BOARD CERTIFICATION EXAM STUDY GUIDES Lower Extremity Trauma
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A common stock is the least senior of securities issued by a company.
A preferred stock, in contrast, is slightly more senior to common stock, since dividends owed to the preferred stockholders should be paid before distributions are made to common stockholders.
However, distributions to preferred stockholders are limited to the level outlined in the preferred stock agreement (i.e., the stated dividend payments). Like a fixed income security, preferred stocks have a specific periodic payment that is either a fixed dollar amount or an amount adjusted based upon short-term market interest rates.
However, unlike fixed income securities, preferred stocks typically do not have a specific maturity date and preferred stock dividend payments are made from the corporation’s after tax income rather than its pre-tax income. Likewise, dividends paid to preferred stockholders are considered income distributions to the company’s equity owners rather than creditors, so the issuing corporation does not have the same requirement to make dividend distributions to preferred stockholders.
So, preferred stock is generally referred to as a “hybrid” security, since it has elements similar to both fixed income securities (i.e., a stated periodic payments) and equity securities (i.e., shareholders are considered owners of the issuing company rather than creditors).
Convertible preferred stocks (and convertible corporate bonds) are also considered hybrid securities since they have both equity and fixed income characteristics. A convertible security whether a preferred stock or a corporate bond, generally includes a provision that allow the security to be exchanged for a given number of common stock shares in the issuing corporation. The holder of a convertible security essentially owns both the preferred stock (or the corporate bond) and an option to exchange the preferred stock (or corporate bond) for shares of common stock in the company.
ASSESSMENT: Thus, at times the convertible security may behave more like the issuing company’s common stock than it does the issuing company’s preferred stock (or corporate bonds), depending upon how close the common stock’s market price is to the designated conversion price of the convertible security.
According to Rick Kahler MS CFP® ChFC CCIM [www.KahlerFinancial.com] real estate is one of the largest asset classes in the world. The family home is the largest asset many middle-class Americans own. And, real estate makes up a significant portion of the net worth of many wealth accumulators. Directly owning real estate is not an investment for the faint of heart, the armchair investor, or the uneducated. Most wealth accumulators would do well to leave direct ownership of real estate to the pros and invest in real estate investment trusts (REITs) instead [personal communication].
Still, as we have seen, the lure of investing in a tangible asset like real estate is enticing for high risk tolerant physician-investors who need a sense of control and interaction with their investments. If you are among them, here are a few guidelines that may keep you on a profitable path.
1. Don’t attempt to purchase investment real estate without the help of a commercial real estate specialist who is a fiduciary bound to look out for your best interest. Engage a Certified Commercial Investment Member (CCIM) with years of training and experience in analyzing and acquiring investment real estate. To find a CCIM near you, go to http://www.ccim.com.
2. You will sign a disclosure agreement that will tell you who the Realtor represents. Be sure the Realtor you engage represents you and not the seller, both parties, or neither party.
3. Never trust the income and expense data provided by the seller’s Realtor. While a seller represented by a CCIM will have a greater chance of supplying you with accurate data, most will significantly understate expenses and overstate the capitalization rate. Selling Realtors often understate the average annual cost of repairs and maintenance. I estimate this annual expense at 10%.
4. Another often understated expense is management. Many owners manage their own properties, so the selling broker doesn’t include an estimate for management expenses. They should. Real estate doesn’t manage itself, ever. You will either need to hire professional management or do your own management (always a scary proposition). Even if you do it yourself, you have an opportunity cost of your time, so you must include a management fee in the expenses. Most small residential apartments and single-family homes will pay 10% of their rents to a manager.
5. You must verify all the costs presented to you by the seller’s Realtor. Demand copies of at least the last three and preferably five years of tax returns. Research items like utility bills, property taxes, legal fees, insurance costs and repairs, maintenance costs, replacement reserves, tax preparation and all management fees. As a rule of thumb, expenses will average 40% of rental income on average-aged properties where the tenants pay all utilities except water. Newer properties may have expenses as low as 35%, while older properties can be as high as 50%.
6. By subtracting the vacancy rate and stabilized expenses from the rent, you will find the net operating income. This is the income you will put in your pocket—assuming the property is paid for. By dividing the net operating income by the purchase price, you will find the return you will receive on your investment, called the capitalization or “cap” rate. In Rapid City SD, for example, the cap rate tends to be 4% for single-family homes, 5% to 8% for duplexes to eight-plexes, and 8% to 12% for larger residential and commercial properties.
ASSESSMENT: Yes, physician-investors and all of us can build wealth with real estate. You just need to educate yourself, work hard, start conservatively, think long-term, and be prepared for lean years. This is not a quick or easy path to riches. Your comments are appreciated. Thank You.
Posted on August 16, 2024 by Dr. David Edward Marcinko MBA MEd CMP™
PHYSICIAN RETIREMENT PLANNING
By Staff Reporters
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The rule of 25 is just a different way to look at another popular retirement rule, the 4% rule. It flips the equation (100/4% = 25) to emphasize a different part of the retirement planning process — withdrawing vs. saving.
The 4% rule outlines a safe rate to withdraw funds for 30 years without running out of money. On the other hand, the rule of 25 is a savings-focused approach, providing a quick estimate of how much you need to accumulate before exiting the workforce.
Let’s consider a scenario to highlight the difference:
Rule of 25: After accounting for her Social Security and other sources of retirement income, Dr. Matie PhD plans to spend $40,000 a year in retirement. 40,000 x 25 = $1 million, so Matie would need $1 million invested to cover annual expenses of $40,000.
The 4% rule: Dr. Matie, now a retiree, has $1 million in retirement savings and follows the 4% rule. She can safely withdraw $40,000 annually (4% of $1 million).
Long-Short is an active portfolio construction discipline that balances long positions in high expected return securities and short positions in low expected return securities of approximately equal value and market sensitivity. This type of portfolio is “neutralized” or immunized against changes in value of the underlying market and, therefore, has zero systematic (beta) risk. If the selected securities perform as expected, the long-short positions will provide a positive return, whether the market rises or falls.
Misconceptions
While long-short portfolios are often perceived and portrayed as much costlier and much riskier than long-only, it is inherently neither. Much of the incremental cost and risk is either largely dependent on the amount of leverage employed or controllable via optimization. Those costs and risks that are not controllable—financial intermediation costs of borrowing shares to short, the trading costs incurred to meet long-short balancing, margin requirements, uptick rules, and the risks of unlimited losses on short positions—do not invalidate the viability of long-short strategies.
Long-Short Advantages
Compared with long-only portfolios, long-short portfolios offer enhanced flexibility not only in the control of risk and pursuit of return, but also in asset allocation. Basic market-neutral portfolios achieve a return consisting of three components: (1) interest on funds held as a liquidity buffer, (2) interest on the short sale proceeds maintained with the broker, and (3) the return spread between the aggregate long and aggregate short positions in the portfolios.
Disadvantages
Share borrow-ability and uptick rules make short-selling more difficult and costly than going long. Also, it may be legally or contractually restricted for some investors, such as mutual funds. Inefficiencies may be concentrated in overpriced stocks and, accordingly, short sales of the most overpriced stocks may offer higher positive returns than long purchases of underpriced stocks.
Assessment
Long-only portfolios are confined to altering the weighting of securities within an index in order to realize an excess return. Long-short portfolios are not constrained by index weights and, because they can short securities, they can “underweight” a security by as much as investment insights and risk considerations dictate. Long-short portfolios can be enhanced by “equitizing” them using stock index futures.
Note: “The Long and Short on Long-Short” by Bruce I. Jacobs and Kenneth N. Levy, The Journal of Investing, Spring 1997, pp. 73–86, Institutional Investor, Inc.
Conclusion
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The stock markets have been near all time highs, lately. Physician colleagues and clients are so excited that they are even checking the overnight status of favorite stocks and/or the domestic/overseas markets.
Some colleagues are even becoming a bit OCD by checking the implied open of various markets the night before. But, what exactly is the Implied Open? How is it calculated?
DEFINITION: The Implied Open attempts to predict the prices at which various stock indexes will open, at 9:30am New York time. It is frequently shown on various cable television channels prior to the start of the next business day.
EXAMPLE: Considering the DJIA as an example, the basis of calculating implied open is the price of a “DJX index option futures contract”. This is not the price of the DJIA itself but rather the current ticker price of an option issued by the Chicago Board Options Exchange.
CBOE: The Chicago Board Options Exchange, located at 400 South LaSalle Street in Chicago, is the largest U.S. options exchange with annual trading volume that hovered around 1.27 billion contracts at the end of 2014. CBOE offers options on over 2,200 companies, 22 stock indices, and 140 exchange-traded funds.
NOTE: We would like to remind you that new amendments adopted by the U.S. Securities Exchange Commission (SEC) have gone into effect as of September 28, 2021. These amendments restrict the ability of market makers to publish OTC quotations for those companies that have not made required current financial and company information available to regulators and investors.
Investment fees matter. They can make a big difference to your financial health in the long run. Before you put money into any investment, it’s vital to uncover the real costs.They typically include these six types of fees:
1. An up-front commission earned by the salesperson or their firm. Don’t rely on a vague assurance or a verbal answer: get a specific number in writing.If you have trouble getting a number, ask, “If I buy this investment today and want to get out tomorrow, how much do I get back?” If the answer is not “all your money,” the difference is probably the upfront fees and commissions.
I don’t recommend purchasing financial products with significant upfront commission or costs. I have seen investments where these fees run as high as 30% of the money invested. If you were to earn 5% a year on the investment, it would take 8 years just to break even.
2. Ongoing advisory fees. These are monthly, quarterly, or annual fees you pay advisors for their investment advice and oversight. This includes working with you to pick the asset classes, set the diversification, select the managers, tax optimization, rebalancing, and other periodic tasks.
This fee can have many names including wrap fee or investment advisory fee. The normal “rule of thumb” is 1% of the assets the advisor is managing, although fees can range from 0 to 7%. This fee can be charged to you even if the advisor receives an upfront commission. It can be easy to see or hidden away in the fine print of the investment.
3. Additional fees for services. Find out specifically what services are included in the advisor fee. Additional fees for financial planning or ancillary services are rarely disclosed or discussed.
Services can range from minimal hand-holding only focused on your investments to comprehensive, holistic financial planning. Amazingly, there is no correlation between price and the breadth of services. That’s illogical, but the financial services industry gets away with this, in part because consumers don’t do their homework.
4. Ongoing fees charged by the managers of the specific funds or investment products. These fees are referred to as the fund’s expense ratio. This comes out of the profits generated by the manager, and it is one of the hardest fees to find. Only the most transparent advisor or salesperson will disclose it. It is incredibly well hidden; you will never see it in your brokerage statements or your advisor’s invoices. The only way to know the amount of this fee is to read the prospectus or some other third party analysis of the investment, like Morningstar.
These fees can vary greatly for the same investment, depending on the class of share you buy. For example, American Fund’s New Perspective Fund’s expense ratio ranges from0.45% to 1.54%. The average expense ratio of a mutual fund that invests in stocks is 1.35%. Conversely, the average expense ratio of a Vanguard S&P 500 fund is 0.10%. The difference of 1.25% is staggering over time.
5. Miscellaneous fees. These are also rarely talked about and hard to find. Many advisors charge $50 to $100 a year per account, hundreds of dollars to open or close an account, and even fees to dollar cost average your funds into the market.
6. Transaction fees. Every time you buy or sell a fund, a fee is typically paid to a custodian. These can range from $5 to hundreds of dollars per transaction.
Assessment
Remember, it’s your job to persist until you find out the total costs of an investment. Next week I’ll suggest ways to ask the tough questions about fees.
Conclusion
Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.
Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. https://medicalexecutivepost.com/dr-david-marcinkos-bookings/
Posted on August 9, 2024 by Dr. David Edward Marcinko MBA MEd CMP™
MEDICAL EXECUTIVE-POST–TODAY’SNEWSLETTERBRIEFING
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Essays, Opinions and Curated News in Health Economics, Investing, Business, Management and Financial Planning for Physician Entrepreneurs and their Savvy Advisors and Consultants
“Serving Almost One Million Doctors, Financial Advisors and Medical Management Consultants Daily“
A Partner of the Institute of Medical Business Advisors , Inc.
Almost 40,000 seniors will be forced to change Medicare Advantage plans after yet another insurer decides to exit markets over cost concerns. Centene Corp announced it would be ending its Medicare Advantage plans in at least six states this year as the company faces cost pressures.
Hanesbrands surged 18.17% in spite of sales sagging faster than the waistband of your favorite old pair of undies. Shareholders liked that the company has become more lean and efficient after selling its Champions brand.
SolarEdge Technologies fell 3.05% despite beating revenue forecasts, but its bottom line was weaker than expected.
JFrog tanked 27.52% after beating profit estimates, missing revenue estimates, and guiding for a much worse third quarter and fiscal year than expected.
Here’s where the major stock market benchmarks ended:
The SPX rose 119.81 points (2.3%) to 5,319.31; the Dow Jones Industrial Average® ($DJI) climbed 683.04 points (1.76%) to 39,446,49; the NASDAQ Composite® ($COMP) rose 464.21 points (2.9%) to 16,660.02.
The 10-year Treasury note yield (TNX) rose to just under 4%.
Posted on August 8, 2024 by Dr. David Edward Marcinko MBA MEd CMP™
MEDICAL EXECUTIVE-POST–TODAY’SNEWSLETTERBRIEFING
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Essays, Opinions and Curated News in Health Economics, Investing, Business, Management and Financial Planning for Physician Entrepreneurs and their Savvy Advisors and Consultants
“Serving Almost One Million Doctors, Financial Advisors and Medical Management Consultants Daily“
A Partner of the Institute of Medical Business Advisors , Inc.
You might be affected by one of the biggest data breaches ever and not even know it. A recent class action lawsuit filed against Jerico Pictures Inc., a background check company that does business under the name National Public Data, claims that the company was breached by hackers earlier this year.
The SPX dipped 40.5 points (0.8%) to 5,199.5; the Dow Jones Industrial Average® ($DJI) fell 234.2 points (0.6%) to 38,763.45 the NASDAQ Composite ($COMP) fell 171 points (1.1%) to 16,195.8.
The 10-year Treasury note yield (TNX) rose to 3.96%.
Fortinet skyrocketed 25.30% after the cybersecurity company posted strong second-quarter earnings that only served to underline its potential as a CrowdStrike alternative.
Lumen Technologies continued to power higher, rising another 32.90% today as the investors poured money into the telecom due to its AI business boom.
Shopify tore 17.80% higher after posting a beat-and-raise earnings report highlighted by strong demand despite weak consumer spending.
Lyft drove 17.23% lower in spite of strong ridership in the second quarter. Shareholders, however, did not like management’s dour financial forecast for the third quarter.
CVS Health sank 3.19% after it slashed its profit guidance for the full year, though it also announced a new cost-cutting program.
TripAdvisor took a trip south today, falling 16.61% due to a mixed earnings report and dire warnings of lower revenue in the coming quarter.
Novo Nordisk sales thinned on Ozempic earnings miss. Shares of Danish pharmaceutical giant Novo Nordisk sank 8.27% today after the company missed expectations on its sales of popular weight-loss drugs Ozempic and Wegovy. Novo reported $1.7 billion in Wegovy sales, below the $2 billion analysts expected, while Ozempic sales came in $0.2 billion lower than analyst estimates. Overall, the company reported a net profit of $1.86 billion in the second quarter.
Posted on August 7, 2024 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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Stock Marketsseesawed up yesterday, making back some of the ground lost to Monday’s sell-off. Analysts say the market could remain volatile until September, when the Fed is widely expected to cut interest rates—barring an emergency cut before then. One of the day’s big winners was Uber, which revved up after smashing Q2 revenue expectations thanks to unexpectedly strong consumer demand.
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One day after the S&P 500’s worst session since 2022, stocks partially rebounded, putting fears of a recession on hold. Tuesday started well, with Japan’s Nikkei—which had cratered on Monday—logging its best day since 2008, giving US investors some positive energy From there, US stocks, including Magnificent Seven stalwarts like Microsoft and Nvidia, and both major cryptocurrencies, moved up. “Get used to the volatility,” one Bank of America analyst told Bloomberg. The S&P 500 is still up over 10% this year despite this week’s turbulence.
Finally, DuckDuckGo might soon get its time to shine. A federal judge just ruled that Google has a monopoly over the search engine business, creating the potential for curbs to its power that could change how you look up people you just met online. Google said it will appeal the ruling, but that’s just on one front. It faces another lawsuit questioning whether it abused its monopoly on online advertising technology.
The relative strength index (RSI) is a technical indicator used in the analysis of financial markets. It is intended to chart the current and historical strength or weakness of a stock or market based on the closing prices of a recent trading period. The indicator should not be confused with relative strength.
The RSI is classified as a momentum oscillator, measuring the velocity and magnitude of price movements. Momentum is the rate of the rise or fall in price. The relative strength RS is given as the ratio of higher closes to lower closes. Concretely, one computes two averages of absolute values of closing price changes, i.e. two sums involving the sizes of candles in a candle chart. The RSI computes momentum as the ratio of higher closes to overall closes: stocks which have had more or stronger positive changes have a higher RSI than stocks which have had more or stronger negative changes.
The RSI is most typically used on a 14-day time frame, measured on a scale from 0 to 100, with high and low levels marked at 70 and 30, respectively. Short or longer time frames are used for alternately shorter or longer outlooks. High and low levels—80 and 20, or 90 and 10—occur less frequently but indicate stronger momentum.
The relative strength index was developed by J. Welles Wilder and published in a 1978 book, New Concepts in Technical Trading Systems, and in Commodities magazine (now Modern Trader magazine) in the June 1978 issue. It has become one of the most popular oscillator indices.
The RSI provides signals that tell investors to buy when the security or currency is oversold and to sell when it is overbought.
RSI with recommended parameters and its day-to-day optimization was tested and compared with other strategies in Marek and Šedivá (2017). The testing was randomized in time and companies and showed that RSI can still produce good results; however, in longer time it is usually overcome by the simple buy-and-hold strategy.
When it comes to purchasing a medical practice, there are a variety of factors that one must consider in evaluating the worth of the practice. Assessing the value of a practice is fraught with potential landmines if one does not go into the process with a strong understanding of some key principles to medical practice valuation.
According to the Dictionary of Health Economics and Finance, practice valuation is the “formal process of determining the worth of healthcare or other medical business entity at a specific point in time and the act or process of determining fair market value.” Fair market value is defined as “ … the price at which a willing buyer will buy and a willing seller will sell an asset in an open free market with full disclosure.”
The Internal Revenue Service (IRS) Revenue Ruling 59-60 clearly states that fair market value “is essentially a future prophecy and must be based on facts available at the required date of appraisal.”
Unfortunately, one cannot directly observe the value of a medical practice as there are a number of underlying issues. Obviously, the buyer and seller are pursuing opposite objectives, and this reality is not necessarily conducive to facilitating clarity on those issues.
Accordingly, let us consider a few mistakes that are commonly made by physicians who are considering the purchase of a medical practice.
A Guide To The Myths And Realities Of Medical Practice Valuation
• Valuations are material representations providing a range of transferable worth. • Valuations are reproducible estimates based on economic assumptions. • Valuations are not “back of the envelope multiples” using specious benchmarks. • Valuations are defensible and should be “signed off” by the completing firm attesting to origination guidelines and in accordance with the Uniform Standards of Professional Appraisal Practice (USPAP) and IRS formats as needed. • Financial accounting value (book value) is not fair market value. • Professional valuators represent only one party. The buyer or seller-owner is the client. • Unbiased valuators do not provide financing or equity participation schemes.
Knowing The Distinctions Among Engagement Types
The Institute of Medical Business Advisors uses three levels that approximate engagement types for the industry. These levels are comprehensive valuation, limited valuation and ad-hoc valuation.
A comprehensive valuation is an extensive service designed to provide an unambiguous opinion of the value range. It is supported by all procedures that valuators deem relevant with mandatory onsite review. This gold standard is suitable for contentious situations like divorce, partnership dissolution, estate planning and gifting, etc. The written opinion of value is applicable for litigation support activities like depositions and trial. It is also useful for external reporting to bankers, investors, the public and IRS, etc.
A limited valuation lacks additional suggested USPAP procedures. It is considered to be an “agreed upon procedure,” which is used in circumstances in which the client is the only user. For example, one may use the limited valuation when updating a buy-sell agreement or when putting together a practice buy-in for a valued associate. This limited valuation would not be for external purposes. No onsite visit is needed. A formal opinion of value is not rendered.
An ad-hoc valuation is a low level engagement that provides a gross and non-specific approximation of value based on limited limited parameters or concerns by involved parties. Neither a written report nor an opinion of value is rendered. The ad-hoc valuation is often used periodically as an internal organic growth/decline gauge.
Are You Following Industry Standards And Rules?
Specifically, when it comes to USPAP transactions involving physician practices, the following points are implied by the industry and the IRS.
• Discounted cash flow analysis is the most relevant income approach and must be done on an “after-tax” basis. It generally produces a higher value but is costly, detail-oriented and time consuming. • Project practice collections based on reasonable assumptions for the practice and market, etc. • Physician compensation is based on market rates consistent with age, experience and productivity. • Majority (control) premiums and minority (lack of control) discounts are also to be considered. A majority premium is the amount paid to gain enough ownership to set policies, direct operations and make decisions for the practice. A minority discount for partial ownership does not allow this power. Thus, majority ownership is valuated higher than minority ownership purchase.
What About Personal Goodwill And Practice Goodwill?
Goodwill represents the difference between practice purchase price and the value of the net assets. Personal goodwill results from the charisma, skills and reputation of a specific doctor. These attributes accrue solely to the individual, are not transferable and cannot be sold. Personal goodwill has little or no economic value.
Transferable medical practice goodwill has value, may be transferred and is defined as the unidentified residual attributes that contribute to the propensity of patients and managed care contracts (and their revenue streams) to return in the future.
However, bear in mind that the Goodwill Registry, an older source used to determine the average percentage of revenue contributed to practice goodwill, has sparse to no podiatry input, may be dated for some specialties and leads to abnormally high values.
In addition to various multiple factors, one must also appreciate the impact of a changing environment and practice transfer in a local market, which can augment or blunt goodwill value. It is also important to determine whether patients or HMOs return because of true goodwill or are mandated to do so by contractual obligations.
Now to further confuse the issue, how each kind of goodwill is allocated in situations like divorce depends on state law. For example, some courts weigh in on the apportionment of both kinds of goodwill, other courts exclude both kinds of goodwill and other courts pursue a case-by-case approach.
Understanding ‘Excess Earnings Capitalization’ And Compensation Issues
Another way to determine goodwill value is through “excess earnings capitalization.” This economic method looks at the difference between salary and what you would have to pay a comparable doctor replacement.
As an example, when you subtract the numbers and divide the result by 20 percent, an important percentage referred to as the capitalization rate emerges. The final number gives a dollar value for practice goodwill. Courts seem to prefer this method in divorce situations because it tends to reflect a practice’s current value.
Regardless of the practice business model, physician compensation is inversely related to practice value. In other words, the more a doctor takes home in above average salary, the less the practice is generally worth and vice versa.
Emphasize Practice Specifics Over Benchmarks And Formulas
In the stable economic past, physicians may have used industry benchmarks as quick and inexpensive substitutes for professionally prepared valuations. However, this practice can be fraught with peril if challenged. The courts seem to frown on this simplistic and dated methodology. Moreover, generic benchmark formulas assume a financial statement reporting standard that just does not exist with contemporary professional valuations.
Therefore, almost every competitive issue that impacts value should be addressed with each practice engagement. This includes but is not limited to:
• contemporary dislocations by third parties, Medicare and commercial payers; • retail clinics and changes in supply/ demand and specialty trends; • the rise of ambulatory surgery centers, walk-in clinics and specialty hospitals; • outsourced care and medical tourism; • alterations in resource based-relative value units, ambulatory payment classifications (APCs), diagnosis-related groups (DRGs) and newer Medicare-severity diagnosis-related groups (MS-DRGs); and • the Medicare Modernization Act, HIPAA, OSHA, the EEOC and other regulations.
One must also consider the impact of current employee trends to high-deductible health care plans and private concierge medicine. Another consideration is employer shifts away from defined benefits plans to defined contribution plans.
Aggregating Or ‘Normalizing’ Financial Information: What You Should Know
In addition to possibly conducting employee interviews, one must gather appropriate financial information in order to properly value a practice. As a starting point, interested physician buyers should be able to see the following information for the most recent three-year period.
It is especially important to eliminate one-time, non-recurring practice expenses. These are adjusted for excessive or below normal expenses on the profit and loss statement. Such “normalization” can produce a big surprise for benchmark proponents and formula-driven advocates when a selling doctor runs personal expenditures through the practice that a buyer or court would not consider legitimate. Of course, one is less likely to encounter such shenanigans when the valuation is conducted according to professional USPAP and IRS style guidelines.
For example, we recall one doctor who painted his home and wrote it off as a valid business expense. Deleting other major expenses such as country club memberships make a practice look more profitable. This is good news if you are selling it. It is bad news if you are getting a divorce.
Conversely, you may have to defend legitimate business expenses that an appraiser may seek to normalize. For example, doctors may pay for a vehicle through their practice. If they use the vehicle to travel between multiple offices and hospitals, the expense may be legitimate.
Also realize that the appraiser may also add expenses that have not been incurred. For example, the appraiser may add an office manager’s salary if your spouse is in that role for free. This produces a lower appraised value and is common in small podiatry practices. Honorarium is another example that does not figure into value calculations.
Of course, normalization is a sophisticated and time intensive process. However, the expert earns his or her professional fee, and defends the resulting valuation range when challenged.
Keys To Selecting The Right Valuator Professional
The most important credentials to look for are fiduciary level experience, specificity and independence. Some doctors mistakenly turn to those who may have never appraised a practice before. Just because an appraiser has initials behind his or her name, it does not mean he or she understands the peculiarities of medical specialties. Agents, brokers, solicitors and other intermediaries are not fiduciaries.
Physicians looking to assess a practice for possible sale/purchase should only select an independent health economist, who will be your advocate under Securities Exchange Commission (SEC), IRS or other relevant managerial accounting guidelines.
Moreover, be very wary if the valuation is not done in an independent manner or, worse, performed for both parties simultaneously.
Essential Insights On Professional Fees And What You Can Expect
Of course, it is almost impossible to answer concerns regarding fees without specific information. The cost of a valuation can range from $0 to $50,000 for an onsite team of experts for behemoth practices and ambulatory surgery centers. Keep in mind that in most cases you want to ensure the value determination will stand up to IRS scrutiny so the $0 rule of thumb approach is not an option.
However, most reputable firms use a blended fee schedule of fixed and hourly rates (plus expenses). Internists should expect to spend approximately $5,000 to $10,000 for an average sized practice and a limited appraisal that is completely suitable for most internal activities.
External appraisals or poorly aggregated financial information, onsite reviews and litigation support services incur additional costs. However, most doctors find the money well spent. Expect to pay a retainer and sign a formal professional engagement letter.
Finally, once the practice price is agreed upon, sales contract terms and agreements present a plethora of financing challenges for both parties to consider. For example, one must negotiate bank loans (if they are even available), payment rates and length, personal promissory guarantees, down payment offsets, earn-out arrangements and Uniform Commercial Codes.
Final Notes
Do not be surprised if a sales broker does not consider the aforementioned issues as the modern health era emerges. Most agent-appraisers are predominantly concerned with earning commissions by working both transaction parties and may not represent your best interests. Also be aware that they are usually not obliged to disclose conflicts of interest and do not provide testimony as a court approved expert witness.
However, it is a fait accompli that medical practice worth is presently deteriorating. As the population ages and third-party reimbursements plummet, doctors are commoditized and traditional retail medicine is replaced by more efficient wholesale business models like workplace health clinics. The subprime mortgage default fiasco, credit freeze, potential tax reform law expiration, the ACA, VBC, capitation payments and the political specter of a nationalized healthcare system only add fuel to the macroeconomic fires of uncertainty. Do not forget the corona pandemic.
As a result, a good medical practice is no longer good business necessarily and retiring doctors can no longer automatically expect to extract premium sales prices. Moreover, uninformed young physicians should not be goaded to overpay.
Posted on July 26, 2024 by Dr. David Edward Marcinko MBA MEd CMP™
MEDICAL EXECUTIVE-POST–TODAY’SNEWSLETTERBRIEFING
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Essays, Opinions and Curated News in Health Economics, Investing, Business, Management and Financial Planning for Physician Entrepreneurs and their Savvy Advisors and Consultants
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Here’s where the major stock market benchmarks ended:
The S&P 500® index (SPX) fell about 28 points (0.5%) to 5,399.22; the Dow Jones Industrial Average® ($DJI) rose 81 points (0.2%) to 39,935.07; the NASDAQ Composite ended 161 points lower (0.9%) at 17,181.72.
The 10-year Treasury note yield (TNX) dropped four basis points to 4.255%.
The CBOE Volatility Index® (VIX)declined 0.6% to 17.94.
What’s up
IBM popped 4.36% after it crushed earnings expectations thanks to high AI bookings.
Tesla recovered 1.97% after yesterday’s terrible day as investors continue to digest a mixed earnings report.
ServiceNow soared 13.19% thanks to a strong earnings report that solidified the software company’s position as beneficiary of the AI trade.
Airline stocks flew higher today thanks to good news from two big players. Southwest Airlines ascended 5.64% on better-than-expected earnings, while American Airlines rose 4.23% in spite of issuing a profit warning for the coming quarter.
Ford plummeted 18.40% for the automaker’s worst day of trading since 2009 after it missed profit expectations and provided no positive forecast for the quarters ahead.
Royal Caribbean sank 7.61% after the company indicated that it’s facing a slowdown in demand.
Edwards Lifesciences crashed 31.27% thanks to a mixed earnings report, as well as management’s guidance that sales for its key heart valve replacement therapy will sink next quarter.
Thousands of seniors are losing coverage at local hospitals as problems plague Medicare Advantage. Lower payout rates for Medicare and Medicaid are sparking insurance companies to leave certain areas and change coverage options across the country.
Posted on July 22, 2024 by Dr. David Edward Marcinko MBA MEd CMP™
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Essays, Opinions and Curated News in Health Economics, Investing, Business, Management and Financial Planning for Physician Entrepreneurs and their Savvy Advisors and Consultants
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Shares of Charles Schwab (NYSE: SCHW) fell over 15% last week, according to data from S&P Global Market Intelligence. One of the largest brokerages posted slow growth and poor earnings as the company deals with low-yielding assets on its balance sheet. As of 1:31 p.m. ET on Friday, July 19th, Charles Schwab stock was down 17.5% this week.
Markets: The S&P 500 logged its worst week since April as investors pulled back from Big Tech stocks. CrowdStrike fell because causing a global IT outage is not good (more on that in a sec).
In a recent video, finance YouTuber Lena Petrova highlighted the troubling financial state of U.S. banks as they report significant losses and increase their reserves to cover a surge in loan delinquencies. With the second quarter results rolling in, it’s evident that the banking sector is under considerable strain.
Posted on July 21, 2024 by Dr. David Edward Marcinko MBA MEd CMP™
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CrowdStrike saw its share price plummet Friday, although it is still up ~24% YTD. At $74.2 billion, CrowdStrike has the second-largest market cap in the IT security industry, behind only Palo Alto Networks ($107.1 billion), and reported $900 million in revenue for the quarter ending in April, per Reuters. It’s got ~29,000 customers, which is part of why the outage caused so much havoc.
Crowdstrike Banks: Some traders at JPMorgan Chase, UBS, Bloomberg, and other financial institutions couldn’t execute orders yesterday morning, with one unnamed senior trader telling the Financial Times that it was “the biggest upset in years.”
Crowdstrike Healthcare: Many hospitals—including some of the largest in Europe and the US—were forced to cancel all elective operations, routine appointments, and walk-ins, and online portals for most UK general practitioners went down.
Posted on July 19, 2024 by Dr. David Edward Marcinko MBA MEd CMP™
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Essays, Opinions and Curated News in Health Economics, Investing, Business, Management and Financial Planning for Physician Entrepreneurs and their Savvy Advisors and Consultants
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The S&P 500 and NASDAQ both continued to sink under the weight of a tech selloff today, with semiconductors leading the way down. But even the Dow and Russell 2000, which have been the clear winners of the recent rally, took a beating today as investors assessed what a market rotation really means for them. 10-year Treasury yields bounced from recent lows as investors try to read between the lines of a full week of Fedspeak. Gold and oil both sold off a bit more today, though both remain near recent highs.
Warner Bros Discovery soared 2.40% on a report from the Financial Times that the company is preparing to break itself up.
Chuy’s Holdings skyrocketed 47.76% after Darden Restaurants announced it is acquiring the company for $605 million. Shares of Darden Restaurants fell 3.03% on the news.
D.R. Horton rose 10.01%, though it initially sank after a mixed earnings report, but turned things around by announcing a $4 billion buyback program.
Cintas popped 5.44% thanks to a strong earnings report, as businesses continue to spend on uniforms no matter what the economic environment may be.
What’s down
Domino’s Pizza sank 13.42% after it missed earnings expectations last quarter and warned it will open fewer stores for the rest of 2024.
Beyond Meat tanked 10.32% on a report from the Wall Street Journal that management is in talks to restructure the company’s debt.
Eli Lilly slid another 6.24% as its selloff continues thanks to news that rival Roche Holdings is on its way to developing a weight-loss pill.
Nokia dropped 7.05% after posting its worst quarterly sales since 2015. Seems like nobody is buying phones with the shape and durability of a brick any more.
The S&P 500 index fell 43.68 points (–0.78%) to 5,544.59; the Dow Jones Industrial Average® ($DJI) lost 533.06 points (–1.29%) to 40,665.02; the NASDAQ Composite gave up 125.70 points (–0.7%) to 17,871.22.
The 10-year Treasury note yield (TNX) rose about four basis points to 4.18%.
The CBOE Volatility Index climbed sharply to 15.9, its highest close since late April.
Posted on July 18, 2024 by Dr. David Edward Marcinko MBA MEd CMP™
as MEDICAL EXECUTIVE-POST–TODAY’SNEWSLETTERBRIEFING
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The Dow surged another 240 points as the cyclical rotation continues, sending the index to its 22nd record closing high of the year. The S&P 500 had its worst day since late April, while the NASDAQ slumped to its worst finish since December 2022. The last time the Dow rose on the same day the S&P 500 fell by more than 1% was all the way back in 1999. Gold hit a record high yesterday on hopes of a rate cut, not a hike. Oil bubbled up thanks to an Energy Information Administration report highlighting higher demand and lower crude inventories. Bond yields stayed steady throughout the trading session before sinking slightly 20-year Treasury bond auction.
The S&P 500® index (SPX) fell 78.93 points (–1.39%) to 5,588.27; the Dow Jones Industrial Average added 243.6 points (0.59%) to 41,198.08; the NASDAQ Composite plunged 512.41 points (–2.77%) to 17,996.92.
The 10-year Treasury note yield (TNX) dropped just below 4.15%.
The CBOE Volatility Index jumped sharply to 14.48.
What’s up
VF Corp. rose 13.64% on the news that it is selling its Supreme brand to EssilorLuxottica for $1.5 billion.
Roche soared 7.55% after the Swiss pharmaceutical company announced it has made strides in developing a weight-loss and diabetes treatment that uses a pill rather than an injection. Competitors sank on the news, with Eli Lilly declining 3.78% and Novo Nordisk falling 3.87%.
GitLab popped 9.34% on a report that the software developer is exploring a sale, potentially to cloud company Datadog, whose shares fell 7.35%.
Johnson & Johnson rose a tepid 3.67% thanks to a mixed earnings announcement that included beating expectations this quarter but warning of lower profits ahead.
What’s down
Spirit Airlines descended 10.76% to a new all-time low after warning that both earnings and revenue will come in lower than expected this coming quarter.
Five Below plummeted 25.05% after its CEO, who has helmed the company for over a decade, announced his departure smack in the middle of a very difficult year.
J.B. Hunt tanked 6.88% thanks to a poor second-quarter earnings report in which earnings and revenue came in well below analyst expectations.
Charles Schwab fell yet another 5.34% as the hits keep coming. Today, the culprit was a price target downgrade from Bank of America analysts.
Elevance Health slipped 5.96% despite beating analyst expectations this quarter, but warning that Medicaid membership declined.
UnitedHealthGroup has bounced back in the second quarter, reaffirming its guidance for the year as it posts a profit of $4.2 billion.
An audit of Aetna Health of Texas found significant errors in how the health plan calculated the qualifying payment amount for air ambulance services, raising more questions over broader noncompliance in the industry for the No Surprises Act.
And … clinical decision software company Regard pocketed $61 million in series B funding to scale its reach in healthcare as investors have a growing appetite for AI-powered startups.
A study published in JAMA this month found that nearly 7% of the US population (or roughly 18 million people) have had long Covid. Symptoms of the condition vary widely, but often include fatigue, brain fog, and post-exertional malaise (meaning symptoms worsen after minimal exertion), according to the CDC. Booster shots may help protect against long Covid, the JAMA study suggested.
And, President Joe Biden tested positive for COVID-19 while campaigning in Las Vegas with ‘mild symptoms’.
Physician burnout is on the decline after spiking to unprecedented levels during the Covid-19 pandemic, according to a survey from professional group the American Medical Association (AMA).
Posted on July 17, 2024 by Dr. David Edward Marcinko MBA MEd CMP™
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Essays, Opinions and Curated News in Health Economics, Investing, Business, Management and Financial Planning for Physician Entrepreneurs and their Savvy Advisors and Consultants
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The Dow jumped 700 points at one point today, its biggest single-day surge this year. The S&P 500 spent the entire trading session in positive territory, ending the afternoon at another record close, while the NASDAQ was flat most of the day as tech stocks sat out the rally.
Bitcoin continued to surge, rising as high as $65,191 as predictions of a second Trump presidency helped erase the cryptocurrency’s recent losses.
Gold hit a new record as hopes of a rate hike continue to rise, while oil sank on the news of slower economic growth in China translating to lower demand for crude.
The Russell 2000 enjoyed its 5th straight gain of 1% or more for the first time since 1979 as small caps make their comeback (more on that below).
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Apple released public beta versions of the newest software for iPhone, Mac, iPad, and Apple Watch. Macy’s ended talks of a buyout with investment firms Arkhouse Management and Brigade Capital Management after months of wrangling. Goldman Sachs was the latest big bank to benefit from rebounding investment banking fees as deals start making a comeback.
Despite such challenges as high interest rates, a sluggish M&A market, and increased regulatory scrutiny, bank executives are feeling optimistic about the road ahead. That’s according to KPMG’s 2024 US Banking Industry Outlook Survey, published last month, which polled 200 senior executives at US banks of varying sizes in March 2024.
The S&P 500® index (SPX) rose 35.98 points (0.64%) to 5,667.20; the Dow Jones Industrial Average® ($DJI) climbed 742.76 points (1.85%) to 40,954.48; the NASDAQ Composite® ($COMP) added 36.77 points (0.2%) to 18,509.34.
The 10-year Treasury note yield (TNX) fell slightly to just under 4.17%.
The CBOE Volatility Index® (VIX) ticked up to 13.19, still near three-week highs.
What’s up
Match Group climbed 7.46% after activist investor Starboard Value revealed it has taken a 6.6% stake in the matchmaking company.
Bank of America rose 5.35% on strong earnings, and management’s expectation that the bank’s net interest income will rise this year.
UnitedHealth Group popped 6.49% after beating analyst earnings estimates, missing revenue expectations, and most importantly, avoided higher costs after a recent cyberattack.
Shopify surged 8.57% thanks to an analyst upgrade from “neutral” to “buy” on the company’s turnaround efforts. Shares of Etsy rose 6.33% in sympathy.
GRAIL boomed 24.76% on the news that it is kicking off the clinical trials of its new cancer detection test.
Home builders’ hot streak continues: Hopes of a rate cut are fueling a rally for home builder stocks, with D.R. Horton up 6.64%, Lennar rising 6.55%, KB Home gaining 7.17%, and Builders FirstSource popping 8.11%.
What’s down
Trump Media & Technology Group fell 9.09%, sinking back to Earth after yesterday’s big pop on the news that the company is reselling 38 million shares of common stock.
Posted on July 16, 2024 by Dr. David Edward Marcinko MBA MEd CMP™
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Essays, Opinions and Curated News in Health Economics, Investing, Business, Management and Financial Planning for Physician Entrepreneurs and their Savvy Advisors and Consultants
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Though the accountant shortage is still a concern, a shortage of AI and tech skills might be a more pressing issue right now. That’s according to a pulse survey by consulting firm RGP and YouGov, which polled 213 US financial professionals at the director level and above this June.
Read: What do you do when you hit your insurance deductible? Some people throw parties. (the New York Times)
The S&P 500® index (SPX) rose 15.87 points (0.28%) to 5,631.22; the Dow Jones Industrial Average® ($DJI) climbed 210.82 points (0.53%) to 40,211.72, a new record-high close; the NASDAQ Composite® ($COMP) added 74.12 points (0.4%) to 18,472.57.
The 10-year Treasury note yield (TNX) gained four basis points to just below 4.23%.
The CBOE Volatility Index® (VIX) increased to 13.14, its highest close since June 24.
What’s up
Bitcoin-related stocks rose alongside the crypto rally today, with Coinbase up 11.39% and Microstrategy climbing 15.36%.
Gun manufacturersalways rise after a major shooting incident, and the assassination attempt on Donald Trump certainly meets that criteria. Sturm, Ruger & Company jumped 5.44%, and Smith & Wesson rose 11.38%.
AutoNation popped 2.01% on the news that it’s cutting $1.50 off of its EPS for the latest quarter due to the CDK cyberattack. Apparently getting ahead of the bad news is actually good news?
What’s down
Macy’s sank 11.76% after the department store’s board voted to end acquisition negotiations with activist investors Arkhouse and Brigade.
Burberry fell 16.08% after a poor quarterly report, a profit warning, and the ousting of its CEO.
AES plummeted 10.01% thanks to a storm cutting power to thousands of the utility company’s customers throughout Ohio.
SolarEdge Technologies dropped 15.36% after the company announced it will lay off 400 employees to improve profitability. Shares of solar competitors slumped in sympathy: First Solar fell 8.50%, Sunrun sank 8.95%, and Sunnova Energy fell 9.96%.
The Federal Trade Commission (FTC) frequently sets its sights on healthcare, which has previously included efforts to crack down on data privacy and ban noncompetes in contracts. Lately, the agency has turned its attention to pharmacy benefit managers (PBMs)—the groups that negotiate drug prices between insurers and pharmaceutical manufacturers—to shed light on how they impact the healthcare industry.
DEFINITION: The PPI is a group of indexes that measure the change, over time, in the prices received by domestic producers of goods and services. It measures price changes from the perspective of the seller rather than the consumer, as with the CPI. The CPI would include imported goods, while the PPI is relevant to U.S. producers, and therefore would not include imports.
The PPI measures over 10,000 products and services. It reports the price changes prior to the retail level. This information is useful to the government in formulating fiscal and monetary policies. The data gathered from the PPI is often used in escalating purchase and sales contracts. That is the dollar amount to be paid at some time in the future.
NOTE: Long-term managed medical care contracts of the future will seek escalation clauses for increases in prices.
According to the Health Dictionary Series of administrative terms; valuation expert and colleague Robert James Cimasi MHA, ASA, AVA CMP™ of www.HealthCapital.com; an ACO is a healthcare organization in which a set of providers, usually large physician groups and hospitals, are held accountable for the cost and quality of care delivered to a specific local population. ACOs aim to affect provider’s patient expenditures and outcomes by integrating clinical and administrative departments to coordinate care and share financial risk [personal communication]
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Enter the PP-ACA
Since their four-page introduction in the PP-ACA of 2010, ACOs have been implemented in both the Federal and commercial healthcare markets, with 32 Pioneer ACOs selected (on December 19, 2011), 116 Federal applications accepted (on April 10, 2012 and July 9, 2012), and at least 160 or more Commercial ACOs in existence today.
Federal Contracts
More recently, Donna Marbury writing in Medical Economics, revealed that Federal ACO contracts are established between an ACO and CMS, and are regulated under the CMS Medicare Shared Savings Program (MSSP) Final Rule, published November 2, 2011. ACOs participating in the MSSP are accountable for the health outcomes, represented by 33 quality metrics, and Medicare beneficiary expenditures of a prospectively assigned population of Medicare beneficiaries. If a Federal ACO achieves Medicare beneficiary expenditures below a CMS established benchmark (and meets quality targets), they are eligible to receive a portion of the achieved Medicare beneficiary expenditure savings, in the form of a shared savings payment.
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Commercial Contracts
Commercial ACO contracts are not limited by any specific legislation, only by the contract between the ACO and a commercial payer. In addition to shared savings models which may not be in effect for another 3-5 years, Commercial ACOs may incentivize lower costs and improved patient outcomes through reimbursement models that share risk between the payer and the providers, i.e., pay for performance compensation arrangements and/or partial to full capitation.
Although commercial ACOs experience a greater degree of flexibility in their structure and reimbursement, the principals for success for both Federal ACOs and Commercial ACOs are similar. And, nearly any healthcare enterprise can integrate and become an ACO, larger enterprises, may be best suited for ACO status.
Larger organizations are more able to accommodate the significant capital requirements of ACO development, implementation, and operation (e.g., healthcare information technology), and sustain the sufficient number of beneficiaries to have a significant impact on quality and cost metrics.
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The International Franchise Association (IFA) estimates that that about $1 trillion in sales, or 40% of all retail sales, were made through franchised establishment last decade. On the positive side, franchises offer a branded practice concept with management training and access to proprietary methods, marketing and advertising campaigns and a host of support. Moreover, there are franchises available for virtually every healthcare product or service, including: diet, weight loss and fitness; vein care and laser surgery; vitamins, nutriceuticals and pharmaceuticals; plastic and cosmetic surgery; dermatology, tanning and skin care; home healthcare and extended, etc.
Some well know established healthcare and medical franchises are: Doctors Express, Being There Senior Care, Home Care Assistance, Personal Training Institute, Inches-A-Weigh, Remedy Intelligent Staffing, Visiting Angels, Unlimited MedSearch, prnYourHealth and Any Lab Test Now.
On the downside, franchises incur high start-up costs, rules and obligations, payment of franchise percentages and many contractual obligations.
Questions to consider when contemplating this business entity include:
Franchise stability, track record, licensing and costs. Training, support and proximity of other franchises. Independence, ownership laws, contracts and dispute resolutions, Screening methods, market size and potential market share. Replacement cost and transferability?
For more information on Uniform Franchise Offerings Circulars (UFOCs) contact:
Frandata 1130 Connecticut Avenue, NW Washington DC 20036 202.659.8640
International Franchise Association7 1350 New York Avenue, NW Washington, DC 20005 202.628.800
Multi-Level Marketing and In-Office Dispensation
A multi-level marketing (MLM) business delivers products or services through a chain of independent distributors rather than traditional retail business outlets. Existing medical practices not only pursue income ancillary, but it is not unusual for beginning practitioners to plan for and include it in their start-up models and business plans.
The first layer is usually the distributor who must sell products/services and recruit additional members to produce a hierarchical organization with many employees. Each distributor profits from direct sales, and from a varying commission stream down-line. It may be best to investigate before you leap into these situations since some may be fraudulent pyramid schemes that sell no useful product or service, and requires only recruiting others into the scheme. Be sure to obtain a Dunn & Bradstreet or TRW credit report about any MLM company and inquire about current litigation. Most authorities agree that it take 3-5 years before serious money is made in the MLM business.
Moreover, care must be taken with this model. According to colleague Stephen Barrett MD, writing on the Mirage of Multilevel Marketing: “Many any physicians are selling health-related multi-level products to patients in their offices. The companies most involved have included Amway (now doing business as Quixtar), Body Wise, Nu Skin (Interior Design), Rexall, and Juice Plus+. Doctors are typically recruited with promises that the extra income will replace income lost to managed-care.
Back, in December 1997, the AMA Council on Ethical and Judicial Affairs (CEJA) advised against profiting from the sale of “non- health-related products” to their patients. Although CEJA’s policy statement does not mention products sold through multilevel marketing, CEJA’s chairman said the statement was triggered by the growing number of physicians who had added an Amway distributorship to their practice.”
Posted on July 10, 2024 by Dr. David Edward Marcinko MBA MEd CMP™
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The S&P 500 index®(SPX) rose 4.13 points (0.1%) to 5,576.98; the Dow Jones Industrial Average® ($DJI) fell 52.82 points (0.1%) to 39,291.97; the NASDAQ Composite® ($COMP) climbed 25.55 points (0.1%) to 18,429.9.
The 10-year Treasury note yield increased two basis points to 4.29%.
The CBOE Volatility Index® (VIX) inched up to 12.49, still near recent lows.
What’s up
Tesla rose 3.71%, putting the company squarely in the green year to date as investors continue to celebrate the automaker’s strong delivery numbers.
Corning rose yet another 3.76%, extending the glassmaker’s gains as it quickly becomes the new hot AI stock du jour.
KymeraTherapeutics shot 23.40% higher after its partner Sanofi gave the go-ahead for further studies of its experimental skin disease treatment.
Jumia Technologies soared 29.79% after Benchmark analysts initiated coverage of the African e-commerce company with a “buy” rating.
Sony rose 4.46% on the news that it has nothing to do with the merger of Paramount and Skydance as shareholders celebrate dodging a Paramount-shaped bullet.
What’s down
Albemarle dropped 8.76% after Baird analysts warned that lower lithium demand will translate to lower profits for the miner in its upcoming second quarter.
BP sank 4.80% after management warned of lower-than-expected profits and a writedown of its German refining facility to the tune of up to $2 billion.
Helios Technologies fell 10.94% on the news that the CEO of the industrial manufacturer had been placed on paid leave for potentially violating the company’s code of ethics.
OpenAI’s venture fund and Arianna Huffington’s Thrive Global are jointly funding a new startup that aims to build an AI health coach to promote healthier lifestyles.
Function Health, a health tech company focused on preventive medicine, recently closed a series A round led by Andreessen Horowitz (a16z) Bio + Health along with a slew of celebrity investors.
Posted on July 9, 2024 by Dr. David Edward Marcinko MBA MEd CMP™
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Essays, Opinions and Curated News in Health Economics, Investing, Business, Management and Financial Planning for Physician Entrepreneurs and their Savvy Advisors and Consultants
“Serving Almost One Million Doctors, Financial Advisors and Medical Management Consultants Daily“
A Partner of the Institute of Medical Business Advisors , Inc.
The CBOE Volatility Index® (VIX) climbed slightly to 12.37.
The S&P 500 index®(SPX) rose 5.66points (0.1%) to 5,572.85; the Dow Jones Industrial Average® ($DJI) dropped 31.08 points (0.1%) to 39,344.79; the NASDAQ Composite® ($COMP) gained 50.98 points (0.3%) to 18,403.74.
The 10-year Treasury note yield (TNX) was roughly flat at 4.27%.
Intel popped 6.15% after an analyst at Melius Research declared the company could be one of the big AI winners in the second half of this year.
Morphic Holding skyrocketed 75.06% on the news that Eli Lilly will acquire the drugmaker for $3.2 billion in cash.
SolarEdge climbed 9.26% thanks to an upgrade from “underperform” to “neutral” by Bank of America analysts, who see big upside and few downside risks ahead.
Lucid rose 7.85% on the news that its deliveries rose 70% in the second quarter.
What’s down
ServiceNow dipped 5.04% after Guggenheim analysts downgraded the cloud computing company to “sell,” citing growing risks in the second half of this year.
Stat: 27. That’s a tally of some of the hospital mergers, acquisitions, joint ventures, affiliations, and partnerships that have been canceled since January 2022. (Becker’s Hospital Review)
Read: Health insurers received $50 billion from Medicare for diseases that doctors did not treat over three years, according to a recent analysis. (Wall Street Journal)
Private equity and venture capital investments typically involve ownership of shares in a company and represent title to a portion of the company’s future earnings. However, private equity is an equity interest in a company or venture whose stock is not yet traded on a stock exchange.
Venture capital is typically a special case of private equity in which the investment is in a company or venture that has little financial history or is embarking on a high risk/high potential reward business strategy.
Like real estate, private equity and venture capital investments generally share a general lack of liquidity and a lack of comparability across different individual investments. The lack of liquidity comes from the fact that private equity and venture capital investments are typically not tradable on a stock exchange until the company has an IPO.
The lack of comparability is due to the fact that most private equity and venture capital investments are the result of direct negotiation between the investor/venture capitalist and the existing owners of the company /venture.
With widely divergent terms and provisions across different investments, it is difficult to make general claims regarding the characteristics of private equity and venture capital investments.
Posted on July 6, 2024 by Dr. David Edward Marcinko MBA MEd CMP™
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Essays, Opinions and Curated News in Health Economics, Investing, Business, Management and Financial Planning for Physician Entrepreneurs and their Savvy Advisors and Consultants
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As home hospital programs continue to grow—employment in the home health industry is projected to increase by nearly 30% by 2029—so does the concern that home healthcare professionals are increasingly vulnerable to assault and harassment.
The S&P 500 index® (SPX)rose 30.17 points (0.54%) to 5,567.19; the Dow Jones Industrial Average® ($DJI) rose 67.87 points (0.17%) to 39,375.87; the NASDAQ Composite® ($COMP) climbed 164.46 points (0.9%) to 18,352.76.
The 10-year Treasury note yield (TNX) dropped nearly seven basis points to just below 4.28%.
The CBOE Volatility Index® (VIX) increased slightly to 12.45.
What’s up
Meta Platforms rose 5.88% a day after CEO Mark Zuckerberg posted a video of himself wearing a tux, holding an American flag and a beer, and wakeboarding. Shareholders apparently approve of such an absolute stud running the company.
Koss Corp. rose another 25.68% as the latest meme stock continues to rally for no reason at all.
Macy’s popped 9.48% after bidders looking to acquire the beleaguered retailer raised their offer from $6.6 billion to $6.9 billion.
Southwest sank 5.67% on the first full trading day after the company adopted a “poison pill” to fend off activist investor Elliott Management.
Budget airline companies took a blow after a Raymond James analyst downgraded the industry due to a “clear as mud” outlook for the third quarter. Frontier Group fell 6.79%, while Spirit Airlines dropped 8.70%.
Crypto-related stocks tumbled after bitcoin fell below $54,000 at one point today, though they recovered alongside the cryptocurrency later in the trading session. Coinbase Global fell 0.56%, Robinhood Markets dropped 0.98%, and MicroStrategy fell 1.56%.
Posted on July 4, 2024 by Dr. David Edward Marcinko MBA MEd CMP™
MEDICAL EXECUTIVE-POST–TODAY’SNEWSLETTERBRIEFING
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Essays, Opinions and Curated News in Health Economics, Investing, Business, Management and Financial Planning for Physician Entrepreneurs and their Savvy Advisors and Consultants
“Serving Almost One Million Doctors, Financial Advisors and Medical Management Consultants Daily“
A Partner of the Institute of Medical Business Advisors , Inc.
The S&P 500 broke above 5,500 yesterday and stayed there for the first time in market history, notching yet another all-time high for the index—its 32nd this year alone. With so much bullishness it’s understandable that investors may be wondering if we’re at the top yet, but chartists suggests gains tend to beget gains. The bulls have too much momentum to stop now—and if/when the FOMC cuts rates later this year, it seems likely that we’ll see more all-time highs in 2024? Any thoughts.
The Biden administration has awarded $206.3 million of funding to clinician training programs across 42 universities and provider organizations to bolster the nation’s geriatrics care workforce. Programs will be able to integrate geriatrics training into primary care and will work to educate older adults’ families on their care needs. Health and Human Services, in its announcement, noted that primary care providers are a crucial source of care for much of the aging population.
As Walmart shutters its primary care clinics, the retail giant inked a deal to sell its MeMD telehealth business to health tech startup Fabric. Fabric provides a telemedicine platform for a range of customers, including provider groups, with the goal of improving the clinician and patient experience, as well as operational efficiency. The acquisition will expand its provider network, add virtual behavioral health to the company’s services and build on Fabric’s employer and payer solutions.
And…The U.S. Supreme Court has overturned the Chevron deference, stripping power from federal agencies to interpret and enforce regulations. Courts no longerhave to defer to reasonable agency interpretations. One healthcare attorney told Fierce Healthcare he predicts the Centers for Medicare & Medicaid Services will be under a microscope from the courts going forward, and there will be more scrutiny towards provider reimbursement cuts, drug pricing regulation and the Inflation Reduction Act.
The S&P 500 index®(SPX)rose 28.01 points (0.51%) to 5,537.02; the Dow Jones Industrial Average® ($DJI) fell 23.85 points (-0.1%) to 39,308.00; the NASDAQ Composite® ($COMP) gained 159.54 points (0.9%) to 18,188.30.
The 10-year Treasury note yield (TNX) dropped seven basis points to 4.36%.
The CBOE Volatility Index® (VIX) held steady at 12.09.
What’s up
Tesla rose yet another 6.54% as investors continue to celebrate stronger-than-expected delivery numbers. Much like the company’s self-driving mode, this stock can’t stop.
Nvidia rose 4.57%, with the bulls seemingly beating profit-taking bears heading into the holiday.
MGM Resorts popped 2.24% after BTIG analysts gave the company a “buy” rating and a price target 20% higher than shares trade for today.
Quest Diagnostics rose 3.11% after announcing it will acquire fellow laboratory service provider LifeLabs for $985 million.
What’s down
First Foundation plummeted 23.81% after the bank announced it will raise $225 million to shore up a balance sheet burdened by commercial real estate loans.
Constellation Brands fell 3.76% after the alcoholic beverage maker reported stronger than expected earnings but missed Wall Street’s expectations on revenue.
Simulations Plus slid 14.87% after it reported strong third-quarter earnings but announced it’s cutting its dividend.
CureVac popped then dropped 6.59% after GSKbought the rights to the smaller pharma company’s Covid-19 and flu vaccines for $1.6 billion.
Posted on July 3, 2024 by Dr. David Edward Marcinko MBA MEd CMP™
MEDICAL EXECUTIVE-POST–TODAY’SNEWSLETTERBRIEFING
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Essays, Opinions and Curated News in Health Economics, Investing, Business, Management and Financial Planning for Physician Entrepreneurs and their Savvy Advisors and Consultants
“Serving Almost One Million Doctors, Financial Advisors and Medical Management Consultants Daily“
A Partner of the Institute of Medical Business Advisors , Inc.
SCOTUS: Two technology company cases involving Texas and Florida laws challenging social-media companies’ content moderation were sent to lower courts. SCOTUS thus effectively granted the companies a victory. The Supreme Court isn’t willing to blow up the internet just yet.
PitchBook released its analysis of digital health venture capital deals done in the first quarter. The first quarter saw downturns in telehealth and digital therapeutics, but opportunities exist in mental health chatbots and care search platforms.
Amedisys, a large home health provider, plans to divest a number of care centers to an affiliate of VitalCaring Group in advance of its planned merger with UnitedHealth Group later this year.
Paramount Global rose 5.97% on a report from the New York Times that Barry Diller’s IAC may be exploring an acquisition of the embattled entertainment company. IAC fell just 0.26%.
Archer Aviation popped 8.92% after the air taxi manufacturer received a $55 million investment from Stellantis.
Oliveda International is up 19.81% today after the olive oil company announced massive quarterly revenue growth at a key subsidiary.
Pure Storage plunged 4.15% after UBS analysts downgraded the stock to “sell,” citing its high valuation and overhyped AI potential.
Homebuilders took a beating after Citi analysts downgraded Lennar and D.R. Horton from “neutral” to “sell,” noting the housing market will remain soft in the second half of the year. Lennar dropped 1.61%, and D.R. Horton fell 1.35%.
Here’s where the major benchmarks ended:
The S&P 500 index rose 33.92 points (0.62%) to 5,509.01; the Dow Jones Industrial Average® ($DJI) climbed 162.33 points (0.41%) to 39,331.85; the NASDAQ Composite® ($COMP) rallied 149.46 points (0.84%) to 18,028.76.
The 10-year Treasury note yield (TNX) dipped four basis points to 4.43%.
The CBOE Volatility Index® (VIX) dropped to 12.03 after earlier trading at its lowest intraday level since late May.
SCOTUS: Health policy leaders say patients, providers, and health systems should brace for more uncertainty and less stability in the healthcare system. Even routine government functions such as deciding the rate to pay doctors for treating Medicare beneficiaries could become embroiled in long legal battles that disrupt patient care or strain providers to adapt.
Posted on July 2, 2024 by Dr. David Edward Marcinko MBA MEd CMP™
MEDICAL EXECUTIVE-POST–TODAY’SNEWSLETTERBRIEFING
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Essays, Opinions and Curated News in Health Economics, Investing, Business, Management and Financial Planning for Physician Entrepreneurs and their Savvy Advisors and Consultants
“Serving Almost One Million Doctors, Financial Advisors and Medical Management Consultants Daily“
A Partner of the Institute of Medical Business Advisors , Inc.
Private equity gets a big accounting firm yet. The March story about private equity firm New Market Capital buying a $2.8 billion stake in accounting firm Grant Thorton was a big story. Private equity is gobbling up accounting firms, signaling a potential sea change in how accounting firms will operate in the future, with “more than half” of the top 20 accounting firms in talks with private equity.
The S&P 500® index (SPX) rose 14.61 points (0.27%) to 5,475.09; the Dow Jones Industrial Average® ($DJI) climbed 50.66 points (0.13%) to 39,169.52; the NASDAQ Composite® ($COMP) added 146.70 points (0.83%) to 17,879.30.
The 10-year Treasury note yield (TNX) rose 12 basis points to 4.47%, the highest level since May 30 and back above its 50-day moving average, a technically important move.
The CBOE Volatility Index® (VIX) slipped to 12.19.
Crude oil is up sharply over the last month amid rising Middle East tensions.
Spirit AeroSystems Holdings rose 3.35% on the news that Boeing plans to acquire the airplane parts supplier. Boeing shares rose a tepid 2.58%.
Birkenstock climbed 1.78% after UBS analysts rated the stock a “buy” and increased their price target 63% due to the company’s expansion plans.
French stocks rose on snap election results that showed the far-right National Rally may be unable to form a majority after the next round of elections on July 7.
What’s down
Chewy stock popped then dropped 6.63% after Roaring Kitty revealed a 6.6% stake in the pet products company.
GameStop shares fell 5.35% after CEO Ryan Cohen posted on Twitter/X for the first time in months to advertise a job opening.
Uber fell 2.17% and Lyft fell 0.92% on the news that Massachusetts now requires both companies to pay rideshare drivers $32.50 an hour, plus benefits.
Cruise stocks sank on the news that Hurricane Beryl is stronger than expected and will disrupt service throughout the Caribbean. Norwegian Cruise Line fell 5.86%, Carnival fell 5.40%, and Royal Caribbean fell 1.86%.
The largest nursing union in the US, National Nurses United (NNU), is sounding the alarm about the use of artificial intelligence (AI) in healthcare. In April, the union’s affiliate California Nurses Association (CNA) protested an AI conference helmed by managed care consortium Kaiser Permanente. Like workers in other sectors who are worried about AI encroachment, the nurses fear that the tech is contributing to the devaluation of their skills amid what they say is already a “chronic” understaffing crisis, nurses reported in an NNU survey of 2,300 registered nurses and members in early 2024.
Posted on July 1, 2024 by Dr. David Edward Marcinko MBA MEd CMP™
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Essays, Opinions and Curated News in Health Economics, Investing, Business, Management and Financial Planning for Physician Entrepreneurs and their Savvy Advisors and Consultants
“Serving Almost One Million Doctors, Financial Advisors and Medical Management Consultants Daily“
A Partner of the Institute of Medical Business Advisors , Inc.
If you can believe it, Friday was the final trading day of the first half of 2024. It might be a good time to reflect on your New Year’s resolutions to see how you’re measuring up halfway through the year.
Dogs of the Dow: The 139-year-old index has never looked more its age, with components Nike, Intel, and Boeing all down more than 30% in 2024. The Dow has gained less than 4% this year.
But, the S&P 500 gained a sublime 15% in H1, and Nvidia alone was responsible for more than a third of that gain. The maker of AI chips surged ~150% since Jan. 1st to become the most valuable company in the USA at one point.
Going into 2024, investors were expecting the Fed to cut interest rates six times. There hasn’t been a single rate cut yet, but that hasn’t stopped the S&P from notching 31 all-time closing highs, good for the second-best tally of records this century. Stocks have overcome the Fed’s delay thanks to strong earnings, a sturdy economy, and AI fever.
Commodities soar and a currency plummets. Cocoa boomed nearly 85% over shortage concerns. Gold hit a record high last month. The Japanese yen has slumped to a 38-year low against the US dollar.
Bitcoin got a boost from new ETFs, but it’s getting boring.
Posted on June 29, 2024 by Dr. David Edward Marcinko MBA MEd CMP™
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Essays, Opinions and Curated News in Health Economics, Investing, Business, Management and Financial Planning for Physician Entrepreneurs and their Savvy Advisors and Consultants
“Serving Almost One Million Doctors, Financial Advisors and Medical Management Consultants Daily“
A Partner of the Institute of Medical Business Advisors , Inc.
In an interview with the Wall Street Journal, CEO Tim Wentworth said the pharmacy chain Walgreens will shutter a significant share of its 8,600 locations in the US. The closures are part of a broader attempt to boost the ailing company, which also includes reducing its stake in the primary care business VillageMD. Wentworth said the company can reassign most employees instead of conducting layoffs. Shares cratered yesterday after Walgreens whiffed on Wall Street’s earnings projections due to weak consumer spending.
And, read how some counties reduced opioid overdose deaths during the pandemic. (Politico)
Oliveda International, which makes beauty products from olive oil, rose 38.33% for no apparent reason. Maybe people just really like the feel of extra virgin olive oil on their skin?
Infinera popped 16.38% after Nokia announced it would acquire the telecommunications hardware manufacturer for $2.3 billion.
Synchrony Financial rose 6.17% after a Baird analyst initiated coverage of the financial services company with an outperform rating.
Regional banking stocks rose on the hopes that a good PCE reading means a better chance of the Fed cutting rates soon. RegionsFinancial rose 3.83%, while CitizensFinancialGroup rose 3.16%.
What’s down
Trump Media & Technology Group fell 18.09%, despite initially popping this morning after the first presidential debate.
Accolade bombed 44.29% after the health tech company reported decent earnings but revealed lower guidance for the year ahead than Wall Street expected.
Kura Sushi USA, which is in fact a publicly traded sushi company, plummeted 24.04% due to worse-than-expected earnings, as well as poor full-year guidance.
A late round of selling in the Treasury market sent yields to fresh highs as the day ended so here’s where the major benchmarks ended:
The S&P 500® index (SPX) dipped 22.39 points (0.41%) to 5,460.48; the Dow Jones Industrial Average® ($DJI) fell 45.20 points (0.12%) to 39,118.86; the NASDAQ Composite® ($COMP) lost 126.08 points (0.71%) to 17,732.6.
The 10-year Treasury note yield climbed nine basis points to 4.38%.
The CBOE Volatility Index® (VIX) moved up slightly to 12.43.
Nearly 200 people have been charged for their roles in various health care fraud schemes across the U.S. that federal authorities say amounted to over $2.7 billion in intended losses, the Justice Department announced. Attorney General Merrick Garland said charges against 193 people, including 76 doctors, nurse practitioners, and other licensed medical professionals in 32 different federal districts. The defendants were charged over a two-week sweep involving numerous law enforcement agencies nationwide, resulting in the seizure of more than “$231 million in cash, luxury vehicles, gold, and other assets,” according to Garland.
Posted on June 28, 2024 by Dr. David Edward Marcinko MBA MEd CMP™
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Essays, Opinions and Curated News in Health Economics, Investing, Business, Management and Financial Planning for Physician Entrepreneurs and their Savvy Advisors and Consultants
“Serving Almost One Million Doctors, Financial Advisors and Medical Management Consultants Daily“
A Partner of the Institute of Medical Business Advisors , Inc.
Stat: 40%. That’s how much Tenet Healthcare’s shares jumped in Q1. (Yahoo Finance)
Stat: 12%. This is how much the yen has weakened so far this year against the US dollar, which has people wondering whether the Japanese government will need to intervene. (Bloomberg)
Quote: “We believe the opportunity ahead is significant.”—RJ Scaringe, CEO and co-founder of Rivian, commenting on Volkswagen Group’s plans to invest as much as $5 billion in the EV company. (CNBC)
Walgreens Boots Alliance plummeted 22.16% due to a worse-than-expected earnings report that saw the company slash its full-year guidance.
Hims & Hers dropped 7.19% after Hunter Growth Capital accused the company of using a shady supplier for its new weight-loss drugs.
Levi Strauss crashed 15.27% in a denim downfall for the ages, with second quarter earnings missing expectations after consumers spent less on blue jeans.
Micron Technology slid 7.12% despite beating analyst expectations in the third quarter. Unfortunately, management isn’t as bullish as analysts about the rest of the year.
Chewy fell 0.03% despite a tweet from Roaring Kitty of a cartoon dog—which is apparently all it takes to move markets these days.
The U.S. government’s final gross domestic product (GDP) estimate announced early Thursday included a downward revision to quarterly consumer spending.
Treasury yields could move on the data, especially if the report is “hotter” than expected. Yields fell Thursday following mostly soft U.S. economic readings this morning.
Here’s where the major benchmarks ended:
The S&P 500® index (SPX) rose 4.97 points (0.1%) to 5,482.87; the Dow Jones Industrial Average® ($DJI) rose 36.26 points (0.1%) to 39,164.06; the NASDAQ Composite® ($COMP) rose 53.53 points (0.3%) to 17,858.68.
The 10-year Treasury note yield lost two basis points to 4.29%.
The CBOE Volatility Index® (VIX) fell to 12.29, its lowest close since June 13.
Now – Trading individual bonds is not like trading stocks. Stocks can be bought at uniform prices and are traded through exchanges. Most bonds trade over the counter, and individual brokers price them. But, price transparency has gotten better in the last decade.
For example, in 1999, the bond markets gained clearness from the House of Representatives’ Bond Price Competition Improvement Act of 1999. Responding to this pioneering law, the site http://www.investinginbonds.com was established. This site provides current prices on bonds that have traded more than four times the previous day. With the advent of Investinginbonds.com and real-time reporting of many trades, investors are much better off today. Many well regarded brokers including Schwab, Ameritrade, and Fidelity Investments now have dedicated websites devoted to bond trading and pricing.
Fidelity Investments chose to disclose its fee structure for all bonds, making it clear what it will cost you per trade. Fidelity charges $1 per bond trade. Some on-line brokers charge a flat fee as well, ranging from $10.95 at Zions Direct to $45 at TD Ameritrade. Depending on the number of bonds trading, one may be more complimentary than another. The trading fee disclosures, however, do not divulge the spreads between the buy and sell price embedded in the transaction that some dealer is making in the channel. Keep in mind that only by comparison shopping can assist you in finding the best transaction price, after all fees are taken into account. Other sites may not charge any fee, but rather embed the profit in the spread.
Despite the difficulty in pricing and transparency, investing in individual bonds offers several rewards over purchasing bond mutual funds.
First, bond mutual funds never mature.
Second, you know exactly what you will be receiving in interest each year. You will also know the exact maturity date.
Furthermore, your individual investment is protected against interest rate risk, at least over the full term to maturity. Both individual bonds and bond funds share interest-rate risk (the risk of locking up an investment at a given rate, only to see rates rise). This pushes bond prices down. At least with an individual bond, you can re-invest it at the higher, market rate once the bond matures.
But, the lack of a fixed maturity date on a bond mutual fund causes an open ended problem; there is no promise of the original investment back. Short of default, an individual bond will return all principal and pay all interest assuming you hold it to maturity. Bond funds are not likely to default as most funds maintain positions in hundreds of individual bonds. The force of interest rate risk to individual bond or bond mutual fund prices depends on the maturity of a bond investment: the longer the maturity of a bond or bond fund (average), the more the price will drop due to rising rates. This is known as duration.
Duration is a statistical term that measures the price sensitivity to yield, is the primary measurement of a bond or bond fund’s sensitivity to interest rate changes. Duration indicates approximately how much the price of a bond or bond fund will adjust in the reverse direction given a rise in interest rates. For instance, an individual bond with an average duration of five years will fall in value approximately 5% if rates rise by 1% and the opposite is accurate as well.
Although stated in years, duration is not simply a gauge of time. Instead, duration signals how much the price of your bond investment is likely to oscillate when there is an up or down movement in interest rates. The higher the duration number, the more susceptible your bond investment will be to changes in interest rates. If you have money in a bond or bond fund that holds primarily long-term bonds, expect the value of that fund to decline, perhaps significantly, when interest rates rise. The higher a bond’s duration, the greater its sensitivity to interest rates alterations. This means fluctuations in price, whether positive or negative, will be more prominent.
For example, a bond fund with 10-year duration will diminish in value by 10 percent if interest rates increase by one percent. On the other hand, the bond fund will rise in value by 10 percent if interest rates descend by one percent. The important concept to remember is once you recognize a bond’s or bond fund’s duration, you can forecast how it will react to a change in interest rates.
UPDATE:
The yield on the 10-year Treasury note serves as a benchmark for interest rates across the US economy. Since bond prices and yields move in opposite directions, falling yields signal higher demand for Treasuries.
Why it matters: At the most basic level, the 10-year yield is a key indicator of investors’ confidence in future US economic growth. As the Delta variant spreads and threatens to slow the economic recovery, the fall in yields means investors are souring on a mega growth spurt and snapping up safer assets rather than riskier stocks.
What does this mean for inflation? Because investors sell bonds when they think inflation is coming, the runup in bond prices means the worst of Wall Street’s inflation concerns may be over. “It feels like we have moved from thinking inflation will be transitory, to fearing growth will be transitory,” Art Hogan, chief marketing strategist at National Securities, said.
Posted on June 27, 2024 by Dr. David Edward Marcinko MBA MEd CMP™
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Essays, Opinions and Curated News in Health Economics, Investing, Business, Management and Financial Planning for Physician Entrepreneurs and their Savvy Advisors and Consultants
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The S&P 500® index (SPX) rose 8.6 points (0.16%) to 5,477.9; the Dow Jones Industrial Average® ($DJI) added 15.64 points (0.04%) to 39,127.8; the NASDAQ Composite® ($COMP) climbed 87.5 points (0.49%) to 17,805.16.
The 10-year Treasury note yield rose 8 points to 4.32%.
The CBOE Volatility Index® (VIX) eased to 12.5
What’s up
FedEx shipped 15.52% directly to your portfolio after beating fourth-quarter earnings expectations and guiding for higher-than-expected earnings in the coming fiscal year.
Vista Outdoor rose 9.09% after MNC Capital raised its bid to acquire the ammunition maker to $3.2 billion.
What’s down
General Mills dipped 4.58% thanks to a poor quarterly earnings report, with lower sales due to lower demand from consumers.
Paychex fell 6.11% despite beating earnings estimates this quarter. The problem is slower growth ahead due to small and mid-sized businesses struggling with high inflation.
Aptiv dropped 7.93% after news of the Rivian-Volkswagen deal prompted Piper Sandler analysts to downgrade the stock and lower their price target.
The disastrous ransomware attacks on Change Healthcare and Ascension this year ran up staggering costs and put a spotlight on the healthcare sector’s vulnerability. But healthcare orgs are hardly new to eye-popping bills after a major hack. Analyzing attacks on organizations in 16 countries, IBM/Ponemon Institute has shown healthcare to be the industry with the highest cost per data breach for over a decade, coming in at an average hit of $10.93 million in 2023.
Posted on June 26, 2024 by Dr. David Edward Marcinko MBA MEd CMP™
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Essays, Opinions and Curated News in Health Economics, Investing, Business, Management and Financial Planning for Physician Entrepreneurs and their Savvy Advisors and Consultants
“Serving Almost One Million Doctors, Financial Advisors and Medical Management Consultants Daily“
A Partner of the Institute of Medical Business Advisors , Inc.
The U.S. surgeon general just declared gun violence a public health crisis, driven by the fast-growing number of injuries and deaths involving firearms in the country. The advisory issued by Dr. Vivek Murthy, the nation’s top doctor, came as the U.S. grappled with another summer weekend marked by mass shootings that left dozens of people dead or wounded.
The S&P 500 index rose 21.43 points (0.39%) to 5,469.30; the Dow Jones Industrial Average® ($DJI) fell 299.05 points (0.76%) to 39,112.6; the NASDAQ Composite® ($COMP) gained 220.84 points (1.26%) to 17,717.65.
The 10-year Treasury note yield (TNX) fell slightly to 4.24%.
The CBOE Volatility Index® (VIX) dropped to 12.84.
What’s up
Nvidia rose 6.76% as investors realized they could buy shares of the world’s biggest semiconductor company at a discounted price.
Trump Media & Technology Group rose another 8.50% today on the hopes of a cash infusion, as well as hype ahead of Thursday’s presidential debate.
Carnival popped 8.85% after it beat analyst expectations for the second quarter, and raised its profit forecast for the rest of the year.
Novo Nordisk rose 3.25% after its weight-loss drug Wegovy was approved in China.
Enovix soared 35.05% on the news that it signed a major deal to provide VR headset batteries for an as-yet-unnamed California company.
SolarEdge Technologies dropped 20.60% through no fault of its own—instead, a key customer declared bankruptcy, and will be unable to pay the solar power company the $11.4 million it is owed.
Airbus fell 9.41% after the company announced it is cutting financial guidance for the remainder of 2024 thanks to supply chain snarls and higher costs.
Auto dealer stocks continue to suffer the effects of a massive cyberattack on CDK, a key supplier of dealership management software. The company says its systems will remain down until June 30, but in the meantime shares of Autonation fell 2.04%, Sonic Automotive dropped 2.56%, and Group 1 Automotive slid 2.49%.
Digital health company Sharecare has agreed to be acquired by private equity firm Altaris for $1.43 in cash per share, or about $518 million.
Nearly three months after Kaiser Permanente’s Risant Health acquired Geisinger Health, the group has now agreed to terms with Cone Health in North Carolina.
Several years ago a group of highly trusted and deeply experienced financial services professionals and estate planners noted that far too many of their physician clients, using traditional stock brokers, management consultants and financial advisors, seemed to be less successful than those who went it alone. These Do-it-Yourselfers [DIYs] had setbacks and made mistakes, for sure. But, the ME Inc. doctors seemed to learn from their mistakes and did not incur the high management and service fees demanded from general or retail one-size-fits-all “advisors.“
”In fact, an informal inverse relationship was noted, and dubbed the “Doctor Effect.” In others words, the more consultants an individual doctor retained; the less well they did in all disciplines of the financial planning and medical practice management, continuum.
Of course, the reason for this discrepancy eluded many of them as Wall Street brokerages and wire-houses flooded the media with messages, infomercials, print, radio, TV, texts, tweets, and internet ads to the contrary. Rather than self-learn the basics, the prevailing sentiment seemed to purse the holy grail of finding the “perfect financial advisor.” This realization was a confirmation of the industry culture which seemed to be: Bread for the advisor – Crumbs for the client!
And so, at D.E. Marcinko & Associates, our informed cadre’ of technology focused and highly educated doctors, nurses, financial advisors, attorneys, accountants, psychologists and educational visionaries decided there must be a better way for their healthcare colleagues to receive financial planning advice and related management services within a culture of fiduciary responsibility.
Posted on June 25, 2024 by Dr. David Edward Marcinko MBA MEd CMP™
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Essays, Opinions and Curated News in Health Economics, Investing, Business, Management and Financial Planning for Physician Entrepreneurs and their Savvy Advisors and Consultants
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A Partner of the Institute of Medical Business Advisors , Inc.
The S&P 500 index lost 16.75 points (0.31%) to 5,447.87; the Dow Jones Industrial Average ($DJI) gained 260.88 points (0.67%) to 39,411.21; the NASDAQ Composite ($COMP) dropped 192.54 points (1.09%) to 17,496.82.
The 10-year Treasury note yield (TNX) fell one basis point to 4.25%.
The CBOE Volatility Index® (VIX) ended slightly up at 13.47, the highest close since May 30.
Trump Media & Technology Group soared 36.15% today after the company announced it expects to receive over $69.4 million from recently exercised stock warrants.
Target rose 2.44% on the news that it has teamed up with Shopify to allow vendors to sell on Target’s third-party website, Target Plus. Shopify shares fell 1.11%.
Alnylam Pharma popped 34.52% after trial results revealed its new drug to treat a rare form of heart disease cuts the risk of death and cardiovascular events by up to 33%.
Nvidia dropped 6.68% as the semiconductor stock continues to fall, with the stock entering correction territory earlier today—a sentence we never thought we’d write.
Eli Lilly’s weight-loss drug Zepbound can also help people with sleep apnea, cutting into the sleep-aid market, sending shares of ResMed down 11.40% and Inspire Medical Systems down 16.45% on the news.
Bitcoin-connected stocks are taking a hit as the crypto selloff continues. Coinbase Global fell 6%, while MicroStrategy fell 7.52%.
The dental industry—like other parts of healthcare—is facing significant staffing challenges. The US is in need of nearly 10,000 dental professionals and has more than 6,800 health professional shortage areas (HPSAs), which the US Department of Health and Human Services defines as “a geographic area, population, or facility with a shortage of primary care, dental, or mental health providers and services.”
Posted on June 24, 2024 by Dr. David Edward Marcinko MBA MEd CMP™
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Essays, Opinions and Curated News in Health Economics, Investing, Business, Management and Financial Planning for Physician Entrepreneurs and their Savvy Advisors and Consultants
“Serving Almost One Million Doctors, Financial Advisors and Medical Management Consultants Daily“
A Partner of the Institute of Medical Business Advisors , Inc.
Apple and Meta are considering an AI partnership. The two tech giants are discussing integrating Meta’s generative AI model into Apple’s new AI platform, Apple Intelligence, the WSJ reports. Instead of building an in-house AI model, Apple opted for the partnership route and previously announced a deal with OpenAI to bring ChatGPT to iPhones. Apple has also reportedly held talks with AI startups Anthropic and Perplexity to fuse their AI models with Apple Intelligence and get that sweet, sweet distribution Apple provides.
Genome testing can spot rare disease risks at birth. Newborn babies typically get blood tested for dozens of diseases, but some parents living in North Carolina and New York have recently been able to get their bundles of joy screened for hundreds of potentially life-threatening medical conditions that regular tests can’t catch thanks to a growing field called genomic medicine. Early results from two ongoing studies are very promising, the Washington Post reported, but scaling the new type of testing could be tricky: A full genome read (which covers all of your DNA) costs around $1,000 per patient. Still, research into the cost-benefit of genome sequencing has found that it can ultimately save families money on hospital care.
Markets: Sweating the upcoming election? Investors aren’t. The S&P 500 is on track for its best first-half performance in an election year going back to 1976, per Dow Jones Market Data. And as trading begins Monday morning, Microsoft is back on the Iron Throne as the US’ most valuable company following Nvidia’s stumbles at the end of last week.
A general understanding of these bank types is suggested for any medical professional prior to launching a self-directed [ME, Inc] medical practice, clinic, guided investment strategy, personal financial plan or wealth building portfolio effort; etc.
Posted on June 23, 2024 by Dr. David Edward Marcinko MBA MEd CMP™
MEDICAL EXECUTIVE-POST–TODAY’SNEWSLETTERBRIEFING
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Essays, Opinions and Curated News in Health Economics, Investing, Business, Management and Financial Planning for Physician Entrepreneurs and their Savvy Advisors and Consultants
“Serving Almost One Million Doctors, Financial Advisors and Medical Management Consultants Daily“
A Partner of the Institute of Medical Business Advisors , Inc.
The de-aging biz: Time to pull back the hospital curtain and see who’s behind the booming longevity market. This article, sponsored by Timeline, lays out who’s making $$$ on “reverse aging.*
The S&P 500 and NASDAQ have often outperformed the Dow in recent years thanks to their focus on tech, as well as their market-cap weighting vs the Dow’s price weighting. When tech stocks roar higher, the younger indexes rise above their older peer—but the last few days have seen a sell off of tech stocks led by NVIDIA, bringing the S&P 500 and NASDAQ lower to end the week while the Dow has continued to rise.
Bonds remained unchanged for most of the day, ending the trading session flat as investors parse through a week of economic data and prepare for next week’s PCE report.
Gold plunged after the dollar rose, making it more expensive for gold bugs to hold the precious metal.
As for oil, read on to learn why crude has high hopes today but may not be a smart investment tomorrow.
Nvidia faltered for the second day in a row, falling off the world’s most valuable company perch and shedding $220+ billion in market cap. But the S&P 500 has gone 377 days without a 2.05% sell-off, the longest streak since the 2008 financial crisis, per CNBC.
The Credit Card Competition Act is proposed legislation in Congress that could fundamentally change credit card systems. If passed, it could devastate the future of cash-back and travel rewards.
Posted on June 22, 2024 by Dr. David Edward Marcinko MBA MEd CMP™
MEDICAL EXECUTIVE-POST–TODAY’SNEWSLETTERBRIEFING
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Essays, Opinions and Curated News in Health Economics, Investing, Business, Management and Financial Planning for Physician Entrepreneurs and their Savvy Advisors and Consultants
“Serving Almost One Million Doctors, Financial Advisors and Medical Management Consultants Daily“
A Partner of the Institute of Medical Business Advisors , Inc.
Amazon Pharmacy announced on June 18 that, effective immediately, its RxPass medication delivery service will be available to more than 50 million Medicare beneficiaries, a move the company says could save up to $2 billion annually for the federal health insurance program.
The S&P 500 index fell 8.55 points (0.2%) to 5,464.62, up 0.6% for the week; the Dow Jones Industrial Average® ($DJI) gained 15.57 points (0.04%) to 39,150.33, up 1.5% for the week; the NASDAQ Composite® ($COMP) shed 32.23 points (0.2%) to 17,689.36, little changed for the week.
The 10-year Treasury note yield (TNX) was little changed at 4.255%.
The CBOE Volatility Index® (VIX) dipped 0.06 to 13.22.
What’s up
Sarepta Therapeutics soared 30.14% thanks to FDA approval of Elevidys, its new Duchenne muscular dystrophy treatment.
Zealand Pharma rose 18.62% after Phase 1b trial results revealed its new weight-loss drug could compete with Ozempic.
Asana jumped 14.95% on the news that its board has approved a share repurchase program of up to $150 million of its own stock.
CarMax shares rose 0.37% after the company reported first-quarter earnings. The number isn’t big, but the performance is impressive considering the used car company posted a 33% decline in profits.
Hertz Global popped 15.95% after the company announced it was raising the size of its bond offering to $1 billion as it looks to update its fleet of rental cars.
What’s down
Nvidia fell another 3.22% today as the sell off continued, with investors taking profits after a record run higher.
Smith & Wesson Brands dropped 12.87% after the gun maker beat earnings forecasts but announced that next quarter’s sales will be lower than expected.
LendingTree slid 2.48% after a Bloomberg report revealed that hackers are auctioning off stolen customer data.
Palantir fell 6.78% after the company earned an analyst downgrade for its “gluttonous valuation,” a phrase you never want to hear as an investor.
Bitcoin mining stocks took a hit today, selling off after popping higher yesterday after bitcoin prices rallied. Marathon Digital Holdings dropped 7.02%, Riot Platforms fell 8.35%, and CleanSpark sank 9.81%.
With a record number of people insured and seeking healthcare services post-pandemic, US health spend growth is outpacing GDP growth, and is expected to keep doing so through 2032, according to a June 12 report from actuaries at the Centers for Medicare and Medicaid Services (CMS). By 2032, CMS actuaries project healthcare spending will total $7.7 trillion and make up 19.7% of total US GDP, compared to $4.8 trillion and 17.6% of GDP in 2023.
It has been argued that physicians have abdicated the “moral high ground” in health care by their interest in seeking protection for their high incomes, their highly publicized self-referral arrangements, and their historical opposition toward reform efforts that jeopardized their clinical autonomy.
Experts Speak
In his book Medicine at the Crossroads, colleague and Emory University professor Melvin Konnor, MD noted that “throughout its history, organized medicine has represented, first and foremost, the pecuniary interests of doctors.” He lays significant blame for the present problems in health care at the doorstep of both insurers and doctors, stating that “the system’s ills are pervasive and all its participants are responsible.”
In order to reclaim their once esteemed moral position, physicians must actively reaffirm their commitment to the highest standards of the medical profession and call on other participants in the health care delivery system also to elevate their values and standards to the highest level.
Evolution
In the evolutionary shifts in models for care, physicians have been asked to embrace business values of efficiency and cost effectiveness, sometimes at the expense of their professional judgment and personal values. While some of these changes have been inevitable as our society sought to rein in out-of-control costs, it is not unreasonable for physicians to call on payers, regulators and other parties to the health care delivery system to raise their ethical bar.
Harvard University physician-ethicist Linda Emmanuel noted that “health professionals are now accountable to business values (such as efficiency and cost effectiveness), so business persons should be accountable to professional values including kindness and compassion.”
Within the framework of ethical principles, John La Puma, M.D., wrote in Managed Care Ethics, that “business’s ethical obligations are integrity and honesty. Medicine’s are those plus altruism, beneficence, non-maleficence, respect, and fairness.”
Incumbent in these activities is the expectation that the forces that control our health care delivery system, the payers, the regulators, and the providers will reach out to the larger community, working to eliminate the inequities that have left so many Americans with limited access to even basic health care.
Charles Dougherty clarified this obligation in Back to Reform, when he noted that “behind the daunting social reality stands a simple moral value that motivates the entire enterprise”.
ASSESSMENT
Health care is indeed grounded in caring. And, managing risk is a component of caring. It arises from a sympathetic response to the suffering of others.
Posted on June 21, 2024 by Dr. David Edward Marcinko MBA MEd CMP™
MEDICAL EXECUTIVE-POST–TODAY’SNEWSLETTERBRIEFING
***
Essays, Opinions and Curated News in Health Economics, Investing, Business, Management and Financial Planning for Physician Entrepreneurs and their Savvy Advisors and Consultants
“Serving Almost One Million Doctors, Financial Advisors and Medical Management Consultants Daily“
A Partner of the Institute of Medical Business Advisors , Inc.
Wells Fargo is losing $10 million per month on its partnership with Bilt, whose credit card offers users reward points for paying rent, and is looking to renegotiate, the WSJ reports. Apple has stopped offering its buy now, pay later program, Apple Pay Later, after partnering with outside companies, including Affirm.
Private equity (PE) is all over healthcare, with investment firms owning more than 400 hospitals around the US. But as the country faces a mental health crisis—US Surgeon General Vivek Murthy called it the “the defining public health crisis of our time”—PE has its sights set on one of the fastest-growing areas of the industry: behavioral health care. PE has accounted for over 60% of all behavioral health deal flow since 2018, and firms like Thurston Group and Five Points Capital now own about a quarter of facilities offering behavioral health care in some states, according to a recent cross-sectional study published in JAMA Psychiatry.
U.S. markets were closed Wednesday for the Juneteenth holiday. Here’s where the major benchmarks ended:
The S&P 500 index fell 13.86 points (0.3%) to 5,473.17; the Dow Jones Industrial Average® ($DJI) gained 299.90 points (0.8%) to 39,134.76; the NASDAQ Composite® ($COMP) dropped 140.64 points (0.8%) to 17,721.59.
The 10-year Treasury note yield (TNX) climbed about 4 basis points to 4.257%.
The CBOE Volatility Index® (VIX) rose 0.80 to 13.28.
What’s up
Gilead jumped 8.46% after clinical data revealed that its new twice-a-year shot prevents 100% of HIV cases.
Penn Entertainment rose 9.93% on the news that Boyd Gaming has approached its competitor with an acquisition offer.
Accenture rose 7.30% after the IT consulting company missed earnings estimates but more than made up for it with bullish bookings data thanks to AI.
Darden Restaurants rose 1.53% after a mixed earnings report. Its acquisition of Ruth’s Chris Steak House propped up earnings, while Olive Garden’s same-store sales came in flat, probably because I eat several hundred free breadsticks there every month.
What’s down
Trump Media & Technology Group fell 14.56% after the SEC ruled that early shareholders can resell their stock in the company, diluting new shareholders—though providing upward of $247 million in funding for the beleaguered company.
Nikola plummeted 31.46% after the company announced a 1-for-30 stock split in a bid to stay listed on the Nasdaq.
Kroger fell 3.27% despite beating analyst revenue estimates in its fiscal first quarter as investors digest the chances of the company sealing a deal to buy Albertsons.
TempestTherapeutics dropped 29.47% upon the release of the latest trial data for its liver cancer treatment.
Jabil fell 11.45% today after the electronics supplier beat earnings estimates but warned of softer growth in the year ahead.
Mortgage rates fell below 7% last week to their lowest level since March, but this didn’t spur much extra demand.
Posted on June 21, 2024 by Dr. David Edward Marcinko MBA MEd CMP™
Here is My Teaching Philosophy
[By Dr. David Edward Marcinko MBA, MEd]
Although any learner-centered teaching philosophy, or Boyer Model of scholarship, is constantly in flux, the mission of a public or private educator is: [1] to promote positive learning; [2] to motivate students, staff and graduates; [3] to provide a strong foundation for lifelong learning; and in modernity [4] to enhance career and life-work opportunities; to [5] improve bottom-line financial metrics, and [6] to collaborate on a national and global basis.
However, because we are specifically operating in the rapidly changing healthcare, business management, investing, finance, economics and education milieu, even deeper experiential insight is needed.
Developing NEW Teaching AND Education Skills FOR Business and Healthcare 2.0
Medicine and healthcare business today is different than a generation ago, and all educators and healthcare professionals need new skills to be successful.
Traditionally, the physician – like the classroom professor – was viewed as the “captain of the ship”. Today, their role may be more akin to a ship’s navigator, utilizing clinical, teaching skills and knowledge to chart the patient’s, or student’s, course through a confusing morass of requirements, choices, rules and regulations to achieve the best attainable clinical or didactic outcomes.
This new teaching paradigm includes many classic business school principles, now modified to fit the PP-ACA, the era of health reform, and modern technical connectivity. Thus, a Professor, Chair or Dean must be a subtle guide on the side; not bombastic sage on the stage.
These, newer teaching philosophies must include:
Negotiation – working to optimize appropriate curricula, services and materials;
Team play – working in concert with others to coordinate education delivery within a clinically appropriate and cost-effective framework;
Working within the limits of competence – avoiding the pitfalls of the generalist teacher versus the subject matter expert that may restrict access to professors, texts and facilities by clearly acknowledging when a higher degree of didactic service is needed on behalf of the student;
Respecting different cultures and values – inherent in the support of the academic Principle of Autonomy is the acceptance of values that may differ from one’s own. As the US becomes more culturally heterogeneous, educators and medical providers are called upon to work within, and respect, the socio-cultural and/or spiritual framework of patients, students and their families;
Seeking clarity on what constitutes marginal education – within a system of finite resources; providers and professors are called upon to openly communicate with students and patients regarding access to marginal education and/or treatments.
Supporting evidence-based practice – educators, like healthcare providers, should utilize outcomes data to reduce variation in treatments and curriculum to achieve higher academic efficiencies and improved care delivery;
Fostering transparency and openness in communications – teachers and healthcare professionals should be willing, and prepared, to discuss all aspects of care and academic andragogy; especially when disclosing problems or issues that arise;
Exercising decision-making flexibility – treatment algorithms, templates and teaching pathways are useful tools when used within their scope; but providers and professors must have the authority to adjust the plan if circumstances warrant;
Becoming skilled in the art of listening and interpreting — In her ground-breaking book, Narrative Ethics: Honoring the Stories of Illness, Rita Charon, MD PhD, a professor at Columbia University, writes of the extraordinary value of using the patient’s personal story in the treatment plan. She notes that, “medicine practiced with narrative competence will more ably recognize patients and diseases; convey knowledge and regard, join humbly with colleagues, and accompany patients and their families through ordeals of illness.” In many ways, attention to narrative returns medicine full circle to the compassionate and caring foundations of the patient-physician relationship. The educational analog to this book is, The Ethics of Teaching [A Casebook], co-edited by my teacher and colleague Deborah Ware Balogh PhD of the University of Indianapolis.
***
Assessment
Finally, these thoughts represent only a handful of examples to illustrate the myriad of new skills that tomorrow’s healthcare professionals, and modern educators, must master in order to meet their timeless professional obligations of compassionate patient care and contemporary teaching effectiveness.
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If you do not have a market niche; you are not deeply informed If you are not deeply informed; you can’t different yourself If you can’t differentiate yourself; you can’t differentiate price If you can’t differentiate price; you have no market power If you have no market power; you have no unique knowledge If you have no unique knowledge; you have fewer profits
If you have fewer profits; you are not likely a CMP™
Posted on June 20, 2024 by Dr. David Edward Marcinko MBA MEd CMP™
Demanding High Professional Moral Standards of Self and Financing Organizations
By Dr. David Edward Marcinko MBAMEd
ByRender Davis MBA
***
***
It has been argued that physicians have abdicated the “moral high ground” in health care by their interest in seeking protection for their high incomes, their highly publicized self-referral arrangements, and their historical opposition toward reform efforts that jeopardized their clinical autonomy.
In his book Medicine at the Crossroads, Emory University professor Melvin Konnor, M.D., noted that “throughout its history, organized medicine has represented, first and foremost, the pecuniary interests of doctors.” He goes on to lay significant blame for the present problems in health care at the doorstep of both insurers and doctors, stating that “the system’s ills are pervasive and all its participants are responsible.” In order to reclaim their once esteemed moral position, physicians must actively reaffirm their commitment to the highest standards of the medical profession and call on other participants in the health care delivery system also to elevate their values and standards to the highest level.
In the evolutionary shifts in models for care, physicians have been asked to embrace business values of efficiency and cost effectiveness, sometimes at the expense of their professional judgment and personal values. While some of these changes have been inevitable as our society sought to rein in out-of-control costs, it is not unreasonable for physicians to call on payers, regulators and other parties to the health care delivery system to raise their ethical bar.
Harvard University physician-ethicist Linda Emmanuel noted that “health professionals are now accountable to business values (such as efficiency and cost effectiveness), so business persons should be accountable to professional values including kindness and compassion.
”Within the framework of ethical principles, John La Puma, M.D., wrote in Managed Care Ethics, that “business’s ethical obligations are integrity and honesty. Medicine’s are those plus altruism, beneficence, nonmaleficence, respect, and fairness.”
Incumbent in these activities is the expectation that the forces that control our health care delivery system, the payers, the regulators, and the providers will reach out to the larger community, working to eliminate the inequities that have left so many Americans with limited access to even basic health care. Charles Dougherty clarified this obligation in Back to Reform, when he noted that “behind the daunting social reality stands a simple moral value that motivates the entire enterprise. Health care is grounded in caring. It arises from a sympathetic response to the suffering of others.”
Posted on June 19, 2024 by Dr. David Edward Marcinko MBA MEd CMP™
MEDICAL EXECUTIVE-POST–TODAY’SNEWSLETTERBRIEFING
***
Essays, Opinions and Curated News in Health Economics, Investing, Business, Management and Financial Planning for Physician Entrepreneurs and their Savvy Advisors and Consultants
“Serving Almost One Million Doctors, Financial Advisors and Medical Management Consultants Daily“
A Partner of the Institute of Medical Business Advisors , Inc.
Wells Fargo is losing $10 million per month on its partnership with Bilt, whose credit card offers users reward points for paying rent, and is looking to renegotiate, the WSJ reports. Apple has stopped offering its buy now, pay later program, Apple Pay Later, after partnering with outside companies, including Affirm.
The S&P 500 index gained 13.80 points (0.3%) to 5,487.03; the Dow Jones Industrial Average® ($DJI) added 56.76 points (0.2%) to 38,834.86; the NASDAQ Composite® ($COMP) rose 5.21 points (0.03%) to 17,862.23, a record close for the seventh day in a row.
The 10-year Treasury note yield (TNX) dipped more than 6 basis points to 4.215%.
The CBOE Volatility Index® (VIX) fell 0.45 to 12.30.
What’s up
La-Z-Boy, your dad’s favorite recliner/stock, rose 19.39% after beating analyst expectations in the fourth quarter and issuing upbeat guidance for the year.
Dell rose 5.13% a day after Morgan Stanley analysts named the company one of their top stock picks thanks to its focus on servers powering AI.
Aerovate Therapeutics dropped another 14.55% today, a day after the company announced a failure in the phase 2 trial of its new blood pressure medication.
Lennar sank 4.96% after announcing lower-than-expected home deliveries last quarter in yet another sign that the housing market is in the dumps.
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