HEALTHCARE LEADERSHIP ON THE BRINK: Executives Eyeing the Exits

By Health Capital Consultants LLC

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While the healthcare industry has been dealing with high employee turnover since the start of the COVID-19 pandemic, that turnover was largely among clinical staff.

However, a recent survey found that significant healthcare leadership turnover may also be on the horizon. AMN Healthcare subsidiary B.E. Smith found that nearly half of healthcare executives plan to leave their organization in the next year.

This Health Capital Topics article reviews the survey and the reasons behind the intended exits. (Read more…) 

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QUANTUM COMPUTING: Healthcare and Banking Affected [B-QTUM Index Fund]

FUNDAMENTAL INDUSTRY CHANGES

By Staff Reporters

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Index Funds

An index mutual fund or ETF (exchange-traded fund) tracks the performance of a specific market benchmark—or “index,” like the popular S&P 500 Index—as closely as possible. That’s why you may hear people refer to indexing as a “passive” investment strategy.

Instead of hand-selecting which stocks or bonds the fund will hold, the fund’s manager buys all (or a representative sample) of the stocks or bonds in the index it tracks.

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Quantum Computing

Unlike traditional computers that use bits, quantum computers utilize qubits. These qubits are capable of being in a state of superposition, where they can represent both 0 and 1 simultaneously, enabling the processing of multiple calculations at once. This could allow quantum computers to outperform classical computers in solving certain complex problems. However, the field is still overcoming challenges such as qubit stability and decoherence; especially in these three areas:

  • Quantum computing could fundamentally alter healthcare by accelerating drug discovery and improving individualized medicine. Rapid analysis of enormous volumes of biological data allows quantum computers to find trends that might guide the creation of more potent treatments. In addition to accelerating drug development, this will enable customized treatments tailored to unique genetic profiles.
  • Faster and more accurate financial models produced by quantum computing will transform the banking sector. Through real-time analysis of intricate financial systems, it can help investors to control risk and make better decisions. More precise market forecasts will help maximize portfolio management and trading strategies.
  • Through greatly enhanced medical diagnosis and patient care, quantum computing can transform the healthcare industry. Quantum computers can remarkably accurately find trends and possible health hazards by analyzing enormous volumes of medical data in a fraction of the time. Early diagnosis and more customized treatment alternatives follow from this.

BQTUM Index Fund

Index Description: The BlueStar® Machine Learning and Quantum Computing Index (BQTUM) tracks liquid companies in the global quantum computing and machine learning industries, including products and services related to quantum computing or machine learning, such as the development or use of quantum computers or computing chips, superconducting materials, applications built on quantum computers, embedded artificial intelligence chips, or software specializing in the perception, collection, visualization, or management of big data.

Citation and Disclosure: https://www.defianceetfs.com/qtum/

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ECONOMIC COMPETITION MODELS: In Medicine and Health Care

By Staff Reporters

SPONSOR: http://www.CertifiedMedicalPlanner.org

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HEALTH CARE ECONOMIC COMPETITION MODELS

In a discussion of competitive healthcare economic models, assumptions must include normal demand quantities, many fully informed patients and the fact that physicians cannot directly influence demand for medical care. These assumptions, although fluid, also preclude that patient buyers are large enough to have any influence over price and result in the following”:

  • In a “pure monopoly”, there is only one provider with a unique service. The doctor   is a “price maker” and charges whatever s/he wishes.
  • In an “oligopoly”, there are a few physicians who provide similar services. For example, when it becomes clear to Dr. Smith and Dr. Jones that neither can win their price war, oli-gopolists return prices to prior, but still inflated levels!  
  • In “monopolistic competition”, there are many providers with differentiated services. For example, should Dr. Jones decide to have evening hours, she may charge a premium for her fees if Dr. Jones doe not follow suit.
  • Finally, when “pure competition” occurs, there are many physicians, providing providing similar and substitutable services. Marketing and advertising does not affect fees, and prices are determined by supply and demand. The doctors become “price takers” by accepting fees arrived at by practicing competitively.

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The Medical Executive-Post is a  news and information aggregator and social media professional network for medical and financial service professionals.

Feel free to submit education content to the site as well as links, text posts, images, opinions and videos which are then voted up or down by other members. Comments and dialog are especially welcomed.

Daily posts are organized by subject. ME-P administrators moderate the activity. Moderation may also conducted by community-specific moderators who are unpaid volunteers.

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AOMB: Assignment of Medical Benefits

By Staff Reporters

SPONSOR: http://www.CertifiedMedicalPlanner.org

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Classic: An arrangement by which a patient requests that their health benefit payments be made directly to a designated person or facility, such as a physician or hospital. It is a legally binding agreement between patient and Insurance company asking them to send your reimbursement checks directly to your doctor.
 
Modern: To accept assignment means that the provider agrees to accept what ever the insurance company allows or approves as payment in full for the claim. The patient signs paperwork requiring his health insurance provider to pay his physician or hospital directly.
 
EXAMPLES:
 
CMS: The approved amount, also known as the Medicare-approved amount, is the fee that Medicare sets as how much a provider or supplier should be paid for a particular service or item. Original Medicare calls this “assignment.”
 
Tardiness: When a medical office accepts an assignment of benefits, the insured patients may have to wait several months for their insurance reimbursement to arrive.

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BLOGGING: All Doctors Please Beware!

WARNING – WARNING

By Dr. DavidEdwardMarcinko; MBA MEd

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According to www.NPR.org, there are more than120,000 health care forums on the Internet with opinions ranging from pharmaceuticals, to sexual dysfunction, to acne. The same goes for commercial doctor blogs that promote lotions, balms and potions, diets and vitamins, minerals, herbs, drinks and elixirs, or various other ingest-ants, digest-ants or pharmaceuticals, etc.

And, to other doctors, the blogging craze is a new novelty where there are no rules, protocols, standards or precise figures on how many “medical-doctor” or related physician-blogs are “out there.” Unfortunately, too many recount gory ER scenes, or pictorially illustrate horrific medical conditions, or serious and traumatic injuries. Of course, others simply are medical practice websites, or those that entice patients into more lucrative plastic surgery or concierge medical practices. Some are from self-serving/credible plaintiff-seeking attorneys wishing to assist patients.

Not all physician blogs are geared toward practice information, marketing or medical sensationalism. In fact, just the opposite seems to be the case in extremely candid blogs, like “Ranting Docs”, “White Coat Rants,” “Grunt Docs”, “Cancer Doc,” “The Happy Hospitalist,” “Mom MD”, “Cross-Over Health”, “Angry Docs” and “M.D.O.D.,” which bills itself as “Random Thoughts from a Few Cantankerous American Physicians.”

According to some of these, they are more like personal journals, or public diaries, where doctors vent about reimbursement rates, difficult cases, medical mistakes, declining medical prestige and control, and/or what a “bummer” it is to have so many patients die; not pay, or who are indigent, noncompliant. We call these the “disgruntled doctor sites.” Some even talk about their own patients, coding issues, or various doctor-patient shenanigans.

But, according to psychiatrist and blogger Dr. Deborah Peel and others, the problem with blogging about patients is the danger that one will be able to identify themselves – the doctor – or that others who know them will be able to identify them.”  Her affiliation, Patient Privacy Rights, rightly worries that patients might track back to the individual, and adversely affect their employment, health insurance or other aspects of life.

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And, according to Dr. Jay S. Grife; MA Esq., it is certainly true that if a doctor violates a patient’s privacy there could be legal consequences. Under HIPAA, physicians could face fines or even jail time. In some states, patients can file a civil lawsuit if they believe a doctor has violated their privacy. Still, internet privacy issues are an evolving gray-area that if not wrong, may still be morally and ethically questionable [personal communication].

Our colleague Robert Wachter MD, author of the blog called “Wachter’s World,” says it’s important for doctors to be able to share cases, as long as they change the facts substantially. On the other hand, the author of “Wachter’s World” and a leading expert on patient safety alternately suggests “You might say we as doctors should never be talking about experiences with our patients online or in books or in articles.” But, he says that “patients shouldn’t take all the information on blogs at face value. Taken for what they are — unedited opinions, and in some cases entertainment — blogs can give readers some useful insight into the good, the bad and the ugly of the medical profession”. Link: http://www.the-hospitalist.org/blogs

Well, fair enough! But, doctors unhappy with their current medical career choice, or its modern evolution, should probably consider counseling or even career change guidance, re-education and re-engineering. It is very inappropriate to vent career frustrations in a public venue. It’s far better for the blog to be private and/or by invitation only; if at all [Personal communication].

We believe that a hybrid mash-up of both views can be wholly appropriate, or grossly inappropriate in some cases. Of course the devil is in the details; linguistics and semantics aside. Nevertheless; what is not addressed in electronic physician “mea-culpas” are the professional liability risks and concerns that are evolving in this quasi-professional, quasi-lay, communication forum.

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Example: We have seen medical mistakes, and liability admissions of all sorts, freely and glibly presented. In fact,

“Some physicians find that the act of liability blogging as a professional confession that is useful in moving past their malpractice mistakes. And, it is also a useful way to begin a commitment to a better professional life of caring in the future. It helps eliminate the toxic residue and angst of professional liability and guilt. Moreover, as they are unburdened of past acts of omission or commission, doctors should remember to also forgive those who have wronged them. This helps greatly with the process and brings additional peace.”

However, although some may say that this electronic confession is good for the soul, it may not be good for your professional liability carrier, or you, when plaintiff’s attorneys release a legion of IT focused interns, or automated bots, searching online for your self-admissions and scouring for your self-incriminations. Of course, a direct connection to a specific patient may still not be made and no HIPAA violation is involved. But, a vivid imagination is not need needed to envision this type of blind medical malpractice discovery deposition query even now.

QUESTION: “Doctor Smith, I noted all the medical errors admitted on your blog. What other mistakes did you make in the care and treatment of my client?”

And so, the question of plausible deniability, or culpability, is easily raised.  If you must journalize your thoughts for sanity or stress release; do it in print. And, don’t tell anyone about it so the diary won’t be subpoenaed. Then tear it up and throw it away. Remember, with risk management, “It is all about credibility.” Don’t trash yours! These thoughts may be especially important if you covet a medical career as a researcher, editor, educator, medical expert or something other than a working-class or employed physician.

EDUCATION: Books

SPEAKING: Dr. Marcinko will be speaking and lecturing, signing and opining, teaching and preaching, storming and performing at many locations throughout the USA this year! His tour of witty and serious pontifications may be scheduled on a planned or ad-hoc basis; for public or private meetings and gatherings; formally, informally, or over lunch or dinner. All medical societies, financial advisory firms or Broker-Dealers are encouraged to submit a RFP for speaking engagements: CONTACT: MarcinkoAdvisors@outlook.com 

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DAILY UPDATE: US Healthcare History as Stock Markets Soar

MEDICAL EXECUTIVE-POST TODAY’S NEWSLETTER BRIEFING

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Essays, Opinions and Curated News in Health Economics, Investing, Business, Management and Financial Planning for Physician Entrepreneurs and their Savvy Advisors and Consultants

Serving Almost One Million Doctors, Financial Advisors and Medical Management Consultants Daily

A Partner of the Institute of Medical Business Advisors , Inc.

http://www.MedicalBusinessAdvisors.com

SPONSORED BY: Marcinko & Associates, Inc.

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We are embarking on the ambitious task of highlighting some big moments from the last 25 years of healthcare.

CITE: https://tinyurl.com/2h47urt5

US stocks closed near session highs on Monday as investors welcomed reports that the next wave of President Trump’s tariffs will be narrower than expected.

The S&P 500 (^GSPC) rose almost 1.8% on the heels of the broad benchmark snapping a four-week losing streak. The Dow Jones Industrial Average (^DJI) advanced 1.4%, while contracts on the tech-heavy NASDAQ Composite (^IXIC) led the gains, up 2.3%.

CITE: https://tinyurl.com/tj8smmes

Visualize: How private equity tangled banks in a web of debt, from the Financial Times.

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EDUCATIONAL TEXTBOOKS: https://tinyurl.com/4zdxuuwf

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HOSTILE COMPANY TAKEOVER: Definition, Defense & Pharmaceutical Company Example

By Staff Reporters

SPONSOR: http://www.MarcinkoAssociates.com

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SPONSOR: http://www.HealthDictionarySeries.org

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A hostile takeover happens when an entity takes control of a company without the knowledge and against the wishes of the company’s management. A hostile takeover is an acquisition strategy requiring that the entity acquire and control more than 50% of the voting shares issued by the company.

In mergers and acquisitions (M&A), a hostile takeover is the acquisition of a target company by an acquiring company that goes directly to the target company’s shareholders, either by making a tender offer or through a proxy vote.

Ideally, an entity interested in acquiring a company should seek approval from the target company’s Board of Directors. The difference between a hostile and a friendly takeover is that, in a friendly takeover, the target company’s board of directors approve of the transaction and recommend shareholders vote in favor of the deal.

Defenses against a hostile takeover

These defense mechanisms can be preemptive or reactive, depending on how prepared the company is for the possibility of a hostile bid.

Poison pill is one of the most common defenses against a hostile takeover. Officially known as a “shareholder rights plan,” the poison pill allows existing shareholders to purchase additional shares at a discount, diluting the ownership interest of the acquiring company. The goal is to make it prohibitively expensive for the acquirer to complete the takeover.

A golden parachute is another defense strategy, which involves providing lucrative compensation packages (bonuses, severance pay, stock options, etc.) to key executives in the event they are terminated as a result of the takeover. This creates a financial disincentive for the acquiring company, as it would need to pay out these large sums upon completing the takeover.

In a Crown jewel defense, the target company sells or threatens to sell its most valuable assets—its “crown jewels”—if the takeover is completed. This reduces the attractiveness of the company to the acquirer, as the most desirable assets would no longer be part of the deal.

The Pac-Man defenses a more aggressive strategy in which the target company turns the tables by attempting to buy shares of the acquiring company, effectively launching a counter-takeover. While rare, this defense can deter hostile bids by making the takeover battle more costly and complex.

A White-Knight defense involves the target company seeking out a more favorable acquirer, or “white knight,” to make a friendly takeover bid. This allows the target company to avoid the hostile acquirer while still securing the benefits of a merger or acquisition.

EXAMPLE: Sanofi-Aventis and Genzyme Corp. Year: 2011 Deal value: $20.1 billion Industry: Pharmaceutical

The hostile takeover between Sanofi-Aventis and Genzyme Corp. occurred in 2010 when Sanofi, a French pharmaceutical company, wanted to buy Genzyme, a US biotech firm specializing in rare diseases. Genzyme resisted the offer, leading to conflict. Sanofi started a public campaign to pressure Genzyme’s shareholders into selling.

After months of negotiations, the two companies reached a deal in 2011. Sanofi agreed to pay $74 per share, with additional payments tied to Genzyme’s future performance, bringing the total deal value to around $20.1 billion. This acquisition allowed Sanofi to expand into the lucrative market for rare disease treatment.

MORE: https://www.law.cornell.edu/wex/hostile_takeover

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WORKER’S COMPENSATION: Physician Insurance

By Staff Reporters

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While some medical practitioners and facilities can operate without Professional Liability Insurance coverage, one business related insurance that cannot / should not be avoided is Worker’s Compensation.  Employers in all but seven states – so-called “monopolistic” states because they have their own state funds, are under statutory obligation to provide coverage for their employees.  Historically, Worker’s Compensation pre-dates Social Security entitlements and well before the emergence of employer sponsored group benefits.

The coverage under worker’s compensation provides for lost income due to on-the-job accidents or work-related disability or death and the amount of benefits vary by state.  In some instances, the coverage will reimburse the employee for medical expenses incurred with the accident. 

The four general benefits covered under Worker’s Compensation are:

Medical Care – for expenses incurred usually without limitations on amount or period of care.

Disability Income – payable for both total and partial disability and is usually based on 66 2/3 percent of their wage base.

Death Benefits – generally fall into two categories; one a flat amount for “burial” insurance; and two, survivor benefits.  Though varying by state, these benefits are similar to the disability payment (a percentage of weekly base wages) but may be capped as to total benefit, such as $50,000 or a period, such as 10 years

Rehabilitation Benefits – includes not only medical rehabilitation, but vocational rehabilitation, vocational counseling, retraining or educational benefits, and job placement

Traditionally, the secondary purpose of Worker’s Compensation was to reduce potential litigation because employees accepting the benefits from a Worker’s Compensation claim generally waived their right to sue their employer. 

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However, in our litigious society, this “protective shelter” has been severely tested and is crumbling.

Employers may provide their Worker’s Compensation three ways:

  • Private commercial insurance
  • State government funds
  • Self-insurance

Very few factors drive the premium structure – the occupation of the workers is the single most important determinant of premiums.  An office worker may have premiums as low as $.10 per hundred of wages and a coal miner may exceed $50.00 per hundred of wages.  Generally speaking, however, Worker’s Compensation premiums for the medical profession or healthcare worker are among the lowest available.

Therefore, for the medical practice, some physicians may consider self-insurance because the weekly benefits are typically below $500, thus making this decision attractive. 

Alternatively, because officers and owners can elect not to be covered by Worker’s Compensation, the decision to purchase coverage from a private insurance company may afford inexpensive assurance that the benefits will be conveniently provided, and administered, by a private insurance company for their employees.

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FINANCIAL ADVISORS & MEDICAL MANAGEMENT CONSULTANTS: Marcinko & Associates, Inc

SPONSOR: http://www.MarcinkoAssociates.com

D. E. Marcinko & Associates Core Operating Values

9.   We act with honesty, integrity and are always straightforward.
8.   We strive to be innovative, creative, iconoclastic, and flexible.
7.   We admit and learn from mistakes and don’t repeat them.
6.   We work hard always as competitors are trying to catch up.
5.   We treat others with dignity and respect.
4.   We are the onus of consulting advice for the well being of others.
3.   We fight complacency as former success is in the past.
2.   The best management styles are timeless, not timely.
1.   Our clients are colleagues and always come first.

EDUCATION: Books

SPEAKING: Dr. David Edward Marcinko MBA MEd will be speaking and lecturing, signing and opining, teaching and preaching, storming and performing at many locations throughout the USA this year! His tour of witty and serious pontifications may be scheduled on a planned or ad-hoc basis; for public or private meetings and gatherings; formally, informally, or over lunch or dinner. All medical societies, financial advisory firms or Broker-Dealers are encouraged to submit a RFP for speaking engagements.

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CONTACT: Ann Miller RN MHA at: MarcinkoAdvisors@outlook.com 

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HEALTH ACTUARY: Medical Professions

By Dr. David Edward Marcinko MBA MEd CMP®

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SPONSOR: http://www.MarcinkoAssociates.com

THE MEDICAL AND HEALTHCARE ACTUARY

Health actuaries analyze potential risks, profits and trends that will affect their employers, which are often in the health insurance, government health services and medical provider industries. They advise companies on issuing policies to consumers based on risks, calculated premiums and upcoming changes in health-care costs.

It’s common for an actuary to have a bachelor’s degree or higher in actuary studies, mathematics or statistics. Coursework on medical terminology and hierarchy of the medical field is also beneficial. In addition to academic education, certification is also necessary to reach “professional status,” which is required by most employers.

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The professional organization, Society of Actuaries, certifies actuaries in the health and medical field. Their statistical work is commonly done with predictive tables, probability tables and life tables that are created on customized statistical analysis software such as Stata or XLSTAT.

The actuary field as a whole is growing faster than other fields, according to the Bureau of Labor Statistics [BLS]. In 2020, it expanded by 27 percent. The average annual salary for an actuary in 2010 was $87,650. More specifically, in the health insurance field, the salary was slightly higher at $91,000.

EDUCATION: Books

SPEAKING: Dr. Marcinko will be speaking and lecturing, signing and opining, teaching and preaching, storming and performing at many locations throughout the USA this year! His tour of witty and serious pontifications may be scheduled on a planned or ad-hoc basis; for public or private meetings and gatherings; formally, informally, or over lunch or dinner. All medical societies, financial advisory firms or Broker-Dealers are encouraged to submit a RFP for speaking engagements: CONTACT: MarcinkoAdvisors@outlook.com 

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ABBREVIATIONS GLOSSARY: Risk Management, Insurance and Asset Protection for Physicians

By Staff Reporters

SPONSOR: http://www.HealthDictionarySeries.org

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RISK MANAGEMENT, LIABILITY INSURANCE AND ASSET PROTECTION ABBREVIATIONS

[Glossary of Important Acronyms]

Much has been written and much has been opined on the topic of medical risk management, insurance, asset protection and professional liability for physicians and healthcare providers in this textbook; and elsewhere.

But occasionally, we all still get lost in a wide array of abbreviations, acronyms, and initialisms that are constantly changing in this ecosystem.

And so, this glossary serves as a ready reference for those who want to know about these medical risk management definitions in a quick and ready fashion.

Acronyms and Abbreviations

AAASC             American Association of Ambulatory Surgery Centers

AAHP                American Association of Health Plans

ABN                  advance beneficiary notice

ABQAUR          American Board of Quality Assurance and Utilization Review

ACE                   acute care episode

ACHCE             American College of Health Care Executives

ACS                   American College of Surgeons

ADA                  Americans with Disabilities Act

ADC                  average daily census

ADL                  activities of daily living

ADT                  Admission/Discharge/Transfer

AHA                  American Hospital Association

AHIMA             American Health Information Management Association

AHRQ               Agency for Healthcare Research and Quality

AI                      average inventory

AIMR                Association for Investment Management and Research

AIR                    assumed interest rate

ALE                   annualized loss expectancy

ALF                   assisted living facility

ALOS                average length of stay

AMA                 American Medical Association

AMBAC            AMBAC Indemnity Corporation

AMGA               American Medical Group Association

ANSI                 American National Standards Institute

AP                     accounts payable

APA                  American Psychiatric Association

APC                   ambulatory payment classification

APG                   ambulatory payment group

APR                   annual percentage rate

AR                     accounts receivable

ASA                   American Society of Appraisers

ASC                   ambulatory surgery centers; also Accredited Standards Committee

ASHA                American Surgical Hospital Association

ASO                   administrative services only

ASTC                 ancillary service technical component

ATM                  asynchronous transfer mode

AVG                  ambulatory visit group

BANTA             best alternative to negotiated agreement

BBA                  Balanced Budget Act of 1997

BBRA                Balanced Budget Refinement Act [1999]

BCP                   business continuity planning

BEA                   break-even analysis

BEP                   break-even point

BIPA                 Benefits Improvement and Protection Act [2000]

BLS                   Bureau of Labor Statistics

BPD                   border protection device

BS                      balance sheet

BSA                   Bank Secrecy Act

BVS                   business valuation standard

CA                     certificate authority

CAC                  Carrier Advisory Committee

CAS                   cost accounting standards

CASB                Cost Accounting Standards Board

CC                     common criteria [for IT Security Evaluation —ISO/IEC 15408];
complication or comorbidity [for MS-DRGs]

CCA                  certified cost accountant

CCC                   cash conversion cycle

CCEVS              common criteria evaluation and validation scheme

CCHIT               Certification Commission for Healthcare Information Technology

CCU                  critical care unit

CDC                  Centers for Disease Control and Prevention

CDH                  consumer-directed healthcare

CDHP                consumer-directed healthcare plan

CDPM               Clinical Data Project Manager

CDSS                 clinical decision support system

CEO                   Chief Executive Officer

CF                      conversion factor

CFA                   Chartered Financial Analyst

CFO                   Chief Financial Officer

CFR                   Code of Federal Regulations

CHAMP             Children’s Health and Medicare Protection Act of 2007

CHAMPUS        Civilian Health and Medical Program of the Uniformed Services

CHE                   Certified Healthcare Executive

CHIPS               Center for Healthcare Industry Performance Studies

CIA                    Corporate Integrity Agreement

CIO                    Chief Information Officer

CIP                    Customer Identification Program

CIS                    computer information systems

CLIA                 Clinical Laboratory Improvement Act

CLT                   capitation liability theory

CME                  continuing medical education

CMI                   case mix index

CMIO                Chief Medical Information Officer

CMIS                 contribution margin income statement

CMN                  Certificate of Medical Necessity

CMP                  Certified Medical Planner ™

CMS                  Centers for Medicare and Medicaid Services [formerly HCFA]

COD                  cash on delivery

COGME             Council of Graduate Medical Education

COH                  cash on hand

COLA                cost of living allowance

CON                  Certificate of Need

COO                  Chief Operating Officer

COSO                Committee of Sponsoring Organizations

COTS                 commercial off-the-shelf

CPHQ                Certified Physician in Healthcare Quality

CPIM                 Certificate in Production and Inventory Management

CPI-U                Consumer Price Index—urban

CPM                  critical (clinical) path method

CPOE                computerized physician order entry [system]

CPR                   computer-based patient record

CPT                   current procedural terminology

CQI                    continuous quality improvement

CRL                   Certification Revocation List

CRM                  customer relationship management

CRVS                California Relative Value Studies

CSO                   Chief Security Officer

CT scan              computed tomography scan [also called CAT scan]

CUSIP               Committee on Uniform Security Identification Procedures

CVE                   common vulnerabilities and exposures

CVPA                cost-volume-profit analysis

CY                     calendar year

DAC                  discretionary access control

DBMS                database management system

DCF                   discounted [net] cash flow

DEA                  Drug Enforcement Agency

DHHS                Department of Health and Human Services

DHMR               Designated Healthcare Management Representative

DIO                   days inventory outstanding

DLH                  doctor labor hours

DME                  durable medical equipment

DNFB                discharged, not finally billed

D&O                  directors and officers

DO                     Doctor of Osteopathy

DOA                  dead on arrival

DoD                   Department of Defense

DOJ                   Department of Justice

DOT                  Department of Transportation

DPH                  Department of Public Health

DPM                  Doctor of Podiatric Medicine

DPO                  days payable outstanding

DPP                   direct participation program

DRA                  Deficit Reduction Act of 2005

DRG                  diagnosis-related group

DES                   disease-specific care

DSH                   disproportionate share hospital [adjustment]

DSO                   days sales outstanding

DSS                   decision support system

DVP                  delivery versus payment

DWC                 days working capital

EAP                   Employee Assistance Program

EBDIT               earnings before depreciation, interest and taxes

EBM                  evidence-based medicine

ECP                   Exposure Control Plan

ED                     emergency department

EDI                    Electronic Data Interchange

EDSS                 Executive Decision Support System

EEOC                Equal Employment Opportunity Commission

EHCR                Efficient Healthcare Consumer Response Report

EHO                  emerging healthcare organization

EHR                   electronic health record

EIN                    employer identification number

E&M                  evaluation and management

EMR                  electronic medical record(s)

EMTALA           Emergency Medical Treatment and Active Labor Act

EOB                   explanation of benefits

EOMB               Explanation of Medicare Benefits

EOQ                  economic order quantity

EOQC                economic order quantity cost [analysis]

EPA                   Environmental Protection Agency

ePHI                  electronic personal health information

EPO                   exclusive provider organization

EPR                   electronic patient record

EPRI                  Emergency Preparedness Resource Inventory

ERISA               Employee Retirement Income Security Act

ERP                   enterprise resource planning

FACT Act          Fair and Accurate Credit Transactions Act of 2003

FAR                   federal acquisition regulation

FASB                 Financial Accounting Standards Board

FBCA                Federal Bridge Certification Authority

FC                      fixed cost

FCA                   False Claims Act

FDA                   Food and Drug Administration

FEHBP              federal employees health benefits program

FF&E                 furniture, fixtures and equipment

FFS                    fee-for-service

FGIC                  Financial Guaranty Insurance Company

FHA                   Federal Housing Administration

FIFO                  first in first out

FIPS                   Federal Information Processing Standard

FMAP                Federal Medical Assistance Percentage

FMLA                Family Medical Leave Act

FMV                  fair market value                                                                                                                                                                                                                    

FTP                    file transfer protocol

FV                     fair value

  • FY                     fiscal year

GAAP                generally accepted accounting principles

GAO                  [U.S.] Government Accountability Office (name changed in 2004 from General Accounting Office)

GDP                   gross domestic product

GIGO                 garbage in, garbage out

GMC                  guaranteed mortgage certificate

GNMA               Government National Mortgage Association

GNP                   gross national product

GPWW              Group Practice Without Walls

GSA                   General Services Administration

HARA               Healthcare Accounts Receivable Analysis [report]

HCCM               Hierarchical Condition Category Management

HCFA                [former] Health Care Financing Administration

HCFAC              Healthcare Fraud and Abuse Control [program]

HCFMA             Health Care Financial Management Association

HCPCS              healthcare common procedure coding system

HCSS                 Health Care Staffing Services

HD-HCP            high deductible healthcare plan

HEDIS               Health Plan Employer Data and Information Set

HFMA               Healthcare Financial Management Association

HH                     home health

HHA                  home health agency

HHCA               home healthcare agency

HHRG                home health resource group

[D]HHS             [Department of] Health and Human Services

HIM                   health information management

HIMSS               Health Information and Management Systems Society

HIPAA              Health Insurance Portability and Accountability Act [of 1996]

HIPDB               Healthcare Integrity and Protection Data Bank

HIPPS                health insurance prospective payment system

HIS                    hospital information system

HISAC               Healthcare Information Sharing and Analysis Center

HIT                    healthcare information technology

HMMIS              hospital materials management information system

HMO                 health maintenance organization

HOPPS              hospital outpatient prospective payment system

HR                     Human Resources

HSA                   health systems agency; also health savings account

HSG                   hospital service group

HSRV                hospital-specific relative value

I&A                   identification and authentication

IBA                    Institute of Business Appraisers

IBNR                 incurred but not reported [expenses]

ICD-9-CM          International Classification of Diseases, Ninth Revision, Clinical Modification [10-CM]

ICP                    inventory conversion period

ICSI                   Institute for Clinical Systems Improvement

IDS                    integrated delivery system; also intrusion detection system

IDTF                  independent diagnostic testing facilities

IHS                    Indian Health Services

IME                   indirect medical education [adjustment]

IOM                   Institute of Medicine

IPA                    Independent Physician Association; also Independent Practice Association

IPPS                  [Medicare] inpatient prospective payment system

IRB                    Institutional Review Boards

IRC                    Internal Revenue Code

IRR                    internal rate of return

IRS                    Internal Revenue Service

ISAC                  Information Sharing and Analysis Center

ISMS                  information security management system

ISO                    International Standards Organization

ISP                     Internet service provider

I-SPY Act          Internet Spyware Prevention Act

IT                       information technology

ITL                    Information Technology Laboratory

ITR                    inventory turnover ratio

JAMA                 Journal of the American Medical Association

JCAHO              [former] Joint Commission on Accreditation of Healthcare Organizations

[now known as the The Joint Commission-TJC]

JIT                     just-in-time

[inventory management]

LAN                  local area network

LCC                   life-cycle cost

LEP                   limited English proficiency

LIFO                  last in, first out

LIS                     Laboratory Information Systems

LISW                 Licensed Independent Social Worker

LLC                   Limited Liability Company

LLP                   Limited Liability Partnership

LMFT                Licensed Marriage and Family Therapist

LPCC                 Licensed Professional Clinical [Mental Health] Counselor

LOS                   length of stay

LVN                  licensed vocational nurse

LPN                   licensed practical nurse

LRAC                long-range average cost

LRRA                Liability Risk Retention Act

LSP                    limited service provider

LTCPP               long-term care pharmacy provider

MABC               medical activity-based costing

MAC                  monitored anesthesia care; also mandatory access control

MB                    marginal benefit

MBT                  Mechanical Biological Treatment [organization]

MC                    marginal cost

MCC                  major complication or co-morbidity

MCM                 mixed cost method

MCO                  managed care organization

MCS                  Monte Carlo Simulation

MD                    medical doctor

MDC                  major diagnostic category

MEC                  modified endowment contract

MedPAC            Medicare Payment Advisory Commission

MGMA              Medical Group Management Association

MI                      Medical Informatics

MIS                    management information services

MLIC                 malpractice liability insurance component

MMA                 Medicare Prescription Drug, Modernization, and Improvement Act of 2003

MMCO              Medicare Managed Care Organizations

MOE                  maximum office efficiency

MPCA               medical practice cost analysis

MPT                  Modern Portfolio Theory

MR                    medical records, marginal revenue

MSA                  medical savings account

MSCI                 Metals Service Center Institute

MS-DRG            Medicare Severity DRG

MSDS                material safety data sheet

MSO                  management services organization

MUD                 medically unnecessary days

MVO                 mean variance optimization

NACVA             National Association of Certified Valuation Analysts

NAICS               North American Industry Classification System

NAIP                 National Association of Inpatient Physicians

NAHC               National Association of Healthcare Consultants

NASD                National Association of Securities Dealers

NASDAQ          National Association of Securities Dealers Automated Quotations

NAT                  network address translation

NAV                  net asset value

NBER                National Bureau of Economic Research

NCFFR              National Commission on Fraudulent Financial Reporting

NCPDP              National Council for Prescription Drug Programs

NCQA               National Committee for Quality Assurance

NCUA               National Credit Union Administration

NCVHS             National Committee on Vital and Health Statistics

NDC                  National Drug Code

NEJM                New England Journal of Medicine

NGC                  National Guideline Clearinghouse

NIAP                 National Information Assurance Partnership

NIC                    net interest cost

NIOSH               National Institute of Occupational Safety and Health

NIS                    net income statement

NISAC               National Infrastructure Simulation and Analysis Center

NIST                  National Institute of Standards and Technology

NOW account     negotiable order of withdrawal account

NPDB                National Practitioner Data Bank

NPI                    National Provider Identification [number]

NPP                   Notice of Privacy Practices

NPS                   national provider system

NPV                  net present value

NQF                   National Quality Forum

NRC                  National Research Council

NRV                  net-realized accounts receivable value

NSA                   National Security Agency

NTFS                 new technology file system

NTPA                net target profit analysis

NYSE                New York Stock Exchange

OBO                  order book official

OBRA                Omnibus Budget Reconciliation Act [of 1989]

OCC                  Option Clearing Corporation

OCR                  optical character recognition; also Office of Civil Rights

OFAC                Office of Foreign Assets Control

OFPP                 Office of Federal Procurement Policy

OID                   original issue discount

OIG                    Office of the Inspector General [U.S. Department of Health and Human Services]

OMB                  Office of Management and Budget

OPHC                Office of Prepaid Health Care

OPIM                 other potentially infectious material

OPPS                 outpatient prospective payment system

OS                     operating system

OSI                    open systems interconnect

OR                     operating room

OSHA                Occupational Safety and Health Administration

OSJ                    Office of Supervisory Jurisdiction

OTC                   over-the-counter

P4P                    pay-for-performance

P/E                     price to earnings [ratio]

P/R                    price to revenue [ratio]

PAC                   planned amortization certificate

PAY                  post-acquisition year

PC                     [mortgage] participation certificate; also personal computer

PCC                   project cost of capital

PCMCIA            Personal Computer Memory Card International Association

PCP                   primary care physician

PDA                  personal digital assistant

PDX                   Patient Data Exchange

PE[C]                 practice expense [component]

PEO                   professional employer organization

PFS                    patient financial services

PG                     purchasing group

PHA                  public housing authority

PHI                    protected health information

PHN                  Private Health Network

PHO                  physician-hospital organization

PHR                   patient health record

PIN                    personal identification number

PIO                    public information office

PKI                    public/private key informatics/infrastructure

PKIX                 public key infrastructure for X.509 certificates

PLIC                  [mal]practice liability insurance component

PMG                  primary medical group

PM/PM              per member per month

PO                     purchase order

POC                   point-of-care

POL                   physician office laboratory

POS                   point-of-service

POSP                 point of service plan

PP                      projection profile

PP&E                property, plant, and equipment

PPE                   personal protective equipment

PPMC                physician practice management company

PPO                   preferred provider organization

PPS                    [Medicare] prospective payment system

PR                     pregnancy and related conditions

PROM               programmable read-only memory

PSI                     patient safety indicator

PSN                   provider-sponsored network

PSO                   provider-sponsored organization

Pt                       patient

PTO                   paid time off

PWC                  physician work component

PY                     projected year

QA                     quality assurance

QI                      quality improvement

RA                     registration authority

RADIUS            remote authentication dial-in user service

RAN                  Revenue Anticipation Note

RBAC                role-based access control

RBRVG             resource-based relative value group

RBRVS              resource-based relative value scale

RBRVU             resource-based relative value unit

RDBMS             regional database management system

REIT                  real estate investment trust

RERVU             resource-based relative value unit

REV/PP             revenue per patient

RFI                    request for information

RFID                  radio frequency identification device [scanner]

RFP                   request for payment

RHIO                 Regional Health Information Organization

RN                     Registered Nurse

RNANS             Registered Nurses Association of Nova Scotia

ROE                   return on equity

ROI                    return on investment

ROM                  read-only memory

ROP                   re-order point

RRG                   risk-retention group

RSNA                Radiological Society of North America

RUG-III             resource utilization group III

RVS                   relative value scale

RVUm               relative value unit – malpractice

RVUpe               relative value unit – practice expenses

RVUw               relative value unit – work

rWACC              relative weighted average cost of capital

S&P                   Standard and Poor’s

SaaS                   Software-as-a-Service

SAMHSA           Substance Abuse and Mental Health Services Administration

SAN                   storage area network

SARS                 Sever Acute Respiratory Syndrome

SBBI                  Stocks, Bonds, Bills and Inflation [Yearbook]

SCIM                 supply chain inventory management

SCF                    statement of cash flows

SCM                  supply chain management

SCP                   standard cost profile

SD                     standard deviation

SDLC                 system development life cycle

SDN                   specially designated nationals

SDO                   standards development organization

SEC                   Securities and Exchange Commission

SERP                 supplemental extended reporting policy

SESIP                sharps with engineered sharps injury protection

SHM                  Society of Hospital Medicine

SIC                    Standard Industrial Code

SIPC                  Securities Investor Protection Corporation

SLA                   service level agreement

SMA                  special miscellaneous account

SMD                  Society of Medical Dental Management Consultants

SMS                   socioeconomic monitoring system

SMTP                simple mail transfer protocol

SNF                   skilled nursing facility

SNMP                simple network management protocol

SP                      special publication

SSH                   single-specialty hospitals

SSL                    secure socket layer

STP                    standard treatment protocol

SVPN                secure virtual private network

TEL                   Terror Exclusion List

TFC                   total fixed cost

TIC                    true interest cost

TIN                    tax identification number

TLS                    transport layer security

TPA                   third party administrator

TQIM                 total quality and improvement management

TQM                  total quality management

UCC                  Uniform Commercial Code

UCSF                 University of California at San Francisco

UDP                  user datagram protocol

UFS                   unix file system

UIIRC                University of Iowa Injury Prevention Research Center

UM                    utilization management

UPIN                 Unique Provider Identification Number

UR                     utilization review

USPAP              Uniform Standards of Professional Appraisal Practices

v                        variance

VA                     Veterans Affairs

VAR                  value at risk

VC                     variable cost

VOC                  volatile organic chemicals

VPN                  virtual private network

WACC               weighted average cost of capital

WAN                 wide area network

WHO                 World Health Organization

WIA                   weighted industry average

WORM              wrote once-read many

READINGS

  • Marcinko, DE and Hetico, RN: Dictionary of Health Insurance and Managed Care. Springer Publishing, New York, NY 2007
  • Marcinko, DE and Hetico, RN: Dictionary of Health Information Technology and Security. Springer Publishing, New York, NY 2009
  • Marcinko, DE and Hetico, RN: Dictionary of Health Economics and Finance. Springer Publishing, New York, NY 2008

EDUCATION: Books

HEALTHCARE ADMINISTRATION BLOGS 

  • Candid CIO: Will Weider, CIO of Ministry Health Care and Affinity Health System, offers his perspectives on administration issues in this blog.
  • Christina’s Considerations: Christina Thielst is a hospital and healthcare administrator and entrepreneur with a deep desire for continually improving the health of the community being served. This is her blog.
  • Healing Hospitals — Formerly Ask a Hospital President: F. Nicholas “Nick” Jacobs has more than 20 years experience in hospital management, with an acknowledged reputation for innovation and consumer-centered leadership.
  • Hospital Impact: Part of the Fierce network of health sites, this site is becoming popular among healthcare administrators for its news updates, tips and opinions on health care matters.
  • Leading the Way to Medical Excellence: the president of McLeod Health non-profit institutions provides weekly insights into his facilities and health care in general.
  • Let’s Talk Health Care: Bruce Bullen, Interim Chief Executive Officer at Harvard Pilgrim in Massachusetts, provides and open and ongoing conversation about health care administration.
  • Life as a Healthcare CIO: Dr. John Halamka records his experiences with infrastructure, applications, policies, management, and governance as he supports 3,000 doctors, 18,000 faculty and about three million patients.
  • Managed Care Matters: Joe Paduda shares his knowledge on managed care for group health, health policy, health research, and medical news for insurers, employers, and healthcare providers.
  • More than Medicine: Tom Quinn, president and CEO of Community General Hospital in Syracuse, New York, began his career as a hospital kitchen worker. His perspective on administration reflects his knowledge on how hospitals work from every angle.
  • Regis University Health Services Administration Blog: Learn more about a college health service through the blog provided by its health administrator, Michael Jackson.
  • Running a Hospital: A CEO of a large Boston hospital shares thoughts on hospitals, medicine and health care issues.
  • St. Joseph Medical Center: Chief Executive Officer at St. Joseph Medical Center in Missouri, Mr. Kashman, provides personal insight into administrative matters and general topics.
  • Todd’s Perspective: Todd Linden, president and CEO of Grinnell Regional Medical Center, offers insights into medical administration and guest bloggers provide insight into various departments.
  • Wachter’s World: This blog focuses on hospitals, hospitalists, quality, safety, policy and much more from Robert M. Wachter, MD, Professor and Associate Chairman of the Department of Medicine at the University of California, San Francisco.

                 Legal Matters

  • Drug and Device Law: This blog contains an attorney’s personal views (and those of several other Dechert attorneys) on topics that arise in the defense of pharmaceutical and medical device product liability litigation.
  • Drug Injury Watch: Learn more about drug injury lawsuits from an attorney who represents patients and their families.
  • FDA Law Blog: Hyman, Phelps & McNamara, P.C. is the largest dedicated food and drug law firm in the country. Their knowledge about laws and regulations governing drugs, medical devices, foods, dietary supplements, and cosmetics is helpful to anyone interested in these topics.
  • Health Care Law Blog: Bob Coffield’s expertise lies in helping businesses and health care providers weave through a variety of state and federal health care regulations and assisting them in business transactions.
  • Health Plan Law: This site contains information about group health plans, claims administration and related ERISA fiduciary issues. This site also contains tutorials.
  • HealthBlawg: this is David Harlow’s popular health care law blog, offering expert insights and easy-to-understand analysis.
  • Healthcare Law Blog: Holland & Hart’s healthcare practice provides insight into this arena, including HIPAA, Stark law, the Anti-kickback Statute and more.
  • HIPAA Blog: Join in on this discussion of medical privacy issues often buried in “political arcana.”
  • HIPAA, HiTech & HIT: This updated blog brings insight into legal issues, developments and other pertinent information that relates to the creation, use and exchange of electronic health records.
  • HIT Blawg: This blog is focused on national health information technology legal trends and current news on this topic.
  • Home Care Law Blog: Learn more about legal and policy issues in the home health care, private duty and hospice industries from Gilliland & Markette LLP.
  • Med Law Blog: This law blog focuses on topics that range from compliance to contracts and from employee benefits to HIPAA and HIT.
  • Physician Law: This blog provides and easy way to stay on top of current news, updates and useful tips relating to legal issues that affect physicians and non-institutional providers.

                 eHealth and Health IT

  • Chilmark Research: This blog provides perspectives on key IT trends in the healthcare sector.
  • davidrothman.net: David is the Information Services Specialist at the Community General Hospital Medical Library, but he also provides great ideas for 2.0 tools and tips for healthcare industry professionals on this blog.
  • e-CareManagement blog: Vince Kuraitis, owner of Better Health Technologies, LLC, has a passion for disease management and care coordination that dates back to 1995.
  • e-HealthExpert: A non-profit organization provides a free and open forum to support the development of expertise in the field of eHealth, Healthcare Information Systems, and Health IT (Clinical IT).
  • eHealth: John Sharp is an IT Manager for a major medical center in Northeast Ohio, with a focus on ehealth, personal health records, Web 2.0 technologies, Windows Sharepoint Services and project management.
  • Found In Cache: If you would prefer a professional’s take on social media matters, Web sites and all things technological, then follow Ed Bennett, a technology expert for a Maryland medical care system.
  • Future Health IT: A health IT and EPR advocate from the UK provides a format to discuss the future of health care and IT.
  • Informaticopia: This UK blogger provides eclectic news and views on health informatics and elearning.
  • MedGadget: Stay ahead of the gadget curve with this site, which offers information about the newest health care gadgets on the market as well as emerging medical technologies.
  • Neil Versel’s Healthcare IT Blog: A healthcare journalist’s provides his views on the major segment of the industry he covers — and, he provides a ton of links to other sites as well.
  • Schwartz Healthcare IT Blog: A variety of authors from Schwartz Communications provide insights into ways to use IT effectively within healthcare facilities.
  • The Health IT Channel: For a different perspective on IT and EHR as well as other health care issues, watch a few videos at this site.
  • The Healthcare IT Guy: The CEO of Netspective, a Java/.NET consultancy that specializes in healthcare IT with an emphasis on e-health, EMRs, data integration, and legacy modernization, supplies tips and information for physicians and healthcare administration.

ACKNOWLEDGEMENTS: To Mackenzie H. Marcinko PhD of iMBA Inc., Perry D’Alessio CPA CMP™ [Hon] New York, NY; and Daniel B.  Moisand CFP®, Principal for Moisand Fitzgerald Tamayo, Melbourne, FL.

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STOCK: Common V. Preferred V. Hybrid Securities

BY DR. DAVID EDWARD MARCINKO; MBA MEd CMP™

SPONSOR: http://www.MarcinkoAssociates.com

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Common Stock versus Preferred Stock

A common stock is the least senior of securities issued by a company.  A preferred stock, in contrast, is slightly more senior to common stock, since dividends owed to the preferred stockholders should be paid before distributions are made to common stockholders. 

However, distributions to preferred stockholders are limited to the level outlined in the preferred stock agreement (i.e., the stated dividend payments).  Like a fixed income security, preferred stocks have a specific periodic payment that is either a fixed dollar amount or an amount adjusted based upon short-term market interest rates.  However, unlike fixed income securities, preferred stocks typically do not have a specific maturity date and preferred stock dividend payments are made from the corporation’s after tax income rather than its pre-tax income.  Likewise, dividends paid to preferred stockholders are considered income distributions to the company’s equity owners rather than creditors, so the issuing corporation does not have the same requirement to make dividend distributions to preferred stockholders. 

Preferred Stock

Thus, preferred stock is generally referred to as a “hybrid” security, since it has elements similar to both fixed income securities (i.e., a stated periodic payments) and equity securities (i.e., shareholders are considered owners of the issuing company rather than creditors). 

Hybrid Securities

Convertible preferred stocks (and convertible corporate bonds) are also considered hybrid securities since they have both equity and fixed income characteristics.   A convertible security whether a preferred stock or a corporate bond, generally includes a provision that allow the security to be exchanged for a given number of common stock shares in the issuing corporation. The holder of a convertible security essentially owns both the preferred stock (or the corporate bond) and an option to exchange the preferred stock (or corporate bond) for shares of common stock in the company. 

Thus, at times the convertible security may behave more like the issuing company’s common stock than it does the issuing company’s preferred stock (or corporate bonds), depending upon how close the common stock’s market price is to the designated conversion price of the convertible security.

EDUCATION: Books

SPEAKING: Dr. Marcinko will be speaking and lecturing, signing and opining, teaching and preaching, storming and performing at many locations throughout the USA this year! His tour of witty and serious pontifications may be scheduled on a planned or ad-hoc basis; for public or private meetings and gatherings; formally, informally, or over lunch or dinner. All medical societies, financial advisory firms or Broker-Dealers are encouraged to submit a RFP for speaking engagements:

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DAILY UPDATE: Health Care is Wealth Care as Stock Markets Close Mixed

MEDICAL EXECUTIVE-POST TODAY’S NEWSLETTER BRIEFING

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Essays, Opinions and Curated News in Health Economics, Investing, Business, Management and Financial Planning for Physician Entrepreneurs and their Savvy Advisors and Consultants

Serving Almost One Million Doctors, Financial Advisors and Medical Management Consultants Daily

A Partner of the Institute of Medical Business Advisors , Inc.

http://www.MedicalBusinessAdvisors.com

SPONSORED BY: Marcinko & Associates, Inc.

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Daily Update Provided By Staff Reporters Since 2007.
How May We Serve You?
© Copyright Institute of Medical Business Advisors, Inc. All rights reserved. 2025

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In great news for investors, a new study found that major healthcare companies have paid out $2.6 trillion to shareholders over the past 20 years in the form of dividends and share buybacks, and those payments are increasing. Bad news for patients: Some of that money could’ve been spent on, well, healthcare. The study, published Februrary 10th in JAMA, found that publicly traded S&P 500 healthcare companies paid shareholders a total of $170.2 billion in 2022, up 315% from payouts of just $54 billion in 2001.

CITE: https://tinyurl.com/2h47urt5

The S&P 500 fell 0.5%. The NASDAQ 100 slid 1.2%. A gauge of the “Magnificent Seven” mega-caps sank 2.2%. Nvidia Corp.’s shares slid 2.8% on the eve of the company’s results, while Tesla slumped 8.4% to fall below $1 trillion in market value. The DJIA was up.

CITE: https://tinyurl.com/tj8smmes

The yield on 10-year Treasuries sank 11 basis points, while its Australian counterpart fell four points in early trading on Wednesday.

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EDUCATIONAL TEXTBOOKS: https://tinyurl.com/4zdxuuwf

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HEALTHCARE: Paradox of Choice

By Staff Reporters

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ORIGINAL: May 2021 | Matt Cohlmia

As the future of healthcare becomes digitized, the threat of disruption to health systems has never been greater. Despite their best intentions, the flood of new competitors and ever-proliferating modalities of care each compete for patient attention, creating the potential for a fragmented, confusing, and impersonal patient experience.  At the same time, health systems possess the breadth of care, the access to data, and the patient trust to become their community’s preferred partner in care.

But to achieve success, they must leverage these resources to create easy to navigate and personalized experiences for their patients, and for the first time ever, those are within reach.

READ: https://blog.providence.org/digital-innovation-content/the-paradox-of-choice

EDUCATION: Books

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DOCTORATE: Physical Therapy

By Staff Reporters

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A Doctor of Physical Therapy (DPT) helps people improve their mobility and physical functioning, manage pain, and prevent disability. After earning an undergraduate degree, a person can enroll in a DPT program, which is typically three years. The curriculum includes courses in biology, anatomy, physiology, kinesiology (movement), neurology, cardiopulmonary (heart and lung) rehabilitation, behavioral sciences, and pharmacology.

Clinical rotations are a major component of DPT education. They may perform clinical rotations in various settings including a PT clinic, hospital, nursing care facility, rehabilitation clinic, and school.  At the end of their coursework and clinical rotation, a student earns a DPT degree but still must pass a state licensure exam to practice as a physical therapist.2

On average, a DPT in the U.S. makes $105,710 per year, according to 2024 statistics.

While a DPT may use the title “Dr,” they are different from an MD/DO/DPM/DDS. A DPT cannot write prescriptions or perform surgery. A DPT is also different from a PhD (Doctor of Philosophy). DPT is treatment-focused, whereas the PhD is research-focused.

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PharmD: Doctor of Pharmacy

By Staff Reporters

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PharmD – Doctor of Pharmacy

A Doctor of Pharmacy [ParrmD] is the professional degree required to become a pharmacist in the US. Practicing pharmacists complete an average of six years in school—including their pre-pharmacy education—before passing required exams and completing post-graduate training.

Here’s where things often get confusing. The word “pharmacist” is sometimes used in casual conversation to refer to healthcare professionals who aren’t technically licensed to be pharmacists.

For example, pharmacy technicians assist licensed pharmacists. They work behind the counter among the medications right alongside the pharmacist. However, they don’t need a Doctor of Pharmacy to do their job. A pharmaceutical sales representative typically needs four years of a bachelor’s degree with a foundation in chemistry and biology, though this is not always a requirement. Neither of these professionals is technically a pharmacist, although laypeople may mistakenly describe them that way.

And pursuing a PharmD doesn’t always mean you’ll work in a community pharmacy. In fact, just slightly fewer than half of all PharmD recipients end up in this role. Another 15 percent practice in other healthcare settings—hospitals, nursing homes, and managed care centers, for example. Other pharmacy students pursue research roles, government regulation positions, or work in highly specialized areas like oncology or geriatric pharmacy.

A PharmD or RPH [registered pharmacist] fills the electronic or written prescriptions of a MD/DO/DPM/DDS/DMD. They generally can not prescribe drugs or write prescriptions, however.

As of February 01, 2025, the average annual pay of Doctor of Pharmacy in the United States was $196,904. While Salary.com suggests that a Doctor of Pharmacy salary in the US can go up to $236,908 or down to $149,197, most earn between $171,932 and $217,844.

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DAILY UPDATE: BC/BS Anti-Trust Lawsuit as Stock Markets Close Mixed

MEDICAL EXECUTIVE-POST TODAY’S NEWSLETTER BRIEFING

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Essays, Opinions and Curated News in Health Economics, Investing, Business, Management and Financial Planning for Physician Entrepreneurs and their Savvy Advisors and Consultants

Serving Almost One Million Doctors, Financial Advisors and Medical Management Consultants Daily

A Partner of the Institute of Medical Business Advisors , Inc.

http://www.MedicalBusinessAdvisors.com

SPONSORED BY: Marcinko & Associates, Inc.

***

http://www.MarcinkoAssociates.com

Daily Update Provided By Staff Reporters Since 2007.
How May We Serve You?
© Copyright Institute of Medical Business Advisors, Inc. All rights reserved. 2025

REFER A COLLEAGUE: MarcinkoAdvisors@outlook.com

SPONSORSHIPS AVAILABLE: https://medicalexecutivepost.com/sponsors/

ADVERTISE ON THE ME-P: https://tinyurl.com/ytb5955z

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

Blue Cross Blue Shield will soon begin paying out $2.67 billion to customers follow a years-long lawsuit alleging that the health insurance giant broke antitrust laws. The litigation began in 2013, when a class-action lawsuit was filed against more than 35 Blue Cross Blue Shield health insurance plans. The lawsuit claims the company broke antitrust laws by limiting market competition, resulting in increased premiums and reduced options for customers.

CITE: https://tinyurl.com/2h47urt5

US stocks closed mixed on Tuesday as investors assessed more tariff policy shifts from President Donald Trump and looked ahead to upcoming inflation data.

Traders also digested the start of Federal Chair Jerome Powell’s two-day testimony in Congress. In his opening remarks, Powell told lawmakers the Fed is not in a rush to adjust interest rates and reiterated the central bank’s stance of not commenting on trade policy.

The Dow Jones Industrial Average (^DJI) edged around 0.3% higher, while the benchmark S&P 500 (^GSPC) closed just above the flatline. The tech-heavy NASDAQ Composite (^IXIC) pulled back about 0.4%.

CITE: https://tinyurl.com/tj8smmes

Visualize: How private equity tangled banks in a web of debt, from the Financial Times.

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EDUCATIONAL TEXTBOOKS: https://tinyurl.com/4zdxuuwf

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My Thoughts on Artificial Intelligence [AI]

By Vitaliy Katsenelson CFA

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Article available in Spanish here.

A century ago, one fifth of the country was involved in agriculture. Due to the transformation of farming technology, only 1% of the country is now involved in farming, while our supermarkets are flooded with cheap food. I could be wrong, but I don’t see the 19% of the country who used to farm wandering around unemployed. They have retrained to do other things.

Innovation disrupts, but it also creates new jobs and improves the standard of living of society. A century ago, you could not have imagined most of the jobs we have today. I’m not just talking about social media celebrities; think about software engineers, data scientists, cybersecurity experts, etc. In fact, most white-collar jobs you see today did not exist 100 years ago. Yes, if you specialized in driving horse-powered carriages, you had to acquire new skills.

AI will displace many jobs, but it will also empower people with new productivity tools. Microsoft Excel replaced jobs that required people to add up rows of numbers with calculators, but it created many more. In the 1960s, corporations had departments filled with typists. A photocopier and then the personal computer put these hardworking folks out of a job, but they retrained to do other things.

If we have a victim mentality, AI will run us over; if we embrace it and adapt it to our lives, it may become our best friend to do the jobs we are doing, while our soon-to-be-unemployed coworkers complain about AI.

AI may have a similar impact on our lives as electricity did. Unless it becomes sentient and just like the Terminator, it turns against us (smarter people than me cannot agree on this, especially on a reasonable time frame, so I withhold my opinion on it), it will likely improve our lives significantly. One industry that immediately comes to mind is healthcare – we need major disruption in that sector.

AI may disrupt and completely reshuffle the power dynamics in some industries. Travel, for example, comes to mind; we may start looking for trips and booking tickets with the help of our AI assistant without going to the travel websites. Some companies will adapt and become winners, while others won’t and will become market-share donors.

As I am typing this, I realize (again, something I do daily now) how important management is. In our analysis, we should pay close attention to how companies are embracing AI. Are they giving it lip service or are they really adopting it and changing the business to take advantage of it?

ChatGPT is a statistical representation of things found on the web, which will increasingly include ITS OWN output (directly and secondhand). You post something picked up from it and it will use it to reinforce its own knowledge. Progressively a self-licking lollipop.

If you want to see ChatGPT creating art, for the fun of it, spend some time on myfavoriteclassical.com, where I post music articles. Every single picture there is created by AI. I love impressionist artists, and thus I love these little AI creations. However, if you zoom in closer, you’ll find violinists playing with toothpicks, pianists with three hands and cellists with multiple arms and legs.

This self-licking lollipop is impressive, but it still has a lot to learn. (By the way, if you have not signed up to receive my classical music-only articles, you have an opportunity to do it here).

Finally, the more we rely on AI and the more content it creates, the less creative it and we become.

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DAILY UPDATE: Pharmacy Schools and PBMs as Stocks Recover

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One year after forming an alliance with pharmacy schools, Walgreens says it has taken steps to get more people interested in the profession and improve working conditions at the chain.

Walgreens announced the Deans Advisory Council last February, framing it as a collaboration with pharmacy schools to boost the number of students enrolling and address some of the broader issues in the industry, like burnout and declining reimbursements from pharmacy benefit managers.

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US stocks recovered from losses on Wednesday to close higher on the day. Earnings from Alphabet (GOOG, GOOGL) and AMD (AMD) fell short, but Big Tech got a boost from a jump in Nvidia (NVDA) shares.

The tech-heavy NASDAQ Composite (^IXIC) rose 0.2%, while the benchmark S&P 500 (^GSPC) added 0.4%. The Dow Jones Industrial Average (^DJI) led the gains, rising 0.7%, or more than 300 points.

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DAILY UPDATE: Healthcare Bankruptcies as Stock Markets Slide

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Stat: 57. That’s how many healthcare bankruptcies there were in 2024, down from 79 in 2023. (Healthcare Dive)

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US stocks lost ground on Friday after the White House said tariffs against Mexico, Canada, and China will take effect on Saturday, reigniting fears of a coming trade war with the nation’s closest trading partners. White House Press Secretary Karoline Leavitt said the president would impose 25% tariffs on goods from Mexico and Canada, as well as a 10% tariff on goods from China.

All three major gauges fell into the red Friday. The S&P 500 (^GSPC) lost 0.5% at the closing bell, while the Dow Jones Industrial Average (^DJI) shed 0.8%. The tech-heavy NASDAQ Composite (^IXIC) gave up 0.3%, reversing earlier gains.

The dramatic tariff news pushed aside more optimistic updates from earlier in the day, which had buoyed stocks. Solid earnings from Apple (AAPL) and an inflation reading that matched expectations lifted market sentiment for much of the day.

Finally, the S&P and the Nasdaq posted losses for the week of 1% and 1.6%, respectively. The Dow, meanwhile, recorded a weekly gain of 0.3%.

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TRUMP ADMINISTRATION: Day-One Healthcare Moves

By Health Capital Consultants, LLC

In the first days of his second (nonconsecutive) presidential term, Donald Trump and his administration took a number of actions that will affect the healthcare industry in the near- and long-term. Further, the Trump Administration is reportedly poised to take a number of additional actions to pause, end, or otherwise change Biden-era initiatives.

Meanwhile, President Trump’s cabinet pick for the Department of Health & Human Services (HHS) hangs in the balance. This Health Capital Topics article reviews the new administration’s actions impacting the healthcare industry as of the date of publication. (Read more...)

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RN versus LPN Licenses

DEFINITIONS

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Registered Nurse [RN]

RNs must complete an accredited Associate Degree in Nursing (ADN) or Bachelor of Science in Nursing (BSN) program (or, in rare cases, diploma programs). After that, they become eligible to sit the NCLEX-RN exam and apply for registered nurse licensure in their state.

As a registered nurse, duties include basic patient care but expand to more technical responsibilities like medication administration, performing diagnostic tests, and operating medical equipment. Depending on the role, one may also supervise other healthcare workers like LPNs, certified nursing assistants (CNAs), or even other RNs.

Licensed Practical Nurses [LPN]

LPNs may also be called licensed vocational nurses (LVNs), and like registered nurses, LPNs must also complete an education program before becoming eligible for licensure. LPN programs typically take around one year, and you can find them at community colleges or vocational schools. 

Prospective LPNs must then take and pass the NCLEX-PN exam to become licensed. As an LPN, focus is on patient care tasks like monitoring vitals and changing bandages as part of a care team supervised by a physician or RN.

MORE: https://www.nursingprocess.org/lpn-vs-rn.html

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MBBS versus MD Degree

POPULAR MEDICAL DEFINITIONS

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MBBS Degree [Bachelor of Medicine, Bachelor of Surgery]

The MBBS is usually a five-year undergraduate degree that medical students complete when they want to become doctors. However, some programs take six years to complete because the institution expects you to earn a Bachelor of Science (BSc) in your training. 

By the time a student applies to a medical program, they have likely taken several foundational science courses as part of their high school (or secondary) education. For example, medical applicants in the United Kingdom are often expected to show high scores on their General Certificate of Secondary Education (GCSE) and A-levels. 

Earning an MBBS means that students are certified to care for patients as junior physicians without specialized training. Graduates are expected to complete two years of additional training, which rotates them through different specialties. Once they identify a specialty they like, they can apply for additional training, which can take anywhere between three and eight years.  

MD Degree [Doctor of Medicine]

The acronym “MD” stands for the Latin termMedicinae Doctor,” which translates to “Doctor of Medicine” in English.

It refers to the title that students from the United States of America obtain after finishing medical school. Some countries consider the “MD” title a postgraduate doctoral degree that MBBS graduates can obtain with additional years of training. 

MORE: https://medicalschoolexpert.co.uk/medical-degrees-explained/

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DAILY UPDATE: PBM Mark-Ups as Stocks Waiver

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The FTC’s second interim staff report on consolidated pharmacy benefit managers (PBMs) found that the three largest of these middlemen—CVS Health’s Caremark Rx, Cigna Group’s Express Scripts, and UnitedHealth Group’s OptumRx—”marked up two specialty generic cancer drugs by thousands of percent and then paid their affiliated pharmacies hundreds of millions of dollars of dispensing revenue in excess of estimated acquisition costs for each drug annually.”

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The S&P 500 fell 0.2%. The NASDAQ 100 lost 0.7%. The Dow Jones Industrial Average slid 0.2%. A gauge of the “Magnificent Seven” megacaps slipped 1.9%. The Russell 2000 added 0.2%. The KBW Bank Index declined 0.2%.

The yield on 10-year Treasuries declined four basis points to 4.61%. The Bloomberg Dollar Spot Index rose 0.1%.

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DAILY UPDATE: Capital One, CPI and Medicare as Wall Street Blasts Off

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The U.S. Department of Labor reported a 0.4% increase in the monthly CPI after seasonal adjustment, overshooting the forecast of 0.3% and the previous value of 0.3%. On an annual basis, inflation climbed to 2.9%, up from 2.7% in November, the highest rate since July 2024.

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US stocks ripped higher on Wednesday as high hopes for bank earnings paid off and a crucial consumer inflation update showed key prices increased less than expected in December.

The benchmark S&P 500 (^GSPC) popped more than 1.8%, while the Dow Jones Industrial Average (^DJI) rose more than 1.6%, or over 700 points. Meanwhile, the tech-heavy NASDAQ Composite (^IXIC) soared 2.5%.

Stocks took a leg higher after the Consumer Price Index (CPI) showed progress toward the Fed’s 2% inflation target in December. Prices climbed 0.2% month-on-month on a “core” basis, which strips out the more volatile costs of food and gas, an easing from November’s 0.3% gain. Over last year, core CPI rose 3.2%.

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Capital One is being sued by the US government’s consumer watchdog agency for “cheating millions of consumers” and not paying more than $2 billion in interest to holders of its high-interest savings accounts.

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As of January 1st 2025, beneficiaries enrolled in Part D prescription drug plans will have their out-of-pocket spending capped at $2,000 for the year. This new policy was part of President Joe Biden’s 2022 Inflation Reduction Act (IRA), which included other drug pricing measures such as capping the cost of insulin at $35 per month for seniors.

But only a small share of Medicare enrollees will benefit from the cap, according to an analysis from nonprofit organization AARP’s Public Policy Institute, as most don’t spend more than $2,000 annually on their medications after hitting their deductible (which is up to $590 for standard plans in 2025). Beneficiaries spent an average of $400 to $500 per year as of 2022, the Hill reported, citing data from the US Department of Health and Human Services (HHS).

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DAILY UPDATE: Medicare Advantage Bonus Payments as Stocks Rise and Technology Pops

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Health plans made billions in Medicare Advantage bonus payments. A yearlong investigation reveals how. (the Wall Street Journal)

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The 10-year Treasury note yield ($TNX) is higher by ~3 basis points to 4.63%.

The U.S. Dollar Index ($DXY) is lower by 0.69 to 108.26.

WTI Crude Oil (/CL) is trading higher by 0.68% to $74.46 per barrel.

Gold prices have traded in a range of $2,624.60 to $2,663.80 and were last seen trading lower by 0.39% to $2,644.40/oz.

Natural Gas prices have traded in a range of $3.502-3.726 and were last seen trading higher by 7.30% to $3.599/MMBtu.

Bitcoin (/BTC) is trading higher by 3.83% to $102,114.50 today.

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US stocks largely rose on Monday as chip names popped and investors awaited the release of key monthly jobs data later this week.

The S&P 500 (^GSPC) was up about 0.5%, while the Dow Jones Industrial Average (^DJI) fell about 0.1% after being higher for most of the session. The tech-heavy NASDAQ Composite (^IXIC) led the gains, adding about 1.2%, after a tech-led rally on Friday.

Chip stocks rallied after a record revenue and a strong sales forecast from Nvidia (NVDA) server partner Foxconn (2317.TW, HNHPF), which boosted optimism for AI-fueled growth. Shares of Nvidia climbed more than 3%, as the stock closed at a record high. Meanwhile peer Micron Technology (MU) rose over 10%.

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DAILY UPDATE: Veterans Scammed as 3 Major Markets Drop

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Read: Health insurers reportedly took billions of dollars from Medicare to cover veterans who didn’t use services. (the Wall Street Journal)

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US stocks closed the holiday week on a downbeat note as Wall Street slogged to the finish of a largely triumphant year.

The S&P 500 (^GSPC) lost 1.1%, while the tech-heavy NASDAQ Composite (^IXIC) shed 1.5% Friday at the close. The Dow Jones Industrial Average (^DJI) gave up 0.8%. Meanwhile, the 10-year Treasury yield (^TNX) hovered near seven-month highs around 4.6%.

After stacking impressive gains this year, some of the biggest names in tech lost ground as investors took profits, rebalance portfolios, or reassessed their lofty valuations. Tesla (TSLA) lost 5%. Nvidia (NVDA) gave up c2%, while Amazon (AMZN) decreased by 1%.

Wall Street has just three trading days remaining in a 2024 full of big gains, but markets have been unable to mount a “Santa Claus” rally into the end of the year.

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DAILY UPDATE: Medicare Tele-Health Out as DJIA Finishes Up a Tad

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Absent Congressional action, beginning January 1sy, 2025, the statutory limitations that were in place for Medicare telehealth services prior to the COVID-19 PHE will retake effect for most telehealth services.

This means most telehealth visits will not be covered by Medicare in 2025, unless Congress acts by the end of December 2024.

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(Reuters) -The Dow Jones Industrial Average closed fractionally higher on Thursday, stretching its winning streak to five sessions despite light trading volumes and rising U.S. Treasury yields weighing on some of the dominant technology megacaps.

While the NASDAQ Composite and the S&P 500 were broadly unchanged, the indexes both finished slightly in negative territory. This snapped the NASDAQ’s four-session run of higher closes, and ended the S&P 500’s own run at three sessions.

On a day of few catalysts, investors responded to yields on U.S. government bonds inching higher, including the yield on the benchmark 10-year Treasury note hitting its highest since early May at 4.64% earlier in the session. And, a strong auction of seven-year notes early in the afternoon though helped yields come off slightly, with the 10-year note at 4.58% in late-afternoon trade.

Higher yields are traditionally seen as negative for growth stocks, as it raises the cost of their borrowing to fund expansion. With markets increasingly dominated by the megacap technology stocks known as the Magnificent Seven, crimping their performance – especially in lieu of other market catalysts – will put downward pressure on benchmark indexes.

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The S&P 500 slipped 2.45 points, or 0.04%, to 6,037.59 points, while the NASDAQ Composite lost 10.77 points, or 0.05%, to 20,020.36. The Dow Jones Industrial Average rose 28.77 points, or 0.07%, to 43,325.80.

Six of the megacaps fell, with Tesla leading decliners with a 1.8% fall. The outlier was Apple, rising 0.3% and continuing to edge closer to becoming the first company in the world to hit a market value of $4 trillion.

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DAILY UPDATE: PBMs and Healthcare A.I. as All Major Market Indexes Drop

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Stat: 97%. That’s how many healthcare leaders think A.I. will become important in healthcare over the next five years.

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Pharmacy benefit managers (PBMs) are once again under pressure from federal leaders. A group of Democratic and Republican congresspeople proposed legislation that would attempt to prevent pharmacies from also owning PBMs. The three largest PBMs—CVS Health’s Caremark, Cigna’s Express Scripts, and UnitedHealth Group’s Optum Rx—currently operate pharmacies and administer more than 80% of the prescriptions in the US, and officials have linked this practice to drug price increases.

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US stocks fell across the board on Tuesday, with the Dow logging its biggest losing streak in 46 years. The Dow Jones Industrial Average (^DJI) finished the session down roughly 0.6%, registering its ninth straight day of losses. The last 9-day losing streak for the Dow was Feb. 1978. Prior to that, the index suffered an 11-day losing streak in 1974 and another in 1971.

The other major indexes dropped in tandem on Tuesday, with the benchmark S&P 500 (^GSPC) falling around 0.4% and the NASDAQ Composite (^IXIC) losing about 0.3% after the tech-heavy index closed at a record high on Monday.

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DAILY UPDATE: Medicare Open Enrollment Ends as Stock Market Weekly Gains

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Medicare Open enrollment ended December 7th, 2024. New Plans commence January 1st, 2025.

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Potential Market-Moving Catalysts:

Economic:

  • Monday (12/9): Wholesale Inventories
  • Tuesday (12/10): Productivity-Revised, Unit Labor Costs-Revised
  • Wednesday (12/11): Consumer Price Index (CPI), EIA Crude Oil Inventories, MBA Mortgage Applications Index, Treasury Budget  
  • Thursday (12/12): Producer Price Index (PPI), EIA Natural Gas Inventories, Initial Claims, Continuing Claims
  • Friday (12/13): Export Prices ex-ag, Import Prices ex-oil

Earnings:

  • Monday (12/9): Oracle Group (ORCL), MongoDB Inc. (MDB), Toll Brothers Inc. (TOL), Casey’s General Stores Inc. (CASY), Vail Resorts Inc. (MTN)
  • Tuesday (12/10): AutoZone Inc. (AZN), Ferguson Enterprises Inc. (FERG), Academy Sports and Outdoors Inc. (ASO), GameStop Corp. (GME)   
  • Wednesday (12/11): Adobe Inc. (ADBE), Nordson Corp. (NDSN), REV Group Inc. (REVG)
  • Thursday (12/12): Ciena Corp. (CIEN), Broadcom Inc. (AVGO), Costco Wholesale Corp. (COST)   
  • Friday (12/13): -no reports-

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U.S. stocks closed mostly higher Friday, with the S&P 500 and NASDAQ Composite each notching fresh record peaks after the latest employment report showed jobs growth bounced back in November. The S&P 500 rose 15.16 points, or 0.2%, to end at 6,090.27. The NASDAQ climbed 159.05 points, or 0.8%, to close at 19,859.77. The Dow Jones Industrial Average fell 123.19 points, or 0.3%, to end at 44,642.52.

CITE: https://tinyurl.com/tj8smmes

Visualize: How private equity tangled banks in a web of debt, from the Financial Times.

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2025 MEDICARE: Agent & Broker Pay Day Changes

How insurance agents will be compensated for helping seniors?

By Staff Reporters

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Health insurance agents offering support to seniors signing up for healthcare coverage will be compensated differently starting in 2025. For example:

The government will pay $100 more per enrollment to agents who sign seniors up for Medicare Advantage Plans or Medicare Part D for the first time — a significant increase from the proposed $31 pay increase for agents.

And, Medicare is ending sales incentives for agents who currently receive bonuses, including volume-based bonuses, for signing people up for Medicare Advantage Plans, Medigap Supplement Plans or Part D. Medicare is also putting a stop to agents and brokers collecting “administrative fees” above the fixed compensation cap the government has put in place.

The hope is that providing agents with fair initial compensation will no longer incentivize them to steer seniors towards plans that may not be a good fit.

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

PS: Medicare open enrollment ended December 7th, 2024. New plans commence January 1st, 2025

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AMA: 41 Senators Sign Letter to Stop Medicare Cuts

By Staff Reporters

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In a sign of legislative momentum, 41 senators are supporting efforts to prevent a pending 2.8 percent cut in Medicare physician payments that will go into effect January 1st. The bipartisan letter led by Sens. John Boozman, R-Ark., and Peter Welch, D-Vt., to Senate leaders says the cuts would interfere with the ability of physicians to provide high-quality care. “These continued payment cuts undermine the ability of independent clinical practices – especially in rural and under served areas – to care for their communities,” the letter said.

The Senate letter follows one from the American Medical Association (AMA) and 127 other state medical associations and national medical societies asking Congress to use these last few congressional days to prevent the scheduled cuts. The letter to congressional leaders also urges Congress to provide a positive payment update for 2025. All 50 state medical societies – and DC— as well as 77 national medical societies signed.

Source: AMA

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

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DAILY UPDATE: Health Insurance Affordability as Stock Markets Broadly Rise

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The Commonwealth Fund’s 2024 biennial health insurance survey, released November 21, found that though 79% of US adults had continuous health insurance for 12 months, 23% were under insured, meaning they have health insurance and still can’t afford care. About 56% of those surveyed had adequate insurance coverage all year.

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

STOCKS UP

  • Rocket Lab rocketed (sorry) 3.44% to a new record high after launching not one, but two different rockets in two different hemispheres in a single day.
  • Bath & Body Works soared 16.51% on a strong beat-and-raise quarter.
  • Robinhood jumped 3.27% after Morgan Stanley analysts doubled their price target for the investing app.
  • Super Micro Computer surged yet another 15.87%, more than doubling in the last seven days, and shareholders cheered its comeback.
  • Hims & Hers Health climbed 23.77% on the news that the new head of the FDA may be an ally.
  • Flying taxi company Vertical Aerospace popped 45.51% after announcing an additional $50 million in funding from one of its biggest shareholders.

STOCKS DOWN

  • Defense contractor stocks got a double whammy today: Hopes of a ceasefire between Israel and Hezbollah, combined with Elon Musk’s declaration on X that buying manned military aircraft is wasteful. Lockheed Martin fell 3.76%, Northrop Grumman dropped 2.39%, and Raytheon Technologies parent company RTX Corp. fell 1.74%.
  • Speaking of Musk, Tesla sank 3.96% after California announced it may exclude the automaker from incentives that encourage drivers to buy EVs in the state.
  • Pipeline operator Oneok lost 4.72% on the news that it will acquire the remaining portion of EnLink Midstream that it doesn’t already own.
  • After rallying last week thanks to its inclusion in the S&P 500, Texas Pacific Land sank 6.71% today as investors took profits.

CITE: https://tinyurl.com/2h47urt5

Here’s where the major benchmarks ended:

  •  The SPX rose 18.03 points (0.30%) to 5,987.37; the $DJI added 440.06 points (0.99%) to 44,736.57; and the NASDAQ Composite® ($COMP) gained 51.18 points (0.27%) to 19,054.84.
  • The 10-year Treasury note yield fell 15 basis points to 4.27%.
  • The CBOE Volatility Index® (VIX)dropped to 14.74, the lowest since November 14.

CITE: https://tinyurl.com/tj8smmes

Visualize: How private equity tangled banks in a web of debt, from the Financial Times.

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CHARGE MASTER: Medical Bills Paradox

By Dr. David Edward Marcinko MBA MEd CMP™

SPONSOR: http://www.CertifiedMedicalPlanner.org

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CHARGE MASTER MEDICAL BILLS

Classic Definition: A comprehensive review of a physician, clinic, facility, medical provider or hospital’s charges to ensure Medicare billing compliance through complete and accurate HCPCS/CPT and UB-92 revenue code assignments for all items including supplies and pharmaceuticals. The charge master captures the costs of each procedure, service, supply, prescription drug, and diagnostic test provided at the hospital, as well as any fees associated with services, such as equipment fees and room charges

Modern Circumstance: A charge master quizlet (charge description master [CDM]) document that contains a computer-generated list of procedures, services, and supplies with charges for each. Charge master rates are essentially the health care market equivalent of Manufacturer’s Suggested Retail Price (MSRP) in the car buying market. Poor charge master maintenance can lead to overpayments or underpayments. It can also lead to claim rejections from insurance companies, poor patient experience, or compliance violations.

Paradox Examples:

  • Superbills: An encounter form that is the financial record source document used by healthcare providers and other personnel to record treated diagnoses and services rendered to the patient during the current encounter. It is also called a superbill.
  • Payment rates: Almost no one actually pays the publicized charge master rates. The vast majority of health care consumers are represented by a payer of some kind, such as a commercial health insurance company, Medicaid, or Medicare. Commercial insurers negotiate the actual prices they pay during the process of contracting with providers. Medicare and Medicaid establish their own payment levels independent of hospitals’ charge master lists – Medicare through the federal government and Medicaid through state governments.
  • Cash pay: The sad irony of the charge master is that the uninsured are the most likely to be billed charge master rates because they are not represented by a third-party payer.
  • Problematic features: Other items also impede the ability of payers to have a comprehensive and accurate understanding of hospitals’ financial positions. For example, nonprofit hospitals are required to report charity care, bad debt expenses, community benefit initiatives, and uncompensated care. When these expenses are reported at the charge master level, expenses can be paradoxically overstated, potentially making a hospital’s financial position look worse than it actually is.

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PRIMARY MEDICAL CARE: The Paradox

BY DR. DAVID EDWARD MARCINKO MBA MEd CMP

Sponsor: http://www.CertifiedMedicalPlanner.org

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Classic Definition: Despite rising costs, health care often is of poor quality. Evidence from a classic medical improvement outcomes study assessed care of patients with several chronic diseases. This study found that patients’ functional health status outcomes are similar to care rendered by specialists and generalists but that generalists use far fewer resources. Similar outcome at lower cost represents higher value.

Modern Circumstance: Current solutions to improving care quality may do more harm than good if they focus more on diseases than on people. Efforts to improve the parts (evidence-based care of specific diseases) may not necessarily improve the whole (the health of people and populations).

Expanding access to specialty care, for example, has been proposed as both a source of and a solution for deficiencies in quality of care. Primary care is touted as an essential building block of a high-value health care system even as it is undermined by systems attempting to improve the quality, effectiveness, and value of their health care..

Paradox Example: The above contradictions plague improvement efforts in health care systems around the world, particularly the United States The paradox is that compared with specialty care or with systems dominated by specialty medical care, primary care is associated with the following: (1) poorer quality care for individual diseases, yet (2) similar functional health status at lower cost for people with chronic disease, and (3) better quality, better health, greater health  equity and lower costs for whole peoples and populations.

And so, this contradiction plagues improvement efforts in health care systems around the world, particularly the United States.

Cite: Kurt Stange MD PhD and Robert Ferrer MD MPH

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California Passes Bill Regulating Private Equity Deals

By Health Capital Consultants, LLC

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On September 28th, 2024, California Governor Gavin Newsom vetoed Assembly Bill (AB) 3129, which sought to regulate private equity (PE) transactions involving healthcare organizations by requiring certain transactions to be reviewed by, and to receive approval from, the California Attorney General (AG).

In his veto message, Governor Newsom stated that the state’s Office of Health Care Affordability (OHCA), established in 2022, has the power to review and evaluate healthcare transactions (including the ones at issue in AB 3129). While OHCA does not have the power to block proposed transactions, as the AG would have had under AB 3129, it can refer transactions to the AG for further examination. Put simply, the governor’s veto seems to stem from concern that taking power away from the newly-created OHCA could muddy the waters in healthcare transaction regulation.

While there is a possibility that the California legislature could override Governor Newsom’s veto, it appears unlikely as of the publication of this Alert. However, the overall popularity of this bill in the legislature (as evidenced by the fairly wide margins with which it passed) indicates that PE groups looking to transact in the healthcare space – both in California and across the U.S. – should be on high alert, as regulators are increasingly turning their focus on the role of PE in healthcare.

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

For more information on AB 3129, as well as the status of state and federal regulation of PE, see the September 2024 Health Capital Topics article entitled, California Passes Bill Regulating Private Equity Deals.”

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GDP: Private Domestic Health Care Investments

By Dr. David Edward Marcinko MBA MEd CMP™

SPONSOR: http://www.MarcinkoAssociates.com

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SPONSOR: http://www.CertifiedMedicalPlanner.org

GROSS PRIVATE DOMESTIC HEALTH CARE INVESTMENTS

Classic:  Investment purchases and private expenditures of healthcare firms, the value of related construction, and the change in inventory during the year.

Modern: Gross Revenue Per Day is the average amount charged by a hospital for one day of inpatient care (gross inpatient revenue divided by patient-census days).

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

Examples:

  • Gross Revenue Per Discharge: The average amount charged by a hospital to treat an inpatient from admission to discharge (gross inpatient revenue divided by discharges).
  • Gross Revenue Per Visit: The average amount charged by a hospital for an outpatient visit (gross outpatient revenue divided by outpatient visits).

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DAILY UPDATE: Nvidia, Intel, Oil, Bitcoin, Treasury Yields, CMS and Physician Pay

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Nvidia is replacing Intel on the Dow Jones Industrial Average, a shakeup to the blue-chip index that replaces a flagging semiconductor company with the primary vendor of GPUs for AI.

CITE: https://tinyurl.com/2h47urt5

  • Despite selling off last week, stocks spent Friday comfortably in the green thanks to strong earnings from big tech.
  • Treasury yields rose back above 4.3% as bonds sold off and investors poured money into risk assets.
  • Oil rose a bit on reports that Iran may retaliate against Israel sometime soon.
  • Bitcoin was unable to hold the line and continued to fall today as crypto volatility continues to escalate ahead of the election.

CITE: https://tinyurl.com/tj8smmes

Bipartisan Legislation Aims to Stop Medicare Cuts & Boost Physician Pay in 2025

Physicians and other healthcare practitioners may get a pay boost in 2025 through a bipartisan bill recently introduced in Congress. The proposed bill seeks to block planned Medicare pay cuts next year and would provide the first inflationary update to physician pay in years. The Medicare Patient Access and Practice Stabilization Act would counteract the 2.8% cut to the conversion factor proposed by the Centers for Medicare and Medicaid Services (CMS) in the draft CY-2025 Physician Fee Schedule. A stop-gap pay fix is usually enacted by Congress at the end of the year. 

Source: Emma Beavins, Fierce Healthcare [10/30/24].

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IN & OUT OF NETWORK: Medical Care

By Dr. David Edward Marcinko MBA MEd CMP™

SPONSOR: http://www.CertifiedMedicalPlanner.org

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What does in-network mean?

In-network refers to a health care provider that has a contract with your health plan to provide health care services to its plan members at a pre-negotiated rate. Because of this relationship, you pay a lower cost-sharing when you receive services from an in-network doctor.

What does out-of-network mean?

Out-of-network refers to a health care provider who does not have a contract with your health insurance plan. If you use an out-of-network provider, health care services could cost more since the provider doesn’t have a pre-negotiated rate with your health plan. Or, depending on your health plan, the health care services may not be covered at all.

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

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OUT OF NETWORK [OON] MEDICAL CARE

Classic: Any medical provider, supplier or facility that is in-network is one that has contracted with your health insurer to provide services;as above.

Modern: Depending on your plan, if you visit an out-of-network provider, it may not be covered or might be only partially covered. When making appointments with various doctors and service providers, you may notice some are listed as “in-network” while others are “out-of-network.”

THINK: Medicare Advantage {Part C] Plans

Example: You can expect a higher deductible and out-of-pocket limit at out-of-network providers. Your coinsurance and co-payment may also be higher for out-of-network providers.

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EMPLOYER’S: Pay for Health Insurance Paradox

By Dr. David Edward Marcinko MBA MEd CMP

SPONSOR: http://www.CertifiedMedicalPlanner.org

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Classic Definition: Employers write checks that cover most health insurance premiums for employees and their dependents. But as the late Princeton health economist Uwe Reinhardt PhD once explained, employer-sponsored insurance is like a pickpocket taking money out of your wallet at a bar and buying you a drink. You appreciate the cocktail until you realize you paid for it yourself.

Modern Circumstance: With health coverage, employers write the check to the insurer, but employees bear the cost of the premium — the entire premium, not just the portion listed as their contribution on their pay stub. The premium money that goes to the insurance company is cash that employers would otherwise deposit in employees’ accounts like the rest of their salary.

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

Paradox Example: The fallacy paradox is in thinking an employer’s contribution comes out of profits. In fact, higher health insurance premiums mean lower wages for workers. Since 1999, health insurance premiums have increased 147 percent and employer profits have increased 148 percent. But in that time, average wages have hardly moved, increasing just 7 percent. Clearly workers’ wages, not corporate profits, have been paying for higher health insurance premiums. Health care costs are one — though not the only — reason wages have stagnated over the last few decades. With health insurance costs rising faster than growth in the economy, more labor costs go to benefits like health insurance and less to take-home pay. Yet the paradox that employees don’t pay for their own health insurance is widespread:

  • The first reason is that individuals cannot be sure what causes their wages to change or remain stagnant for decades.
  • The second reason is that employers want Americans to believe that they pay for their workers’ health insurance.
  • The third reason is that there are those who profit from the employment-based system: drug companies, device manufacturers, specialty physicians and high-income individuals.

And so, they all want you to believe companies are being magnanimous in giving you insurance, but they are not!

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PARADOX: Value Based Care

BY DR. DAVID EDWARD MARCINKO MBA MED CMP

Sponsor: http://www.CertifiedMedicalPlanner.org

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A young clinician representative advising to consider the cost versus value of medicine. Health care concept for economic cost-effectiveness analysis, driving down medical costs, improved access.

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Value Based Care Classic Definition: Value-based care is a type of payment model that pays doctors and hospitals for treating patients in the right place, at the right time and with just the right amount of care. You can look at it as a financial incentive to motivate healthcare providers to meet specific performance measures related to the quality and efficiency of the process. The same way, it penalizes weaker experiences, such as medical errors. The concept is often counter-intuitive.

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

Modern Circumstance: As healthcare costs continue to rise, value-based care has been growing in popularity compared to the traditional fee-for-service method.

Think: HMOs, PPOs, capitation payments and Medicare Advantage [Part C].

Paradox Examples:

  • Payment: A physician paid through fee-for-service compensation might like to see a packed medical office waiting room. More patients and services equate to higher pay. But, the same doctor paid through a VBC contract might wish to see an emptier waiting room as s/he will get the exact same daily pay for seeing fewer patients and working much less.
  • Prospectivity: Traditional Fee-for-Service medicine treats sick patients. VBC medicine seeks to keep patients healthy and out of the doctor’s office. 

Nursing Capitation: https://medicalexecutivepost.com/2024/07/07/on-nursing-capitation-reimbursement/

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DAILY UPDATE: Stock Markets, Netflix and Medicare Part C as CVS Closes Stores

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Markets: The S&P 500 hit an all-time high yesterday, closing out its sixth consecutive week of gains for its longest streak of 2024. The Dow and NASDAQ also closed in the green.

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

The largest Medicare Advantage insurers have prioritized profits over patient care by increasing the use of prior authorization in recent years to frequently deny post-acute care services to older adults, according to a report published Oct. 17th by the Senate Permanent Subcommittee on Investigations.

CITE: https://tinyurl.com/2h47urt5

The drugstore chain CVS is in the process of shuttering “roughly 300” locations across the country in 2024, a spokesperson confirmed to Good Housekeeping. That includes the dozens of pharmacies in Target stores.

CITE: https://tinyurl.com/tj8smmes

Stock spotlight: Netflix stock jumped on Friday, a day after its earnings report beat expectations.

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Do Doctors Use ChatGPT in Clinical Decisions?

By Staff Reporters

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Are doctors using publicly available tools like ChatGPT? The answer, Fierce Healthcare finds, is yes. In the first in-depth look of its kind into physician use of public genAI tools, Fierce Healthcare spoke with nearly two dozen doctors, students, AI experts and regulators, and helped conduct a survey of more than 100 physicians. The reporting confirms that some doctors are turning to tools intended for non-clinical uses to make clinical decisions. 

More: https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2804309

A collaborative survey between Fierce Healthcare and physician social network Sermo found that 76% of respondents reported using general-purpose LLMs in clinical decision-making. With no standardized guidelines, lagging physician training and regulators racing to try to keep up with rapidly changing technology, guardrails to protect patients appear to be years behind current rates of utilization.

Source: Fierce Healthcare [10/8/24]

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DAILY UPDATE: Maximum Lifespan as Medicare Part C is Down and Stocks Markets Decline

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Maximum lifespans. The upper limit of human life expectancy is leveling out, according to a new study published in the journal Nature Aging. Back in 1990, life-extending tech and health measures were increasing the average global lifespan by about 2.5 years per decade, but that dropped to 1.5 years per decade in the 2010s and closer to zero in the US, where there are more drug overdoses, shootings, and medical care inequities.

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

STOCKS UP

Sphere Entertainment popped 6.33% on the news that a second Sphere will be built in Abu Dhabi. London was originally supposed to be the location of a second venue, but they’ve already got the Eye, and didn’t need more circular tourist attractions.

  • Oklo, a Sam Altman-backed nuclear energy startup, rose another 16.04% on the news that Google will purchase nuclear power to turbocharge its AI infrastructure.
  • Charles Schwab climbed 6.10% after the bank announced a top and bottom line beat last quarter, as well as higher revenue projections for the full fiscal year.
  • Boeing somehow gained 2.26% after announcing it is raising $35 billion to support its struggling finances as the machinist union strike enters its second month.
  • Wolfspeed, which sounds like a super power in a YA novel, soared 21.27% on the news that the US government will provide the chipmaker with up to $750 million in government grants.

STOCKS DOWN

  • Semiconductor stocks got a double whammy in the last 48 hours. First, Bloomberg revealed that US officials are considering limiting the sale of AI chips outside the country. Then, ASML missed its Q3 sales estimates (more on that below). Nvidia shares slid 4.52%, AMD fell 5.22%, and Intel dropped 3.33%.
  • Citigroup beat earnings estimates this quarter, but shareholders punished the bank for setting aside more money in case of higher loan losses ahead. Shares dropped 5.11%.
  • Coty, parent company of numerous beauty brands like CoverGirl, fell 10.74% to a new 52-week low after it warned of a sales slowdown in the coming quarters.
  • Enphase Energy tumbled 9.29% after RBC analysts downgraded the solar power stock, citing growing competition from the likes of Tesla as well as slowing demand for solar batteries.
  • Speaking of energy, oil stocks plummeted on news of Israel’s targeting of Iranian military assets rather than crude production facilities. Exxon Mobil fell 3.01%, Chevron dropped 2.67%, and Valero Energy sank 4.62%.

CITE: https://tinyurl.com/2h47urt5

Here’s where the major benchmarks ended yesterday:

  • The S&P 500® index (SPX) fell 44.59 points (–0.76%) to 5,815.26; the Dow Jones Industrial Average® ($DJI) dropped 324.80 points (–0.75%) to 42,740.42; and the NASDAQ Composite® ($COMP) lost 187.09 points (–1.01%) to 18,315.59.
  • The 10-year Treasury note yield (TNX) fell three basis points to 4.04%, the lowest close in a week.
  • The CBOE Volatility Index® (VIX) climbed to 20.72, an elevated level.

CITE: https://tinyurl.com/tj8smmes

Millions of seniors will lose access to their Medicare Advantage plans after major insurer cuts in the aftermath of the Inflation Reduction Act. Experts spoke with Newsweek about what’s going on and what steps seniors can take to get the coverage they need.

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MEDICARE: Open Enrollment Period Commences

By Staff Reporters & The Medicare Team

Medicare open enrollment—which runs from October 15th through December 7th this year—is your chance to check in on your Medicare plan and, if needed, change it.

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Mark your calendars — Medicare Open Enrollment starts October 15th! Did you know new benefits are coming to Medicare drug coverage next year?

Starting in 2025, all Medicare plans will include a $2,000 cap on what you pay out-of-pocket for prescription drugs covered by your plan. So, it’s more important than ever to make sure your drugs are covered.

Also starting next year, you can choose to participate in a program that spreads your out-of-pocket drug costs across the calendar year, instead of paying all at once at the pharmacy. It’s called the Medicare Prescription Payment Plan — and you can opt in with your plan throughout the 2025 plan year. Contact your plan for more details.

Preview Coverage Options

Remember, Medicare plans can change from one year to the next, and so can your health needs. Preview and compare all your health and drug options and see if you can save!

The Medicare Team

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DAILY UPDATE: Exxon Mobil, Medicare Part C, Boeing and UniCredit as Stocks Rise

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California state officials filed a lawsuit against one of the world’s top oil giants accusing Exxon Mobil of driving global pollution by running a “decades-long campaign of deception” that dramatically overstated the effectiveness of plastic recycling. The suit seeks “multiple billions of dollars” in civil damages from Exxon Mobil—a main producer of the petrochemicals used to make single-use plastics—California Attorney General Rob Bonta said.

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What’s up

  • Smartsheet popped 6.47% on the news that Blackstone and Vista Equity Partners will pay $8.4 billion in cash to take the software maker private.
  • Freeport-McMoRan gained 7.95% after the Chinese government announced stimulus plans. Shareholders are hopeful that more economic activity means more business for the copper miner.
  • Liberty Broadband soared 25.92% thanks to its counterproposal to Charter Communications, asking for a higher payout before an acquisition takes place. Charter shares fell 2.49%.
  • Thor Industries rose 6.18% after the RV company announced stronger-than-expected earnings.

What’s down

  • Visa fell 5.36% as the US government sued it over an alleged debit card monopoly.
  • Regeneron Pharmaceuticals dropped 4.21% due to a federal judge’s ruling that it cannot block a new product from rival pharma company Amgen that mimics its eye-care drug Eylea.

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Here’s where the major benchmarks ended:

  • The S&P 500® index (SPX) added 14.36 points (0.25%) to 5,732.93; the Dow Jones Industrial Average® ($DJI) rose 83.57 points (0.20%) to 42,208.22; the NASDAQ Composite® ($COMP) gained 100.25 points (0.56%) to 18,074.52.
  • The 10-year Treasury note yield (TNX) finished unchanged at 3.74%.
  • The CBOE Volatility Index® (VIX) keeps setting new lows for September, dropping to 15.49.

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Boeing offers 30% raise in attempt to end strike. With 30,000 factory workers on strike and 737 production halted for a second week, the embattled aviation company offered to hike wages for union members higher than the original 25% increase over four years they voted to reject.

Seniors could see large increases to their Medicare Advantage costs in 2025 as major changes are underway for prescription plans.

German Chancellor Olaf Scholz warned Italian bank UniCredit against “unfriendly” acts after the bank upped its stake in Germany’s Commerzbank, eclipsing the country as its largest shareholder.

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