VENTURE Capitals and Investment BANKERS

Posted on April 5, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

By Lon Jefferies MBA CFP® CMP®

By Dr. David Edward Marcinko MBA MEd CMP®

SPONSOR: http://www.CertifiedMedicalPlanner.org

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OUR TAKE ON PRIVATE EQUITY AND VENTURE CAPITAL

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.

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

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Why Some Career Doctors Still DO NOT Get Rich?

Posted on April 4, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

SOME DIFFERENT REASONS WHY DOCTORS DON’T GET RICH

“Physicians have a significantly low propensity to accumulate substantial wealth.”

Thomas Stanley – Author “The Millionaire Next Door”

[New York Times]

How come doctors fail to get rich? Re-read the above!

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By Dr. David Edward Marcinko MBA CMP®

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The Institute of Medical Business Advisors Inc identified several reasons based on observations working with medical professional and physician clients over the years.

A late start

By the time doctors finish medical school and residency they’re typically in their middle or late thirties. Many have families to feed, and substantial student loans to pay off. It will be years before they can even start accumulating wealth. Consider that physicians typically enter careers at later ages, often with larger debts from training. Some specialties may not lead a case until 10 years of practice, and many specialties have limited longevity. Peak earning years may also be shorter for health care providers than other professionals. Financial survival skills are paramount for converting the limited earnings time period to personal financial security.

Challenging socio-political environment

It is increasingly challenging to practice medicine. With the Medicare Trust Fund slated to go bust in 2019, the Center for Medicare and Medicare Service (CMS) is increasingly resorting to cutting physician reimbursements and implementing capitation and bundled value based medical payments models. The medical reimbursement effects of the PP-ACA are not yet fully discerned; but appear to continue the decline in compensation. And to illustrate this potential governmental control, in what other industry can participants debate the simple question, “who is the customer?”

Lifestyle expectations

Society expects a doctor to live like a doctor, dress like a doctor, and drive like a doctor. Meeting social expectations can be quite expensive.

Time and energy

A doctor can’t be just a doctor any more. S/he also has to deal with ever increasing regulatory mandates, paperwork requirements by state and federal agencies and capricious insurance companies. It is estimated that for every hour spent on patient care, and additional half-hour is spent on paperwork. To-date, the use of electronic medical records has exacerbated; not ameliorated this problem. The demand on their time is mind-boggling. A typical doctor works a ten- to twelve-hour day. After work and family, they simply don’t have time and energy left to do comprehensive financial planning.

Financially naïve

Doctors are smart. They’re highly trained in their area of expertise. But, that doesn’t translate into understanding about finance or economics. Because they are smart, it’s easy for them to think they can easily master and execute concepts of personal financial planning, as well. Often, they don’t.

Lack of trust and delegation

Many doctors don’t trust financial advisors working for major Wall Street banks. They have the good instinct to realize that their interests are not aligned. Not knowing there are independent advisors out there who observe a strict fiduciary standard, they tend to do everything by themselves.

In fact, Paul Larson CFP®, President-CEO of the firm LARSON Financial Group LLC, noted a disquieting trend among physician client in his firm [personal communication]. Almost 90% of them fail to take care of their own family finances in a comprehensive manner; while only 10% are succeeding.  The strategies in this chapter and book are common to their success.

Too Trusting

Another aspect of naivety, many physicians do not realize that the financial advisory industry lacks the same discipline and regulation that the average physician operates in. A primary care doctor would never even attempt a complicated surgery on a patient, but is trained to refer such patients to a specialist in the field with the proper training and experience. Financial Advisors often come from a sales background and are trained to keep a client in house even if the advisor is lacking in expertise. Also, many physicians are not trained to discern a qualified financial advisor from a sales person dressed up like a financial advisor. It is illegal to call yourself a physician in the United States unless you have the credentials to back it up; yet, anyone in the US can legally call themselves a financial advisor or a financial planner.

Your thoughts are appreciated.

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SPRING: Automobile Detailing Tips for Neurotic Docs

Posted on March 31, 2024 by Dr. David Edward Marcinko MBA MEd CMP™
Use a Pro -or- DIY? By Dr. David E. Marcinko MBADr. David E. Marcinko MBA

It’s never a source of pride stepping out of a dirty car or truck, especially for image conscious doctors. But, keeping your vehicle looking like new, for the doctor’s parking lot, is tough work. Sure, you may take it through the drive-thru car wash every now and then, but that isn’t the deep cleaning that your car deserves.

All in the Details

Detailing, on the other hand, is promised to give your beloved vehicle that ‘new-car’ feeling all over again. It isn’t easy work, but the results are amazing. While you could detail your car at home, is it really worth it? Let’s take a look at why letting the pros detail your vehicle is the way to go – or – not!

Working at the Car Wash

When you wash your vehicle at a drive-thru car wash, you may be doing more harm than good. If the car wash has brushes or pieces of cloth that scrub your vehicle as it goes through, these components can easily scratch your car’s finish. All of the bits of dirt from cars before can be trapped in the cloth   and brushes, and as they scrub your vehicle, they act as sandpaper, permanently marring your paint.

One step better is hand washing your car at home, but even then, you must be careful to not just become a humanized version of the car wash. Using two buckets is a good start, with one bucket being a rinse bucket to remove the dirt from your sponge, and the other containing the soap.

car

SOAP Suds – Not SOAP Notes

Also, be careful of the type of soaps and car care products being used. The interior and exterior cleaners found at the local parts store are often of decent quality, but they aren’t always the best, and they must be used properly. Even then, for a normal car owner, detailing a car can become an all-day task, sometimes with less than perfect results.

Don’t forget to use a clay bar or brick followed by your favorite Carnuba wax, too.

XJ-V8-LWB

Jaguar front seat

My Jaguar's engine after a steam

The Pros

So, why should you let the pros handle your detailing needs? They should know exactly what specialty products are right for your vehicle to get the perfect results every time. And, they know the techniques that will yield showroom-finish results while you don’t have to even touch your car.

And, while you won’t want to clean out all the dried soda, coffee stains, or leftover cheeseburger wrappers from under your seat, they will gladly do it for you – for a price.

Imagine

Just picture getting into a blindingly shiny, clean vehicle with an interior that looks equally as pristine. No more purchasing all kinds of car care products that don’t deliver results. No more spending hours in the driveway getting soaked and frustrated. No more wasted time. Pros know what it takes to detail your vehicle to concourse standards.

But then, it is just a job for them. It is a labor of love for me. Am I neurotic or compulsive?

More:

Assessment

My near showroom and mint conditioned 2000 Jaguar XJ-V8-L is a full-size luxury sedan, offers sporting drive characteristics, mixed with a classic style and interior comfort. It was available in multiple trims which all came very well equipped with upscale amenities.

And, this extended wheelbase version offers much more rear seat leg room for long and winding Georgia road trips. The standard steel engine [not nikasil] in this XJ is a 4.0L V8 which produces 290 hp. The upper and lower timing chain tensioners are original, second generation metal, not plastic.

There is also a supercharged version of this vehicle which bumps output to an impressive 370 hp. Even with all of its power and weight, my XJ-8-L is still rated at over 20 mpg on the highway. Ammenities and upgrades include a mobile phone, Magellan GPS, LoJack theft recovery system, CD and MP-3 players, with internal and external cable antenna for satellite radio.

What a Cat? She is my third favorite female after my intelligent and beautiful wife, and smart and lovely daughter.

Conclusion

Are you a DIYer, like me? Nothing says you care more than doing it yourself.

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INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors

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HAPPY DOCTORS DAY: 2024

Posted on March 30, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

SPONSOR: http://www.MarcinkoAssociates.com

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DOCTORS ARE FINANCIALLY DIFFERENT: https://tinyurl.com/ycyrmsdh

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FINANCE: “Prudence” in Investment Management?

Posted on March 29, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

SPONSOR: http://www.MARCINKOASSOCIATES.com

ON “PRUDENCE” IN FINANCE AND INVESTMENT MANAGEMENT
Courtesy: http://www.CertifiedMedicalPlanner.org

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TERMS & DEFINITIONS FOR PHYSICIANS AND ALL INVESTORS:

PRUDENT BUYER: The efficient purchaser of market balance between value and cost.

PRUDENT MAN RULE: An 1830 court case stating that a person in a fiduciary capacity (a trustee, executor, custodian, etc) must conduct him/herself faithfully and exercise sound judgment when investing monies under care. “He is to observe how men of prudence, discretion and intelligence manage their own affairs, not in regard to speculation, but in regard to the permanent distribution of their funds, considering the probable income as well as the probable safety of the capital to be invested.” Allows for mutual funds and variable annuities.

PRUDENT INVESTOR RULE: A fiduciary is required to conduct him/herself faithfully and exercise sound judgment when investing monies and take measured and reasonable investment risks in return for potential future rewards. Allows for mutual funds, stocks, bonds, variable annuities asset allocation & Modern Portfolio Theory.

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

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UNIFORM PRUDENT INVESTOR ACT: https://medicalexecutivepost.com/2011/02/18/the-uniform-prudent-investor-act-versus-fiduciary-accountability/

EDITOR’S NOTE: We interviewed noted authority Ben Aikin AIF® on this topic more than a decade ago. He was ahead of his time regarding fiduciary accountability and we appreciate his insights.

Dr. David Edward Marcinko MBA CMP®

[Editor-in-Chief]

INTERVIEW: https://medicalexecutivepost.com/2009/03/01/an-interview-with-bennett-aikin-aif/

FIDUCIARY OATH: http://www.thefiduciarystandard.org/wp-content/uploads/2015/02/fiduciaryoath_individual.pdf

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

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A Brief Historical Review of Behavioral Finance and Economics

Posted on March 28, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

By Related Influential Thought-Leaders

  • Dr. Brad Klontz CSAC CFP®
  • Dr. Ted Klontz PsyD
  • Dr. Eugene Schmuckler MBA MEd CTS
  • Dr. Kenneth Shubin-Stein FACP CFA
  • Dr. David Edward Marcinko MEd MBA CMP™

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James O. Prochaska PhD, Professor of Psychology and Director of the Cancer Prevention Research Center at the University of Rhode Island, developed the Trans-Theoretic Model of Behavior Change [TTM] which has been evolving since in 1977. Nominated as one of the five most influential authors in Psychology, by the Institute for Scientific Information and the American Psychological Society, Dr. Prochaska is author of more than 300 papers on behavior change for health promotion and disease prevention.

TTM Stages of Change

In his Trans-Theoretical Model, behavior change is a “process involving progress through a series of these stages:

  • Pre-Contemplation (Not Ready) – “People are not intending to take action in the foreseeable future, and can be unaware that their behavior is problematic”
  • Contemplation (Getting Ready) – “People are beginning to recognize that their behavior is problematic, and start to look at the pros and cons of their continued actions”
  • Preparation (Ready) – “People are intending to take action in the immediate future, and may begin taking small steps toward behavior change”
  • Action – “People have made specific overt modifications in changing their problem behavior or in acquiring new healthy behaviors”
  • Maintenance – “People have been able to sustain action for a while and are working to prevent relapse”
  • Termination – “Individuals have zero temptation and they are sure they will not return to their old unhealthy habit as a way of coping”

Relapse

In addition, researchers conceptualized “relapse” (recycling) which is not a stage in itself but rather the “return from Action or Maintenance to an earlier stage.” In medical care, these stages of behavior change have applicability to anti-hypertension and lipid lowering medication use, as well as depression prevention, weight control and smoking cessation.

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Psychology

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Uniting Psychology and Financial Behavior

More recently, validating the emerging alliance between psychology (human behavior) and finance (economics) are two Americans who won the Royal Swedish Academy of Science’s 2002 Nobel Memorial Prize in Economic Science. Their research was nothing short of an explanation for the idiosyncrasies incumbent in human financial decision-making outcomes.

Enter Kahneman and Smith

Daniel Kahneman, PhD, professor of psychology at Princeton University, and Vernon L. Smith, PhD, professor of economics at George Mason University in Fairfax, Va., shared the prize for work that provided insight on everything from stock market bubbles, to regulating utilities, and countless other economic activities. In several cases, the winners tried to explain apparent financial paradoxes.

For example, Professor Kahneman made the economically puzzling discovery that most of his subjects would make a 20-minute trip to buy a calculator for $10 instead of $15, but would not make the same trip to buy a jacket for $120 instead of $125, saving the same $5.

1608708312704

in vitro and in-vivo Economics

Initially, in the 1960’s, Smith set out to demonstrate how economic theory worked in the laboratory (in vitro), while Kahneman was more interested in the ways economic theory mis-predicted people in real-life (in-vivo). He tested the limits of standard economic choice theory in predicting the actions of real people, and his work formalized laboratory techniques for studying economic decision making, with a focus on trading and bargaining.

Later, Smith and Kahneman together were among the first economists to make experimental data a cornerstone of academic output. Their studies included people playing games of cooperation and trust, and simulating different types of markets in a laboratory setting. Their theories assumed that individuals make decisions systematically, based on preferences and available information, in a way that changes little over time, or in different contexts.

University of Chicago

By the late 1970’s, Richard H. Thaler, PhD, an economist at the University of Chicago also began to perform behavioral experiments further suggesting irrational wrinkles in standard financial theory and behavior, enhancing the still embryonic but increasingly popular theories of Kahneman and Smith.

Laboratory

Other economists’ laboratory experiments used ideas about competitive interactions pioneered by game theorists like John Forbes Nash Jr., PhD, who shared the Nobel in 1994, as points of reference.

Assessment

But, Kahneman and Smith often concentrated on cases where people’s actions departed from the systematic, rational strategies that Nash envisioned. Psychologically, this was all a precursor to the informal concept of life or holistic financial planning. Kahneman was awarded the Medal of Freedom, by President Barack Obama, on November 20, 2013.

READ: Behavioral Economics and Psychology DEM

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Understanding Medical Cost Accounting

Posted on March 28, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

A Subset of Managerial Accounting

By Dr. David E. Marcinko MBA CMP®

http://www.MARCINKOASSOCIATES.com

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Managerial and medical cost accounting is not governed by generally accepted accounting principles (GAAP) as promoted by the Financial Accounting Standards Board (FASB) for CPAs. Rather, a healthcare organization costing expert may be a Certified Cost Accountant (CCA) or Certified Managerial Accountant (CMA) designated by the Cost Accounting Standards Board (CASB), an independent board within the Office of Management and Budget’s (OMB) Office of Federal Procurement Policy (OFPP).

The Cost Accounting Standards Board

CASB consists of five members, including the OFPP Administrator who serves as chairman and four members with experience in government contract cost accounting (two from the federal government, one from industry, and one from the accounting profession). The Board has the exclusive authority to make, promulgate, and amend cost accounting standards and interpretations designed to achieve uniformity and consistency in the cost accounting practices governing the measurement, assignment, and allocation of costs to contracts with the United States.

Codified at 48 CFR

CASB’s regulations are codified at 48 CFR, Chapter 99.  The standards are mandatory for use by all executive agencies and by contractors and subcontractors in estimating, accumulating, and reporting costs in connection with pricing and administration of, and settlement of disputes concerning, all negotiated prime contract and subcontract procurement with the United States in excess of $500,000. The rules and regulations of the CASB appear in the federal acquisition regulations.

North American Industry Classification System (NAICS) codes are used to categorize data for the federal government.  In acquisition they are particularly critical for size standards.  The NAICS codes are revised every five years by the Census Bureau.  As of October 1, 2007, the federal acquisition community began using the 2007 version of the NAICS codes at www.census.gov/epcd/www/naics.html

Cost Accounting Standards

Healthcare organizations and consultants are obligated to comply with the following cost accounting standards (CAS) promulgated by federal agencies:

  • CAS 501 requires consistency in estimating, accumulating, and reporting costs.
  • CAS 502 requires consistency in allocating costs incurred for the same purpose.
  • CAS 505 requires proper treatment of unallowable costs.
  • CAS 506 requires consistency in the periods used for cost accounting.

The requirements of these standards are different from those of traditional financial accounting, which are concerned with providing static historical information to creditors, shareholders, and those outside the public or private healthcare organization.

AssessmentTwo Doctors

Functionally, most healthcare organizations also contain cost centers, which have no revenue budgets or mission to earn revenues for the organization.  Examples include human resources, administration, housekeeping, nursing, and the like.  These are known as responsibility centers with budgeting constraints but no earnings.  Furthermore, shadow cost centers include certain non-cash or cash expenses, such as amortization, depreciation and utilities, and rent. These non-centralized shadow centers are cost allocated for budgeting purposes and must be treated as costs http://www.CertifiedMedicalPlanner.org

MORE:  CASE MODEL EOQ 1

Conclusion

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CRM: Patient Relations Management and Concierge Medicine

Posted on March 27, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

Characteristics of a Retainer or Cash-Based Practice

By DeeVee Devarakonda; MBA [Former CMO of Quaero, Inc]

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

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A young concierge medical practice is a business with challenges in these Customer [Patient] Relationship Management’s [CRM] areas that are critical for success.

Areas of Most Challenge

Maturity of Processes:

Processes are often associated with bureaucracy or stuffy hierarchical healthcare systems that are anathema to emerging concierge medical practices. At small practices, doctors are often owners who fiercely pride themselves on flat structures, autonomy and flexibility. However, processes are imperative to conduct a streamlined practice that can be woven around a CM culture that still ensures practice business is conducted in a systematic manner.

Organization Structure:

Young concierge medical practices have challenges managing growth while grappling to incorporate an organization structure that promotes the elite private practice culture.

Multi-tasking, rapidly growing work places:

Young CM practices are often characterized by employees who multi-task and assume several roles to make their resources stretch farther. Especially in the current healthcare reform climate, young practice employees take up a broader set of responsibilities. In addition, as young private CM practices grow, they may become anguished with a growing office workplace that may not be equipped with an evolving infrastructure to cope. They have a fierce need to carefully control growth with tightly managed resources.

Changing business needs and strategy:

In an era after the golden age of traditional medicine, profitability is critical for emerging concierge practices. It is imperative to be nimble and change marketing strategies as socio-political and competitive climates dictate. A good C[P] RM system is tightly integrated, but loosely coupled, to allow CM practices to communicate appropriately with patients.

Little room for Slack:

Small concierge medical practices do not have as much established name-brand equity as larger, established practices of any model type, and patients are less willing to tolerate mistakes. Concierge practices have to run a much tighter ship and build impeccable patient experiences.

Fierce Competition:

The cash or retainer medicine landscape today looks very different from just five years ago. Competition is becoming fierce and practices are fighting for mindshare and patients. Young practices are competing with older concierge practices – large traditional practices, micro-practices, behemoth healthcare systems, enterprise-wide medical corporations and every other practice model in-between – to attract and retain patients with private resources.

Assessment

The above characteristics form the basis of a compelling strategy to embrace C[P]RM and streamline patient relationships and cash revenue opportunities. Concierge practices still need to build scalable marketing programs that can easily ramp up and down effortlessly as needs and economic environments demand. But, they do need to establish marketing metrics and processes that can demonstrate the Return on Investment (ROI) on their CRM, and marketing programs, and for getting critical cash-paying patient buy-in.

Related link: https://healthcarefinancials.wordpress.com/2009/04/28/defining-and-understanding-%e2%80%9cboutique-medicine%e2%80%9d/

MORE: https://medicalexecutivepost.com/2009/10/30/return-on-investment-calculations-for-concierge-medical-practice-marketing-initiatives/

Conclusion

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MEDICAL SCHOOLS: Why They Don’t Teach Business and How it’s Costing Doctors?

Posted on March 26, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

SPONSOR: http://www.MarcinkoAssociates.com

[THE MILLION DOLLAR MISTAKE]

By Curtis G. Graham MD

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The fact that every physician in private medical practice, without a business education, leaves approximately a million dollars on the table and is unaware of it is well known to business experts who work with medical doctors experiencing financial difficulties.

Business experts such as Dan S. Kennedy, Peter Drucker, Michael Gerber, Maxwell Maltz, Neil Baum, William Hanson, Huss and Coleman, Steven Hacker, Thomas Stanley, Chris Hurn, Napoleon Hill, and Dave Ramsey, among others, understand the financial problems faced by medical practices and how to solve them.

READ HERE: https://www.kevinmd.com/2023/01/the-million-dollar-mistake-why-medical-schools-dont-teach-business-and-how-its-costing-physicians.html

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WHAT IS THE “LUXURY PRODUCT” ECONOMIC PARADOX?

Posted on March 26, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

WHAT IS THE “LUXURY PRODUCT” ECONOMIC PARADOX?

By Dr. David Edward Marcinko MBA

Courtesy: http://www.CertifiedMedicalPlanner.org

The more expensive something is – the less likely you are to use it. This relationship between price and product utility is graphed as an “inverted U.”

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

So, super car Ferraris sit in garages; but Fords get driven.

ESSAY: https://medicalexecutivepost.com/2014/01/08/the-jaguar-touring-sedan-one-of-the-finest-luxury-cars-built-yesterday/

My own Jaguar touring sedan illustrates this paradox.

dem-jag

ESSAY: https://medicalexecutivepost.com/2018/09/02/my-jaguar-mechanic-vs-doctor-story/

This theory may even be valid for services; as well as products?

THINK: Plastic and cosmetic surgery?

Assessment: Your thoughts and comments are appreciated.

THANK YOU

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Product DetailsProduct DetailsProduct Details

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Me, Marcinko and Dr. Avatar [Metaverse?]

Posted on March 25, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

The Virtual Doctor Will See You Now!

By Dr. David Edward Marcinko MBA CMP™

[Publisher-in-Chief]

Recently, I was invited to speak at a regional convention. No surprise there as I have been doing so – around the world – for more than twenty years – webcasts included. And, I was asked to submit the usual paraphernalia; a formal CV, audio-visual needs, travel arrangements and times, PPE, and a personal photo which were all dutifully supplied.

Then, I was asked to supply something that flabbergasted me; I became slack-jawed, actually.

DEM’s Avatar 

Imagine my surprise when I was asked for an avatar; not just a digital photograph. So – having none – I had one made and now submit it for your review.

  Photograph of Dr. David Edward Marcinko @ home

 Avatar of Dr. David Edward Marcinko @ work

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Assessment

So, how do I virtually look – better or worse – glasses or contact lens? It seems as though some folks are more interested in the virtual me; than the real me. Go figure!

Conclusion

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

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

Our Other Print Books and Related Information Sources:

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

Product DetailsProduct DetailsProduct Details

Product Details  Product Details

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Health Care Entity: Venture Capital Funding

Posted on March 22, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

http://www.MARCINKOASSOCIATES.com

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Venture capital funding in the digital health space cooled a bit in 2022 following a red-hot 2021. Overall, digital health companies raised $15.3 billion last year, down from the $29.1 billion raised in 2021—but still above the $14.1 billion raised in 2020, according to Rock Health a seed fund that supports digital health startups.

MORE: https://marcinkoassociates.com/fmv-appraisals/

Nevertheless, analysts predict VC investors and bankers will still put a good amount of money into digital health in 2024 and 2025, especially in alternative care, drug development, health information technology technology, EMRs and software that reduces physician workload.

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

Of course. an essential first part of attracting VC interest and money is the crafting and presentation of your formal business plan [“elevator pitch”]; as well as the needed technical and managerial experience. This is crucial for success and exactly where we can assist.

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READ MORE: https://marcinkoassociates.com/welcome-medical-colleagues/

CONTACT: MarcinkoAdvisors@msn.com

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FINANCIAL PLANNING: Next Generation for Physicians Only

Posted on March 22, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

By Dr. David Edward Marcinko MBA CMP™

SPONSOR: http://www.MARCINKOASSOCIATES.com

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SPONSOR: http://www.CertifiedMedicalPlanner.org

(“Informed Voice of a New Generation of Fiduciary Advisors for Healthcare”)

For most lay folks, personal financial planning typically involves creating a personal budget, planning for taxes, setting up a savings account and developing a debt management, retirement and insurance recovery plan. Medicare, Social Security and Required Minimal Distribution [RMD] analysis is typical for lay retirement. Of course, we can assist in all of these activities, but lay individuals can also create and establish their own financial plan to reach short and long-term savings and investment goals.

But, as fellow doctors, we understand better than most the more complex financial challenges doctors can face when it comes to their financial planning. Of course, most physicians ultimately make a good income, but it is the saving, asset and risk management tolerance and investing part that many of our colleagues’ struggle with. Far too often physicians receive terrible guidance, have no time to properly manage their own investments and set goals for that day when they no longer wish to practice medicine.

For the average doctor or healthcare professional, the feelings of pride and achievement at finally graduating are typically paired with the heavy burden of hundreds of thousands of dollars in student loan debt.

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

You dedicated countless hours to learning, studying, and training in your field. You missed birthdays and holidays, time with your families, and sacrificed vacations to provide compassionate and excellent care for your patients. Amidst all of that, there was no time to give your finances even a second thought.

Between undergraduate, medical school, and then internship and residency, most young physicians do not begin saving for retirement until late into their 20s, if not their 30s. You’ve missed an entire decade or more of allowing your money and investments to compound and work for you. When it comes to addressing your financial health and security, there’s no time to waste.

And you may be misled by unscrupulous “advisors”.

READ HERE: https://marcinkoassociates.com/financial-planning/

RELATED: https://medicalexecutivepost.com/2023/12/15/doctor-are-you-a-financial-advisors-customer-or-client/

COMMENTS APPRECIATED

Thank You

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PODCAST: AMA to Teach Medical Students Health Economics?

Posted on March 13, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

AMA TO TEACH MEDICAL STUDENTS ABOUT HEALTH ECONOMICS?

CMP logo

Dr. David Edward Marcinko MBA

Courtesy: www.CertifiedMedicalPlanner.org

DICTIONARY: https://medicalexecutivepost.com/2009/06/08/dictionary-of-health-economics-and-finance/

Did you know that the American Medical Association is calling on medical schools and residency programs to include specific information about healthcare economics and financing in their curricula.

But, is health economics heterodoxic, or not? And; what about demand-derived economics in medicine?

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economic freedom

LINKS

ESSAY: https://medicalexecutivepost.com/2019/08/31/is-health-economics-heterodoxic-or-not/

ESSAY: https://www.modernhealthcare.com/education/ama-adopts-new-policy-training-physicians-healthcare-economics

MORE: https://medicalexecutivepost.com/2019/11/10/ricardian-derived-demand-economics-in-medicine/

MORE: https://medicalexecutivepost.com/2014/08/27/financial-and-health-economics-benchmarking/

MORE: https://medicalexecutivepost.com/wp-content/uploads/2019/01/big-data.pdf

PODCAST: https://vimeo.com/ihe

Your thoughts are appreciated.

BUSINESS, FINANCE, INVESTING AND INSURANCE TEXTS FOR DOCTORS:

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

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What is the Goodhart Economics Principle?

Posted on March 5, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

The Goodhart Principle, and related

[By staff reporters]

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Goodhart’s law is a sociological analogue of Heisenberg’s uncertainty principle in quantum mechanics. Measuring a system usually disturbs it. The more precise the measurement, and the shorter its timescale, the greater the energy of the disturbance and the greater the unpredictability of the outcome.
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CAMPBELL’S LAW:
“The more any quantitative social indicator is used for social decision-making, the more subject it will be to corruption pressures and the more apt it will be to distort and corrupt the social processes it is intended to monitor.”
Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™8Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™
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FINANCIAL PLANNING: Physician and Fiduciary Focused

Posted on March 5, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

(“Informed Voice of a New Generation of Fiduciary Advisors for Healthcare”)

By Dr. David Edward Marcinko MBA CMP™

http://www.MarcinkoAssociates.com

As fellow doctors, we understand better than most the more complex financial challenges physicians can face when it comes to their financial planning. Of course, most physicians ultimately make a good income, but it is the saving, asset and risk management tolerance and investing part that many of our colleagues’ struggle with. Far too often physicians receive terrible guidance, have no time to properly manage their own investments and set goals for that day when they no longer wish to practice medicine.

For the average doctor or healthcare professional, the feelings of pride and achievement at finally graduating are typically paired with the heavy burden of hundreds of thousands of dollars in student loan debt.

You dedicated countless hours to learning, studying, and training in your field. You missed birthdays and holidays, time with your families, and sacrificed vacations to provide compassionate and excellent care for your patients. Amidst all of that, there was no time to give your finances even a second thought.

Between undergraduate, medical school, and then internship and residency, most young physicians do not begin saving for retirement until late into their 20s, if not their 30s. You’ve missed an entire decade or more of allowing your money and investments to compound and work for you. When it comes to addressing your financial health and security, there’s no time to waste.

And you may be misled by unscrupulous “advisors”.

For example:

Question: Do you know the difference between a “Fee-Only” and a “Fee-Based financial advisor? Not knowing may cost you tens of thousands of dollars, or more, in excessive advisory fees.

MORE: https://marcinkoassociates.com/financial-planning/

Of course, all of this compound’s physician stress and burnout related issues, as well.

MORE: https://marcinkoassociates.com/process-what-we-do/

COMMENTS APPRECIATED

Thank You

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The New Federal SAVE Act

Posted on February 28, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

BY DR. DAVID E. MARCINKO MBA

SPONSOR: http://www.MARCINKOASSOCIATES.com

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In a January 24th letter, AHA and other national hospital organizations voiced support for the Safety from Violence for Healthcare Employees (SAVE) Act (H.R. 2584/S. 2768), bipartisan legislation that would provide federal protections for health care workers similar to those that apply to aircraft and airport workers. 

“Although our members have for many years had protocols in place designed to protect their employees and promote a safe environment for patient care, the number of violent attacks against health care workers has increased markedly in recent years,” the letters to House and Senate sponsors note. “Recent studies indicate that 44% of nurses have reported being subjected to physical violence and 68% have reported verbal abuse. These experiences affect the individual provider, who may suffer from both physical and psychological trauma, and they can also interfere with care delivery when providers fear for their personal safety, are distracted by disruptive patients or family members, or are traumatized from prior violent interactions. These types of incidents also consume scarce hospital and health system resources, which in turn could impact the care available for other patients.”

Link: https://www.govtrack.us/congress/bills/117/hr7961

Link: https://www.congress.gov/bill/117th-congress/house-bill/7961/text?r=179&s=1

Guidelines: https://medicalexecutivepost.com/2024/02/05/medical-workplace-violence-prevention-guidelines/

Healthcare Violence: https://medicalexecutivepost.com/2024/02/19/assessment-of-workplace-violence-in-healthcare/

COMMENTS APPRECIATED

Thank You

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DECEPTION: Mis-Managed Medicare [Dis] Advantage [Part C] Plans?

Posted on February 22, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

SPONSOR: http://www.MarcinkoAssociates.com

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Managed care insurers have profited handsomely from Medicare Advantage plans, scoring billions in annual profits. They credit this financial wizardry to their use of sophisticated data analytics, preventative care, cost optimization, provider networks, evidence and value-based care and risk mitigation strategies. However, doctors, hospitals, and medical providers assert something else.

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

In fact, Medicare Advantage plans have been making headlines in 2024, but not in a positive light, at least for health insurance companies. Medicare is a government-sponsored health insurance benefit; generally for retired people aged 65 and older.

For most, the money for Medicare Part B medical insurance or Part C Medicare Advantage plans is withdrawn directly from Social Security benefits monthly, coupled with a relatively small monthly payment from the patient. Nearly half of the Medicare population is enrolled in Part C Medicare Advantage plans.

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However, there have been rumblings in the medical sector between medical providers and medical insurers coming to a head. So, where do you stand?

COMMENTS APPRECIATED

Thank You

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RESOURCES: Financial and Economic Essays for Doctors and Healthcare Professionals

Posted on February 20, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

https://marcinkoassociates.com

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Informational essays of most current interest to healthcare professionals. Check back periodically for practical updates. Our catalogue library of major books, texts, case models and dictionaries is suggested for additional financial, economic, business and medical practice management information and education.

READ HERE: https://marcinkoassociates.com/articles-essays/

UPDATE: Prior ME-P Topics:

1-The number of balance billing disputes reaching arbitration is far higher than federal projections suggested.

2-Experts worry ACOs could face lasting financial difficulties due to an alleged $2 billion Medicare urinary catheter fraud scheme. 

COMMENTS APPRECIATED

Thank You

INVITE DR. MARCINKO: https://medicalexecutivepost.com/2024/02/05/invite-dr-marcinko-to-speak-at-your-next-seminar-webcast-or-event-in-2024/

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Some Cool New Health Care Administration Abbreviations and Terms

Posted on February 19, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

By Ann Miller RN MHA

[Executive-Director]

Abbreviations for 2024

  • AALL American Association for Labor Legislation
  • ACA Accountable Care Organizations (see PPACA)
  • AAMC Association of American Medical Colleges
  • AHA American Hospital Association
  • ALOS Average Length of Stay
  • AMA American Medical Association
  • ANA American Nurses Association
  • ASTHO Association of State and Territorial Health Offi cials
  • CAT Computerized Axial Tomography
  • CCMC Committee on the Costs of Medical Care
  • CDC Centers for Disease Control and Prevention
  • CHC Community Health Center
  • CHSS Cooperative Health Statistics System
  • CME Continuing Medical Education
  • CMS Centers for Medicare and Medicaid Services
  • CPO Combined Provider Organization
  • DHHS Department of Health and Human Services
  • DO Doctor of Osteopathy
  • DOD Department of Defense
  • DRG Diagnosis-Related Group
  • DVA Department of Veterans Affairs
  • EAP Employee Assistance Program
  • ED Emergency Department
  • EMS Emergency Medical Service (or System)
  • EMT Emergency Medical Technician
  • EPA Environmental Protection Agency
  • EPO Exclusive Provider Organization
  • FDA Food and Drug Administration
  • GAO General Accounting Offi ce
  • GPO Government Printing Offi ce
  • GDP Gross Domestic Product
  • GMENAC Graduate Medical Education National Advisory Committee
  • GNP Gross National Product
  • GPEP General Professional Education of the Physician Panel
  • HCFA Health Care Financing Administration
  • HIV Human Immunodeficiency Virus
  • HMO Health Maintenance Organization
  • HRSA Health Resources and Services Administration
  • IDS Integrated Delivery System
  • IPA Individual or Independent Practice Association
  • IPO Independent Practice Organization
  • JCAHO Joint Commission on Accreditation of Healthcare Organizations
  • LCME Liaison Committee on Medical Education
  • LPN Licensed Practical Nurse
  • MC Managed Care
  • MCH Maternal and Child Health
  • MCO Managed Care Organization
  • MEPS Medical Expenditure Panel Survey
  • MHS Marine Hospital Service
  • MMWR Morbidity and Mortality Weekly Report
  • MRI Magnetic Resonance Imaging
  • MVSR Monthly Vital Statistics Report
  • NCHS National Center for Health Statistics
  • NHANES National Health and Nutrition Examination Survey
  • NHIS National Health Interview Survey
  • NIH National Institutes of Health
  • NIMH National Institute of Mental Health
  • NIOSH National Institute of Occupational Safety and Health
  • NLN National League for Nursing
  • NP Nurse Practitioner
  • OMB Offi ce of Management and Budget
  • OPD Outpatient Department
  • OSHA Occupational Safety and Health Administration
  • PA Physician Assistant (or Associate)
  • PPACA Patient Protection and Affordable Care Act of 2010
  • PHO Physician–Hospital Organization
  • PHS Public Health Service
  • POS Point of Service
  • PPGP Prepaid Group Practice
  • PPO Preferred Provider Organization
  • RBRVS Resource-Based Relative Value System
  • RN Registered Nurse
  • SAMSHA Substance Abuse and Mental Health Services Administration
  • UR Utilization Review
  • USDA United States Department of Agriculture
  • USPHS United States Public Health Service
  • VA United States Department of Veterans Affairs
  • WHO World Health Organization
  • WIC Women, Infants, and Children Supplemental Nutrition Program

Assessment

Feel free to send us your own new-wave abbreviations and terms.

MORE: Glossary Terms Ap 3

SOURCE: Jonas’ US Health Care System

http://www.springerpub.com/product/9780826109309?utm_medium=email&utm_campaign=718+Public+Health+Single&utm_content=718+Public+Health+Single+Version+A+CID_ba75230692a1f4f7e4e896da56f9dff2&utm_source=MyemailFX&utm_term=Jonas+Introduction+to+the+US+Health+Care+System+7th+Edition

Product DetailsProduct DetailsProduct Details

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Order Our “Best-Selling” Healthcare Administration Dictionaries

Posted on February 19, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

Get ’em … While They are Hot!

By Ann Miller RN MHA

[ME-P Executive Director]

Just click on the book icon to order; get any one or all three! You’ll be glad you did.

 Product Details

Product Details

Product Details

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

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DAILY UPDATE: BoA Personal Data Breach

Posted on February 19, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

By Staff Reporters

HAPPY PRESIDENT’S DAY 2024

The Stock and Bond Markets are Closed!

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READ BANK TYPES: https://marcinkoassociates.com/bank-types/

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Bank of America just acknowledged that the personal information of 57,028 of its customers has been compromised. This breach, attributed to a failure at Infosys McCamish Systems (IMS), a provider of insurance business process solutions engaged by the bank, poses a substantial risk of identity theft to the affected individuals.

The data breach notification, filed in Maine, reveals that sensitive information related to Bank of America’s deferred compensation plans was inadvertently accessed. IMS, in a notification letter to customers, disclosed that the compromised data encompasses a range of critical personal details. The accessed information includes customers’ names, addresses, business email addresses, dates of birth, Social Security numbers, and other account specifics. Such data is typically all required for an identity thief to execute fraudulent activities under another person’s name.

IMS’s admission that it might never be able to precisely identify what information was accessed underscores the severity and potential long-term consequences of the breach. This uncertainty adds an additional layer of anxiety for customers, highlighting the challenges in mitigating the aftermath of such security failures.

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

Finally, Walmart and Home Depot will be the star of the show this week they report their earnings for the holiday quarter. Nvidia will also try to keep its historic hot streak going when it reports on Wednesday—expectations are through the roof.

COMMENTS APPRECIATED

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EDUCATION: Types of Learning, Teaching and Training

Posted on February 19, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

By Dr. David Edward Marcinko MBA MEd

http://www.MARCINKOASSOCIATES.com

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  • Pedagogy is the teaching of children, or dependent personalities. [teaching the child]
  • Andragogy is the facilitated learning for self-directed adult learners. [teaching the man or woman]
  • Heutagogy is the management of learning for self-managed learners. [teaching each other]

COMMENTS APPRECIATED

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DICTIONARY: Health Economics and Finance

Posted on February 18, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

BY DR. DAVID E. MARCINKO MBA

http://www.MARCINKOASSOCIATES.com

Designated a Doody’s Core Title!

“”Medical economics and finance is an integral component of the health care industrial complex. Its language is a diverse and broad-based concept covering many other industries: accounting, insurance, mathematics and statistics, public health, provider recruitment and retention, Medicare, health policy, forecasting, aging and long-term care, are all commingled arenas.

The Dictionary of Health Economics and Finance will be an essential tool for doctors, nurses and clinicians, benefits managers, executives and health care administrators, as well as graduate students and patients? With more than 5,000 definitions, 3,000 abbreviations and acronyms, and a 2,000 item oeuvre of resources, readings, and nomenclature derivatives? it covers the financial and economics language of every health care industry sector.””
– From the Preface by David Edward Marcinko “

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

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

THANK YOU!

Product Details

ORDER HERE: https://www.r2library.com/Resource/Title/0826102549

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Onsite Visits for Medical Office Appraisals

Posted on February 13, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

The Medical Practice Walk-through – A Necessity?

Dr. David E. Marcinko MBA

The most effective means for any professional appraiser to confirm his or her understanding of business value, and how internal controls over financial and managerial reporting is designed and operated in a medical practice, is to evaluate and test its effectiveness.

This includes making inquiries about and observing the personnel who actually perform the managerial duties and controls; reviewing documents that are used in – and that result from – the application of the controls; and comparing supporting documentation to the accounting records.

In performing an onsite office walkthrough, professional valuators examine and review transactions in a medical practices information system to the point where it is reflected in the company’s financial reports.

Practice onsite walkthroughs provide the valuator with evidence to:

·Confirm the medical process flow of transactions

·Understand the management design components of a medical practice valuation related to the prevention or detection of fraud, over utilization, excessive expenses, etc

 · Learn about office workforce processes by determining whether points at which misstatements related to each relevant financial statement assertion that could occur have been identified

·Document whether office controls have been placed in operation.

Of course, an onsite walk-through is the premier component of any comprehensive medical practice valuation engagement.

CONCLUSION: What are your thoughts on onsite valuation visits; pro or con?

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

Product Details 

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VALUE BASED CARE: Guidelines and Best Practices?

Posted on February 11, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

http://www.MarcinkoAssociates.com

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Three healthcare industry groups—America’s Health Insurance Plans (AHIP), the American Medical Association (AMA), and the National Association of Accountable Care Organizations (NAACOS)—released the 36-page playbook on July 25th, 2023. Adoption of the best practices in the playbook is voluntary; the playbook is intended to encourage the adoption of value-based care arrangements in the private sector, according to a news release from the three groups.

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

Under a value-based care model, providers are reimbursed based on patient outcomes rather than the quantity of services provided like in the traditional fee-for-service model. The value-based care model has been around since the late 1960s. But, widespread adoption has been slow—less than half of the primary care physicians said in a 2022 survey from the Commonwealth Fund that they had received any value-based payments.

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COMMENTS APPRECIATED

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CASH FLOW ANALYSIS: Real Life ACO Accounting Example

Posted on February 10, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

ACCOUNTABLE CARE ORGANIZATION EXAMPLE

BY DR. DAVID EDWARD MARCINKO MBA CMP®

http://www.MARCINKOASSOCIATES.com

CMP logo

SPONSOR: http://www.CertifiedMedicalPlanner.org

What is an ACO?

ACOs are groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high-quality care to their Medicare patients. The goal of coordinated care is to ensure that patients get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors.

When an ACO succeeds both in delivering high-quality care and spending health care dollars more wisely, the ACO will share in the savings it achieves for the Medicare program.

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

Case Model

Now, suppose that in a new Accountable Care Organization [ACO] contract, a certain medical practice was awarded a new global payment or capitation styled contract that increased revenues by $100,000 for the next fiscal year. The practice had a gross margin of 35% that was not expected to change because of the new business. However, $10,000 was added to medical overhead expenses for another assistant and all Account’s Receivable (AR) are paid at the end of the year, upon completion of the contract.

Cost of Medical Services Provided (COMSP):

The Costs of Medical Services Provided (COMSP) for the ACO business contract represents the amount of money needed to service the patients provided by the contract.  Since gross margin is 35% of revenues, the COMSP is 65% or $65,000.  Adding the extra overhead results in $75,000 of new spending money (cash flow) needed to treat the patients. Therefore, divide the $75,000 total by the number of days the contract extends (one year) and realize the new contract requires about $ 205.50 per day of free cash flows.

Assumptions

Financial cash flow forecasting from operating activities allows a reasonable projection of future cash needs and enables the doctor to err on the side of fiscal prudence. It is an inexact science, by definition, and entails the following assumptions:

  • All income tax, salaries and Accounts Payable (AP) are paid at once.
  • Durable medical equipment inventory and pre-paid advertising remain constant.
  • Gains/losses on sale of equipment and depreciation expenses remain stable.
  • Gross margins remain constant.
  • The office is efficient so major new marginal costs will not be incurred.

Physician Reactions:

Since many physicians are still not entirely comfortable with global reimbursement, fixed payments, capitation or ACO reimbursement contracts; practices may be loath to turn away short-term business in the ACA era.  Physician-executives must then determine other methods to generate the additional cash, which include the following general suggestions:

1. Extend Account’s Payable

Discuss your cash flow difficulties with vendors and emphasize their short-term nature. A doctor and her practice still has considerable cache’ value, especially in local communities, and many vendors are willing to work them to retain their business

2. Reduce Accounts Receivable

According to most cost surveys, about 30% of multi-specialty group’s accounts receivable (ARs) are unpaid at 120 days. In addition, multi-specialty groups are able to collect on only about 69% of charges. The rest was written off as bad debt expenses or as a result of discounted payments from Medicare and other managed care companies. In a study by Wisconsin based Zimmerman and Associates, the percentages of ARs unpaid at more than 90 days is now at an all time high of more than 40%. Therefore, multi-specialty groups should aim to keep the percentage of ARs unpaid for more than 120 days, down to less than 20% of the total practice. The safest place to be for a single specialty physician is probably in the 30-35% range as anything over that is just not affordable.

The slowest paid specialties (ARs greater than 120 days) are: multi-specialty group practices; family practices; cardiology groups; anesthesiology groups; and gastroenterologists, respectively. So work hard to get your money, faster. Factoring, or selling the ARs to a third party for an immediate discounted amount is not usually recommended.

3. Borrow with Short-Term Bridge Loans

Obtain a line of credit from your local bank, credit union or other private sources, if possible in an economically constrained environment. Beware the time value of money, personal loan guarantees, and onerous usury rates. Also, beware that lenders can reduce or eliminate credit lines to a medical practice, often at the most inopportune time.

4. Cut Expenses

While this is often possible, it has to be done without demoralizing the practice’s staff.

5.  Reduce Supply Inventories

If prudently possible; remember things like minimal shipping fees, loss of revenue if you run short, etc.

6. Taxes

Do not stop paying withholding taxes in favor of cash flow because it is illegal.

Hyper-Growth Model:

Now, let us again suppose that the practice has attracted nine more similar medical contracts. If we multiple the above example tenfold, the serious nature of potential cash flow problem becomes apparent. In other words, the practice has increased revenues to one million dollars, with the same 35% margin, 65% COMSP and $100,000 increase in operating overhead expenses.  Using identical mathematical calculations, we determine that $750,000 / 365days equals $2,055.00 per day of needed new free cash flows!  Hence, indiscriminate growth without careful contract evaluation and cash flow analysis is a prescription for potential financial disaster.

ASSESSMENT: Your comments are appreciated.

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Digital Entrepreneurial Health for Aging Populations

Posted on February 7, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

THE FUTURE OF ELDER CARE FOR ENTREPRENEURIAL DOCTORS?

By Dr. David Edward Marcinko MBA

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I was delighted to read a scientific paper that goes beyond just detailing a complex topic and encourages us to broaden our horizons, imagine what the future of elder care could hold and define our roles in shaping it’s future.

It was sent to me my colleague Bertalan Meskó, MD PhD [The Medical Futurist]

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COMMENTS APPRECIATED

Thank You

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INVITE: Dr. Marcinko to Speak at your Next Big Event in 2024?

Posted on February 1, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

Invite Dr. Marcinko

The Choice is Up to You

http://www.MARCINKOASSOCIATES.com

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Colleagues know that I enjoy personal coaching and public speaking and give as many talks each year as possible, at a variety of medical society and financial services conferences around the country and world.

These include lectures and visiting professorships at major academic centers, keynote lectures for hospitals, economic seminars and health systems, keynote lectures at city and statewide financial coalitions, and annual keynote lectures for a variety of internal yearly meetings.

 Topics Link: imba-inc-firm-services

My Fond Farewell to Tuskegee University

And so, we appreciate your consideration.

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THANK YOU!

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Can this Doctor RETIRE?

Posted on January 20, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

AFFORDABILITY IN 2024

By Staff Reporters

SPONSOR: http://www.MARCINKOASSOCIATES.com

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CAN THIS DOCTOR RETIRE – HE ASKS?

I’m a late career entry and 55 year old burned out doctor who wants out. Can I retire in 2 years with a pension of $6,100 a month (net). I have $825,000 in my 401(k) and 457 plan and a mortgage of $95,000 at 5.30%. I am not planning to move and will retire in place.

SOME THOUGHTS AND ANSWERS?

Congratulations on you solid retirement fund on top of a pending pension. 

The first step you should take is to create a detailed budget for your retirement years. Consider expected living costs, healthcare expenses, travel and any other major expenses. Many folks make the mistake of setting up a monthly budget, but keep out significant milestones that are often costly, such as paying for a child’s college education or wedding.

Next, you should figure out your plan for housing. Mortgage payments, upkeep and taxes are important considerations. There was no mention of mortgage equity. 

Another factor to take into account is state and Federal tax projections. If the 401(k) funds are all pre-tax dollars, any distributions will be taxable and there may be penalties if funds are withdrawn prior to 59 ½ years old. That will impact your retirement plan if you’re preparing to retire at 57-58.

It also sounds like you haven’t taken into account your Social Security allowance. It’s possible that your pension is one that comes with a government pension offset which would explain why you didn’t include it. On the other hand, maybe you’re thinking it’s far out enough that it doesn’t factor into your calculations?

Finally, you may want to look for a fee-only financial advisor that is paid directly by the client and doesn’t receive commissions for recommending financial products. So, advice is less biased. And get a fiduciary advisor which means they are required to put your best interests ahead of their own. 

Also, someone with medical niche specificity. Good Luck!

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NOTE: This is not an offer to buy or sell any security or interest. All investing involves risk, including loss of principal. Working with an adviser may come with potential downsides such as payment of fees (which will reduce returns). There are no guarantees that working with an adviser will yield positive returns. The existence of a fiduciary duty does not prevent the rise of potential conflicts of interest.

Refer a Colleague: MarcinkoAdvisors@msn.com

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Crafting a Medical Practice Strategic Marketing Plan

Posted on January 17, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

Necessary Today – Not So In the Past

http://www.MarcinkoAssociates.com

dem

[By Dr. David Edward Marcinko; MBA, CMP™]

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Marketing plays a vital role in successful practice ventures. How well you market your practice, along with a few other considerations, will ultimately determine your degree of success or failure. 

The key element of a successful marketing plan is to know your patients – their likes, dislikes and expectations. By identifying these factors, you can develop a strategy that will allow you to arouse and fulfill their wants and needs. 

The Beginning

Identify your patients by their age, sex, income/educational level and residence. At first, target only those patients who are more likely to want or need your medical services. As your patient base expands, you may need to consider modifying the marketing plan to include other patient types or medical services. 

Your marketing plan should be included in your medical business plan and contain answers to the questions asked below:

·Who are your patients; define your target market(s)?

·Are your markets growing; steady; or declining?

·How is the practice unique?

·What is its market position?

·Where will we implement the marketing strategy?

·How much revenue, expense and profit will the practice achieve?

·Are your markets large enough to expand?

·How will you attract, hold, increase your market share?

·If a franchise, how is your market segmented?

·How will you promote your practice and services?

Practice Competition

Competition is a way of life. We compete for jobs, promotions, scholarships to institutions of higher learning, medical school, residency and fellowship programs, and in almost every aspect of our lives. 

When considering these and other factors, we can conclude that medical practice is a highly competitive, volatile arena. Because of this volatility and competitiveness, it is important to know your medical competitors. Questions like these can help you determine:

·Who are your five nearest direct physician competitors?

·Who are your indirect physician competitors?

·How are their practices: steady; increasing; or decreasing?

·What have you learned from their operations or advertising?

·What are their strengths and weaknesses?

·How do their services differ from yours?

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Chief-Marketing-Officer

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Patient Targeting

Patient targeting generally describes the strategic competitive advantage and/or professional synergy that is specific and unique to the practice. Intuitively, it answers such questions as:

·Who is the target market?

·How is the practice unique?

·What is its market position?

·Where will we implement the marketing strategy?

· How much revenue, expense and profit will the practice achieve?  

The science of modern marketing however, is based on intense competition largely derived from the interplay of five forces, codified in the early 1980s, by Professor Michael F. Porter of Harvard Business School. They are placed in this section of the business plan and include the following:

Power of suppliers: The bargaining power of physicians has weakened markedly in the last managed care decade.  Reasons include demographics, technology, over/under supply and a lack of business acumen. 

Power of buyers: Corporate buyers of employee healthcare are demanding increased quality and decreased premium costs within the entire healthcare industry. The extents to which these conduits succeed in their bargaining efforts depend on several factors:

·Switching Costs: Notable emotional switching costs include the turmoil caused by uprooting a trusted medical provider relationship.

·Integration Level: The practitioner must decide early on whether or not he will horizontally integrate as a solo practitioner, or vertically integrate into a bigger medical healthcare complex.

·Product Importance: Increasingly, HMOs do not often strive to delight their clients and may be responsible for the beginning backlash these entities are starting to experience. Additionally, some medical specialties have more perceived value than others (i.e., neurosurgery v. dermatology)

· Concentration:  Insurance companies, not patients, represent buyers that can account for a large portion of practice revenue, thereby bringing about certain concessions.  A danger sign is noted when any particular entity encompasses more than 15-25% of a practice’s revenues.

Threat of new entrants: Some authorities argue that medical schools produce more graduates than needed, inducing a supply side shock. Others suggest that there too many patients? Regardless, this often can be mitigated by practicing in rural or remote locations, away from managed care entities, or in areas with under-served populations.

Current or existing competition: Heightened inter-professional competition has increased the intensity and volume of certain medical services and referrals may be correspondingly with-held.  Rivalry occurs because a competitor acts to improve his standing within the marketplace or to protect its position by reacting to moves made by other specialists.

Substitutions: Examples include: PAs for DOs, nurse practitioners for MDs, technicians for physical therapists, hygienists for dentists, cast technicians for orthopedists, nurse midwives for obstetricians, foot care extenders for podiatrists and even, hospital sanitation workers for medical and surgical care technicians.  Any strategy to ameliorate these conditions will augment the successful business practice plan. 

MORE: Healthcare Market.Tensions 2,0 MARCINKO

MORE: Strategic Management Improvement

Enter the Chief Marketing Officer [CMO]

A Chief Marketing Officer or marketing director is a corporate executive responsible for marketing activities in an organization.  The CMO leads brand management, marketing communications, market research, product management, distribution channel management, pricing, often times sales, and customer service, etc.

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DEM at Drexel

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Academic Metaphor?

Now, with all the competition today at the college and university level; notwithstanding the recent Hollywood Elite University acceptance debacle, can you see how these basic ideas might also be helpful in the academic and educational strategic marketing ecosystem?

The Emerging Role of University CHIEF STRATEGY OFFICER

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 The changing role of a college / university Chief Marketing Office [narrow focus] –versus–  Chief Strategy Officer [broader entity focus].

Assessment

A good way to accomplish and codify the above marketing plan concept is through a SWOT analysis. Mention the Strengths, Weaknesses, Opportunities and Threats of your specialty specific practice and what you plan do to maximize the positive, and minimize the negative aspects of the analysis.

Conclusion

Only after the above forces have been considered, should you begin the process that many physicians mistake for crafting their marketing efforts; executing the actual marketing plan. 

If you are not going to the right audience, making the correct statements or delivering your message through the proper advertising channels, you might as well put your medical practice marketing plan into the trash can because it will not secure you funds, or benefit your practice. 

Do you have a marketing plan, and more importantly, how well do you execute it? 

More info: http://www.springerpub.com/prod.aspx?prod_id=23759

Speaker: If you need a moderator or a speaker for an upcoming event, Dr. David Edward Marcinko; MBA is available for speaking engagements. Contact him at: MarcinkoAdvisors@msn.com

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

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DAILY UPDATE: Canadian Drugs, ACA and the Mixed Stock Markets

Posted on January 13, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

By Staff Reporters

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SPONSOR: http://www.MarcinkoAssociates.com

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States that have long pushed the FDA to allow drug importation from Canada touted the move as a major step forward in their efforts to lower prescription drug spending and rein in healthcare costs. But while the idea of importing drugs from Canada is new for states, some businesses have been using existing drug import pathways to help consumers save money on certain high-cost medications.

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More than 20 million US residents—a record number, according to the Biden administration—have signed up for health insurance through the Affordable Care Act’s marketplaces. (the New York Times)

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Here’s where the major benchmarks ended:

Stocks were a mixed bag yesterday as investors pored over the first big earnings reports and new data showing that wholesale prices surprisingly went down in December. Airlines took a hit after Delta beat earning expectations but lowered its profit forecast.

  • The S&P 500 index rose 3.59 points (0.1%) to 4,783.83, up 1.8% for the week; the Dow Jones Industrial Average® (DJI) fell 118.04 points (0.3%) to 37,592.98, up 0.3% for the week; the NASDAQ Composite rose 2.57 points to 14,972.76, up 3.1% for the week.
  • The 10-year Treasury note yield (TNX) fell about 3 basis points to 3.943%.
  • The CBOE® Volatility Index (VIX) rose 0.26 to 12.70.

Retailers and consumer discretionary shares were among the market’s weakest performers Friday, and regional banks were also under pressure. The KBW Regional Banking Index (KRX) fell 2% for the week and ended at a one-month low. Energy shares led gainers behind strength in crude oil futures. The small-cap-focused Russell 2000® Index (RUT) ended little-changed for the week but is still down 3.8% so far this year.

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

COMMENTS APPRECIATED

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BANKS: JPMorgan Chase, BoA, Wells Fargo and CitiGroup Report

Posted on January 12, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

By Staff Reporters

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JPMorgan Chase’s profit fell in the fourth quarter as the lender set aside nearly $3 billion to help refill a government deposit insurance fund. JPMorgan and several major banks are required to pay a bulk of the $16 billion to replenish the Federal Deposit Insurance Corporation’s deposit insurance fund (DIF), which was drained after Silicon Valley Bank and Signature Bank failed last year.

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Bank of America’s fourth-quarter profit shrank as the lender took $3.7 billion in combined charges to refill a government deposit insurance fund and phase out a loan index. Its net interest income (NII) – the difference between what banks earn from loans and pay to depositors – fell 5% to $13.9 billion as the company spent more to keep customer deposits and demand for loans stayed subdued amid high interest rates.

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Wells Fargo press release (NYSE:WFC): Q4 Non-GAAP EPS of $1.29 beats by $0.20. Revenue of $20.48B (+2.2% Y/Y) beats by $100M. Shares -1% PM. Fourth quarter 2023 results included: ◦ $(1.9) billion, or ($0.40) per share, of expense from an FDIC special assessment ◦ $(969) million, or ($0.20) per share, of severance expense for planned actions ◦ $621 million or $0.17 per share, of discrete tax benefits related to the resolution of prior period tax matters ◦ Provision for credit losses in fourth quarter 2023 included an increase in the allowance for credit losses driven by credit card and commercial real estate loans, partially offset by a lower allowance for auto loans. The change in allowance for credit losses also included higher net loan charge-offs for commercial real estate office and credit card loans

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Citigroup (C) is in the middle of a complicated restructuring. It made it clear Wednesday that its fourth quarter earnings report Friday will be complicated, too.

The giant New York-based bank said in a regulatory document it will take more than $3 billion in one-time reserves and expenses as part of those fourth quarter results. They include everything from a $1.3 billion reserve build for currency exposure in Argentina and Russia to $780 million in charges related to severance costs and other aspects of a wide-ranging restructuring of the bank led by CEO Jane Fraser.

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

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BANK: Types

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SAMPLE: New Physician Letter of Employment Contract

Posted on January 12, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

BY DR. DAVID E. MARCINKO MBA CMP®

CMP logo

SPONSOR: http://www.CertifiedMedicalPlanner.org

SAMPLE NEW PHYSICIAN LETTER OF EMPLOYMENT INTENT

Dear Dr. [Name of Physician]

On behalf of [Name of medical practice or clinic] (hereinafter called the “practice”), this letter sets out a proposed agreement for your initial employment in Dr. [Name of physician]’s medical practice. After both you and Dr. [Name of physician] have agreed upon all issues related to your employment, a formal physician employment agreement will be prepared for your review and signature.

1.   Term: You will be an employee of the practice for an initial [Duration]-month period starting [Month, Date, Year]. Should you and the practice want to proceed past this initial employment period, an offer of co-ownership may be made to you as described in item nine below.

      Your employment with the practice will essentially be “at will,” since you or the practice may voluntarily terminate it at any time upon 30 days’ written notice to the other. However, the following are conditions under which the practice may terminate your em­ployment immediately: (a) upon your death or disability for three (3) consecutive months; (b) upon the suspension, revocation, or cancellation of your right to practice medicine in the State of [State]; (c) if you should lose privileges at any hospital at which the practice regularly maintains admission privileges; (d) should you fail or refuse to follow reasonable policies and directives es­tablished by the practice; (e) should you commit an act amounting to gross negligence or willful misconduct to the detriment of the practice or its patients; (f) if you are convicted of a crime involving moral turpitude, including fraud, theft, or embezzlement; and (g) if you breach any of the terms of your employment contract.

2.   Compensation: Your salary for the initial 12-month period will be $[dollar value] and $[dollar value] in the second 12-month period, each year payable in monthly installments. You will also be enti­tled to an incentive bonus calculated as follows: [Percentage] % of your collected production when such collections exceeds $[dollar value] in the first year and $[dollar value] in the second year. The bonus each year will be calculated and paid on a semiannual basis. You will also be entitled to receive a one-time signing bonus of $[dollar value] if you sign your employment contract before [Month, Date, Year].

      A portion of your compensation may be paid for by proceeds received from [Name of hospital] under the terms and conditions of a hospital recruitment agreement. The parties to this agreement will be the hospital and the practice only. However, forgiveness of any advances made by the hospital will be directly contingent upon the length of time you remain with the practice. Therefore, should your employment terminate for any reason, the practice will re­quire you to repay to it any amounts the practice repays the hospi­tal, in no matter what form, per the terms and conditions in the hospital recruitment agreement. [Note: Use this if the practice signs a hospital recruitment agreement with the hospital.]

3.   Benefits: In addition to your base compensation and incentive bo­nus, the practice will pay for the following: (a) health insurance, (b) malpractice insurance, (c) continuing medical education (CME) costs, (d) medical license fee, (e) board certification exam fee, (f) reasonable cellular phone costs, and (g) a pager. You will also be entitled to a moving cost allowance for relocating to [Location.] You will be entitled to two weeks of paid vacation, 10 working days as paid sick leave, and four days paid time off for CME or the board certification exam.

4.   Disability Leave: In case of absence because of your illness or injury, your base salary will continue for a period not exceeding 30 days per calendar year, plus any unused vacation time and sick leave. You will be entitled to any incentive bonus payments that may be due to you as collections are received on your prior production. Absence in excess of 30 days would be without pay. Unused sick leave cannot be carried over to succeeding years, nor will it be paid for at any time.

5.   Exclusive Employment: As an employee, you will be involved full-time in the practice and you may not take any outside employ­ment during the term of your employment agreement without the practice’s written approval. However, you will be entitled to keep compensation from honorariums, royalties, and copyrights if ap­proved by the practice in writing. If the practice does not give approval, then the income from such activities shall remain the property of the practice.

6.   Termination Compensation:  Should your employment terminate for any reason, you will be entitled to accrued but unpaid base compensation, earned but unpaid incentive bonus, and unused va­cation leave.

7.   Non-Solicitation: During the course of your employment, the prac­tice will introduce and make available to you its contacts and refer­ring physician relationships, ongoing patient flow, general hospital sources, business and professional relationships, and the like. Since you have not been in private practice in the area previously, you acknowledge that you currently have no established patients following you. If there should be a termination, the practice will not restrict your ability to practice medicine in the area; however, it will require you to enter into a nonsolicitation agreement in which you agree not to solicit the employees of the practice nor its patients to follow you into your new medical practice. [Note: Insert Covenant Not to Compete here, if applicable.]

8.   Employee-Only Status: During the term of your employment, you will not be required to contribute any money toward the practice’s equipment or operations, but likewise your work will give you no financial interest in the assets of the practice. However, the prac­tice intends to offer you the opportunity to buy into the ownership of the practice as set forth in item 9 below.

9.   Ownership Opportunity: At the end of your employment period, the practice will evaluate your relationship and may offer you the opportunity to become a co-owner in the practice (or enter into an office-sharing relationship). This offer is not mandatory and is at the total discretion of the practice. Should an offer not be tendered for some reason, the practice will wait until the end of your next 12-month employment period to decide whether to tender an offer of co-ownership.        If an offer of co-ownership is made, Dr. [Name of physician] will discuss with you the following: (a) what percentage of the practice you will be allowed to acquire, (b) how best to value such interest, and (c) how you will pay for the acquisition of such interest. The practice hopes to achieve mutually agreeable solutions to these ownership issues.

We hope this offer meets with your approval. If so, please contact Dr. [Name of physician] as soon as possible. This letter is not intended to be a legally binding agreement; it is, rather, a tool to be used to prepare your formal physician employment agreement. If you should have any questions, please do not hesitate to contact myself or Dr. [Name of physician] at your convenience.

Sincerely,

Atlantic Physicians Group

MEDICAL GROUP PRACTICE, LLC

Lantana FLA

ASSESSMENT: Your thoughts are appreciated.

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

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

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DAILY UPDATE: Stock Markets Rocket Upward

Posted on January 11, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

By Staff Reporters

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SPONSOR: http://www.MarcinkoAssociates.com

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Investors are a day away from an inflation report that may offer some direction in a young year that has seen markets meander, with a brief sell-off and a partial rally back. More action may come as Wall Street banks kick off earnings season on Friday.

Here is where the major benchmarks ended:

  • The S&P 500 index rose 26.95 points (0.6%) to 4,783.45, a two-year closing high; the Dow Jones Industrial Average® (DJI) increased 170.57 points (0.5%) to 37,695.73; the NASDAQ Composite gained 111.94 points (0.8%) to 14,969.65.
  • The 10-year Treasury note yield (TNX) added about 2 basis points to 4.04%.
  • The CBOE® Volatility Index (VIX) fell 0.06 to 12.70.

Among market sectors, the S&P 500 Communication Services Index (SP500#50), which includes “mega-cap” tech companies like Google parent Alphabet (GOOGL) and Facebook parent Meta Platforms (META), gained 1.2% and ended near a two-year high. Consumer discretionary shares were also firm. Energy stocks were one of the weakest performers behind a 1.3% drop in crude oil futures.

Peterson noted strength in tech shares may in part reflect news from this week’s Consumer Electronics Show in Las Vegas, with escalating bullishness surrounding artificial intelligence (AI) driving further gains in Nvidia (NVDA) and other chip companies capable of serving the most advanced forms of AI. Nvidia has jumped more than 10% so far this week and posted a record high for the third straight day.

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DOWN: Digital Health Care Funding

Posted on January 11, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

By Dr. David Edward Marciniko MBA CMP™

SPONSOR: http://www.MarcinkoAssociates.com

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DEFINITION: According to the Food and Drug Administration [FDA], the broad scope of digital health includes categories such as mobile health (mHealth), health information technology (IT), wearable devices, tele-health and tele-medicine, and personalized medicine. From mobile medical apps and software that support the clinical decisions doctors make every day to artificial intelligence and machine learning, digital technology has been driving a revolution in health care. Digital health tools have the vast potential to improve our ability to accurately diagnose and treat disease and to enhance the delivery of health care for the individual. Digital health technologies use computing platforms, connectivity, software, and sensors for health care and related uses. These technologies span a wide range of uses, from applications in general wellness to applications as a medical device. They include technologies intended for use as a medical product, in a medical product, as companion diagnostics, or as an adjunct to other medical products (devices, drugs, and biologics). They may also be used to develop or study medical products.

Cite: http://tinyurl.com/2jbafuc7

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As many investors predicted, digital health funding took a dive in 2023, according to Rock Health’s year-end funding report. Startups got creative to stay afloat but many digital health founders will have to “face the music” in 2024, the VC firm’s analysts say.

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Editor’s Note: I am on the Advisory Board of Medblob™a start-up based in Boston, MA. The digital mission of Medblob™ is to improve community and national health by allowing patients to better manage their health, providers to better treat their patients, and researchers to have the best information to discover cures to the most prevalent and pernicious diseases.

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DAILY UPDATE: Stocks Rocket Back for Highest 2024 Close as Key Inflation Updates Loom

Posted on January 9, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

By Staff Reporters

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Here is where the major benchmarks ended:

Bond yields and stock prices often move inversely to each other, in part because higher interest rates on virtually risk-free bonds lower the premium investors can expect from riskier assets like stocks, making it less appealing to buy equities. Last week, the 10-year Treasury yield briefly increased to 4.10%, near a three-week high, before dropping back near 4% Monday.

  • The S&P 500 index was up 66.30 points (1.4%) at 4,763.54; the Dow Jones Industrial Average was up 216.90 points (0.6%) at 37,683.01; the NASDAQ Composite was up 319.70 points (2.2%) at 14,843.77.
  • The 10-year Treasury note yield (TNX) was down about 3 basis points at 4.015%.
  • The CBOE® Volatility Index (VIX) was down 0.28 at 13.07.

Semiconductors shares were among the strongest performers, helped by a surge of 6.4% in Nvdia Corp. (NVDA), the top 2023 performer in the S&P 500 with a gain of 239%. Small-cap stocks were also firm as were consumer discretionary and communication services. The Russell 2000® Index (RUT) gained 1.9% to partly climb back from last week’s 3.7% drop.

Energy shares were soft because crude oil futures sank nearly 4% following reports Saudi Arabia lowered its prices.

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DAILY UPDATE: Crypto-Currency, ETFs and the Stock Markets

Posted on January 8, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

By Staff Reporters

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The Markets as of 10:00am ET. Here’s what these numbers mean.
Markets: One week into 2024, stocks and bonds are off to their worst start in 21 years as investors maybe got a bit ahead of their skis in anticipating Fed rate cuts.

This week, Wall Street will be focused on fresh inflation data and the beginning of Q4 earnings season.

                        

Bitcoin ETF cleared for launch? The first spot bitcoin ETF—could be approved by regulators this week in what would be a watershed moment for Wall Street’s embrace of digital tokens. The hype around these proposed funds, which would allow regular investors to gain exposure to bitcoin without buying it directly, drove bitcoin’s price up 162% over the past year.

Here is where the major benchmarks ended:

  • The S&P 500 Index was up 84.15 points (1.9%) at 4,495.70; the Dow Jones Industrial Average (DJI) was up 489.83 points (1.4%) at 34,827.70; the NASDAQ Composite (COMP) was up 326.64 points (2.4%) at 14,094.38.
  • The 10-year Treasury note yield (TNX) was down about 18 basis points at 4.453%.
  • CBOE’s Volatility Index (VIX) was down 0.60 at 14.16.

The small-cap focused Russell 2000 Index (RUT), which has lagged large-cap benchmarks for most of the year, jumped more than 5% Tuesday. Small-caps are often seen as being more exposed to the economic cycle and had suffered because of concerns that high interest rates could push the economy into recession.

Other interest rate-sensitive sectors, such as real estate, materials, and utilities, also saw outsize gains.

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DAILY UPDATE: “Medical Properties Trust” Tanks, FDA Approves Canadian Drugs and Medicare Advantage Health Plan [Part C] Patient Traps

Posted on January 7, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

By Staff Reporters

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Markets: Stocks climbed a bit on Friday as investors took in the news that the US added more jobs than expected in December, capping off an epic 2023 for the labor market. But it wasn’t a bright start to the year, as all three major averages broke a nine-week winning streak. Stock spotlight: The country’s largest hospital landlord, Medical Properties Trust, tanked after revealing that its biggest tenant was $50 million behind on rent.

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Yesterday, the Food and Drug Administration (FDA) approved Florida’s request to import bargain medications from the country. It’s the first state to get permission from the agency to bring in medications from Canada under a law Congress passed 20 years ago to help Americans pay less for drugs. Florida officials say ordering cheaper drugs for conditions like HIV and diabetes from Canadian wholesalers will save Medicaid and other state programs $150 million over the first year.

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Older Americans say they feel trapped in Medicare Advantage plans.

READ HERE: http://tinyurl.com/yck2yb8z

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DAILY UPDATE: Walgreens’s Dividend Dives as Stocks Post Down Week

Posted on January 6, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

By Staff Reporters

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DEFINITION: A stock dividend is a payment to shareholders that consists of additional shares rather than cash. The distributions are paid in fractions per existing share. For example, if a company issues a stock dividend of 5%, it will pay 0.05 shares for every share owned by a shareholder. The owner of 100 shares would get five additional shares.

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Stat: 3.9%. That’s Walgreens’s new dividend yield after the pharmacy chain cut its quarterly dividend of 7.0%. The company said that it was using the money to “strengthen [its] long-term balance sheet and cash position.” Walgreens stock fell 11% the day after the announcement. (CNBC)

Here is where the major benchmarks ended:

  • The S&P 500 index was up 8.56 points (0.2%) at 4,697.24, down 1.6% for the week; the Dow Jones Industrial Average® (DJI) was up 25.77 points (0.1%) at 37,466.11, down 0.6% for the week; the NASDAQ Composite® (COMP) was up 13.77 points (0.1%) at 14,524.07, down 3.2% for the week.
  • The 10-year Treasury note yield (TNX) was up about 6 basis points at 4.051%.
  • The CBOE® Volatility Index (VIX) was down 0.77 at 13.36.

Consumer staples and real estate ranked among the market’s weakest performers Friday, and technology shares remained under pressure with tech bellwether Apple (AAPL) extending this week’s nearly-6% slide and ending near a two-month low. Financial shares were one of the stronger sectors with the Philadelphia KBW Bank Index (BKX) rising 1.6% to a 10-month high. Small-cap stocks remained in the red with the Russell 2000® Index (RUT) ending the week down 3.7%. 

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DAILY UPDATE: Second Apple Downgrade with Mixed Markets as Investors Await Payroll Data and Lilly Sells Medications Directly to Patients

Posted on January 5, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

By Staff Reporters

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Here’s where the major benchmarks ended:

  • The S&P 500® index (SPX) was down 16.13 points (0.3%) at 4,688.68; the Dow Jones Industrial Average® (DJI) was up 10.15 points at 37,440.34; the NASDAQ Composite was down 81.91 points (0.6%) at 14,510.30.
  • The 10-year Treasury note yield (TNX) was up about 9 basis points at 3.997%.
  • The CBOE® Volatility Index (VIX) was up 0.08 at 14.12.

Oilfield services and consumer discretionary shares were also among the market’s weakest performers Thursday. Banking and health care were among the strongest sectors, illustrating renewed investor interest in stocks that lagged the broader market last year.

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And, Eli Lilly is poised to sell medicine directly to consumers — with an emphasis on newly popular weight-loss drugs — in a move toward cutting out the controversial middle players in drug distribution.

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DAILY UPDATE: Technology Stocks Tank on Perihelion Day

Posted on January 4, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

By Staff Reporters

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Today the Earth is the closest it can get to the sun, a point in orbit known as perihelion, which happens every year two weeks after the December solstice.

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Here’s where the major benchmarks ended:

  • The S&P 500® index (SPX) was down 38.02 points (0.8%) at 4,704.81; the Dow Jones Industrial Average® (DJI) was down 284.85 points (0.8%) at 37,430.19; the NASDAQ Composite was down 173.73 points (1.2%) at 14,592.21.
  • The 10-year Treasury note yield (TNX) was down about 3 basis points at 3.91%.
  • The CBOE® Volatility Index (VIX) was up 0.84 at 14.04.

In addition to tech shares, retailers and banks were also among the market’s weakest performers Wednesday. Small-cap stocks were also under pressure with the Russell 2000® Index (RUT) down about 2.7% to a three-week low. Energy shares strengthened behind a jump of nearly 4% in crude oil futures.

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DAILY UPDATE: Apple and the “Magnificent 7” Stocks Drop with the Markets

Posted on January 3, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

By Staff Reporters

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Driving much of the tech slump was a 4% drop by Apple’s stock, a dive precipitated by an analyst downgrade questioning why the $2.9 trillion (market capitalization) company is trading at such an expensive valuation considering its negative earnings and profit growth.

Other members of the “magnificent seven” tech stocks, which gained a collective $5.1 trillion in market cap last year, also flailed Tuesday. Alphabet, Amazon, Meta, Microsoft, Nvidia and Meta each fell 1.6% or more, while Tesla was the sole magnificent seven member in the green, as its shares slipped less than 1% after reporting more fourth-quarter electric vehicle deliveries than fore-casted.

Here is where the major benchmarks ended:

  • The S&P 500 index was down 27.00 points (0.6%) at 4,742.83; the Dow Jones Industrial Average® (DJI) was up 25.50 points (0.1%) at 37,715.04; the NASDAQ Composite was down 245.41 points (1.6%) at 14,765.94.
  • The 10-year Treasury note yield (TNX) was up about 7 basis points at 3.931%.
  • The CBOE® Volatility Index (VIX) was up 0.73 at 13.18.

Semiconductor companies led the way lower Tuesday after Bloomberg reported Netherlands-based ASML Holding NV (ASML) canceled shipments of some of its machines to China at the request of U.S. President Biden’s administration weeks before export bans on the high-end chipmaking equipment came into effect. The Philadelphia Semiconductor Index (SOX) tumbled 3.7%. Health care and energy sectors were among the few areas of strength, the latter gaining despite a 1.6% drop in crude oil futures.

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DAILY UPDATE: ChristianaCare Settles FCA Lawsuit as Stock Markets Celebrate 2023 but Start Off Rocky in 2024

Posted on January 2, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

By Staff Reporters

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ChristianaCare agreed to pay $47.1 million to resolve illegal kickback allegations flagged by its former chief compliance officer.

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Markets: The stock market was closed yesterday to give investors time to celebrate New Year’s Day 2024. As the just passed old year, 2023, provided plenty of reasons to pop bottles and celebrate:

For example, global stock markets had their best year since 2019, and all three major US indexes finished the year higher than they started it, with tech company gains pushing the NASDAQ up the most. Even among tech giants, Nvidia was a standout, boosted by A.I. suddenly being everywhere.

But, all major markets are down as of this posting time, today.

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HELPING DOCTORS ACHIEVE: New Year Resolutions

Posted on January 2, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

COACHING AND MENTORING

Physician Goal Setting [Business V. Personal Approach] in 2024

By Marcinko Associates, Inc.

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CORPORATE APPROACH

The year-end physician, nurse and/or medical employee reviews in general aren’t very effective at motivating employees in ACOs, and VBC organizations, etc.

And, according to a Gallup [non-medical worker] poll, only 14% of employees “strongly agreed” that a performance review inspired them to improve. But in recent years, some workplaces have changed how they conduct performance reviews—or abandoned them altogether especially in technology.

  • A decade ago, Microsoft disbanded its version of stack ranking, the practice pioneered by General Electric CEO Jack Welch in the 1980s in which the company would rank every employee. Experts say it hurts morale and can create a toxic work culture.
  • Netflix has around 10,000 employees but has eschewed the year-end review for informal conversations during the year.
  • Google revamped its system last May by reducing performance reviews from twice to once a year.
  • Apple dropped performance reviews completely.

Healthcare business and corporate employees want feedback, even physicians, but it has to be useful.

PERSONAL APPROACH

Now that you’ve set your personal goals on your landmark date (New Year 2024), how you pursue it will go a long way toward whether you achieve it. There are generally two ways to tackle the goals you’ve set for yourself—and one yields more success than the other.

  • Avoidance goals: While this works well when it comes to your ex-medical partner or spouse, it’s not how you want to attack resolutions. Avoidance goals include “stop eating sweets” or “watch less TV.”
  • Approach goals: Instead of avoiding a behavior, you create a new one. Your goals would be “eating more vegetables” or “reading more books” to replace the habits you want to shake.

And, a recent study found that approach goals are more likely to be accomplished (59%) than avoidance goals (47%) across a wide range of potential resolutions. Good luck with that!

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HAPPY NEW YEAR: From All of Us at the ME-P

Posted on January 1, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

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 From us all to you and yours.
Here’s to making a difference and paying it forward today, in 2024, and beyond. 

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DAILY UPDATE: S&P 500 is High as McKinsey Settles Opioid Claims

Posted on December 31, 2023 by Dr. David Edward Marcinko MBA MEd CMP™

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The S&P 500 has climbed about 24% in 2023, hovering right around its all-time high. And, the NASDAQ Composite is up 44%, although the tech-heavy index still has some ground to cover before it starts carving out new all-time highs of its own.

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By Staff Reporters

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Consulting firm McKinsey and Co. has agreed to pay $78 million to settle claims from insurers and health care funds that its work with drug companies helped fuel an opioid addiction crisis. The agreement was revealed late Friday in documents filed in federal court in San Francisco. The settlement must still be approved by a judge.

Under the agreement, McKinsey would establish a fund to reimburse insurers, private benefit plans and others for some or all of their prescription opioid costs. The insurers argued that McKinsey worked with Purdue Pharma – the maker of OxyContin – to create and employ aggressive marketing and sales tactics to overcome doctors’ reservations about the highly addictive drugs. Insurers said that forced them to pay for prescription opioids rather than safer, non-addictive and lower-cost drugs, including over-the-counter pain medication. They also had to pay for the opioid addiction treatment that followed.

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DAILY UPDATE: Stocks Fall on Last Day of a Strong 2023 Year

Posted on December 30, 2023 by Dr. David Edward Marcinko MBA MEd CMP™

By Staff Reporters

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Here’s where the major benchmarks ended:

  • The S&P 500 index fell 13.52 points (0.28%) to 4,769.83; the Dow Jones Industrial Average® was down 20.56 points (0.05%) at 37,689.54; the NASDAQ Composite® (COMP) was down 83.78 points (-0.56%) at 15,011.35.
  • The 10-year Treasury note yield (TNX) rose nearly 2 basis points to 3.86%. 
  • The CBOE® Volatility Index (VIX) finished nearly unchanged at 12.51, still near recent four-year lows.

The S&P 500 and Dow Jones Industrial Average posted their ninth consecutive weekly advances, but the NASDAQ Composite finished slightly lower for the week, hurt in part by a soft performance from Apple (AAPL). The Russell 2000® Index (RUT) fell 1.18% on Friday but climbed 15% for the year.

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