on Monday as investors processed growing concerns about the health of the US economy after President Trump and his top economic officials acknowledged the possibility of a potential rough patch.
The Dow Jones Industrial Average (^DJI) fell nearly 900 points, or over 2%, while the benchmark S&P 500 (^GSPC) dropped around 2.7% after the index posted its worst week since September. The tech-heavy NASDAQ Composite (^IXIC) fell 4% in its worst day since 2022, as the “Magnificent Seven” stocks led the sell-off. Tesla’s (TSLA) rout continued, plunging 15% and officially wiping out the gains it had made in the wake of Trump’s election win. Nvidia (NVDA), Apple (AAPL), Google parent Alphabet (GOOG), and Meta (META) all each lost more than 4%.
Key inflation data includes the Consumer Price Index (CPI) and Producer Price Index (PPI) on Wednesday and Thursday could help set the tone, though economic growth concerns seem to have replaced inflation as the prime concern. The S&P 500 index (SPX) dropped more than 3% last week, the worst performance since September.
However, the U.S. economy “is in a good place” despite recent policy uncertainty, Federal Reserve Chairman Jerome Powell said Friday. He sees no need to hurry rate cuts until there’s more policy clarity, Bloomberg reported. Stocks rallied on Powell’s words late Friday, but Monday’s early action indicates that rallies continue being sold, and the Cboe Volatility Index (VIX) rose above 26 as investors piled into risk-off assets like bonds. The 200-day moving average of 5,734 for the SPX remains a key technical support area, and the SPX was on pace to open below that Monday, now more than 6% off of all-time highs but not yet in –10% correction territory.
RISK MANAGEMENT, LIABILITY INSURANCE AND ASSET PROTECTION ABBREVIATIONS
[Glossary of Important Acronyms]
Much has been written and much has been opined on the topic of medical risk management, insurance, asset protection and professional liability for physicians and healthcare providers in this textbook; and elsewhere.
But occasionally, we all still get lost in a wide array of abbreviations, acronyms, and initialisms that are constantly changing in this ecosystem.
And so, this glossary serves as a ready reference for those who want to know about these medical risk management definitions in a quick and ready fashion.
Acronyms and Abbreviations
AAASC American Association of Ambulatory Surgery Centers
AAHP American Association of Health Plans
ABN advance beneficiary notice
ABQAUR American Board of Quality Assurance and Utilization Review
ACE acute care episode
ACHCE American College of Health Care Executives
ACS American College of Surgeons
ADA Americans with Disabilities Act
ADC average daily census
ADL activities of daily living
ADT Admission/Discharge/Transfer
AHA American Hospital Association
AHIMA American Health Information Management Association
AHRQ Agency for Healthcare Research and Quality
AI average inventory
AIMR Association for Investment Management and Research
AIR assumed interest rate
ALE annualized loss expectancy
ALF assisted living facility
ALOS average length of stay
AMA American Medical Association
AMBAC AMBAC Indemnity Corporation
AMGA American Medical Group Association
ANSI American National Standards Institute
AP accounts payable
APA American Psychiatric Association
APC ambulatory payment classification
APG ambulatory payment group
APR annual percentage rate
AR accounts receivable
ASA American Society of Appraisers
ASC ambulatory surgery centers; also Accredited Standards Committee
ASHA American Surgical Hospital Association
ASO administrative services only
ASTC ancillary service technical component
ATM asynchronous transfer mode
AVG ambulatory visit group
BANTA best alternative to negotiated agreement
BBA Balanced Budget Act of 1997
BBRA Balanced Budget Refinement Act [1999]
BCP business continuity planning
BEA break-even analysis
BEP break-even point
BIPA Benefits Improvement and Protection Act [2000]
BLS Bureau of Labor Statistics
BPD border protection device
BS balance sheet
BSA Bank Secrecy Act
BVS business valuation standard
CA certificate authority
CAC Carrier Advisory Committee
CAS cost accounting standards
CASB Cost Accounting Standards Board
CC common criteria [for IT Security Evaluation —ISO/IEC 15408]; complication or comorbidity [for MS-DRGs]
CCA certified cost accountant
CCC cash conversion cycle
CCEVS common criteria evaluation and validation scheme
CCHIT Certification Commission for Healthcare Information Technology
CCU critical care unit
CDC Centers for Disease Control and Prevention
CDH consumer-directed healthcare
CDHP consumer-directed healthcare plan
CDPM Clinical Data Project Manager
CDSS clinical decision support system
CEO Chief Executive Officer
CF conversion factor
CFA Chartered Financial Analyst
CFO Chief Financial Officer
CFR Code of Federal Regulations
CHAMP Children’s Health and Medicare Protection Act of 2007
CHAMPUS Civilian Health and Medical Program of the Uniformed Services
CHE Certified Healthcare Executive
CHIPS Center for Healthcare Industry Performance Studies
CIA Corporate Integrity Agreement
CIO Chief Information Officer
CIP Customer Identification Program
CIS computer information systems
CLIA Clinical Laboratory Improvement Act
CLT capitation liability theory
CME continuing medical education
CMI case mix index
CMIO Chief Medical Information Officer
CMIS contribution margin income statement
CMN Certificate of Medical Necessity
CMP Certified Medical Planner ™
CMS Centers for Medicare and Medicaid Services [formerly HCFA]
COD cash on delivery
COGME Council of Graduate Medical Education
COH cash on hand
COLA cost of living allowance
CON Certificate of Need
COO Chief Operating Officer
COSO Committee of Sponsoring Organizations
COTS commercial off-the-shelf
CPHQ Certified Physician in Healthcare Quality
CPIM Certificate in Production and Inventory Management
CPI-U Consumer Price Index—urban
CPM critical (clinical) path method
CPOE computerized physician order entry [system]
CPR computer-based patient record
CPT current procedural terminology
CQI continuous quality improvement
CRL Certification Revocation List
CRM customer relationship management
CRVS California Relative Value Studies
CSO Chief Security Officer
CT scan computed tomography scan [also called CAT scan]
CUSIP Committee on Uniform Security Identification Procedures
Candid CIO: Will Weider, CIO of Ministry Health Care and Affinity Health System, offers his perspectives on administration issues in this blog.
Christina’s Considerations: Christina Thielst is a hospital and healthcare administrator and entrepreneur with a deep desire for continually improving the health of the community being served. This is her blog.
Healing Hospitals — Formerly Ask a Hospital President: F. Nicholas “Nick” Jacobs has more than 20 years experience in hospital management, with an acknowledged reputation for innovation and consumer-centered leadership.
Hospital Impact: Part of the Fierce network of health sites, this site is becoming popular among healthcare administrators for its news updates, tips and opinions on health care matters.
Leading the Way to Medical Excellence: the president of McLeod Health non-profit institutions provides weekly insights into his facilities and health care in general.
Let’s Talk Health Care: Bruce Bullen, Interim Chief Executive Officer at Harvard Pilgrim in Massachusetts, provides and open and ongoing conversation about health care administration.
Life as a Healthcare CIO: Dr. John Halamka records his experiences with infrastructure, applications, policies, management, and governance as he supports 3,000 doctors, 18,000 faculty and about three million patients.
Managed Care Matters: Joe Paduda shares his knowledge on managed care for group health, health policy, health research, and medical news for insurers, employers, and healthcare providers.
More than Medicine: Tom Quinn, president and CEO of Community General Hospital in Syracuse, New York, began his career as a hospital kitchen worker. His perspective on administration reflects his knowledge on how hospitals work from every angle.
Running a Hospital: A CEO of a large Boston hospital shares thoughts on hospitals, medicine and health care issues.
St. Joseph Medical Center: Chief Executive Officer at St. Joseph Medical Center in Missouri, Mr. Kashman, provides personal insight into administrative matters and general topics.
Todd’s Perspective: Todd Linden, president and CEO of Grinnell Regional Medical Center, offers insights into medical administration and guest bloggers provide insight into various departments.
Wachter’s World: This blog focuses on hospitals, hospitalists, quality, safety, policy and much more from Robert M. Wachter, MD, Professor and Associate Chairman of the Department of Medicine at the University of California, San Francisco.
Legal Matters
Drug and Device Law: This blog contains an attorney’s personal views (and those of several other Dechert attorneys) on topics that arise in the defense of pharmaceutical and medical device product liability litigation.
Drug Injury Watch: Learn more about drug injury lawsuits from an attorney who represents patients and their families.
FDA Law Blog: Hyman, Phelps & McNamara, P.C. is the largest dedicated food and drug law firm in the country. Their knowledge about laws and regulations governing drugs, medical devices, foods, dietary supplements, and cosmetics is helpful to anyone interested in these topics.
Health Care Law Blog: Bob Coffield’s expertise lies in helping businesses and health care providers weave through a variety of state and federal health care regulations and assisting them in business transactions.
Health Plan Law: This site contains information about group health plans, claims administration and related ERISA fiduciary issues. This site also contains tutorials.
HealthBlawg: this is David Harlow’s popular health care law blog, offering expert insights and easy-to-understand analysis.
Healthcare Law Blog: Holland & Hart’s healthcare practice provides insight into this arena, including HIPAA, Stark law, the Anti-kickback Statute and more.
HIPAA Blog: Join in on this discussion of medical privacy issues often buried in “political arcana.”
HIPAA, HiTech & HIT: This updated blog brings insight into legal issues, developments and other pertinent information that relates to the creation, use and exchange of electronic health records.
HIT Blawg: This blog is focused on national health information technology legal trends and current news on this topic.
Home Care Law Blog: Learn more about legal and policy issues in the home health care, private duty and hospice industries from Gilliland & Markette LLP.
Med Law Blog: This law blog focuses on topics that range from compliance to contracts and from employee benefits to HIPAA and HIT.
Physician Law: This blog provides and easy way to stay on top of current news, updates and useful tips relating to legal issues that affect physicians and non-institutional providers.
eHealth and Health IT
Chilmark Research: This blog provides perspectives on key IT trends in the healthcare sector.
davidrothman.net: David is the Information Services Specialist at the Community General Hospital Medical Library, but he also provides great ideas for 2.0 tools and tips for healthcare industry professionals on this blog.
e-CareManagement blog: Vince Kuraitis, owner of Better Health Technologies, LLC, has a passion for disease management and care coordination that dates back to 1995.
e-HealthExpert: A non-profit organization provides a free and open forum to support the development of expertise in the field of eHealth, Healthcare Information Systems, and Health IT (Clinical IT).
eHealth: John Sharp is an IT Manager for a major medical center in Northeast Ohio, with a focus on ehealth, personal health records, Web 2.0 technologies, Windows Sharepoint Services and project management.
Found In Cache: If you would prefer a professional’s take on social media matters, Web sites and all things technological, then follow Ed Bennett, a technology expert for a Maryland medical care system.
Future Health IT: A health IT and EPR advocate from the UK provides a format to discuss the future of health care and IT.
Informaticopia: This UK blogger provides eclectic news and views on health informatics and elearning.
MedGadget: Stay ahead of the gadget curve with this site, which offers information about the newest health care gadgets on the market as well as emerging medical technologies.
Neil Versel’s Healthcare IT Blog: A healthcare journalist’s provides his views on the major segment of the industry he covers — and, he provides a ton of links to other sites as well.
Schwartz Healthcare IT Blog: A variety of authors from Schwartz Communications provide insights into ways to use IT effectively within healthcare facilities.
The Health IT Channel: For a different perspective on IT and EHR as well as other health care issues, watch a few videos at this site.
The Healthcare IT Guy: The CEO of Netspective, a Java/.NET consultancy that specializes in healthcare IT with an emphasis on e-health, EMRs, data integration, and legacy modernization, supplies tips and information for physicians and healthcare administration.
ACKNOWLEDGEMENTS: To Mackenzie H. Marcinko PhD of iMBA Inc., Perry D’Alessio CPA CMP™ [Hon] New York, NY; and Daniel B. Moisand CFP®, Principal for Moisand Fitzgerald Tamayo, Melbourne, FL.
Posted on March 8, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
MEDICAL EXECUTIVE-POST–TODAY’SNEWSLETTERBRIEFING
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Essays, Opinions and Curated News in Health Economics, Investing, Business, Management and Financial Planning for Physician Entrepreneurs and their Savvy Advisors and Consultants
“Serving Almost One Million Doctors, Financial Advisors and Medical Management Consultants Daily“
A Partner of the Institute of Medical Business Advisors , Inc.
Walgreens Boots Alliance says it has agreed to be acquired by private equity firm Sycamore Partners as the struggling retailer looks to turn itself around after years of losing money. Walgreens said Thursday that Sycamore will pay $11.45 per share, giving the deal an equity value just under $10 billion. Shareholders could eventually receive up to an
A common stock is the least senior of securities issued by a company. A preferred stock, in contrast, is slightly more senior to common stock, since dividends owed to the preferred stockholders should be paid before distributions are made to common stockholders.
However, distributions to preferred stockholders are limited to the level outlined in the preferred stock agreement (i.e., the stated dividend payments). Like a fixed income security, preferred stocks have a specific periodic payment that is either a fixed dollar amount or an amount adjusted based upon short-term market interest rates. However, unlike fixed income securities, preferred stocks typically do not have a specific maturity date and preferred stock dividend payments are made from the corporation’s after tax income rather than its pre-tax income. Likewise, dividends paid to preferred stockholders are considered income distributions to the company’s equity owners rather than creditors, so the issuing corporation does not have the same requirement to make dividend distributions to preferred stockholders.
Preferred Stock
Thus, preferred stock is generally referred to as a “hybrid” security, since it has elements similar to both fixed income securities (i.e., a stated periodic payments) and equity securities (i.e., shareholders are considered owners of the issuing company rather than creditors).
Hybrid Securities
Convertible preferred stocks (and convertible corporate bonds) are also considered hybrid securities since they have both equity and fixed income characteristics. A convertible security whether a preferred stock or a corporate bond, generally includes a provision that allow the security to be exchanged for a given number of common stock shares in the issuing corporation. The holder of a convertible security essentially owns both the preferred stock (or the corporate bond) and an option to exchange the preferred stock (or corporate bond) for shares of common stock in the company.
Thus, at times the convertible security may behave more like the issuing company’s common stock than it does the issuing company’s preferred stock (or corporate bonds), depending upon how close the common stock’s market price is to the designated conversion price of the convertible security.
SPEAKING: Dr. Marcinko will be speaking and lecturing, signing and opining, teaching and preaching, storming and performing at many locations throughout the USA this year! His tour of witty and serious pontifications may be scheduled on a planned or ad-hoc basis; for public or private meetings and gatherings; formally, informally, or over lunch or dinner. All medical societies, financial advisory firms or Broker-Dealers are encouraged to submit a RFP for speaking engagements:
Posted on March 7, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
MEDICAL EXECUTIVE-POST–TODAY’SNEWSLETTERBRIEFING
***
Essays, Opinions and Curated News in Health Economics, Investing, Business, Management and Financial Planning for Physician Entrepreneurs and their Savvy Advisors and Consultants
“Serving Almost One Million Doctors, Financial Advisors and Medical Management Consultants Daily“
A Partner of the Institute of Medical Business Advisors , Inc.
US stocks tanked to session lows on Thursday after more tariff whiplash from the Trump administration.
The Dow Jones Industrial Average (^DJI) fell 1%, or over 400 points, while the S&P 500 (^GSPC) dropped nearly 2%. The tech-heavy NASDAQ Composite (^IXIC) plummeted more than 2.6%. The Nasdaq is now more than 10% off its December record high and officially entered into correction territory.
Trade-war uncertainty has persisted as investors weighed how far President Donald Trump would be willing to negotiate on tariffs. On Thursday, Trump said he would pause tariffs on some Mexican goods, and the White House later said the delay also includes goods from Canada.
Separate Account Management offers medical professionals customized personal money management services. In the typical separate account structure, a money manager invests the individual’s assets in stocks and bonds (as opposed to mutual funds providing exposure to specific asset classes) on a discretionary basis.
For physicians and healthcare providers with significant investment assets (e.g., $100,000), a separately managed portfolio can be customized to reflect their tax situation, social investment guidelines, and cash flow needs.
An additional benefit of the separate account management structure is that a client’s portfolio may be positioned over time as opportunities arise, rather than forcing stocks into the portfolio without regard to current conditions.
Although separate account management generally offers a higher degree of customization than mutual funds, fees for separate account management are generally consistent with mutual funds fees, especially given that separate account managers may discount their fees for larger portfolios.
SPEAKING: Dr. Marcinko will be speaking and lecturing, signing and opining, teaching and preaching, storming and performing at many locations throughout the USA this year! His tour of witty and serious pontifications may be scheduled on a planned or ad-hoc basis; for public or private meetings and gatherings; formally, informally, or over lunch or dinner. All medical societies, financial advisory firms or Broker-Dealers are encouraged to submit a RFP for speaking engagements: MarcinkoAdvisors@outlook.com
Posted on March 6, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
MEDICAL EXECUTIVE-POST–TODAY’SNEWSLETTERBRIEFING
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Essays, Opinions and Curated News in Health Economics, Investing, Business, Management and Financial Planning for Physician Entrepreneurs and their Savvy Advisors and Consultants
“Serving Almost One Million Doctors, Financial Advisors and Medical Management Consultants Daily“
A Partner of the Institute of Medical Business Advisors , Inc.
Endometriosis Awareness Week, which brings attention to the chronic disease that affects about 10% of reproductive-age patients with uteruses worldwide. There’s still no known cure, due in part to research being underfunded—in 2022, the NIH allocated just $16 million, or $2 per patient, to endometriosis research, according to a 2024 study.
After sliding earlier in the session, the tech-heavy NASDAQ Composite (^IXIC) led the gains, rising more than 1.4%. Meanwhile, the Dow Jones Industrial Average (^DJI) and the S&P 500 (^GSPC) rose roughly 1.1%.
Stocks lifted higher after the White House delayed by one month auto tariffs that could significantly impact US automakers Ford (F), GM (GM), and Stellantis (STLA). Shares of all three automakers were at least 5% higher.
Posted on March 5, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
MEDICAL EXECUTIVE-POST–TODAY’SNEWSLETTERBRIEFING
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Essays, Opinions and Curated News in Health Economics, Investing, Business, Management and Financial Planning for Physician Entrepreneurs and their Savvy Advisors and Consultants
“Serving Almost One Million Doctors, Financial Advisors and Medical Management Consultants Daily“
A Partner of the Institute of Medical Business Advisors , Inc.
Despite high flu cases, vaccine this season looks overall like a good match. Early season laboratory testing by the CDC suggested this year’s flu vaccine was 100% match for the strain influenza A (H1N1), which accounts for 48% of cases this year, and a 100% match for influenza B, which accounts for just under 3% of cases so far. For targeting influenza A (H3N1), which makes up 49% of cases so far, the CDC said the vaccine is a 51% match.
The Dow Jones Industrial Average (^DJI) fell about 1.5%, or over 650 points, as losses escalated into the close, while the benchmark S&P 500 dropped around 1.2%, hitting its lowest level in four months. The tech-heavy NASDAQ Composite (^IXIC), which traded in the green at one point of the trading day, closed down about 0.4% but was able to avoid entering correction territory.
As in the case of Declinism, to better understand the Forer effect (commonly known as the Barnum Effect), it’s helpful to acknowledge that people like their world to make sense. If it didn’t, we would have no pre-existing routine to fall back on and we’d have to think harder to contextualise new information.
Note: Phineas Taylor Barnum (July 5, 1810 – April 7, 1891) was an American showman, businessman, and politician remembered for promoting celebrated hoaxes and founding with Jim Bailey the Ringling Bros. and Barnum & Bailey Circus. He was also an author, publisher, and philanthropist although he said of himself: “I am a showman by profession … and all the gilding shall make nothing else of me.” According to Barnum’s critics, his personal aim was “to put money in his own coffers”. According to Wikipedia, the adage “there’s a sucker born every minute” has frequently been attributed to him, although no evidence exists that he had coined the phrase
With that, if there are gaps in our thinking of how we understand things, we will try to fill those gaps in with what we intuitively think makes sense, subsequently reinforcing our existing schema(s). As our minds make such connections to consolidate our own personal understanding of the world, it is easy to see how people can tend to process vague information and interpret it in a manner that makes it seem personal and specific to them. Given our egocentric nature (along with our desire for nice, neat little packages and patterns), when we process vague information, we hold on to what we deem meaningful to us and discard what is not. Simply, we better process information we think is specifically tailored to us, regardless of ambiguity.
More specifically, according to colleague Dan Ariely PhD, the Forer effect refers to the tendency for people to accept vague and general personality descriptions as uniquely applicable to themselves without realizing that the same description could be applied to just about everyone else (Forer, 1949). For example, when people read their horoscope, even vague, general information can seem like it’s advising something relevant and specific to them.
Remember, we make thousands of decisions every day, some more important than others. Make sure that the ones that do matter are not made based on bias, but rather on reflective judgment and critical thinking.
SPEAKING: Dr. Marcinko will be speaking and lecturing, signing and opining, teaching and preaching, storming and performing at many locations throughout the USA this year! His tour of witty and serious pontifications may be scheduled on a planned or ad-hoc basis; for public or private meetings and gatherings; formally, informally, or over lunch or dinner. All medical societies, financial advisory firms or Broker-Dealers are encouraged to submit a RFP for speaking engagements: MarcinkoAdvisors@outlook.com
Marketability and liquidity are two concepts that are interrelated but often confused by the medical professional. Marketability deals with the speed at which an asset can be turned into cash. Liquidity, on the other hand, deals with an asset that can be turned to cash without a significant loss of value. A physician’s practice may still be good investment, but is it not particularly marketable or liquid. A common stock traded on the New York Stock Exchange can be easily sold for its quoted fair market value.
[B] The Time Value of Money
To the young physician starting a career, the time value of money is not a primary concern. It involves spending dollars in the future compared with spending today. Paying off high student loans while earning a relatively low salary leaves barely enough for present personal consumption. In the past, the rationale to spend today, forsaking the future, was not only a function of necessity but stemmed from the probability that future income would grow appreciably higher. Today, this is no longer a given for medical professionals.
In the simplest terms, a dollar today is worth more than a dollar tomorrow. The supply and demand for a dollar today to be paid back in the future is what determines interest rates. This calls for an understanding of the concepts of present and future value.
Present value is what you have today. So a dollar is a worth a dollar.Future value is what that dollar will grow to when compounded at a given interest rate. If you started with 100 dollars and earned 10 percent for five years, you would end up with 161 dollars.
Year Paying Interest Ending Interest
Amount of Factor Amount (annual)
1 $ 100 1.10 $ 110.00 $ 10.00
2 110 1.10 121.00 11.00
3 121 1.10 133.10 12.10
4 133.10 1.10 146.41 13.31
5 146.41 1.10 161.05 14.64
$ 61.05
Whenever you do not have a financial calculator, such as a Hewlett-Packard 12-C, Texas Instruments BA III plus, apps, SAAS, or computer spreadsheet or handy, you can figure future value with this formula.
FV = PV (1 + i)^N
FV is future value and PV is present value. The periodic interest rate is represented by the i. The number of periods being compounded is the n. The N means to the power of some number. In the example above, the equation would appear as follows:
FV = $100(1+.1)^2
FV = $100(1.21)
FV = $121
N
Likewise, the formula for present value is: PV = amount / (1 + i )
Other time value of money concepts, easily determined with a calculator, or interest table include the future value of multiple (equal) cash flows (ordinary annuity); conversion to an annuity due; the present value of multiple (equal) cash flows (ordinary annuity); and the conversion to an annuity due.
Example: Determining a Funding Amount
Dr. Smith has a daughter who plays the piano very well. He wishes to accumulate funds for his daughter Mackenzie’s advanced music education. He estimates that she will need $6,000 per year in today’s dollars, and will start school at age 18. She is 10 years old now. Costs are expected to increase 6 percent annually. Dr. Smith and his financial advisor believe that he can earn 9 percent after tax on his funds. How much is required?
Step # 1: Determine the future value of $6,000, 8 years from now. Or, what will Mackenzie’s first-year piano school cost, considering inflation?
Using a financial calculator, such as the HP 12-C: @ 8n (years), 6i (interest rate); $ 6,000 PV; the future value is $9,563
Step # 2: Next, determine the lump sum necessary to provide the above amount at the start of each year (present value annuity due).
Again, using the HP12-C @ $9,563 PMT; g7 (PVAD); 4 N; 1.09/1.06 i; the present value is $36, 702.
Step # 3: Compute the annual savings required at the end of each year (ordinary annuity) to provide the lump sum needed at age 18.
Finally, calculate with the HP 12-C @ g8 (ordinary annuity); $ 36,702 FV; 8N; 9i, and solve for PMT = $ 3,328.
SPEAKING: Dr. Marcinko will be speaking and lecturing, signing and opining, teaching and preaching, storming and performing at many locations throughout the USA this year! His tour of witty and serious pontifications may be scheduled on a planned or ad-hoc basis; for public or private meetings and gatherings; formally, informally, or over lunch or dinner. All medical societies, financial advisory firms or Broker-Dealers are encouraged to submit a RFP for speaking engagements: MarcinkoAdvisors@outlook.com
Posted on March 4, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
MEDICAL EXECUTIVE-POST–TODAY’SNEWSLETTERBRIEFING
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Essays, Opinions and Curated News in Health Economics, Investing, Business, Management and Financial Planning for Physician Entrepreneurs and their Savvy Advisors and Consultants
“Serving Almost One Million Doctors, Financial Advisors and Medical Management Consultants Daily“
A Partner of the Institute of Medical Business Advisors , Inc.
Independent pharmacies and pharmacy benefit managers (PBMs) are at odds over a proposed rule change from the Centers for Medicare and Medicaid Services (CMS) over the Medicare Part D program. Pharmacies vs. PBMs
US stocks plummeted on Monday afternoon, as selling accelerated in the last hour of trading after President Trump indicated there was “no room left” for tariff negotiations with Canada and Mexico, with levies against both countries set to go into effect tomorrow.
The S&P 500 (^GSPC) fell 1.7% while the tech-heavy NASDAQ Composite (^IXIC) dropped 2.6%. The Dow Jones Industrial Average (^DJI) fell more than 600 points, or almost 1.5%, as the major US indexes came off a volatile week and a losing February.
Tech led the sell-off with shares of Nvidia (NVDA) tanking more than 8%. All of the “Magnificent 7” stocks declined.
If the definition of a security is title to a stream of cash flows, then the dividends a company is expected to pay to equity shareholders on a periodic basis (e.g., quarterly) are a clear source of return for an investor. A dividend is simply a distribution of (some portion of) the company’s earnings to equity shareholders. Like a bond yield, a stock’s dividend yield can be used to measure the income return on the stock.
To determine a stock’s dividend yield, the trailing year’s dividends per share paid are divided by the current stock price. However, a key difference between a dividend yield and a bond yield is the level of certainty that can be assumed regarding future payments, since a bond’s coupon is generally predetermined and its payment is expected to be senior to the payment of dividends.
After a company has determined that it has earned a profit, management has to decide what to do with those profits. One choice is to distribute the earnings to shareholders in the form of dividends, while another option is to reinvest the profits in the company. A company’s management may determine that the shareholders interest is best served by using the earnings to pursue growth opportunities (e.g., capital expansion, research & development, etc.) at the corporate level. Thus, when management believes that its investment opportunities are likely to produce a higher return than what investors’ could generate with their dividends or that reinvestment is needed to maintain its financial strength, the company will retain the earnings.
One of the biggest myths in investing is capital appreciation accounts for the largest part of investors’ gains. Dividends, or cash payments to shareholders, actually account for a substantial part of an equity investor’s total return. In fact since 1926, dividends have accounted for more than 40% of the total return of the S&P 500 stock index. In the last decade (2000-2009), the S&P 500’s total return of -9% would have been a heftier loss of -24% had it not been for the 15% contribution from dividends.
History has shown that dividends have been a powerful source of total return in a diversified investment portfolio, especially during periods of market turbulence. In examining the prior eight decades of stock market performance, dividends often account for more than 2/3 of the total return (1930s, 1940s, 1970s, & 2000s). If an investor avoided dividend paying stocks during these elongated time periods, most of the total gains would be lost.
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DIVIDEND CONTRIBUTION OF S&P 500 RETURN BY DECADE
S&P 500
Cumulative
Dividends
Average
Price %
Dividend
Total
% of Total
Payout
Years
Change
Contribution*
Return
Return
Ratio**
1930s
-41.9%
56.0%
14.1%
>100%
90.1%
1940s
34.8%
100.3%
135.0%
74.3%
59.4%
1950s
256.7%
180.0%
436.7%
41.2%
54.6%
1960s
53.7%
54.2%
107.9%
50.2%
56.0%
1970s
17.2%
59.1%
76.4%
77.4%
45.5%
1980s
227.4%
143.1%
370.5%
38.6%
48.6%
1990s
315.7%
117.1%
432.8%
27.0%
47.6%
2000s
-24.1%
15.0%
-9.1%
>100%
35.3%
2010s
27.9%
8.4%
36.3%
23.1%
28.4%
as of 12/31/12
Source: Strategas
During those decades such as the 2000s where the stock market struggled to advance, dividends were a significant element for investor survival. This is not only due to the dividends alone, but also the risk element of stocks that pay dividends. Dividend stocks have historically provided lower overall volatility and stronger downside protection when markets decline. Since 1927, dividend stocks have consistently held up better than the broader market during downturns. You can measure downside risk through a statistic known as downside capture ratio.
Downside capture ratio is a statistical measure of overall performance in a down stock market. An investment category, or investment manager, who has a down-market ratio less than 100 has outperformed the index during a falling stock market.
For example, a down-market capture ratio of 80 indicates that the portfolio measure declined only 80% as much as the index during the period. The downside capture ratio of high-dividend-yielding stocks, since 1927, has been 81% or lower over various long-term periods. Put a better way, during months that the S&P 500 stock index fell, dividend stocks declined by nearly 19% less than the broader market.
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DOWNSIDE AND UPSIDE CAPTURE RATIOS OF HIGH DIVIDEND STOCKS – 1927 TO 2011
SPEAKING: Dr. Marcinko will be speaking and lecturing, signing and opining, teaching and preaching, storming and performing at many locations throughout the USA this year! His tour of witty and serious pontifications may be scheduled on a planned or ad-hoc basis; for public or private meetings and gatherings; formally, informally, or over lunch or dinner. All medical societies, financial advisory firms or Broker-Dealers are encouraged to submit a RFP for speaking engagements: CONTACT: MarcinkoAdvisors@outlook.com
Posted on March 1, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
MEDICAL EXECUTIVE-POST–TODAY’SNEWSLETTERBRIEFING
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Essays, Opinions and Curated News in Health Economics, Investing, Business, Management and Financial Planning for Physician Entrepreneurs and their Savvy Advisors and Consultants
“Serving Almost One Million Doctors, Financial Advisors and Medical Management Consultants Daily“
A Partner of the Institute of Medical Business Advisors , Inc.
US stocks gained ground Friday following a key inflation reading that largely met expectations and as fresh tariff threats added to uncertainty over Big Tech prospects. The S&P 500 (^GSPC) gained 1.6%%, while the tech-heavy NASDAQ Composite (^IXIC) was up about 1.5% after suffering a Nvidia-led (NVDA) sell-off on Thursday. The Dow Jones Industrial Average (^DJI) climbed 1.3%. All three major averages reversed earlier losses, sending February off with a relief rally.
Markets wrapped the month February with sharp weekly and monthly losses after suffering the buffets of tariff moves. The NASDAQ shed close to 5% in February, while the S&P 500 and Dow suffered drops of around 2%.
Posted on February 28, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
MEDICAL EXECUTIVE-POST–TODAY’SNEWSLETTERBRIEFING
***
Essays, Opinions and Curated News in Health Economics, Investing, Business, Management and Financial Planning for Physician Entrepreneurs and their Savvy Advisors and Consultants
“Serving Almost One Million Doctors, Financial Advisors and Medical Management Consultants Daily“
A Partner of the Institute of Medical Business Advisors , Inc.
A new bill could change Medicare coverage requirements for Americans across the country. With Medicare was set to run out of funding for telehealth coverage by the end of March, Democratic Representative Ro Khanna of California has introduced the Telehealth Coverage Act to continue the services.
Stocks plummeted on Thursday as tech sold off following Nvidia’s (NVDA) latest earnings report while investors took stock of the economy amid President Trump’s latest tariff pledges.
The S&P 500 (^GSPC) fell more than 1.6%, while the tech-heavy NASDAQ Composite (^IXIC) dropped 2.8%. The Dow Jones Industrial Average (^DJI) dropped 0.4%.
Investors dug into Nvidia’s quarterly earnings beat, which signaled plenty of scope for growth as it eased worries about DeepSeek and faltering AI demand. The results initially met a muted response as its profit outlook raised doubts on Wall Street. Nvidia’s stock erased early morning gains to dropped more than 8%.
Posted on February 26, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
MEDICAL EXECUTIVE-POST–TODAY’SNEWSLETTERBRIEFING
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Essays, Opinions and Curated News in Health Economics, Investing, Business, Management and Financial Planning for Physician Entrepreneurs and their Savvy Advisors and Consultants
“Serving Almost One Million Doctors, Financial Advisors and Medical Management Consultants Daily“
A Partner of the Institute of Medical Business Advisors , Inc.
In great news for investors, a new study found that major healthcare companies have paid out $2.6 trillion to shareholders over the past 20 years in the form of dividends and share buybacks, and those payments are increasing. Bad news for patients: Some of that money could’ve been spent on, well, healthcare. The study, published Februrary 10th in JAMA, found that publicly traded S&P 500 healthcare companies paid shareholders a total of $170.2 billion in 2022, up 315% from payouts of just $54 billion in 2001.
The S&P 500 fell 0.5%. The NASDAQ 100 slid 1.2%. A gauge of the “Magnificent Seven” mega-caps sank 2.2%. Nvidia Corp.’s shares slid 2.8% on the eve of the company’s results, while Tesla slumped 8.4% to fall below $1 trillion in market value. The DJIA was up.
Posted on February 25, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
MEDICAL EXECUTIVE-POST–TODAY’SNEWSLETTERBRIEFING
***
Essays, Opinions and Curated News in Health Economics, Investing, Business, Management and Financial Planning for Physician Entrepreneurs and their Savvy Advisors and Consultants
“Serving Almost One Million Doctors, Financial Advisors and Medical Management Consultants Daily“
A Partner of the Institute of Medical Business Advisors , Inc.
A grand jury is investigating criminal misconduct at a Silicon Valley fintech firm where customer funds went missing, and has questioned an executive who raised alarms before the company collapsed, people familiar with the matter said. Synapse connected financial technology firms with banks, helping startups that marketed flashy savings apps find a place to park their digital customers’ funds. The middleman managed billions of dollars at its peak, before its sudden collapse in April left thousands of people unable to access their money.
The US Department of Justice is reportedly investigating the insurance giant UnitedHealthcare for its Medicare billing practices. The federal government is examining whether UnitedHealthcare is using patient diagnoses to illegally increase the lump sum monthly payments received through the Medicare Advantage program, according to a report in the Wall Street Journal.
US stocks sold off into the close on Monday as investors weighed the prospects of President Donald Trump’s tariff policies and also shifted focus to this week’s Nvidia (NVDA) earnings.
The Dow Jones Industrial Average (^DJI) was little changed on the heels of its worst week since October. The S&P 500 (^GSPC) fell 0.5%, while the tech-heavy NASDAQ Composite (^IXIC) fell 1.2%.
It has been said that most ordinary people should have at least three to six months of living expenses (not including taxes) in a cash-equivalent reserve fund that is easily accessible (i.e., liquid). The amount needed for a one-month reserve is equal to the amount of expenses for the month, rather than the amount of monthly income. This is because during no-income months there is no income tax.
However, the situation might not be the same for physicians in today’s harsh economic climate.
The New Realities
Now, some physician-focused financial advisors, financial planners and Certified Medical Planners™ suggest even more reserve fund savings; up to two years. That’s because many factors come into play when determining how much a particular doctor’s family should have.
For example:
Does the family have one income or two? If the doctor is in a dual-income family with stable incomes and they live on a single income, the need for a liquid reserve is less.
How stable is the doctor’s income source? If a sole provider with an unstable income who spends all of the income each month, the need for a liquid cash reserve is high.
Does the doctor own the practice, work in a clinic, medical group, hospital or healthcare system? In other words – employee (less control) or employer (more control).
What is the doctor’s medical specialty and how has managed care penetrated his locale, or affected her focus? What about a DO, DDS/DMD or DPM, etc.
How does the family use its income each month; does it have a saver, spender, or investor mentality?
Does the family anticipate the possibility of large expenses occurring in the future (medical practice start-up costs or practice purchase; children, medical school student debts; auto or home loans; and/or liability suits, etc)?
Pan physician lifestyle?
The Past
In the ancient past, a doctor may have opted for a nine-twelve month reserve if the need for security was high – and a six-to-nine month reserve if the need for security was low. But today, even more may be needed. How about 15-18 months, or more? Perhaps even 24 months!
So, the following questions may be helpful in determining the amount of reserve needed by the physician:
1. How long would it take you to find another job in your medical specialty if you suddenly found yourself unemployed – same for your spouse?
2. Would you have to relocate – same for your spouse?
3. How much do you spend each month on fixed or discretionary expenses and would you be willing to lower your monthly expenses if you were unemployed?
Assessment
Once the amount of reserve is determined, the doctor should use the appropriate investment vehicles for the funds.
At minimum, the reserve should be invested in a money market fund. For larger reserves, an ultra-short-term bond fund might be appropriate for amounts over three-six months. While even larger reserves might be kept in a short term bond fund depending on interest rates and trends.
So, what do the initials M.D. really mean? … More Dough!
How much reserve do you have and where is it stashed?
SPEAKING: Dr. Marcinko will be speaking and lecturing, signing and opining, teaching and preaching, storming and performing at many locations throughout the USA this year! His tour of witty and serious pontifications may be scheduled on a planned or ad-hoc basis; for public or private meetings and gatherings; formally, informally, or over lunch or dinner. All medical societies, financial advisory firms or Broker-Dealers are encouraged to submit a RFP for speaking engagements: MarcinkoAdvisors@outlook.com
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