METAVERSE: Expert Consensus in Medicine?

By Staff Reporters

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A multi-disciplinary panel of doctors and IT experts from Asia, the United States, and Europe analyzed published articles regarding expert consensus on the Medical Internet of Things, with reference to study results in the field of metaverse technology.

READ HERE: https://reader.elsevier.com/reader/sd/pii/S2588914122000016?token=4509ACBB9748F76769BCB6562B7413EAFAA5D83509412E53E17AC36F08A581B66B0F4E7B2D31A444F80A603E8FF22792&originRegion=us-east-1&originCreation=20221015174759

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MEDICINE: https://www.amazon.com/Business-Medical-Practice-Transformational-Doctors/dp/0826105750/ref=sr_1_9?s=books&ie=UTF8&qid=1287563112&sr=1-9

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CITE: https://www.amazon.com/Dictionary-Health-Information-Technology-Security/dp/0826149952/ref=sr_1_5?ie=UTF8&s=books&qid=1254413315&sr=1-5

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

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MEDICAL RISK MANAGEMENT, Liability Insurance and Asset Protection Strategies

FOR PHYSICIANS AND THEIR FINANCIAL ADVISORS

SPONSOR: http://www.CertifiedMedicalPlanner.org

CMP logo

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REVIEWS:

“Physicians who don’t understand modern risk management, insurance, business, and asset protection principles are sitting ducks waiting to be taken advantage of by unscrupulous insurance agents and financial advisors; and even their own prospective employers or partners. This comprehensive volume from Dr. David Marcinko and his co-authors will go a long way toward educating physicians on these critical subjects that were never taught in medical school or residency training.”
Dr. James M. Dahle, MD, FACEP, Editor of The White Coat Investor, Salt Lake City, Utah, USA


“With time at a premium, and so much vital information packed into one well organized resource, this comprehensive textbook should be on the desk of everyone serving in the healthcare ecosystem. The time you spend reading this frank and compelling book will be richly rewarded.”
—Dr. J. Wesley Boyd, MD, PhD, MA, Harvard Medical School, Boston, Massachusetts, USA

ASSESSMENT: Your thoughts are appreciated.

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

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

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

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

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PODCAST: Hospital Debt and Tax Exempt Bonds

By Eric Bricker MD

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

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

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PODCAST[s]: Medicare Re-Admission Penalties

UPDATE 83% Penalized!

By Eric Bricker MD

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HRRP PODCAST: https://www.youtube.com/watch?v=mwRrKM83CVQ

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Wither DROP-IN Group Medical Appointments?

THE RE-EMERGING RE-VOLUTION!

By Dr. David Edward Marcinko MBA CMP®

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SPONSOR: http://www.CertifiedMedicalPlanner.org

HISTORY

DIGMAs (Drop-In Group Medical Appointments) are medical office appointments with a patient’s physician that take place in a supportive group setting. The model, developed in 1996 by Kaiser Permanente psychologist Dr. Ed Noffsinger, is a combination of an extended medical appointment with the patient’s own physician and effective group learning and support.

The group consists of the physician, a behavioral health professional, and patients from the physician’s panel. DIGMAs are best suited for routine appointments. Unfortunately, the nascent concept was met with mockery and great derision after the PP-ACA era.

PRANKSTERS: https://medicalexecutivepost.com/2016/01/31/group-drop-in-doctor-visits-evolving/

Today, after the pandemic and with the rise of tel-health and tele-medicine, Shared Medical Appointments (SMAs), also known as Group Medical Visits [GMVs], are again a growing topic of discussion among providers and health economists, looking for ways to increase access to care and improve efficiency. The group visit format is also getting more attention in recent years as a strategy to add value for the patient. They typically involve up to a dozen patients or so and offer various efficiencies as well as benefits of shared discussion and experiences.

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Behavioral Changes

Moreover, physicians and medical providers know that simply telling patients what to do often does not improve their health. The basic premise of DIGMAs, SMAs and GMVs is to build more patient engagement and inspire lasting behavior change by offering patients the opportunity to share their personal experiences not only with their provider but also with other patients dealing with similar issues.

NEWER REALITY: https://www.hqontario.ca/Portals/0/Documents/qi/learningcommunity/Roadmap%20Resources/Advanced%20Access%20and%20Efficiency/Step%205/pc-nha-group-medical-appointments-manual-en.pdf#:~:text=DIGMAs%20%28Drop-In%20Group%20Medical%20Appointments%29%20are%20medical%20appointments,that%20take%20place%20in%20a%20supportive%20group%20setting.

BILLING: https://www.aafp.org/family-physician/practice-and-career/getting-paid/coding/group-visits.html

QUERY: Might this be an approach for tele-health visits as well as rural healthcare, etc.

ASSESSMENT: Your thoughts are comments are appreciated.

Product Details

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MONOGRAM: The “Knee Joint” Replacement IPO

Modernizing the $19.6B Knee Replacement Industry

By Staff Reporters

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One way to classify joints is by range of motion. Immovable joints include the sutures of the skull, the articulations between teeth and the mandible, and the joint located between the first pair of ribs and the sternum. Some joints have slight movement; an example is the distal joint between the tibia and fibula. Joints that allow a lot of motion (think of the shoulder, wrist, hip, and ankle) are located in the upper and lower limbs.

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KNEE: No bones about it

The $19.6b joint-replacement industry uses outdated methods, leading to 100,000 surgeries failing annually. Monogram aims to fix it with precision surgical robots + personalized implants.

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BANKS: Goldman Sachs Overhaul

By Staff Reporters

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Goldman Sachs is planning a major overhaul that would combine its investment banking and trading businesses into one unit and its asset and wealth management branches into another.

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Bank Types: https://medicalexecutivepost.com/2022/10/14/the-three-various-types-of-banks/

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

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METAVERSE: Potential in the Healthcare Industry

By Staff Reporters

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The metaverse could be a huge technological change for health care, just like telemedicine and mobile device integration were in the past.

This technology has huge potential because it uses both virtual reality (VR) and augmented reality (AR) technology to work in virtual spaces: All signs point to the metaverse being widely used as a disruptive change in healthcare, from better surgical precision to therapeutic uses to social-distance accommodations and more.

But along with these improvements come new problems that will change what we know about modern healthcare. The metaverse is a paradigm shift in healthcare that everyone involved needs to be aware of. This is because it changes how medical infrastructure is built, how startup costs are covered, and how data security and privacy are handled.

To help you understand how the metaverse development services will change healthcare as a whole, let’s take a look at the pros and cons of this technology that are already making a difference in healthcare.

READ HERE: https://factstea.com/potential-metaverse-healthcare-industry/


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DHITS: https://www.amazon.com/Dictionary-Health-Information-Technology-Security/dp/0826149952/ref=sr_1_5?ie=UTF8&s=books&qid=1254413315&sr=1-5

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PODCAST: How Accurate was that Medical Test?

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Understanding Test Characteristics
By Aaron E. Carroll MD
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Does a positive test mean that you have a disease? Does a negative test mean you’re healthy? Unfortunately, the answer to both these questions isn’t a definitive “yes”. How good a test is depends on many things.
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syringe

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Healthcare Triage: Frequent Lab Testing Isn’t Very Useful

A couple of weeks ago, Mark Cuban got into an interesting debate with much of the health wonk Twitter community (including me) over whether more lab testing is better. It began when he advocated that everyone get quarterly lab testing:

While I’m a fan of Cuban’s Shark Tank, and I respect his business acumen immensely, there are a couple of things wrong with this. It’s worth discussing them in detail. We’re going to do that here today, on Healthcare Triage.

MORE:

For those of you who want to read more, here you go:

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Healthcare Triage: Frequent Lab Testing Isn’t Very Useful

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Conclusion

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

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

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PODCAST: Start-Ups & Healthcare Venture Capital in the COVID-19 Recession

By Eric Bricker MD

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

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PODCAST: Machine Learning For Population Health

BY ERIC BRICKER MD

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ORDER: https://www.amazon.com/Dictionary-Health-Information-Technology-Security/dp/0826149952/ref=sr_1_5?ie=UTF8&s=books&qid=1254413315&sr=1-5

POPULATION HEALTH: https://medicalexecutivepost.com/2016/06/28/what-is-population-health/

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FOREWORD: https://medicalexecutivepost.com/wp-content/uploads/2007/10/foreword-mata.pdf

BUSINESS MEDICINE: https://www.amazon.com/Business-Medical-Practice-Transformational-Doctors/dp/0826105750/ref=sr_1_9?ie=UTF8&qid=1448163039&sr=8-9&keywords=david+marcinko

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PODCAST: How Extensive is Healthcare Prior Authorization?

A New Study

BY ERIC BRICKER MD

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MORE: https://www.amazon.com/Financial-Management-Strategies-Healthcare-Organizations/dp/1466558733/ref=sr_1_3?ie=UTF8&qid=1380743521&sr=8-3&keywords=david+marcinko

MORE: https://www.amazon.com/Hospitals-Healthcare-Organizations-Management-Operational/dp/1439879907/ref=sr_1_4?s=books&ie=UTF8&qid=1334193619&sr=1-4

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PODCAST: Google Starts a Health Insurance Stop-Loss Company

By Eric Bricker MD

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INSURANCE: https://www.amazon.com/Dictionary-Health-Insurance-Managed-Care/dp/0826149944/ref=sr_1_4?ie=UTF8&s=books&qid=1275315485&sr=1-4

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New Medical Practice Entrepreneurial Business Rules for Young Physicians [circa 2022]

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Go “Out-of-Box” – OR – Go Employee

By Dr. David Edward Marcinko MBA CMP™ www.CertifiedMedicalPlanner.org

There are more than 950,000 physicians in the United States. Yet, the brutal supply and demand, and demographic calculus of the matter is that there are just too many aging patients chasing too few doctors. Compensation and reimbursement is plummeting as Uncle Sam becomes the payer-of-choice for more than 52% of us. More so, going forward with the PP-ACA OR, perhaps not so much after the Trump election.

Furthermore, many large health care corporations, hospitals, and clinical and medical practices have not been market responsive to this change. Some physicians with top-down business models did not recognize the changing health care ecosystem or participatory medicine climate. Change is not inherent in the DNA of traditionalists. These entities and practitioners represented a rigid or “used-to-be” mentality, not a flexible or “want-to-be” mindset.

Yet today’s physicians and emerging Health 2.0 initiatives must possess a market nimbleness that cannot be recreated in a command-controlled or collectivist environment. Going forward, it is not difficult to imagine the following rules for the new virtual medical culture, and young physicians of the modern era.

A. Rule 1

Forget about large office suites, surgery centers, fancy equipment, larger hospitals, and the bricks and mortar that comprised traditional medical practices. One doctor with a great idea, good bedside manners, or competitive advantage can outfox a slew of insurance companies, Certified Public Accountants, or the Associate Management Accountant, while still serving patients and making money. It is now a unit-of-one economy where “ME Inc.,” is the standard. Physicians must maneuver for advantages that boost their standing and credibility among patients, peers, and payers.

Examples include patient satisfaction surveys, outcomes research analysis, evidence-based-medicine, direct reimbursement compensation, physician economic credentialing, and true patient-centric medicine. Physicians should realize the power of networking, vertical integration, and the establishment of virtual offices that come together to treat a patient and then disband when a successful outcome is achieved. Job security is earned with more successful outcomes; not a magnificent office suite or onsite presence.

B. Rule 2

Challenge conventional wisdom, think outside the traditional box, recapture your dreams and ambitions, disregard conventional gurus, and work harder than you have ever worked before. Remember the old saying, “if everyone is thinking alike, then nobody is thinking.” Do traditionalists or collective health care reform advocates react rationally or irrationally?

For example, some health care competition and career thought-leaders, such as Shirley Svorny, PhD, a professor of economics and chair of the Department of Economics at California State University, Northridge, wonder if a medical degree is a barrier—rather than enabler—of affordable health care. An expert on the regulation of health care professionals, including medical professional licensing, she has participated in health policy summits organized by Cato and the Texas Public Policy Foundation. She argues that licensure not only fails to protect consumers from incompetent physicians, but, by raising barriers to entry, makes health care more expensive and less accessible.

Institutional oversight and a sophisticated network of private accrediting and certification organizations, all motivated by the need to protect reputations and avoid legal liability, offer whatever consumer protections exist today.

C. Rule 3

Differentiate yourself among your health care peers. Do or learn something new and unknown by your competitors. Market your accomplishments and let the world know. Be a non-conformist. Conformity is an operational standard and a straitjacket on creativity. Doctors must create and innovate, not blindly follow entrenched medical societies into oblivion.

For example, the establishment of virtual medical schools and hospitals, where students, nurses, and doctors learn and practice their art on cyber entities that look and feel like real patients, can be generated electronically through the wonders of virtual reality units.

D. Rule 4

Realize that the present situation is not necessarily the future. Attempt to see the future and discern your place in it. Master the art of quick change with fast, but informed decision making. Do what you love, disregard what you do not, and let the fates have their way with you.

Assessment

I receive a couple of phone calls each month from young doctors on this topic. I ask them to decide if they are of the philosophical ilk to adhere to the above rules; or become another conformist and go along … to get along? In other words, get fly!

Or, become an employed, or government doctor.  Just remember … the entity that gives you a job, can also take it away.

Sample fly: http://crossoverhealth.com/

MORE: Marriage Business

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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TWO SKILLS: Physician Programmers Need to Know

By Joel Comm

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Machine Learning

The global machine learning market was valued at $15.44 billion in 2021, and it is expected to grow to $209 billion by 2029. Machine Learning is a technology that has grown in popularity over the past years, especially driven by the success of companies like Google in the field of AI.

This success is also in big part due to the technology becoming more accessible to the masses. Take OpenAI’s AI image generator, DALL-E, as an example: Since DALL-E Mini went public, it has been given uses ranging from making memes to artwork worth the attention of The New Yorker.

Gone are the days in which machine learning was only accessible to researchers in top-notch institutions. Today, machine learning can be mastered all around the globe in official institutions, online education platforms, and even via comics.

Web3 / Blockchain Development

Whether you are invested in crypto and NFTs or not, the Metaverse is being built, and it promises to turn centralized, corporate-controlled Web2 on its head. The world of computer users–that’s pretty much all of us–has, for years, grown increasingly frustrated by having to operate under the oversight of a few monoliths.

The promise of Web3 is community–not corporation–first.

Innovators in the space like Proof of Learn are developing easily accessible educational platforms where Web2 pros and the tech-interested can learn to code in Web3, in a learn and earn model. The company’s first project is a lore-rich online academy called Metacrafters.io, drawing in gamers and developers, and attracting some serious backing from leading VCs and crypto investors. Fellow industry leaders, such as Solana, Flow, Avalanche, and Polygon Foundations, recently gave $4.5 million in grant funding to support Metacrafters’ mission of upskilling Web2 developers. This grant helps fund their learn and earn protocol, so you get to take courses in a game world and get paid for it.

Metacrafters.io might be one with this learn and earn model teaching coding skills, but it is in line to inspire more of its kind. Look around at the landscape of Web3 education and get cracking, because the Metaverse will be here sooner than expected, and developers will be the major players in it.

HIT: https://www.amazon.com/Dictionary-Health-Information-Technology-Security/dp/0826149952/ref=sr_1_5?ie=UTF8&s=books&qid=1254413315&sr=1-5

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RELATED: https://www.amazon.com/Dictionary-Health-Information-Technology-Security/dp/0826149952/ref=sr_1_5?ie=UTF8&s=books&qid=1254413315&sr=1-5

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MONKEYPOX – All About it Right from the CDC!

Centers for Disease Control and Prevention

By Staff Reporters

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READ HERE: https://www.cdc.gov/poxvirus/monkeypox/index.html

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LONG Covid Virus Symptoms

By Staff Reporters

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One in eight people develop long COVID after being infected with the coronavirus, a new study has shown.

It is the first research to measure long-term symptoms in both infected and non-infected people and therefore creates a more accurate distinction between symptoms caused by long COVID and those from other reasons such as stress or insomnia.

READ: https://www.msn.com/en-us/health/medical/new-data-reveals-how-many-people-scientists-suspect-have-long-covid/ar-AA10m6eC?cvid=88db7713206b47daa0b90a697036cdf6

GLOSSARY: https://www.amazon.com/Dictionary-Health-Insurance-Managed-Care/dp/0826149944/ref=sr_1_4?ie=UTF8&s=books&qid=1275315485&sr=1-4

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Physician Mistreatment by Patients, Visitors and Doctors

By UPI News and Staff Reporters

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Nearly 1 in 4 hospital doctors are mistreated at work by patients, visitors and other doctors, and female doctors are nearly two times more likely than male doctors to face this abuse, a new study reveals.

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“All members of the healthcare team share the responsibility to mitigate mistreatment,” said senior study author Dr. Mickey Trockel, a clinical professor of psychiatry and behavioral sciences at the Stanford University School of Medicine and director of Evidence Based Innovation for the Stanford WellMD/WellPhD Center.

LINK: https://www.msn.com/en-us/health/medical/1-in-4-hospital-physicians-face-mistreatment-by-patients-visitors/ar-AAXa6Jp?li=BBnb7Kz

MD Burnout: https://medicalexecutivepost.com/2017/12/03/u-s-hospitals-feeling-the-pain-of-physician-burnout/

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PODCASTS: HEDIS Explained

Healthcare Effectiveness Data & Information Set

By Eric Bricker MD

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#2 PODCAST: https://www.ahealthcarez.com/how-hedis-quality-scores-work

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AMA ECONOMICS: https://medicalexecutivepost.com/2022/08/01/ama-to-teach-medical-students-about-health-economics/

Health Economics: https://medicalexecutivepost.com/2022/07/31/podcast-history-applied-to-health-economics/

DHEF: https://www.amazon.com/Dictionary-Health-Insurance-Managed-Care/dp/0826149944/ref=sr_1_4?ie=UTF8&s=books&qid=1275315485&sr=1-4

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Capital Market Expectations, Asset Allocation and Safe Portfolio Withdrawal Rates

By Staff Reporters

From: Munich Personal RePEc Archive [MPRA]

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Economist Wade Donald Pfau wrote an article called, “Capital Market Expectations, Asset Allocation, and Safe Withdrawal more than a decade ago. Today, is is still a vital read.

Abstract

Most retirement withdrawal rate studies are either based on historical data or use a particular assumption about portfolio returns unique to the study in question.

But, financial advisors and planners may have their own capital market expectations for future returns from stocks, bonds, and other assets they deem suitable for their clients’ portfolios. These uniquely personal expectations may or may not bear resemblance to those used for making retirement withdrawal rate guidelines. The objective here is to provide a general framework for thinking about how to estimate sustainable withdrawal rates and appropriate asset allocations for clients based on one’s capital market expectations, as well as other inputs about the client including the planning horizon, tolerance for exhausting wealth, and personal concerns about holding riskier assets.

The study also tests the sensitivity of various assumptions for the recommended withdrawal rates and asset allocations, and finds that these assumptions are very important. Another common feature of existing studies is to focus on an optimal asset allocation, which is expected either to minimize the probability of failure for a given withdrawal rate, or to maximize the withdrawal rate for a given probability of failure. Retirement withdrawal rate studies are known in this regard for lending support to stock allocations in excess of 50 percent.

Assessment

This study shows that usually there are a wide range of asset allocations which can be expected to perform nearly as well as the optimal allocation, and that lower stock allocations are indeed justifiable in many cases.

Link: MPRA_paper_32973

About MPRA: http://mpra.ub.uni-muenchen.de/information.html

NOTE: Wade Donald Pfau is an Associate Professor of Economics at the National Graduate Institute for Policy Studies (GRIPS) in Tokyo, Japan. His PhD in economics was from Princeton University.

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

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Biden Administration to Overhaul Vertical [Health Systems] Merger Guidelines

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By Health Capital Consultants, LLC

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Biden Administration to Overhaul Vertical Merger Guidelines

The U.S. healthcare industry has seen a rise in vertical integration transactions since the passage of the ACA, especially among physician groups integrating with health systems or insurers, as providers seek to fill gaps in their continuum of care. In response to these trends and resulting market imbalances, the Biden Administration is aggressively pursuing antitrust enforcement by updating and revising U.S. antitrust law guidance.

This Health Capital Topics article will discuss the vertical integration movement and the proposed changes to antitrust laws that may affect the future of healthcare. (Read more…) 

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

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The “Uberization” of Nursing

By MCOL.com

Dr. Seleem R. Choudhury

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“Uberization” is a catchphrase that has quickly become part of common parlance in discussions about the pandemic-induced economy. Uberization is the movement by organizations to “replace fixed wage contracts with ‘dynamic pricing’ for labor” (Davis, & Sinha, 2021).  It is transforming many elements of the economy and replacing employees employed by the organization with a type of self-employed or contract employee. In essence, it allows businesses to “recruit labour at a large scale in new ways” (Davis, & Sinha, 2021). 

The global business community has had a range of responses to the trend of uberization (Babali, 2019), as has the healthcare industry in particular.  Yet as health systems emerge from the pandemic, Bloomberg reports that “the ongoing elevated costs of [healthcare] workers are causing profit warnings” (KHN, 2022; Court, & Coleman-Lochner, 2022). Regardless of one’s resistance or acceptance of uberization, healthcare employment is in crisis. Change must occur to keep health systems from financial disaster.

It seems that the tide of uberization in the healthcare industry is already rising. An increasing number of employees are contracting with hospitals and health systems via a staffing agency. This trend is likely to evolve, with a portion of staff employed directly by the hospital, and the remaining employees self-contracting with hospitals or health systems with short-term or even daily contracts. In fact, hospitals are reporting that rather than temporary “travel nurses” coming from other states to work on a contract basis, nurses are taking short-term contract work at hospitals a short drive from their own homes rather than pursue permanent employment with these organizations.  We are witnessing the uberization of nursing, which will eventually extend to other healthcare occupations.

Why uberization?

The healthcare workforce shouldered the heavy burden of fighting the COVID-19 pandemic. Yet a collaborative study from Indiana University, the nonprofit Rand Corp., and the University of Michigan that analyzed the changes in the U.S. healthcare workforce during the COVID-19 pandemic found that “the average wages for U.S. healthcare workers rose less than wages in other industries during 2020 and the first six months of 2021” (Toler, 2022; Cantor, Whaley, Kosali, & Nguyen, 2022). According to a February 2022 report by the U.S. Bureau of Labor Statistics, only about 35 percent of healthcare and social assistance organizations “increased wages and salaries, paid wage premiums, or provided bonuses because of the COVID-19 pandemic” (U.S. Bureau of Labor Statistics, 2022).

Due to the media attention the “Great Resignation” has received, it is common knowledge that workers across industries have been leaving their jobs at higher rates than before the pandemic (Parker, & Horowitz, 2022).  Yet by October 2021, when the “quit rates” were at their highest recorded levels, healthcare and social assistance job resignations had increased to 35% higher than they had been before the pandemic, slightly higher than the increase of resignations among all workers in the same period (29%) (Wager, Amin, Cox, & Hughes-Cromwick, 2021).  

Over the last ten years, “the salary of registered nurses increased by 1.67 percent in the United States” (Michas, 2021). Whereas healthcare executives make on average eight times more than their hourly employees (Saini, Garber, & Brownlee, 2022). The pandemic has rebalanced the scales in favor of those underpaid for many years. The salary landscape has changed, and in response many hospital systems blindly grasp to the pre-pandemic state of agency staffing. This, combined with near flat salary increases, contribute to the uberization of healthcare.

For many healthcare professionals, the combination of work-related stress and incommensurate compensation was the final straw. However, in addition to fair salary, flexibility has become a top demand of employees—even in healthcare. “Gone are the days when job security or pay was everything. Workers now are giving more thought to how their jobs fit into their lives. Ambition for ambition’s sake is being reassessed” (Buckingham, & Richardson, 2022).

A recent survey articulated “higher pay and dissatisfaction with management were also key drivers of nurses changing work settings in 2020 or 2021,” with 28% of respondents saying they’ve changed work settings (Lagasse, 2022). The percentage of nurses considering changing employers increased by 6% from 2020 to 2021, with 17% saying they are contemplating making an employment change. The percentage of nurses who are “passive job seekers – not actively looking for a new job but open to new opportunities – also increased, from 38% in 2020 to 47% in the current survey” (Lagasse, 2022).

The moment: contractor or non-contractor

As the trend of uberization continues to spread beyond the transportation industry, the global business community should be watchful of challenges that the trendsetter Uber is facing to understand future implications of this movement in their own industry. For example, recent legal battles regarding the employment status of Uber drivers will likely impact the cost-benefit analysis of those considering traditional employment or independent contracting. While an independent contractor is free to offer services to anyone and doesn’t have the limits on their freedom that comes with being an employee of a single organization, the U.S. National Labor Relations Board decision that Uber drivers are independent contractors means that drivers have no federal right to unionize (HyreCar, 2021; Fishman, 2020). In Europe, however, Uber drivers are considered employees and not independent, which could mean that unionization could occur en masse.

The future

The future of healthcare employment could be via an app on smart phones. Imagine: daily staffing supplemented by workers employed and credentialed through the app. The healthcare worker could choose their rate and shifts, and the hospital could determine the desired experience, quality, and patient experience reviews for the open position. It could shift the future of employment healthcare significantly.

The rate of change in today’s workplace is accelerating whether it is through the uberization of healthcare workers or advancements in workers’ rights. A recent New York Times article entitled “The Revolt of the College-Educated Working Class” states: “The support for labor unions among college graduates has increased from 55 percent in the late 1990s to around 70 percent in the last few years, and is even higher among younger college graduates” (Scheiber, 2022).  

This may have a ripple effect on the healthcare workforce. Years of stagnating salaries and organizations’ undefined workforce vision has primed the industry for action with record job-quits within healthcare. This has proven especially true in rural markets where recruitment of permanent and agency staff has posed numerous challenges. Our current climate potentially opens the door for workers to leverage themselves via the advocacy of a union.   

Summary

The labor supply and demand are out of balance. The long-term effects on the health sector labor market from the pandemic are unknown, but changes in healthcare delivery (such as the growth of telehealth) may lead to lasting shifts in the healthcare industry. Fierce competition for healthcare workers means that employers must go beyond good pay and benefits to attract the best candidates. Healthcare recruitment is a zero-sum game. There isn’t a pool of healthcare workers lying idle, and so recruitment is often at the cost of a competitor. The employee knows that this demand exists, and this could further drive the uberization of healthcare workers. However, there is potential for this new movement to benefit both parties. As limited number of employees equates to skill scarcity which drives salaries, hospitals could utilize their skilled workforce based on need and demand. 

Resources

Babali, B. (2019). What is Uberization? The Business Year.

Buckingham, M., & Richardson, N. (2022). What’s Really Driving the ‘Great Resignation’. Barron’s.

Cantor, J., Whaley, C., Kosali, S., & Nguyen, T. (2022). US Health Care Workforce Changes During the First and Second Years of the COVID-19 Pandemic. JAMA Health Forum. 2022;3(2):e215217.

Court, E., & Coleman-Lochner, L. (2022). ‘Unsustainable’ Squeeze Grips U.S. Hospitals on Covid Labor Cost. Bloomberg.

Davis, G., & Sinha, A. (2021). Varieties of Uberization: How technology and institutions change the organization(s) of late capitalism. Sage Journals, 2(1).

Fishman, S. (2020). Uber Drivers are Contractors Not Employees According to the NLRB. NOLO.

HyreCar (2021). Are Uber Drivers Employees or Independent Contractors: Explained. HyreCar

KHN (2022). Hospitals Losing Money, Thanks To Covid-Driven Cost Increases. KHN Morning Briefing, April 28, 2022.

Lagasse, J. (2022). Almost 30% of nurses are considering leaving the profession. Healthcare Finance News.

Michas, F. (2021). Average annual salary of registered nurses in the United States from 2011 to 2020. Statista.

Parker, K., & Horowitz, J. (2022). Majority of workers who quit a job in 2021 cite low pay, no opportunities for advancement, feeling disrespected. Pew Research Center.

Saini, V., Garber, J., & Brownlee, S. (2022). Nonprofit Hospital CEO Compensation: How Much Is Enough? Health Affairs.

Scheiber, N. (2022). The Revolt of the College-Educated Working Class. The New York Times.

Toler, A. (2022). Health care wage growth has lagged behind other industries, despite pandemic burden. Indiana University.

U.S. Bureau of Labor Statistics (2022). 24 percent of establishments increased pay or paid bonuses because of COVID-19 pandemic. U.S. Bureau of Labor Statistics.

Wager, E., Amin, K., Cox, C., & Hughes-Cromwick, P. (2021). What impact has the coronavirus pandemic had on health employment? Peterson-KFF Health System Tracker.

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Enter “Population Health” Management

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Understanding the Costs and Risks

Dr. DEM

[By Dr. David Edward Marcinko MBA]

Gratefully, our book, Financial Management Strategies of Hospitals and Healthcare Organizations [Tools, Techniques, Case Studies and Checklists] has become an academic best seller.

It contains a chapter on Wellness and Population Health 2.0; included here for your review [By Jennifer Tomasik, Carey Huntington, and Fabian Poliak].                 .

Population Health

I am especially proud of this work.  This managerial book mimics the popular style of colleague Atul Gawande MD in his acclaimed work The Checklist Manifesto.

Why? All hospitals are still subject to the imperative: No Margin – No Mission.

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Pop Health

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Assessment

In an example of population health management and policy leadership, another colleague, David B. Nash MD MBA of the Wharton School, and Endowed Dean of Jefferson University Medical School [father of population health], even wrote the “Foreword”.

Click on this link to read it entirely.

Link: Foreword.Nash

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New Medical Informed Consent Dilemma

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Emerging Problems

By Dr. David Edward Marcinko; MBA, CMP™

[Publisher-in-Chief]dem21

According to the Dictionary of Health Insurance and Managed Care, informed consent is the oral and written communication process between a patient and physician that results in the agreement to undergo a particular procedure, surgical intervention or medical treatment.

Unfortunately, a lack of standardization surrounding this process represents a major risk for patients and surgeons, and may lead to inaccurate patient expectations, lost or incomplete consent forms, missing encounter documentation and delays in critical surgeries and procedures.

History: Render S. Davis of Emory University [2008 recipient of the Health Care Ethics Consortium’s Heroes in Healthcare Ethics Award] writes for us in the Business of Medical Practice www.MedicalBusinessAdvisors.com that the concept of informed consent is rooted in medical ethics and codified as a legal principle. It is based on the assertion that a competent person has the right to determine what is done to him or her [self-regulated autonomy].

Rationale: The American Medical Association recommends that its members disclose and discuss the following with their patients:  

  • The patient’s diagnosis, if known,
  • The nature and purpose of a proposed treatment or procedure,
  • The risks and benefits of a proposed treatment or procedure,
  • Alternatives (regardless of cost or health insurance coverage),
  • The risks and benefits of the alternative treatments and,
  • The risks and benefits of not the procedure.

The requirements for informed consent are spelled out in statutes and case law in all 50 states. It is a necessary protocol for all hospitals, medical clinics, podiatry practices and ASCs.

Inadequacy of Traditional Consent Forms-to-Date

The typical informed consent process, particularly one that relies solely on traditional generic consent forms, is often inadequate, incomplete or offers the potential for not fully explaining and documenting a particular procedure to a given patient. 

Traditional consent forms are subject to errors and omissions, such as missing signatures (patient, provider or witness), missing procedure(s), and missing dates that place the validity of consent at risk. Lost or misplaced forms may result in delayed or postponed procedures often at the expensive of costly operating room time. Moreover, far too many forms are generic in nature and wholly unsuited for a specific patient or increasingly sophisticated medical procedure.

Patient Safety Background

According to the Institute of Medicine’s [IOM] repot, To Err is Human, more than 1 million injuries and nearly 100,000 deaths occur annually in the United States due to mistakes in medical care. Wrong patient, wrong-side, wrong-procedure and wrong-toe surgery are particularly egregious. In fact, these are among several other “never-events” that Medicare, and an increasing number of private insurance companies are refusing to reimburse.

Based on the need to make healthcare safer, the Agency for Healthcare Research and Quality (AHRQ) undertook a study to identify patient safety issues and develop recommendations for “best practices”.

AHRQ Evidence Report

The AHRQ report identified the challenge of addressing shortcomings such as missed, incomplete or not fully comprehended informed consent, as a significant patient safety opportunity for improvement.

The authors of the AHRQ report hypothesized that better informed patients “are less likely to experience errors by acting as another layer of protection.” And, the AHRQ study ranked a more interactive informed consent process among the top 11 practices supporting more widespread implementation.

General Accounting Office report found that malpractice insurance premiums were relatively flat for most of the 1990’s, but projections began to increase dramatically to 2010.

Results of Improper Informed Consent

Failure to obtain adequate informed consent, depending on state law, may place surgeons, resident, fellows, ambulatory and office surgery centers, medical clinics and hospitals at risk for litigation ranging from medical negligence to assault and battery.

Proceedings Involving Informed Consent

Informed consent is often a factor in medical malpractice litigation. Some attorneys note that physicians are liable, and that plaintiffs may be able to recover damages, in cases involving improper informed consent, even if the procedure is successful. Inadequate informed consent is often cited as a secondary cause in malpractice complaints and anecdotal evidence suggests this strategy may be especially pursued in podiatric malpractices cases.

Avoiding Litigation

The AMA advises its membership of the following regarding informed consent:  

“To protect yourself in litigation, in addition to carrying adequate liability insurance, it is important that the communications process itself be documented. Good documentation can serve as evidence in a court of the law that the process indeed took place. A timely and thorough documentation in the patient’s chart by the physician providing the treatment and/or performing the procedure can be a strong piece of evidence that the physician engaged the patient in an appropriate discussion.”

Impact of Comprehensive Informed Consent Forms

Another study found that providing informed consent information to patients in written form increased comprehension of the procedure. It was also hypothesized that: 

  • Better informed patients are more compliant with medical advice and recover faster.
  • Informed consent discussions strengthen physician-patient relationships and increase patients’ confidence in their doctor.
  • Well informed patients are more engaged in their own care, and are thus less likely to experience surgical errors than more passive, or less informed patients. 

Medical Ethics

The ethical foundation of informed consent is based on the creation of an environment that supports respect for patients and protects their right to autonomous, informed participation in all collaborative Healthcare 2.0 decisions. 

Assessment 

Thus, the essence of the informed consent problems of modern medicine today!

More: http://www.ePodiatryConsentForms.com 

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PODCAST: Employer Healthcare Priorities

By Eric Bricker MD

A Mercer Employer Survey

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5 Initiatives to Improve Health Equality in the U.S.

Percentage with Initiative in Place

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By Charlene Ice

  1. Increasing access to care: 25% of U.S. healthcare leaders
  2. Providing care in the community/community outreach: 24% of U.S. healthcare leaders
  3. Promoting community education: 17% of U.S. healthcare leaders
  4. Generating financial support for under-served communities: 16% of U.S. healthcare leaders
  5. Identifying collaborative partners: 11% of U.S. healthcare leaders

Notes: Responses from U.S. healthcare leaders according to Philips’ “Future Health Index 2022” report, an analysis of feedback from nearly 3,000 healthcare leaders across 15 countries.
Source: Phillips, June 8, 2022
Source URL: https://www.usa.philips.com/a-w/about/news/archive/standard/…

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A.I. Examiners and the CERTIFIED MEDICAL PLANNER® Professional Designation Program

Artificial Intelligence and “Robo-Examiners” Let Adult-Learners and Students Take Control of their Career Education and On-Line Matriculation

Dr. David Edward Marcinko MBA CMP®
[Academic Dean and CEO: Institute of Medical Business Advisors, Inc]

Enter the CMPs

[Course Curriculum]

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.

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.

Get a robo advisor on board to help with your investment ...

http://www.CertifiedMedicalPlanner.org

Assessment

According to Eugene Schmuckler PhD MBA MEd, Academic Provost 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.

COURSE TEXTBOOKS: https://medicalexecutivepost.com/2021/04/29/why-are-certified-medical-planner-textbooks-so-darn-popular/

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ADMISSIONS CONTACT:

Ann Miller RN MHA CMP®

[Executive-Director]

PH: 770-448-0769

EM: MarcinkoAdvisors@msn.com

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ENTREPRENEURIAL MANAGEMENT EFFICIENCY: “Slowly I Turned … Step by Step … Inch by Inch”

By Staff Writers

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Venture capitalists who are in a rut should stop talking about how hard it is to raise a $100 million fund. Instead, raise a $5 million fund.

Rather, they should stop trying to invest $5 million at a time (with an 18-month window before going public). A better strategy is to start doing smaller investments with longer time horizons.

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

Just like chili, low and slow is the way to maximum flavor.

READ: https://tinyurl.com/2ewwvz2c

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Schulze School of Entrepreneurship

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State Economy Engine

Since launching a two-year commercial course in 1895, the University of St. Thomas has placed an emphasis on helping the state of Minnesota create entrepreneurial endeavors that contribute to the state’s thriving, diverse economy.

Opus College of Business

More than 150 years later, the university’s Opus College of Business continues that tradition, as this interactive graphic shows.

engine

Download a PDF of the full infographic for larger viewing

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FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors

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PODCAST: Health Tech Faves & Investment Trends from Entrepreneurs

START-UPS AND INNOVATIONS

Health tech investment raced ahead in 2020. Join innovation insiders for a discussion on new health technologies, health-care’s digital transformation timeline, and what to expect for mid- to long-term health tech investment.

Health Care Technology Today | Canadian Physiotherapy ...

PODCAST: https://www.healthsharetv.com/content/golive-webinar-health-tech-faves-investment-trends-innovation-insiders

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PODCAST: Roadmap to a High Performance Employee Health Plan

By Eric Bricker MD

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SURVEY: Resources Offered by Health Insurance Plan Transparency Tool

By MCOL

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Percentage of Resources

 •  Finding in-network providers: 72%
 •  Telehealth: 55%
 •  Ability to select PCP online: 53%
 •  Help navigating benefits and healthcare options: 50%
 •  Cost estimates for healthcare services: 50%
 •  Status of deductible: 49%
 •  Reviews of doctors and facilities: 46%
 •  Online appointment scheduling: 41%
 •  Financial incentives/rewards for choosing cost-effective care: 25%

Source: Health Sparq, “2022 Annual Consumer Sentiment Benchmark Report,” January 2022

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

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Capitalism Blame Does Nothing to Offer Solutions

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Blaming it on capitalism does nothing to offer any real solutions

Rick Kahler MS CFP

By Rick Kahler MSFS CFP®

http://www.KahlerFinancial.com

Recently, a respected colleague noted that the “capitalistic goal of accumulation, consumption, and collecting” is responsible for a collective mindset in Americans that “I consume, therefore I am” and “more is better.” He passionately feels the “more is better capitalistic mentality” assures a predictable future of dwindling resources. He is not alone in his views.

Certainly, identifying our self-worth by what we accumulate or spend does not produce emotional, physical, or financial well-being.

Those who embrace a money script of “I consume, therefore I am” are likely to eventually encounter financial and emotional pain. Either they will run out of money to spend, lack products to buy, or discover the futility of trying to use money and possessions as a substitute for genuine self-worth.

More is Better?

What I found curious was my colleague’s attribution of the money script “more is better” as the product of capitalism. That money script has been around a lot longer than capitalism, which according to Investopedia originated during the Middle Ages when a variety of factors, including a labor shortage caused by the Black Plague, caused the collapse of the manorial system. More is better” was part of the human condition much earlier.

For example, in the Hebrew Scriptures, Ecclesiastes 5:10 says, “Whoever loves money never has money enough; whoever loves wealth is never satisfied with his income.”

Greed

Greed, whether for money or food or anything else, is not produced by an economic model. Whether people live under a capitalistic, socialistic, or communist system—or in a Stone Age tribal group—greed is alive and well in all of them. Every human being experiences it in some way and on some level. It has been considered one of the seven deadly sins since the early days of the Christian church.

Definition

“Capitalism” is defined by Merriam-Webster as “an economic system characterized by private or corporate ownership of capital goods, by investments that are determined by private decision, and by prices, production, and the distribution of goods that are determined mainly by competition in a free market.”

There is nothing in that definition about greed or any goals of “accumulation, consumption, and collecting.”

Core to capitalism is a method of distributing limited resources in the most efficient manner possible, where the dynamics of the free market and competition drive down prices and improve quality. I find no other economic system that delivers this outcome. In fact, systems controlled by central planning have a track record of producing the opposite: economies where shortages prevail and those in charge prosper on the backs of the masses.

Research

Research shows capitalism has lifted more people out of poverty than any other economic system. Since 1945 the number of those living below the poverty line has decreased 57%, from 35% to 15%, while income inequality has risen just 15%. Any American earning over $30,600 is in the top 1% of income earners globally. Even the bottom 1% of Americans are in the top 33% of income earners globally.

Certainly there are business owners and wealthy people who are greedy, selfish, and materialistic, because such people are found in every walk of life. These traits are not tied to any particular economic system. They are signs of people who are trying to satisfy spiritual and emotional needs with material things that can never meet those needs.

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buy-sell-merge

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Assessment

Because one of the qualities that helps people create financial security is frugality, I actually agree with my colleague that excess consumption is often destructive and can be a genuine problem. Blaming it on capitalism, however, does nothing to offer any real solutions.

Conclusion

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About Medical Workplace Violence

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UPDATE

At least three people are dead and multiple people are injured following a shooting at the Natalie Building at St. Francis Hospital in Tulsa, Oklahoma.

Link: https://www.msn.com/en-us/news/crime/at-least-3-dead-multiple-people-injured-in-shooting-at-oklahoma-medical-office/ar-AAXYITO?li=BBnb7Kz

More than Physical Assault

[By Staff Reporters and Dr. David E. Marcinko MBA]

Business Med PracticeWorkplace violence is more than physical assault.

According to trauma specialist Eugene Schmuckler; PhD, MBA, CTS opining and writing in www.BusinessofMedicalPractice.com; workplace violence is any act in which a person is abused, threatened, intimidated, harassed, or assaulted in his or her employment. Swearing, verbal abuse, playing “pranks,” spreading rumors, arguments, property damage, vandalism, sabotage, pushing, theft, physical assaults, psychological trauma, anger-related incidents, rape, arson, and murder are all examples of workplace violence.

The RNANS

The Registered Nurses Association of Nova Scotia [RNANS], a leading study group, defines violence as “any behavior that results in injury whether real or perceived by an individual, including, but not limited to, verbal abuse, threats of physical harm, and sexual harassment.” As such, medical workplace violence includes:

· threatening behavior — such as shaking fists, destroying property, or throwing objects;

· verbal or written threats — any expression of intent to inflict harm;

· harassment — any behavior that demeans, embarrasses, humiliates, annoys, alarms, or verbally abuses a person and that is known or would be expected to be unwelcome. This includes words, gestures, intimidation, bullying, or other inappropriate activities;

· verbal abuse — swearing, insults, or condescending language;

· muggings — aggravated assaults, usually conducted by surprise and with intent to rob; or

· physical attacks — hitting, shoving, pushing, or kicking.

Cause and Affect

Workplace violence can be brought about by a number of different actions in the workplace. It may also be the result of non-work related situations such as domestic violence or “road rage.” Workplace violence can be inflicted by an abusive employee, a manager, supervisor, co-worker, customer, family member, patient, physician, nurse, or even a stranger.

The UI-IPRC 

The University of Iowa – Injury Prevention Research Center [UI-IPRC] classifies most workplace violence into one of four categories.

· Type I Criminal Intent — Results while a criminal activity (e.g., robbery) is being committed and the perpetrator had no legitimate relationship to the workplace.

· Type II Customer/Client — The perpetrator is a customer or client at the workplace (e.g., healthcare patient) and becomes violent while being assisted by the worker.

· Type III Worker on Worker — Employees or past employees of the workplace are the perpetrators.

· Type IV Personal Relationship — The perpetrator usually has a personal relationship with an employee (e.g., domestic violence in the workplace).

Conclusion

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[Medical] Entrepreneurs Drawn to Starting Incubators?

INFORMATION FROM THE TRENCHES

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More Ideas to Help [Medical] Entrepreneurs

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David Cummings on Startups

Last week I was reading an article about a successful entrepreneur that had started an incubator to work on multiple startups simultaneously. Incubators, now called studios or labs, were popularized during the dot com boom, and most failed to work, leaving a negative connotation for many people. Now, the cost to start is 10x cheaper and there are millions of people with mobile broadband connections, making for a different dynamic compared to 15 years ago. While it is still expensive to scale, getting started is easy.

Here are a few ideas why entrepreneurs are drawn to incubators:

  • Timing a market is terribly difficult, so having multiple startups running simultaneously increases the chance of finding a fit
  • For many (most?) entrepreneurs, the starting part is more fun than the scaling part
  • Small, dedicated teams without a legacy customer base can innovate fast, making it more fun to see rapid progress
  • When…

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RECAST: An Interview with Fiduciary Bennett Aikin AIF®

On Financial Fiduciary Accountability

[By Dr. David E. Marcinko MBA CMP™]

[By Ann Miller; RN, MHA]

Currently, there is a growing dilemma in the financial sales and services industry. It goes something like this:

  • What is a financial fiduciary?
  • Who is a financial fiduciary?
  • How can I tell if my financial advisor is a fiduciary?

Now, in as much as this controversy affects laymen and physician-investors alike, we went right to the source for up-to-date information regarding this often contentious topic, for an email interview and Q-A session, with Ben Aikin.ben-aikin

About Bennett Aikin AIF® and fi360.com

Bennett [Ben] Aikin is the Communications Coordinator for fi360.com. He oversees all communications for fi360. His responsibilities include messaging, brand management, copyrights and trademarks, and publications. Mr. Aikin received his BA in English from Virginia Tech in 2003 and is currently an MS candidate in Journalism from Ohio University.

Q. Medical Executive Post 

You have been very helpful and gracious to us. So, let’s get right to it, Ben. In the view of many; attorneys, doctors, CPAs and the clergy are fiduciaries; most all others who retain this title seem poseurs; sans documentation otherwise.

A. Mr. Aikin

You are correct. Attorneys, doctors and clergy are the prototype fiduciaries. They have a clear duty to put the best interests of their clients, patients, congregation, etc., above their own. [The duty of a CPA isn’t as clear to me, although I believe you are correct]. Furthermore, this is one of the first topics we address in our AIF training programs, and what we call the difference between a profession and an industry.  The three professions you name have three common characteristics that elevate them from an industry to a profession:

  1. Recognized body of knowledge
  2. Society depends upon practitioners to provide trustworthy advice
  3. Code of conduct that places the clients’ best interests first

Q. Medical Executive Post 

It seems that Certified Financial Planner®, Chartered Financial Analysts, Registered Investment Advisors and their representatives, Registered Representative [stock-brokers] and AIF® holders, etc, are not really financial fiduciaries, either by legal statute or organizational charter. Are we correct, or not? Of course, we are not talking ethics or morality here. That’s for the theologians to discuss.

A. Mr. Aikin

One of the reasons for the “alphabet soup”, as you put it in one of your white papers [books, dictionaries and posts] on financial designations, is that while there is a large body of knowledge, there is no one recognized body of knowledge that one must acquire to enter the financial services industry.  The different designations serve to provide a distinguisher for how much and what parts of that body of knowledge you do possess.  However, being a fiduciary is exclusively a matter of function. 

In other words, regardless of what designations are held, there are five things that will make one a fiduciary in a given relationship:

  1. You are “named” in plan or trust documents; the appointment can be by “name” or by “title,” such as CFO or Head of Human Resources
  2. You are serving as a trustee; often times this applies to directed trustees as well
  3. Your function or role equates to a professional providing comprehensive and continuous investment advice
  4. You have discretion to buy or sell investable assets
  5. You are a corporate officer or director who has authority to appoint other fiduciaries

So, if you are a fiduciary according to one of these definitions, you can be held accountable for a breach in fiduciary duty, regardless of any expertise you do, or do not have. This underscores the critical nature of understanding the fiduciary standard and delegating certain duties to qualified “professionals” who can fulfill the parts of the process that a non-qualified fiduciary cannot.

Q. Medical Executive Post 

How about some of the specific designations mentioned on our site, and elsewhere. I believe that you may be familiar with the well-known financial planner, Ed Morrow, who often opines that there are more than 98 of these “designations”? In fact, he is the founder of the Registered Financial Consultants [RFC] designation. And, he wrote a Foreword for one of our e-books; back-in-the-day. His son, an attorney, also wrote as a tax expert for us, as well. So, what gives?

A. Mr. Aikin

As for the specific designations you list above, and elsewhere, they each signify something different that may, or may not, lend itself to being a fiduciary: For example:

• CFP®: The act of financial planning does very much imply fiduciary responsibility.  And, the recently updated CFP® rules of conduct does now include a fiduciary mandate:

• 1.4 A certificant shall at all times place the interest of the client ahead of his or her own. When the certificant provides financial planning or material elements of the financial planning process, the certificant owes to the client the duty of care of a fiduciary as defined by CFP Board. [from http://www.cfp.net/Downloads/2008Standards.pdf]

•  CFA: Very dependent on what work the individual is doing.  Their code of ethics does have a provision to place the interests of clients above their own and their Standards of Practice handbook makes clear that when they are working in a fiduciary capacity that they understand and abide by the legally mandated fiduciary standard.

• FA [Financial Advisor]: This is a generic term that you may find being used by a non-fiduciary, such as a broker, or a fiduciary, such as an RIA.

• RIA: Are fiduciaries.  Registered Investment Advisors are registered with the SEC and have obligations under the Investment Advisers Act of 1940 to provide services that meet a fiduciary standard of care.

• RR: Registered Reps, or stock-brokers, are not fiduciaries if they are doing what they are supposed to be doing.  If they give investment advice that crosses the line into “comprehensive and continuous investment advice” (see above), their function would make them a fiduciary and they would be subject to meeting a fiduciary standard in that advice (even though they may not be properly registered to give advice as an RIA).

• AIF designees: Have received training on a process that meets, and in some places exceeds, the fiduciary standard of care.  We do not require an AIF® to always function as a fiduciary. For example, we allow registered reps to gain and use the AIF® designation. In many cases, AIF designees are acting as fiduciaries, and the designation is an indicator that they have the full understanding of what that really means in terms of the level of service they provide.  We do expect our designees to clearly disclose whether they accept fiduciary responsibility for their services or not and advocate such disclosure for all financial service representatives.

Q. Medical Executive Post 

Your website, http://www.fi360.com, seems to suggest, for example, that banks/bankers are fiduciaries. We have found this not to be the case, of course, as they work for the best interests of the bank and stockholders. What definitional understanding are we missing?

A. Mr. Aikin

Banks cannot generally be considered fiduciaries.  Again, it is a matter of function. A bank may be a named trustee, in which case a fiduciary standard would generally apply.  Banks that sell products are doing so according to their governing regulations and are “prudent experts” under ERISA, but not necessarily held to a fiduciary standard in any broader sense.

Q. Medical Executive Post 

And so, how do we rectify the [seemingly intentional] industry obfuscation on this topic. We mean, our readers, subscribers, book and dictionary purchasers, clients and colleagues are all confused on this topic. The recent financial meltdown only stresses the importance of understanding same.

For example, everyone in the industry seems to say they are the “f” word. But, our outreach efforts to contact traditional “financial services” industry pundits, CFP® practitioners and other certification organizations are continually met with resounding silence; or worse yet; they offer an abundance of parsed words and obfuscation but no confirming paperwork, or deep subject-matter knowledge as you have kindly done. We get the impression that some FAs honesty do-not have a clue; while others are intentionally vague.

A. Mr. Aikin

All of the evidence you cite is correct.  But that does not mean it is impossible to find an investment advisor who will manage to a fiduciary standard of care and acknowledge the same. The best way to rectify confusion as it pertains to choosing appropriate investment professionals is to get fiduciary status acknowledged in writing and go over with them all of the necessary steps in a fiduciary process to ensure they are being fulfilled. There also are great resources out there for understanding the fiduciary process and for choosing professionals, such as the Department of Labor, the SEC, FINRA, the AICPA’s Personal Financial Planning division, the Financial Planning Association, and, of course, Fiduciary360.

We realize the confusion this must cause to those coming from the health care arena, where MD/DO clearly defines the individual in question; as do other degrees [optometrist, clinical psychologist, podiatrist, etc] and medical designations [fellow, board certification, etc.]. But, unfortunately, it is the state of the financial services industry as it stands now.

Q. Medical Executive Post 

It is as confusing for the medical community, as it is for the lay community. And, after some research, we believe retail financial services industry participants are also confused. So, what is the bottom line?

A. Mr. Aikin

The bottom line is that lay, physician and all clients have a right to expect and demand a fiduciary standard of care in the managing of investments. And, there are qualified professionals out there who are providing those services.  Again, the best way to ensure you are getting it is to have fiduciary status acknowledged in writing, and go over the necessary steps in a fiduciary process with them to ensure it is being fulfilled.

Q. Medical Executive Post 

The “parole-evidence” rule, of contract law, applies, right? In dealing with medical liability situations, the medics and malpractice attorneys have a rule: “if it wasn’t written down, it didn’t happen.”  

A. Mr. Aikin

An engagement contract accepting fiduciary status should trump a subsequent attempt to claim the fiduciary standard didn’t apply. But, to reiterate an earlier point, if someone acts in one of the five functional fiduciary roles, they are a fiduciary whether they choose to acknowledge it or not.  I have attached a sample acknowledgement of fiduciary status letter with copies of our handbook, which details the fiduciary process we instruct in our programs, and our SAFE, which is basically a checklist that a fiduciary should be able to answer “Yes” to every question to ensure the entire fiduciary process is being covered.

Q. Medical Executive Post 

It is curious that you mention checklists. We have a post arguing that very theme for doctors and hospitals as they pursue their medial error reduction, and quality improvement, endeavors. And, we applaud your integrity, and wish only for clarification on this simple fiduciary query?

A. Mr. Aikin

Simple definition: A fiduciary is someone who is managing the assets of another person and stands in a special relationship of trust, confidence, and/or legal responsibility.

Q. Medical Executive Post 

Who is a financial fiduciary and what, if any, financial designation indicates same?

A. Mr. Aikin

Functional definition: See above for the five items that make you a fiduciary.

Financial designations that unequivocally indicate fiduciary duty: Short answer is none, only function can determine who is a fiduciary. 

Q. Medical Executive Post 

Please repeat that?

A. Mr. Aikin

Financial designations that indicate fiduciary duty: none. It is the function that determines who is a fiduciary.  Now, having said that, the CFP® certification comes close by demanding their certificants who are engaged in financial planning do so to a fiduciary standard. Similarly, other designations may certify the holder’s ability to perform a role that would be held to a fiduciary standard of care.  The point is that you are owed a fiduciary standard of care when you engage a professional to fill that role or they functionally become one.  And, if you engage a professional to fill a non-fiduciary role, they will not be held to a fiduciary standard simply because they have a particular designation.  One of the purposes the designations serve is to inform you what roles the designation holder is capable of fulfilling.

It is also worth keeping in mind that just being a fiduciary doesn’t equate to a full knowledge of the fiduciary standard. The AIF® designation indicates having been fully trained on the standard.

Q. Medical Executive Post 

Yes, your website mentions something about fiduciaries that are not aware of same! How can this be? Since our business model mimics a medical model, isn’t that like saying “the doctor doesn’t know he is doctor?” Very specious, with all due respect!

A. Mr. Aikin

I think it is first important to note that this statement is referring not just to investment professionals.  Part of the audience fi360 serves is investment stewards, the non-professionals who, due to facts and circumstances, still owe a fiduciary duty to another.  Examples of this include investment committee members, trustees to a foundation, small business owners who start 401k plans, etc.  This is a group of non-sophisticated investors who may not be aware of the full array of responsibilities they have. 

However, even on the professional side I believe the statement isn’t as absurd as it sounds.  This is basically a protection from both ignorant and unscrupulous professionals.  Imagine a registered representative who, either through ignorance or design, begins offering comprehensive and continuous investment advice.  Though they may deny or be unaware of the fact, they have opened themselves up to fiduciary liability. 

Q. Medical Executive Post 

Please clarify the use of arbitration clauses in brokerage account contracts for us. Do these disclaim fiduciary responsibility? If so, does the client even know same?

A. Mr. Aikin

By definition, an engagement with a broker is a non-fiduciary relationship.  So, unless other services beyond the scope of a typical brokerage account contract are specified, fiduciary responsibility is inherently not applicable.  Unfortunately, I do imagine there are clients who don’t understand this. Furthermore, AIF® designees are not prohibited from signing such an agreement and there are some important points to understand the reasoning.

First, by definition, if you are entering into such an agreement, you are entering into a non-fiduciary relationship. So, any fiduciary requirement wouldn’t apply in this scenario.

Second, if this same question were applied into a scenario of a fiduciary relationship, such as with an RIA, this would be a method of dispute resolution, not a practice method. So, in the event of dispute, the advisor and investor would be free to agree to the method of resolution of their choosing. In this scenario, however, typically the method would not be discussed until the dispute itself arose.

Finally, it is important to know that AIF/AIFA designees are not required to be a fiduciary. It is symbolic of the individuals training, knowledge and ongoing development in fiduciary processes, but does not mean they will always be acting as a fiduciary.

Q. Medical Executive Post 

Don’t the vast majority of arbitration hearings find in favor of the FA; as the arbitrators are insiders, often paid by the very same industry itself?

A. Mr. Aikin

Actual percentages are reported here: http://www.finra.org/ArbitrationMediation/AboutFINRADR/Statistics/index.htm However, brokerage arbitration agreements are a dispute resolution method for disputes that arise within the context of the securities brokerage industry and are not the only means of resolving differences for all types of financial advisors.  Investment advisers, for example, are subject to respond to disputes in a variety of forums including state and federal courts.  Clients should look at their brokerage or advisory agreement to see what they have agreed to. If you wanted to go into further depth on this question, we would recommend contacting Brian Hamburger, who is a lawyer with experience in this area and an AIFA designee. Bio page: http://www.hamburgerlaw.com/attorneys/BSH.htm.

Q. Medical Executive Post 

What about our related Certified Medical Planner® designation, and online educational program for financial advisors and medical management consultants? Is it a good idea – reasonable – for the sponsor to demand fiduciary accountability of these charter-holders? Cleary, this would not only be a strategic competitive advantage, but advance the CMP™ mission to put medical colleagues first and champion their cause www.CertifiedMedicalPlanner.org above all else. 

A. Mr. Aikin

I think it is a good idea for any plan sponsor to demand fiduciary status be acknowledged from anyone engaged to provide comprehensive and continuous investment advice.  I also think it is a good idea to be proactive in verifying that the fiduciary process is being followed.

Q. Medical Executive Post 

Is there anything else that we should know about this topic?

A. Mr. Aikin

Yes, a further note about fi360’s standards. I wrote generically about the fiduciary standard, because there is one that is defined by multiple sources of regulation, legislation and case law.  The process defined in our handbooks, we call a Fiduciary Standard of Excellence, because it covers that minimum standard and also best practice standards that go above and beyond.  All of our Practices, which comprise that standard, are legally substantiated in our Legal Memoranda handbook, which was written by Fred Reish’s law firm, who is considered a leading ERISA attorney.

Additional resources:

Q. Medical Executive Post 

Thank you so much for your knowledge and willingness to frankly share it with the Medical-Executive-Post.

Assessment

All are invited to continue the conversation with Mr. Aikin, asynchronously online, or thru this contact information:

fi360.com
438 Division Street
Sewickley, PA 15143
412-741-8140 Phone
866-390-5080 Toll-free phone
412-741-8142 Fax

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

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

LEXICONS: http://www.springerpub.com/Search/marcinko
PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
BLOG: www.MedicalExecutivePost.com

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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™

On Psychological Stress

And Out-Patient Care

By http://www.MCOL.com

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COACHING

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Conclusion

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

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

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

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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™

GO FUND ME: Medical Campaigns Reveal a Big Problem with Health Care

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By Jules Lipoff, MD: Senior fellow at the Leonard Davis Institute of Health Economics and an assistant professor of clinical dermatology at Perelman School of Medicine, both of the University of Pennsylvania. Erica Mark, medical student at the University of Virginia, contributed to this article. The opinions expressed in this article do not necessarily represent those of the University of Pennsylvania Health System or the Perelman School of Medicine.

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If you follow the news or your social media feed, you know that crowdsourcing medical expenses is increasingly popular for financing health care costs. In fact, you might have contributed to one; 22 percent of American adults report donating to GoFundMe medical campaigns.

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

As of 2021, approximately $650 million, or about one-third of all funds raised by GoFundMe, went to medical campaigns. That staggering amount of money highlights how dysfunctional our health care system is, forcing people to resort to crowdsourcing to afford their medical care — but it’s not surprising. In the United States, 62 percent of bankruptcies are related to medical costs. This should be a wake-up call to address and reform the system further.

Related: https://medicalexecutivepost.com/2021/12/30/does-crowd-sourcing-democratize-the-health-care-insurance-system/

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ESSAY: https://www.msn.com/en-us/news/politics/gofundme-medical-campaigns-reveal-a-big-problem-with-health-care/ar-AAXabGB?li=BBnbfcL

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COMMENTS APPRECIATED

Thank You

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PODCASTS: The GREAT ECONOMIC MODERATION / RESIGNATION in Medicine?

A HISTORICAL REVIEW WITH UPDATE

Dr. David Edward Marcinko | The Leading Business Education Network for  Doctors, Financial Advisors and Health Industry Consultants

By Dr. David E. Marcinko MBA CMP®

CMP logo

SPONSOR: http://www.CertifiedMedicalPlanner.org

What was the Great Economic Moderation?

The Great Moderation is the name given to the period of decreased macroeconomic volatility experienced in the United States starting in the 1980s.

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

During this period, the standard deviation of quarterly real gross domestic product (GDP) declined by half and the standard deviation of inflation declined by two-thirds, according to figures reported by former U.S. Federal Reserve Chair Ben Bernanke. The Great Moderation can be summed up as a multi-decade period of low inflation and positive economic growth.

But, what about health economics, writ large? And, the actual practice of medicine by physicians in the trenches. Consider this historical review.

GOLDEN AGE OF MEDICINE

The ‘golden age of medicine’ – the first half of the 20th century, reaching its zenith with Jonas Salk’s 1955 polio vaccine – was a time of profound advances in surgical techniques, immunization, drug discovery, and the control of infectious disease; however, when the burden of disease shifted to lifestyle-driven, chronic, non-communicable diseases, the golden era slipped away. Although modifiable lifestyle practices now account for some 80% of premature mortality, medicine remains loathe to embrace lifestyle interventions as medicine Here, we argue that a 21st century golden age of medicine can be realized; the path to this era requires a transformation of medical school recruitment and training in ways that prioritize a broad view of lifestyle medicine. Moving beyond the basic principles of modifiable lifestyle practices as therapeutic interventions, each person/community should be viewed as a biological manifestation of accumulated experiences (and choices) made within the dynamic social, political, economic and cultural ecosystems that comprise their total life history. This requires an understanding that powerful forces operate within these ecosystems; marketing and neoliberal forces push an exclusive ‘personal responsibility’ view of health – blaming the individual, and deflecting from the large-scale influences that maintain health inequalities and threaten planetary health. The latter term denotes the interconnections between the sustainable vitality of person and place at all scales. We emphasize that barriers to planetary health and the clinical application of lifestyle medicine – including authoritarianism and social dominance orientation – are maintaining an unhealthy status quo.

NOTE: https://pubmed.ncbi.nlm.nih.gov/31828026/

GOLDEN AGE OF MEDICAL PRACTICE

To listen to all those desperate to reform health care, you get the impression that physicians are pretty horrible people. We are all sexist, greedy, money grubbing tyrants who will perform unnecessary tests and procedures just to make money. We don’t care about quality or cost. We are killing off 250,000 patients every year with our ignored “errors.”

We purposely keep our patients in pain, or we addict them to narcotics just to shut them up. We are constantly told by lawyers that lawsuits are necessary to protect patients from doctors. We provide unsafe drugs just because the drug reps give us free pens and coffee cups. The government must step in to clean up the mess.

PODCAST: https://www.kevinmd.com/blog/2017/08/9-reasons-golden-age-medicine-golden.html

GOLDEN AGE OF PATIENT TRUST

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THE GREAT PHYSICIAN RETIREMENT AND RESIGNATION: https://medicalexecutivepost.com/2021/11/09/healthcare-industry-hit-with-the-great-resignation-retirement/

YOUR COMMENTS ARE APPRECIATED.

Thank You

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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™

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

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

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What is the plan for a future with COVID?

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Q: What is the plan for a future with COVID?
A:
A new 136-page report written by dozens of experts provides a comprehensive roadmap to the next normal both to address the pandemic and protect against future biosecurity threats. The group identified 12 key areas of focus, including long COVID, equity, and vaccines. The report also addressed concerns about how the end of the pandemic will disrupt the U.S. health care system when policies introduced during the public health emergency come to an end. 

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COMMENTS APPRECIATED

Thank You

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Stress Testing your Investment Portfolio

Join Our Mailing List

What is Your Risk Number?

DG

[By David Gratke]

Are your current investments aligned with YOUR investment goals and expectations in 2022?

As we all know, the global financial markets have responded tremendously to the past seven years of Global Central Bank monetary polices. i.e. asset prices, stocks, bonds and real estate have all gone up in price as a result. But now, we have the pandemic and Ukraine war to consider.

So, when have you last ‘stress-tested’ your portfolio to see how durable it may through various market cycles? And, how do you determine if your current investment holdings are right for you? Maybe they are too conservative, or just the opposite, still too aggressive?  Maybe they are right where they need to be, but how do you know, how do you measure that?

  • Capture you Risk Tolerance
  • See if your portfolio fits you.
  • OK, How do I Start?

By simply answering a few questions, and spending 10 minutes of your time, based upon the size of your investment portfolio, you will quickly determine your own tolerance for risk.

Comparing your Risk Number to your Portfolio

Now that you have calculated your Risk Number, how does that number compare to your actual portfolio holdings? Is the portfolio you have today, the one you started with some time ago regarding risk and return? Is it still in alignment with your original expectations?

Does your portfolio have?

  • Too much risk?
  • Is it too conservative?
  • Or, is it just right
  • What if the market drops significantly? Instead, what if the market goes up significantly? See how your current portfolio will fair in any one of these market conditions:
  • Let’s put your portfolio onto the treadmill; just like the doctor’s office.
  • How do you know, how do you measure?

Let’s Stress Test your Portfolio

  1. Bull Market (Prices generally rise)
  2. Bear Market (Prices generally fall)
  3. Financial Crisis
  4. Rising Interest Rates

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ScreenShot2015-06-01at11_34_02AM_113439

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  • Are the results in alignment with your expectations?
  • Any ‘hot spots’ you need to know about?
  • Are there any individual holdings that will cause you loss of sleep over?
  • Maybe investments don’t generate enough income?
  • Maybe investments fluctuate too much in price?
  • Now you can have a look and see if there are any ‘hot spots’ where you may need to re-balance a portion of your holdings based upon these findings.

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Yes! That feels like me

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Congratulations. Once you have determined your Risk Number, and perhaps re-aligned your current portfolio to your Risk Number, then yes, you DO have the portfolio that is right for you, one that ‘feels like you’.

ABOUT

David Gratke is chief executive officer of Gratke Wealth LLC in Beaverton, Ore. A Registered Investment Advisory Firm.

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Conclusion

Your thoughts and comments on this ME-P are appreciated. How does the current market tumult affect this ME-P or your own investing strategy? Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

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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™

“Physicians who don’t understand modern risk management, insurance, business and asset protection principles are sitting ducks waiting to be taken advantage of by unscrupulous insurance agents and financial advisors; and even their own prospective employers or partners. This comprehensive volume from Dr. David Marcinko, and his co-authors, will go a long way toward educating physicians on these critical subjects that were never taught in medical school or residency training.”

Dr. James M. Dahle MD FACEP [Editor of The White Coat Investor, Salt Lake City, Utah]

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USA “With time at a premium, and so much vital information packed into one well organized resource, this comprehensive textbook should be on the desk of everyone serving in the healthcare ecosystem. The time you spend reading this frank and compelling book will be richly rewarded.”

Dr. J. Wesley Boyd MD PhD MA [Harvard Medical School, Boston, Massachusetts, USA]

PODCAST: 50% of Medical Treatments Have Unknown Effectiveness

By Eric Bricker MD

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

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PODCAST: The Dartmouth Atlas of Healthcare

Geographic Variation in Spine Surgery

By Dr. Eric Bricker MD

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MORE: https://www.dartmouthatlas.org/

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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INDUSTRIAL ORGANIZATION: For Hospitals, Clinics and Healthcare CXOs, CEOs, CMOs and CTOs, etc.

MANAGEMENT STRATEGIES, TOOLS TEMPLATES AND CASE STUDIES

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Reviews:

Hospitals and Health Care Organizations is a must-read for any physician and other health care provider to understand the multiple, and increasingly complex, interlocking components of the U.S. health care delivery system, whether they are employed by a hospital system, or manage their own private practices.

The operational principles, methods, and examples in this book provide a framework applicable on both the large organizational and smaller private practice levels and will result in better patient care. Physicians today know they need to better understand business principles and this book by Dr. David E. Marcinko and Professor Hope Rachel Hetico provides an excellent framework and foundation to learn important principles all doctors need to know.
―Richard Berning, MD, Pediatric Cardiology

… Dr. David Edward Marcinko and Professor Hope Rachel Hetico bring their vast health care experience along with additional national experts to provide a health care model-based framework to allow health care professionals to utilize the checklists and templates to evaluate their own systems, recognize where the weak links in the system are, and, by applying the well-illustrated principles, improve the efficiency of the system without sacrificing quality patient care. … The health care delivery system is not an assembly line, but with persistence and time following the guidelines offered in this book, quality patient care can be delivered efficiently and affordably while maintaining the financial viability of institutions and practices.
―James Winston Phillips, MD, MBA, JD, LLM

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PURCHASE: https://www.amazon.com/dp/B00BC9IIUM?ref_=k4w_oembed_faGUzLlJ9ojLIx&tag=kpembed-20&linkCode=kpd

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