HBCUs and the Production of Doctors

By Marybeth Gasman, Tiffany Smith,Carmen Ye, and Thai-Huy Nguyen

Abstract

An important issue facing the world of medicine and health care is the field’s lack of diversity, especially regarding African American doctors. African Americans made up 6% of all physicians in the U.S. in 2008, 6.9% of enrolled medical students in 2013 and 7.3% of all medical school applicants.

The existing literature on the lack of diversity within the medical field emphasizes the role that inclusion would play in closing the health disparities among racial groups and the benefits acquired by African Americans through better patient-doctor interactions and further respect for cultural sensitivity. A large portion of current research regarding Black medical students and education focuses on why minority students do not go into medical school or complete their intended pre-med degrees.

Common notions and conclusions are that many institutions do not properly prepare and support students, who despite drive and desire, may lack adequate high school preparation and may go through additional stress unlike their other peers. Historically Black Colleges and Universities (HBCUs) are institutions that were designed to support African American students by providing an educational learning environment that caters to their unique challenges and cultural understandings. Given that HBCUs have had much success in preparing minority students for STEM fields, and for medical school success more specifically, this article looks at the history of such universities in the context of medical education, their effective practices, the challenges faced by African Americans pursing medical education, and what they can do in the future to produce more Black doctors.

We also highlight the work of Xavier University and Prairie View A&M University, institutions that regularly rank among the top two and top ten producers, respectively, of future African American doctors among colleges and universities.

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READ: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6111265/

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PODCAST: Why AMAZON CARE Will Fail?

BY Eric Bricker MD

Employee AGE AND Demographics

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Healthcare Costs (Per Person Per Year) by Age:
Less than 18: $3,628
19 – 44: $4,422
45-64: $8,370
65+: $18,424

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

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What is Techno SCAM-BAITING?

BY ANONYMOUS

SPONSOR: http://www.CertifiedMedicalPlanner.org

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Scam-Baiting Behind the Scenes

The most basic form of scambaiting sets out to waste a scammer’s time. At a minimum, scambaiters attempt to make scammers answer countless questions or perform pointless and random tasks. By keeping a scammer busy, scambaiters claim they’re preventing the scammer from defrauding a real victim.

Scambaiting may also be conducted with a specific purpose in mind. Sometimes scambaiters attempt to obtain an offender’s bank account information, for instance, which they then report to a financial institution. But there are other, less benevolent motives in the scambaiting community.

Thousands of scambaiters are organised on the 419eater forum, which describes itself as the “largest scambaiting community on earth”, with over 1.7 million forum threads. The forum was first established in 2003 to tackle the growing issue of 419 emails – a scam that promises people huge sums of cash in return for a small upfront fee.

419eater provides a particularly interesting case study because members are incentivised and rewarded for their scambaits through a unique system of icons, regarded as trophies, that they can obtain in their profile’s signature lines.

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Romance Scam : Find Out How We Uncovered This Chinese Scam

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MORE: https://www.theguardian.com/technology/2021/oct/03/who-scams-the-scammers-meet-the-amateur-scambaiters-taking-on-the-crooks?utm_source=pocket-newtab

Healthcare: https://www.scamwatch.gov.au/types-of-scams/buying-or-selling/health-medical-products

Medical Insurance: https://www.reddit.com/r/scambait/comments/jsgffx/just_got_a_scam_call_to_sign_me_up_for_bogus/

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PODCAST: How Health Care Can Win by Adapting to Changes in Consumer Behavior

LESSONS FROM THE RETAIL SECTOR

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Discover how ProMedica uses customer feedback and a digital-first approach to consumers to achieve stellar results across more than 400 facilities in 28 states.

PODCAST: https://www.youtube.com/watch?v=861em_pJfVM&t=3070s

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INTERVIEW: A Solution for Healthcare Financing?

HEALTHCARE FINANCING

Former: CEO and Founder
Superior Consultant Company, Inc.
[SUPC-NASD]

EDITOR’S NOTE: I first met Rich in B-school, when I was a student, back in the day. He was the Founder and CEO of Superior Consultant Holdings Corp. Rich graciously wrote the Foreword to one of my first textbooks on financial planning for physicians and healthcare professionals. Today, Rich is a successful entrepreneur in the technology, health and finance space.

-Dr. David E. Marcinko MBA CMP®

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Staff & Contributors - CHAMPIONS OF WAYNE

By Richard Helppie

Today for your consideration – How to fix the healthcare financing methods in the United States?

I use the term “methods” because calling what we do now a “system” is inaccurate. I also focus on healthcare financing, because in terms of healthcare delivery, there is no better place in the world than the USA in terms of supply and innovation for medical diagnosis and treatment. Similarly, I use the term healthcare financing to differentiate from healthcare insurance – because insurance without supply is an empty promise.

This is a straightforward, 4-part plan. It is uniquely American and will at last extend coverage to every US citizen while not hampering the innovation and robust supply that we have today. As this is about a Common Bridge and not about ideology or dogma, there will no doubt be aspects of this proposal that every individual will have difficulty with. However, on balance, I believe it is the most fair and equitable way to resolve the impasse on healthcare funding . . . .

CITE: https://www.r2library.com/Resource/Title/0826102549

Let me start in an area sure to raise the ire of a few. And that is, we have to start with eliminating the methods that are in place today. The first is the outdated notion that healthcare insurance is tied to one’s work, and the second is that there are overlapping and competing tax-supported bureaucracies to administer that area of healthcare finance.

Step 1 is to break the link between employment and health insurance. Fastest way to do that is simply tax the cost of benefits for the compensation that it is. This is how company cars, big life insurance policies and other fringe benefits were trimmed. Eliminating the tax-favored treatment of employer-provided healthcare is the single most important change that should be made.

Yes, you will hear arguments that this is an efficient market with satisfied customers. However, upon examination, it is highly risky, unfair, and frankly out of step with today’s job market.

Employer provided health insurance is an artifact from the 1940’s as an answer to wage freezes – an employer could not give a wage increase, but could offer benefits that weren’t taxed. It makes no sense today for a variety of reasons. Here are a few:

1. Its patently unfair. Two people living in the same apartment building, each making the same income and each have employer provided health insurance. Chris in unit 21 has a generous health plan that would be worth $25,000 each year. Pays zero tax on that compensation. Pat, in unit 42 has a skimpy plan with a narrow network, big deductibles and hefty co-pays. The play is worth $9,000 each year. Pat pays zero tax.

3. The insurance pools kick out the aged. Once one becomes too old to work, they are out of the employer plan and on to the retirement plan or over to the taxpayers (Medicare).

4. The structure is a bad fit. Health insurance and healthy living are longitudinal needs over a long period of time. In a time when people change careers and jobs frequently, or are in the gig economy, they are not any one place long enough for the insurance to work like insurance.

5. Creates perverse incentives. The incentives are weighted to have employers not have their work force meet the standards of employees so they don’t have to pay for the health insurance. Witness latest news in California with Uber and Lyft.

6. Incentives to deny claims abound. There is little incentive to serve the subscriber/patient since the likelihood the employer will shop the plan or the employee will change jobs means that stringing out a claim approval is a profitable exercise.

7. Employers have difficulty as purchasers. An employer large enough to supply health insurance has a diverse set of health insurance needs in their work force. They pay a lot of money and their work force is still not 100% happy.

Net of it, health insurance tied to work has outlived its usefulness. Time to end the tax-favored treatment of employer-based insurance. If an employer wants to provide health insurance, they can do it, but the value of that insurance is reflected in the taxable W-2 wages – now Pat and Chris will be treated equally.

Step 2 is to consolidate the multiple tax-supported bureaus that supply healthcare. Relieve the citizens from having to prove they are old enough, disabled enough, impoverished enough, young enough. Combine Medicare, Medicaid, CHIP, Tricare and even possibly the VA into a single bureaucracy. Every American Citizen gets this broad coverage at some level. Everyone pays something into the system – start at $20 a year, and then perhaps an income-adjusted escalator that would charge the most wealthy up to $75,000. Collect the money with a line on Form 1040.

I have not done the exact math. However, removing the process to prove eligibility and having one versus many bureaucracies has to generate savings. Are you a US Citizen? Yes, then here is your base insurance. Like every other nationalized system, one can expect longer waits, fewer referrals to a specialist, and less innovation. These centralized systems all squeeze supply of healthcare services to keep their spend down. The reports extolling their efficiencies come from the people whose livelihoods depend on the centralized system. However, at least everyone gets something. And, for life threatening health conditions, by and large the centralized systems do a decent job. With everyone covered, the fear of medical bankruptcy evaporates. The fear of being out of work and losing healthcare when one needs it most is gone.

So if you are a free market absolutist, then the reduction of vast bureaucracies should be attractive – no need for eligibility requirements (old enough, etc.) and a single administration which is both more efficient, more equitable (everyone gets the same thing). And there remains a private market (more on this in step 3) For those who detest private insurance companies a portion of that market just went away. There is less incentive to purchase a private plan. And for everyone’s sense of fairness, the national plan is funded on ability to pay. Bearing in mind that everyone has to pay something. Less bureaucracies. Everyone in it together. Funded on ability to pay.

Step 3 is to allow and even encourage a robust market for health insurance above and beyond the national plan – If people want to purchase more health insurance, then they have the ability to do so. Which increases supply, relieves burden on the tax-supported system, aligns the US with other countries, provides an alternative to medical tourism (and the associated health spend in our country) and offers a bit of competition to the otherwise monopolistic government plan.

Its not a new concept, in many respects it is like the widely popular Medigap plans that supplement what Medicare does not cover.

No one is forced to make that purchase. Other counties’ experience shows that those who choose to purchase private coverage over and above a national plan often cite faster access, more choice, innovation, or services outside the universal system, e.g., a woman who chooses to have mammography at an early age or with more frequency than the national plan might allow.  If the insurance provider can offer a good value to the price, then they will sell insurance. If they can deliver that value for more than their costs, then they create a profit. Owners of the company, who risk their capital in creating the business may earn a return.

For those of you who favor a free market, the choices are available. There will be necessary regulation to prevent discrimination on genetics, pre-existing conditions, and the like. Buy the type of plan that makes you feel secure – just as one purchases automobile and life insurance.For those who are supremely confident in the absolute performance of a centralized system to support 300+ million Americans in the way each would want, they should like this plan as well – because if the national plan is meeting all needs and no one wants perhaps faster services, then few will purchase the private insurance and the issuers will not have a business. Free choice. More health insurance for those who want it. Competition keeps both national and private plans seeking to better themselves.

Step 4 would be to Permit Access to Medicare Part D to every US Citizen, Immediately

One of the bright spots in the US Healthcare Financing Method is Medicare Part D, which provides prescription drug coverage to seniors. It is running at 95% subscriber satisfaction and about 40% below cost projections.

Subscribers choose from a wide variety of plans offered by private insurance companies. There are differences in formularies, co-pays, deductibles and premiums.

So there you have it, a four part plan that would maintain or increase the supply of healthcare services, universal insurance coverage, market competition, and lower costs. Its not perfect but I believe a vast improvement over what exists today. To recap:

1. Break the link between employment and healthcare insurance coverage, by taxing the benefits as the compensation they are.

2. Establish a single, universal plan that covers all US citizens paid for via personal income taxes on an ability-to-pay basis.  Eliminate all the other tax-funded plans in favor of this new one.

3. For those who want it, private, supplemental insurance to the national system, ala major industrialized nations.

4. Open Medicare Part D (prescription drugs) to every US citizen. Today.

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PODCASTS: FDA Pharmaceutical Industry Ties

CONFLICTS OF INTEREST?

The New York Times Had an Excellent Article on the FDA on September 2, 2021.

The Article Described How the FDA Began Receiving Funding from the Pharmaceutical Industry Itself to Pay for FDA Employee Salaries in 1992–a Potential Conflict-of-Interest. Subsequently, a Study Found that 1/3 of Drugs Approved by the FDA Were Found to Have Safety Problems from 2000 -2010. Another Potential Conflict-of-Interest is Number of FDA Regulators Who Leave Their Positions to Take High-Paying Jobs at Pharmaceutical Companies.

By Eric Bricker MD

FDA rescinds emergency authorization for COVID-19 antibody treatment  bamlanivimab | TheHill

PODCAST:

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PODCAST: The Dartmouth Atlas of Healthcare

Geographic Variation in Spine Surgery

By Dr. Eric Bricker MD

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John Wennberg MD: https://tdi.dartmouth.edu/about/our-people/directory/john-e-wennberg-md-mph

CHECKLISTS: https://medicalexecutivepost.com/2009/01/20/a-homer-simpson-moment-of-clarity-on-medical-quality/

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PODCAST: The ‘Weaponization’ Of The CV19 Vaccine?

DR. JOHN TRAVIS MD MPH

John W. “Jack” Travis, MD, MPH, completed his medical degree at Tufts University and a residency in preventive medicine at Johns Hopkins, where he received a Masters in Public Health and created one of the first computerized Health Risk Assessments (HRAs).

Dr. Jack joins colleague Pete R. Peter R. Quinones to describe what he refers to as the “weaponization of vaccines” and specifically concentrates on the CV19 “vaccines”.

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COVID-19 Information | Peachtree Corners, GA

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PODCAST: https://freemanbeyondthewall.libsyn.com/episode-586

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A Brief History of Managed Medical Care in the USA

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By National Council on Disability

The origins of managed care can be traced back to at least 1929, when Michael Shadid, a physician in Elk City, Oklahoma, established a health cooperative for farmers in a small community without medical specialists or a nearby general hospital. He sold shares to raise money to establish a local hospital and created an annual fee schedule to cover the costs of providing care. By 1934, 600 family memberships were supporting a staff that included Dr. Shadid, four newly recruited specialists, and a dentist. That same year, two Los Angeles physicians, Donald Ross and Clifford Loos, entered into a prepaid contract to provide comprehensive health services to 2,000 employees of a local water company.endnote[i]

Development of Prepaid Health Plans

Other major prepaid group practice plans were initiated between 1930 and 1960, including the Group Health Association in Washington, DC, in 1937, the Kaiser-Permanente Medical Program in 1942, the Health Cooperative of Puget Sound in Seattle in 1947, the Health Insurance Plan of Greater New York in New York City in 1947, and the Group Health Plan of Minneapolis in 1957. These plans encountered strong opposition from the medical establishment, but they also attracted a large number of enrollees.

Today, such prepaid health plans are commonly referred to as health maintenance organizations (HMOs). The term “health maintenance organization,” however, was not coined until 1970, with the aim of highlighting the importance that prepaid health plans assign to health promotion and prevention of illness. HMOs are what most Americans think of when the term “managed care” is used, even though other managed care models have emerged over the past 40 years.

Public Managed Care Plans

The enactment of the Health Maintenance Organization Act of 1973 (P. L. 93-222) provided a major impetus to the expansion of managed health care. The legislation was proposed by the Nixon Administration in an attempt to restrain the growth of health care costs and also to preempt efforts by congressional Democrats to enact a universal health care plan. P. L. 93-222 authorized $375 million to assist in establishing and expanding HMOs, overrode state laws restricting the establishment of prepaid health plans, and required employers with 25 or more employees to offer an HMO option if they furnished health insurance coverage to their workers. The purpose of the legislation was to stimulate greater competition within health care markets by developing outpatient alternatives to expensive hospital-based treatment. Passage of this legislation also marked an important turning point in the U.S. health care industry because it introduced the concept of for-profit health care corporations to an industry long dominated by a not-for-profit business model.endnote[ii]

In the decade following the passage of P. L. 93-222, enrollment in HMOs grew slowly. Stiff opposition from the medical profession led to the imposition of regulatory restrictions on HMO operations. But the continued, rapid growth in health care outlays forced government officials to look for new solutions. National health expenditures grew as a proportion of the overall gross national product (GNP) from 5.3 percent in 1960 to 9.5 percent in 1980.endnote[iii] In response, Congress in 1972 authorized Medicare payments to free-standing ambulatory care clinics providing kidney dialysis to beneficiaries with end-stage renal disease. Over the following decade, the Federal Government authorized payments for more than 2,400 Medicare procedures performed on an outpatient basis.endnote[iv]

Responding to the relaxed regulatory environment, physicians began to form group practices and open outpatient centers specializing in diagnostic imaging, wellness and fitness, rehabilitation, surgery, birthing, and other services previously provided exclusively in hospital settings. As a result, the number of outpatient clinics skyrocketed from 200 in 1983 to more than 1,500 in 1991,endnote[v] and the percentage of surgeries performed in hospitals was halved between 1980 (83.7%) and 1992 (46.1%).endnote[vi]

mind-investing-behavioral-finance

The Influence of Medicare Prospective Payments

Health care costs, however, continued to spiral upward, consuming 10.8 percent of GNP by 1983. In an attempt to slow the growth rate, Congress in 1982 capped hospital reimbursement rates under the Medicare program and directed the secretary of HHS to develop a case mix methodology for reimbursing hospitals based on diagnosis-related groups (DRGs). As an incentive to the hospital industry, the legislation (the Tax Equity and Fiscal Responsibility Act (P. L. 97-248)) included a provision allowing hospitals to avoid a Medicare spending cap by reaching an agreement with HHS on implementing a prospective payment system (PPS) to replace the existing FFS system. Following months of intense negotiations involving federal officials and representatives of the hospital industry, the Reagan Administration unveiled a Medicare PPS. Under the new system, health conditions were divided into 468 DRGs, with a fixed hospital payment rate assigned to each group.

Once the DRG system was fully phased in, Medicare payments to hospitals stabilized.endnote[vii] However, since DRGs applied to inpatient hospital services only, many hospitals, like many group medical practices, began to expand their outpatient services in order to offset revenues lost as a result of shorter hospital stays. Between 1983 and 1991, the percentage of hospitals with outpatient care departments grew from 50 percent to 87 percent. Hospital revenues derived from outpatient services doubled over the period, reaching 25 percent of all revenues by 1992.endnote[viii]

Since DRGs were applied exclusively to Medicare payments, hospitals began to shift unreimbursed costs to private health insurance plans. As a result, average per employee health plan premiums doubled between 1984 and 1991, rising from $1,645 to $3,605.endnote[ix] With health insurance costs eroding profits, many employers took aggressive steps to control health care expenditures. Plan benefits were reduced. Employees were required to pay a larger share of health insurance premiums. More and more employers—especially large corporations—decided to pay employee health costs directly rather than purchase health insurance. And a steadily increasing number of large and small businesses turned to managed health care plans in an attempt to rein in spiraling health care outlays.

Managed Long-Term Services and Supports

Arizona became the first state to apply managed care principles to the delivery and financing of Medicaid-funded LTSS in 1987, when the federal Health Care Financing Administration (later renamed the Centers for Medicare and Medicaid Services) approved the state’s request to expand its existing Medicaid managed care program. Medicaid recipients with physical and developmental disabilities became eligible to participate in the Arizona Long-Term Care System as a result of this program expansion. Over the following two decades, a number of other states joined Arizona in providing managed LTSS, and by the summer of 2012, 16 states were operating Medicaid managed LTSS programs.endnote[x]

Scientists at work

Growth of Commercial Managed Care Plans

During the late 1980s and early 1990s, managed care plans were credited with curtailing the runaway growth in health care costs. They achieved these efficiencies mainly by eliminating unnecessary hospitalizations and forcing participating physicians and other health care providers to offer their services at discounted rates. By 1993, a majority (51%) of Americans receiving health insurance through their employers were enrolled in managed health care plans.endnote[xi] Eventually, however, benefit denials and disallowances of medically necessary services led to a public outcry and the enactment of laws in many states imposing managed care standards. According to one analysis, nearly 900 state laws governing managed health practices were enacted during the 1990s.endnote[xii] Among the measures approved were laws permitting women to visit gynecologists and obstetricians without obtaining permission from their primary care physician, establishing the right of patients to receive emergency care, and establishing the right of patients to appeal decisions made by managed care firms. Congress even got into the act in 1997 when it passed the Newborns’ Mother Health Protection Act, prohibiting so-called “drive-through deliveries” (overly restrictive limits on hospital stays following the birth of a child).endnote[xiii]

Research studies have yielded little evidence that managed health care excesses have undermined the quality of health care services. For example, in a survey of 2,000 physicians, Remler and colleagues found that managed care insurance plans denied only about 1 percent of recommended hospitalizations, slightly more than 1 percent of recommended surgeries, and just over 2.5 percent of referrals to specialists.endnote[xiv] In another study, Franks and colleagues found that medical outcomes were similar for participants in HMOs versus FFS health plans.endnote[xv] Franks also reported that HMO patients were hospitalized 40 percent less frequently than FFS patients, and the rate of inappropriate hospitalizations was lower among HMO patients.

Link: http://www.ncd.gov/publications/2013/20130315/20130513_AppendixB

Recent Developments

Over the past 15 to 20 years, the public outcry against draconian managed care practices has waned, primarily due to the expanded out-of-network options afforded to participants in HMOs, PPOs, and POS health plans. But the perception that managed care represents an overly cost-conscious, mass market approach to delivering medical services lingers among the American public, even though more than 135 million people with health insurance coverage now receive their primary, preventive, and acute health services through a managed care plan.endnote[xvi]People with disabilities, especially high users of medical care and LTSS, share many of the same negative perceptions of managed care as the general public.

More:

Footnotes

[i]. R. Kane, R. Kane, N. Kaye, R. Mollica, T. Riley, P. Saucier, K. I. Snow, and L. Starr, “Managed Care Basics,” in Managed Care: Handbook for the Aging Network (Minneapolis: Long-Term Care Resource Center, University of Minnesota, 1996).

[ii]. D. Mitchell, Managed Care and Developmental Disabilities: Reconciling the Realities of Managed Care with the Individual Needs of Persons with Disabilities (Homewood, IL: High Tide Press, 1999).

[iii]. M. Freeland and C. Schendler, “Health Spending in the 1980s,” Health Care Financing Review 5 (Spring 1984): 7.

[iv]. D. Drake, Reforming the Health Care Market: An Interpretive Economic History (Washington, DC: Georgetown University Press, 1994).

[v]. Ibid.

[vi]. Mitchell, Managed Care and Developmental Disabilities.

[vii]. Drake, Reforming the Health Care Market.

[viii]. L. Weiss, Private Medicine and Public Health (Boulder, CO: Westview Press, 1997).

[ix]. Employee Benefits Research Institute, EBRI Databook on Employee Benefits (Washington, DC: Employee Benefits Research Institute, 1992).

[x]. P. Saucier, “Managed Long-Term Services and Supports,” a presentation to the National Policy Forum, May 11, 2012.

[xi]. J. Iglehart, “Physicians and the Growth of Managed Care,” The New England Journal of Medicine 331, no. 17 (1994): 1167–71.

[xii]. R. Cauchi, “Where Do We Go From Here?” State Legislatures (March 1999): 15–20.

[xiii]. U.S. Department of Labor, Fact Sheet: Newborns’ and Mothers’ Protection Act, http://www.dol.gov/ebsa/newsroom/fsnmhafs.html.

[xiv]. D. Rembler, K. Donelan, R. Blendon, L. Lundberg, D. Leape, K. Binns, and J. Newhouse, “What Do Managed Care Plans Do to Affect Care: Results of a Survey of Physicians,” Inquiry 34 (1997): 196–204.

[xv]. P. Franks, C. Clancy, and P. Nutting, “Gatekeeping Revisited: Protecting Patients from Overtreatment,” The New England Journal of Medicine 337, no. 6 (1992): 424–9.

[xvi]. Statistics taken from Managed Care Online, http://www.mcol.com/factsheetindex.

Conclusion

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PODCAST: Role of the “Entrepreneur” in Society

ACCORDING TO AUSTRIAN ECONOMISTS

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BY PER BYLUND

Colleague Peter R. Quinones and Per Bylund return to the show to talk about the role of the entrepreneur not only in society, but according to the Austrian School of Economics. Medical perspectives are implied.

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The Medical Entrepreneur Symposium Adds "LifeScience Innovation Roadmap"

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PODCAST: https://freemanbeyondthewall.libsyn.com/episode-312

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Dr. Dave Marcinko at YOUR Service in 2021

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Book Marcinko for your next Seminar, Meeting or Medical Business Event 

By Ann Miller RN MHA

Professor and physician executive David Edward Marcinko MBBS DPM MBA MEd BSc CMP® is originally from Loyola University MD, Temple University in Philadelphia and the Milton S. Hershey Medical Center in PA; Oglethorpe University, and Atlanta Hospital & Medical Center in GA; and the Aachen City University Hospital, Koln-Germany. He is one of the most innovative global thought leaders in health care business and entrepreneurship today.

Dr. Marcinko is a multi-degreed educator, board certified physician, surgical fellow, hospital medical staff President, Chief Education Officer and philanthropist with more than 400 published papers; 5,150 op-ed pieces and over 125+ international presentations to his credit; including the top 10 biggest pharmaceutical companies and financial services firms in the nation. He is also a best-selling Amazon author with 30 published text books in four languages [National Institute of Health, Library of Congress and Library of Medicine].

Dr. Marcinko is past Editor-in-Chief of the prestigious “Journal of Health Care Finance”, and a former Certified Financial Planner®, who was named “Health Economist of the Year” in 2001. He is a Federal and State court approved expert witness featured in hundreds of peer reviewed medical, business, management and trade publications [AMA, ADA, APMA, AAOS, Physicians Practice, Investment Advisor, Physician’s Money Digest and MD News].

As a licensed insurance agent, RIA and SEC registered endowment fund manager, Dr. Marcinko is Founding Dean of the fiduciary focused CERTIFIED MEDICAL PLANNER® chartered designation education program; as well as Chief Editor of the HEALTH DICTIONARY SERIES® Wiki Project. His professional memberships include: ASHE, AHIMA, ACHE, ACME, ACPE, MGMA, FMMA and HIMSS.

Dr. Marcinko is a MSFT Beta tester, Google Scholar, “H” Index favorite and one of LinkedIn’s “Top Cited Voices”.

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PODCAST: Never Pay Your First Medical Bill?

Marshall Allen Has a New Healthcare Book Out Called Never Pay the First Bill.”

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PODCAST: Nursing Home Care

Residents disproportionately affected by COVID-19

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New Covid-19 death data reveals 'hidden' crisis in care ...

BY JAMES BLUMENSTOCK MA

Residents of nursing homes have been disproportionately affected by COVID-19. The nature of this coronavirus—which is particularly harmful to older adults and people with multiple chronic conditions—has left residents vulnerable.

Additionally, the pandemic has exacerbated existing challenges in our fragmented long-term care system, which is financed, regulated, and administered by states, the federal government, and private care facilities.

During this webinar, panelists discussed policy options to support high quality care for nursing home residents during the COVID-19 pandemic.

NOTE: This webinar is a project of the Alliance for Health Policy and NIHCM Foundation, in collaboration with The Commonwealth Fund.

PODCAST: https://nihcm.org/publications/nursing-home-care

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PODCAST: Novartis Drug Company Settlement with the USA

Why SOME Doctors Take Money from Pharmaceutical Companies

Q&A: Eric Bricker, chief medical officer of Compass patient advocacy service - Dallas Business ...

BY ERIC BRICKER MD

MAssive Global Drug Company Novartis Paid $678M to Settle Charges from the US Federal Government.

The Charges Were Regarding Illegal Payments and Kickbacks to Doctors that Were Thinly-Veiled as ‘Speaker Fees’ and Fancy Dinners.

Why Where the Doctors Not Held Accountable and What Does This Say About a Doctor’s Mentality on Money?

Learn the Psychology of Doctors and Money.

Understand How It Leads to Counterproductive Relationships Between Physicians and Drug Companies, Which Can Compromise the #1 Rule in Medicine: The Patient Comes First, Always.

Disclaimer: Dr. Bricker is the Chief Medical Officer of Virtual Care Company First Stop Health

YOUR THOUGHTS ARE APPRECIATED

Thank You

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Are Today’s Doctors Desperate?

Emotions Rise with Healthcare Reform

By Dr. David Edward Marcinko; MBA, CMP™

[Publisher-in-Chief]

NOTE:  I penned this essay more than a decade ago.dem2

Managed care is a prospective payment method where medical care is delivered regardless of the quantity or frequency of service, for a fixed payment, in the aggregate. It is not traditional fee-for-service medicine or the individual personal care of the past, but is essentially utilitarian in nature and collective in intent. Will new-age healthcare reform be even more draconian?

Unhappy Physicians

There are many reasons why doctors are professionally and financially unhappy, some might even say desperate, because of managed care; not to mention the specter of healthcare reform from the Obama administration. For example:

  • A staggering medical student loan debt burden of $100,000-250,000 is not unusual for new practitioners. The federal Health Education Assistance Loan (HEAL) program reported that for the Year 2000, it squeezed significant repayment settlements from its Top 5 list of deadbeat doctor debtors. This included a $303,000 settlement from a New York dentist, $186,000 from a Florida osteopath, $158,000 from a New Jersey podiatrist, $128,000 from a Virginia podiatrist, and $120,000 from a Virginia dentist. The agency also excluded 303 practitioners from Medicare, Medicaid, and other federal healthcare programs and had their cases referred for nonpayment of debt.
  • Because of the flagging economy, medical school applications nationwide have risen. “Previously, there were a lot of different opportunities out there for young bright people”; according to Rachel Pentin-Maki; RN, MHA”; not so today. In fact, Physicians Practice Digest recently stated, “Medicine is fast becoming a job in which you work like a slave, eke out a middle class existence, and have patients, malpractice insurers, and payers questioning your motives.” Remarkably, the Cornell University School of Continuing Education has designed a program to give prospective medical school students a real-world peek, both good and bad.

The Ripple Effects of Managed Care and Reform

“Many people who are currently making a great effort and investment to become doctors may be heading for a role and a way of life that are fundamentally different from what they expect and desire,” according to Stephen Scheidt, MD, director of the $1,000 Cornell fee program; why?

  • Fewer fee-for-service patients and more discounted patients.
  • More paperwork and scrutiny of decisions with lost independence and morale.
  • Reputation equivalency (i.e., all doctors in the plan must be good), or commoditization (i.e., a doctor is a doctor is a doctor).
  • The provider is at risk for (a) utilization and acuity, (b) actuarial accuracy, (c) cost of delivering medical care, and (d) adverse patient selection.
  • Practice costs are increasing beyond the core rate of inflation.
  • Medicare reimbursements are continually cut.

Mad Obama

Early Opinions

Richard Corlin MD, opined back in 2002 that “these are circumstances that cannot continue because we are going to see medical groups disappearing.” Furthermore, he stated, “This is an emergency that lawmakers have to address.” Such cuts also stand to hurt physicians with private payers since commercial insurers often tie their reimbursement schedules to Medicare’s resources. “That’s the ripple effect here,” says Anders Gilberg, the Washington lobbyist for the Medical Group Management Associations (MGMA).

Assessment

And so, some desperate doctors are pursing these sources of relief, among many others:

  • A growing number of doctors are abandoning traditional medicine to start “boutique” practices that are restricted to patients who pay an annual retainer of $1,500 and up for preferred services and special attention. Franchises for the model are also available.
  • Regardless of location, the profession of medicine is no longer ego-enhancing or satisfying; some MDs retire early or leave the profession all together. Few recommend it, as a career anymore.

Assessment

To compound the situation, it is well known that doctors are notoriously poor investors and do not attend to their own personal financial well being, as they expertly minister to their patients’ physical illnesses.

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Tell us what you think? Are you a desperate doctor? Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, be sure to subscribe to the ME-P. It is fast, free and secure.

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos 

References:

  1. www.managedcaremagazine.com/archives/9809/9809/.qna_dickey.shtml
  2. www.hrsa.dhhs.gov/news-pa/heal.htm
  3. www.bhpr.hrsa.gov/dsa/sfag/health-professions/bk1prt4.htm
  4. Pamela L. Moore, “Can We All Just Get Along: Bridging the Generation Gap, Physicians Practice Digest (May/June 2001).

Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™8Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

PODCAST: Established Sales Strategies That Are Effective When Applied to Healthcare

HEALTHCARE SALES TECHNIQUES

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Learn Established Sales Strategies That Are Effective When Applied to Healthcare:

1) Prospecting: The Strategy of Aaron Ross in Dividing Prospecting into Seeds, Nets and Spears Was Effective in Generating Leads at Compass Professional Health Services.

2) Pitching: The Miller-Heiman Strategy of Identifying Economic, Outcome and Technical Buyers Allows for Effective Pitching to a Buying Team.

3) Closing: The Model of ‘Fit-Risk-Price’ is Essential To Understanding How and When to Close a Sale.

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BY ERIC BRICKER MD

THANK YOU

***

The Next-Generation of “Anti-Millionaire” Doctors

“$1 Million Mistake: Becoming a Doctor”

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BY DR. DAVID E. MARCINKO MBA CMP®

CMP logo

SPONSOR: http://www.CertifiedMedicalPlanner.org

CBS Moneywatch published an article entitled “$1 Million Mistake: Becoming a Doctor” Aside from the possibility that devoting one’s life to helping others might be considered a mistake, medical student Dan Coleman was struck by the “$1 million” figure.

Before medical school, he worked in the pharmaceutical industry and even turned down a hefty promotion to his education as soon as possible, rather than defer for a year or two. But, his financial calculations made it fairly obvious that, including benefits, bonuses, and potential promotions, his medical decision was not a $1 million mistake, but was more like a $1.3 million dollar disaster. Still; he opined:

Yet, even today, as we stare down the barrel of the Affordable Care Act, being a doctor is a very desirable job. We may not be famous, but we will be well-respected. We may not be rich, but we will certainly live comfortably. We may work a lot, but we will never be out of work. To future doctors, the young and impecunious, the anti-millionaires, tuition is a mere afterthought. All that matters is the MD.

Source: http://in-training.org/medical-students-the-anti-millionaires-4361

Millionaire Interview 81 - ESI Money

OVER HEARD IN THE MEDICAL STUDENT’S LOUNGE

“We are medical students.
We are young, proud, and righteous.
We have made the hard choice (medicine), but we have cleared the high hurdle (getting into school).


We know healthcare is a difficult, imperfect art, but we are devoted.
We arm ourselves with the weapons of knowledge and compassion, prepared to defend against the onslaught of trauma, disease, and time.
We are here to the bitter end, for our patients and ourselves.
And above all, we know the cost of our choice.

And if we’re lucky, it will stay under 6% interest through graduation”.

Daniel Coleman

[Georgetown University School of Medicine]

First-year Student

Your thoughts are appreciated,

THANK YOU

***

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

ORDER Textbook: https://www.amazon.com/Comprehensive-Financial-Planning-Strategies-Advisors/dp/1482240289/ref=sr_1_1?ie=UTF8&qid=1418580820&sr=8-1&keywords=david+marcinko

ODER TEXTBOOK: https://www.routledge.com/Risk-Management-Liability-Insurance-and-Asset-Protection-Strategies-for/Marcinko-Hetico/p/book/9781498725989

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PODCAST: The Future of Healthcare Looks to Medicare’s Past?

See the Future of Healthcare By Looking to Medicare’s Past

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Texas CEO Magazine 2016 Economic Forecast: Dallas - Texas ...

BY DR. ERIC BRICKER MD

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Desire for a Healthcare ‘Safety Net’ Goes Back Almost 100 years to President F.D.R. and His “New Deal

FDR Was Able to Pass Social Security, but He Also Wanted a Healthcare Safety Net Too.

Presidents Truman and Kennedy Also Wanted a Federally-Funded Healthcare Safety Net.

LBJ Carried the Torch of the Healthcare Safety Net. He Was Able to Have Medicare Legislation Passed in 1965 by Combining 3 Separate Proposals and Acts:

1) Hospital Insurance

2) Doctor Insurance That Was Voluntary

3) the State-Administered Kerr-Mills Act 

Hospital Insurance Became Medicare Part A. Doctor Insurance Became Medicare Part B. The Kerr-Mills Act Became Medicaid.

Presidents Carter and Clinton Also Wanted to Expand the Healthcare Safety Net. President Obama Expanded the Healthcare Safety Net with Passage of Obamacare. President Biden is Seeking to Expand the Healthcare Safety Net Too.

The Arc of Government-Funded Healthcare Stretches Back Almost 100 Years and Will Inevitably Result in the Full Government Payment for Healthcare in America.

It’s Not a Question of If, But When.

Implication: United Health Group is Making Many Acquisitions to Become a Vertically Integrated Healthcare Company to Position Itself as a Major Government Contractor for the Eventual Federal Takeover.

PODCAST: https://www.youtube.com/watch?v=OAh7Rl7w1wM

Your thoughts are appreciated.

THANK YOU

***

PODCAST: “Real ACOs Haven’t Been Tried Yet!”

What is an Accountable Care Organization?

DEFINITION: ACOs are groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high-quality care to their patients. The goal of coordinated care is to ensure that patients get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors. When an ACO succeeds both in delivering high-quality care and spending health care dollars more wisely, the ACO will share in the savings.

Citation: https://www.r2library.com/Resource/Title/0826102549

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QUESTION: What happens when you’re a healthcare policy wonk and the pilot study for your pet program has failed miserably? 

ANSWER: You declare “Success!” in the editorial pages of the New England Journal of Medicine and demand that the program become nationwide and mandatory. I kid you not.  This is exactly what happens.

Thankfully, Anish Koka is vigilant and explains the blatant obfuscations and manipulations that the central planners engage in to have their way.

***

And so, In this video, Anish and colleague Michel Accad, MD, will reveal the machinations, take the culprits to task, and discuss pertinent questions regarding health care organization: 

  • Does “capitation” reduce costs? 
  • Do employed physicians necessarily utilize fewer resources? 
  • What happens when a HMO and a traditional fee-for-service health system operate side-by-side in a community?
BMC and Accountable Care - Boston Medical Center

Enjoy!

PODCAST: http://alertandoriented.com/real-acos-havent-been-tried-yet/

Your thoughts are appreciated.

THANK YOU

***

INFLATION Is Here!

But for How Long?

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Vitaliy N. Katsenelson, CFA

[CEO & Chief Investment Officer]

READERS

DEFINITION: In economics, inflation (or less frequently, price inflation) is a general rise in the price level of an economy over a period of time. When the general price level rises, each unit of currency buys fewer goods and services; consequently, inflation reflects a reduction in the purchasing power per unit of money – a loss of real value in the medium of exchange and unit of account within the economy. The opposite of inflation is deflation, a sustained decrease in the general price level of goods and services. The common measure of inflation is the inflation rate, the annualized percentage change in a general price index, usually the consumer price index, over time.

CITATION: https://www.r2library.com/Resource/Title/0826102549

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See the source image

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DEAR READERS

This essay is going to be long.
I blame inflation, be it transitory or not, for inflating its length. 

The number one question I am asked by clients, friends, readers, and random strangers is, are we going to have inflation? 

I think about inflation on three timelines: short, medium, and long-term

The pandemic disrupted a well-tuned but perhaps overly optimized global economy and time-shifted the production and consumption of various goods. For instance, in the early days of the pandemic automakers cut their orders for semiconductors. As orders for new cars have come rolling back, it is taking time for semiconductor manufacturers, who, like the rest of the economy, run with little slack and inventory, to produce enough chips to keep up with demand. A $20 device the size of a quarter that goes into a $40,000 car may have caused a significant decline in the production of cars and thus higher prices for new and used cars. (Or, as I explained to my mother-in-law, all the microchips that used to go into cars went into a new COVID vaccine, so now Bill Gates can track our whereabouts.)

Here is another example. The increase in new home construction and spike in remodeling drove demand for lumber while social distancing at sawmills reduced lumber production – lumber prices spiked 300%. Costlier lumber added $36,000 to the construction cost of a house, and the median price of a new house in the US is now about $350,000.

The semiconductor shortage will get resolved by 2022, car production will come back to normal, and supply and demand in the car market will return to the pre-pandemic equilibrium. High prices in commodities are cured by high prices. High lumber prices will incentivize lumber mills to run triple shifts. Increased supply will meet demand, and lumber prices will settle at the pre-pandemic level in a relatively short period of time. That is the beauty of capitalism! 

Most high prices caused by the time-shift in demand and supply fall into the short-term basket, but not all. It takes a considerable amount of time to increase production of industrial commodities that are deep in the ground – oil, for instance. Low oil prices preceding the pandemic were already coiling the spring under oil prices, and COVID coiled it further. It will take a few years and increased production for high oil prices to cure high oil prices. Oil prices may also stay high because of the weaker dollar, but we’ll come back to that.

Federal Reserve officials have told us repeatedly they are not worried about inflation; they believe it is transitory, for the reasons I described above. We are a bit less dismissive of inflation, and the two factors that worry us the most in the longer term are labor costs and interest rates. 

Let’s start with labor costs 

During a garden-variety recession, companies discover that their productive capacity exceeds demand. To reduce current and future output they lay off workers and cut capital spending on equipment and inventory. The social safety net (unemployment benefits) kicks in, but not enough to fully offset the loss of consumer income; thus demand for goods is further reduced, worsening the economic slowdown. Through millions of selfish transactions (microeconomics), the supply of goods and services readjusts to a new (lower) demand level. At some point this readjustment goes too far, demand outstrips supply, and the economy starts growing again.

This pandemic was not a garden-variety recession 

The government manually turned the switch of the economy to the “off” position. Economic output collapsed. The government sent checks to anyone with a checking account, even to those who still had jobs, putting trillions of dollars into consumer pockets. Though output of the economy was reduced, demand was not. It mostly shifted between different sectors within the economy (home improvement was substituted for travel spending). Unlike in a garden-variety recession, despite the decline in economic activity (we produced fewer widgets), our consumption has remained virtually unchanged. Today we have too much money chasing too few goods– that is what inflation is. This will get resolved, too, as our economic activity comes back to normal.

But …

Today, though the CDC says it is safe to be inside or outside without masks, the government is still paying people not to work. Companies have plenty of jobs open, but they cannot fill them. Many people have to make a tough choice between watching TV while receiving a paycheck from big-hearted Uncle Sam and working. Zero judgement here on my part – if I was not in love with what I do and had to choose between stacking boxes in Amazon’s warehouse or watching Amazon Prime while collecting a paycheck from a kind uncle, I’d be watching Sopranos for the third time. 

To entice people to put down the TV remote and get off the couch, employers are raising wages. For instance, Amazon has already increased minimum pay from $15 to $17 per hour. Bank of America announced that they’ll be raising the minimum wage in their branches from $20 to $25 over the next few years. The Biden administration may not need to waste political capital passing a Federal minimum wage increase; the distorted labor market did it for them. 

These higher wages don’t just impact new employees, they help existing employees get a pay boost, too. Labor is by far the biggest expense item in the economy. This expense matters exponentially more from the perspective of the total economy than lumber prices do. We are going to start seeing higher labor costs gradually make their way into higher prices for the goods and services around us, from the cost of tomatoes in the grocery store to the cost of haircuts.

Only investors and economists look at higher wages as a bad thing. These increases will boost the (nominal) earnings of workers; however, higher prices of everything around us will negate (at least) some of the purchasing power. 

Wages, unlike timber prices, rarely decline. It is hard to tell someone “I now value you less.” Employers usually just tell you they need less of your valuable time (they cut your hours) or they don’t need you at all (they lay you off and replace you with a machine or cheap overseas labor). It seems that we are likely going to see a one-time reset to higher wages across lower-paying jobs. However, once the government stops paying people not to work, the labor market should normalize; and inflation caused by labor disbalance should come back to normal, though increased higher wages will stick around.

There is another trend that may prove to be inflationary in the long-term: de-globalization.  Even before the pandemic the US set plans to bring manufacturing of semiconductors, an industry deemed strategic to its national interests, to its shores. Taiwan Semiconductor and Samsung are going to be spending tens of billions of dollars on factories in Arizona.  

The pandemic exposed the weaknesses inherent in just-in-time manufacturing but also in over reliance on the kindness of other countries to manufacture basic necessities such as masks or chemicals that are used to make pharmaceuticals.  Companies will likely carry more inventory going forward, at least for a while.  But more importantly more manufacturing will likely come back to the US. This will bring jobs and a lot of automation, but also higher wages and thus higher costs.  

If globalization was deflationary, de-globalization is inflationary  

We are not drawing straight-line conclusions, just yet. A lot of manufacturing may just move away from China to other low-cost countries that we consider friendlier to the US; India and Mexico come to mind.  

And then we have the elephant in the economy – interest rates, the price of money. It’s the most important variable in determining asset prices in the short term and especially in the long term. The government intervention in the economy came at a significant cost, which we have not felt yet: a much bigger government debt pile. This pile will be there long after we have forgotten how to spell social distancing
 
The US government’s debt increased by $5 trillion to $28 trillion in 2020 – more than a 20% increase in one year! At the same time the laws of economics went into hibernation: The more we borrow the less we pay for our debt, because ultra-low interest rates dropped our interest payments from $570 billion in 2019 to $520 billion in 2020. 

That is what we’ve learned over the last decade and especially in 2020: The more we borrow the lower interest we pay. I should ask for my money back for all the economics classes I took in undergraduate and graduate school.

This broken link between higher borrowing and near-zero interest rates is very dangerous. It tells our government that how much you borrow doesn’t matter; you can spend (after you borrow) as much as your Republican or Democratic heart desires. 

However, by looking superficially at the numbers I cited above we may learn the wrong lesson. If we dig a bit deeper, we learn a very different lesson: Foreigners don’t want our (not so) fine debt. It seems that foreign investors have wised up: They were not the incremental buyer of our new debt – most of the debt the US issued in 2020 was bought by Uncle Fed. Try explaining to your kids that our government issued debt and then bought it itself. Good luck.

Let me make this point clear: Neither the Federal Reserve, nor I, nor a well-spoken guest on your business TV knows where interest rates are going to be (the total global bond market is bigger even than the mighty Fed, and it may not be able to control over interest rates in the long run). But the impact of what higher interest rates will do the economy increases with every trillion we borrow. There is no end in sight for this borrowing and spending spree (by the time you read this, the administration will have announced another trillion in spending). 

Let me provide you some context about our financial situation 


The US gross domestic product (GDP) – the revenue of the economy – is about $22 trillion, and in 2019 our tax receipts were about $3.5 trillion. Historically, the-10 year Treasury has yielded about 2% more than inflation. Consumer prices (inflation) went up 4.2% in April. Today the 10-year Treasury pays 1.6%; thus the World Reserve Currency debt has a negative 2.6% real interest rate (1.6% – 4.2%). 

These negative real (after inflation) interest rates are unlikely to persist while we are issuing trillions of dollars of debt. But let’s assume that half of the increase is temporary and that 2% inflation is here to stay. Let’s imagine the unimaginable. Our interest rate goes up to the historical norm to cover the loss of purchasing power caused by inflation. Thus it goes to 4% (2 percentage points above 2% “normal” inflation). In this scenario our federal interest payments will be over $1.2 trillion (I am using vaguely right math here). A third of our tax revenue will have to go to pay for interest expense. Something has to give. It is not going to be education or defense, which are about $230 billion and $730 billion, respectively. You don’t want to be known as a politician who cut education; this doesn’t play well in the opponent’s TV ads. The world is less safe today than at any time since the end of the Cold War, so our defense spending is not going down (this is why we own a lot of defense stocks). 

The government that borrows in its own currency and owns a printing press will not default on its debt, at least not in the traditional sense. It defaults a little bit every year through inflation by printing more and more money. Unfortunately, the average maturity of our debt is about five years, so it would not take long for higher interest expense to show up in budget deficits. 

Money printing will bring higher inflation and thus even higher interest rates

If things were not confusing enough, higher interest rates are also deflationary 

We’ve observed significant inflation in asset prices over the last decade; however, until this pandemic we had seen nothing yet. Median home prices are up 17% in one year. The wild, speculative animal spirits reached a new high during the pandemic. Flush with cash (thanks to kind Uncle Sam), bored due to social distancing, and borrowing on the margin (margin debt is hitting a 20-year high), consumers rushed into the stock market, turning this respectable institution (okay, wishful thinking on my part) into a giant casino. 

It is becoming more difficult to find undervalued assets. I am a value investor, and believe me, I’ve looked (we are finding some, but the pickings are spare). The stock market is very expensive. Its expensiveness is setting 100-year records. Except, bonds are even more expensive than stocks – they have negative real (after inflation) yields.

But stocks, bonds, and homes were not enough – too slow, too little octane for restless investors and speculators. Enter cryptocurrencies (note: plural). Cryptocurrencies make Pets.com of the 1999 era look like a conservative investment (at least it had a cute sock commercial). There are hundreds if not thousands of crypto “currencies,” with dozens created every week. (I use the word currency loosely here. Just because someone gives bits and bytes a name, and you can buy these bits and bytes, doesn’t automatically make what you’re buying a currency.)

“The definition of a bubble is when people are making money all out of proportion to their intelligence or work ethic.”

By Mike Burry MD
[The Big Short]

I keep reading articles about millennials borrowing money from their relatives and pouring their life savings into cryptocurrencies with weird names, and then suddenly turning into millionaires after a celebrity CEO tweets about the thing he bought. Much ink is spilled to celebrate these gamblers, praising them for their ingenious insight, thus creating ever more FOMO (fear of missing out) and spreading the bad behavior.

Unfortunately, at some point they will be writing about destitute millennials who lost all of their and their friends’ life savings, but this is down the road. Part of me wants to call this a crypto craziness a bubble, but then I think, Why that’s disrespectful to the word bubble, because something has to be worth something to be overpriced. At least tulips were worth something and had a social utility. (I’ll come back to this topic later in the letter).

But ….

When interest rates are zero or negative, stocks of sci-fi-novel companies that are going to colonize and build five-star hotels on Mars are priced as if El Al (the Israeli airline) has regular flights to the Red Planet every day of the week except on Friday (it doesn’t fly on Shabbos). Rising interest rates are good defusers of mass delusions and rich imaginations. 

In the real economy, higher interest rates will reduce the affordability of financed assets. They will increase the cost of capital for businesses, which will be making fewer capital investments. No more 2% car loans or 3% business loans. Most importantly, higher rates will impact the housing market. 

Up to this point, declining interest rates increased the affordability of housing, though in a perverse way: The same house with white picket fences (and a dog) is selling for 17% more in 2021 than a year before, but due to lower interest rates the mortgage payments have remained the same. Consumers are paying more for the same asset, but interest rates have made it affordable.

At higher interest rates housing prices will not be making new highs but revisiting past lows. Declining housing prices reduce consumers’ willingness to improve their depreciating dwellings (fewer trips to Home Depot). Many homeowners will be upside down in their homes, mortgage defaults will go up… well, we’ve seen this movie before in the not-so-distant past. Higher interest rates will expose a lot of weaknesses that have been built up in the economy. We’ll be finding fault lines in unexpected places – low interest has covered up a lot of financial sins.

And then there is the US dollar, the world’s reserve currency. Power corrupts, but the unchallenged and unconstrained the power of being the world’s reserve currency corrupts absolutely. It seems that our multitrillion-dollar budget deficits will not suddenly stop in 2021. With every trillion dollars we borrow, we chip away at our reserve currency status (I’ve written about this topic in great detail, and things have only gotten worse since). And as I mentioned above, we’ve already seen signs that foreigners are not willing to support our debt addiction. 

A question comes to mind.
Am I yelling fire where there is not even any smoke? 

Higher interest rates is anything but a consensus view today. Anyone who called for higher rates during the last 20 years is either in hiding or has lost his voice, or both. However, before you dismiss the possibility of higher rates as an unlikely plot for a sci-fi novel, think about this. 

In the fifty years preceding 2008, housing prices never declined nationwide. This became an unquestioned assumption by the Federal Reserve and all financial players. Trillions of dollars of mortgage securities were priced as if “Housing shall never decline nationwide” was the Eleventh Commandment, delivered at Temple Sinai to Goldman Sachs. Or, if you were not a religious type, it was a mathematical axiom or an immutable law of physics. The Great Financial Crisis showed us that confusing the lack of recent observations of a phenomenon for an axiom may have grave consequences. 

Today everyone (consumers, corporations, and especially governments) behaves as if interest rates can only decline, but what if… I know it’s unimaginable, but what if ballooning government debt leads to higher interest rates? And higher interest rates lead to even more runaway money printing and inflation? 

This will bring a weaker dollar 

A weaker US dollar will only increase inflation, as import prices for goods will go up in dollar terms. This will create an additional tailwind for commodity prices. 

If your head isn’t spinning from reading this, I promise mine is from having written it. 

To sum up: A lot of the inflation caused by supply chain disruption that we see today is temporary. But some of it, particularly in industrial commodities, will linger longer, for at least a few years. Wages will be inflationary in the short-term and will reset prices higher, but once the government stops paying people not to work, wage growth should slow down. Finally, in the long term a true inflationary risk comes from growing government borrowing and budget deficits, which will bring higher interest rates and a weaker dollar with them, which will only make inflation worse and will also deflate away a lot of assets.

THE END

Your thoughts are appreciated.

THANK YOU

***
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MEDICAL ETHICS: Managing Risk is a Component of Real Health Caring

Demanding High Moral Standards of Self … and Economic HEALTHCARE Organizations

Dr. David Edward Marcinko MBA CMP®

SPONSOR: http://www.CertifiedMedicalPlanner.org

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It has been argued that physicians have abdicated the “moral high ground” in health care by their interest in seeking protection for their high incomes, their highly publicized self-referral arrangements, and their historical opposition toward reform efforts that jeopardized their clinical autonomy. 

Experts Speak

In his book Medicine at the Crossroads, colleague and Emory University professor Melvin Konnor, MD noted that “throughout its history, organized medicine has represented, first and foremost, the pecuniary interests of doctors.” He lays significant blame for the present problems in health care at the doorstep of both insurers and doctors, stating that “the system’s ills are pervasive and all its participants are responsible.” 

In order to reclaim their once esteemed moral position, physicians must actively reaffirm their commitment to the highest standards of the medical profession and call on other participants in the health care delivery system also to elevate their values and standards to the highest level.

Evolution

In the evolutionary shifts in models for care, physicians have been asked to embrace business values of efficiency and cost effectiveness, sometimes at the expense of their professional judgment and personal values.  While some of these changes have been inevitable as our society sought to rein in out-of-control costs, it is not unreasonable for physicians to call on payers, regulators and other parties to the health care delivery system to raise their ethical bar. 

Harvard University physician-ethicist Linda Emmanuel noted that “health professionals are now accountable to business values (such as efficiency and cost effectiveness), so business persons should be accountable to professional values including kindness and compassion.” 

Within the framework of ethical principles, John La Puma, M.D., wrote in Managed Care Ethics, that “business’s ethical obligations are integrity and honesty.  Medicine’s are those plus altruism, beneficence, non-maleficence, respect, and fairness.”

Incumbent in these activities is the expectation that the forces that control our health care delivery system, the payers, the regulators, and the providers will reach out to the larger community, working to eliminate the inequities that have left so many Americans with limited access to even basic health care. 

Charles Dougherty clarified this obligation in Back to Reform, when he noted that “behind the daunting social reality stands a simple moral value that motivates the entire enterprise”. 

ASSESSMENT

Health care is indeed grounded in caring. And, managing risk is a component of caring. It arises from a sympathetic response to the suffering of others.

YOUR THOUGHTS ARE APPRECIATED

ORDER TEXTBOOK: https://www.routledge.com/Risk-Management-Liability-Insurance-and-Asset-Protection-Strategies-for/Marcinko-Hetico/p/book/9781498725989

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

INVITE DR. MARCINKO: https://medicalexecutivepost.com/dr-david-marcinkos-bookings/

THANK YOU

***

FORM ADV is a Must Read for Selecting a Financial “Advisor”

Form ADV – The Essential Document

Dr. David Edward Marcinko MBA - WEGO Health Awards Nominee

By Dr. David Edward Marcinko MBA CMP©

SPONSOR: http://www.CertifiedMedicalPlanner.org

CMP logo

Under law, financial advisors and planners must provide you with a form ADV Part II or a brochure that covers the same information.  Even if a brochure is provided, ask for the ADV.  While it is acceptable, even desirable, for the brochure to be easier to read than the ADV, the ADV is what is filed with the appropriate state or SEC.  If the brochure reads more like a slick sales brochure or the information in the brochure glosses over the items on the ADV to a high degree, one should consider eliminating the advisor from consideration.

FIDUCIARY: https://medicalexecutivepost.com/2020/06/15/the-new-fiduciary-rule/

Registering with a state or SEC gives an advisor a fiduciary duty to the client.  This is a high standard under the law. 

There are several types of advisors who are exempt from registering and filing an ADV. 

First, there are registered representatives (brokers).  Brokers have a fiduciary responsibility to their firms regardless of whether they are statutory employees or independent contractors. Not the client.

Second are attorneys and accountants whose advice is “incidental” to their legal or accounting practices. But, why would one hire someone whose advice is “incidental” to his primary profession?  A top-notch advisor is a full-time professional and should be registered.  One should insist that their advisor be registered.

CFP: https://medicalexecutivepost.com/2016/11/18/why-we-cannot-assume-cfp-equals-fiduciary/

The ADV will describe the advisor’s background and employment history, including any prior disciplinary issues.  It will describe the ownership of the firm and outline how the firm and advisor are compensated.  Any referral arrangements will be described.  If an advisor has an interest in any of the investments to be recommended, it must be listed as well as the fee schedule.  There is also a description of the types of investments recommended and the types of research information that is used.

ASSESSMENT: A review of the ADV should result in an alignment of what the advisor said during the interview and what is filed with the regulators.  If there is a clear discrepancy, choose another advisor.  If it is unclear, discuss the issue with the advisor.

Your thoughts and comments are appreciated.

Form ADV | Moneygrow.com | Registered Investment Advisor ...

SEC Headquarters
100 F Street, NE
Washington, DC 20549
(202) 942-8088

TEXTBOOK ORDER: ORDER Textbook: https://www.amazon.com/Comprehensive-Financial-Planning-Strategies-Advisors/dp/1482240289/ref=sr_1_1?ie=UTF8&qid=1418580820&sr=8-1&keywords=david+marcinko

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

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

INVITE DR. MARCINKO: https://medicalexecutivepost.com/dr-david-marcinkos-bookings/

THANK YOU

***

The CERTIFIED MEDICAL PLANNER® Online Designation Program is Now Automated

[By Staff Reporters]

The concept of a self-taught and student motivated, but automated outcomes driven classroom may seem like a nightmare scenario for those who are not comfortable with computers.

Now everyone can breathe a sigh of relief, because the Institute of Medical Business Advisors just launched an “automated” final examination review protocol that requires no programming skill whatsoever.

Enter the CMPs

cmp

In fact, everything is designed to be very simple and easy to use. Once a student’s examination “blue-book” is received, computerized “robotic reviewers” correct student assignments and quarterly test answers. This automated examination model lets the robots correct tests and exams, while the students concentrate on guided self-learning.

SplitShire-

http://www.CertifiedMedicalPlanner.org

Assessment

According to Eugene Schmuckler PhD MBA MEd, Dean of the CERTIFIED MEDICAL PLANNER® professional designation and certification program,

“This option allows the modern adult-learner save both time and money as s/he progresses toward the ultimate goal of board certification as a CMP® mark holder.”

The trend is growing and iMBA, Inc., is leading the way.

imba inc

THANK YOU

TEXTBOOK LINK: https://www.amazon.com/Comprehensive-Financial-Planning-Strategies-Advisors/dp/1482240289/ref=sr_1_1?ie=UTF8&qid=1418580820&sr=8-1&keywords=david+marcinko

***

REAL ESTATE Investing for Physicians?

OVER HEARD IN THE ADVISOR’S LOUNGE

Real Estate and Physicians

What I see in my accounting practice is that significant accumulation in younger physician portfolio growth is not happening as it once did. This is partially because confidence in the equity markets is still not what it was; but that doctors are also looking for better solutions to support their reduced incomes.

For example, I see older doctors with about 25 percent of their wealth in the market, and even in retirement years, do not rely much on that accumulation to live on. Of this 25 percent, about 80 percent is in their retirement plan, as tax breaks for funding are just too good to ignore.

What I do see is that about 50 percent of senior physician wealth is in rental real estate, both in a private residence that has a rental component, and mixed-use properties. It is this that provides a good portion of income in retirement.

So; could I add dialog about real estate as a long term solution for retirement?

Yes, as I believe a real estate concentration in the amount of 5 percent is optimal for a diversified portfolio, but in a very passive way through mutual or index funds that are invested in real estate holdings and not directly owning properties.

Today, as an option, we have the ability to take pension plan assets and transfer marketable securities for rental property to be held inside the plan collecting rents instead of dividends.

Real estate holdings never vary very much, tend to go up modestly, and have preferential tax treatment due to depreciation of the property against income.

YOUR THOUGHTS ARE APPRECIATED.

GLEASONS GIVE A KID A DREAM | gleasonsgiveakidadream

Perry D’Alessio, CPA
[D’Alessio Tocci & Pell LLP]

THANK YOU

***

In Defense of Employed Physicians

The History of Managed Care

Episode 91: Dr. Michel Accad - How Did Medicine Go Wrong?

By Michel Accad, MD

EDITOR’S NOTE: Dr. Accad practices internal medicine and cardiology in San Francisco.

***

I wish to make one clarification and one prediction regarding employed physicians.

The clarification is this:  There is a common misconception that if healthcare operated under free market conditions, it would primarily be a cottage industry of solo practices and of small physician-owned hospitals.  Such operations would not develop the capabilities of large healthcare entities that we commonly associate with central planning.

See the source image

ASSESSMENT: In reality, however, the opposite would be the case.

LINK: http://alertandoriented.com/in-defense-of-the-employed-physician/

[Related article: One hundred years of managed care]

Your thoughts are appreciated.

THANK YOU

***

Clue-Less Physicians and Taxes

OVER HEARD IN THE DOCTOR’S LOUNGE

Dr.s' Lounge دكتورز لونج - Identity Design by YaStudio

A PHYSICIAN POLL

[IRS Tax Day – May 17, 2021]

“I read a poll on SERMO (a doctor-only web forum) asking what percentage of income was paid in taxes. The lowest option was <20%.  I thought it ridiculous since I make about an average salary and paid about 8% in Federal tax, 3.5% in payroll tax, and 4% in state income taxes. So, I spoke up about it. 

After a few days of correspondence, it became evident that most doctors have no idea what they pay in taxes, or that they pay far too much in taxes.  For example, of 58 responses on the poll, I was the only one who paid less than 20% in taxes.  Keep in mind that more than half of doctors make less money than I do.

I found it hilarious that 4 doctors thought they paid more than 50% in taxes.  I can’t quite figure out how to pull that off; even if you are single, make a ton of money, take a standard deduction, are self-employed, and pay ridiculous state and local income taxes. Really … more than 50%!  You’re either mistaken or stupid … hopefully; just mistaken.

Or is the problem simply that doctor’s have no idea what their effective tax rate is”?

DJ. Morgane DO

[Internal Medicine]

Your thoughts are appreciated.

ORDER TEXTBOOK: https://www.amazon.com/Comprehensive-Financial-Planning-Strategies-Advisors/dp/1482240289/ref=sr_1_1?ie=UTF8&qid=1418580820&sr=8-1&keywords=david+marcinko

THANK YOU

***

Physician Recruitment and Executive Search Firms

Facts about Physician Recruiters and Executive Search Firms

May Launches the Busy Season

By Dr. David E. Marcinko MBA CMP®

CMP logo

Sponsored: http://www.CertifiedMedicalPlanner.org

1) If you are job hunting, you should send your resume to recruiters

Different recruiters know about different positions. They do not usually know about the same ones. This is particularly true with retained firms. By sending your resume out widely, you will be placed in many different confidential databases and be alerted of many different positions. If you send your resume to only a few, it may be that none you send to will be working with positions which are suited for you. Throw your net widely.

If you change jobs, it is also wise to send follow-up letters to the recruiters and alert them of your new career move. Many search firms follow people throughout their careers and enjoy being kept up-to-date. It is a good idea to have your resume formatted in plain text so you can copy and paste it into email messages when requested to do so. Then, follow up with a nicely formatted copy on paper by postal mail.

Some estimate that only 1% to 3% of all resumes sent will result in actual job interviews. So, if you only send 50 resumes, you may only have less than 2 interviews, if that many. Send your resume to as many recruiters as you can. It is worth the postage or email time. Generally, recruiters will not share your resume with any employer or give your name to anyone else without obtaining your specific permission to do so. The recruiter will call first, talk to you about a particular position and then ask your permission to share your resume with that employer.

2) Your resume will be kept strictly confidential by the executive search firm.

It is safe to submit your resume to a search firm and not worry that the search firm will let it leak out that you are job hunting. Recruiters will call you each and every time they wish to present you to an employer in order to gain your permission. Only after they have gained your permission will they submit your name or resume to the identified employer. The wonderful aspect of working with search firms is that you can manage your career and your job search in confidence and privacy.

3) Fees are always paid by the employer, not the job candidate.

Recruiters and search firms work for the employer or hiring entity. The employer pays them a fee for locating the right physician for the job opening. This is important to remember, in that when you interact with executive recruiters, you are essentially interacting with an agent or representative of the employer. Recruiters are more loyal to employers than they are to job candidates because they work for the employer. This should not present a problem, but, should cause you to develop your relationship with the recruiter with the same integrity and professionalism that you would with the employer.

Recruiters are paid fees in one of two ways – retainer fees or contingency fees. This is an important distinction and will affect your process with both the employer and the recruiter. Some employers prefer working with contingency firms and some with retained firms. Both are respected by employers and useful in your job search, but, the two types of firms will not be handling the same positions with the same employers simultaneously.

A “retained recruiter” has entered an exclusive contract with an employer to fill a particular position. The retained recruiter, then, is likely to advertise a position, sharing the specifics of the position, location and employer openly. The retained firm feels a great obligation to fulfill the contract by finding the best person for the job.

A “contingency recruiter” on the other hand, usually does not have an exclusive relationship with the employer, and is only paid a fee if the job search is successful. Often, if the employer uses contingency firms, there will be more than one contingency firm competing to fill a certain position. As a job hunter, if you are sent to an interview by a contingency firm, you may find that you are competing with a larger number of applicants for a position. Generally, retained firms only send in from 3 to 5 candidates for a position.

Recruiters will be paid fees equal to about 25% to 35% of the resulting salary of the successful candidate plus expenses. This does not come out of the job candidate’s salary. This is paid to the recruiter through a separate relationship between the employer and the search firm. This may seem like a large fee, but, keep in mind that recruiters incur a great many expenses when searching for successful job candidates. They spend enormous amounts of money on computer systems, long distance calls, mail-outs, travel and interviews. Recruiters work very hard for these fees. Employers recognize the value of using recruiters and are more than willing to pay recruiters the fees. All you have to do is contact the recruiter to get the process moving. 

4) Not all medical recruiters work only with physicians.

Some search firms work exclusively with physicians or in healthcare, while others may work in several fields at once. Some of the larger generalist firms will have one or more search consultants that specialize in healthcare. It is important for you, as a job hunter, to assess the recruiters’ knowledge of your field. If you use industry or medical specialty buzz words in describing your skills, experience or career aspirations, you may or may not be talking a language the recruiter understands fully. It is wise to explore fully with the recruiter his understanding of your field and area of specialization.

5) Recruiters and search consultants move around.

Recruiters, like many professionals, move to new firms during their careers. Often you will find that recruiters will work at several firms during their careers. Since it is much more effective to address your letters to a person rather than “to whom it may concern”, it is smart for job hunters to have accurate and up-to-date information about who is who and where, since this can change frequently. Search firms also move their offices, sometimes to another suite, street or state. If you have a list of recruiters that is over one year old, you will certainly waste some postage in mailing your resumes and cover letters. Many of your mail-outs will be returned to you stamped “non-deliverable”, unless you obtain an up-to-date list. A resource, like the Directory of Healthcare Recruiters is updated very frequently, usually monthly [www.pohly.com/dir3.html].

6) Most search firms work with positions all over the country.

If you are from a particular state, and want to remain in that state, don’t make the mistake of only sending your resume to recruiters in your state. Often the recruiters in your state are working on positions in other states, and recruiters in other states are working on positions in your state. This is usually the case. Very few recruiters work only in their local area, most work all around the US and some internationally. Regardless of your geographic preference, you should still send your resume to all the healthcare recruiters. If you really only want to remain in your area, you can specify that preference in your cover letter.

7) Recruiters primarily work with hard to fill positions or executive positions.

Some recruiters specialize in clinical positions for physicians, managed care executive positions, healthcare financial positions or health administration positions. Others may specialize in finding doctors, nurses or physical therapists. Generally, an employer does not engage a recruiter’s assistance in filling a position unless it is hard to fill. Sometimes employers will engage search firms to save them the valuable time of advertising or combing through dozens of resumes.

A Career in Medical Recruiting - The Campus Career Coach

ASSESSMENT

Contingency recruiters tend to work with more mid-level management and professional positions, but, this is not always the case. Retained firms generally work with the higher level clinical or administrative positions.

One thing you will be assured of is that if a recruiter is working on a position that means that the employer is willing to pay a fee. That usually means that the position is a valued position and one worth closer inspection on your part. Even in healthcare, with certain exceptions, our economy is an “employer’s market”. This means that employers receive a deluge of resumes for their open positions. Increasingly, employers are using recruitment firms to handle their openings and schedule the interviews because employers simply do not have the manpower or time to handle the many resumes they receive.

Therefore, if a job hunter is submitted by a recruiter, that job hunter has a great advantage over all other applicants.

Your thoughts are appreciated.

Product Details

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

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THANK YOU

***

A Treatise on Disabled Physicians

The disabled doctors not believed by their colleagues

[By Miranda Schreiber]

FACT: People often feel nervous when they visit a doctor with some fearing their symptoms may not be believed.

QUERY: But what if you are the doctor, and your colleagues dismiss your disabilities and mental health difficulties?

Three Ways to Improve Care for Patients With Disabilities ...

LINK: https://www.bbc.com/news/disability-56244376?utm_source=pocket-newtab

EDITOR’S NOTE: I had a classmate in both high school and medical school with Charctot-MarieTooth disease so I am aware of this phenomenon: https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Charcot-Marie-Tooth-Disease-Fact-Sheet

Dr. David Edward Marcinko MBA

[Editor-in-Chief]

ASSESSMENT: Your thoughts are appreciated

THANK YOU

***

What Exactly is a D.O.?

DOCTOR OF OSTEOPATHIC MEDICINE

See the source image

By Dr. David Edward Marcinko MBA CMP®

[Editor-in-Chief]

OK; I admit it. I have a formal educational background in allopathic, podiatric and osteopathic medicine. I also have both earned and conferred medical degrees from the States as well as Europe. I even dropped out of dental and law school back in the day … Such the protean dilettante!

Now, today there are about 950,000 allopathic physicians, 20,000 podiatrists, 150,000 dentists and 50,000 osteopaths. And, from this cohort of medical professionals, the Doctor of Osteopathic Medicine [DO] seems to be the least well understood practitioner.

And so, I thought this essay from Very Well Health might be helpful to all our Medical Executive-Post readers and subscribers [Differences Between a DO Physician and an MD – Comparing Osteopathic and Allopathic Medical Training].

LINK: https://www.verywellhealth.com/do-doctors-vs-md-doctors-whats-the-difference-3157310

ASSESSMENT: Your thoughts are appreciated.

INVITE DR. MARCINKO: https://medicalexecutivepost.com/dr-david-marcinkos-bookings/

THANK YOU

***

What is Your Teaching Philosophy?

 Here is My Teaching Philosophy

[By Dr. David Edward Marcinko MBA]

Although any learner-centered teaching philosophy, or Boyer Model of scholarship, is constantly in flux, the mission of a public or private educator is: [1] to promote positive learning; [2] to motivate students, staff and graduates; [3] to provide a strong foundation for lifelong learning; and in modernity [4] to enhance career and life-work opportunities; to [5] improve bottom-line financial metrics, and [6] to collaborate on a national and global basis.

However, because we are specifically operating in the rapidly changing healthcare, business management, investing, finance, economics and education milieu, even deeper experiential insight is needed.

Developing NEW Teaching AND Education Skills FOR Business and Healthcare 2.0

Medicine and healthcare business today is different than a generation ago, and all educators and healthcare professionals need new skills to be successful.

Traditionally, the physician – like the classroom professor – was viewed as the “captain of the ship”. Today, their role may be more akin to a ship’s navigator, utilizing clinical, teaching skills and knowledge to chart the patient’s, or student’s, course through a confusing morass of requirements, choices, rules and regulations to achieve the best attainable clinical or didactic outcomes.

This new teaching paradigm includes many classic business school principles, now modified to fit the PP-ACA, the era of health reform, and modern technical connectivity. Thus, a Professor, Chair or Dean must be a subtle guide on the side; not bombastic sage on the stage.

These, newer teaching philosophies must include:

  • Negotiation – working to optimize appropriate curricula, services and materials;
  • Team play – working in concert with others to coordinate education delivery within a clinically appropriate and cost-effective framework;
  • Working within the limits of competence – avoiding the pitfalls of the generalist teacher versus the subject matter expert that may restrict access to professors, texts and facilities by clearly acknowledging when a higher degree of didactic service is needed on behalf of the student;
  • Respecting different cultures and values – inherent in the support of the academic Principle of Autonomy is the acceptance of values that may differ from one’s own. As the US becomes more culturally heterogeneous, educators and medical providers are called upon to work within, and respect, the socio-cultural and/or spiritual framework of patients, students and their families; 
  • Seeking clarity on what constitutes marginal education – within a system of finite resources; providers and professors are called upon to openly communicate with students and patients regarding access to marginal education and/or treatments.
  • Supporting evidence-based practice – educators, like healthcare providers, should utilize outcomes data to reduce variation in treatments and curriculum to achieve higher academic efficiencies and improved care delivery;
  • Fostering transparency and openness in communications – teachers and healthcare professionals should be willing, and prepared, to discuss all aspects of care and academic andragogy; especially when disclosing problems or issues that arise;
  • Exercising decision-making flexibility – treatment algorithms, templates and teaching pathways are useful tools when used within their scope; but providers and professors must have the authority to adjust the plan if circumstances warrant;
  • Becoming skilled in the art of listening and interpretingIn her ground-breaking book, Narrative Ethics: Honoring the Stories of Illness, Rita Charon, MD PhD, a professor at Columbia University, writes of the extraordinary value of using the patient’s personal story in the treatment plan. She notes that, “medicine practiced with narrative competence will more ably recognize patients and diseases; convey knowledge and regard, join humbly with colleagues, and accompany patients and their families through ordeals of illness.” In many ways, attention to narrative returns medicine full circle to the compassionate and caring foundations of the patient-physician relationship. The educational analog to this book is, The Ethics of Teaching [A Casebook], co-edited by my teacher and colleague Deborah Ware Balogh PhD of the University of Indianapolis.

***

The Ohio State University
 Photo by Kevin Fitzsimons

***

Assessment

Finally, these thoughts represent only a handful of examples to illustrate the myriad of new skills that tomorrow’s healthcare professionals, and modern educators, must master in order to meet their timeless professional obligations of compassionate patient care and contemporary teaching effectiveness.

Dr. Marcinko Teaching Philosophy

CHAIR: Chair 3.0 Philosophy Dr. Marcinko

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements.

Book Marcinko: https://medicalexecutivepost.com/dr-david-marcinkos-bookings/

Subscribe: MEDICAL EXECUTIVE POST for curated news, essays, opinions and analysis from the public health, economics, finance, marketing, IT, business and policy management ecosystem.

DOCTORS:

“Insurance & Risk Management Strategies for Doctors” https://tinyurl.com/ydx9kd93

“Fiduciary Financial Planning for Physicians” https://tinyurl.com/y7f5pnox

“Business of Medical Practice 2.0” https://tinyurl.com/yb3x6wr8

HOSPITALS:

“Financial Management Strategies for Hospitals” https://tinyurl.com/yagu567d

“Operational Strategies for Clinics and Hospitals” https://tinyurl.com/y9avbrq5

***

Product DetailsProduct Details

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Keeping the CORONA VIRUS Out of Dental Offices?

Opinion-Editorial

[By Darrell K. Pruitt DDS]

The ONLY way to protect dentists, staff, patients and their families from the risk of fatal COVID-19 infections is to keep the virus out of dental offices. (See graph from the New York Times).

***

Prediction: If quick and reliable testing is not available soon, within weeks after dental offices re-open for routine dental care – creating aerosols with high speed hand pieces, air/water syringes and ultrasonic scalers – dental offices will justifiably become known as reliable sources of COVID-19 infections, before being closed down again by the state.

Assessment: Your thoughts are appreciated.

***

Product Details

 

Investing in Financial Counseling

Investing in Financial Counseling

By Rick Kahker MSFS CFP

As a long-time advocate of blending financial planning with counseling, I’ve had years of seeing the benefit for clients. I have come to see financial counseling as an investment: one that can pay greater dividends than investments in a home, retirement account, or college education.

How can this be the case?

Mostly because making good financial decisions is the foundation of financial and emotional well-being. Most financial and many emotional problems result from disordered and dysfunctional money beliefs and behaviors. Money disorders can impair people’s functioning and disrupt their well-being just as significantly as disorders like alcoholism or other addictions.

Some common disordered money behaviors include the following:

• Compulsive Spending is a consuming focus on buying. It can include buying things you can’t afford as well as “retail therapy” shopping where no money is actually spent. It can mean you underfund emergency reserves and don’t adequately set aside enough for retirement.

• Financial Enabling is an attempt to meet your emotional needs by “helping” others, which usually does more harm than good. A pattern of bailing kids out financially is a good example. Enabling can financially harm the parent by diverting resources from other needs and sabotage the child by rewarding dependency and entitlement thinking.

• Hoarding is compulsively buying and storing things that you don’t need or will never use.

• Financial Infidelity is keeping money secrets (such as spending, saving, or investment mistakes) from your partner because you would be ashamed to have them find out.

• Inappropriate Financial Boundaries is sharing of worries or financial details in ways that violate the boundaries between children and adults.

• Workaholism is a consuming focus on work or earning to a point of damaging your relationships.

• Underspending is frugality taken to extremes, such as inadequate spending on health care, nutrition, shelter, or clothing even when you can afford them.

All these disordered financial behaviors have one thing in common: fundamentally, they aren’t about the money. They are often an unconscious response to emotional pain, in the same way addiction or anger might be. The disordered financial behavior may be a medicator that works to deaden deep emotional stress and painful emotions. While one person may find relief in alcohol or drugs and another may find it in work, someone else might use shopping, saving, or financial enabling as a way to feel better and function in the world.

Just like addictions, however, disordered financial behaviors only relieve pain for a short time. Eventually, the pain returns, sometimes even stronger. The result is an escalating cycle of destructive behavior that has many negative consequences, including financial.

To see the link between emotional health and financial health, just read a celebrity magazine or observe people you know. I’ve seen high-earning professionals who have a negative net worth because they can’t control their spending. You probably know people who bounce from one financial mess to another, never seeming to learn from their money mistakes. Some very capable and intelligent people struggle financially and in their careers because of emotional issues.

For most people experiencing financial problems, financial counseling to resolve emotional issues is a low-priority expense that comes far down the list after basic needs like housing, food, and transportation. Yet for anyone who struggles to overcome destructive patterns of behavior—even those that aren’t directly about money—counseling can pay off in very real monetary ways.

***

mind-investing-behavioral-finance

***

Assessment

Emotionally healthy and confident people make better choices about relationships, careers, and other major aspects of their lives. They also make better choices about money. This is why financial counseling is more than an investment in your emotional health. It can also make a measurable difference in your financial wealth.

Your thoughts are appreciated.

BUSINESS, FINANCE, INVESTING AND INSURANCE TEXTS FOR DOCTORS:

1 – https://lnkd.in/ebWtzGg

2 – https://lnkd.in/ezkQMfR

3 – https://lnkd.in/ewJPTJs

THANK YOU

InVesting Temperament and Tolerance Shenanigans

Financial Advisors Evaluating Malarkey

cropped-dem

By Dr. David E. Marcinko MBA

Courtesy: www.CertifiedMedicalPlanner.org

Evaluating “Sham” Risk Aversion Determination Methodologies

BACK STORY: You visit a local financial advisor as a prospective client. S/he gives you a form to complete that purports to discern your investing risk tolerance?

FORM: It says: “Please indicate by ranking the items below from 1 to 4, with 1 being the most descriptive and 4 being the least descriptive”.

LINK: https://medicalexecutivepost.com/2009/12/28/risk-aversion-and-investment-alternatives/

EPIPHANY: After reviewing the form, you realize it is a superfluous one-size-fits-all risk reduction mechanism for the advisor. You identify the sheer malarkey of the exercise and leave in disgust. You ruminate to yourself – “there must be a better way,”

MORE: https://medicalexecutivepost.com/2017/10/24/on-investing-risk-tolerance/

And so, colleague Rick Kahler MSFS CFP® suggests alternative methods.

MORE: https://medicalexecutivepost.com/2017/10/18/on-retirement-planning-risks/

Your thoughts are appreciated.

***

***

BUSINESS, FINANCE AND ECONOMICS TEXTBOOKS FOR DOCTORS:

1 – https://lnkd.in/ebWtzGg

2 – https://lnkd.in/ezkQMfR

3 – https://lnkd.in/ewJPTJs

THANK YOU

Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™8Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

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Kentucky Derby Day 2020 on September 5th!

Join Our Mailing List

Readers, Visitors, Clients and Friends 

Sean G. Todd[By Sean G. Todd; Esq. M. Tax, CFP©, CPA]

Greetings … This ME-P will have nothing to do with finances / money / taxes / healthcare / the economy … or all the other things you are hearing about 24/7 – don’t stop reading though.  It’s merely about the most exciting 2 minutes in sports; always held on the 1st Saturday in May … a tradition lasting 145 years … can you think of what it is?

Kentucky Derby

You’re right! — 146th running of the Kentucky Derby. The “Run for the Roses” is set for [today] Sept 5th, 2020.  Here are several reasons why the Kentucky Derby is such a tradition.

Twin Spires

Throughout the world, the Twin Spires are a recognized landmark that has become symbolic to Churchill Downs.  Constructed in 1895, the Spires were the creation of a twenty-four-year-old draftsman, Joseph Dominic Baldez. Surpassing a century after being built, the Twin Spires continue to greet the winner of the Kentucky Derby and stand as a familiar beacon to horse racing enthusiasts everywhere.

The Trophy

Since the 50th running of the Kentucky Derby in 1924, Churchill Downs has annually presented a gold trophy to the winning owner of the famed “Run for the Roses.” History is unclear if a trophy was presented in 1875 to the winner of the first Kentucky Derby, and trophy presentations were sporadically made in following years. Finally, in 1924, legendary Churchill Downs President Matt Winn commissioned that a standard design be developed for the “Golden Anniversary” of the Derby.

To commemorate Derby 125 a change was made and the horseshoe was turned 180 degrees so that its ends pointed up. The trophy now annually incorporates the horseshoe with the ends pointing up. Racing superstition decrees that if the horseshoe is turned down all the luck will run out.

Since 1975, the trophy has been created by New England Serling located in North Attleboro, MA. The trophy, which is topped by an 18-karat gold horse and rider, includes horseshoe shaped handles, is 22 inches tall and weighs 56 ounces, excluding its jade base. The entire trophy is handcrafted with the exception of the horse and rider that are both cast from a mold.

To complete the trophy by April, craftsmen begin the process during the fall of the previous year and literally work hundreds of hours. The trophy is believed to be the only solid gold trophy that is annually awarded the winner of a major American sporting event.

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MORE: https://bleacherreport.com/articles/2834432-kentucky-derby-2019-lineup-full-race-guide-for-all-horses-and-jockeys

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Mint Julep

The Mint Julep has been the traditional beverage of Churchill Downs and the Kentucky Derby for nearly a century. Each year; almost 120,000 Early Times Mint Juleps are served over the two-day period of the Kentucky Oaks and Kentucky Derby.

Hit Parade

The second most entertaining parade next to the Kentucky Derby post parade is the parade of hats on display at Churchill Downs. From the fantastic to the sublime, there are no rules or limits.  Does a Derby hat improve one’s luck at picking winners? Some say; “yes, it certainly helps.”

Assessment

Be sure to take a moment out of your day and participate in the running of 145th Kentucky Derby. As always, make the most of each day!

MORE: https://www.nytimes.com/2018/05/01/sports/kentucky-derby-draw-odds.html

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

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The Emerging Role of University CHIEF STRATEGY OFFICER

Common in Industry – Still Not so Much in Academe’

By Dr. David Edward Marcinko MBA

Invite Dr. Marcinko

http://www.CertifiedMedicalPlanner.org

A Chief Strategy Officer [CSO], or chief strategist, is the senior  executive responsible for assisting the Chief Executive Officer [CEO] with developing, communicating, executing, and sustaining corporate strategic initiatives. Some companies give the title Chief Business Officer [CBO] to its’ senior executives who are holding the top strategy role.

My opinion in academia

A few decades ago, the role of university Chief Strategy Officer [CSO] did not exist or marginally existed as a mid-level project manager in the communications department. It may have consisted of a formal background in teaching and education exhibited by the BA and/or B.Ed degrees or HR certification.

A first generation didactic CSO 1.0; if you will.

Then, as academic competition and granularity increased along with new technology information exchange, the need for deeper subject matter expertise arose. Next – generation business, under/graduate LAs, HUMANITIES, modern culture, psychology / sociology and STEM expertise arose to create and explore new – real or perceived – strategic advantages for university public relations in the form of the M.Ed, MA or MBA degrees in marketing, advertising, sales or competitive analysis.

THINK: Michal Porter PhD, known for his theories on economics, business strategy, and social causes. He is the Bishop William Lawrence University Professor at Harvard Business School, and a social impact consultant. He is credited for creating Porter’s five forces analysis, which is instrumental in business strategy development today.

Also, consider traditional S.W.O.T analysis, as well. SWOT analysis (alternatively SWOT matrix) is an initialism for strengths, weaknesses, opportunities, and threats—and is a structured planning method that evaluates those four elements of a project or business venture. A SWOT analysis can be carried out for a product, place, industry, university or person.

So, let’s call this a second generation expert CSO 2.0

However, as the complex business of running any college or university is ever changing, the ideal profile of CSO is still morphing to face modern business and management challenges like: physical and cyber security; culture and organizational behavior; gender differences, racial disparities and workplace violence issues; enrollment and international expansion; corporatization and competition; online and e-learning initiatives; with accounting, financial and economic pressures, etc.

Consequently, BODs are now seeking and embracing a new kind of CSO with advanced PhD or DBA degrees; and college and university experience. In fact, the role of contemporary CSO is emerging and becoming closer to that of an experienced corporate Chief Executive Officer, than the mere educator, academician or manager of the past.

Definitions: https://www.amazon.com/Dictionary-Health-Economics-Finance-Marcinko/dp/0826102549/ref=sr_1_6?ie=UTF8&s=books&qid=1254413315&sr=1-6

Universities and colleges  today

Insightful academic search committees are now seeking a new type of modern CSO who can build university and college rankings, maintain relationships with stakeholders, and project a positive image as a “celebrity university”.

This means shepherding students and attracting qualified youth, and faculty, for matriculation as areas of particular importance. This new entrepreneurial CSO must focus on business management, economics and finance – operational, marketing, advertising and consultative sales strategies to attract a qualified, protean and diverse student / professional staff that sets it apart from the competition; as well as more meaningfully interacting within [research and development], and without the university [outreach].

Accordingly, this  modern CSO must be a combination and protean surrogate for the university  CEO / CFO / CMO / COO / CAO and leader – NOT just a teacher or manager – who will help run it like a matrix business unit that makes a profit to generate needed capital and ROI.

Multiple lines of business – tuition; certifications; worker-placement; grants and endowments; CEUs and non-degree program fees; as well as for-profit R&D, publications, patents, copyrights and trade-marks; and applied business incubators – must ALL be created and managed as a diversified portfolio. S/he must lead in the implementation, planning and operations of systemic community responsive programs, as well as policy interventions requiring advocacy, political action and public analysis.

I prefer the moniker – CSO 3.0

Assessment

This academic CSO 3.0 must be a change-agent, crisis manager, corporate strategist, Machiavellian devotee and/or seasoned C-suite executive with the required inter – disciplinary skills outlined for this important position.

Above all – the modern CSO 3.0 must be pro-active, flexible and market responsive. This is not the place for tenure tracking.

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MEDICAL PRACTICE AND HOSPITAL OPERATIONS, STRATEGIC DEVELOPMENT, ORGANIZATIONAL BEHAVIOR AND FINANCIAL MANAGEMENT COMPANION TEXTBOOK SET

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[Foreword Dr. Phillips MD JD MBA LLM] *** [Foreword Dr. Nash MD MBA FACP]  [Foreword Dr. Hashem MD PhD] *** [Foreword Dr. Silva MD MBA]

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements.

imageproxy5

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My Pragmatic Philosophy of Education

It is NOT the Boyer Model

[By Dr. David E. Marcinko MBA]

The Boyer Model of Education and Scholarship

OK – I may subscribe to the Boyer Model but with several specific personal variations which I will keep propriety and not disclose here. But, I will discuss my teaching pragmatism, below.

Definition

Boyer’s Model of scholarship and education is an academic model advocating expansion of the traditional definition of scholarship and research into four types of scholarship. It was introduced in 1990 by Ernest Boyer.

According to Boyer, traditional research, or the scholarship of discovery, had been the center of academic life and crucial to an institution’s advancement but it needed to be broadened and made more flexible to include not only the new social and environmental challenges beyond the campus but also the reality of contemporary life.

His vision was to change the research mission of universities by introducing the idea that scholarship needed to be redefined.

MORE: https://en.wikipedia.org/wiki/Boyer%27s_model_of_scholarship

ME: Dr. Marcinko Teaching Philosophy

ENTER MY PRAGMATISM

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DEAN: Dean 3.0 Philosophy

Assessment

So, what do you think?

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements.

Book Marcinko: https://medicalexecutivepost.com/dr-david-marcinkos-bookings/

Subscribe: MEDICAL EXECUTIVE POST for curated news, essays, opinions and analysis from the public health, economics, finance, marketing, IT, business and policy management ecosystem.

DOCTORS:

“Insurance & Risk Management Strategies for Doctors” https://tinyurl.com/ydx9kd93

“Fiduciary Financial Planning for Physicians” https://tinyurl.com/y7f5pnox

“Business of Medical Practice 2.0” https://tinyurl.com/yb3x6wr8

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Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™8Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

Popular Pre-Halloween Content for 2019

Join Our Mailing List

Aggregating Content – Disseminating Knowledge

By Dr. David Edward Marcinko MBA [Editor-in-Chief]

Nathaniel Potter MD

Halloween (also spelled Hallowe’en) is an annual holiday celebrated on October 31st.  It has roots in the Celtic festival of Samhain and the Christian holy day of All Saints.

Today, it is largely a secular celebration but some have expressed strong feelings about perceived religious overtones.

Here are two interesting and popular ME-P articles for this Halloween season.

Poe: https://healthcarefinancials.wordpress.com/2009/08/27/off-road-touring-with-dr-marcinko-part-vi/

Potter: https://medicalexecutivepost.com/2009/08/27/off-road-touring-with-dr-marcinko-part-vi/

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thumbnail_IMG_0487_edit2

“DANCE OF DEATH”

[Copyright 2018 iMBA Inc., All rights reserved. USA]

Conclusion

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Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

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Are You a Continuing Education Pioneer?

More on Lifelong Learning

[By Dr. David Marcinko MBA]

Today, it is increasingly imperative for colleges and universities to expand the universe of targeted adult-learners. This is for aspiring professionals, managers, executives and leaders, or those already in the workforce. The tuition gathering universe is thus expanded beyond graduation.

I developed and launched several such successful CE programs that were merged or sold to private investors, colleges and hedge funds

SAMPLE: www.PodiatryPrep.org

Also known as Executive Service Line [ESL] education, this business model refers to academic programs for adults that are generally non-credit and non-degree-granting, but may lead to professional certifications.

Estimates by Business Week magazine suggest that executive education in the United States is a $900 million annual business with approximately 80 percent provided by university schools.

SAMPLE: www.CertifiedMedicalPlanner.org

In addition to the educational benefits, monetary dividends are reaped as enrollment eases matriculation access. Similar programs at the Wharton School, Darden, Harvard, Duke, Yale and the Goizueta Business School at Emory University charge premium rates for the implied institutional moniker.

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ASSESSMENT: Your thoughts are appreciated. Are you a continuing education pioneer?

MORE BUSINESS AND INVESTING FOR DOCTORS:

“Insurance & Risk Management Strategies for Doctors” https://tinyurl.com/ydx9kd93

“Fiduciary Financial Planning for Physicians” https://tinyurl.com/y7f5pnox

“Business of Medical Practice 2.0” https://tinyurl.com/yb3x6wr8

THANK YOU

Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™8Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

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Why 75 Years of American Finance Should Matter to Physician Investors

A Graphic Presentation [1861-1935] with Commentary from the Publisher

By Dr. David Edward Marcinko FACFAS MBA CPHQ CMP™

http://www.CertifiedMedicalPlanner.org

As our private iMBA Inc clients, ME-P subscribers, textbook and dictionary purchasers, seminar attendees and most ME-P readers know, Ken Arrow is my favorite economist. Why?

About Kenneth J. Arrow, PhD

Well, in 1972, Nobel Laureate Kenneth J. Arrow, PhD shocked Academe’ by identifying health economics as a separate and distinct field. Yet, the seemingly disparate insurance, asset allocation, econometric, statistical and portfolio management principles that he studied have been transparent to most financial professionals and wealth management advisors for years; at least until now.

Nevertheless, to informed cognoscenti, they served as predecessors to the modern healthcare advisory era. In 2004, Arrow was selected as one of eight recipients of the National Medal of Science for his innovative views. And, we envisioned the ME-P at that time to present these increasingly integrated topics to our audience.

Healthcare Economics Today

Today – as 2019 nears – savvy medical professionals, management consultants and financial advisors are realizing that the healthcare industrial complex is in flux; and this dynamic may be reflected in the overall economy.

Like many laymen seeking employment, for example, physicians are frantically searching for new ways to improve office revenues and grow personal assets, because of the economic dislocation that is Managed Care, Medi Care and Obama Care [ACA], the depressed business cycle, etc.

Moreover, the largest transfer of wealth in US history is – or was – taking place as our lay elders and mature doctors sell their practices or inherit parents’ estates. Increasingly, the artificial academic boundary between the traditional domestic economy, financial planning and contemporaneous medical practice management is blurring.

I’m Not a Cassandra

Yet, I am no gloom and doom Cassandra like I have been accused, of late. I am not cut from the same cloth as a Jason Zweig, Jeremy Grantham or Nouriel Roubini PhD, for example.

However, I do subscribe to the philosophy of Hope for the Best – Plan for the Worst.

And so dear colleagues, I ask you, “Are the latest swings in the economic, healthcare and financial headlines making you wonder when it will ever stop?”

The short answer is: “It will never stop” because what’s been happening isn’t any “new normal”; it’s just the old normal playing out before a new audience.

What audience?

The next-generation of investors, FAs, management consultants and the medical professionals of Health 2.0.

How do I know all this?

History tells me so! Just read this work, and opine otherwise, or reach a different conclusion.

Evidence from the American Financial Scene, circa 1861-1935

The work was created by L. Merle Hostetler in 1936, while he was at Cleveland College of Western Reserve University (now known as Case Western Reserve University). I learned of him while in B-School, back in the day.

At some point after it was printed, he added the years 1936-1938. Mr. Hostetler became a Financial Economist at the Federal Reserve Bank of Cleveland in 1943. In 1953 he was made Director of Research. He resigned from the Bank in 1962 to work for Union Commerce Bank in Cleveland. He died in 1990.

The volume appears to be self published and consists of a chart, approximately 85′ long, fan-folded into 40 pages with additional years attached to the last page. It also includes a “topical index” to the chart and some questions of technical interest which can be answered by the chart.

Link: http://fraser.stlouisfed.org/75years

Assessment

And so, as with Sir John Templeton’s [whose son is an MD] four most dangerous words in investing (It’s different this time), Hostetler effectively illustrates that it wasn’t so different in his era, and maybe—just maybe—it isn’t so different today for all these conjoined fields.

Conclusion      

Your thoughts and comments on this ME-P are appreciated. While not exactly a “sacred cow,” there is a current theory that investors will experience higher volatility and lower global returns for the foreseeable future.

In fact, it has gained widespread acceptance, from the above noted Cassandra’s and others, as problems in Europe persist and threats of a double-dip recession loom. But, how true is this notion; really?

Is Hostetler correct, or not; and why?

Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

Our Other Print Books and Related Information Sources:

DOCTORS:

“Insurance & Risk Management Strategies for Doctors” https://tinyurl.com/ydx9kd93

“Fiduciary Financial Planning for Physicians” https://tinyurl.com/y7f5pnox

“Business of Medical Practice 2.0” https://tinyurl.com/yb3x6wr8

HOSPITALS:

“Financial Management Strategies for Hospitals” https://tinyurl.com/yagu567d

“Operational Strategies for Clinics and Hospitals” https://tinyurl.com/y9avbrq5

Subscribe Now: Did you like this Medical Executive-Post, or find it helpful, interesting and informative? Want to get the latest ME-Ps delivered to your email box each morning? Just subscribe using the link below. You can unsubscribe at any time. Security is assured.

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  Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™8Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

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The Next Big [Investment] Thing?

Or, NOT!

By Rick Kahler CFP®

How do you spot the investment opportunity that will become the next Apple, Facebook, or Microsoft? Certainly they are out there. Someone is going to discover them and be set for life, so why shouldn’t it be you?

Here’s why it shouldn’t

As with all Registered Investment Advisors, the amount of money I manage for clients is publicly disclosed information that anyone with an Internet connection can find.

Because of that, I am seen as the gatekeeper of a source of funding for every under funded business opportunity that is sure to become the next Apple. I get to see a lot of proposals. Many have promise at first glance. But the promise usually fades the more I dig into the proposal, ask questions, and do the math.

After hours and hours of investigation, every few years I see that one proposal that looks really good. One that calls to me to invest, that really has the promise of being a winner. When all the stars and the planets align, I know I now have a 90% chance of not making a dime on the venture.

That’s why I have learned to save my time and my money when I am approached with “the next big thing.” I just don’t have time to investigate every project and cull hundreds of opportunities down to the one that has a 10% chance of succeeding. I see it as looking for the proverbial needle in the haystack. Certainly, there’s a needle in there somewhere. But examining every piece of hay in order to find it has a significant monetary cost.

To succeed, I would need a lot of time, even more money, and exponentially more intuition and intellect. Not to mention a fair amount of luck. The probability that I will go bankrupt before I ever find the needle is staggering.

Most of the “next big things” are discovered by driven entrepreneurs who bank everything they have on an idea and find the financing to shoestring it together. It usually isn’t the armchair investor who cashes in.

My experience

Over my 40 years of real estate and investment experience, I have seen people lose millions investing in lumber mills, emu farms, highly leveraged real estate, futures contracts, day trading, restaurants, multi-level-marketing companies, rare earth minerals, Iraqi currency, and the newest ones—marijuana farms and crypto-currencies.

As a result, for my money and the money of my clients, I’ll play the odds for success by saying “no” to every opportunity that comes across my desk. I don’t take the time to investigate them. I don’t read the offering circulars. I don’t attend presentations. The answer is “no” to the great odds of losing my money and “yes” to the staggering odds of keeping money growing conservatively for me and for my clients.

What do I say “yes” to? I say yes to investing in mutual funds that own or loan money to 12,000 successful companies around the globe and thousands of real estate properties. I say yes to well-diversified portfolios. I say yes to proven investment strategies with 25-year track records. I say yes to having enough cash reserves to fund two to five years of retirement income.

Boring

I know, it’s not very sexy, is it? In fact, the way I invest my money and the money of those who have entrusted their investments to me is downright boring.

***

https://www.crcpress.com/Comprehensive-Financial-Planning-Strategies-for-Doctors-and-Advisors-Best/Marcinko-Hetico/p/book/9781482240283

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Assessment

So here is my hot tip when it comes to finding investment opportunities to secure your future: forget about the “next big thing.” Instead, stay with the “next boring thing.” The odds are overwhelming that this will make you a long-term winner.

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements.

Book Marcinko: https://medicalexecutivepost.com/dr-david-marcinkos-bookings/

Subscribe: MEDICAL EXECUTIVE POST for curated news, essays, opinions and analysis from the public health, economics, finance, marketing, IT, business and policy management ecosystem.

***

Don’t let Population Health Demographic Trends Guide “Investment” Decisions

A Different Perspective on Population Health

By Dr. David Edward Marcinko MBA CMP®
http://www.CertifiedMedicalPlanner.org

Definition

Population health has been defined as “the health outcomes of a group of individuals, including the distribution of such outcomes within the group”. It is an approach to health that aims to improve the health of an entire human population or cohort. http://www.HealthDictionarySeries.org

History

In fact, the nominal “father of population health” is colleague and Dean David B. Nash MD MBA of Jefferson Medical School in Philadelphia. And, although I attended Temple University down the street, David still wrote the Foreword to my textbook years later; Financial Management Strategies for Hospitals and Healthcare Organizations [Tools, Techniques, Checklists and Case Studies].

Factors

Now age, income, location, race, gender  and education are just a few characteristics that differentiate the world’s population. These are called ”disparities” and they have a major impact on people’s lives; especially their healthcare. And, I’ve written about them before.  Perform a ME-P “search” for more.

So, it’s only natural that we’re keeping an eye on two major demographic trends: aging baby boomers and maturing Millennials [1982-2002 approximately].

Why it’s important

The impact of large population shifts propagate throughout an economy benefitting certain sectors more than others and influencing a country’s growth prospects; tantalizing investing ideas?

Example:

For example, as baby boomers retire, we’ll likely see higher spending on health care, but less on education and raising children. Likewise, tech-savvy Millennials will likely prioritize consumption on experiences over cars and houses [leading economic indicator].

So, can we profit from these trends?

Assessment

Well maybe – maybe not! Overall economic prospects may not be completely affected by these trends. Spending habits on combined goods and services will shift, rather than rise or decline.

So, be careful. What matters most for your investment success is your demographics and investing according to your personal circumstances and goals [paradox-of-thrift].

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. https://medicalexecutivepost.com/dr-david-marcinkos-bookings/

Subscribe: MEDICAL EXECUTIVE POST for curated news, essays, opinions and analysis from the public health, economics, finance, marketing, IT, business and policy management ecosystem.

***

APPLE and the iPhone X

Now Apple must show what’s next after iPhone X

By  Vitaliy Katsenelson CFA

The iPhone X is likely to be a phenomenal success for Apple. But its success will not be driven by anything new that the new phone packs inside. Instead, its success will be based on the phone’s screen size. Essentially, iPhone X provides the same screen real-estate as an iPhone Plus, but with the sleeker form factor of the iPhone 7 or 8.

Apple has done a great job at changing the paradigm of our thinking about the iPhone. If you only care about making phone calls, then an iPhone 4 is good enough. Why pay for more? You probably don’t even need to upgrade your phone for years, as long as the battery keeps holding its charge. However, for most, the actual “phone” function is the least important of the iPhone.

Earnings

From an earnings perspective, iPhone X will be a tremendous boost. It will increase the average selling price per unit by a few hundred dollars, which should help not just sales, but profit margins as well. This is actually healthy for both Apple and the entire iPhone ecosystem (including DRAM and solid state drive makers — for example, we still have a large position in Micron Technology). People were also postponing buying new iPhones while waiting for the iPhone X; thus, the number of units sold will probably exceed most optimistic expectations.

What is next?

Then the question becomes, What is next? Higher-priced iPhones will also change the dynamics of the upgrade cycle. Apple is going to have a harder time convincing iFanatics to shell out $1,000-$1,200 every year (or even every two years). The upgrade cycle will likely be elongating to three or four years.

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Thus, any blow-out success of iPhone X in 2017 and early 2018 will be coming at the expense of future years. Even if you are a loyal Apple shareholder, you have to be prepared for this.

Assessment

Absent a new category of products, Apple is turning into a fully ripe stock. Yes, it will look statistically cheap based on 2018 earnings, but that will not be the case if you look at 2019 or 2020 earnings.

As all the excitement subsides, Apple stock will have to answer an extremely important question: What is next? After all, the value of any business is a lot more than the earnings generated next year, but far beyond that.

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, urls and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements.

Contact: MarcinkoAdvisors@msn.com

Subscribe: MEDICAL EXECUTIVE POST for curated news, essays, opinions and analysis from the public health, economics, finance, marketing, I.T, business and policy management ecosystem.

***

Did ADA Leaders Mislead Congress about EDR Security?

 Electronic Dental Records [EDR] Security?

By Darrell K. Pruitt DDS

“Terrifying Truth: Ransomware is Everywhere – At its basest level, ransomware is a form of kidnapping. Hackers effectively ‘kidnap’ a business’s data and information systems and threaten to destroy it unless the business pays a ransom for its safe return.”

Todd Lewis for Nibletz [October 24, 2017]
http://www.nibletz.com/security/ransomware

Lewis: “Healthcare and hospital networks are prime targets for these attacks. A patient whose medical service provider is unable to access critical patient information can be in a life-or-death situation unless the healthcare network is rapidly recovered and brought back on line. Cyberattackers take advantage of this urgency and realize that hospitals have greater incentives to pay a ransom to recover their systems and operations. Moreover, hospital networks operate on a 24-hour basis and are rarely taken down for maintenance and updating that might include patches for security holes. Ransomware attacks frequently take advantage of holes in networks that have not been patched with regular updates, and hospitals and medical centers are more likely than businesses in other industries to have failed to close those holes.”

ADA: “Dentists will have a more complete data set of the patient they are treating, enabling better care.”

Dr. Robert H. Ahlstrom, representing the American Dental Association and by default, all US dentists, in testimony before the National Committee on Vital and Health Statistics (NCVHS) on the benefits of EHRs in dentistry. His testimony is featured in an official document titled “Testimony of the American Dental Association, National Committee on Vital and Health Statistics Subcommittee on Standards and Security July 31, 2007.”

Click to access 070731p08.pdf

Insightful or clueless dentist?

Conclusion

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Just Say “NO” to Hospitals!

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Just Say No to Hospitals!

Hospitals are examples and metaphors for the iatrogenesis of our entire provision of health care.

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EHRs, ADA Leaders and Conflict of Interest

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A decade later ….?


By D. Kellus Pruitt DDS

In July 2007, Dr. Robert H. Ahlstrom, representing the American Dental Association and by default, all US dentists, testified before the National Committee on Vital and Health Statistics (NCVHS) on the benefits of EHRs in dentistry.

His testimony is featured in an official document titled:

“Testimony of the American Dental Association, National Committee on Vital and Health Statistics Subcommittee on Standards and Security July 31, 2007

http://www.ncvhs.hhs.gov/070731p08.pdf

Here are the ADA’s 11 selling points which Dr. Ahlstrom presented to HHS in support of electronic dental records:

  1. Dental office computer systems will be compatible with those of the hospitals and plans they conduct business with. Referral inquiries will be handled easily.
  2. Vendors will be able to supply low-cost software solutions to physicians/dentists who support standards-based electronic data interchange. Costs associated with mailing, faxing and telephoning will decrease.
  3. All administrative tasks can be accomplished electronically. Dentists will have more time to devote to direct care.
  4. Dentists will have a more complete data set of the patient they are treating, enabling better care.
  5. Patients seeking information on enrollment status or health care benefits will be given more accurate, complete and easier-to-understand information.
  6. Consumer documents will be more uniform and easier to read.
  7. Cost savings to providers and plans will translate in less costly health care for consumers. Premiums and charges will be lowered.
  8. Patients will save postage and telephone costs incurred in claims follow-up.
  9. Patients will have the ability to see what is contained in their medical and dental records and who has accessed them. Patient records will be adequately protected through organizational policies and technical security controls.
  10. Visits to dentists and other health care providers will be shorter without the burden of filling out forms.
  11. Consumer correspondence with insurers about problems with claims will be reduced.

Not one of Ahlstrom’s 11 promises has been fulfilled. None …. Total failure!

A decade later, it has become clear that the nation was misled by ambitious leaders of the American Dental Association who have since enjoyed power and/or profit from members’ misinformed adoption of digital records.

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 In my opinion, the grandest deception in the history of dentistry is clearly a result of a secretive not-for-profit corporation’s conflict of interest. This very important business lesson would have been lost to history if I hadn’t been documenting the true progress of EHRs in dentistry.

I (alone?) recognized very early that paperless was doomed simply because the needs of dentists and their patients was secondary to implementation of third-parties’ half-baked, selfish ideas. And I got spanked for that by the same ADA leadership behind Ahlstrom’s tainted testimony to Congress.

My ADA membership was suspended, and I still have not been told why. All the President of the Texas Dental Association would tell me is, “You know what you did.”

Assessment 

To this day, dental EHRs are both increasingly less secure than paper dental records as well as increasingly more expensive. What’s more, they offer no tangible benefits for the patients. ADA leadership failed my profession.

Transparency is accountability.

Conclusion

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Backward Market Business Research

Experimenting in Business

By Dan Ariely PhD

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 Part of the CAH Startup Lab Experimenting in Business Series

By Rachael Meleney and Aline Holzwarth

Missteps in business are costly—they drain time, energy, and money.

Of course, business leaders never start a project with the intention to fail—whether it’s implementing a new program, launching a new technology, or trying a new marketing campaign.

Yet, new…

Beginning at the End — Dan Ariely

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The Crypto-future through Bitcoin, Ethereum, Ripple XRP and IOTA

Peering into the Crypto-Future 

By Phil Baumann RN

In order to gain a clearer view of the impacts of the incoming future of technologies and their economic, behavioral, cultural, political and other impacts, categorization can perform useful veil-lifting.

I’ll let the reader do the deep-dive research into the technologies underlying each of these currencies, but here is a peeled-away breakdown of their respective categories:

Whether these specific “coins” succeed the slaughtering rapidity of techno-culture shocks remains to be seen.

Yes, they are traded assets that can make you rich or poor. That’s certainly interesting. What matters much more than their capital markets is that each has attempted to confront crucial problems that can liberate the ramifying “potential energies” of other technologies that can plug in to them.

Their premises spur economy-generating economies.

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Don’t feel bad if you missed the Bitcoin gold-rush. That’s in the past. Sometimes understanding the world confers its own wealth (insert Latin aphorism here). If you run the currency of knowledge through the circuitry of imagination you gain the power of foresight.

Assessment:

That’s my two cents: take them and spread the wealth.

Disclosure: I hold Bitcoin (BTC), Ethereum (ETH), Ripple XRP and IOTA (MIOTA). But this post is not about finance per se nor is it about promoting these currencies as investments. Rather this post is about envisioning the four kinds of markets that the respective technologies underlying each of these four cryptocoins can help grow and power. These aren’t simply currencies and stores of monetary value – they are technologies.

Conclusion

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HITECH: A politically-correct Scam?

Update on HITECH

By Kellus Pruitt DDS

“How bad science can lead to bad science journalism — and bad policy – This is what happens when news organizations don’t catch lousy studies.”

By Stephen Soumerai and Ross Koppel for The Washington Post, June 7, 2017/

Https://www.washingtonpost.com/posteverything/wp/2017/06/07/how-bad-science-can-lead-to-bad-science-journalism-and-bad-policy/?Utm_term=.631e0a2d022c#comments

Soumerai and Koppel:  “As researchers who focus on health care, we see news coverage of badly designed studies constantly. And we’re concerned that breathless reporting on bad science can result in costly, ineffective and even harmful national policies.”

You mean like HITECH?

Since the HITECH Act was passed in 2009, it has been well-documented that not only were the premises of the law fiction, but the law itself has always favored healthcare stakeholders like Cerner at the expense of patients and their doctors – the healthcare principals.

The grandest blunder in medical history gained traction in 1999 with an Institute of Medicine (IOM) report titled, “To Err is Human,” which promises that EHRs should have already saved 100,000 lives a year … Not even close. Not unlike the dangerous research bias described in Soumerai and Koppel’s article that was posted recently, several researchers have also pointed out that the studies cited in the IOM report did not show that people were dying from medical errors that health information technology could detect or correct.

The questionable IOM report was followed in 2005 by a tainted RAND Corporation report which promised savings of $77 billion annually… Wrong again!

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Shortly after the report was published, rumors quickly spread that the data for the study were cherry-picked by those with software to sell. By 2011, the passage of time revealed that RAND had clearly made a vendor-friendly mistake, forcing RAND to disown their study – but not before its optimistic conclusion was instrumental in the successful passage of the HITECH Act in 2009 (two years after Minnesota lawmakers had already passed the doomed EHR mandate based on the same tainted RAND results).

Political Fiat

Then presidential candidate Hillary Clinton was only one of many lawmakers to quote the RAND study. Almost everyone the nation was suckered in. Ultimately, it was revealed that the study’s vendor-friendly conclusion was largely financed by software giant Cerner, who continues to profit from years of misinformation.

(See: “In 2nd Look, Few Savings From Digital Records,” by Reed Abelson and Julie Creswell, New York Times, Jan. 10, 2013).

Http://www.nytimes.com/2013/01/11/business/electronic-records-systems-have-not-reduced-health-costs-report-says.html

In fact, it was announced last Monday that Cerner, which is responsible for the most dishonest research in the history of health information technology, has been awarded the Department of Veterans Affairs contract for the VA’s next-generation electronic health records system.

Assessment

Dishonesty wins.

Conclusion

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Why Cognizant Shines Brighter as a Stock Pick

Why Cognizant Shines Brighter as a Stock Pick

By Vitaliy Katsenelson, CFA

Originally written for Institutional Investor Magazine

Conclusion

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Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

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