DAILY UPDATE: DJIA, S&P 500 & NASDAQ Futures Rise in Search of Bounce-Back Week

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US stock futures rose yesterday Sunday, as the major indexes looked for another week of gains toward the end of a rough month and quarter.

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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%.

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Visualize: How private equity tangled banks in a web of debt, from the Financial Times.

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DAILY UPDATE: Medicare TeleHealth Coverage as Wall Street Stock Markets Rise

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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

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Stocks on Wall Street shook off a weak start and closed slightly higher Friday, snapping a four-week losing streak.

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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%.

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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.

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DAILY UPDATE: US Stock Markets Retreat

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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.

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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%.

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Visualize: How private equity tangled banks in a web of debt, from the Financial Times.

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TAXATION: Avoidance V. Evasion V. Voluntary Compliance

DEFINITION

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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.

MORE: https://apps.irs.gov/app/understandingTaxes/whys/thm01/les03/media/ws_ans_thm01_les03.pdf

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DAILY UPDATE: Scripps Health & WHO as US Stock Markets Rise

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FIRST DAY OF SPRING

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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.

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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 Index SPX+1.08% rising 1.08% to 5,675.29 and the Dow Jones Industrial Average DJIA+0.92% rising 0.92% to 41,964.63.

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Visualize: How private equity tangled banks in a web of debt, from the Financial Times.

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LIFE INSURANCE: Split Dollar Plans

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.

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FINANCIAL ADVISORS & MEDICAL MANAGEMENT CONSULTANTS: Marcinko & Associates, Inc

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D. E. Marcinko & Associates Core Operating Values

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.

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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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DAILY UPDATE: US Stock Markets Routed

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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.

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Uncertainty still dogs markets as investors debate whether the sell-off that pushed the S&P 500 into correction territory is over. Traders now turn their attention to the Fed’s two-day policy meeting, which kicked off on Tuesday, for clues on the health of the economy and potential tariff risks.

Policymakers are largely expected to hold rates steady in their decision on Wednesday.

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FINANCIAL ADVISORS: Real Monetary Worth?

BY DR. DAVID EDWARD MARCINKO; MBA MEd CMP®

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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?

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DAILY UPDATE: JPMorgan Chase Lawsuit as DJIA Gains 350 Points and Stocks Climb for 2nd Day After S&P 500 Enters Correction Territory

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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.

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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.

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Visualize: How private equity tangled banks in a web of debt, from the Financial Times.

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BIN Credit Card Attack?

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.

  1. 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.
  2. Using dedicated software such as an auto-dialer, they generate thousands, often tens of thousands, combinations of possible existing card numbers by this issuer.
  3. At this point, these credentials need to be tested. The fraudster identifies a suitable online shop or donation page.
  4. They start card testing by attempting a small payment with each generated card number.
  5. 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.

MORE: https://seon.io/resources/dictionary/bin-attack/

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MEDICAL PRACTICE: Valuation Adjustments

NET INCOME STATEMENT AND BALANCE SHEET ADJUSTMENTS

By Dr. David Edward Marcinko; MBA MEd CMP®

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Net Income Statement Adjustments

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.

EDUCATION: Books

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 

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DAILY UPDATE: Bayer Executive Arson, Pi Day, Ides of March as Stock Markets Lift Off!

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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.

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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%.

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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.

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DAILY UPDATE: State Farm Insurance VP Fired as US Markets Tank, Again!

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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.

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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.

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Visualize: How private equity tangled banks in a web of debt, from the Financial Times.

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DAILY UPDATE: US Stocks Advance

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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.

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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.

CITE: https://tinyurl.com/tj8smmes

Visualize: How private equity tangled banks in a web of debt, from the Financial Times.

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DAILY UPDATE: Stocks Still Struggling Downward

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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

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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.

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

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. 

CITE: https://tinyurl.com/tj8smmes

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.

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MONETARISM: Financing and Policy

By Staff Reporters

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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.

Cite: Economist.com

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DAILY UPDATE: Mayo Clinic Operating Margin Up as Domestic Stocks Crushed Down!

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Serving Almost One Million Doctors, Financial Advisors and Medical Management Consultants Daily

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Stat: 6.5%. That was the size of Mayo Clinic’s operating margin in 2024, with an operating income of $1.3 billion. (Becker’s Hospital CFO Report)

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

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.

CITE: https://tinyurl.com/tj8smmes

Visualize: How private equity tangled banks in a web of debt, from the Financial Times.

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ABBREVIATIONS GLOSSARY: Risk Management, Insurance and Asset Protection for Physicians

By Staff Reporters

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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

CVE                   common vulnerabilities and exposures

CVPA                cost-volume-profit analysis

CY                     calendar year

DAC                  discretionary access control

DBMS                database management system

DCF                   discounted [net] cash flow

DEA                  Drug Enforcement Agency

DHHS                Department of Health and Human Services

DHMR               Designated Healthcare Management Representative

DIO                   days inventory outstanding

DLH                  doctor labor hours

DME                  durable medical equipment

DNFB                discharged, not finally billed

D&O                  directors and officers

DO                     Doctor of Osteopathy

DOA                  dead on arrival

DoD                   Department of Defense

DOJ                   Department of Justice

DOT                  Department of Transportation

DPH                  Department of Public Health

DPM                  Doctor of Podiatric Medicine

DPO                  days payable outstanding

DPP                   direct participation program

DRA                  Deficit Reduction Act of 2005

DRG                  diagnosis-related group

DES                   disease-specific care

DSH                   disproportionate share hospital [adjustment]

DSO                   days sales outstanding

DSS                   decision support system

DVP                  delivery versus payment

DWC                 days working capital

EAP                   Employee Assistance Program

EBDIT               earnings before depreciation, interest and taxes

EBM                  evidence-based medicine

ECP                   Exposure Control Plan

ED                     emergency department

EDI                    Electronic Data Interchange

EDSS                 Executive Decision Support System

EEOC                Equal Employment Opportunity Commission

EHCR                Efficient Healthcare Consumer Response Report

EHO                  emerging healthcare organization

EHR                   electronic health record

EIN                    employer identification number

E&M                  evaluation and management

EMR                  electronic medical record(s)

EMTALA           Emergency Medical Treatment and Active Labor Act

EOB                   explanation of benefits

EOMB               Explanation of Medicare Benefits

EOQ                  economic order quantity

EOQC                economic order quantity cost [analysis]

EPA                   Environmental Protection Agency

ePHI                  electronic personal health information

EPO                   exclusive provider organization

EPR                   electronic patient record

EPRI                  Emergency Preparedness Resource Inventory

ERISA               Employee Retirement Income Security Act

ERP                   enterprise resource planning

FACT Act          Fair and Accurate Credit Transactions Act of 2003

FAR                   federal acquisition regulation

FASB                 Financial Accounting Standards Board

FBCA                Federal Bridge Certification Authority

FC                      fixed cost

FCA                   False Claims Act

FDA                   Food and Drug Administration

FEHBP              federal employees health benefits program

FF&E                 furniture, fixtures and equipment

FFS                    fee-for-service

FGIC                  Financial Guaranty Insurance Company

FHA                   Federal Housing Administration

FIFO                  first in first out

FIPS                   Federal Information Processing Standard

FMAP                Federal Medical Assistance Percentage

FMLA                Family Medical Leave Act

FMV                  fair market value                                                                                                                                                                                                                    

FTP                    file transfer protocol

FV                     fair value

  • FY                     fiscal year

GAAP                generally accepted accounting principles

GAO                  [U.S.] Government Accountability Office (name changed in 2004 from General Accounting Office)

GDP                   gross domestic product

GIGO                 garbage in, garbage out

GMC                  guaranteed mortgage certificate

GNMA               Government National Mortgage Association

GNP                   gross national product

GPWW              Group Practice Without Walls

GSA                   General Services Administration

HARA               Healthcare Accounts Receivable Analysis [report]

HCCM               Hierarchical Condition Category Management

HCFA                [former] Health Care Financing Administration

HCFAC              Healthcare Fraud and Abuse Control [program]

HCFMA             Health Care Financial Management Association

HCPCS              healthcare common procedure coding system

HCSS                 Health Care Staffing Services

HD-HCP            high deductible healthcare plan

HEDIS               Health Plan Employer Data and Information Set

HFMA               Healthcare Financial Management Association

HH                     home health

HHA                  home health agency

HHCA               home healthcare agency

HHRG                home health resource group

[D]HHS             [Department of] Health and Human Services

HIM                   health information management

HIMSS               Health Information and Management Systems Society

HIPAA              Health Insurance Portability and Accountability Act [of 1996]

HIPDB               Healthcare Integrity and Protection Data Bank

HIPPS                health insurance prospective payment system

HIS                    hospital information system

HISAC               Healthcare Information Sharing and Analysis Center

HIT                    healthcare information technology

HMMIS              hospital materials management information system

HMO                 health maintenance organization

HOPPS              hospital outpatient prospective payment system

HR                     Human Resources

HSA                   health systems agency; also health savings account

HSG                   hospital service group

HSRV                hospital-specific relative value

I&A                   identification and authentication

IBA                    Institute of Business Appraisers

IBNR                 incurred but not reported [expenses]

ICD-9-CM          International Classification of Diseases, Ninth Revision, Clinical Modification [10-CM]

ICP                    inventory conversion period

ICSI                   Institute for Clinical Systems Improvement

IDS                    integrated delivery system; also intrusion detection system

IDTF                  independent diagnostic testing facilities

IHS                    Indian Health Services

IME                   indirect medical education [adjustment]

IOM                   Institute of Medicine

IPA                    Independent Physician Association; also Independent Practice Association

IPPS                  [Medicare] inpatient prospective payment system

IRB                    Institutional Review Boards

IRC                    Internal Revenue Code

IRR                    internal rate of return

IRS                    Internal Revenue Service

ISAC                  Information Sharing and Analysis Center

ISMS                  information security management system

ISO                    International Standards Organization

ISP                     Internet service provider

I-SPY Act          Internet Spyware Prevention Act

IT                       information technology

ITL                    Information Technology Laboratory

ITR                    inventory turnover ratio

JAMA                 Journal of the American Medical Association

JCAHO              [former] Joint Commission on Accreditation of Healthcare Organizations

[now known as the The Joint Commission-TJC]

JIT                     just-in-time

[inventory management]

LAN                  local area network

LCC                   life-cycle cost

LEP                   limited English proficiency

LIFO                  last in, first out

LIS                     Laboratory Information Systems

LISW                 Licensed Independent Social Worker

LLC                   Limited Liability Company

LLP                   Limited Liability Partnership

LMFT                Licensed Marriage and Family Therapist

LPCC                 Licensed Professional Clinical [Mental Health] Counselor

LOS                   length of stay

LVN                  licensed vocational nurse

LPN                   licensed practical nurse

LRAC                long-range average cost

LRRA                Liability Risk Retention Act

LSP                    limited service provider

LTCPP               long-term care pharmacy provider

MABC               medical activity-based costing

MAC                  monitored anesthesia care; also mandatory access control

MB                    marginal benefit

MBT                  Mechanical Biological Treatment [organization]

MC                    marginal cost

MCC                  major complication or co-morbidity

MCM                 mixed cost method

MCO                  managed care organization

MCS                  Monte Carlo Simulation

MD                    medical doctor

MDC                  major diagnostic category

MEC                  modified endowment contract

MedPAC            Medicare Payment Advisory Commission

MGMA              Medical Group Management Association

MI                      Medical Informatics

MIS                    management information services

MLIC                 malpractice liability insurance component

MMA                 Medicare Prescription Drug, Modernization, and Improvement Act of 2003

MMCO              Medicare Managed Care Organizations

MOE                  maximum office efficiency

MPCA               medical practice cost analysis

MPT                  Modern Portfolio Theory

MR                    medical records, marginal revenue

MSA                  medical savings account

MSCI                 Metals Service Center Institute

MS-DRG            Medicare Severity DRG

MSDS                material safety data sheet

MSO                  management services organization

MUD                 medically unnecessary days

MVO                 mean variance optimization

NACVA             National Association of Certified Valuation Analysts

NAICS               North American Industry Classification System

NAIP                 National Association of Inpatient Physicians

NAHC               National Association of Healthcare Consultants

NASD                National Association of Securities Dealers

NASDAQ          National Association of Securities Dealers Automated Quotations

NAT                  network address translation

NAV                  net asset value

NBER                National Bureau of Economic Research

NCFFR              National Commission on Fraudulent Financial Reporting

NCPDP              National Council for Prescription Drug Programs

NCQA               National Committee for Quality Assurance

NCUA               National Credit Union Administration

NCVHS             National Committee on Vital and Health Statistics

NDC                  National Drug Code

NEJM                New England Journal of Medicine

NGC                  National Guideline Clearinghouse

NIAP                 National Information Assurance Partnership

NIC                    net interest cost

NIOSH               National Institute of Occupational Safety and Health

NIS                    net income statement

NISAC               National Infrastructure Simulation and Analysis Center

NIST                  National Institute of Standards and Technology

NOW account     negotiable order of withdrawal account

NPDB                National Practitioner Data Bank

NPI                    National Provider Identification [number]

NPP                   Notice of Privacy Practices

NPS                   national provider system

NPV                  net present value

NQF                   National Quality Forum

NRC                  National Research Council

NRV                  net-realized accounts receivable value

NSA                   National Security Agency

NTFS                 new technology file system

NTPA                net target profit analysis

NYSE                New York Stock Exchange

OBO                  order book official

OBRA                Omnibus Budget Reconciliation Act [of 1989]

OCC                  Option Clearing Corporation

OCR                  optical character recognition; also Office of Civil Rights

OFAC                Office of Foreign Assets Control

OFPP                 Office of Federal Procurement Policy

OID                   original issue discount

OIG                    Office of the Inspector General [U.S. Department of Health and Human Services]

OMB                  Office of Management and Budget

OPHC                Office of Prepaid Health Care

OPIM                 other potentially infectious material

OPPS                 outpatient prospective payment system

OS                     operating system

OSI                    open systems interconnect

OR                     operating room

OSHA                Occupational Safety and Health Administration

OSJ                    Office of Supervisory Jurisdiction

OTC                   over-the-counter

P4P                    pay-for-performance

P/E                     price to earnings [ratio]

P/R                    price to revenue [ratio]

PAC                   planned amortization certificate

PAY                  post-acquisition year

PC                     [mortgage] participation certificate; also personal computer

PCC                   project cost of capital

PCMCIA            Personal Computer Memory Card International Association

PCP                   primary care physician

PDA                  personal digital assistant

PDX                   Patient Data Exchange

PE[C]                 practice expense [component]

PEO                   professional employer organization

PFS                    patient financial services

PG                     purchasing group

PHA                  public housing authority

PHI                    protected health information

PHN                  Private Health Network

PHO                  physician-hospital organization

PHR                   patient health record

PIN                    personal identification number

PIO                    public information office

PKI                    public/private key informatics/infrastructure

PKIX                 public key infrastructure for X.509 certificates

PLIC                  [mal]practice liability insurance component

PMG                  primary medical group

PM/PM              per member per month

PO                     purchase order

POC                   point-of-care

POL                   physician office laboratory

POS                   point-of-service

POSP                 point of service plan

PP                      projection profile

PP&E                property, plant, and equipment

PPE                   personal protective equipment

PPMC                physician practice management company

PPO                   preferred provider organization

PPS                    [Medicare] prospective payment system

PR                     pregnancy and related conditions

PROM               programmable read-only memory

PSI                     patient safety indicator

PSN                   provider-sponsored network

PSO                   provider-sponsored organization

Pt                       patient

PTO                   paid time off

PWC                  physician work component

PY                     projected year

QA                     quality assurance

QI                      quality improvement

RA                     registration authority

RADIUS            remote authentication dial-in user service

RAN                  Revenue Anticipation Note

RBAC                role-based access control

RBRVG             resource-based relative value group

RBRVS              resource-based relative value scale

RBRVU             resource-based relative value unit

RDBMS             regional database management system

REIT                  real estate investment trust

RERVU             resource-based relative value unit

REV/PP             revenue per patient

RFI                    request for information

RFID                  radio frequency identification device [scanner]

RFP                   request for payment

RHIO                 Regional Health Information Organization

RN                     Registered Nurse

RNANS             Registered Nurses Association of Nova Scotia

ROE                   return on equity

ROI                    return on investment

ROM                  read-only memory

ROP                   re-order point

RRG                   risk-retention group

RSNA                Radiological Society of North America

RUG-III             resource utilization group III

RVS                   relative value scale

RVUm               relative value unit – malpractice

RVUpe               relative value unit – practice expenses

RVUw               relative value unit – work

rWACC              relative weighted average cost of capital

S&P                   Standard and Poor’s

SaaS                   Software-as-a-Service

SAMHSA           Substance Abuse and Mental Health Services Administration

SAN                   storage area network

SARS                 Sever Acute Respiratory Syndrome

SBBI                  Stocks, Bonds, Bills and Inflation [Yearbook]

SCIM                 supply chain inventory management

SCF                    statement of cash flows

SCM                  supply chain management

SCP                   standard cost profile

SD                     standard deviation

SDLC                 system development life cycle

SDN                   specially designated nationals

SDO                   standards development organization

SEC                   Securities and Exchange Commission

SERP                 supplemental extended reporting policy

SESIP                sharps with engineered sharps injury protection

SHM                  Society of Hospital Medicine

SIC                    Standard Industrial Code

SIPC                  Securities Investor Protection Corporation

SLA                   service level agreement

SMA                  special miscellaneous account

SMD                  Society of Medical Dental Management Consultants

SMS                   socioeconomic monitoring system

SMTP                simple mail transfer protocol

SNF                   skilled nursing facility

SNMP                simple network management protocol

SP                      special publication

SSH                   single-specialty hospitals

SSL                    secure socket layer

STP                    standard treatment protocol

SVPN                secure virtual private network

TEL                   Terror Exclusion List

TFC                   total fixed cost

TIC                    true interest cost

TIN                    tax identification number

TLS                    transport layer security

TPA                   third party administrator

TQIM                 total quality and improvement management

TQM                  total quality management

UCC                  Uniform Commercial Code

UCSF                 University of California at San Francisco

UDP                  user datagram protocol

UFS                   unix file system

UIIRC                University of Iowa Injury Prevention Research Center

UM                    utilization management

UPIN                 Unique Provider Identification Number

UR                     utilization review

USPAP              Uniform Standards of Professional Appraisal Practices

v                        variance

VA                     Veterans Affairs

VAR                  value at risk

VC                     variable cost

VOC                  volatile organic chemicals

VPN                  virtual private network

WACC               weighted average cost of capital

WAN                 wide area network

WHO                 World Health Organization

WIA                   weighted industry average

WORM              wrote once-read many

READINGS

  • Marcinko, DE and Hetico, RN: Dictionary of Health Insurance and Managed Care. Springer Publishing, New York, NY 2007
  • Marcinko, DE and Hetico, RN: Dictionary of Health Information Technology and Security. Springer Publishing, New York, NY 2009
  • Marcinko, DE and Hetico, RN: Dictionary of Health Economics and Finance. Springer Publishing, New York, NY 2008

EDUCATION: Books

HEALTHCARE ADMINISTRATION BLOGS 

  • 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.
  • Regis University Health Services Administration Blog: Learn more about a college health service through the blog provided by its health administrator, Michael Jackson.
  • 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.

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DAILY UPDATE: Walgreens Boots Private Equity, Medical Cost Debt as Stock Markets Stabilize

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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.

http://www.MedicalBusinessAdvisors.com

SPONSORED BY: Marcinko & Associates, Inc.

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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

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Stocks

  • The S&P 500 rose 0.6%
  • The NASDAQ 100 rose 0.7%
  • The Dow Jones Industrial Average rose 0.5%
  • The MSCI World Index rose 0.2%
  • Bloomberg Magnificent 7 Total Return Index rose 0.2%
  • The Russell 2000 Index rose 0.4%

Currencies

  • The Bloomberg Dollar Spot Index fell 0.2%
  • The euro rose 0.6% to $1.0851
  • The British pound rose 0.4% to $1.2929
  • The Japanese yen was little changed at 147.89 per dollar

Cryptocurrencies

  • Bitcoin fell 4% to $86,226.2
  • Ether fell 3.8% to $2,129.51

Bonds

  • The yield on 10-year Treasuries advanced two basis points to 4.30%
  • Germany’s 10-year yield was little changed at 2.84%
  • Britain’s 10-year yield declined two basis points to 4.64%

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Stat: 20%. That’s how many US residents under age 49 have borrowed money to cover medical costs. (West Health and Gallup)

Visualize: How private equity tangled banks in a web of debt, from the Financial Times.

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STOCK: Common V. Preferred V. Hybrid Securities

BY DR. DAVID EDWARD MARCINKO; MBA MEd CMP™

SPONSOR: http://www.MarcinkoAssociates.com

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Common Stock versus Preferred Stock

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.

EDUCATION: Books

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:

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DAILY UPDATE: US Stocks Clobbered

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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.

http://www.MedicalBusinessAdvisors.com

SPONSORED BY: Marcinko & Associates, Inc.

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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.

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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.

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Visualize: How private equity tangled banks in a web of debt, from the Financial Times.

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SEPARATE ACCOUNTS: Management for Physicians

DEFINITION

BY DR. DAVID EDWARD MARCINKO; MBA MED CMP™

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SPONSOR: http://www.MarcinkoAssociates.com

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.

EDUCATION: Books

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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DAILY UPDATE: Endometriosis Awareness Week as Stock Markets Soar!

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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.

http://www.MedicalBusinessAdvisors.com

SPONSORED BY: Marcinko & Associates, Inc.

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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.

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US stocks rallied on Wednesday as President Trump provided a one-month auto tariff exemption on Mexico and Canada.

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.

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Visualize: How private equity tangled banks in a web of debt, from the Financial Times.

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DAILY UPDATE: High Flu Cases as Stock Markets Collapse

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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.

http://www.MedicalBusinessAdvisors.com

SPONSORED BY: Marcinko & Associates, Inc.

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Daily Update Provided By Staff Reporters Since 2007.
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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.

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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.

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Visualize: How private equity tangled banks in a web of debt, from the Financial Times.

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PT BARNUM: Forer Bias Effect

By Dr. David Edward Marcinko MBA MEd CMP™

SPONSOR: http://www.MarcinkoAssociates.com

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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.

EDUCATION: Books

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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TIME VALUE MONEY: Present Dollars – Future Dollars

BY DR. DAVID EDWARD MARCINKO; MBA MEd CMP™

SPONSOR: http://www.MarcinkoAssociates.com

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[A] Marketability and Liquidity

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.

EDUCATION: Books

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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DAILY UPDATE: Pharmacies v. PBMs as Stock Markets Tank!

MEDICAL EXECUTIVE-POST TODAY’S NEWSLETTER BRIEFING

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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.

http://www.MedicalBusinessAdvisors.com

SPONSORED BY: Marcinko & Associates, Inc.

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http://www.MarcinkoAssociates.com

Daily Update Provided By Staff Reporters Since 2007.
How May We Serve You?
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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

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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.

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Visualize: How private equity tangled banks in a web of debt, from the Financial Times.

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STOCK DIVIDENDS: Company Earnings Distribution

BY DR. DAVID EDWARD MARCINKO; MBA MEd CMP™

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SPONSOR: http://www.MarcinkoAssociates.com

DEFINITION

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 CumulativeDividendsAverage 
 Price %DividendTotal% of TotalPayout 
YearsChangeContribution*ReturnReturnRatio** 
       
1930s-41.9%56.0%14.1%>100%90.1% 
1940s34.8%100.3%135.0%74.3%59.4% 
1950s256.7%180.0%436.7%41.2%54.6% 
1960s53.7%54.2%107.9%50.2%56.0% 
1970s17.2%59.1%76.4%77.4%45.5% 
1980s227.4%143.1%370.5%38.6%48.6% 
1990s315.7%117.1%432.8%27.0%47.6% 
2000s-24.1%15.0%-9.1%>100%35.3% 
2010s27.9%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  
The lower the number, the better    
                                                                            Downside 
                                                                              Capture Ratio 
   
Since 192781.53 
50-year67.45 
30-year65.86 
20-year65.83 
10-year81.61 
   

Source: Kenneth French as of 12/31/11

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DAILY UPDATE: Human Biological Age as Stock Markets Blast Off

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Read: Inside the rise—and questionable reliability—of commercial tests for “biological age.” (Nature)

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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%.

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DAILY UPDATE: TeleHealth Coverage Act as Stock Markets Plummet

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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.

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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%.

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DAILY UPDATE: Health Care is Wealth Care as Stock Markets Close Mixed

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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.

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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.

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The yield on 10-year Treasuries sank 11 basis points, while its Australian counterpart fell four points in early trading on Wednesday.

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DAILY UPDATE: Synapse Fin-Tech and UnitedHealthcare Part C as Stock Markets Slide

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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.

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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.

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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%.

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NEWEST THOUGHTS: Physician Personal Emergency Fund Size is Getting Complicated

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By Dr. David Edward Marcinko MBA MEd

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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?

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PHYSICIAN ENTREPRENEURS: Rising Again!

By Dr. David Edward Marcinko MBA MEd

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Marcinko Associates is a financial guide. We help answer your questions in an empowering way. We educate and empower medical colleagues to understand their financial picture and to make better financial decisions. We strive to simplify everything, clear up confusion, and address specific needs and goals.

Whatever your financial situation, we do not shame, criticize, or sell. We enrich, educate and empower. We work with medical colleagues at every stage of their financial journey, through big life personal changes to annual employment reviews, in order to help them understand, invest, and protect their money and autonomy.

And, like the famed ‘Tibetan Sherpas“, we guide physician entrepreneurs from medical practice business plan creation, funding, start-up operations and strategic management improvement to maximize profits and stream-line patient care quality initiatives.

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DAILY UPDATE: Pain MD and Measles Outbreak as Stock Markets Plunge Deep!

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Stat: 700,000. That’s how many “unnecessary and expensive” injections pain management company Pain MD gave patients over eight years, according to court documents in a healthcare fraud case that led to four employees pleading guilty or being convicted. (KFF Health News)

Quote: “A small measles outbreak could be the start of a public health catastrophe that is completely preventable.”—Alok Patel, a pediatrician at Stanford Children’s Health, on why he worries about the current US measles outbreak (ABC News)

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U.S. stocks plummeted on Friday on poor economic news. Consumer confidence weakened to the lowest level since November 2023, even as long-run inflation expectations rose to the highest since 1995. The services purchasing managers’ index fell into contractionary territory and January home sales contracted by more than expected.

The Dow Jones Industrial Index plunged by 724 points, or 1.6%, as of 3:30 p.m., the S&P 500 slid 1.6% and the NASDAQ Composite index fell about 2.1%. Adding to the negative sentiment: UnitedHealth fell almost 7% on news of a Justice Department investigation.

Notable market movers on Friday also included Alibaba, Celsius, Block, Dropbox.

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SATISFICING: In Health Economics

A decision-making strategy 

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What is satisficing? Definition and meaning - Market Business News

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Satisficing is a business decision-making strategy or cognitive heuristic that entails searching through the available alternatives until an acceptability threshold is met.

The term economic satisficing, a portmanteau of satisfy and suffice, was introduced by Herbert A. Simon in 1956, although the concept was first posited in his 1947 book Administrative Behavior. Simon used satisficing to explain the behavior of decision makers under circumstances in which an optimal solution cannot be determined. He maintained that many natural problems are characterized by computational intractability or a lack of information, both of which preclude the use of mathematical optimization procedures.

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He observed in his Nobel Prize in Economics speech that “decision makers can satisfice either by finding optimum solutions for a simplified world, or by finding satisfactory solutions for a more realistic world. Neither approach, in general, dominates the other, and both have continued to co-exist in the world of management science”.

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Assessment

“Satisficing” – a made-up word created by combining satisfactory and sufficient – indicates something good, but not great. Like the Canadian single-payer health system, like Medicare-for-All.

KEN ARROW PhD: https://medicalexecutivepost.com/2010/08/17/on-professor-kenneth-arrow-phd/

MORE: https://www.acsh.org/news/2018/09/18/canadas-single-payer-health-system-satisfices-13272

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HEALTH ECONOMICS: Who Should Study and Learn this Dismal Science?

DR. DAVID EDWARD MARCINKO MBA MEd CPHQ CMP™

By Staff Reporters

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Who should study health economics?

Understanding how economic behavior factors into health and health care decisions can benefit anyone interested in this field. However, the following groups of individuals may benefit most from the study of health economics:

  • Medical providers: Doctors, nurses, and assistants can evaluate new treatments, technologies, and services to determine ways to deliver value-based care. Medical providers benefit from understanding the economics behind these developments [MD/DO, DPM, DDS/DMD, RN, PA, etc].
  • Administrators: Health care administrators process insurance co-payments and manage financial metrics for health care providers. Learning the intricacies of health care economics can provide the necessary context as they liaise with insurance providers and use new technologies to process payments.
  • Policymakers or public health officials: Those who are in charge of policy decisions at the local, state, federal, or international levels benefit from understanding the economic relationship between stakeholders and the general public.
  • Business leaders: Because many Americans receive private insurance, health care becomes a major expense for employers. Business leaders must understand the health economics outlook to appease their employees, shareholders, and even their customers.

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DAILY UPDATE: Stock Markets Down

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The Dow Jones Industrial Average (^DJI) fell roughly 450 points, or around 1%. The S&P 500 (^GSPC) dropped 0.5%, pulling back after its second record close in a row on Wednesday, while the tech-heavy NASDAQ Composite (^IXIC) also lost about 0.5%.

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Worries grew about coming headwinds for corporate America after Walmart beat on quarterly profit but issued cautious 2026 fiscal year guidance. Shares of the retail giant tumbled more than 6%. Walmart’s decline combined with more roughly 4% drops in Goldman Sachs (GS) and JPMorgan (JPM) weighed on the Dow.

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DAILY UPDATE: New Non-Opioid Medication as Stock Markets Pop

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FDA recently approved the first new kind of painkiller since 1998. The drug, called Journavx and made by Vertex Pharmaceuticals, is a non-opioid medication, and the company says it comes with “no evidence of addictive potential.” One downside? At $15.50 per pill, it’s not cheap, and it’s not clear yet how much insurers will cover.

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US stocks closed higher on Wednesday as investors weighed President Trump’s latest 25% tariff salvo and digested the Federal Reserve minutes for insight into future policy.

The benchmark S&P 500 (^GSPC) moved up about 0.2%, hitting a fresh record high of 6,144.15, after notching a record on Tuesday as well. The NASDAQ Composite (^IXIC) and the Dow Jones Industrial Average (^DJI) both rose about 0.1%.

Wednesday’s minutes from the Fed’s January meeting revealed most central bank officials supported holding policy at restrictive levels amid concerns about persistent inflation.

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CAPITAL MARKETS: Defined

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Capital Market: This is a market where buyers and sellers engage in the trade of financial assets, including stocks and bonds. Capital markets feature several participants, including:

  • Companies: Firms that sell stocks and bonds to investors
  • Institutional investors: Investors who purchase stocks and bonds on behalf of a large capital base
  • Mutual funds: A mutual fund is an institutional investor that manages the investments of thousands of individuals
  • Hedge funds: A hedge fund is another type of institutional investor, which controls risk through hedging—a process of buying one stock and then shorting a similar stock to make money from the difference in their relative performance

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DAILY UPDATE: S&P 500 Notches Record Market Close

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US stocks were mixed on Tuesday to begin a holiday-shortened week of trading, with potential policy moves by the Federal Reserve and President Donald Trump in focus.

The benchmark S&P 500 (^GSPC) rose nearly 0.2%, with most of the games coming in the final 10 minutes of trading, to hit a fresh record close of 6,129.58. Meanwhile, the Dow Jones Industrial Average (^DJI) and NASDAQ Composite (^IXIC) finished barely in the green.

Stocks on Wall Street were largely cautious after Monday’s closure for Presidents Day as investors debate the future path of interest rates. Fed officials over the long weekend signaled a firm belief that rates should stay at current levels to combat rising inflation.

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Treasury yields stepped higher as investors sought more clues to the chances of rate cuts this year, given recent data failed to give a clear steer. The benchmark 10-year yield (^TNX) rose to trade around 4.54%.

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Visualize: How private equity tangled banks in a web of debt, from the Financial Times.

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INFLATION: Rule of 70 [Doubling Time]

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DOUBLING TIME

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Whether you know it, or not, inflation is your biggest financial and investing enemy. Fortunately, the rule of 70 will tell you in how many years the value of money will be halved.

For example, you just need to divide 70 with the rate of inflation. So if the rate of inflation is 7%, then 70/7 = 10 years. Therefore, in 10 years, your 100 note will be worth 50.

Note: The phrase rule of thumb refers to an approximate method for doing something, based on practical experience rather than theory. This usage of the phrase can be traced back to the 17th century and has been associated with various trades where quantities were measured by comparison to the width or length of a human adult thumb.

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NET WORTH: Retirees Economic Class

LIMITED RESOURCES TO WEALTHY

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In retirement, according to Josephine Nesbit, your economic class can be broadly categorized into four distinct groups, each defined by their net worth and financial capabilities, ranging from retirees with limited resources to the wealthy. And, according to Moneywise, here are the net worth categories of the poor, middle class (and upper-middle class) and rich:

  • Poor retirees: Poor retirees are in the lower 20th percentile, and may have a net worth of around $10,000. This is often without property ownership, forcing many to rely mainly on Social Security or minimal pensions.
  • Middle-class retirees: Making up the 50th percentile, with a median net worth of approximately $281,000, this group usually includes home equity, retirement savings and a 401(k) plan.
  • Upper-middle-class retirees: These retirees possess a net worth between $201,800 and $608,900. They have diversified assets and enjoy a comfortable retirement cushion.
  • Rich retirees: In the 90th percentile, with net worth starting at $1.9 million, this group has much more financial freedom and is able to afford luxuries and legacy planning.

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INTERNATIONAL vs. GLOBAL: The Mutual Fund Difference

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With international stock markets comprising about 40 percent of the world’s capitalization as of 2023, a broad range of investment opportunities exist outside the borders of the U.S.

For investors who are looking to diversify their mutual fund portfolio with exposure to companies located outside the U.S., there exist two basic choices: A global mutual fund or an international mutual fund.

By definition, international funds invest in non-U.S. markets, while global funds may invest in U.S. stocks alongside non-U.S. stocks.

Make a Choice: The definition may seem clear, but what may seem less clear is why an investor might select one over the other. The reason that an investor may select a global fund is to provide the portfolio manager with the latitude to move the fund’s investments among non-U.S. markets and the U.S. market in order to take advantage of the shifts in relative opportunities these markets may present at any given moment.

By investing in a global fund, the challenge for the investor is that he or she may not know at any point in time their total exposure to the U.S. market within the context of their overall portfolio.

An Inside Look: As a consequence, some investors want to manage their allocation risk by setting the broad asset allocation for their portfolio and then identifying funds that are within those asset classes. For these investors, an international fund may make more sense since it allows them to maintain a greater adherence to their desired domestic/international stock allocation.

Keep in mind that asset allocation is an approach to help manage investment risk. Asset allocation does not guarantee against investment loss. As you consider a global or an international fund, you should also be aware of the fund’s approach to the inherent currency risks. Some funds choose to engage in strategies that may mitigate the effects of currency fluctuations, while others consider currency movements – up and down – to be an element of portfolio performance.

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DAILY UPDATE: Tariffs Up as Stocks Close Higher

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US stocks moved higher on Thursday after President Donald Trump said he plans to introduce reciprocal tariffs as soon as April, while investors digested another report that suggested inflation is once again heating up.

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The Dow Jones Industrial Average (^DJI) added more than 0.6%, while the S&P 500 (^GSPC) put on 0.7% after closing lower on Wednesday. The tech-heavy NASDAQ Composite (^IXIC) rose more than 1% as Nvidia (NVDA) and Tesla (TSLA) gained.

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DAILY UPDATE: Inflation Leaps as Wall Street Worries

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Consumer prices overall increased 3% from a year earlier, up from 2.9% the previous month, according to the Labor Department’s consumer price index, a measure of goods and service costs across the U.S. That’s the most since June and above the 2.9% expected by economists surveyed by Bloomberg.

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Most U.S. stocks fell Wednesday after a report showed inflation is unexpectedly worsening for Americans.

The S&P 500 dropped 0.3%, though it had been on track for a much worse loss of 1.1% at the start of trading. The Dow Jones Industrial Average sank 225 points, or 0.5%, while the NASDAQ composite edged higher by less than 0.1%

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DAILY UPDATE: BC/BS Anti-Trust Lawsuit as Stock Markets Close Mixed

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Blue Cross Blue Shield will soon begin paying out $2.67 billion to customers follow a years-long lawsuit alleging that the health insurance giant broke antitrust laws. The litigation began in 2013, when a class-action lawsuit was filed against more than 35 Blue Cross Blue Shield health insurance plans. The lawsuit claims the company broke antitrust laws by limiting market competition, resulting in increased premiums and reduced options for customers.

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US stocks closed mixed on Tuesday as investors assessed more tariff policy shifts from President Donald Trump and looked ahead to upcoming inflation data.

Traders also digested the start of Federal Chair Jerome Powell’s two-day testimony in Congress. In his opening remarks, Powell told lawmakers the Fed is not in a rush to adjust interest rates and reiterated the central bank’s stance of not commenting on trade policy.

The Dow Jones Industrial Average (^DJI) edged around 0.3% higher, while the benchmark S&P 500 (^GSPC) closed just above the flatline. The tech-heavy NASDAQ Composite (^IXIC) pulled back about 0.4%.

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TEST: Financial Literacy in the USA

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A new report from the Global Financial Literacy Excellence Center shows that the average American scored just 48% on a financial literacy test, with groups scoring as low as 37% in certain areas. Since the report’s inception in 2017, the results have been relatively stable: Americans have scored 48% to 52% correctly on the annual study.

But only 16% of Americans scored between 75% and 100% on the test in 2024. This alarming statistic has far-reaching consequences for companies, the wider economy, and more than half all Americans. 

Cite: https://www.benzinga.com

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DAILY UPDATE: Community Health Center Data Hack and CHIP Revocations as Markets Bounce Back

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Community Health Center, Inc. (CHC) detected a data breach on Jan. 2 after identifying unusual activity within its computer systems. An investigation confirmed that a skilled hacker had accessed and extracted data but did not delete or lock any information. If CHC’s claims are accurate, this is a positive outcome, as hackers often deploy ransomware, a type of attack in which they lock systems and demand payment before restoring access.

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Over one million Floridians have had their health insurance revoked as a result of a nationwide disenrollment from coverage that was previously safeguarded as part of the COVID-19 pandemic response. Medicaid and Children’s Health Insurance Program (CHIP) enrolment in Florida has fallen from 5.1 million to 3.8 million between March 2023 and October 2024, according to health care research non-profit the Kaiser Family Foundation (KFF).

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US stocks bounced back on Monday as investors looked beyond President Trump’s latest tariff threats, including new levies on steel and aluminum imports.

The Dow Jones Industrial Average (^DJI) added nearly 0.4% after the blue-chip index on Friday booked its worst loss in nearly four weeks. The S&P 500 (^GSPC) rose roughly 0.6%, while the NASDAQ Composite (^IXIC) popped nearly 1% as shares of AI chip giant Nvidia (NVDA) surged 3%, along with other tech stocks.

Investors weighed Trump’s recent pledge to introduce additional 25% tariffs on steel and aluminum from all countries, with the official announcement expected on Monday.

Visualize: How private equity tangled banks in a web of debt, from the Financial Times.

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