DAILY UPDATE: Semaglutide Drugs, CMS, Emory & UnitedHealthcare as Stock Markets Rise High

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

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In breaking news, the Biden administration is attempting to cover anti-obesity drugs for weight loss under Medicare and Medicaid. A recent study finds 137 million people are eligible for semaglutide drugs nationwide.


Another insurer can claim victory against CMS after UnitedHealthcare prevailed in its star ratings lawsuit on Friday. The feds will now have to recalculate the scores.


And ... Emory Healthcare is looking to expand value-based care for more than 350,000 patients through a population health partnership with tech company Guidehealth.

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STOCKS UP

Uncrustables taste almost as good as today’s gains: J.M. Smucker rose 5.70% thanks to a beat-and-raise quarter for the company.

  • Walmart gained 2.02% on a report that Target is losing its high-end customers to the low-price retailer. Target sank 3.03%.
  • Semiconductor stock Semtech rose another 18.10% after announcing stronger-than-expected earnings last night.

STOCKS DOWN

  • Amgen’s new drug did help patients lose up to 20% of their weight in a given year, but that wasn’t enough to impress shareholders, who kicked shares down 4.76%.
  • Kohl’s plummeted 17.01% after the retailer met revenue expectations but missed on earnings last quarter. It definitely doesn’t help that the CEO announced his retirement last night.
  • Abercrombie & Fitch’s turnaround is well underway, and the company beat earnings forecasts last quarter and projected strong holiday sales. But it still fell short of shareholder expectations, and the stock sank 5.10% today.
  • Best Buy rounded out retailer earnings today, dropping 4.89% after missing revenue expectations last quarter and cutting its full-year guidance.
  • Zoom Communications changed its name, but that wasn’t enough to save the company from a 6.31% decline today thanks to its tepid fiscal outlook.

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Here’s where the major benchmarks ended:

  •  The S&P 500® index (SPX)rose 34.26 points (0.57%) to 6,021.63; the Dow Jones Industrial Average® ($DJI) added 123.74 points (0.28%) to 44,860.31; and the NASDAQ Composite® ($COMP) gained 119.46 points (0.63%) to 19,174.30.
  • The 10-year Treasury note yield climbed four basis points to 4.3% after Trump’s tariff comments, but shorter-term yields fell after the Fed minutes, keeping the yield curve slightly out of inversion.
  • The CBOE Volatility Index® (VIX)dropped to 14.19, near a two-week low.

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

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FIXED FINANCIAL SPREADS FOR PHYSICIANS: Duration, Sectors, Widening, Tightening and Other Fixed Income Strategies

DEFINITIONS FOR PHYSICIANS

By Dr. David Edward Marcinko MBA MEd

SPONSOR: http://www.MarcinkoAssociates.com

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Spread duration is a risk measure, expressed in years, that estimates the price sensitivity of a fixed income investment to a 100 basis point change in credit spreads relative to similar-maturity Treasuries.

Spread sectors (aka “spread products,” “spread securities”) in fixed income parlance, are typically non-Treasury securities that usually trade in the fixed income markets at higher yields than same-maturity U.S. Treasury securities. The yield difference between Treasuries and non-Treasuries is called the “spread”), hence the name “spread sectors” for non-Treasuries.

These sectors–such as corporate-issued securities and mortgage-backed securities (MBS–typically trade at higher yields (spreads) than Treasuries because they usually have relatively lower credit quality and more credit / default risk and / or they have more prepayment risk.

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Spread widening, tightening are changes in spreads that reflect changes in relative value, with “spread widening” usually indicating relative price depreciation and “spread tightening” indicating relative price appreciation.

Spreads (aka “interest-rate spreads”, “maturity spreads,” “yield spreads” or “credit spreads”)

In fixed income parlance, spreads are simply measured differences or gaps that exists between two interest rates or yields that are being compared with each other. Spreads typically exist and are measured between fixed income securities of the same credit quality, but different maturities, or of the same maturity, but different credit quality.

Changes in spreads typically reflect changes in relative value, with “spread widening” usually indicating relative price depreciation of the securities whose yields are increasing most, and “spread tightening” indicating relative price appreciation of the securities whose yields are declining most (or remaining relatively fixed while other yields are rising to meet them). Value-oriented investors typically seek to buy when spreads are relatively wide and sell after spreads tighten.

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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.

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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.

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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.

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

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DAILY UPDATE: Morningstar, Amazon Anthropic and Private Equity Banks

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Amazon invests $4 billion more in Anthropic. The deal marks the second time in a year that Amazon has earmarked $4 billion for Anthropic as it seeks to keep pace with its main rival, OpenAI, which raised $6.6 billion in October.

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Morningstar Inc. has announced a change to the methodology for its Morningstar Medalist Rating system that it says provides a more precise assessment of investment alpha. The change, which will take effect on October 29th, will alter the medalist ratings of about 20% of the 200,000 funds Morningstar has rated, with most of those changes downgrades. For example, Morningstar expects around 40% of funds currently assigned Bronze ratings globally will be assigned Neutral ratings after the change.

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CONTRAST EFFECT: Cognitive Bias

FOR FINANCIAL ADVISORS

By Dr. David Edward Marcinko MBA MEd CMP

SPONSOR: http://www.CertifiedMedicalPlanner.org

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Sensation, emotion and cognition work by Contrast Effect [cognitive bias]. 

Now, such perception is not only on an absolute scale, it also functions relative to prior stimuli.  This is why room temperature water feels hot when experienced after being exposed to the cold.  It is also why the cessation of negative emotions “feels” so good. 

Cognitive bias functioning also works on this principle.  So one’s ability to analyze information and draw conclusions is very much related to the context with in which the analysis takes place, and to what information was originally available.  This is why it is so important to manage one’s own expectations as well as those of a financial advisor’s or stock broker’s clients. 

For example, a client is much more likely to be satisfied with a 10% portfolio return if they were expecting 7% than if they were hoping for 15%.

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BID/ASK SPREAD: Basis Points with Formulas

By Staff Reporters

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DEFINITIONS

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Basis Points are used in financial literature to express values that are carried out to two decimal places (hundredths of a percentage point), particularly ratios, such as yields, fees, and returns. Basis points describe values that are typically on the right side of the decimal point–one basis point equals one one-hundredth of a percentage point (0.01%). So 25 basis points equals 0.25%, and 50 basis points equals 0.50%.

Only when basis points equal or exceed 100 does the value move to the left of the decimal point–100 basis points equals 1.00%, 500 basis points equals 5.00%, etc.

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

Bid/Ask Spread (also known as bid/offer spread) is the difference between the National Best Bid and the National Best Offer, which represents the implied cost to trade a security.

As compensation for the risk taken, the market maker (or dealer) earns the bid/offer spread in exchange for facilitating the trade. Wider spreads generally indicate higher costs associated with trading the underlying assets in the ETF, hedging costs, inventory management costs, and general market risk.

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PHYSICIAN FINANCIAL FEAR: Money Anxiety & Chrometophobia

By Dr. David Edward Marcinko MBA MEd

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If you’ve found yourself worrying about the stock market or money lately, you definitely have company. Money anxiety, also called financial anxiety, has become more common than ever after the presidential election of November 2024.

In fact, the American Psychological Association’s 2022 Stress in America Survey, 87 percent of people who responded listed inflation as a source of significant stress. The rise in prices for everything from fuel to food has people from all backgrounds worried, today. The researchers say, in fact, that no other issue has caused this much stress since the survey began in 2007.

When money and financial concerns cause ongoing stress in your life, you could eventually begin to experience some feelings of anxiety as a result. This anxiety can, in turn, have a negative impact on your quality of life.

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Chrometophobia, commonly known as fear of money, is a psychological condition characterized by overwhelming anxiety and avoidance of currency; according to colleague Dan Ariely PhD.

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Physician Financial Fear is probably the most common emotion among physicians. The fear of being wrong – as well as the fear of being correct! It can be debilitating, as in the corollary expression on fear: the paralysis of analysis.

According to Paul Karasik, there are four common investor and physician fears, which can be addressed by financial advisors and psychologists in the following manner:

  • Fear of making the wrong decision: ameliorated by being a teacher and educator.
  • Fear of change: ameliorated by providing an agenda, outline and/or plan.
  • Fear of giving up control: ameliorated by asking for permission and agreement.
  • Fear of losing self-esteem: ameliorated by serving the client first and communicating that sentiment in a positive manner.

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MEDICAL ECONOMICS: Healthcare Inflation

By Staff Reporters

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Inflation has hit record levels this year as demand for goods and services far outpaced supply, and many companies are still trying to bounce back from the shutdowns of early 2020. Health systems, which have razor-thin operating margins even in the best of times, aren’t an exception.

“In the past, we’ve always said that healthcare was kind of recession-proof because demand for healthcare keeps going, regardless of what’s happening in the economy,” said Tina Wheeler, leader of consulting firm Deloitte’s US healthcare practice.

But in the last year, inflation hovered around 8% for much of the year, while medical-care prices increased by only 4.8%, according to Wheeler. Since medical costs are negotiated between hospitals and payers years in advance, hospitals can’t just raise their prices now to keep up with the pace of inflation, said Gerard Brogan Jr., senior vice president and chief revenue officer at Northwell Health.

READ: https://medicalexecutivepost.com/2022/11/10/the-cpi-and-stock-markets/

Here’s how badly hospitals could be hurting:

  • Inflation could cause an additional $370 billion more in healthcare spending than the expected baseline increase by 2027, according to McKinsey.
  • The national health expenditure could grow at a rate of 7.1% over the next five years, compared to the expected economic growth rate of 4.7%, according to McKinsey.
  • By the end of 2021, total hospital expenses per adjusted discharge were up 20.1% compared to 2019, according to the trade group American Hospital Association.

Rising interest rates also hurt hospitals since their main access to capital is through issuing tax-exempt bonds, Wheeler said. The rising cost of capital limits hospitals’ ability to fund projects, like opening a new oncology center to treat patients, for example. Keep reading here

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DAILY UPDATE: Bitcoin, MicroStrategy and Credit Card Competition as the DJIA Hits a Record

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Bitcoin jumped about 130% this year, but MicroStrategy has skyrocketed almost 500%.

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The proposed Credit Card Competition Act (CCCA) could devastate credit card rewards at the national level if passed. Now, states are getting involved too Read on.

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STOCKS UP

Ross Stores rose 2.19% after beating earnings estimates but missing sales forecasts last quarter, with shoppers spending less thanks to inflation.

  • MicroStrategy tumbled big time yesterday after a short seller report highlighted the risk inherent in betting it all on bitcoin, but the stock recovered 6.19% today.
  • Super Micro Computer continues to recover from the brink of defeat, rising another 11.62% as investors beg the tech company’s forgiveness for ever doubting it.
  • Data analytics company Elastic sprang 14.77% higher today on a strong earnings report highlighted by rising demand from customers building AI applications.

STOCKS DOWN

Tax-filing company Intuit sank 5.68% after reporting strong earnings last quarter but forecasting weaker results this quarter.

  • Reddit dropped 7.18% after a one-two punch from shareholders: Tencent Holdings sold a chunk of its stake in the social media company, while Advance Magazine Publishers is selling its stake but, through some financial trickery, is keeping control of the shares.
  • Palo Alto Networks may have beaten earnings expectations yesterday afternoon, but the cybersecurity stock fell 3.61% after shareholders weren’t impressed by its full-year guidance.

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Here’s where the major benchmarks ended:

  •  The S&P 500® index (SPX) rose 20.63 points (0.35%) to 5,969.34 to end the week up 1.68%; the $DJI gained 426.16 points (0.97%) to 44,296.51 to end the week up 1.96%; and the NASDAQ Composite® ($COMP) added 31.23 points (0.16%) to 19,003.65 to end the week up 1.73%.
  • The 10-year Treasury note yield fell two basis points to 4.41% and is down two basis points for the week, while the 2-year note yield rose seven basis points this week as rate cut odds fell.
  • The CBOE Volatility Index® (VIX)fell sharply to 15.31 and finished slightly lower for the week.

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MORTGAGE BACKED SECURITIES: Prepayment Risk

DEFINITION

By Staff Reporters

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Prepayment risk is typically used in reference to mortgage-backed securities. It refers to the risk that mortgage refinancing activity might increase when market interest rates decline, which is generally not favorable for MBS investors.

For example, when homeowners refinance their mortgages, MBS investors are “prepaid,” shortening the life of their investments and forcing investors to reinvest the proceeds under lower interest rate conditions than what were most likely prevailing at the time of the original MBS investment.

Price adjustments for prepayment risk are one factor that helps explain why MBS, despite their generally high credit quality, have higher yields than comparable-maturity Treasury securities.

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DAILY UPDATE: Google and Ford Motor as Stock Markets Rise and Broaden

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The DOJ asked a judge to force Google to sell its Chrome browser, following his ruling that Google maintained an illegal monopoly in search.
Ford said it is cutting 4,000 jobs in Europe, about 14% of its workforce on the continent, citing weak demand for EVs and competition from Chinese cars.

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STOCKS UP

  • Data analytics firm Snowflake soared 32.71% after posting impressive earnings, including a 28% increase in revenue last quarter.
  • BJ’s Wholesale Club has had an okay year, but its latest earnings report gave shareholders plenty to cheer. The big news: BJ’s is increasing its membership fee for the first time in seven years. Shares rose 8.24%.
  • Despite the fact that the world’s largest farming equipment manufacturer sees a big slowdown ahead, Deere beat earnings estimates last quarter, which was enough to help shares climb 8.12%.

STOCKS DOWN

It took a second, but it’s finally registering that Alphabet may be forced by the Department of Justice to divest its popular Chrome browser. Shares fell 4.74% as investors digest this stark reality.

  • Speaking of search engines, Baidu sank 5.90% after the Chinese tech stock missed analyst estimates on both earnings and revenue last quarter.
  • Speaking of Chinese companies, PDD Holdings, parent company of online retailer Temu, reported higher earnings and revenue last quarter—but it still fell short of analyst forecasts. Shares dropped 10.64%.
  • Speaking of struggling retailers, Beyond Inc., the company that owns Bed, Bath & Beyond and Overstock.com, was supposed to invest $40 million into struggling retailer The Container Store. Unfortunately for both, the deal fell through. Shares of Beyond sank 2.87%, while The Container Store dropped 9.79%.

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

Here’s where the major benchmarks ended:

  • The SPX buoyed 31.60 points (0.53%) to 5,948.71; the Dow Jones Industrial Average® ($DJI) rose 461.88 points (1.06%) to 43,870.35; and the NASDAQ Composite® ($COMP) stayed relatively flat, up 6.28 points (0.03%) to 18,972.42.
  • The 10-year Treasury note yield added two basis points to 4.42%, staying rangebound.
  • The CBOE Volatility Index® (VIX) slipped to 16.87, still above last week’s levels.

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

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INVESTMENT: Management Strategies

By Staff Reporters

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Active investment management strategies are the opposite of passive investment strategies. Active portfolio managers regularly take investment positions that clearly differ from those of the portfolio’s performance benchmark, with the objective of outperforming the benchmark over time.

Passive: https://medicalexecutivepost.com/2024/06/09/active-or-passive-investing-pursuits/

In addition to the upside potential of outperforming the benchmark, there’s also the downside possibility of under performing the benchmark. In an efficient market, there should be roughly the same magnitude of out performers and under performers for any given benchmark. But, markets are not always efficient.

Active non-transparent investment management strategies are Exchange Traded Funds that are actively managed by a portfolio manager or team of managers without daily disclosure of portfolio holdings. Active transparent strategies are daily disclosures of portfolio holdings as an attribute of traditional index-based Exchange Traded Funds (ETFs). Active transparent exchange traded funds are actively managed by a portfolio manager or team of managers. As with index-based ETFs, their portfolio holdings are disclosed daily.

Di-Worsification: https://medicalexecutivepost.com/2024/04/09/what-is-financial-portfolio-di-worsification-2/

NOTE: Absolute return as an investment vehicle seeks to make positive returns by employing investment management techniques that differ from traditional mutual funds. Absolute return investment techniques include using short selling, futures, options, derivatives, arbitrage, leverage and unconventional assets.

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DAILY UPDATE: GoodRx as Stocks End Flat

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It’s not all good news for GoodRx.

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STOCKS UP

Williams-Sonoma soared 27.50% to a record high after the home goods store beat top and bottom line earnings expectations. Its operating profit margin jumped to 17.8% from 17% last year, and the company said its board greenlit a $1 billion stock buyback plan.

  • Wix jumped 14.31% on a solid beat for its third quarter. Profit for the software firm reached $0.46 per share, compared to the $0.12 per share it reported last year.
  • Lemonade rose 16.04% after Morgan Stanley upgraded the insurance company from “underweight” to “equal-weight.” At its investor day, Lemonade unveiled a plan to juice its premiums from $1 billion to $10 billion over the next several years.

STOCKS DOWN

  • Ford said it was cutting 4,000 jobs in Europe, about 14% of its workforce on the continent, citing weak demand for EVs and competition from Chinese cars. Shares fell 2.90%.
  • Qualcomm dropped 6.34% after its first Investor Day in three years disappointed. On Tuesday, the chipmaker revealed its big plans to expand from its bread-and-butter smartphone business into making chips for cars and PCs.
  • Elf sank 2.23% after short seller Carson Block, the founder of Muddy Waters Research, accused the beauty company of inflating revenue.

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

Here’s where the major benchmarks ended:

  •  The S&P 500® index (SPX) stayed mostly flat, up 0.13 points (0.0%) to 5,917.11; the Dow Jones Industrial Average® ($DJI) rose 139.53 points (0.32%) to 43,408.47; and the NASDAQ Composite® ($COMP) fell 21.32 points (0.11%) to 18,966.14. 
  • The 10-year Treasury note yield added four basis points to 4.41%.
  • The CBOE Volatility Index® (VIX) climbed to 17.26, near recent highs.

CITE: https://tinyurl.com/tj8smmes

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

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Stocks, Treasuries, Gold and Bitcoin

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  • Stocks sank yesterday on news that Russian President Vladimir Putin lowered the threshold for using nuclear weapons, retaliation against the US for allowing Ukraine to use American-made long-range missiles. The NASDAQ and S&P 500 managed to recover, but the DJIA stayed all day in the red.
  • Treasury yields dropped as bonds rose.
  • Gold popped as traders sought safety, as the commodity benefited from the US dollar pulling back from a recent one-year high.
  • Bitcoin continued to climb slowly but surely, reaching another new all-time high.

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CHARGE MASTER: Medical Bills Paradox

By Dr. David Edward Marcinko MBA MEd CMP™

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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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DAILY UPDATE: Dermatology and Oura Rings as NASDAQ Rises

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How dermatology became the hottest field in medicine.

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STOCKS UP

  • Talk about cutting it close: Super Micro Computer filed a much-delayed financial plan at the 11th hour, avoiding a delisting from the Nasdaq. Shares soared 31.24%.
  • AI-enabled robotics company Symbotic surged 27.68% after announcing an impressive beat-and-raise quarter.
  • MicroStrategy climbed another 11.89% after yesterday’s huge surge. The crypto company announced it will continue to purchase more bitcoin in the weeks ahead.

STOCKS DOWN

  • More Trump Trade 2.0 developments: The newly formed Department of Government Efficiency is considering creating an app that allows Americans to file their taxes on a phone for free. Intuit sank 5.10%, and H&R Block dropped 8.31% on the news.
  • Speaking of Trump, platform Bakkt popped then dropped 0.67% following yesterday’s news that Trump Media & Technology Group may acquire the company. Trump Media shares fell 8.88%.
  • Kraft Heinz fell 1.58% on a Piper Sandler downgrade due to the company’s slow retail sales and the threat of new government regulations from the Health Department.
  • Lowe’s may have beaten top and bottom line expectations last quarter, but the home improvement retailer’s forecast of slower sales next year sent the stock falling 4.62%.
  • Incyte tumbled 8.33% after the pharma company announced it was pausing the Phase 2 trial of its new spontaneous hives treatment.

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Here’s where the major benchmarks ended:

  •  The S&P 500® index (SPX) was up 23.36 points (0.4%) to 5916.98; the Dow Jones Industrial Average® ($DJI) dipped 120.66 points (0.28%) to 43,268.94; and the NASDAQ Composite® ($COMP) rose 195.66 points (1.04%) to 18,987.49.
  • The 10-year Treasury note yield fell four basis points to 4.38%.
  • The CBOE Volatility Index® (VIX) eased to 16.04 after an earlier pop above 17.

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Oura rings will soon be integrated with glucose biosensors after a $75 million series D funding round with medical device maker Dexcom.

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

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CBOE: Chicago Board Options Exchange [Volatility Indexes]

By Staff Reporters

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RELATED DEFINITIONS

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Volatility indexes are forward-looking measures of the market’s expectations of volatility (or how much a stock index’s price moves). The CBOE manages and publishes three of the most widely used volatility indexes based on three major stock indexes:

The VIX Index tracks the expected 30-day future volatility of the S&P 500 Index.

The VXN Index tracks the expected 30-day future volatility of the NASDAQ-100 Index.

The VXD Index tracks the expected 30-day future volatility of the Dow Jones Industrial Average Index.

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SECURITY ORDERS: Stop-Loss and Stop-Limit

By Dr. David Edward Marcinko MBA MEd

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A Stop order, also known as a “stop-loss order,” a stop order is an order placed with a bank or brokerage firm to either buy or sell a security after it reaches a specified price. Once the price is reached, the stop order becomes a market order, meaning there is no guarantee that an order will be completely filled at the specified stop price.

MORE: https://medicalexecutivepost.com/2024/08/30/stock-orders-positions-doctors-should-know/

A Stop-limit order is order placed with a bank or brokerage firm to buy or sell a fixed amount of an investment after it reaches a specified or better price, combining the features of a stop order and a limit order.

MORE: https://medicalexecutivepost.com/2024/08/07/about-securities-order-and-position-types/

A stop-limit order requires investors to set two price points: the first initiates the stop (the order to buy or sell) and the second sets the limit, or price beyond which the investor would not like to buy or sell. The investor also sets a time frame for which the order is valid before being cancelled. If the investor’s price cannot be met during the specified time frame, the order will be cancelled.

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DAILY UPDATE: All About the Stock Markets

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  • Stocks ended the day mixed, with the Dow sinking into the red while the S&P 500 and NASDAQ kicked off the week on a positive note thanks to gains from tech stocks.
  • Oil popped on a double-whammy of news: Long-range, US-made ballistic missiles launched from Ukraine into Russia might disrupt oil supply, while the shutdown of Norway’s Johan Sverdrup oil field due to a power outage will definitely disrupt oil supply.
  • Crypto continued its hot streak today: Bitcoin popped back above $90,000, giving other cryptocurrencies a boost.
  • Bitcoin’s boom has certainly helped MicroStrategy, which announced today that it purchased 51,780 bitcoins for approximately $4.6 billion in cash, or roughly $88,627 per bitcoin, in the last week alone.

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STOCKS UP

The new Trump Trade continues: The president-elect’s selection of Liberty Energy CEO Chris Wright to lead the Department of Energy gave Liberty a 4.85% boost today. Wright is also on the board of nuclear company Oklo, which popped 14.83%.

  • Speaking of Trump, Trump Media & Technology Group soared 16.65% on the news that it may purchase crypto trading firm Bakkt.
  • Netflix disappointed viewers with its glitchy showing of Jake Paul vs. Mike Tyson, but shareholders forgave the company after it announced record viewership of the fight. Shares climbed 2.80%.
  • CVS Health gained 5.41% on news that it struck a deal with activist investor Glenview Capital Management to add four new seats to its board.
  • Robinhood jumped 8.29% to a new all-time high thanks to an upgrade from Needham analysts giving the investing app a “buy” rating due to its crypto offerings under a pro-crypto Trump presidency.
  • Warner Bros. Discovery rose 2.71% on a Wall Street Journal report that it has settled its legal dispute with the NBA, guaranteeing broadcast rights for the next decade.

STOCKS DOWN

  • Nvidia isn’t often in this section of the newsletter, but the semiconductor leader sank 1.29% today on a report from The Information that its new Blackwell chips are prone to overheating.
  • Palantir popped after moving over to the Nasdaq last week, but the red-hot software stock dropped 6.86% as investors collected profits.
  • Redfin may help you buy a house, but the online real estate brokerage is a “sell,” according to Goldman Sachs. The Wall Street firm cited low home sales, low affordability, and low chances of success in a competitive market. Shares fell 4.42%.
  • Uber dropped 5.35% to a new 52-week low on the threat of Tesla’s robotaxis ruling the road thanks to a Trump administration that seems keen on cutting self-driving regulations.

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Here’s where the major benchmarks ended:

  •  The SPX was up 23.00 points (0.4%) to 5893.62; the Dow Jones Industrial Average® ($DJI) fell 55.39 points (0.1%) to 43,389.6; and the NASDAQ Composite® ($COMP) was up 111.69 points (0.6%) to 18,791.81.
  • The 10-year Treasury note yield fell one basis point to 4.41%.
  • The CBOE Volatility Index® (VIX) eased to 15.57.

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

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DAILY UPDATE: Spirit Airlines in Chapter 11 as Nvidia Rises and Target, Lowes & Walmart Highlight Stock Earnings Week

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Spirit Airlines said Monday it has filed for Chapter 11 bankruptcy protection after struggling with losses, growing debt and a failed merger during the post-pandemic travel lull. The company said in a stock market statement that it had secured a prearranged deal with bondholders that includes £300 million in financing to keep it afloat, with the business planning to end its bankruptcy in the first quarter of 2025.

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Analysts are expecting Nvidia, the world’s largest publicly traded company, to show quarterly sales of ~$33 billion, up 10% from the previous quarter and 83% year over year, but they also warn the mind-blowing growth of the chip maker could begin to slow.

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And, reports this week from Walmart, Target, Lowe’s, and other retailers will offer a peek at consumer health.

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NOVEMBER: National Alzheimer’s Awareness Month

By Dr. David Edward Marcinko MBA MEd

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The number of people living with Alzheimer’s disease is growing. The ripple effect is straining families, communities, and the healthcare system, yet talking about the disease on a personal level can be difficult.

November is Alzheimer’s Awareness Month because it can happen in any family, and because it’s worth talking about the challenges of living with or caring for someone with this disease.

You may notice splashes of teal and purple sprouting up this November, as both colors are associated with Alzheimer’s awareness. Teal is the color of the Alzheimer’s Foundation of America, chosen for its calming effect. Purple is the signature color of the Alzheimer’s Foundation, which stands for strength in the fight against Alzheimer’s disease.

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CURSE of the “Stereotype”

By Dr. David Edward Marcinko MBA MEd

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The Stereotype Curse is the negative impact of stereotypes on an individual’s performance or behavior. It’s like a self-fulfilling prophecy where being aware of a stereotype makes you more likely to conform to it.

For example, if you’re told you’re bad at math because of your gender, that stress can affect your performance. Breaking free from stereotypes requires awareness and effort.

So, next time you feel boxed in by a stereotype, remind yourself: you’re more than a cliché.

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DAILY UPDATE: 401[k] and Wamco as Stock Markets Crash!

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The Internal Revenue Service (IRS) ruled that employees at an unnamed company can designate a portion of their employer match to student debt repayments or health reimbursement accounts, in addition to their traditional 401(k).

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STOCKS UP

  • Warren Buffett’s Midas touch gave a boost to Domino’s Pizza and Pool Corp. after Berkshire Hathaway announced it has bought shares of both companies. Domino’s popped to start the day but dropped 1.27%, while Pool climbed just 0.54%.
  • Palantir is jumping ship, moving from the NYSE to the Nasdaq. Shareholders liked the move, pushing the stock up 11.14%.
  • Bloom Energy…bloomed 59.19% on the news that the renewable energy company reached an agreement to provide utility company American Electric Power with 1 gigawatt worth of fuel cells.

STOCKS DOWN

  • What Buffett giveth, Buffett taketh away: Apple sank on the news that Berkshire Hathaway has sold shares of the company, and almost completely eliminated its position in Ulta Beauty. Apple fell 1.41%, while Ulta Beauty dropped 4.60%.
  • Shareholders were expecting the worst from Chinese online retailer Alibaba, and although the company actually beat earnings forecasts, it wasn’t enough—shares still sank 2.20%.
  • Applied Materials tumbled 9.20% after beating both top and bottom line expectations, but shareholders balked at the slowdown in several key businesses.
  • AST SpaceMobile plummeted 9.59% after reporting bigger losses and smaller sales than Wall Street wanted to see.

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Here’s where the major stock market benchmarks ended:

  • The SPX fell 78.55 points (–1.32%) to 5,870.62 to end the week down 2.08%; the Dow Jones Industrial Average® ($DJI) lost 305.87 points (–0.70%) to 43,444.99 to end the week down 1.24%; and the NASDAQ Composite® ($COMP) decreased 427.52 points (–2.24%) to 18,680.12 to end the week down 3.15%.
  • The 10-year Treasury note yield rose one basis point to 4.43% but added 12 basis points for the week. Shorter-term yields rose less.
  • The CBOE Volatility Index® (VIX) climbed sharply to 16.11 as stocks fell.

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The problems at storied bond manager Western Asset Management keep growing. Clients have pulled about $55 billion from Wamco, as the division is known, since mid-August, representing about 15% of its assets. Franklin Templeton, its 77-year-old parent company and one of the largest asset managers in the U.S., recently reported its steepest quarterly outflows on record.

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

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BIAS: Of “Social Proof” and Influencers

INVESTING DEFINITION

By Dr. David Edward Marcinko MBA MEd

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Social Proof is a subtle but powerful reality that having others agree with a decision one makes, gives that person more conviction in the decision, and having others disagree decreases one’s confidence in that decision. 

This bias is even more exaggerated when the other parties providing the validating/questioning opinions are perceived to be experts in a relevant field, or are authority figures, like doctors, attorneys, financial advisors, teachers and/or people on television.  In many ways, the short term moves in the stock market are the ultimate expression of social proof – the price of a stock one owns going up is proof that a lot of other people agree with the decision to buy, and a dropping stock price means a stock should be sold. 

According to colleague Dan Ariely PhD, when these stressors become extreme, it is of paramount importance that all participants in the financial planning and investing process have a clear understanding of what the long-term goals are, and what processes are in place to monitor the progress towards these goals. 

Without these mechanisms it is very hard to resist the enormous pressure to follow the crowd; think social media and related influences.

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FATAL: Narcissism

BY DR. DAVID EDWARD MARCINKO MBA MEd

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Imagine if Narcissus had a social media account. Fatal narcissism is what happens when self-love goes off the rails. It’s not just about admiring your reflection; it’s an all-consuming need for admiration and validation. Think endless selfies and humblebrags.

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While a bit of narcissism is normal, fatal narcissism is like a black hole – it sucks in all attention and gives nothing back.

So, if my Instagram looks like a shrine to my own greatness, you might be witnessing fatal narcissism in action.

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Convertible Securities, Bonds and Corporate Securities

By Dr. David Edward Marcinko MBA MEd

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Convertible securities are those that can be converted at the investor’s choice into other investments, normally into shares of the issuer’s underlying common stock. Convertibles are typically issued as bonds or preferred stock.

Convertible bonds, which provide an ongoing stream of income, can be converted into a preset number of shares of the company’s common stock and have a maturity date. Unlike common stock, which pays a variable dividend depending on a corporation’s earnings, convertible preferred stock pays a fixed quarterly dividend. It can be converted into common stock at any time, but often are perpetual.

Corporate securities (corporate bonds and notes) are debt instruments issued by corporations, as distinct from those issued by governments, government agencies, or municipalities.

Corporate securities typically have the following features: 1) they are taxable, 2) they tend to have more credit (default) risk than government or municipal securities, so they tend to have higher yields than comparable-maturity securities in those sectors; and 3) they are traded on major exchanges, with prices published in newspapers.

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DAILY UPDATE: Healthcare Private Equity Prominent as Stocks Go Down

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Private equity (PE) dollars have become prominent in the US healthcare industry in recent decades, with PE firms now owning roughly 8% of all private hospitals in the country, according to nonprofit Private Equity Stakeholder Project. But studies have illustrated the financial model’s potential adverse effects, such one published in JAMA in December 2023 that found PE-owned hospitals are 25.4% more likely to report patient complications. Others have found that PE-owned healthcare companies represented more than one-fifth of healthcare company bankruptcies in 2023 and that PE-owned hospitals see their assets drop an average of 24% following an acquisition.

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STOCKS UP

Tapestry, parent company of luxury brands like Coach and Kate Spade, and Capri, parent company of luxury brands like Versace and Jimmy Choo, have announced they will mutually terminate their planned merger. Tapestry popped 12.80%, while Capri rose 4.43%.

  • Speaking of luxury brands, Burberry soared 18.04% after its CEO announced a turnaround plan designed to halt the company’s recent decline.
  • Semiconductor maker ASML plummeted last month on a profit warning, but rose 2.90% today on reassurances that it’s still on track to meet its 2030 revenue forecasts.

STOCKS DOWN

  • Super Micro Computer fell yet another 11.41% as it nears the November 16 deadline to report fiscal year earnings or be delisted from the Nasdaq.
  • Trump Media & Technology Group dropped 6.71% as investors digested news that company insiders are shedding shares, as well as in reaction to a number of President-elect Trump’s cabinet appointments.
  • Hims & Hers Health tumbled 24.46% on the news that Amazon is getting into the telehealth game, offering Prime members fixed prices on treatments for hair loss and erectile dysfunction.
  • Ibotta is a cashback rewards company, but its shareholders may want their cash back. The company beat on top and bottom line estimates last quarter, but the win wasn’t good enough, and shares sank 12.55%.

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Here’s where the major benchmarks ended:

  • The S&P 500® index (SPX) fell 36.21 points (–0.60%) to 5,949.17; the Dow Jones Industrial Average® ($DJI) lost 207.33 points (–0.47%) to 43,750.86; and the NASDAQ Composite® ($COMP) dropped 123.07 points (–0.64%) to 19,107.65. 
  • The 10-year Treasury note yield fell three basis points to 4.42%.
  • The CBOE Volatility Index® (VIX) edged up to 14.17.

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

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INVESTMENT STRATEGIES: Market Neutral and Extended Equity

By Staff Reporters

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Equity market neutral strategies seek to eliminate the risks of the equity market by holding up to 100% of net assets in long equity positions and up to 100% of net assets in short equity positions. These strategies attempt to exploit differences in stock prices by being long and short in stocks within the same sector, industry, market capitalization, etc. If successful, these strategies should generate returns independent of the equity market.

Equity market neutral portfolios have two key sources of return: 1) the Treasury Bill return (the interest on proceeds from short sales held in cash as collateral), and 2) the difference (the “spread”) between the return on the long positions and the return on the short positions. Stock picking, rather than broad market moves, should drive most of a market-neutral strategy’s total return (save for any return from the 100% cash position).

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Extended Equity Strategies attempt to provide better returns than possible with long-only investments

An example of an extended equity strategy is a 130/30 portfolio, which gets its designation from taking a 130% long position and a 30% short position. In practice, this would mean $100mm invested in stocks that are viewed as attractive.

Next, the manager would borrow and sell short $30mm of unattractive stocks. Then the manager uses the proceeds from the short sale to buy an additional $30mm of attractive stocks. This results in a portfolio that has 130% long and 30% short exposure to stocks, or “extended” exposure to equities relative to a long-only, 100% stock portfolio.

Note: It’s important to point out that here is the risk of theoretical unlimited amount of loss with short selling, (i.e. the price of the short-sold stocks increases; the long position can only go down to $0).

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DAILY UPDATE: United Health, Cigna and Inflation as Stock Markets Flatten

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UnitedHealth Group posted nearly $6.1 billion in profit last quarter, edging out Elevance Health with $5.6 billion. Paige Minemyer has more takeaways from third quarter earnings results.


Cigna told investors the company is no longer pursuing a merger with Humana, opting to avoid tricky questions from federal regulators.

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

STOCKS UP

  • EV startup Rivian popped 13.71% after announcing a new $5.8 billion joint venture with Volkswagen to collaborate on a new line of vehicles that will begin rolling off the assembly line in 2027.
  • Rocket Lab…rocketed 28.44% to a new all-time high after increasing revenue 55% last quarter and announcing the first launch deal for its new Neutron rocket.
  • Charter Communications will purchase Liberty Broadband in an all-stock deal. Charter shares rose 3.63% on the news, while Liberty shares sank 5.05%.
  • Cava reported strong earnings today, including impressive same-store sales growth of 18%. Shares soared on the open, though ended the day up just 1.57%.
  • Flutter Entertainment, parent company of sports betting app FanDuel, rose 6.89% to hit an all-time high thanks to incredibly strong betting on the NFL last quarter.

STOCKS DOWN

  • The problems continue at Super Micro Computer, which announced it will need EVEN MORE time to submit its quarterly 10-Q form to the SEC. That’s on top of the delayed filing of its annual 10-K filing from back in June—and if it doesn’t file that by November 16, the stock will be delisted from the Nasdaq. Shares sank 6.31%.
  • Spirit Airlines really may go bankrupt this time. The beleaguered airline has lost hope of merging with Frontier Airlines, so shares plunged 59.32%.
  • Maplebear, which is the parent company of Instacart, delivered bad news for shareholders: Next quarter will be worse than expected. Shares fell 11.01%.
  • SoundHound AI reported record revenue last quarter, but shares plummeted 17.06% after the voice recognition stock also revealed much lower margins.

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

Here’s where the major benchmarks ended:

  • The S&P 500® index (SPX) rose 1.39 points (0.02%) to 5,985.38; the Dow Jones Industrial Average® ($DJI) added 47.21 points (0.11%) to 43,958.19; and the NASDAQ Composite® ($COMP) fell 50.66 points (–0.26%) to 19,230.74. 
  • The 10-year Treasury note yield added two basis points to 4.45%, just below last week’s four-month high.
  • The CBOE Volatility Index® (VIX) slid to 14.03, down sharply from above 20 early last week.

CITE: https://tinyurl.com/tj8smmes

The Labor Department on Wednesday reported that consumer prices in October rose 2.6% from a year earlier. That marks a pickup in the pace of inflation from September, when prices were up 2.4% on the year.

A digital token inspired by a Shiba Inu dog meme is now worth more than the company that pioneered the assembly line. Yesterday, dogecoin continued its post-election surge to become more valuable than 121-year-old Ford.

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

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MEDICAL TESTS: The Surprise Paradox

By Staff Reporters

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THE SURPRISE MEDICAL TEST PARADOX

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Classic Definition:  A doctor announces to her hospitalized patient that there will be a painful medical test sometime during the following week. The patient begins to speculate about when it might occur, until another patient announces that there is no reason to worry because a medical surprise test is impossible.

The test cannot be given on Friday, because by the end of the day on Thursday we would know that the test must be given the next day. Nor can the test be given on Thursday, because, given that we know that the test cannot be given on Friday, by the end of the day on Wednesday we would know that the test must be given the next day. And likewise for Wednesday, Tuesday, and Monday!

Modern Circumstance: The patient spends a restful weekend not worrying about the test, yet is very surprised when it is given on Wednesday. How could this happen?

Paradox Example: There are various versions of this paradox; one of them, called the Hangman, concerns a condemned prisoner who is clever but ultimately overconfident. The implications of the paradox are as yet unclear, and there is virtually no agreement about how it should be solved.

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FINANCIAL YIELDS: All About Fixed Income Securities

By Dr. David Edward Marcinko MBA MEd CMP™

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Yield: For bonds and other fixed-income securities, yield is a rate of return on those securities. There are several types of yields and yield calculations. “Yield to maturity” is a common calculation for fixed-income securities, which takes into account total annual interest payments, the purchase price, the redemption value, and the amount of time remaining until maturity.

Yield curve: A line graph showing the yields of fixed income securities from a single sector (such as Treasuries or municipals), but from a range of different maturities (typically three months to 30 years), at a single point in time (often at month-, quarter- or year-end). Maturities are plotted on the x-axis of the graph, and yields are plotted on the y-axis. The resulting line is a key bond market benchmark and a leading economic indicator.

Yield to maturity [real yield to maturity]: Yield to maturity is a common performance calculation for fixed-income securities, which takes into account total annual interest payments, the purchase price, the redemption value, and the amount of time remaining until maturity. Real yield to maturity is simply yield to maturity minus any “inflation premium” that had been added/priced in. (See Real yield.)

Yield ratio: A ratio of one yield divided by another. Most often used as a relative value measurement.

Yield spread: A “spread,” in fixed income parlance, is simply a difference. Yield spreads measure yield differences, typically between debt securities with high credit ratings (which typically have lower yields) and those with lower ratings (which typically have higher yields). Yield spreads can also be measured between debt securities with different maturities (shorter-maturity securities typically have lower yields and longer-maturity securities typically have higher yields).

Yield trap: An investment that can lure investors with an attractive yield that may not be fundamentally sustainable, or that may lead to undesired price volatility. Yield traps can lurk in both the equity and fixed income markets. They have a tendency to prey on those who can least afford them, including retirement investors looking for increased relative income and stability, who may have been too focused on their income goals and not enough on stability.

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

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CELEBRATE: World Kindness Day

November 13th, 2024

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World Kindness Day is an international holiday first introduced in 1998 by the World Kindness Movement.

The holiday is devoted to promoting kindness throughout the world, understanding the positive potential of large and small acts of kindness, and unifying together as human beings.

WKD: https://worldkindness.org/

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DAILY UPDATE: Bitcoin Fog as Chegg the DJIA and NASDAQ Drop

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The operator of the longest-running money laundering machine in dark web history, Bitcoin Fog, has been sentenced to 12 years and six months in US prison. Roman Sterlingov, 36, a Russian-Swedish national, was also ordered to repay more than half a billion dollars accrued from the cryptocurrency mixing service that he ran for a decade between 2011 and 2021.

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

Stocks Up

  • r Elliott Investment Management is at it again, this time with a $5 billion stake in industrial conglomerate Honeywell. Shares gained 3.87% on the news.
  • Shopify announced its ninth consecutive quarter of beating analyst revenue expectations, pushing shares up 21.04%.
  • Bad news is good news: 40% of the workforce at 23andMe is getting laid off to cut costs. Shareholders cheered, and shares climbed 2.17%.
  • Where’s the beef? Tyson Foods popped 6.55% after announcing strong earnings thanks to higher beef and chicken prices last quarter.
  • Sentinel One climbed 2.01% after Deutsche Bank analysts upgraded the cybersecurity stock from “hold” to “buy,” noting it should profit from CrowdStrike’s outage earlier this year.

Stocks Down

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

Here’s where the major benchmarks ended:

  • The S&P 500® index (SPX) fell 17.36 points (–0.29%) to 5,983.99; the Dow Jones Industrial Average® ($DJI) lost 382.15 points (–0.86%) to 43,910.98; and the NASDAQ Composite® ($COMP) decreased 17.36 points (–0.09%) to 19,281.40.
  • The 10-year Treasury note yield added 12 basis points to 4.43%.
  • The CBOE Volatility Index® (VIX) fell to 14.81, unusual on a day when stocks lost ground.

CITE: https://tinyurl.com/tj8smmes

Chegg is on the verge of collapse. Its stock is down 99% since 2021, the Wall Street Journal reported, wiping out nearly $15 billion in market value.

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

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Take the Physician-Focused FINANCIAL PLAN “Challenge”

Do You Have “What it Takes”?

Book Marcinko

DEM 2

By Professor David E. Marcinko MBBS DPM MBA MEd CMP®

Institute of Medical Business Advisors, Inc.

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www.CertifiedMedicalPlanner.org

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My History

More than 20 years ago I crafted a comprehensive holistic financial plan for a young doctor colleague who was born in 1959. In fact, he was not even a medical student at the time; so “canned off-the-shelf plans”, computer generated software or generic spread sheets were not a viable creation option. It was all a granular, detailed, specific and cognitive work-product. Today, he is a board-certified internist.

So, in 2023, it is right and just to take a look back and see how well, or poorly, we’ve fared.

Now, I appreciate more than most how financial planning is a “process”; and not an isolated event. Yet, all sorts of “advisors” and “consultants” create and charge hefty fees for same, and on-going monitoring, every day.

The ME-P Challenge

Nevertheless, I challenge all you mid-career or senior financial planners /advisors to this competition; regardless of degree, certification or designation.

“Show me your financial plan” – AND – “I’ll show you my financial plan”

Here Comes the Judge

Then, our community of ME-P readers, subscribers, visitors and “judges” will decide the winner.

The contest is open to any financial advisor, planner, consultant, wealth manager, CFP®, CFA, insurance agent, CPA or CLU, ChFC, or stock-broker, etc., who is not afraid of transparency in his or her work product and purported expertise.

Of Financial Certifications and Designations

*** [Creating and Evaluating a physician focused financial plan]

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Assessment

So, just send in a copy of any “blinded” physician-focused financial plan that is about 21 years old. We will post for all to see and review …. warts and all … including my own; three part mega-plan!

The winner will receive bragging rights, academic swagger, and expert promotion to our entire ME-P ecosystem and network of medical, business, law and graduate school communities; as well as physicians, nurses, healthcare executives and allied health care professionals.

An informed sought-after and lucrative sector – indeed!

IOW: Free publicity and positive “new-wave” PR – PRICELESS!

Of course, as an educator and professor of health economics and finance, we are pleased to present you with the deep medical business knowledge and detailed financial,managerial and accounting techniques used, with some real-life “tips and pearls” developed over the last two decades of R&D, right here:

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

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

Conclusion

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

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

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

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

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PART 1: My Sample Financial Plan I [Data gathering, goals and objectives]

PART 2: My Sample Financial Plan II [Data Analytics, Creation and Crafting]

PART 3: Request here: MarcinkoAdvisors@msn.com [Stress Testing and Completion]

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BONDS: Zero Coupon [Pros & Cons]

DEFINITIONS

By Staff Reporters

SPONSOR: http://www.MarcinkoAssociates.com

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Zero-coupon securities (aka zeros) are debt securities [bonds] that, unlike most of their debt security counterparts, make no periodic interest payments to investors. Instead, they are sold at a deep discount (with an imputed interest rate priced into the discount), then redeemed for their full face value at maturity.

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

When held to maturity, a zero’s entire return comes from the difference between its purchase price and its value at maturity.

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DAILY UPDATE: About the Markets

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The S&P 500 closed above 6,000 for the first time. Chips fell on China trade tension. The US dollar rose. Treasuries were closed.

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

Here’s where the major benchmarks ended:

  •  The SPX rose 5.81 points (0.10%) to 6,001.35; the Dow Jones Industrial Average® ($DJI) added 304.14 points (0.69%) to 44,293.13, a new all-time closing high; and the NASDAQ Composite® ($COMP) gained 11.99 points (0.06%) to 19,298.76.
  • The 10-year Treasury note yield (TNX) didn’t trade today due to the Veterans Day holiday.
  • The CBOE Volatility Index® (VIX) inched up to 15.05. 

CITE: https://tinyurl.com/tj8smmes

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

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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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SORTINO: A Financial Risk Ratio

DEFINED

By Staff Reporters

SPONSOR: http://www.MarcinkoAssociates.com

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The Sortino Ratio is similar to the Sharpe Ratio, it is a measure of risk-adjusted performance which looks at returns through the lens of the risk taken to achieve that performance, but instead of volatility of return, it uses downside variance as its measure of risk.

SHARP RATIO: https://medicalexecutivepost.com/2021/11/08/introducing-the-sharp-index/

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DAILY UPDATE: Election Week Wrap-Up

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  • Stocks ended a record-breaking election week by breaking records: The Dow rose above 44,000 for the first time ever, the S&P 500 rose above 6,000 for the first time ever, and the NASDAQ hit its own all-time high.
  • Tesla in particular had an excellent week, rising to a market cap of $1 trillion on a post-election surge.
  • Treasury yields fell and ended the week lower than where they began as investors hedged their bets and bought bonds.

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

  • Oil rose a bit this week on fears that Hurricane Rafael would disrupt supply in the Gulf Coast, but new projections show the storm losing steam, which meant oil did as well.
  • One investment that didn’t go down this week: bitcoin. The crypto king soared to a new all-time high as traders bought into a friendlier regulatory environment under Donald Trump.

CITE: https://tinyurl.com/tj8smmes

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

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FINANCIAL Derivatives

By Dr. David Edward Marcinko MBA MEd

SPONSOR: http://www.MarcinkoAssociates.com

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Derivatives are securities whose performance and/or structure is derived from the performance and/or structure of other assets, interest rates, or indexes. If used moderately and in appropriate situations, derivatives can help stabilize portfolios and/or enhance returns. However, if used in excess and/or in inappropriate circumstances, they can be harmful, potentially causing portfolio instability and/or losses. Derivatives are similar to medicine in their behavior–usually safe when used as directed, potentially toxic when abused.

There are many different types of derivative securities and many different ways to use them. Some derivative securities, such as mortgage-related and other asset-backed securities, are in many respects like any other investment, although they may be more volatile or less liquid than more traditional debt securities.

Futures and options are commonly used for traditional hedging purposes to attempt to protect portfolios from exposure to changing interest rates, securities prices or currency exchange rates, and for cash management purposes as a low-cost method of gaining exposure to a particular securities market without investing directly in those securities.

Certain other derivative securities may be described as structured investments. A structured investment is a security whose value or performance is linked to an underlying index or other security or asset class. Structured investments include collateralized mortgage obligations (CMOs). Structured investments also include securities backed by other types of collateral.

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

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KENNETH ARROW: Information Paradox

To sell information you need to give it away before the sale

By Dr. David Edward Marcinko MBA MEd

SPONSOR: http://www.MarcinkoAssociates.com

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THE FATHER OF HEALTH ECONOMICS

According to Wikipedia, a fundamental tenet of the paradox is that the customer, i.e. the potential purchaser of the information describing a technology (or other information having some value, such as facts), wants to know the technology and what it does in sufficient detail as to understand its capabilities or have information about the facts or products to decide whether or not to buy it. Once the customer has this detailed knowledge, however, the seller has in effect transferred the technology to the customer without any compensation. This has been argued to show the need for patent protection [HIPPA].

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

If the buyer trusts the seller or is protected via contract, then they only need to know the results that the technology will provide, along with any caveats for its usage in a given context. A problem is that sellers lie, they may be mistaken, one or both sides overlook side consequences for usage in a given context, or some unknown-unknown affects the actual outcome.

MORE :https://www.nobelprize.org/prizes/economic-sciences/1972/arrow/facts/

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DAILY UPDATE: SPX Ends Just Short of 6,000

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Stocks up

  • In another daily double-digit swing, Trump Media & Technology Group jumped 15.22% after President-elect Trump announced he has no plans to sell shares of his social media company.
  • Toast isn’t just for breakfast anymore—it’s also a restaurant software company that’s making money hand over fist. Shares popped 14.93% on strong earnings news.
  • Axon Enterprise climbed 28.68% to a new all-time high thanks to an impressive quarter for the law enforcement technology company.
  • Upstart started up and stayed there, soaring 46.02% after the AI lending marketplace beat-and-raised analyst estimates last quarter.
  • Unless you’re a medical professional, you’ve probably never heard of digital platform Doximity, but doctors love it. Shares surged 34.06% on a stronger-than-expected quarter.

Stocks down

  • Pinterest plummeted after the social media site announced slowing user growth combined with lower ad pricing, a one-two combo that sent shares tumbling 14%.
  • Airbnb may have beaten revenue expectations, but shareholders punished it for missing on earnings estimates last quarter. Shares fell 8.66%.
  • Sweetgreen sank 6.01% after the fast casual eatery fell short of analyst estimates last quarter and Goldman Sachs lowered its rating from “buy” to “neutral.”
  • Redfin plunged 15.62% after it announced lower earnings than analysts expected, cut its forecasts, and revealed it’s losing ground to competitors.

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

Here’s where the major benchmarks ended:

  • The SPX rose 22.44 points (0.38%) to 5,995.54 to end the week up 4.66%; the Dow Jones Industrial Average® ($DJI) added 259.65 points (0.59%) to 43,988.99 to end the week up 4.61%; and the NASDAQ Composite®($COMP) climbed 17.31 points (0.09%) to 19,286.78 to end the week up 5.74%.
  • The 10-year Treasury note yield (TNX) fell four basis points to 4.31%, but the 2-year yield added three basis points to 4.25%. Shorter-term yields, which are more closely connected to near-term rate policy, gained on longer-term ones this week.
  • The CBOE Volatility Index® (VIX) fell to 14.99, near a two-month low.

CITE: https://tinyurl.com/tj8smmes

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

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RECIPROCITY: Science “Sales” in Action

FREE SAMPLES

The Art of Giving – And Receiving – Value!

By Staff Reporters

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Imagine you’re at a party, and someone hands you a drink. Your first instinct? Find something to give back. This is [sales] reciprocity in action – our built-in psychological urge to repay kindness.

According to colleague Dan Ariely PhD, it’s like a cosmic balance sheet in our brains, ensuring we don’t owe anyone a favor. This is why companies give out free samples. They’re not just being nice; they know you’ll feel a pang of guilt if you walk away without buying something.

THINK: Free financial planning dinner seminar and prospecting event. That’s you – the Sales Prospect!

So, next time someone does you a favor, remember: it’s not just seller kindness, it’s science!

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CURRENCY OPTIONS: Hedging and Overlays

By Dr. David Edward Marcinko MBA MEd

SPONSOR: http://www.MarcinkoAssociates.com

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Currency Hedging is a risk-management strategy, as part of a foreign investment strategy, currency hedging is designed to reduce the impact from changes in the relative values of currencies involved in the foreign investment strategy.

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

In any foreign investment strategy, a significant part of the potential risk and return comes from exposure to relative currency value fluctuations. If exposure to those currency fluctuations is minimized, investors can experience more of a “pure play” exposure to the foreign investments. There is a variety of possible currency hedging strategies, ranging from swaps, options, and spot contracts to simply buying foreign currencies.

Currency Overlay is a financial trading strategy used to separate the management of currency risk from other portfolio strategies. A currency overlay manager can seek to hedge the risk from adverse movements in exchange rates, and/or attempt to profit from tactical currency views.

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

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DAILY UPDATE: FOMC Cuts Interest Rates as Stock Markets Rise

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

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

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The Federal Reserve cut interest rates by 0.25 percentage points Thursday, the second consecutive cut after a two-year rate-hike run to curb post-pandemic inflation.

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What’s up

  • Lyft announced impressive earnings results thanks to more commuters using the ride-hailing service, as well as upbeat guidance for the future. Shares rose 22.92%.
  • Shareholders worried about a housing market slowdown hurting Zillow had nothing to fear: The real estate website crushed earnings estimates, and shares popped 23.77%.
  • Warner Bros. Discovery enjoyed its biggest single-quarter surge in subscribers ever thanks to streaming service Max, which sent shares soaring 11.81%.
  • Under Armour rocketed 23.33% higher after its cost-savings plan paid off last quarter and management guided for a strong quarter ahead.
  • Planet Fitness surprised shareholders with a solid quarter for the gym giant, as well as forecasts of more growth ahead. Shares climbed 11.26%.
  • Prison operators GEO Group and CoreCivic both surged on Trump’s election, and their rally continued today—in-spite of very different paths forward for each stock. GEO Group gained 13.63%, while CoreCivic rose 25.60%.

What’s down

  • Trump Media & Technology Group was one of the biggest winners on election night, and although the stock soared over the last few days, investors decided to take profits today. Shares sank 22.97%.
  • Wolfspeed plummeted 39.24% after announcing larger-than-expected losses last quarter, poor forecasts for next quarter, and layoffs to cut costs.
  • Match Group shareholders were heartbroken to hear that Tinder’s revenue fell last quarter, though strong revenue growth from Hinge helped ease the pain. Shares dropped 17.87%.
  • Virgin Galactic isn’t just a mean nickname from your high school years—it’s also a space stock that can’t make money to save its life. Shares fell 11.87%.

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Here’s where the major benchmarks ended:

  • The S&P 500® index (SPX) rose 44.06 points (0.74%) to 5,973.10; the Dow Jones Industrial Average® ($DJI) fell 0.59 points (0.00%) to 43,729.34; and the NASDAQ Composite® ($COMP) gained 285.99 points (1.51%) to 19,269.46.
  • The 10-year Treasury note yield (TNX) fell nine basis points to 4.34%, with most of the drop coming long before the Fed decision.
  • The CBOE Volatility Index® (VIX) continued its post-election plunge to 15.21.

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

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INVESTING NEWS: Stocks, Bonds, Oil, Gold, Bitcoin and Sectors Review Post Election

By Staff Reporters

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BREAKING NEWS!

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  • Stocks surged and stayed higher all yesterday day on news of Donald Trump’s presidential victory. The Dow rocketed over 1,350 points as soon as markets opened, and all three indexes ended the day at record highs.
  • Treasury yields have paralleled Trump’s chances of taking the White House for the last few weeks, and his election sent them soaring to over 4.46% at one point today.
  • Oil and gold both fell as the dollar rose after Trump’s win. The greenback popped on the promise of Trump’s protectionist tariff policies and the lower likelihood of the Fed cutting interest rates as fast as previously expected.
  • Bitcoin surged as traders celebrated the beginning of the new, friendlier regulatory environment that Trump promised during his campaign.

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Sector check-up

  • Financials were the biggest sector mover Wednesday, up 6.16%, hitting a new high.
  • Industrials were up 3.93% Wednesday, hitting a new high.
  • Energy was up 3.54% in the session. It’s now 4.28% from the April high.
  • Real Estate fell 2.64% during trading. It’s now 5.6% from the high. 
  • Consumer Staples fell 1.5%. The sector is 5.76% from the September high.
  • Utilities fell 1%. It’s now 5.72% from the mid-October high.
  • Duke Energy was flat over the past three months, and it is 6.3% from the October high.

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PHYSICIAN PERSONAL COACHING: Financial Planning and Retirement Consulting

SPONSORED BY: http://www.MarcinkoAssociates.com

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Most doctors report feeling overworked and are considering a change in career, according to a new poll.

Doximity, a virtual network for physicians, found that 81% doctors surveyed last fall said they felt overworked—a slight decline from 86% who reported burnout in 2022 but still up from 73% in 2021. Meanwhile, about three in five doctors said they were considering early retirement (30%), looking for another employer (15%), or leaving the profession altogether (14%), the poll found.

The findings, released last year, come amid reports of rising rates of physician burnout and dissatisfaction since after the Covid-19 pandemic.

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DAILY UPDATE: Record Stock Market Blast Off Post Trump Presidential Election

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

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SPONSORED BY: Marcinko & Associates, Inc.

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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. 2024

REFER A COLLEAGUE: MarcinkoAdvisors@msn.com

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

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

Stocks Up

  • One more group of stocks that soared on a Trump election: Big Tech companies with antitrust problems. Another Trump presidency should go a long way toward clearing up the regulatory hurdles many companies have faced recently, which is why Alphabet popped 3.99% and Amazon rose 3.8%.
  • CVS Health surged 11.33% after meeting revenue forecasts but missing earnings expectations. However, the miss was due to a one-time charge, so shareholders quickly forgave the healthcare retailer.
  • Planet Fitness gained 6.09% on a surprise bid for bankrupt fitness chain Blink Holdings in an attempt to bolster its own gym business.

Stocks Down

  • Super Micro Computer had a chance to show the world it wasn’t committing the fraud it has recently been accused of. Instead, the company announced it is still unable to determine when it will file the quarterly report due August 29. Shares crashed 18.05%.
  • Home builder stocks sank on fears that a Trump presidency will slow the rate of Fed rate cuts, keeping mortgage rates higher for longer. DR Horton fell 3.8%, Lennar dropped 4.84%, Pulte Group lost 3.09%, and Toll Brothers tumbled 1.46%.
  • Cannabis stocks were betting big on a ballot measure in Florida to allow the sale of recreational marijuana. The initiative’s failure sent shares of Curaleaf plummeting 29.17%, Trulieve Cannabis plunged 38.8%, and Ayr Wellness sank 55.87%.

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Here’s where the major benchmarks ended:

  • The S&P 500® index (SPX) rose 146.28 points (2.53%) to 5,929.04; the Dow Jones Industrial Average® ($DJI) added 1,508.05 points (3.57%) to 43,729.93; and the NASDAQ Composite® ($COMP) gained 544.29 points (2.95%) to 18,983.47—a new closing high. 
  • The 10-year Treasury note yield (TNX) surged 14 basis points to 4.43%, its highest level since July.
  • The CBOE Volatility Index® (VIX) fell sharply to 16.3 as election-related uncertainty diminished.

CITE: https://tinyurl.com/tj8smmes

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

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HINDSIGHT BIAS: The “Curse of Knowledge”

By Staff Reporters

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The Curse of Knowledge and Hindsight Bias

Similar in ways to the availability heuristic (Tversky & Kahneman, 1974) and to some extent, the false consensus effect, once you (truly) understand a new piece of information, that piece of information is now available to you and often becomes seemingly obvious. It might be easy to forget that there was ever a time you didn’t know this information and so, you assume that others, like yourself, also know this information: the curse of knowledge.

Cite: https://medicalexecutivepost.com/2022/11/18/what-is-the-dunning-kruger-effect/

However, according to colleague Dan Ariely PhD, it is often an unfair assumption that others share the same knowledge. The hindsight bias is similar to the curse of knowledge in that once we have information about an event, it then seems obvious that it was going to happen all along.

I should have seen it [divorce, stock market crash/soar my smoking & lung cancer, unemployment, etc] coming!

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