POPULATION HEALTH: Management?

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

By Dr. David Edward Marcinko MBA CMP

SPONSOR: http://www.MarcinkoAssociates.com

What is population health management?

The Care Continuum Alliance, an alliance of stakeholders across the continuum of care, is working precisely toward the goal of improving the health of populations. They espouse a detailed set of principles and a model of “population health management.” It can be summed up, in the broadest sense, as the care provider community, in partnership with patients and their families, conducting proactive and collective monitoring of the patient’s healthcare quality, adherence, access, and outcomes with the goal of improving the health of an entire patient population.

As such, population health management stresses wellness and prevention through lifestyle and disease management and complex case management to remove the gap between zero care and costly chronic or emergency care. It emphasizes the full spectrum of needs from prevention and wellness to keeping healthy people and at-risk people healthy, to better manage the care of those with chronic conditions, and to still be ready to provide emergent or acute care services. In most cases, it also includes the involved providers taking on accountability for the financial risk and quality of care provided.

We have been working with administrative and physician leaders across the country to grapple with what it will mean to actually foster valuable population health management in the different communities they serve. It is clear that this is a whole new paradigm and that the years of experience and training that have brought them to where they are today may not have sufficiently prepared them for what is to come. It requires a well-coordinated and complete continuum of care, with new metrics and advanced analytics. As one might expect,while clusters of resistance to the idea remain, most have flung themselves into learning mode and are beginning to “act their way into new thinking.”

However, we also see a big risk in powering ahead without revisiting the role of a key stakeholder group—patients and their families, whose experience and perspective are often left behind, but whose actions will have a profound effect on the future success of population health management efforts.

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

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PODCASTS: The Physician-Patient Population Health Mis-Match

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Its earnings season once again and CVS Health beat Wall Street estimates with $2.3 billion in profit during Q3. Humana raised its Medicare Advantage enrollment projections again.

And, population management telehealth giant Amwell inked a major federal contract but has seen its losses balloon in 2023.

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Filed under: "Doctors Only", Career Development, CMP Program, Health Law & Policy, Information Technology, Managed Care, Op-Editorials, Quality Initiatives, Touring with Marcinko, Videos | Tagged: Amwell, Certified Medical Planner™, CMP, CVs, CVS Health, david marcinko, Eric Bricker, Humana, Marcinko Associates, Population Health, population health management, public health, tele health | Leave a comment »

Some Modern Issues Impacting Hospital Revenue Cycles

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

By Carol S. Miller RN CPM MHA

Sponsor: http://www.CertifiedMedicalPlanner.org

By Dr. David Edward Marcinko MBA MEd CMP™

“Collectively the healthcare industry spends over $350 Billion to submit and process claims while still working with cumbersome workflows, inefficient processes, and a changing landscape marked by increasing out-of-pocket cost for patients as well as increasing operating costs.”

The Norm Continues Downhill

For many years hospitals and healthcare organizations have struggled to maintain and improve their operating margins. They continue to face a widening gap between their operating costs and the revenues required to cover not only current costs, but also to finance strategic growth initiatives and investments.

Faced with increased operational costs and associated declines in rates of reimbursement, many healthcare hospital executives and leaders are concerned that they will not achieve margin targets. To stabilize the internal financial issue, some hospital have focused on lowering expenses in order to save costs – an area they control and an area that will show an immediate impact; however, that is not the best solution.

Beware Cost Reductions

Hospital executives are concerned with the effect that these reductions may have on patient quality and service. Finding ways to maximize workflow to lower operating costs is vital. Every dollar not collected negatively impacts short- and long term capital projects, lowers patient satisfaction scores and possibly affects quality of patient care.

Status Today

Hospitals, healthcare organizations and all medical providers are under great pressure to collect revenue in order to remain solvent. And so, here are some of the issues impacting the modern hospital revenue cycle as Obama-Care, or the PP-ACA of 2010, as launched last decade?

Issues Impacting the Revenue Cycle

Several of the major leading issues facing the revenue cycle are:

Impact of Consumer-driven Health – This process has emerged as a new approach to the traditional managed care system, shifting payment flows and introducing new “non-traditional” parties into the claims processing workflow. As market adoption enters the mainstream, consumer-driven health stands to alter the healthcare landscape more dramatically than anything we have seen since the advent of managed care. This process places more financial responsibility on the consumer to encourage value-drive healthcare spending decisions.
Competing high-priority projects –Hospitals are feeling pressured to maximize collections primarily because they know changes are coming down the pike due to healthcare reform and they know they will need to juggle these major initiatives along with the day-to-day revenue cycle operations.
Lack of skilled resources in several areas – Hospital have struggled to find the right personnel with sufficient knowledge of project management, clinical documentation improvement, coding and other revenue cycle functions, resulting in inefficient operations.
Narrowing margins – Declines in reimbursement are forcing hospitals to look at their organization to determine if they can increase efficiencies and automate to save money. Hospitals are faced with the potential of increased cost to upgrade and adapt clinical software while not meeting budget projections. There are a number of factors contributing to the financial pressure including inefficient administrative processes such as redundant data collection, manual processes, and repetitive rework of claims submissions. Also included are organizations using outdated processes and legacy technologies.
Significant market changes – Regardless of what happens with the Patient Protection and Affordable Care Act, hospitals will have to deal with fluctuating amounts of insured and uninsured patients and variable payments.
Limited access to capital – With the trend towards more complex and expensive systems, industry may not have the internal resources and funding to build and manage these systems that keep pace with the trends.
Need to optimize revenue – There are five core areas hospitals have to examine carefully and they are:
- ICD-10 – This is an entirely new coding and health information technology issue but is also a revenue issues
- System integration – Hospitals need to look at integrating software and hardware systems that can combine patient account billing, collections and electronic health records.
- Clinical documentation – Meaningful use will require detailed documentation in order for payment to be made and this is another revenue issue.
- Billing and claims management – Reducing denials and reject claims, training staff, improving point-of-service collections and decreasing delays in patient billing can improve the revenue cycle productivity,
- Contract analysis – Hospitals need to focus more on negotiating rates with insurers in order to increase revenue.

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:

HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

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Filed under: "Doctors Only", Accounting, CMP Program, Experts Invited, Health Economics, Marcinko Associates, Practice Management, Recommended Books, Research & Development | Tagged: ACA, carol s. miller, Certified Medical Planner™, CMP, Consumer-driven Health, Dr. David Marcinko, Hospital Revenue Cycle, ICD-10, revenue cycle management, revenue cycles | Leave a comment »

3 FINANCIAL SLANG “T” Terms

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

DEFINITIONS Physician-Investors Need to Know

By. Dr. David E. Marcinko MBA MEd CMP®

SPONSOR: http://www.CertifiedMedicalPlanner.org

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Trading Ahead	Unethical and illegal trading by specialists or market makers. A specialist may buy a stock for themselves from Dr. John Q. Public even though a better price is available from another seller. The specialist can view bid and ask prices and then manually mis-match them, or see ahead to a less favorable price. It happens in this editor’s experience, by observing how long it takes for a stop order to execute after the stop price was reached. This practice is a form of shimming. ***
Trading Imbalance	A situation where a large block of stock is put up for sale, but not enough buyers are available for purchase, and a market maker is unable to buy the imbalance. Lightly traded and tightly held stocks are considered temporarily illiquid during such imbalances. On occasion, a trading halt is put into place until enough buyers are available to purchase the deficit. On rare occasion, a handful of buyers can buy the stock at a huge discount if the stock was not halted during the imbalance. On the New York Stock Exchange, large stocks usually have a “delayed open” for such imbalances, as a trading specialist will fill the order by lining up buyers for the block, and then open trading for the stock for the day. ***
Triple Witching Hour	The final hour of trading on a Friday when stock index futures, stock index options, and stock options all expire. This happens on the third Friday in March, June, September, and December. See Quadruple Witching Hour. ***

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

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Filed under: "Ask-an-Advisor", CMP Program, Ethics, Glossary Terms, Investing, Touring with Marcinko | Tagged: Certified Medical Planner™, CMP, David Edward Marcinko, trading ahead, trading imbalance, tripkle witching hour, triple witching day | Leave a comment »

HSA: An Estate Planning “CON”

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

HEALTH SAVINGS ACCOUNT

SPONSOR: http://www.CertifiedMedicalPlanner.org

By Staff Reporters

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DEFINITION: A Health Savings Account (HSA) is a tax-advantaged account created for or by individuals covered under high-deductible health plans (HDHPs) to save for qualified medical expenses. Contributions are made into the account by the individual or their employer and are limited to a maximum amount each year. The contributions are invested over time and can be used to pay for qualified medical expenses, such as medical, dental, and vision care and prescription drugs.

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

THE “CON”

A Health Savings Account [HSA] can be a good or bad investment to pass on, depending on who the estate planning heir is in relation to you. If you leave it to a spouse, they’ll be able to continue using the money for medical expenses with no taxes or penalties, said Pam Horack, CFP at Pathfinder Planning LLC of Lake Wylie, South Carolina.

“However, if you leave an HSA to your child, estate or other organization, it may be considered income in the year it is received,” she said. “They are not allowed to use the tax advantages for their own healthcare and the income could inadvertently throw your heirs into a higher tax bracket.”

MORE: https://www.irs.gov/pub/irs-pdf/p969.pdf

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Filed under: "Ask-an-Advisor", Accounting, CMP Program, Estate Planning, Experts Invited, Health Economics, Health Insurance, Healthcare Finance, Taxation | Tagged: Certified Medicakl Planner, CFP, CMP, health savings account, HSA, Pam Horack | Leave a comment »

Hurdle Rates V. Highwater Marks V. Claw Back Provisions

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

More on Hedge Funds and Fees

By Dr. David Edward Marcinko MBA MEd CMP®

SPONSOR: http://www.CertifiedMedicalPlanner.org

Many physicians and other investors — even those that meet net worth guidelines — are surprised to learn that there exists a $500 – 999 billion, or more, alternative investment industry that is not generally marketed to the public. Such alternative investments have also been known as hedge funds or private investment funds.

Unlike mutual funds, these alternative investments can be structured in a wide variety of ways. Because of the very same regulations discussed above, these funds cannot be advertised, but they are far from illegal or illicit.

http://www.CertifiedMedicalPlanner.org

cmp

History

In fact, physicians were among the most significant early investors in one of the last century’s most successful hedge funds. Mr. Warren Buffett, Chairman of Berkshire Hathaway, Inc. and a legendary investor got his start in 1957 running the Buffett Partnership, an alternative investment fund not open to the general public. Mr. Buffett’s first public appearance as a money manager was before a group of physicians in Omaha, Nebraska. Eleven decided to put some money with him. A few of these original investors followed him into Berkshire Hathaway, now among the most highly valued companies in the world.

The alternative investment, or hedge, funds of today are similar to the original Buffett Partnership in many ways. So, we will discuss several unique terms which potential investors should be aware.

http://www.HealthDictionarySeries.org

hds

Hurdle Rate

Hedge funds may feature a hurdle rate as part of the calculation of the fund manager’s performance incentive compensation. Also known as a “benchmark,” the hurdle rate is the amount, expressed in percentage points, an investor’s capital account must appreciate before the account becomes subject to a performance incentive fee. Potential medical investors should view the hurdle rate as a form of protection in context with other features of the fee arrangement.

The hurdle rate, which benchmarks a single year’s performance, may be considered mutually exclusive of any other year, or the hurdle rate may compound each year. The former case is more common. In the latter case, a portfolio manager failing to attain a hurdle rate in the first year will find the effective hurdle rate considerably higher during the second year.

Once a fund manager attains the hurdle rate for an investor, the medical investor’s capital account may be charged a performance incentive fee only on the performance above and beyond the hurdle rate. Alternatively, the account may be charged a performance fee for the entire level of performance, including the performance required to attain the hurdle rate. Other variations on the use of the hurdle rate exist, and are limited only by the contract signed between the fund manager and the investor. The hurdle rate is not generally a negotiating point, however.

Example:

A fund charges a performance fee with a 6 percent hurdle rate, calculated in mutually exclusive manner. Dr. Lanouettea, a radiologist investor places $100,000 with the fund. The first year’s performance is 5 percent. The investor therefore owes no performance fee during the first year because the portfolio manager did not attain the hurdle rate. During year two, the portfolio manager guides the fund to a 7 percent return. Because the hurdle rate is mutually exclusive of any other year, the portfolio manager has attained the 6 percent hurdle rate and is entitled to a performance fee.

Highwater Mark

Some funds feature a highwater mark provision, also known as a ”loss-carryforward” provision. As with the hurdle rate, potential investors should consider the highwater mark a form of protection. A high water mark is an amount equal to the greatest value of an investor’s capital account, adjusted for contributions and withdrawals. The high water mark ensures that the hedge fund manager charges a performance incentive fee only on the amount of appreciation over and above the highwater mark set at the time the performance fee was last charged. The current trend is for newer funds to feature this highwater mark, while older, larger funds may not feature it.

Example:

A fund charges a 20 percent performance fee with a highwater mark but no hurdle rate. Dr. Butalak, a dentist investor contributes $100,000 to the fund. During the first year, the hedge fund manager grows that capital account to $110,000 and charges a 20 percent performance fee, or $2,000. The ending capital account balance and highwater mark is therefore $108,000. During year two, the account falls back to $100,000, but the highwater mark remains $108,000. During year three, in order for the manager to charge a performance fee, the manager must grow the capital account to a level above $108,000.

Clawback Provision

Rarely, a fund may provide investors with a clawback provision. This term, borrowed from the venture capital fund world, such provisions result in a refund to the investor of all or part of a previously charged performance fee if a certain level of performance is not attained in subsequent years. Such refunds in the face of poor or inadequate performance may not be legal in some states or under certain authorities.

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

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Filed under: Accounting, Alternative Investments, CMP Program, Financial Planning, Funding Basics, Glossary Terms, Investing, Risk Management, Touring with Marcinko | Tagged: Alternative Investments, Certified Medical Planner™, Clawback Provisions, CMP, hedge funds, Highwater Mark, Hurdle Rates, Marcinko, Warren Buffet | Leave a comment »

PHYSICIAN’S BEWARE: Psychological “INVESTING MIND TRAPS”

Posted on May 23, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

By Dr. David Edward Marcinko MBA MEd CMP™

SPONSOR: http://www.MarcinkoAssociates.com

As, as human beings, our brains are booby-trapped with psychological barriers that stand between making smart financial decisions and making dumb ones. The good news is that once you realize your own mental weaknesses, it’s not impossible to overcome them.

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

In fact, psychiatrist and medical colleague Wes Boyd MD PhD MA related the following mind-traps and investing impediments that have yet to be appreciated by the financial planning community writ-large:

Anchoring happens when we place too much emphasis on the first piece of information we receive regarding a given subject. For instance, when shopping for a wedding ring a salesman might tell us to spend three months’ salary. After hearing this, we may feel like we are doing something wrong if we stray from this advice, even though the guideline provided may cause us to spend more or less than we can afford. Ditto for buy / sell stock recommendations without our own due diligence.
Myopia makes it hard for us to imagine what our lives might be like in the future. For example, because we are young, healthy, and in our prime medical practice earning years now, it may be hard for us to picture what life will be like when our health depletes and we know longer have the earnings necessary to support our standard of living. This short sighted thinking makes it hard to save adequately when we are young, when saving does the most good.
Gambler’s fallacy occurs when we subconsciously believe we can use past events to predict the future. It is common for the hottest sector during one calendar year to attract the most doctor investors the following year. Of course, just because an investment did well last year doesn’t mean it will continue to do well this year. In fact, it is more likely to lag the market.
Avoidance is simply procrastination. Even though you may only have the opportunity to adjust your health care plan through your employer once per year, researching alternative health plans is too much work and too boring for us to get around to it. Consequently, we stick with a plan that may not be best for us.
Loss aversion affected many investors during the stock market crash of 2008. During the crash, many doctors decided they couldn’t afford to lose more and sold their investments. Of course, this caused the investors to sell at market troughs and miss the quick, dramatic recovery.
Overconfident investing happens when we believe we can out-smart other investors via market timing or through quick, frequent trading. Data convincingly shows that people who trade most often under-perform the market by a significant margin over time.
Mental accounting takes place when we assign different values to money depending on where we get it from. For instance, even though we may have an aggressive saving goal for the year, it is likely easier for us to save money that we worked for than money that was given to us as a gift.
Herd mentality makes it very hard for humans to not take action when everyone around us does. For example, we may hear stories of people making significant profits buying, fixing up, and flipping homes and have the desire to get in on the action, even though we have no experience in real estate.

CMP: http://www.CertifiedMedicalPlanner.org

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Filed under: "Ask-an-Advisor", CMP Program, Ethics, Experts Invited, Health Economics, Investing, Touring with Marcinko | Tagged: Anchoring, avoidance, Certified Medical Planner™, CMP, david macinko, herd mentality, investing mind traps, loss aversion, Marcinko Associates, mental accounting, myopia, psychological risks | Leave a comment »

RE-BROADCAST: An Interview with Fiduciary Bennett Aikin AIF®

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

On Financial Fiduciary Accountability

[By Dr. David E. Marcinko MBA MEd CMP™]

[By Ann Miller; RN, MHA]

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

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

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

About Bennett Aikin AIF® and fi360.com

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

Q. Medical Executive Post

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

A. Mr. Aikin

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

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

Q. Medical Executive Post

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

A. Mr. Aikin

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

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

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

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

Q. Medical Executive Post

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

A. Mr. Aikin

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

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

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

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

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

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

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

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

Q. Medical Executive Post

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

A. Mr. Aikin

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

Q. Medical Executive Post

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

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

A. Mr. Aikin

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

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

Q. Medical Executive Post

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

A. Mr. Aikin

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

Q. Medical Executive Post

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

A. Mr. Aikin

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

Q. Medical Executive Post

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

A. Mr. Aikin

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

Q. Medical Executive Post

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

A. Mr. Aikin

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

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

Q. Medical Executive Post

Please repeat that?

A. Mr. Aikin

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

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

Q. Medical Executive Post

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

A. Mr. Aikin

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

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

Q. Medical Executive Post

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

A. Mr. Aikin

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

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

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

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

Q. Medical Executive Post

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

A. Mr. Aikin

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

Q. Medical Executive Post

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

A. Mr. Aikin

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

Q. Medical Executive Post

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

A. Mr. Aikin

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

Additional resources:

Q. Medical Executive Post

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

Assessment

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

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

Conclusion

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CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
BLOG: www.MedicalExecutivePost.com

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CAN: Doctor-Patient Intimacy be Electronic?

Posted on May 15, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

e Communication Tales from the Treatment Room

By Dr. David Edward Marcinko MBA MEd CMP®

www.CertifiedMedicalPlanner.org

Today’s electronic media makes physician-patient communication possible; yet there is another kind of intimacy. ICTs—information and communication technologies—enable 24/7 monitoring of basic information such as blood pressure, glucose levels, pulse, and respiration, etc.

Example:

In one study, an ICT not only made it easier for patients to stay in touch with their doctors, the outcomes were also significantly better.[i] Today, Hippocrates is no longer trailing patients around the house to keep track of their snacks and moods. But Hippocrates has gone digital in the form of a wearable device that records subtle changes in biological markers and communicates them instantaneously to a health provider.

While this is obviously a great advance, we suggest you pause for a moment before plugging in.

Why?

ICTs and social media tools can make a difference to one of the most important dimensions—physiological outcomes. But you can have the latest interactive technology at your disposal and still fail to be connected.

Example:

A story that a friend told me shows how.

***

One morning, her elderly father was touching up the paint on his sailboat. Nearby, another boat-owner, who happened to be an emergency medical technician, noticed her father was struggling to breathe and that his lips had turned purple. A trip to the local community hospital led to a barrage of high-tech tests and procedures, a diagnosis of emphysema, later complications with cerebral hematomas, and hospitalizations and re-hospitalizations that brought him into contact with a neurologist, a neurosurgeon, a cardiologist, and a pulmonologist.

Throughout her father’s medical ordeal, the team of specialists stayed in touch with each other and the primary care physician via various electronic media. But one person remained out of the loop—her father. One day, six months into the experience, the primary care physician phoned our friend’s mother to check on his patient. Her father recalls thinking, “Why was he calling her?”

The physician was communicating, but he was emotionally disconnected.

***

The Moral

The moral of the story: communication needs to be patient-centered in both electronic and psychological terms. That means understanding how someone likes to communicate and making sure the medium fits the message. Electronic media are just part of the equation. The other is the doctor-patient relationship. Once a relationship is established, it may be fine to use e-mail to send information about dosage.

But, delivering a new diagnosis may require the extra effort of scheduling a phone call or a face-to-face visit. Today, since you have so many Health 2.0 choices, it takes some effort to select the right way to communicate in a particular situation.

Use the Right Relationship Strategy

A colleague recently shared another story about an encounter with a specialist.

Example:

***

After an examination for a minor ailment, he was told that there might be a medicated lotion that could ameliorate his condition. The doctor thought for a moment, then swiveled around to the computer on his desk. As our colleague watched the screen, his physician typed a few words into a search engine. Up popped a list and he wrote out a script. “Try this,” his doctor concluded. “I think it will help.”

It did, almost overnight.

***

The Moral

Even though his physical problem had disappeared completely, our colleague felt there was something missing in the interaction. “It bothered me that my doctor turned to the Web for help at that moment. He found a cure, but I felt he wasn’t paying attention to me.”

The physician is supposed to be an authority who has a special relationship to the patient. “Anybody can Google,” our colleague complained. Was he being unreasonable? Maybe.

But; this story tells us something important about technology—it cuts both ways.

***

Assessment

Everyone has their own preferences when it comes to how they want to interact with each other and with technology. If these preferences are explicit and aligned, the chances for a productive partnership are high. The preferences, however, are many and complex. You can easily get lost in the tangled thicket of interpersonal styles and virtual mediums.

In the Web 2.0 environment, it helps to narrow down the endless choices to just a few options.

MORE: Is Text Messaging being Overlooked as an Engagement Tool in Healthcare?

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

[i] Hanson, William M. The Edge of Medicine: The Technology That Will Change Our Lives. New York, NY: Palgrave Macmillan, 2008.

***

Filed under: "Doctors Only", CMP Program, Ethics, Information Technology, Op-Editorials, Practice Management, Touring with Marcinko | Tagged: certified medical planner, CMP, David E. Marcinko, Doctor-Patient Intimacy CAN be Electronic?, EHRs, EMRs | 3 Comments »

REVIEW: Style-Based Stock Portfolio Performance Evaluations

Posted on May 14, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

Stock or Manager Relevance Comparisons and Philosophy

By Dr. David Edward Marcinko MBA, MEd, CMP™

SPONSOR: http://www.CertifiedMedicalPlanner.org

[Publisher-in-Chief]

One relatively recent performance evaluation approach that was developed to help improve the relevance of comparisons is the separation of stock universes and managers by style. This classification method attempts to distinguish between stocks or manager philosophies based upon general financial characteristics of the investments.

The Managers

In very general terms, a manager is often a growth manager if the investment approach that the manager uses focuses on stocks showing growth and momentum in its earnings and price.

A value manager is generally considered to be a manager that attempts to identify under-valued securities based upon fundamental analysis of the company. A stock may be considered either “growth” or “value” based on a given set of valuation measures such as price-to-earnings, price-to-book value, and dividend yield.

The Style

The goal of style-based performance comparisons is to take some of the biases of the market environment out of the comparison, since a portfolio’s returns will ideally be evaluated versus a universe of alternatives that represent similar investment characteristics facing the same basic market environment. Thus, if the environment is one in which investors in stocks with strong past earnings and price momentum have generally performed better than those using fundamental analysis to find under-valued stocks, comparing the growth/momentum portfolio to a growth index or universe should help eliminate the bias.

Style-based universes can help the medical professional better understand the basic environment captured over a given performance time period.

However, there are significant limitations with the various approaches to constructing style-based stock and manager universes that should be understood if they are to be used in direct performance comparisons. Taking style-based stock universes separately from style-based manager universe, one of the most significant issues regarding the categorization of stocks by “growth” and “value” styles is the lack of agreement in the specification of what a growth stock is versus a value stock. With some universes divided by price-to-book value, others by price-to-earnings and/or dividend yields and some by combinations of similar variables, stocks are often classified very differently by two different stock universes. Further, stocks move across a broad spectrum as their price and fundamentals change, resulting in stocks constantly moving between growth and value categories for any given universe. If there is ambiguity in the rating of a given stock, then the difficulty is only compounded when we attempt to boil what may be complex investment processes of an investment manager or mutual fund portfolio manager to a simple classification of growth or value. A beaten down cyclical stock that no self-respecting growth/momentum manager would purchase may be classified as “growth” because it has a high price-to-earnings ratio (i.e., from low earnings) or a high price-to-book value (i.e., from asset write-offs). Value managers are not the only ones to own low valuation stocks that have improving earnings.

***

The second problem with style categorization is that managers are often misclassified or they purposefully “game” the categorization of their own process in order to appear more competitive. As an example, if a manager that typically looks for relatively strong earnings/price momentum is lagging in a period when “growth” managers are outperforming, the rank of the manager can be improved simply by claiming a “value” approach. Morningstar’s “style box” classification of mutual funds by size and style of the current portfolio highlight this problem for any given fund by showing how their portfolio has changed its classification annually.

Current Events

The stock market has been booming lately. Up almost 100% since March 2009, after being down almost 50%. And so, perhaps this is a good time to re-evaluate the performance of your investment portfolio[s].

Assessment

However, this leads to an interesting question for the medical professional or his/her advisor: If a manager is still using the same basic investment philosophy and disciplines, but their “style” category has changed according to the ratings service, should you fire them? If the answer is “yes”, then the burden of monitoring and the cost of manager turnover are an inevitable part of narrow style based performance comparisons.

But, if the answer is “no,” then it is easy to see the difficulty of fitting every management approach into a simple style box. The more reasonable alternative is to use style-based stock and manager universes as a tool for understanding the environment, rather than an absolute performance benchmark.

Conclusion

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About Tombstone Securities Advertising and the “New Issue” Propsectus

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

SPONSOR: http://www.CertifiedMedicalPlanner.org

A Primer for Physician Investors and Medical Professionals

By: Dr. David Edward Marcinko; MBA, MEd, CMP™

[Editor-in-Chief]

[PART 2 OF 8]

NOTE: This is an eight part ME-P series based on a weekend lecture I gave more than a decade ago to an interested group of graduate, business and medical school students. The material is a bit dated and some facts and specifics may have changed since then. But, the overall thought-leadership information of the essay remains interesting and informative. We trust you will enjoy it.

Introduction

Despite the SEC restrictions, noted in Part I of this series, some idea of potential demand for a new security issue can be gauged and have a bearing on pricing decisions.

For example, as CEO of a medical instrument company, or interested investor, would you rather see a great deal of interest in a potential new issue or not very much interest? There is however, one kind of advertisement that the underwriter can publish during the cooling off period. It’s known as a tombstone ad. The ad makes it clear that it is only an announcement and does not constitute an offer to sell or solicit the issue, and that such an offering can only be made by prospectus. SEC Rule 134 of the 1933 Act itself, refers to a tombstone ad as “communication not deemed a prospectus” because it makes reference to the prospectus in the ad. Tombstones have received their name because of the sparse nature of details found in them.

However, the most popular use of the tombstone ad is to announce the effectiveness of a new issue, after it has been successfully issued. This promotes the success of both he underwriter, as well as the company.

Since distributing securities involves potential liability to the investment bank, it will do everything possible to protect itself. So, near the end of the cooling off period, a meeting is held between the underwriter and the corporation. It is known as a due diligence meeting. At this meeting they both discuss amendments that are going to be necessary to make the registration statement complete and accurate. The corporate officers, and the underwriters sign, the final registration statement. They have civil liability for damages that result from omissions of material facts or

Mis-statements of fact. They also have criminal liability if the distribution is done by use of fraudulent, manipulative, or deceptive means. Due diligence takes on a whole new meaning when incarceration from a half-hearted effort underwriting efforts can occur. The investment bank strives to ensure that there have been no material changes to the issuer or the terms of the issue since the registration statement was filed.

Again, as a physician, how would you feel if you were an investment banker raising capital for a new pharmaceutical company that had developed a drug product that was highly marketable. But, on the day after the issue was effective, there was a major news story indicating that the company was being sued for patent infringement? What effect do you think that would have on the market price of this new issue? It would probably plunge. How could this situation have been prevented? The due diligence meeting is more than a cocktail party or a gathering in a smoke filled room. Otherwise, the company would require specially trained people, to do a patent search lessening the likelihood of this scenario. At the due diligence meeting, work is done on the preparation of the final prospectus, but the investment bank does not set the public offering price or the effective date at this meeting. The SEC will eventually set the effective date for the registration and it is on that date that the final offering price will be determined.

Once the SEC sets the effective date, sales may be executed and money can be accepted by the investment bank. It is at this time that the final prospectus, similar to the red herring but without the red ink and with the missing numbers, is issued. A prospectus is an abbreviated form of the registration statement, distributed to purchasers, on and after the effective date of the registration. It is not the same as the registration statement. A typical registration statement consists of papers that stand more than a foot high; rarely does a prospectus go beyond 40 or 50 pages. All purchasers will receive a final prospectus and then it becomes permissible for the underwriter to provide sales literature.

In addition to the requirement that a prospectus must be delivered to a purchaser of new issues no later than with confirmation of the trade, there are two other requirements that healthcare executives investors should know.

90-day: When an issuer has an initial public offering (IPO), there is generally a lack of publicly available material relating to the operations of that issuer. Because of this, the SEC requires that all members of the underwriting group make available a prospectus on an IPO for a period of 90 days after the effective date.

4O-day: Once an issuer has gone public, there are a number of routine filings that must be made with the SEC so there is publicly available information regarding the financial condition of that issuer. Since additional information is now available, the SEC requires that, on all issues other than IPOs, any member of the underwriting group must make available a prospectus for a period of 40 days after the effective date.

In the event that the investment bankers misgauged the marketplace, and the issue moves quite slowly, it is possible that information contained in the prospectus would be rendered obsolete by the SEC. Specifically, the SEC requires that any prospectus used more than 9 months after the effective date, may not have any financial information more than 16 months old. It can however, be amended or stickered, with updated information, as needed.

###

Syndication Among Underwriters

Because the investment banking firm may be underwriting (distributing) a rather large dollar amount of securities, to spread its risk exposure, it may form a group made up of other investment bankers or underwriters, known as a syndicate. The syndicate is headed by a syndicate manager, or lead underwriter, and it is his job to decide whether to participate in the offering. If so, the managing underwriter will sign a non-binding agreement called a letter of intent. .

If all has gone well and the market place is sufficiently interested in the security, and the SEC has been satisfied with respect to the registration statement, it is time for all parties to the offering to formalize their relationships with a contract including the basic understandings reflected in the letter of intent. Three principal underwriting contracts are involved in the usual public offering, each serving a distinct purpose. These are the: Agreement among Underwriters, Underwriting Agreement, and the Dealer Agreement.

In the Agreement Among Underwriters (AAU), the underwriters committing to a portion of the issue, enter into an agreement establishing the nature and terms of their relationship with each other. It designates the syndicate manager to act on their behalf, particularly to enter into an Underwriting Agreement with the issuer, and to conduct the offering on behalf of each of them. The AAU will designate the managing underwriter’s compensation (management fee) for managing the offering.

The authority to manage the offering includes the authority to: agree with the issuer as to the public offering price; decide when to commence the offering; modify the offering price and selling commission; control all advertising; and, control the timing and effectiveness of the registration statement by quickly responding to deficiency letters. Each underwriter agrees to purchase a portion of the underwritten securities, which is known as each under-writer’s allotment (allocation). It is normally signed severally, but not jointly, meaning each underwriter is obligated to sell his allocation but bears no financial obligation for any unsold allotment of another underwriter. This is referred to as a divided account or a Western account. Much less frequently, an undivided or Eastern account, will be used. Each underwriter is responsible for unsold allotments of others, based upon a proportionate share of the offering.

The above comments referred to firm commitment underwriting. Another type of underwriting commitment however, is known as best efforts underwriting. Under the terms of best efforts underwriting, the underwriters make no commitment to buy or sell the issue, they simply do the best they can, acting as an agent for the issuer, and having no liability to the issuer if none of the securities are sold. There is no syndicate formed with a best efforts underwriting. The investment bankers form a selling group, with each member doing his best to sell his allotment. Two variations of a best efforts underwriting are: the all-or-none, and the mini-max (part-or-none) underwriting. Under the provisions of an all-or-none offering, unless all of the shares can be distributed within a specified period of time, the offering will terminate and no subscriptions or orders will be accepted or filled. Under mini-max, unless a set minimum amount is sold, the offering will be terminated.

SEC Rule 15c2-4 requires the underwriter to set up an escrow account for any money received before the closing date, in the event that it is necessary to return the money to prospective purchasers. If the “minimum”, or the “all” contingencies are met, the monies in escrow go to the issuer with the underwriters retaining their appropriate compensation. In order to make sure that investors are properly protected, the escrow account must be maintained at a bank for the benefit of the investors until every appropriate event or contingency has occurred. Then, the funds are properly returned to the investors. If the money is to be placed into an interest bearing account, it must have a maturity date no later than the closing date of the offering, or the account must be redeemable at face with no prepayment penalty as regards principal.

Underwriter Compensation Hierarchy

As we have seen, in a firm commitment the underwriter buys the entire issue from the issuer and then attempts to resell it to the public. The price at which the syndicate offers the securities to the public is known as the public offering price. It is the price printed on the front page of the prospectus.

However, the managing underwriter pays the issuer a lower price than this for the securities. The difference between that lower price and the public offering price is known as the spread or underwriting discount. Everyone involved in the sale of a new issue is compensated by receiving part of the spread. The amount of the spread is the subject of negotiations between the issuer and the managing underwriter, but usually is within a range established by similar transactions between comparable issuers and underwriters. The spread is also subject to NASD [now FINRA] review and approval before sales may commence. The spread is broken down by the underwriters so that a portion of it is paid to the managing underwriter for finding and packaging the issue and managing the offering (usually called the manager’s fee); and a portion is retained by each underwriter (called the underwriting or syndicate allowance) to compensate the syndicate members for their expenses, use of money, and assuming the risk of the underwriting. The remaining portion is allocated to the selling group and is called selling concession. It is often useful to remember the compensation hierarchy pecking order in the following way:

Spread (syndicate manager).
Underwriters allowance (syndicate members)
Selling concession (selling group members)
Re-allowance (any other firm)

While the above deal with corporate equity, the only other significant item with respect to corporate debt is the Trust Indenture Act of 1939. This Federal law applies to public issues of debt securities in excess of $5,000,000. The thrust of this act is to require an indenture with an independent trustee (usually a bank or trust company) who will report to the holders of the debt securities on a regular basis.

Successful marketing of a new issue is a marriage between somewhat alien factors: compliance and numerous Federal, state, and self-regulatory rules and statutes; along with finely honed and profit-motivated sales techniques. It’s not too hard to see that there could be a real, or apparent, conflict of interest here. Most successful investment bankers have built their excellent reputations upon their ability to properly balance these two objectives consistently, year after year.

PART ONE:

Understanding investment banking rules, securities markets, brokerage accounts, margin and debt

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Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

Invite Dr. Marcinko

***

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HEDGE FUNDS: A Brief Review for Physicians

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

By Christopher J. Cummings CFA CFP™

By Dr. David Edward Marcinko MBA MEd CMP™

SPONSOR: http://www.CertifiedMedicalPlanner.org

***

***

A hedge fund in the United States is generally a limited partnership providing a limited number of qualified investors with access to general partner investment decisions with little restriction in the type of investments or use of leverage. While the flexibility available to a hedge fund from a regulatory standpoint implies a high degree of potential risk, there is a wide range of investment philosophies, strategies, security types and objectives captured under the broad title of hedge fund.

Thus, generalizations regarding the characteristics of hedge funds are even less appropriate than with mutual funds, and evaluation of the investment characteristics and merits of a hedge fund strategy must be on a case-by-case basis. Likewise, the cost structure of a hedge fund often includes a base management fee to the general partner plus a performance-based fee or percentage of the profits, and must be evaluated on a case-by-case basis.

Several different investment vehicles operate under the oversight of varying regulatory bodies which provide access to an investment-managers’ discretionary decisions. While each approach generally represents ownership of an underlying pool of securities, there is usually a great deal of flexibility for the manager to deviate from a specific asset class or investment approach. Also, the fee structure of each vehicle can vary greatly and be quite large once distribution fees and sales charges are taken into account.

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

Thus, it is important for a medical professional to remember the following:

1. Evaluate the features and costs of an investment vehicle carefully;

2. Consider the cash flows and valuations of the securities that the manager or management approach will focus on as if the investments were being made directly, and above all;

3. Read the prospectus or agreement carefully before making any investment.

4. Visit: http://www.MarcinkoAssociates.com

COMMENTS APPRECIATED

Thank You.

***

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MENTAL ACCOUNTING: What is it?

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

By Dr. David E. Marcinko MBA CMP®

SPONSOR: http://www.CertifiedMedicalPlanning.org

DEFINITION: Mental accounting attempts to describe the process whereby people code, categorize and evaluate economic outcomes. The concept was first named by Richard Thaler. Mental accounting deals with the budgeting and categorization of expenditures. People budget money into mental accounts for expenses or expense categories

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

Mental Accounting is the act of bucketizing investments and then reviewing the performance of the individual buckets separately (e.g. investing at low savings rate while paying high credit card interest rates).

***

Examples of mental accounting are: (1) matching costs to benefits (wanting to pay for vacation before taking it and getting paid for work after it was done, even though from perspective of time value of money the opposite should be preferred0, (2) aversion to debt (don’t like long-term debt for short-term benefit), (3) sunk-cost effect (illogically considering non-recoverable costs when making forward-going decisions).

In investing, treating buckets separately and ignoring interaction (correlations) induces people not to sell losers (even though they get tax benefits), prevent them from investing in the stock market because it is too risky in isolation (however much less so when looked at as part of the complete portfolio including other asset classes and labor income and occupied real estate), thus they “do not maximize the return for a given level of risk taken).

YOUR COMMENTS ARE APPRECIATED.

Thank You

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FINANCIAL AND HEALTH ECONOMICS BENCH MARKING

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

Understanding the operational and financial status of your organization or practice

[By Dr. David Edward Marcinko MBA MEd CMP™]

SPONSOR: http://www.MarcinkoAssociates.com

Financial benchmarking can assist healthcare managers and professional financial advisors in understanding the operational and financial status of their organization or practice.

The general process of financial benchmarking analysis may include three elements: (1) Historical subject benchmarking; (2) Benchmarking to industry norms; and, (3) Financial ratio analysis.

History

Historical subject benchmarking compares a healthcare organization’s most recent performance with its reported performance in the past in order to: examine performance over time; identify changes in performance within the organization (e.g., extraordinary and non-recurring events); and, to predict future performance.

As a form of internal benchmarking, historical subject benchmarking avoids issues such as: differences in data collection and use of measurement tools; and, benchmarking metrics that often cause problems in comparing two different organizations.

However, it is necessary to common size data in order to account for company differences over time that may skew results.

Benchmarking

Benchmarking to industry norms, analogous to Fong and colleagues’ concept of industry benchmarking, involves comparing internal company-specific data to survey data from other organizations within the same industry. This method of benchmarking provides the basis for comparing the subject entity to similar entities, with the purpose of identifying its relative strengths, weaknesses, and related measures of risk.

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Financial Ratio Analysis

The process of benchmarking against industry averages or norms will typically involve the following steps:

Identification and selection of appropriate surveys to use as a benchmark, i.e., to compare with data from the organization of interest. This involves answering the question, “In which survey would this organization most likely be included?”;
If appropriate, re-categorization and adjustment of the organization’s revenue and expense accounts to optimize data compatibility with the selected survey’s structure and definitions (e.g., common sizing); and,
Calculation and articulation of observed differences of organization from the industry averages and norms, expressed either in terms of variance in ratio, dollar unit amounts, or percentages of variation.

Trends

Financial ratio analysis typically involves the calculation of ratios that are financial and operational measures representative of the financial status of an enterprise. These ratios are evaluated in terms of their relative comparison to generally established industry norms, which may be expressed as positive or negative trends for that industry sector. The ratios selected may function as several different measures of operating performance or financial condition of the subject entity.

The Selected Ratios

Common types of financial indicators that are measured by ratio analysis include:

Liquidity. Liquidity ratios measure the ability of an organization to meet cash obligations as they become due, i.e., to support operational goals. Ratios above the industry mean generally indicate that the organization is in an advantageous position to better support immediate goals. The current ratio, which quantifies the relationship between assets and liabilities, is an indicator of an organization’s ability to meet short-term obligations. Managers use this measure to determine how quickly assets are converted into cash.
Activity. Activity ratios, also called efficiency ratios, indicate how efficiently the organization utilizes its resources or assets, including cash, accounts receivable, salaries, inventory, property, plant, and equipment. Lower ratios may indicate an inefficient use of those assets.
Leverage. Leverage ratios, measured as the ratio of long-term debt to net fixed assets, are used to illustrate the proportion of funds, or capital, provided by shareholders (owners) and creditors to aid analysts in assessing the appropriateness of an organization’s current level of debt. When this ratio falls equal to or below the industry norm, the organization is typically not considered to be at significant risk.
Profitability. Indicates the overall net effect of managerial efficiency of the enterprise. To determine the profitability of the enterprise for benchmarking purposes, the analyst should first review and make adjustments to the owner(s) compensation, if appropriate. Adjustments for the market value of the “replacement cost” of the professional services provided by the owner are particularly important in the valuation of professional medical practices for the purpose of arriving at an ”economic level” of profit.

Data Homogeneity

The selection of financial ratios for analysis and comparison to the organization’s performance requires careful attention to the homogeneity of data. Benchmarking of intra-organizational data (i.e., internal benchmarking) typically proves to be less variable across several different measurement periods.

However, the use of data from external facilities for comparison may introduce variation in measurement methodology and procedure. In the latter case, use of a standard chart of accounts for the organization or recasting the organization’s data to a standard format can effectively facilitate an appropriate comparison of the organization’s operating performance and financial status data to survey results.

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

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Operational Performance Benchmarking

Operational benchmarking is used to target non-central work or business processes for improvement. It is conceptually similar to both process and performance benchmarking, but is generally classified by the application of the results, as opposed to what is being compared. Operational benchmarking studies tend to be smaller in scope than other types of benchmarking, but, like many other types of benchmarking, are limited by the degree to which the definitions and performance measures used by comparing entities differ. Common sizing is a technique used to reduce the variations in measures caused by differences (e.g., definition issues) between the organizations or processes being compared.

Common Sizing

Common sizing is a technique used to alter financial operating data prior to certain types of benchmarking analysis and may be useful for any type of benchmarking that requires the comparison of entities that differ on some level (e.g., scope of respective benchmarking measurements, definitions, business processes). This is done by expressing the data for differing entities in relative (i.e., comparable) terms.

Example:

For example, common sizing is often used to compare financial statements of the same company over different periods of time (e.g., historical subject benchmarking), or of several companies of differing sizes (e.g., benchmarking to industry norms). The latter type may be used for benchmarking an organization to another in its industry, to industry averages, or to the best performing agency in its industry. Some examples of common size measures utilized in healthcare include:

Percent of revenue or per unit produced, e.g., relative value unit (RVU);
Per provider, e.g., physician;
Per capacity measurement, e.g., per square foot; or,
Other standard units of comparison.

Assessment

As with any data, differences in how data is collected, stored, and analyzed over time or between different organizations may complicate the use of it at a later time. Accordingly, appropriate adjustments must be made to account for such differences and provide an accurate and reliable dataset for benchmarking.

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

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BLOG: www.MedicalExecutivePost.com
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors

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HEDGE FUNDS: History in Brief

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

BY DR. DAVID E. MARCINKO MBA MEd CMP®

SPONSOR: http://www.MarcinkoAssociates.com

SPONSOR: http://www.CertifiedMedicalPlanner.org

The investment profession has come a long way since the door-to-door stock salesmen of the 1920s sold a willing public on worthless stock certificates. The stock market crash of 1929 and ensuing Great Depression of the 1930s forever changed the way investment operations are run. A bewildering array of laws and regulations sprung up, all geared to protecting the individual investor from fraud. These laws also set out specific guidelines on what types of investment can be marketed to the general public – and allowed for the creation of a set of investment products specifically not marketed to the general public. These early-mid 20th century lawmakers specifically exempted from the definition of “general public,” for all practical purposes, those investors that meet certain minimum net worth guidelines.

The lawmakers decided that wealth brings the sophistication required to evaluate, either independently or together with wise counsel, investment options that fall outside the mainstream. Not surprisingly, an investment industry catering to such wealthy individuals, such as doctors and healthcare professionals, and qualifying institutions has sprung up.

EARLY DAYS

The original hedge fund was an investment partnership started by A.W. Jones in 1949. A financial writer prior to starting his investment management career, Mr. Jones is widely credited as being the prototypical hedge fund manager. His style of investment in fact gave the hedge fund its name – although Mr. Jones himself called his fund a “hedged fund.” Mr. Jones attempted to “hedge,” or protect, his investment partnership against market swings by selling short overvalued securities while at the same time buying undervalued securities. Leverage was an integral part of the strategy. Other managers followed in Mr. Jones’ footsteps, and the hedge fund industry was born.

In those early days, the hedge fund industry was defined by the types of investment operations undertaken – selling short securities, making liberal use of leverage, engaging in arbitrage and otherwise attempting to limit one’s exposure to market swings. Today, the hedge fund industry is defined more by the structure of the investment fund and the type of manager compensation employed.

The changing definition is largely a sign of the times. In 1949, the United States was in a unique state. With the memory of Great Depression still massively influencing common wisdom on stocks, the post-war euphoria sparked an interest in the securities markets not seen in several decades. Perhaps it is not so surprising that at such a time a particularly reflective financial writer such as A.W. Jones would start an investment operation featuring most prominently the protection against market swings rather than participation in them.

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

Apart from a few significant hiccups – 1972-73, 1987 and 2006-07 being most prominent – the U.S. stock markets have been on quite a roll for quite a long time now. So today, hedge funds come in all flavors – many not hedged at all. Instead, the concept of a private investment fund structured as a partnership, with performance incentive compensation for the manager, has come to dominate the mindscape when hedge funds are discussed. Hence, we now have a term in “hedge fund” that is not always accurate in its description of the underlying activity. In fact, several recent events have contributed to an even more distorted general understanding of hedge funds.

During 1998, the high profile Long Term Capital Management crisis and the spectacular currency losses experienced by the George Soros organization both contributed to a drastic reversal of fortune in the court of public opinion for hedge funds. Most hedge fund managers, who spend much of their time attempting to limit risk in one way or another, were appalled at the manner with which the press used the highest profile cases to vilify the industry as dangerous risk-takers. At one point during late 1998, hedge funds were even blamed in the lay press for the currency collapses of several developing nations; whether this was even possible got short thrift in the press.

Needless to say, more than a few managers have decided they did not much appreciate being painted with the same “hedge fund” brush. Alternative investment fund, private investment fund, and several other terms have been promoted but inadequately adopted. As the memory of 1998 and 2007 fades, “hedge fund” may once again become a term embraced by all private investment managers.

ASSESSMENT: Physicians, and all investors, should be aware, however, that several different terms defining the same basic structure might be used. Investors should therefore become familiar with the structure of such funds, independent of the label. The Securities Exchange Commission calls such funds “privately offered investment companies” and the Internal Revenue Service calls them “securities partnerships.”

Your thoughts are appreciated.

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

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THANK YOU

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What is Hospital WACC?

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

By Calvin Weise CPA and Dr. David E. Marcinko MBA MEd CMP

SPONSOR: http://www.CertifiedMedicalPlanner.org

The Weighted Average Cost of Capital

It is critical to understand and to measure the total cost of capital. Lack of understanding and appreciation of the total cost of capital is widespread, particularly among not-for-profit hospital executives. The capital structure includes long-term debt and equity; total capital is the sum of these two. Each of these components has cost associated with it. For the long-term debt portion, this cost is explicit: it is the interest rate plus associated costs of placement and servicing.

Equity portion

For the equity portion, the cost is not explicit and is widely misunderstood. In many cases, hospital capital structures include significant amounts of equity that has accumulated over many years of favorable operations. Too many executives wrongly attribute zero cost to the equity portion of their capital structure. Although it is correct that generally accepted accounting principles continue to assign a zero cost to equity, there is opportunity cost associated with equity that needs to be considered. This cost is the opportunity available to utilize that capital in alternative ways.

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In general, the cost attributed to equity is the return expected by the equity markets on hospital equity. This can be observed by evaluating the equity prices of hospital companies whose equity is traded on public stock exchanges. Usually the equity prices will imply cost of equity in the range of 10% to 14%.

Almost always, the cost of equity implied by hospital equity prices traded on public stock exchanges will substantially exceed the cost of long-term debt. Thus, while many hospital executives will view the cost of equity to be substantially less than the cost of debt (i.e., to be zero), in nearly all cases, the appropriate cost of equity will be substantially greater than the cost of debt.

http://www.HealthDictionarySeries.org

Hospitals need to measure their weighted average cost of capital (WACC).

WACC is the cost of long-term debt multiplied by the ratio of long-term debt to total capital plus the cost of equity multiplied by the ratio of equity to total capital (where total capital is the sum of long-term debt and equity).

WACC is then used as the basis for capital charges associated with all capital investments. Capital investments should be expected to generate positive returns after applying this capital charge based on the WACC. Capital investments that don’t generate returns exceeding the WACC consume enterprise value; those that generate returns exceeding WACC increase enterprise value.

Assessment

Hospital executives need to be rewarded for increasing enterprise value.

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

***

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DOCTORS & DENTISTS: Obtain a Financial Planning and Economic Education Consultation

Posted on April 24, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

You’ve Earned a Reduced Rate Second-Opinion in 2024

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SPONSOR: http://www.CertifiedMedicalPlanner.org

SPONSOR: http://www.MARCINKOASSOCIATES.com

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We have partnered with fiduciary focused financial advisors and fee-only financial consultants who understand the needs of doctors, dentists and medical professionals. More importantly, they understand how the healthcare industrial complex is currently in flux.

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

INVITATION: So, If you are a colleague, schedule a conversation with one of them to review your goals to see if they can help.

ANN MILLER RN MHA CMP™

Please email us at: MarcinkoAdvisors@msn.com

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RETIREMENT: Can Doctors Afford It?

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

By Staff Reporters

SPONSOR: http://www.MarcinkoAssociates.com

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You’ve got a sense of your ideal retirement age. And you’ve probably made certain plans based on that timeline. But what if you’re forced to retire sooner than you expect? Aging baby-boomers, corporate medicine, the medical practice great resignation and/or the pandemic, etc?

RESIGNATION: https://medicalexecutivepost.com/2021/12/12/healthcare-industry-hit-with-the-great-resignation-retirement/

Early retirement is nothing new, but it’s clear how much the COVID-19 pandemic has affected an aging workforce. Whether due to downsizing, objections to vaccine mandates, concerns about exposure risks, other health issues, or the desire for more leisure time, the retired general population grew by 3.5 million over the past two years—compared to an annual average of 1 million between 2008 and 2019—according to the Pew Research Center.¹ At the same time, a survey conducted by the National Institute on Retirement Security revealed that more than half of Americans are concerned that the COVID-19 pandemic has impacted their ability to achieve a secure retirement.²

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There’s no need to panic, but those numbers make one thing clear, says Rob Williams, managing director of financial planning, retirement income, and wealth management for the Schwab Center for Financial Research. Flexible and personalized financial planning that addresses how you’d cope if you had to retire early can help you make the best use of all your resources.

So – Here are six steps to follow. We’ll use as an example a person who’s seeing if they could retire five years early, but the steps remain the same regardless of your individual time frame.

For most retirees, Social Security and (to a lesser degree) pensions are the two primary sources of regular income in retirement. You usually can collect these payments early—at age 62 for Social Security and sometimes as early as age 55 with a pension. However, taking benefits early will mean that you get smaller monthly benefits for the rest of your life. That can matter to your bottom line, even if you expect Social Security to be merely the icing on your retirement cake.

On the Social Security website, you can find a projection of what your benefits would be if you were pushed to claim them several years early. But if you’re part of a two-income couple, you may want to make an appointment at a Social Security office or with a financial professional to weigh the potential options.

For example, when you die, your spouse is eligible to receive your monthly benefit if it’s higher than his or her own. But if you claim your benefits early, thus receiving a reduced amount, you’re likewise limiting your spouse’s potential survivor benefit.

If you have a pension, your employer’s pension administrator can help estimate your monthly pension payments at various ages. Once you have these estimates, you’ll have a good idea of how much monthly income you can count on at any given point in time.

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Step 2: Pressure-test your 401(k)

In addition to weighing different strategies to maximize your Social Security and/or pension, evaluate how much income you could potentially derive from your personal retirement savings—and there’s a silver lining here if you’re forced to retire early.

Rule of 55

Let’s say you leave your job at any time during or after the calendar year you turn 55 (or age 50 if you’re a public safety employee with a government defined-benefit plan). Under a little-known separation-of-service provision, often referred to as the “rule of 55,” you may be able take distributions (though some plans may allow only one lump-sum withdrawal) from your 401(k), 403(b), or other qualified retirement plan free of the usual 10% early-withdrawal penalties. However, be aware that you’ll still owe ordinary income taxes on the amount distributed.

This exception applies only to the plan (including any consolidated accounts) that you were contributing to when you separated from service. It does not extend to IRAs.

4% rule

There’s also a simple rule of thumb suggesting that if you spend 4% or less of your savings in your first year of retirement and then adjust for inflation each year following, your savings are likely to last for at least 30 years—given that you make no other changes to your withdrawals, such as a lump sum withdrawal for a one-time expense or a slight reduction in withdrawals during a down market.

To see how much monthly income you could count on if you retired as expected in five years, multiply your current savings by 4% and divide by 12. For example, $1 million x .04 = $40,000. Divide that by 12 to get $3,333 per month in year one of retirement. (Again, you could increase that amount with inflation each year thereafter.) Then do the same calculation based on your current savings to see how much you’d have to live on if you retired today. Keep in mind that your money will have to last five years longer in this instance.

Knowing the monthly amount your current savings can generate will give you a clearer sense of whether you’ll have a shortfall—and how large or small it might be. Use our retirement savings calculator to test different saving amounts and time frames.

Step 3: Don’t forget about health insurance, doctor!

Nobody wants to spend down a big chunk of their retirement savings on unanticipated healthcare costs in the years between early retirement and Medicare eligibility at age 65. If you lose your employer-sponsored health insurance, you’ll want to find some coverage until you can apply for Medicare.

Your options may include continuing employer-sponsored coverage through COBRA, insurance enrollment through the Health Insurance Marketplace at HealthCare.gov, or joining your spouse’s health insurance plan. You may also find discounted coverage through organizations you belong to—for example, the AARP.

Step 4: Create a post-retirement budget

To make sure your retirement savings will cover your expenses, add up the monthly income you could get from pensions, Social Security, and your savings. Then, compare the total to your anticipated monthly expenses (including income taxes) if you were to retire five years early and are eligible, and choose to file, for Social Security and pension benefits earlier.

Take into account various life events and expenditures you may encounter. You may not pay off your mortgage by the date you’d planned. Your spouse might still be working (which can add income but also prolong certain expenses). Or your children might not be out of college yet.

You’re probably fine if you anticipate that your monthly expenses will be lower than your income. But if you think your expenses would be higher than your early-retirement income, some suggest that you take one or more of these measures:

Retire later; practice longer.
Save more now to fill some of the potential gap.
Trim your budget so there’s less of a gap down the road.
Consider options for medical consulting or part-time work—and begin to explore some of those opportunities now.

To the last point, finding a physician job later in life can be challenging, but certain employment agencies specialize in this area. If you can find work you like that covers a portion of your expenses, you’ll have the option of delaying Social Security and your company pension to get higher payments later—and you can avoid dipping into your retirement savings prematurely.

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

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

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Step 5: Protect your portfolio

When you retire early, you have to walk a fine line with your portfolio’s asset allocation—investing aggressively enough that your money has the potential to grow over a long retirement, but also conservatively enough to minimize the chance of big losses, particularly at the outset.

“Risk management is especially important during the first few years of retirement or if you retire early,” Rob notes, because it can be difficult to bounce back from a loss when you’re drawing down income from your portfolio and reducing the overall number of shares you own.

To strike a balance between growth and security, start by making sure you have enough money stashed in relatively liquid, relatively stable investments—such as money market accounts, CDs, or high-quality short-term bonds—to cover at least a year or two of living expenses. Divide the rest of your portfolio among stocks, bonds, and other fixed-income investments. And don’t hesitate to seek professional help to arrive at the right mix.

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SPONSOR: http://www.CertifiedMedicalPlanner.org

Many people are unaccustomed to thinking about their expenses because they simply spend what they make when working, Rob says. But one of the most valuable decisions you can make about your life in retirement is to reevaluate where your money is going now.

This serves two aims. First, it’s a reality check on the spending plan you’ve envisioned for retirement, which may be idealized (e.g., “I’ll do all the home maintenance and repairs!”). Second, it enables you to adjust your spending habits ahead of schedule—whichever schedule you end up following. This gives you more control and potentially more income.

Step 6: Reevaluate your current spending

For example, if you’re not averse to downsizing, moving to a less expensive home could reduce your monthly mortgage, property tax, and insurance payments while freeing up equity that could also be invested to provide additional monthly income.

“When you are saving for retirement, time is on your side”. You lose that advantage when you’re forced to retire early, but having a backup plan that anticipates the possibility of an early retirement can make the unknowns you face a lot less daunting.

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

References:

¹Richard Fry, “Amid the Pandemic, A Rising Share Of Older U.S. Adults Are Now Retired”, Pew Research Center, 11/04/2021, https://www.pewresearch.org/fact-tank/2021/11/04/amid-the-pandemic-a-rising-share-of-older-u-s-adults-are-now-retired/.

²Tyler Bond, Don Doonan and Kelly Kenneally, “Retirement Insecurity 2021: Americans’ Views of Retirement”, Nirsonline.Org, 02/2021, https://www.nirsonline.org/wp-content/uploads/2021/02/FINAL-Retirement-Insecurity-2021-.pdf.

COMMENTS APPRECIATED.

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CERTIFIED MEDICAL PLANNER™ Niche Financial Advisor Professional Designation

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

Think Different – Be Different – Thrive

[By Ann Miller RN MHA]

Letterhead CMP

http://www.CertifiedMedicalPlanner.org

Dear Physician Focused Financial Advisors

Did you know that desperate doctors of all ages are turning to knowledgeable financial advisors and medical management consultants for help? Symbiotically too, generalist advisors are finding that the mutual need for knowledge and extreme niche synergy is obvious.

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But, there was no established curriculum or educational program; no corpus of knowledge or codifying terms-of-art; no academic gravitas or fiduciary accountability; and certainly no identifying professional designation that demonstrated integrated subject matter expertise for the increasingly unique healthcare focused financial advisory niche … Until Now!

***

http://www.CertifiedMedicalPlanner.org

Enter the CMPs

“The informed voice of a new generation of fiduciary advisors for healthcare”

**[Think Different – Be Different – Thrive]**

InfoGraphic

http://e.infogr.am/enter_the_certified_medical_planner?src=embed

http://www.CertifiedMedicalPlanner.org

***

So, if you are looking to supplement your knowledge, income and designations; and find other qualified professionals you may want to consider the CMP® program.

Enter the Certified Medical Planner™ charter professional designation. And, CMPs™ are FIDUCIARIES, 24/7.

Channel Surfing the ME-P

Conclusion

***

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

* 8

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Marketing Basics for Financial Advisors and Physicians

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

On Differences and Similarities

By David K. Luke; MIM CMP

The difference between internal marketing and external marketing for physicians is that internal marketing is the management strategy of improving satisfaction by making patients aware of the positive differences in the physician’s practice –versus- other modern or traditional alternatives that the doctor might externally use [yellow pages, coupons, TV, radio, internet, blogs, etc].

Now, compare marketing with advertising, which attempts to draw patients to the medical practice or clinic using more expensive channel distribution means and/or media messaging.

The “X” Factor

Internal marketing gives the patient “something extra” during the visit that tends to make them pleased, satisfied – or better yet – delighted!

In show business, Simon Cowell calls this something extra the “X” factor.

Whether it is a “Patient Bill of Rights” or just making sure that patients are treated fairly, and with respect throughout the process, turns the patient into a practice advocate instead of a patient from hell.

Improved listening/communication can come in the form of an attentive and caring human ear, enhanced bedside manner, or technology like P[C]RM (Patient {Client} Relationship Management) tools and/or eMRs, for example.

Sloppy Medical Office Procedures

Having office staff involved, by noticing improvements, can also help with the implementation of a successful internal marketing strategy. Sloppy office procedures can be cleaned up, scheduling access management can be revamped, and any administrative mix-ups can be avoided.

Negative practices such as “we enforce a minimum $50 office visit fee” should be stopped, as this casts a negative attitude on all patients, not just future deadbeats.

An effective P[C] RM strategy can increase patient satisfaction and be inexpensive to implement and maintain, especially in light of modern advertising tools for medical practices.

Financial Advisor Comparisons

A physician’s internal marketing program is comparative to an FA’s internal marketing program, in that both methods are much more cost effective and yield better results than traditional external marketing or advertising.

For an FA, the practice of encouraging referrals can be done discreetly without making the existing clients uncomfortable.

An FA practice that is “referable” is one in which there are consistent standards and procedures in place. This creates a comfort factor with existing clients and assures them that when they refer their friends and family they will also receive consistent quality treatment.

Assessment

An FA can implement procedures similar to a medical practice by training staff to point out and recognize office procedures that might be improved. Letting clients know they are appreciated and that referrals are accepted sounds like obvious advice, but is often ignored by too many Financial Advisors, and even doctors.

Editor’s Note: David K. Luke is currently enrolled in the online www.CertifiedMedicalPlanner.org chartered professional designation program.

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

Sponsors Welcomed: And, credible sponsors and like-minded advertisers are always welcomed.

Link: https://healthcarefinancials.wordpress.com/2007/11/11/advertise

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DOCTORS FEELING WEALTHY: How Much is [Really] Enough?

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

By Staff Reporters

SPONSOR: http://www.MARCINKOASSOCIATES.com

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***

What does wealth mean to you?

In a recent survey by Edelman Financial Engines, 57% of respondents said they’d feel wealthy if they had $1 million in the bank. But for many people, like doctors, that may not be enough.

Among those with $500,000 and $3 million in assets, 53% said it would take over $3 million in the bank for them to feel wealthy, and 33% said it would take over $5 million. Given that these are amounts some people will never even come close to amassing in their lifetimes, it may be hard to wrap your head around these answers.

***

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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

***

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/

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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?

***

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:

***

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

***

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CERTIFIED MEDICAL PLANNERs™ to Grow and Thrive

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

Think Different – Be Different – Thrive

[By Ann Miller RN MHA]

Letterhead CMP

http://www.CertifiedMedicalPlanner.org

Dear Physician Focused Financial Advisors

***

http://www.CertifiedMedicalPlanner.org

Enter the CMPs

“The informed voice of a new generation of fiduciary advisors for healthcare”

**[Think Different – Be Different – Thrive]**

InfoGraphic

http://e.infogr.am/enter_the_certified_medical_planner?src=embed

http://www.CertifiedMedicalPlanner.org

***

So, if you are looking to supplement your knowledge, income and designations; and find other qualified professionals you may want to consider the CMP® program.

Enter the Certified Medical Planner™ charter professional designation. And, CMPs™ are FIDUCIARIES, 24/7.

Channel Surfing the ME-P

Conclusion

***

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

* 8

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15: PODCAST: CPAs are Out … Are CMPs™ In?

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

CERTIFIED MEDICAL PLANNER™

By Staff Reporters

SPONSOR: http://www.CertifiedMedicalPlanner.org

***

The giant accounting firm Grant Thornton LLP is laying off 200 people, its second round of layoffs in the past six months and an indication that the major players in the professional consulting, accounting and advisory business are preparing for an economic slowdown that could squeeze profits across corporate America.

***

Statistics: 7.4%. That’s the percentage drop in students who graduated with a degree in accounting in the 2021–2022 school year than the year before. Low starting salaries, heavy workloads, and uncertainty around AI are driving the exodus of students from choosing accounting degrees. (the Wall Street Journal).

MORE: https://www.wsj.com/lifestyle/careers/accounting-salary-cpa-shortage-dec2caa2?utm_campaign=mb&utm_medium=newsletter&utm_source=morning_brew

PODCAST: https://www.ted.com/talks/dan_bricklin_meet_the_inventor_of_the_electronic_spreadsheet

***
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Assessment of Workplace Violence in Healthcare

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

ON MEDICAL WORKPLACE VIOLENCE

By Eugene Schmuckler PhD, MBA CTA

By Dr. David E. Marcinko MBA

1. What Is Workplace Violence?

Workplace violence is more than physical assault — it is any act in which a person is abused, threatened, intimidated, harassed, or assaulted in his or her employment. Swearing, verbal abuse, playing “pranks,” spreading rumors, arguments, property damage, vandalism, sabotage, pushing, theft, physical assaults, psychological trauma, anger-related incidents, rape, arson, and murder are all examples of workplace violence. The Registered Nurses Association of Nova Scotia defines violence as “any behavior that results in injury whether real or perceived by an individual, including, but not limited to, verbal abuse, threats of physical harm, and sexual harassment.” As such, workplace violence includes:

threatening behavior — such as shaking fists, destroying property, or throwing objects;
verbal or written threats — any expression of intent to inflict harm;
harassment — any behavior that demeans, embarrasses, humiliates, annoys, alarms, or verbally abuses a person and that is known or would be expected to be unwelcome. This includes words, gestures, intimidation, bullying, or other inappropriate activities;
verbal abuse — swearing, insults, or condescending language;
muggings — aggravated assaults, usually conducted by surprise with intent to rob; or
physical attacks — hitting, shoving, pushing, or kicking.

Workplace violence can be brought about by a number of different actions in the workplace. It may also be the result of non-work related situations such as domestic violence or “road rage.” Workplace violence can be inflicted by an abusive employee, a manager, supervisor, co-worker, customer, family member, or even a stranger. The University of Iowa Injury Prevention Research Center classifies most workplace violence into one of four categories.

Type I Criminal Intent — Results while a criminal activity (e.g., robbery) is being committed and the perpetrator had no legitimate relationship to the workplace.
Type II Customer/Client — The perpetrator is a customer or client at the workplace (e.g., healthcare patient) and becomes violent while being assisted by the worker.
Type III Worker on Worker — Employees or past employees of the workplace are the perpetrators.
Type IV Personal Relationship — The perpetrator usually has a personal relationship with an employee (e.g., domestic violence in the workplace).

2. Effects of Workplace Violence

The healthcare sector continues to lead all other industry sectors in incidents of non-fatal workplace assaults. In 2000, 48% of all non-fatal injuries from violent acts against workers occurred in the healthcare sector. Nurses, nurses’ aides, and orderlies suffer the highest proportion of these injuries. Non-fatal assaults on healthcare workers include assaults, bruises, lacerations, broken bones, and concussions. These reported incidents include only injuries severe enough to result in lost time from work. Of significance is that the median time away from work as a result of an assault or other violent act is 5 days. Almost 25% of these injuries result in longer than 20 days away from work. Obviously, this is quite costly to the facility as well as to the victim.

A study undertaken in Canada found that 46% of 8,780 staff nurses experienced one or more types of violence in the last five shifts worked. Physical assault was defined as being spit on, bitten, hit, or pushed.

Both Canadian and U.S. researchers have described the prevalence of verbal threats and physical assaults in intensive care, emergency departments, and general wards. A study in Florida reported that 100% of emergency department nurses experience verbal threats and 82% reported being physically assaulted. Similar results were found in a study undertaken in a Canadian hospital. Possible reasons for the high incidence of violence in emergency departments include presence of weapons, frustration with long waits for medical care, dissatisfaction with hospital policies, and the levels of violence in the community served by the emergency department.

Similar findings have been reported in studies of mental health professionals, nursing home and long-term care employees, as well as providers of service in home and community health.

Violence in hospitals usually results from patients, and occasionally family members, who feel frustrated, vulnerable, and out of control. Transporting patients, long waits for service, inadequate security, poor environmental design, and unrestricted movement of the public are associated with increased risk of assault in hospitals and may be significant factors in social services workplaces as well. Finally, lack of staff training and the absence of violence prevention programming are associated with elevated risk of assault in hospitals. Although anyone working in a hospital may become a victim of violence, nurses and aides who have the most direct contact with patients are at higher risk. Other hospital personnel at increased risk of violence include emergency response personnel, hospital safety officers, and all healthcare providers. Personnel working in large medical practices fall into this category as well. Although no area is totally immune from acts of violence it most frequently occurs in psychiatric wards, emergency rooms, waiting rooms, and geriatric settings.

Many medical facilities mistakenly focus on systems, operations, infrastructure, and public relations when planning for crisis management and emergency response: they tend to overlook the people. Obviously, no medical facility can operate without employees who are healthy enough to return to work and to be productive. Individuals who have been exposed to a violent incident need to be assured of their safety.

The costs associated with workplace violence crises are not limited to healthcare dollars, absenteeism rates, legal battles, or increased insurance rates. If mishandled, traumatic events can severely impair trust between patients, employees, their peers, and their managers. Without proper planning, an act of violence can disrupt normal group processes, interfere with the delivery of crucial information, and temporarily impair management effectiveness. It may also lead to other negative outcomes such as low employee morale, increased job stress, increased work turnover, reduced trust of management and co-workers, and a hostile working environment.

Data collected by the U.S. Department of Justice shows workplace violence to be the fastest growing category of murder in the country. Homicide, including domestic homicides, is the leading cause of on-the-job death for women, and is the second leading cause for men. The National Institute of Occupational Safety and Health (NIOSH) found that an average of 20 workers is murdered each week in the U.S. In addition, an estimated 1 million workers — 28,000 per week — are victims of non-fatal workplace assaults each year. Workplace attacks, threats, or harassment can include the following monetary costs:

$13.5 billion in medical costs per year;
500,000 employees missing 1,750,000 days of work per year; with a 41% increase in stress levels with the concomitant related costs!

More links:

Racism in Medicine:

MORE: Work Violence

About the Author

Dr. Eugene Schmuckler was Coordinator of Behavioral Sciences at a Public Training Center before accepting his current position as Academic Dean for iMBA, Inc. He is an international expert on personal re-engineering and coaching whose publications have been translated into Dutch and Russian. He now focuses on career development, change management, coaching and stress reduction for physicians and financial professionals. Behavioral finance, life planning and economic risk tolerance assessments are additional areas of focus. Formerly, Dr. Schmuckler was a senior adjunct faculty member at the Keller Graduate School of Management, Atlanta. He taught courses in Organizational Behavior and Leadership, Strategic Staffing, Training and Development, and the capstone course in human resources management. He is a member of a number of professional organizations including the American Psychological Association, the Academy of Management, and the Society for Human Resource Management. A native of Brooklyn New York, he received his BS degree in Psychology from Brooklyn College. He earned his MBA and PhD degrees in Industrial and Organizational Psychology from Louisiana State University. Currently, he serves on the executive BOD for: www.MedicalBusinessAdvisors.com and is the Dean of Admissions for www.CertifiedMedicalPlanner.org

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
BLOG: www.MedicalExecutivePost.com
FINANCE:Financial Planning for Physicians and Advisors
INSURANCE:Risk Management and Insurance Strategies for Physicians and Advisors

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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

***

***

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!

***

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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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

***

***

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

***

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.

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

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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IMPLICATION OF WITHDRAWALS IN A MODERATE INTEREST RATE ENVIRONMENT

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

A SPECIAL ME-P REPORT

A Retrospective Review … and Implications for Modernity

[Copyright Manning & Napier Advisors, Inc.]

By Jeff Coons PhD CFA

By Dr. David Edward Marcinko MBA CMP

SPONSOR: http://www.CertifiedMedicalPlanner.org

The general trend of declining interest rates experienced over the last several decades, part of a long-term trend Manning & Napier Advisors, Inc. and others have focused on since the early 1980’s, created new challenges for managing investment portfolios with regular and significant cash withdrawals.

Historical Review

This continuing report, first prepared 25 years ago, will provide an analysis of the investment implications of withdrawals in light of the secular shift in the economic and market conditions today. This analysis and historical review aims to guide decisions as to the appropriate level of withdrawals from an account in the more current moderate interest rate environment of 2014; and estimated thru to 2023.

The Questions

Declining interest rates restrict the ability to generate income from high quality investments, so a greater proportion of a given withdrawal requirement must come from the potential price appreciation of the securities. Of course, the inherently volatile nature of the financial markets makes price appreciation the less predictable of the sources of total return available to fund withdrawal needs.

The natural questions that arise from this observation include:

What withdrawal rate inhibits the ability to pursue long-term capital growth as a primary investment objective?

What withdrawal rate may create a significant risk of a sustained deterioration of capital?

What is a reasonable range of withdrawal rates given the relatively low interest rate environment that we face?

The answer to the first question can be derived from interest rates and dividend yields. With a dividend yield of 1.0%-2.0% on stocks (e.g., the yield on the S&P 500 Index as of December 2000 was 1.2%) and yields on intermediate-term and long-term fixed income securities between 5.0% and 6.0% (e.g., as of December 2000, a one-year Treasury Bill had a yield of 5.4% and a thirty-year Treasury bond had a yield of 5.5%), growth-oriented portfolios should generally produce a level of income adequate to allow 2.5%-3.5% withdrawals on an annual basis.

Thus, rates of withdrawal of less than 3.5% generally should not inhibit the pursuit of long-term capital growth as a primary investment objective.

***

Management Approach

To establish the high end of the achievable withdrawals under a management approach pursuing long-term capital growth, consider some historical evidence.

Assume that withdrawals are taken from each of three portfolios (i.e., 100% stocks, 80% stocks/20% bonds, and 50% stocks/50% bonds using data from Ibbotson Associates, Inc.) starting at the beginning of 1973. How many years did it take to regain the original capital of the portfolio?

As can be seen in the following table, it took between 4-8 years for these portfolios to recover from the 1973-74 bear market with a 5.0% withdrawal rate. If withdrawals are at a 7.5% rate per year, over ten years elapsed before the original capital was restored.

Finally, with a 10.0% withdrawal rate, it took between 13-15 years to restore the capital. While the 1973-74 bear market was severe, it is not the worst bear market that can be used to illustrate the risk of significant withdrawals taken when the portfolio’s market value is depressed.

The clear conclusion is that withdrawals of greater than 5.0% are a potential impediment to pursuing long-term capital growth, given the long periods required to restore capital for the various growth-oriented asset mixes offered in this analysis.

***

When Was Original (12/72) Capital Restored?
	0% W/D	5% W/D	0% W/D
100% Stock	9/80(7.75 years)	6/83(10.5 years)	6/86(14.5 years)
80% Stock/ 20% Bond	9/80(7.75 years)	3/83(10.25 years)	6/86(14.5 years)
50% Stock/ 50% Bond	12/76(4.0 years)	3/83(10.25 years)	3/87(15.25 years)

***

Another key issue to remember is that the withdrawal rates above are a percentage of current market value, so the dollar value of the cash withdrawn from the account is assumed to decline in a bear market. However, most of us think of our withdrawal needs in terms of dollars instead of percentages (e.g., $50,000 from a $1,000,000 account, which translates to 5%).

If we attempt to maintain the dollar value of withdrawals in bear market periods, the percentage of current market value being withdrawn actually increases, and the impact on the portfolio far exceeds the example provided above.

SAMPLE:

To demonstrate, consider maintaining withdrawals of $50,000, $75,000 and $100,000 on an account with a $1,000,000 market value as of 12/72 (see table below).

In the case of a $50,000 annual withdrawal, approximately 8-10 years elapse before the original $1,000,000 market value is restored. If the withdrawals are $75,000 per year, 13 years elapse for the 50/50 asset mix and almost 19 years pass for the 80/20 asset mix before the $1,000,000 is restored. For the 100% stock portfolio, nearly 25 years elapse before the original $1,000,000 is restored.

Finally, for $100,000 withdrawals off of a $1,000,000 market value in 1972, all capital in the account is depleted within 10-15 years given these withdrawals. Thus, the risk of significant cash withdrawals having a detrimental impact on the ability to preserve and grow capital is much more pronounced when withdrawals remain high in dollar terms.

***

When Was Original Capital ($1,000,000 in 12/72) Restored?
	$50,000 W/D	$75,000 W/D	$100,000 W/D
100% Stock	3/83(10.25 years)	9/97(24.75 years)	Capital Depleted9/83
80% Stock/ 20% Bond	12/80(8.0 years)	9/91(18.75 years)	Capital Depleted3/85
50% Stock/ 50% Bond	9/80(7.75 years)	3/86(13.25 years)	Capital Depleted9/87

***

So far, the major point we have established is that a withdrawal rate of 2.5%-3.5% may be achievable without hampering the pursuit of long-term capital growth, but withdrawals of 5% or greater may have a significant impact on the ability to manage for growth. Therefore, accounts expected to experience withdrawals of 4%-5% (or greater) should be managed with a goal of satisfying these withdrawal needs on a regular basis first, with the pursuit of capital growth taking secondary importance.

However, the analysis provided above also implies that there is a rate of withdrawals that forces us to focus on capital preservation, because depletion of capital is a likely outcome. For withdrawals in the range of 10.0%, the example above shows that the risk of depletion of capital is significant at these high annual levels, especially if the withdrawals are on a dollar basis and not adjusted by the decline of current market value in a bear market.

In fact, with long-term U.S. government bond yields at approximately 5.0%-6.0%, annual withdrawals greater than 7.5% are likely to be too high to allow a manager to effectively pursue long-term capital growth without a high degree of risk to the capital of the account. That is, since attempts to provide returns above the current Treasury yields imply risk of volatility, and volatility can lead to the examples provided above, withdrawals at 7.5% or more and maintained on a dollar basis imply a high likelihood that original capital will be depleted over a 15-20 year period.

In general, the current level of yields in the market imply that management of a portfolio requiring over 7.5% per year in withdrawals faces a strong possibility of depleting capital under any scenario, and so portfolio management should focus on dampening market volatility so as to extend the life of the capital for as long as possible as it is drawn down.

Final Questions

The final question[s] (i.e., the appropriate level of withdrawals) is driven by both the client’s need for the assets and the parameters outlined above:

Withdrawals less than 3.5% of current market value should not inhibit the pursuit of long-term capital growth as a primary objective.
Withdrawal rates between 3.6% and 7.4% require a primary focus on satisfying withdrawal needs over the market cycle, possibly with a secondary goal of long-term capital growth to protect future withdrawal needs.
Withdrawal rates greater than 7.5% are likely to result in a depletion of capital, so the goal should be to manage the drawdown of capital by dampening year-to-year volatility of the portfolio.

While we all would like to achieve capital growth, the ability to pursue growth-oriented strategies depends on the flexibility to moderate withdrawals, if required by market conditions, and on the overall reliance on these assets.

As another example, an endowment can control its withdrawals to some extent, but there is a level beyond which the belt cannot be tightened without harming the services being funded.

Yet another example comes from a physician-executive or someone living primarily on an IRA account, especially after becoming accustomed to the high (and falling) interest rate/high asset return environment of the last fifteen years. Aggressively pursuing capital growth in the face of large withdrawals may result in exposure to significant risk of depletion of the IRA assets when other sources of income are unavailable.

If, on the other hand, the IRA was a small part of the wealth available in retirement, then there is some flexibility to work towards long-term capital growth.

Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants

Implications for defined benefit retirement plans

A defined benefit retirement plan may have an outside source of funding to help restore capital (i.e., contributions from the employer), but defined contribution and Taft-Hartley plans have much less of a safety net. As a result, the risk taken to pursue growth in the face of significant withdrawals must take into account the nature of the assets and the problems associated with a deterioration of capital in the account.

Assessment

And so, withdrawals can have a significant impact on the ability of a manager to preserve capital and pursue long-term capital growth. However, while lessening the level of withdrawals will help provide flexibility for the manager to pursue these goals, the need for the assets may require that withdrawals are maintained at a certain level. Once withdrawals are minimized, the manager should focus on investment goals that correspond with this minimum level.

If withdrawals are below 3% of current market value, pursuit of long-term capital growth can be a primary objective. Withdrawals between 4% and 7.5% of market value on an annual basis require a focus on working towards satisfying these annual needs. Long-term capital growth, in this case, should be a secondary goal.

Finally, if withdrawals are above a 7.5% annual rate, then the investment management approach should focus on preserving capital and dampening market volatility so as to work towards allowing the assets to last as long as possible as they are drawn down.

NOTE: The 10-year Treasury rate’s just fell below 3.91% after Fed, ECB nominees; today.

Conclusion

This historical review paper provides a retrospective review of IRs and implications for modernity.

***

Invite Dr. Marcinko

***

Filed under: "Ask-an-Advisor", CMP Program, Experts Invited, Interviews, Investing, Marcinko Associates, Portfolio Management | Tagged: certified medical planner, CMP, Jeff Coons PhD CFA, low interest rates, Manning & Napier Advisors, Marcinko, Rate of Withdrawals | 1 Comment »

PODCAST: Why Hospitals Cry “Poor”

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

By Eric Bricker MD

***

COMMENTS APPRECIATED

Thank You

***

Filed under: "Ask-an-Advisor", "Doctors Only", Accounting, CMP Program, Experts Invited, Health Economics, Health Insurance, Op-Editorials, Videos | Tagged: certified medical planner, CMP, cross subsidization, Eric Bricker JD, hospital cross subsidization, hospitals poor, poor hospitals, why hospitals cry poor | Leave a comment »

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

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

***

www.CERTIFIEDMEDICALPLANNER.org

www.MARCINKOASSOCIATES.com

***

***

EDUCATION: https://marcinkoassociates.com/textbooks-academic-catalog/

***

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

THANK YOU

***

Filed under: "Advisors Only", "Doctors Only", Book Reviews, Career Development, CMP Program, Experts Invited, Funding Basics, Health Economics, Health Insurance, Health Law & Policy, Healthcare Finance, Investing, LifeStyle, Marcinko Associates, Touring with Marcinko | Tagged: Certified Medical Planner Textbooks, Certified Medical Planner™, CMP, Marcinko | Leave a comment »

DOL: Proposes “Best Interest” Retirement Investment Advice

Posted on December 20, 2023 by Dr. David Edward Marcinko MBA MEd CMP™

SPONSOR: http://www.MARCINKOASSOCIATES.com

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The Department of Labor’s proposal aims to close governance loopholes and require financial advisers to give retirement advice in the best interests of savers rather than chase the highest payday.

“Bad financial advice by unscrupulous financial advisers driven by their own self-interest can cost a retiree up to 1.2% per year in lost investment,” President Biden said. “That doesn’t sound like much but if you’re living long, it’s a lot of money.

MORE: https://medicalexecutivepost.com/2023/03/11/recast-an-interview-with-fiduciary-bennett-aikin-aif-2/

“Over a lifetime, it can add up to 20% less money when they retire. For a middle-class household, that can amount to tens of thousands of dollars over time.”

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

FIDUCIARY OATH: https://medicalexecutivepost.com/2023/02/19/the-fiduciary-oath/

***
COMMENTS APPRECIATED

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Filed under: "Ask-an-Advisor", Career Development, CMP Program, Ethics, Events-Planner, Financial Planning, Funding Basics, Interviews, Investing, Marcinko Associates, Retirement and Benefits, Risk Management, Touring with Marcinko | Tagged: Aikin, best interest, Certified Medical Planner Textbooks, CMP, DOL, fiduciary, fiduciary oath, financial advice, financial advisors, investment, Investment Advice, Marcinko, retirement | Leave a comment »

MICRO-CERTIFICATIONS: Physician Insider Knowledge for Financial Advisor Success?

Posted on December 17, 2023 by Dr. David Edward Marcinko MBA MEd CMP™

Micro-Credentials on the Rise

KNOWLEDGE RICHES IN NICHES

DR. DAVID EDWARD MARCINKO MBA CMP™

SPONSOR: http://www.CertifiedMedicalPlanner.org

***

***

Do you ever wish you could acquire specific information for your career activities without having to complete a university Master’s Degree or finish our entire Certified Medical Planner™ professional designation program? Well, Micro-Certifications from the Institute of Medical Business Advisors, Inc., might be the answer. Read on to learn how our three Micro-Certifications offer new opportunities for professional growth in the medical practice, business management, health economics and financial planning, investing and advisory space for physicians, nurses and healthcare professionals.

Micro-Certification Basics

Stock-Brokers, Financial Advisors, Investment Advisors, Accountants, Consultants, Financial Analyists and Financial Planners need to enhance their knowledge skills to better serve the changing and challenging healthcare professional ecosystem. But, it can be difficult to learn and demonstrate mastery of these new skills to employers, clients, physicians or medical prospects. This makes professional advancement difficult. That’s where Micro-Certification and Micro-Credentialing enters the online educational space. It is the process of earning a Micro-Certification, which is like a mini-degree or mini-credential, in a very specific topical area.

Micro-Certification Requirements

Once you’ve completed all of the requirements for our Micro-Certification, you will be awarded proof that you’ve earned it. This might take the form of a paper or digital certificate, which may be a hard document or electronic image, transcript, file, or other official evidence that you’ve completed the necessary work.

Uses of Micro-Certifications

Micro-Certifications may be used to demonstrate to physicians prospective medical clients that you’ve mastered a certain knowledge set. Because of this, Micro-Certifications are useful for those financial service professionals seeking medical clients, employment or career advancement opportunities.

Examples of iMBA, Inc., Micro-Certifications

Here are the three most popular Micro-Certification course from the Institute of Medical Business Advisors, Inc:

1. Health Insurance and Managed Care: To keep up with the ever-changing field of health care physician advice, you must learn new medical practice business models in order to attract and assist physicians and nurse clients. By bringing together the most up-to-date business and medical prctice models [Medicare, Medicaid, PP-ACA, POSs, EPOs, HMOs, PPOs, IPA’s, PPMCs, Accountable Care Organizations, Concierge Medicine, Value Based Care, Physician Pay-for-Performance Initiatives, Hospitalists, Retail and Whole-Sale Medicine, Health Savings Accounts and Medical Unions, etc], this iMBA Inc., Mini-Certification offers a wealth of essential information that will help you understand the ever-changing practices in the next generation of health insurance and managed medical care.
2. Health Economics and Finance: Medical economics, finance, managerial and cost accounting is an integral component of the health care industrial complex. It is broad-based and covers many other industries: insurance, mathematics and statistics, public and population health, provider recruitment and retention, health policy, forecasting, aging and long-term care, and Venture Capital are all commingled arenas. It is essential knowledge that all financial services professionals seeking to serve in the healthcare advisory niche space should possess.
3. Health Information Technology and Security: There is a myth that all physician focused financial advisors understand Health Information Technology [HIT]. In truth, it is often economically misused or financially misunderstood. Moreover, an emerging national HIT architecture often puts the financial advisor or financial planner in a position of maximum uncertainty and minimum productivity regarding issues like: Electronic Medical Records [EMRs] or Electronic Health Records [EHRs], mobile health, tele-health or tele-medicine, Artificial Intelligence [AI], benefits managers and human resource professionals.

Other Topics include: economics, finance, investing, marketing, advertising, sales, start-ups, business plan creation, financial planning and entrepreneurship, etc.

How to Start Learning and Earning Recognition for Your Knowledge

Now that you’re familiar with Micro-Credentialing, you might consider earning a Micro-Certification with us. We offer 3 official Micro-Certificates by completing a one month online course, with a live instructor consisting of twelve asynchronous lessons/online classes [3/wk X 4/weeks = 12 classes]. The earned official completion certificate can be used to demonstrate mastery of a specific skill set and shared with current or future employers, current clients or medical niche financial advisory prospects.

Mini-Certification Tuition, Books and Related Fees

The tuition for each Mini-Certification live online course is $1,250 with the purchase of one required dictionary handbook. Other additional guides, white-papers, videos, files and e-content are all supplied without charge. Alternative courses may be developed in the future subject to demand and may change without notice.

***

Contact: For more information, or to speak with an academic representative, please contact Ann Miller RN MHA CMP™ at: MarcinkoAdvisors@msn.com [24/7] -OR- 770-448-0769[9:00 – 5:00 EST].

***

Filed under: "Advisors Only", "Ask-an-Advisor", Career Development, CMP Program, Experts Invited, Financial Planning, Glossary Terms, Health Economics, Health Insurance, Health Law & Policy, Healthcare Finance, iMBA, iMBA, Inc., Information Technology, Investing, Op-Editorials | Tagged: accountants, certifications, certified medical planner, CMP, financial advisors, financial planners, Investing, investment advisors, Marcinko, micro, micro-certifications, micro-credentials | Leave a comment »

DEAR COLLEAGUES: Are You a Financial Advisor’s “Customer” or “Client”?

Posted on December 15, 2023 by Dr. David Edward Marcinko MBA MEd CMP™

By Dr. David Edward Marcinko MBA CMP™

SPONSOR: http://www.MarcinkoAssociates.com

First – a little “insider expert” background on the confusion. It exists largely because of the influence that large financial institutions (who earn revenue through the sale of financial products) have on legislators.

The Investment Advisors Act of 1940 requires that anyone giving investment advice must be acting in a fiduciary capacity. The intent was to separate the financial salespeople, who had significant conflicts of interest, from the investment advisors, who had few to none. If you know very little about financial products, would you rather be educated as the customer of a commissioned salesperson or the client of a fee-for-service advisor? Hands down, you’d want the fee-for-service advisor.

Of course, the financial institutions selling products understood this. They were able to influence the drafting of the 1940 Investment Advisors Act, to exclude “any broker or dealer whose performance of such [advisory] services is solely incidental to the conduct of his business as a broker or dealer.” So if salespeople just happen to give some financial advice that is “incidental” to the sale of a product, they and their companies are not held to the fiduciary standard. Our U.S. Congress allows financial companies to advertise as if they are fiduciaries while their sales forces are not held to a fiduciary standard.

Now, according to Rick Kahler CFP®, the same conflict arises in some professional designations, like the Certified Financial Planner® designation conferred by the CFP® Board. The designation initially certified the completion of training in financial planning. In 2008 the Board added a fiduciary requirement to the designation.

However, CFP®’s are only held to a fiduciary requirement when they are doing what the CFP® Board defines as financial planning. If a CFP® professional is giving advice to a client, the fiduciary standard applies. Yet the same professional can sell the same client an annuity with high fees and high commissions, even if the product may not be in the client’s best interest, as long as no “financial planning” is part of the transaction. The result is significant confusion for consumers.

The bottom line is this: when you look for financial advice or financial products, don’t assume the advisor is looking out for you. It’s your responsibility to find out whether any financial professional owes you a fiduciary duty.

So, I suggest you ask directly, “Am I a customer or a client?” The answer is almost always “a client,” as most financial services salespeople honestly don’t know the difference. After you explain that difference, ask them to verify their fiduciary duty in writing. That five-minute solution may have a lasting impact on your financial well-being.

Better yet, consider speaking to your fiduciary focused and fee-only Certified Medical Planner® professional colleagues at D.E. Marcinko & Associates.

“By Doctors – For Doctors”

CMP: http://www.CertifiedMedicalPlanner.org***

COMMENTS APPRECIATED

Thank You

***

Filed under: "Ask-an-Advisor", "Doctors Only", Career Development, CMP Program, Ethics, Experts Invited, Industry Indignation Index, Insurance Matters, Interviews, Investing, Marcinko Associates | Tagged: certified financial planner, Certified Medical Planner™, CFP, CFP Board, CMP, Investment Advisor Act, Marcinko Associates, Rick Kahler CFP® | Leave a comment »

Why CERTIFIED MEDICAL PLANNERs™ Will Thrive in 2024?

Posted on December 10, 2023 by Dr. David Edward Marcinko MBA MEd CMP™

Think Different – Be Different – Thrive

[By Ann Miller RN MHA]

Letterhead CMP

http://www.CertifiedMedicalPlanner.org

Dear Physician Focused Financial Advisors

***

http://www.CertifiedMedicalPlanner.org

Enter the CMPs

“The informed voice of a new generation of fiduciary advisors for healthcare”

**[Think Different – Be Different – Thrive]**

InfoGraphic

http://e.infogr.am/enter_the_certified_medical_planner?src=embed

http://www.CertifiedMedicalPlanner.org

***

So, if you are looking to supplement your knowledge, income and designations; and find other qualified professionals you may want to consider the CMP® program.

Enter the Certified Medical Planner™ charter professional designation. And, CMPs™ are FIDUCIARIES, 24/7.

Channel Surfing the ME-P

Conclusion

***

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

* 8

Filed under: "Advisors Only", "Ask-an-Advisor", Career Development, CMP Program, Investing | Tagged: certified medical planner, CMP, CMP™ Course | Leave a comment »

SCOTUS: “Quadrillion-Dollar” IRS Tax Code Question?

Posted on December 4, 2023 by Dr. David Edward Marcinko MBA MEd CMP™

By Staff Reporters

SPONSOR: http://www.CertifiedMedicalPlanner.org

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SCOTUS will hear the “quadrillion-dollar” question?

Kicking off the Supreme Court this week will hear oral arguments today for a case that could upend the US tax code.

In Moore v. United States, the justices will be asked to decide whether the federal government can tax certain “unrealized gains”—assets that have yet to be sold.

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

***

COMMENTS APPRECIATED

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***

Filed under: "Ask-an-Advisor", Accounting, CMP Program, Financial Planning, Glossary Terms, Investing, Taxation | Tagged: Accounting, Certified Medical Planner™, CMP, Moore v. United States, SCOTUS, Supreme Court, tax, tax code, Taxation, unrealized gains | Leave a comment »

GM ALERT: Buy-Back as Stock Rises

Posted on November 29, 2023 by Dr. David Edward Marcinko MBA MEd CMP™

By Staff Reporters

SPONSOR: http://www.CERTIFIEDMEDICALPLANNER.org

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General Motors plans to sharply increase cash return to shareholders, as Chief Executive Mary Barra seeks to reassure investors about the health of GM’s core car-making business after setbacks in fledgling pursuits such as electric and driver-less vehicles.

The company just announced it will work to offset higher labor expenses from its new contract with the United Auto Workers and unionized employees in Canada. The contracts will add a total of $9.3 billion in costs over about four years, including $1.5 billion next year, higher than analysts had estimated.

Barra is trying to jump-start GM’s flailing shares while also refocusing investors on the underlying strength of its main business: selling gas- and diesel-powered trucks and SUVs. It marks a shift in the message from recent years, during which the CEO sought to recast GM as a tech company poised to transcend the messy world of car manufacturing.

GM said it would log strong profits this year despite a six-week strike that shaved $1.1 billion from its bottom line in the third and fourth quarters. The company expects full-year operating profit of $11.7 billion to $12.7 billion, after withdrawing its guidance last month during the strike

COMMENTS APPRECIATED

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Filed under: "Ask-an-Advisor", Breaking News, CMP Program, Financial Planning, Funding Basics, iMBA, Inc., Investing, Sponsors | Tagged: Certified Medical Planner™, CMP, General Motors, GM, Mary Barra, SUVs | Leave a comment »

CERTIFIED MEDICAL PLANNERs™ Rising thru Niche Physician Knowledge?

Posted on November 8, 2023 by Dr. David Edward Marcinko MBA MEd CMP™

Think Different – Be Different – Thrive

[By Ann Miller RN MHA]

Letterhead CMP

http://www.CertifiedMedicalPlanner.org

Dear Physician Focused Financial Advisors

***

http://www.CertifiedMedicalPlanner.org

Enter the CMPs

“The informed voice of a new generation of fiduciary advisors for healthcare”

**[Think Different – Be Different – Thrive]**

InfoGraphic

http://e.infogr.am/enter_the_certified_medical_planner?src=embed

http://www.CertifiedMedicalPlanner.org

***

So, if you are looking to supplement your knowledge, income and designations; and find other qualified professionals you may want to consider the CMP® program.

Enter the Certified Medical Planner™ charter professional designation. And, CMPs™ are FIDUCIARIES, 24/7.

Channel Surfing the ME-P

Conclusion

***

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

* 8

Filed under: "Advisors Only", "Ask-an-Advisor", Career Development, CMP Program, Investing | Tagged: certified medical planner, CMP, CMP™ Course | Leave a comment »

MICRO-CERTIFICATIONS: Financial Advisors Seeking Physician-Client Niche Success?

Posted on November 5, 2023 by Dr. David Edward Marcinko MBA MEd CMP™

Micro-Credentials on the Rise

KNOWLEDGE RICHES IN NICHES

DR. DAVID EDWARD MARCINKO MBA CMP™

SPONSOR: http://www.CertifiedMedicalPlanner.org

***

***

Micro-Certification Basics

Micro-Certification Requirements

Uses of Micro-Certifications

Examples of iMBA, Inc., Micro-Certifications

Here are the three most popular Micro-Certification course from the Institute of Medical Business Advisors, Inc:

1. Health Insurance and Managed Care: To keep up with the ever-changing field of health care physician advice, you must learn new medical practice business models in order to attract and assist physicians and nurse clients. By bringing together the most up-to-date business and medical prctice models [Medicare, Medicaid, PP-ACA, POSs, EPOs, HMOs, PPOs, IPA’s, PPMCs, Accountable Care Organizations, Concierge Medicine, Value Based Care, Physician Pay-for-Performance Initiatives, Hospitalists, Retail and Whole-Sale Medicine, Health Savings Accounts and Medical Unions, etc], this iMBA Inc., Mini-Certification offers a wealth of essential information that will help you understand the ever-changing practices in the next generation of health insurance and managed medical care.
2. Health Economics and Finance: Medical economics, finance, managerial and cost accounting is an integral component of the health care industrial complex. It is broad-based and covers many other industries: insurance, mathematics and statistics, public and population health, provider recruitment and retention, health policy, forecasting, aging and long-term care, and Venture Capital are all commingled arenas. It is essential knowledge that all financial services professionals seeking to serve in the healthcare advisory niche space should possess.
3. Health Information Technology and Security: There is a myth that all physician focused financial advisors understand Health Information Technology [HIT]. In truth, it is often economically misused or financially misunderstood. Moreover, an emerging national HIT architecture often puts the financial advisor or financial planner in a position of maximum uncertainty and minimum productivity regarding issues like: Electronic Medical Records [EMRs] or Electronic Health Records [EHRs], mobile health, tele-health or tele-medicine, Artificial Intelligence [AI], benefits managers and human resource professionals.

Other Topics include: economics, finance, investing, marketing, advertising, sales, start-ups, business plan creation, financial planning and entrepreneurship, etc.

How to Start Learning and Earning Recognition for Your Knowledge

Mini-Certification Tuition, Books and Related Fees

***

Contact: For more information, or to speak with an academic representative, please contact Ann Miller RN MHA CMP™ at: MarcinkoAdvisors@msn.com [24/7] -OR- 770-448-0769[9:00 – 5:00 EST].

***

DAILY UPDATE: Merck Up, KP and Junk Fees Down, Interest Rates Unchanged as Stock Markets Jump Again

Posted on November 2, 2023 by Dr. David Edward Marcinko MBA MEd CMP™

SPONSOR: http://www.CertifiedMedicalPlanner.org

***

http://www.MarcinkoAssociates.com

Merck reported $640 million in sales for its Covid-19 drug, Lagevrio, in Q3 earnings, blowing past analyst expectations of $140.8 million. Covid drug sales have dropped for most big pharma companies this year, with Pfizer lowering its total expected 2023 earnings by about $9 billion due mostly to declining Paxlovid sales. Merck attributed the boost to increasing demand for Lagevrio in Japan.

***

California’s largest health system agreed to a $200 million settlement on October 12th following an investigation that found the system has failed to provide timely behavioral health appointments for patients and has canceled more than 100,000 appointments.

Kaiser Permanente, which also runs a health plan, will “undertake a systemic overhaul” of its behavioral health services, Mary Watanabe, director of the Department of Managed Health Care (DMHC), the regulatory body that oversees managed care plans in California, said in a statement. The DMHC began investigating Kaiser in May 2022 after the Oakland-based health system saw a 20% increase in behavioral health patient complaints in 2021, the DMHC said in a statement.

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

***

President President Biden spoke Tuesday afternoon on what the White House has called a crackdown on “junk fees” in retirement planning. Such fees chip away at account balances over time, leading to lifetime savings that are up to 20% less than if advisors were held to the highest standards, according to a White House statement.

Under current regulations, advisors who provide advice to workers rolling their 401(k) or related plan into an individual retirement account are generally not considered a fiduciary—that is, a professional who must put clients’ interests ahead of their own. This means that an advisor could steer an investor into, say, an annuity that pays the advisor a big commission, even if it’s not the best option for the investor. In some cases, commission costs and other fees are baked into the product, as opposed to paid outright, and investors don’t realize that they are silently eating into returns over time.

***

The Federal Reserve left interest rates unchanged Wednesday as it continues to track inflation and the health of the economy. The central bank voted unanimously to leave its primary interest rate in the range of 5.25% to 5.50%. U.S. interest rates are the highest they’ve been in 23 years. That means interest rates on loans such as mortgages have gone up sharply, and so have payments on Treasury bonds and interest-bearing accounts.

Here is where the major benchmarks ended:

The S&P 500 Index was up 44.06 points (1.1%) at 4,237.86; the Dow Jones Industrial Average (DJI) was up 221.71 points (0.7%) at 33,274.58; the NASDAQ Composite was up 210.23 points (1.6%) at 13,061.47.
The 10-year Treasury note yield (TNX) was down about 11 basis points at 4.761%.
CBOE’s Volatility Index (VIX) was down 1.30 at 16.84.

In addition to technology, communication services and utilities were among the strongest sectors Wednesday. Energy shares were under pressure as crude oil futures extended this week’s slump and ended at a two-month low. The U.S. dollar index (DXY) tumbled from an earlier rally to a one-month high, potentially reflecting expectations that domestic interest rates may be near a peak.

COMMENTS APPRECIATED

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Filed under: "Ask-an-Advisor", Alerts Sign-Up, Alternative Investments, CMP Program, Financial Planning, Funding Basics, Glossary Terms, Investing, Marcinko Associates, Touring with Marcinko | Tagged: banks, Biden, CMP, david marcinko, DJIAm, DMHC, DXY, energy, Federal Reserve, fiduciary, gold, inflation, interest rates, IRS, junk fees, Kaiser Permanente, Lagevrio, Marcinko, Marcinko Associates, markets, Mary Watanabe, Merck, NASDAQ, oil, Pfizer, Russell Index 2000, S&P 500, US Dollar | Leave a comment »

SCARY STOCK MARKETS: Halloween 2023

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

By Staff Reporters

SPONSOR: http://www.CertifiedMedicalPlanner.org

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The official website of the New York Stock Exchange does not list Halloween 2023 (or 2024 or 2025, for that matter) as a stock market holiday. In fact, no holidays are listed for the month of October. So, get ready for a full day of stock trading and investing today. And, we’ll be here, reporting the major events of the day, and year, as usual.

***

Stocks markets shook off any scary notions yesterday, with the S&P 500 climbing out of correction territory and the DJIA notching its best day since June as companies like Nike and Verizon jumped. Investors will be watching tomorrow to see whether the good vibes can continue after the Fed announces its latest decision on interest rates.

But, worry remains as Adam Crisafulli of Vital Knowledge noted there are several technical factors fueling Monday’s pop in stock futures, “including extremely oversold prices.” The S&P 500 fell more than 2% for a second straight week.

“In addition, catalyst anticipation is playing a role too as investors hope the end of the month coupled with benign central bank decisions (BOJ, FOMC, BOE) and desired economic developments (cooler EU CPI, US JOLTs, and US jobs) will help stabilize the tape,” “However, after three consecutive months of losses … confidence has evaporated, and there’s very little genuine interest in buying the tape,” Crisafulli added.

***

Finally, X is now worth less than half of what Elon Musk paid to buy Twitter last year. A memo to employees said the company was valued at $19 billion—55% less than the $44 billion that Musk paid out.

COMMENTS APPRECIATED

Thank You

***

Filed under: "Ask-an-Advisor", Breaking News, CMP Program, Events-Planner, Experts Invited, Investing, LifeStyle | Tagged: adam crisafulli, Certified Medical Planner™, CMP, DJIA, halloween, musk, NASDAQ, nike, NYSE, S&P 500, stock markets, twitter, Verizon, vital knowledge, x | Leave a comment »

Become a PHYSICIAN FOCUSED Board CERTIFIED MEDICAL PLANNER™ and Thrive

Posted on October 14, 2023 by Dr. David Edward Marcinko MBA MEd CMP™

Think Different – Be Different – Thrive

[By Ann Miller RN MHA]

Letterhead CMP

http://www.CertifiedMedicalPlanner.org

Dear Physician Focused Financial Advisors

***

http://www.CertifiedMedicalPlanner.org

Enter the CMPs

“The informed voice of a new generation of fiduciary advisors for healthcare”

**[Think Different – Be Different – Thrive]**

InfoGraphic

http://e.infogr.am/enter_the_certified_medical_planner?src=embed

http://www.CertifiedMedicalPlanner.org

***

So, if you are looking to supplement your knowledge, income and designations; and find other qualified professionals you may want to consider the CMP® program.

Enter the Certified Medical Planner™ charter professional designation. And, CMPs™ are FIDUCIARIES, 24/7.

Channel Surfing the ME-P

Conclusion

***

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

* 8

Filed under: "Advisors Only", "Ask-an-Advisor", Career Development, CMP Program, Investing | Tagged: certified medical planner, CMP, CMP™ Course | Leave a comment »

Become a Board CERTIFIED MEDICAL PLANNER™ and Thrive

Posted on October 4, 2023 by Dr. David Edward Marcinko MBA MEd CMP™

Think Different – Be Different – Thrive

[By Ann Miller RN MHA]

Letterhead CMP

http://www.CertifiedMedicalPlanner.org

Dear Physician Focused Financial Advisors

***

http://www.CertifiedMedicalPlanner.org

Enter the CMPs

“The informed voice of a new generation of fiduciary advisors for healthcare”

**[Think Different – Be Different – Thrive]**

InfoGraphic

http://e.infogr.am/enter_the_certified_medical_planner?src=embed

http://www.CertifiedMedicalPlanner.org

***

So, if you are looking to supplement your knowledge, income and designations; and find other qualified professionals you may want to consider the CMP® program.

Enter the Certified Medical Planner™ charter professional designation. And, CMPs™ are FIDUCIARIES, 24/7.

Channel Surfing the ME-P

Conclusion

***

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

* 8

Filed under: "Advisors Only", "Ask-an-Advisor", Career Development, CMP Program, Investing | Tagged: certified medical planner, CMP, CMP™ Course | Leave a comment »

Become a Board CERTIFIED MEDICAL PLANNER™ and Thrive

Posted on September 29, 2023 by Dr. David Edward Marcinko MBA MEd CMP™

Think Different – Be Different – Thrive

[By Ann Miller RN MHA]

Letterhead CMP

http://www.CertifiedMedicalPlanner.org

Dear Physician Focused Financial Advisors

***

http://www.CertifiedMedicalPlanner.org

Enter the CMPs

“The informed voice of a new generation of fiduciary advisors for healthcare”

**[Think Different – Be Different – Thrive]**

InfoGraphic

http://e.infogr.am/enter_the_certified_medical_planner?src=embed

http://www.CertifiedMedicalPlanner.org

***

So, if you are looking to supplement your knowledge, income and designations; and find other qualified professionals you may want to consider the CMP® program.

Enter the Certified Medical Planner™ charter professional designation. And, CMPs™ are FIDUCIARIES, 24/7.

Channel Surfing the ME-P

Conclusion

***

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

* 8

Filed under: "Advisors Only", "Ask-an-Advisor", Career Development, CMP Program, Investing | Tagged: certified medical planner, CMP, CMP™ Course | Leave a comment »

Become a Board CERTIFIED MEDICAL PLANNER™ and Thrive

Posted on September 26, 2023 by Dr. David Edward Marcinko MBA MEd CMP™

Think Different – Be Different – Thrive

[By Ann Miller RN MHA]

Letterhead CMP

http://www.CertifiedMedicalPlanner.org

Dear Physician Focused Financial Advisors

***

http://www.CertifiedMedicalPlanner.org

Enter the CMPs

“The informed voice of a new generation of fiduciary advisors for healthcare”

**[Think Different – Be Different – Thrive]**

InfoGraphic

http://e.infogr.am/enter_the_certified_medical_planner?src=embed

http://www.CertifiedMedicalPlanner.org

***

So, if you are looking to supplement your knowledge, income and designations; and find other qualified professionals you may want to consider the CMP® program.

Enter the Certified Medical Planner™ charter professional designation. And, CMPs™ are FIDUCIARIES, 24/7.

Channel Surfing the ME-P

Conclusion

***

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

* 8

Filed under: "Advisors Only", "Ask-an-Advisor", Career Development, CMP Program, Investing | Tagged: certified medical planner, CMP, CMP™ Course | Leave a comment »

CERTIFIED MEDICAL PLANNER™: Helping Physicians Financially Thrive to Avoid the “Doctor Effect”

Posted on September 26, 2023 by Dr. David Edward Marcinko MBA MEd CMP™

By Dr. David Edward Marcinko, MBA CMP™

CEO: D.E. Marcinko & Associates, Inc.

***

SPONSOR: http://www.CERTIFIEDMEDICALPLANNER.org

BEWARE MEDICAL PRACTITIONERS

Several years ago a group of highly trusted and deeply experienced financial services professionals and estate planners noted that far too many of their mature physician clients, using traditional stock brokers, management consultants and financial advisors, seemed to be less successful than those who went it alone. These Do-it-Yourselfers [DIYs] had setbacks and made mistakes, for sure. But, the ME Inc doctors seemed to learn from their mistakes and did not incur the high management and service fees demanded from general or retail one-size-fits-all “advisors.”

In fact, an informal inverse relationship was noted, and dubbed the “Doctor Effect.” In others words, the more consultants an individual doctor retained; the less well they did in all disciplines of the financial planning and medical practice management, continuum.

Of course, the reason for this discrepancy eluded many of them as Wall Street brokerages and wire-houses flooded the media with messages, infomercials, print, radio, TV, texts, tweets, and internet ads to the contrary. Rather than self-learn the basics, the prevailing sentiment seemed to purse the holy grail of finding the “perfect financial advisor.” This realization was a confirmation of the industry culture which seemed to be: Bread for the advisor – Crumbs for the client!

And so, at D.E. Marcinko & Associates, our informed cadre’ of technology focused and highly educated doctors, nurses, financial advisors, attorneys, accountants, psychologists and educational visionaries decided there must be a better way for healthcare colleagues to receive financial planning advice, products and related management services within a culture of fiduciary responsibility.

We trust you agree with this ME Inc, and Certified Medical Planner™ consulting philosophy, as illustrated on our website.

WEBSITE: http://www.MARCINKOASSOCIATES.com

***

RISK MANAGEMENT FOR PHYSICIANS

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

***

Filed under: "Advisors Only", "Doctors Only", Accounting, Career Development, CMP Program, Experts Invited, Financial Planning, iMBA, Investing, Marcinko Associates, Practice Worth, Recommended Books, Retirement and Benefits, Sponsors, Taxation, Touring with Marcinko | Tagged: certified medical planner, CMP, david marcinko, doctor effect, Financial Planning, Investing, Marcinko Associates, physician financial planning, physicians | Leave a comment »

MICRO-CREDENTIALS: For Financial Advisors Seeking Physician-Client Niche Success?

Posted on September 24, 2023 by Dr. David Edward Marcinko MBA MEd CMP™

Micro-Credentials on the Rise

KNOWLEDGE RICHES IN NICHES

DR. DAVID EDWARD MARCINKO MBA CMP™

SPONSOR: http://www.CertifiedMedicalPlanner.org

***

***

Micro-Certification Basics

Micro-Certification Requirements

Uses of Micro-Certifications

Examples of iMBA, Inc., Micro-Certifications

Here are the three most popular Micro-Certification course from the Institute of Medical Business Advisors, Inc:

1. Health Insurance and Managed Care: To keep up with the ever-changing field of health care physician advice, you must learn new medical practice business models in order to attract and assist physicians and nurse clients. By bringing together the most up-to-date business and medical prctice models [Medicare, Medicaid, PP-ACA, POSs, EPOs, HMOs, PPOs, IPA’s, PPMCs, Accountable Care Organizations, Concierge Medicine, Value Based Care, Physician Pay-for-Performance Initiatives, Hospitalists, Retail and Whole-Sale Medicine, Health Savings Accounts and Medical Unions, etc], this iMBA Inc., Mini-Certification offers a wealth of essential information that will help you understand the ever-changing practices in the next generation of health insurance and managed medical care.
2. Health Economics and Finance: Medical economics, finance, managerial and cost accounting is an integral component of the health care industrial complex. It is broad-based and covers many other industries: insurance, mathematics and statistics, public and population health, provider recruitment and retention, health policy, forecasting, aging and long-term care, and Venture Capital are all commingled arenas. It is essential knowledge that all financial services professionals seeking to serve in the healthcare advisory niche space should possess.
3. Health Information Technology and Security: There is a myth that all physician focused financial advisors understand Health Information Technology [HIT]. In truth, it is often economically misused or financially misunderstood. Moreover, an emerging national HIT architecture often puts the financial advisor or financial planner in a position of maximum uncertainty and minimum productivity regarding issues like: Electronic Medical Records [EMRs] or Electronic Health Records [EHRs], mobile health, tele-health or tele-medicine, Artificial Intelligence [AI], benefits managers and human resource professionals.

Other Topics include: economics, finance, investing, marketing, advertising, sales, start-ups, business plan creation, financial planning and entrepreneurship, etc.

How to Start Learning and Earning Recognition for Your Knowledge

Mini-Certification Tuition, Books and Related Fees

***

Contact: For more information, or to speak with an academic representative, please contact Ann Miller RN MHA CMP™ at Email: MarcinkoAdvisors@msn.com [24/7] -OR- 770-448-0769[9:00 – 5:00 EST].

***

Book Offerings:

****

Filed under: "Advisors Only", "Ask-an-Advisor", Career Development, CMP Program, Experts Invited, Financial Planning, Glossary Terms, Health Economics, Health Insurance, Health Law & Policy, Healthcare Finance, iMBA, iMBA, Inc., Information Technology, Investing, Op-Editorials | Tagged: accountants, certifications, certified medical planner, CMP, financial advisors, financial planners, investment advisors, Marcinko, micro, micro-certifications, micro-credentials | Leave a comment »

MICRO-CREDENTIALS: For Financial Advisors Seeking Physician-Client Niche Success?

Posted on September 23, 2023 by Dr. David Edward Marcinko MBA MEd CMP™

Micro-Credentials on the Rise

KNOWLEDGE RICHES IN NICHES

DR. DAVID EDWARD MARCINKO MBA CMP™

SPONSOR: http://www.CertifiedMedicalPlanner.org

***

***

Micro-Certification Basics

Micro-Certification Requirements

Uses of Micro-Certifications

Examples of iMBA, Inc., Micro-Certifications

Here are the three most popular Micro-Certification course from the Institute of Medical Business Advisors, Inc:

1. Health Insurance and Managed Care: To keep up with the ever-changing field of health care physician advice, you must learn new medical practice business models in order to attract and assist physicians and nurse clients. By bringing together the most up-to-date business and medical prctice models [Medicare, Medicaid, PP-ACA, POSs, EPOs, HMOs, PPOs, IPA’s, PPMCs, Accountable Care Organizations, Concierge Medicine, Value Based Care, Physician Pay-for-Performance Initiatives, Hospitalists, Retail and Whole-Sale Medicine, Health Savings Accounts and Medical Unions, etc], this iMBA Inc., Mini-Certification offers a wealth of essential information that will help you understand the ever-changing practices in the next generation of health insurance and managed medical care.
2. Health Economics and Finance: Medical economics, finance, managerial and cost accounting is an integral component of the health care industrial complex. It is broad-based and covers many other industries: insurance, mathematics and statistics, public and population health, provider recruitment and retention, health policy, forecasting, aging and long-term care, and Venture Capital are all commingled arenas. It is essential knowledge that all financial services professionals seeking to serve in the healthcare advisory niche space should possess.
3. Health Information Technology and Security: There is a myth that all physician focused financial advisors understand Health Information Technology [HIT]. In truth, it is often economically misused or financially misunderstood. Moreover, an emerging national HIT architecture often puts the financial advisor or financial planner in a position of maximum uncertainty and minimum productivity regarding issues like: Electronic Medical Records [EMRs] or Electronic Health Records [EHRs], mobile health, tele-health or tele-medicine, Artificial Intelligence [AI], benefits managers and human resource professionals.

Other Topics include: economics, finance, investing, marketing, advertising, sales, start-ups, business plan creation, financial planning and entrepreneurship, etc.

How to Start Learning and Earning Recognition for Your Knowledge

Mini-Certification Tuition, Books and Related Fees

***

Book Offerings:

****

Filed under: "Advisors Only", "Ask-an-Advisor", Career Development, CMP Program, Experts Invited, Financial Planning, Glossary Terms, Health Economics, Health Insurance, Health Law & Policy, Healthcare Finance, iMBA, iMBA, Inc., Information Technology, Investing, Op-Editorials | Tagged: accountants, certifications, certified medical planner, CMP, financial advisors, financial planners, investment advisors, Marcinko, micro, micro-certifications, micro-credentials | Leave a comment »

Become a Board CERTIFIED MEDICAL PLANNER™ and Thrive

Posted on September 20, 2023 by Dr. David Edward Marcinko MBA MEd CMP™

Think Different – Be Different – Thrive

[By Ann Miller RN MHA]

Letterhead CMP

http://www.CertifiedMedicalPlanner.org

Dear Physician Focused Financial Advisors

***

http://www.CertifiedMedicalPlanner.org

Enter the CMPs

“The informed voice of a new generation of fiduciary advisors for healthcare”

**[Think Different – Be Different – Thrive]**

InfoGraphic

http://e.infogr.am/enter_the_certified_medical_planner?src=embed

http://www.CertifiedMedicalPlanner.org

***

So, if you are looking to supplement your knowledge, income and designations; and find other qualified professionals you may want to consider the CMP® program.

Enter the Certified Medical Planner™ charter professional designation. And, CMPs™ are FIDUCIARIES, 24/7.

Channel Surfing the ME-P

Conclusion

***

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

* 8

Filed under: "Advisors Only", "Ask-an-Advisor", Career Development, CMP Program, Investing | Tagged: certified medical planner, CMP, CMP™ Course | Leave a comment »

MICRO-CERTIFICATIONS: For Financial Advisors Seeking Physician-Client Niche Success?

Posted on September 19, 2023 by Dr. David Edward Marcinko MBA MEd CMP™

Micro-Credentials on the Rise

KNOWLEDGE RICHES IN NICHES

DR. DAVID EDWARD MARCINKO MBA CMP™

SPONSOR: http://www.CertifiedMedicalPlanner.org

***

***

Micro-Certification Basics

Micro-Certification Requirements

Uses of Micro-Certifications

Examples of iMBA, Inc., Micro-Certifications

Here are the three most popular Micro-Certification course from the Institute of Medical Business Advisors, Inc:

1. Health Insurance and Managed Care: To keep up with the ever-changing field of health care physician advice, you must learn new medical practice business models in order to attract and assist physicians and nurse clients. By bringing together the most up-to-date business and medical prctice models [Medicare, Medicaid, PP-ACA, POSs, EPOs, HMOs, PPOs, IPA’s, PPMCs, Accountable Care Organizations, Concierge Medicine, Value Based Care, Physician Pay-for-Performance Initiatives, Hospitalists, Retail and Whole-Sale Medicine, Health Savings Accounts and Medical Unions, etc], this iMBA Inc., Mini-Certification offers a wealth of essential information that will help you understand the ever-changing practices in the next generation of health insurance and managed medical care.
2. Health Economics and Finance: Medical economics, finance, managerial and cost accounting is an integral component of the health care industrial complex. It is broad-based and covers many other industries: insurance, mathematics and statistics, public and population health, provider recruitment and retention, health policy, forecasting, aging and long-term care, and Venture Capital are all commingled arenas. It is essential knowledge that all financial services professionals seeking to serve in the healthcare advisory niche space should possess.
3. Health Information Technology and Security: There is a myth that all physician focused financial advisors understand Health Information Technology [HIT]. In truth, it is often economically misused or financially misunderstood. Moreover, an emerging national HIT architecture often puts the financial advisor or financial planner in a position of maximum uncertainty and minimum productivity regarding issues like: Electronic Medical Records [EMRs] or Electronic Health Records [EHRs], mobile health, tele-health or tele-medicine, Artificial Intelligence [AI], benefits managers and human resource professionals.

Other Topics include: economics, finance, investing, marketing, advertising, sales, start-ups, business plan creation, financial planning and entrepreneurship, etc.

How to Start Learning and Earning Recognition for Your Knowledge

Mini-Certification Tuition, Books and Related Fees

***

Filed under: "Advisors Only", "Ask-an-Advisor", Career Development, CMP Program, Experts Invited, Financial Planning, Glossary Terms, Health Economics, Health Insurance, Health Law & Policy, Healthcare Finance, iMBA, iMBA, Inc., Information Technology, Investing, Op-Editorials | Tagged: accountants, certifications, certified medical planner, CMP, financial advisors, financial planners, investment advisors, Marcinko, micro, micro-certifications, micro-credentials | Leave a comment »

Become a Board CERTIFIED MEDICAL PLANNER™ and Thrive

Posted on September 16, 2023 by Dr. David Edward Marcinko MBA MEd CMP™

Think Different – Be Different – Thrive

[By Ann Miller RN MHA]

Letterhead CMP

http://www.CertifiedMedicalPlanner.org

Dear Physician Focused Financial Advisors

***

http://www.CertifiedMedicalPlanner.org

Enter the CMPs

“The informed voice of a new generation of fiduciary advisors for healthcare”

**[Think Different – Be Different – Thrive]**

InfoGraphic

http://e.infogr.am/enter_the_certified_medical_planner?src=embed

http://www.CertifiedMedicalPlanner.org

***

So, if you are looking to supplement your knowledge, income and designations; and find other qualified professionals you may want to consider the CMP® program.

Enter the Certified Medical Planner™ charter professional designation. And, CMPs™ are FIDUCIARIES, 24/7.

Channel Surfing the ME-P

Conclusion

***

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

* 8

Filed under: "Advisors Only", "Ask-an-Advisor", Career Development, CMP Program, Investing | Tagged: certified medical planner, CMP, CMP™ Course | Leave a comment »

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e Communication Tales from the Treatment Room

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Stock or Manager Relevance Comparisons and Philosophy

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A Primer for Physician Investors and Medical Professionals

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Understanding the operational and financial status of your organization or practice

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EARLY DAYS

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Step 1: Think strategically about pension and Social Security benefits

Step 2: Pressure-test your 401(k)

Step 3: Don’t forget about health insurance, doctor!

Step 4: Create a post-retirement budget

Step 5: Protect your portfolio

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Think Different – Be Different – Thrive

[Think Different – Be Different – Thrive]

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On Differences and Similarities

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What does wealth mean to you?

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Think Different – Be Different – Thrive

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ON MEDICAL WORKPLACE VIOLENCE

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A SPECIAL ME-P REPORT

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Micro-Certification Basics

Micro-Certification Requirements

Uses of Micro-Certifications

Examples of iMBA, Inc., Micro-Certifications

How to Start Learning and Earning Recognition for Your Knowledge

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Think Different – Be Different – Thrive

**[Think Different – Be Different – Thrive]**

**[Think Different – Be Different – Thrive]**

**[Think Different – Be Different – Thrive]**

**[Think Different – Be Different – Thrive]**