Appreciating the Six Types of Investment Fees

dr-marcinkoDR. DAVID EDWARD MARCINKO MBA MEd CMP

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Investment fees matter. They can make a big difference to your financial health in the long run. Before you put money into any investment, it’s vital to uncover the real costs.They typically include these six types of fees:

1. An up-front commission earned by the salesperson or their firm. Don’t rely on a vague assurance or a verbal answer: get a specific number in writing.If you have trouble getting a number, ask, “If I buy this investment today and want to get out tomorrow, how much do I get back?” If the answer is not “all your money,” the difference is probably the upfront fees and commissions.

I don’t recommend purchasing financial products with significant upfront commission or costs. I have seen investments where these fees run as high as 30% of the money invested. If you were to earn 5% a year on the investment, it would take 8 years just to break even.

2. Ongoing advisory fees. These are monthly, quarterly, or annual fees you pay advisors for their investment advice and oversight. This includes working with you to pick the asset classes, set the diversification, select the managers, tax optimization, rebalancing, and other periodic tasks.

This fee can have many names including wrap fee or investment advisory fee. The normal “rule of thumb” is 1% of the assets the advisor is managing, although fees can range from 0 to 7%. This fee can be charged to you even if the advisor receives an upfront commission. It can be easy to see or hidden away in the fine print of the investment.

3. Additional fees for services. Find out specifically what services are included in the advisor fee. Additional fees for financial planning or ancillary services are rarely disclosed or discussed.

Services can range from minimal hand-holding only focused on your investments to comprehensive, holistic financial planning. Amazingly, there is no correlation between price and the breadth of services. That’s illogical, but the financial services industry gets away with this, in part because consumers don’t do their homework.

4. Ongoing fees charged by the managers of the specific funds or investment products. These fees are referred to as the fund’s expense ratio. This comes out of the profits generated by the manager, and it is one of the hardest fees to find. Only the most transparent advisor or salesperson will disclose it. It is incredibly well hidden; you will never see it in your brokerage statements or your advisor’s invoices. The only way to know the amount of this fee is to read the prospectus or some other third party analysis of the investment, like Morningstar.

These fees can vary greatly for the same investment, depending on the class of share you buy. For example, American Fund’s New Perspective Fund’s expense ratio ranges from0.45% to 1.54%.  The average expense ratio of a mutual fund that invests in stocks is 1.35%. Conversely, the average expense ratio of a Vanguard S&P 500 fund is 0.10%. The difference of 1.25% is staggering over time.

5. Miscellaneous fees. These are also rarely talked about and hard to find. Many advisors charge $50 to $100 a year per account, hundreds of dollars to open or close an account, and even fees to dollar cost average your funds into the market.

6. Transaction fees. Every time you buy or sell a fund, a fee is typically paid to a custodian. These can range from $5 to hundreds of dollars per transaction.

Assessment

Remember, it’s your job to persist until you find out the total costs of an investment. Next week I’ll suggest ways to ask the tough questions about fees.

Conclusion

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Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. https://medicalexecutivepost.com/dr-david-marcinkos-bookings/ 

Contact: MarcinkoAdvisors@msn.com

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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™

ETFs: Happy 31st. Birthday

EXCHANGE TRADED FUNDS

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Thirty one years ago yesterday, the first exchange-traded fund (ETF) in the US launched. In the decades since, these once-niche investment products have become ubiquitous on Wall Street, disrupting the mutual fund industry and transforming people’s relationship with the stock market.

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Exchange Traded Funds

On January 29th, 1993, a spider decoration hanging in the American Stock Exchange heralded the arrival of the first US ETF—what’s now called the SPDR S&P 500 ETF Trust. It had a measly $6.5 million in assets and no one really paid much attention to it. The first US ETF is now the world’s biggest, with $375 billion in assets, and the ETF sector in total had amassed $6.5 trillion in assets by the end of 2022. While mutual funds still have 3x the amount of assets that ETFs have, the tide is turning: Investors poured $600 billion into US ETFs on a net basis last year, but pulled out almost $1 trillion from mutual funds.

ETFs and Tax Efficiency

Definition: An ETF is simply a security that tracks the performance of a particular basket of investments, like stocks. The SPDR S&P 500 ETF, for example, tracks the performance of companies in the S&P 500. Many other ETFs also track indexes, allowing people to park their money in funds that follow the ebbs and flows of the broader market.

If that sounds like a mutual fund…it’s similar. But ETFs have a few advantages over its stuffy, older cousin.

  • ETFs generally have lower fees than mutual funds.
  • They have built-in tax benefits.
  • They’re accessible to anyone with a brokerage account—you can buy or sell them like you would a stock.

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Finally, all these advantages aside, the rise of ETFs has been also fueled by the growing recognition that trying to invest in individual stocks is foolish. Passive index funds, which aren’t designed for frequent trading, have surged to represent almost half of US fund assets, compared to less than 2% in the early ’90s.

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DAILY UPDATE: Medicare, Google & Meta, FTX and the Rising Markets

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FTX was ordered to pay $12.7 billion to customers. All customers will recoup their deposits that were locked when the crypto exchange went under in 2022, the Commodity Futures Trading Commission just said last Thursday.

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Read: How one-hour patient home visits allowed insurers to collect $15 billion from Medicare between 2019 and 2021. (the Wall Street Journal)

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What’s up

  • Sweetgreen popped 33.33% after a strong earnings report coupled with forecasts of higher-than-expected sales in 2024.
  • Doximity soared 38.70% thanks to a beat-and-raise quarter from the medical platform that has been investing in its own DoximityGPT AI model.
  • Nikola rose 8.21% after a surprisingly strong quarter in which sales soared 318%.
  • Unity Software jumped 8.22% despite revenue coming in lower year over year, but it was still higher than Wall Street expected.
  • Take-Two Interactive Software surged 4.35% after it beat earnings estimates last quarter, but no word yet on how its Gearbox acquisition is helping its bottom line, nor when GTA 6 is going to be released.
  • Expedia traveled 10.21% higher due to an earnings beat, with the company sidestepping a consumer spending slowdown quite nicely.

What’s down

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Here’s where the major benchmarks ended:

  • The S&P 500® index (SPX) rose 25 points (0.5%) to 5,344.16, ending the week little changed; the Dow Jones Industrial Average® ($DJI) rose 51 points (0.1%) to 39,497.54 to end the week down about 0.6%; the NASDAQ Composite® ($COMP) ended 85 points higher (0.5%) at 16,745.30, leaving it about 0.2% lower for the week.
  • The 10-year Treasury note yield (TNX) dropped five basis points to 3.944%.
  • The Cboe Volatility Index (VIX) declined three points (13%) to 20.7.

Google and Meta teamed up to target teens with ads for Instagram on YouTube, going against Google’s own rules, the Financial Times reported.

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What is Financial – Tech?

The Definition of Fin-Tech

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By Dr. David E. Marcinko MBA MEd CMP

Fintech is a portmanteau of financial technology that describes an emerging financial services sector in the 21st century.

Originally, the term applied to technology applied to the back-end of established consumer and trade financial institutions. Since the end of the first decade of the 21st century, the term has expanded to include any technological innovation in the financial sector, including innovations in financial literacy and education, retail banking, investment and even crypto-currencies like bitcoin.

BREAKING DOWN ‘Fintech’

The term financial technology can apply to any innovation in how people transact business, from the invention of money to double-entry bookkeeping. Since the internet revolution and the mobile internet revolution, however, financial technology has grown explosively, and fintech, which originally referred to computer technology applied to the back office of banks or trading firms, now describes a broad variety of technological interventions into personal and commercial finance.

Fintech’s Expanding Horizons

Already technological innovation has up-ended 20th century ways of trading and banking. The mobile-only stock trading app Robinhood charges no fees for trades, and peer-to-peer lending sites like Prosper and Lending Club promise to reduce rates by opening up competition for loans to broad market forces. Technologies being designed that should reach fruition by 2020 include mobile banking, mobile trading on commodities exchanges, digital wallets (like Apple (AAPL) and Google’s (GOOG) developing mobile wallet systems), financial advisory and robo-advisor sites like LearnVest and Betterment, and all-in-one money management tools like Mint and Level.

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New Tech in Fintech

In the olden days, individuals and institutions used the invisible hand of the market – represented by the signaling function of price – to make financial decisions. New technologies, like machine learning, predictive behavioral analytics and data-driven marketing, will take the guess work and hocus pocus out of financial decisions. “Learning” apps will not only learn the habits of users, often hidden to themselves, but will engage users in learning games to make their automatic, unconscious spending and saving decisions better. On the back end, improved data analytics will help institutional clients further refine their investment decisions and open new opportunities for financial innovation.

Fintech Users

Who uses fintech? There are four broad categories: 1) B2B for banks and 2) their business clients; and 3) B2C for small businesses and 4) consumers. Trends toward mobile banking, increased information, data and more accurate analytics and decentralization of access will create opportunities for all four groups to interact in heretofore unprecedented ways.

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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DAILY UPDATE: Data Breach Up, Novo Nordisk Down as Stock Markets Stumble

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You might be affected by one of the biggest data breaches ever and not even know it. A recent class action lawsuit filed against Jerico Pictures Inc., a background check company that does business under the name National Public Data, claims that the company was breached by hackers earlier this year.

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Here’s where the major benchmarks ended:

  • The SPX dipped 40.5 points (0.8%) to 5,199.5; the Dow Jones Industrial Average® ($DJI) fell 234.2 points (0.6%) to 38,763.45 the NASDAQ Composite ($COMP) fell 171 points (1.1%) to 16,195.8. 
  • The 10-year Treasury note yield (TNX) rose to 3.96%.
  • The Cboe Volatility Index® (VIX) inched up to 27.8, still very elevated.

What’s Up

What’s down

  • Super Micro Computer dropped 20.14% thanks to an earnings miss, as well as the announcement of a 10-for-1 stock split.
  • AirBnB tumbled 13.38% after not only missing analyst estimates last quarter, but warning of slowing demand in the coming quarter.
  • Lyft drove 17.23% lower in spite of strong ridership in the second quarter. Shareholders, however, did not like management’s dour financial forecast for the third quarter.
  • CVS Health sank 3.19% after it slashed its profit guidance for the full year, though it also announced a new cost-cutting program.
  • TripAdvisor took a trip south today, falling 16.61% due to a mixed earnings report and dire warnings of lower revenue in the coming quarter.
  • Amgen stumbled 5% after the biotech company missed Wall Street forecasts in the second quarter.

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Novo Nordisk sales thinned on Ozempic earnings miss. Shares of Danish pharmaceutical giant Novo Nordisk sank 8.27% today after the company missed expectations on its sales of popular weight-loss drugs Ozempic and Wegovy. Novo reported $1.7 billion in Wegovy sales, below the $2 billion analysts expected, while Ozempic sales came in $0.2 billion lower than analyst estimates. Overall, the company reported a net profit of $1.86 billion in the second quarter.

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About Securities Order and Position Types

A Primer for Physician Investors and Medical Professionals

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

[Editor-in-Chief] http://www.CertifiedMedicalPlanner.org

[PART 6 OF 8]

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

Introduction

At this point  in our long ME-P essay, it is important to understand the different types of orders and positions that can be used to buy and sell securities from the specialist.

Market Order:

A market order is an order to be executed at the best possible price at the time the order reaches the floor. Market orders are the most common of all orders. The greatest advantage of the market order is speed. The doctor specifies no price in this type of order, he merely orders his broker to sell or buy at the best possible price, regardless of what it may be. The best possible price on a buy is the lowest possible price. The best possible price on a sell is the highest possible price. In other words, if a medical professional customer is buying, he logically wants to pay as little as possible, but he is not going to quibble over price. He wants the stock now, whatever it takes to get it. If he’s a seller, the doctor client wants to receive as much as possible, but will not quibble, he wants out, and will take what he can get, right now. No other type of order can be executed so rapidly.

Some market orders are executed in less than one minute from the time the broker phones in the order. Because the investor has specified no price, a market order will always be executed. The doctor is literally saying, “I will pay whatever it takes, or accept whatever is offered”.

Limit Order:

The chief characteristic of a limit order is that the doctor decides in advance on a price at which he decides to trade. He believes that his price is one that will be reached in the market in reasonable time. He is willing to wait to do business until he has obtained his price even at the risk his order may not be executed either in the near future or at all. In the execution of a limit order, the broker is to execute it at the limit price or better. Better, means that a limit order to buy is executed at the customer’s price limit or lower, in a limit order to sell, at price limit or higher. If the broker can obtain a more favorable price for his doctor customer than the one specified, he is required to do so.

Order Length:

Now, even though the doctor has given his price limit, we need to know the length of effectiveness of the order. Is the order good for today only? If so, it is a day order, it automatically expires at the end of the day.  Alternatively, the doctor may enter an open or, “good until canceled” order. This type of order is used when the doctor believes that the fluctuations in the market price of the stock in which he’s interested will be large enough in the future that they will cause the market price to either fall to, or rise to, his desired price, i.e. his limit price. He is reasonably sure of his judgment and is in no hurry to have/his order executed. He knows what he wants to pay or receive and is willing to wait for an indefinite period.

Years ago, such orders were carried for long periods of time without being reconfirmed. This was very unsatisfactory for all parties concerned.  A doctor would frequently forget his order existed and, if the price ever reached his limit and the order was executed, the resulting trade might not be one he wished to make. To avoid the problem, open (GTC) orders must be reconfirmed by the doctor customer each six months. Does that mean six months after the order is entered? …No! The exchange has appointed the last business day of April and the last business day of October as the two dates per year when all open orders must be reconfirmed.

Example: Dr. Smith wants to buy 100 shares of XYZ. The price has been fluctuating between 50 and 55. He places a limit order to buy at 51, although the current market price is 54. Limit orders to buy (buy limit orders) are always placed below the current market. To do otherwise makes no sense. It is possible that, within a reasonable time, the price will drop to 51 and his broker can purchase the stock for him at that price. If the broker can purchase the stock at less that 51, that would certainly be fine with the doctor customer since he wants to pay no more than 51. A sell limit order works in reverse and is always placed above the current market price.

Example: Dr. Smith wants to sell 100 shares of XYZ stock. The order is 54. A sell limit order is place at 56. Sell limit orders are always placed above the market price. As soon as the pride rises to 56, if it ever does, the broker will execute it at 56 or higher. In no case will it be executed at less than 56.

The advantage of the limit order is that the doctor has a chance to buy at less or to sell at more than the current market price prevailing when he placed the order. He assumes that the market price will become more favorable in the future than it is at the time the order is placed. The word” chance ” is important. There is also the “chance” that the order will not be executed at all. The doctor just mentioned, who wanted to buy at 51, may never get his order filled since the price may not fall that low.  If he wanted to sell at 56, the order may also not ever be executed since it might not rise that high during the time period the order is in effect.

Stop Orders:

A very important type of order is the stop order, frequently called a stop-loss order. There are two distinct types of stop orders. One is the stop order to sell, called a sell stop, and the other is a stop order to buy, called a buy stop. Either type might be thought of as a suspended market order; it goes into effect only if the stock reaches or passes through a certain price.

The fact that the market price reaches or goes through the specified stop price does not mean the broker will obtain execution at the exact stop price. It merely means that the order becomes a market order and will be executed at the best possible price thereafter. The price specified on a stop order bears a relationship to the current market price exactly opposite to that on a limit order. Whereas a sell limit is placed at a price above the current market, a sell stop is placed at a price below the current market. Similarly, while a buy limit is placed at a price below the current market, a buy stop is placed at a price above the current market. Why would a doctor investor use a stop order?

There are two established uses for stop orders. One of them might be called protective, the other might be called preventive.

Protective: This order protects a doctors’ existing profit on a stock currently owned.

For example, a doctor purchases a stock at 60. It rises to 70. He has made a paper profit of $10 per share. He realizes that the market may reverse itself. He therefore gives his broker a stop order to sell at 67. If the reversal does occur and the price drops to 67 or less, the order immediately becomes a market order. The stock is disposed of at the best possible price. This may be exactly 67, or it may be slightly above or below that figure. Why? …Because what happened at 67 was that his order became a market order; the price he actually received was dependent upon the next activity in the market. Let us suppose that the sale was made at 66 1/2. The doctor customer made a gross profit of 6 1/2 points per share on his original purchase. Without the stop order, the stock may have dropped considerably below that before the customer could have placed a market order and his profit might have been less or, in fact, he might have even sold at a loss.

Preventive:

A doctor purchases 100 shares of a stock at 30. He obviously anticipates that the price of the stock will rise in the near future (why else would he buy?). However, he realizes that his judgment may be faulty. He therefore, at the time of purchase, places a sell stop order at a price somewhat below his purchase price, for example, at 28. As yet, he has made neither profit nor loss; he’s merely acting to prevent a loss that might follow if he made the wrong bet and the stock does fall in price. If the stock does drop, the doctor knows that once it gets as low as 28, a market order will be turned in for him and, therefore, he will lose only 2 points or thereabout. It might have been much more had he not used the sell stop.

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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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Miscellaneous Orders and Positions

Beside market, limit  and stop orders, there are some other miscellaneous orders to know.

A stop limit order is a stop order that, once triggered or activated, becomes a limit order. Realize that it is possible for a stop limit to be triggered and not executed, as the limit price specified by the doctor may not be available.

In addition, there are all or none and fill or kill orders, and even though both require the entire order to be filled, there are distinct differences. An all or none (AON) is an order in which the broker is directed to fill the entire order or none of it. A fill or kill (FOK) is an order either to buy or to sell a security in which the broker is directed to attempt to fill the entire”‘ amount of the order immediately and in full, or that it be canceled.

The difference between an all or none and a fill or kill order is that with an all or none order, immediate execution is not required, while immediate execution is a critical component of the fill or kill. Be cause of the immediacy requirement, FOK orders are never found on the specialist’s book. Another difference is that AON orders are only permitted for bonds, not stocks, while FOK orders may be used for either.

Also, there exists an immediate or cancel order (IOC), which is an order to buy or sell a security in which the broker is directed to attempt to fill immediately as much of the order as possible and cancel any part remaining. This type of order differs from a fill or kill order which requires the entire order to be filled. An IOC order will permit a partial fill. Because of the immediacy requirement, IOC and FOK orders are never found on the specialist’s book.

Long and Short Positions

A long buy position means that shares are for sale from a market makers inventory, or owned by the medical investor, outright. Market makers take long positions when customers and other firms wish to sell, and they take short positions when customers and other firms want to buy in quantities larger than the market maker’s inventory. By always being ready, willing, and able to handle orders in this way, market makers assure the investing public of a ready market in the securities in which they are interested. When a security can be bought and sold at firm prices very quickly and easily, the security is said to have a high degree of liquidity, also known as marketability.

A short position investor seeks to make a profit by participating in the decline in the market price of a security.

Now, let’s see how these terms, long and short, apply to transactions by medical investors, rather than market makers, in the securities markets.

When a doctor buys any security, he is said to be taking a long position in that security. This means the investor is an owner of the security. Why does a doctor take a long position in a security? Beside, receiving dividend income, to make a profit from an increase in the market price. Once the security has risen sufficiently in price to satisfy the investor’s profit needs, the investor will liquidate his long position, or sell his stock. This would officially be known as a long sale of stock, though few people in the securities business use the label “long sale”. This is the manner in which the above investor had made a profit is the traditional method used; buy low, sell high.

Let’s look at an actual investment in General Motors to investigate this principle further. A medical investor has taken a long position in 100 shares of General Motors stock at a price of $70 per share. This means that the manner in which he can do that is by placing a market order which will be executed at the best “available market price at the time, or by the / placing of a buy limit order with a limit price of $70 per share. The investor firmly believes, on the basis of reports that he has read about the automobile industry and General Motors specifically, that at $70 a share, General Motors is a real bargain. He believes that based on its current level of performance, it should be selling for a price of between $80 and $85 per share. But, the doctor investor has a dilemma. He feels certain that the price is going to rise but he cannot watch his computer, or call his broker, every hour of every day. The reason he can’t watch is because patients have to be seen in the office. The only people who watch a computer screen all day are those in the offices of brokerage firms (stock broker registered representatives), and doctor day traders, among others.

In the above example, with a sell limit order, if the doctor investor was willing to settle for a profit of $12 per share, what order would he place at this time? If you said, “sell at $82 good ’til canceled”, you are correct. Why GTC rather than a day order? Because our doctor investor knows that General Motors is probably not going to rise from $70 to $82 in one day. If he had placed an order to sell at $82 without the GTC qualification, his order would have been canceled at the end of this trading day. He would have had to re-enter the order each morning until he got an execution at 82. Marking the order GTC (or open) relieves him of any need to replace the order every morning. Several weeks later, when General Motors has reached $82 per share in the market, his order to sell at 82 is executed. The medical investor has bought at 70 and sold at 82 and realized a $12 per share profit for his efforts.

Let’s suppose that the medical investor, who has just established a $12 per share profit, has evaluated the performance of General Motors common stock by looking at the market performance over a period of many years. Let’s further assume that the investor has found by evaluating the market price statistics of General Motors is that the pattern of movement of General Motors is cyclical. By cyclical, we mean that it moves up and down according to a regular pattern of behavior. Let’s say the investor has observed that in the past, General Motors had repeated a pattern of moving from prices in the $60 per share range as a low, to a high of approximately $90 per share. Further, our investor has observed that this pattern of performance takes approximately 10 to l2 months to do a full cycle; that is, it moves from about 60 to about 90 and back to about 60 within a period of roughly l2 months. If this pattern repeats itself continually, the investor would be well advised to buy the stock at prices in the low to mid 60’s hold onto it until it moves well into the 80’s, and then sell his long position at a profit. However, what this means is that our investor is going to be invested in General Motors only 6 months of each year. That is, he will invest when the price is low and, usually within half a year, it will reach its high before turning around and going back to its low again. How can the doctor investor make a profit not only on the rise in price of General Motors in the first 6 months of the cycle, but on the fall in price of General Motors in the second half of the cycle? One technique that is available is the use of the short sale.

The Short Sale

If a doctor investor feels that GM is at its peak of $ 90 per share, he may borrow 100 shares from his brokerage firm and sell the 100 shares of borrowed GM at $ 90. This is selling stock that is not owned and is known as a short sale. The transaction ends when the doctor returns the borrowed securities at a lower price and pockets the difference as a profit. In this case, the doctor investor has sold high, and bought low.

Odd Lots

Most of the thousands of buy and sell orders executed on a typical day on the NYSE are in 100 share or multi-100 share lots. These are called round lots. Some of the inactive stocks traded at post 30, the non-horseshoe shaped post in the northwest corner of the exchange, are traded in 70 share round lots due to their inactivity. So, while a round lot is normally 700 shares, there are cases where it could be 10 shares. Any trade for less than a round lot is known as an odd lot. The execution of odd lot orders is somewhat different than round lots and needs explanation.

When a stock broker receives an odd lot order from one of his doctor customers, the order is processed in the same manner as any other order. However, when it gets to the floor, the commission broker knows that this is an order that will not be part of the regular auction market. He takes the order to the specialist in that stock and leaves the order with the specialist. One of the clerks assisting the specialist records the order and waits for the next auction to occur in that particular stock. As soon as a round lot trade occurs in that particular stock as a result of an auction at the post, which may occur seconds later, minutes later, or maybe not until the next day, the clerk makes a record of the trade price.

Every odd lot order that has been received since the last round lot trade, whether an order to buy or sell, is then executed at the just noted round lot price, the price at which the next round lot traded after receipt of the customer’s odd lot order, plus or minus the specialist’s “cut “.  Just like everything else he does, the specialist doesn’t work for nothing. Generally, he will add 1/8 of a point to the price per share of every odd lot buy order and reduce the proceeds of each odd lot sale order by 1/8 per share. This is the compensation he earns for the effort of breaking round lots into odd lots. Remember, odd lots are never auctioned but, there can be no odd lot trade unless a round lot trades after receipt of the odd lot order.

Part 5 of 8: About Securities “Shelf Registration”

Conclusion

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DAILY UPDATE: New Coronavirus Variant and Stock Markets Both Up

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Health tech startup Guidehealth, which assists health systems with value-based care coordination, has raised $14 million in its seed round to make further investments in technology.


Clover Health reported a net income of $7.2 million during the second quarter and raised its full-year guidance.


And … Tenet Healthcare is selling five Alabama hospitals to Orlando Health and is entering into a new revenue cycle management arrangement through Conifer Health Solution

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What’s up

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Here’s where the major stock market benchmarks ended:

  • The S&P 500 index (SPX) rose 53.7 points (1%) to 5,240.03; the Dow Jones Industrial Average® ($DJI) climbed 294.39 points (0.76%) to 38,997.66; the NASDAQ Composite ($COMP) advanced 166.77 points (1%) to 16,366,85.
  • The 10-year Treasury note yield (TNX) increased about 10 basis points to 3.88%.
  • The CBOE Volatility Index® (VIX) ended at 27.7, well above lows below 11 last month.

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A new coronavirus variant named KP.3.1.1 has risen to dominance in the U.S., almost doubling in prevalence in just two weeks, the Centers for Disease Control and Prevention reports. Experts are warning that the new variant—which, as of August 3, accounts for more than 1 in 4 U.S. COVID-19 cases—is “more of a challenge” to our immune systems compared to previous variants.

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DAILY UPDATE: Google Monopoly, Mag 7 Still Down as VIX “Fear Index” Rises and Stock Markets Plunge!

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A federal judge ruled that Google engaged in illegal practices to preserve its search engine monopoly, delivering a major antitrust victory to the Justice Department in its effort to rein in Silicon Valley technology giants. Google, which performs about 90 percent of the world’s internet searches, exploited its market dominance to stomp out competitors, U.S. District Judge Amit P. Mehta said in the long-awaited ruling.

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Stat: $900 billion. That’s the potential market value loss of the Magnificent Seven tech companies as investors shed tech stocks. The selloff comes as investors are looking for safer bets in the event of a recession. (Reuters)

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Here’s where the major benchmarks ended:

  • The S&P 500 index tanked 160.23 points (–3.00%) to 5,186.33; the Dow Jones Industrial Average® ($DJI) plunged 1,033.99 points (–2.60%) to 38,703.27; the NASDAQ Composite plummeted 576.08 points (–3.43%) to 16,200.08.
  • The 10-year Treasury note yield (TNX) dropped to 3.78%, the lowest close since June 2023.
  • The CBOE Volatility Index® (VIX) ended at 37.04, a four-year high but well-off intraday peaks above 60.

Today, the VIX reached levels not seen since early 2020 during the pandemic panic. This type of volatility can suggest oversold conditions. A higher VIX, sometimes called the “fear index,” reflects uncertainty and can suggest quicker, more intense market swings.

What’s up

What’s down

  • Apple stumbled 4.82% after Warren Buffett’s Berkshire Hathway revealed it has cut its position in the tech company by nearly 50%.
  • Nvidia fell 6.36% after a report this weekend revealed that its brand new chips will be delayed by three months or more due to design flaws.
  • Tesla sank 4.23% due to concerns about the auto maker’s global growth, despite Elon Musk’s recent positivity.
  • Intel continued to crumble, sliding 6.38% as the after-effects of its terrible second-quarter earnings report continue to be felt.
  • Bitcoin-related stocks plummeted today as cryptocurrencies were unable to avoid a major selloff. Coinbase plunged 7.32%, while MicroStrategy dropped 9.60%, and even Robinhood tumbled 8.17%.

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DAILY UPDATE: Turn Key Health, Intel, Coke and Eli Lilly

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The FDA said shortages of Eli Lilly’s popular weight loss and diabetes drugs are over.

Coca-Cola must pay $6 billion in back taxes and interest to the Internal Revenue Service, a federal tax court ruled. Coke is appealing but will pay the bill for now.

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Stat: 40.1%. That’s the percentage of people in the US who said they had “a lot of trust” in physicians and hospitals in January 2024, down from 71.5% in April 2020. (JAMA Network Open)

Quote: “We can usher people here and they can get the help that they need because the hospitals are clearly overwhelmed.”—Yolanda Gales, a program director with a Maryland County mobile crisis response team, on the opening of the county’s first 24/7 mental health centers (the Washington Post)

Read: One report says that dozens of incarcerated patients died while under the care of Turn Key Health Clinics. (the Marshall Project)

Careers in care: Indeed has a dedicated job board for healthcare pros. It features employers with top company ratings for your perusing pleasure. Check it out.*

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Stocks plunged Friday as an unexpectedly bleak jobs report had investors second-guessing the Fed’s decision to wait until September to cut interest rates. Intel suffered its worst drop in 50 years and traded at its lowest price since 2013 after it missed on earnings, announced major layoffs, and suspended its dividend.

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DAILY UPDATE: Wells Fargo and Record Stock Market Sell Off

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Here’s where the major benchmarks ended:

  • The S&P 500® (SPX) index dropped 100.12 points (-1.8%) to 5,346.56, and finished down 2.1% for the week; the Dow Jones Industrial Average® ($DJI) dropped 610.71 points (-1.5%) to 39,737.26, and finished down 2.1% for the week; the NASDAQ Composite®($COMP) fell 417.98 points (-2.4%) to 16,776.16, and ended down 3.4% for the week.  
  • The 10-year Treasury note yield (TNX) fell to 3.79%, the lowest close since last December 27.
  • The CBOE Volatility Index® (VIX) rose to 23.66, the highest close since March 2023 after topping 29, a nearly two-year high, intraday.

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Wells Fargo wealth management client is suing the company for alleged breach of fiduciary duty related to its cash sweep program, which pays customers interest rates as low as 0.05% on their uninvested cash.

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DAILY UPDATE: Intel, Colon Cancer, Fewer Cardiologists and UnitedHealth Tactics as the Stock Markets Tank!

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Stat: $895. That’s the out-of-pocket cost for a blood test that screens for colon cancer, which may receive more widespread insurance coverage now that it has FDA approval. (CNBC)

Quote: “There’s no question that the health statistics of rural America are worse than the health statistics of more urban America.”—Robert Harrington, a cardiologist and dean of Weill Cornell Medicine, on the lack of cardiologists in rural parts of the US (the Washington Post)

Read: Critics say that UnitedHealth has used questionable tactics and exploitation to achieve dominance in healthcare. (Stat)

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Intel is slashing 15% of its staff as part of a $10 billion plan to reduce costs, the tech company announced in its second-quarter earnings Thursday.

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What’s up

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DAILY UPDATE: Rite Aid, Walgreens, CVS and Blood Drops as Technology Stock Rise

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Five years after Theranos went dark, a couple of startups have managed to develop the futuristic tech, according to the Wall Street Journal.

  • Becton Dickinson developed a finger-prick device to collect drops of blood.
  • Babson Diagnostics made a machine that analyzes blood obtained through Becton’s device. It runs routine tests that you’d get at the doctor with one-tenth of the amount of blood that a traditional vein collection requires.

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Here’s where the major benchmarks ended:

  • The S&P 500® (SPX) index climbed 85.86 points (1.6%) to 5,522.30; the Dow Jones Industrial Average® ($DJI) rose 99.46 points (0.2%) to 40,842.79; the NASDAQ Composite®($COMP) added 451.98 points (2.6%) to 17,599.40.
  • The 10-year Treasury note yield (TNX) dropped four basis points to just under 4.11%. 
  • The CBOE Volatility Index® (VIX) fell to 16.36.

What’s up

  • Starbucks rose 2.65% despite missing sales forecasts, with shareholders instead focusing on bullish business projections from management.
  • Boeing ascended 2.05% in a surprise turnaround after announcing subpar earnings. Investors are enthusiastic about the appointment of Robert Ortberg as the new CEO.
  • Match Group swiped right 13.21% after the company announced plans to reduce headcount in order to help offset lower subscriber numbers.
  • DuPont rallied 4.10% as the chemical company’s turnaround plans seem to be bearing fruit.
  • Arista Networks soared 11.32% thanks to high demand from AI users for the company’s data centers.
  • AutoNation revved 6.30% higher due to impressive growth in spite of a massive car dealership cyberattack earlier this year.

What’s down

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Rite Aid has been in Chapter 11 bankruptcy since October and has closed nearly 700 locations. CVS (CVS) and Walgreens (WBA) have managed to stay solvent, but both companies have been closing stores as well.

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DAILY UPDATE: Healthcare Costs, Lobbyists and Private Equity as Technology Drowns

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In the second quarter, 14 healthcare organizations spent more than a million dollars lobbying the federal government for healthcare policy change, led by the American Hospital Association and AARP.

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Sen. Ed Markey (D-Massachusetts) and Rep. Pramila Jayapal (D-Washington) introduced strengthened legislation to rein in the actions of private equity firms that invest in healthcare facilities. The Health Over Wealth Act would require PE firms to put out reports on the facilities’ pay of executives, set up escrow accounts and receive a license from the Department of Health & Human Services prior to investing in healthcare facilities.

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The Federal Open Market Committee (FOMC) meeting ending tomorrow is widely expected to conclude with no interest rate move. Instead, it could serve as a platform to help prepare market participants for a possible cut at the September meeting.

Here’s where the major benchmarks ended:

  • The S&P 500® (SPX) index lost 27.1 points (–0.5%) to 5,436.44; the Dow Jones Industrial Average® ($DJI) climbed 203.4 points (0.5%) to 40,743.33; the NASDAQ Composite®($COMP) fell 222.78 points (–1.3%) to 17,147.42. 
  • The 10-year Treasury note yield (TNX) dropped about two basis points to 4.14%.
  • The CBOE Volatility Index® (VIX) jumped to 17.77, not far below last week’s highs.

What’s up

  • Paypal popped 8.59% after announcing impressive earnings and proving it’s got nothing to fear from Apple’s moves into the online payment world.
  • JetBlue Airways soared 12.31% thanks to a surprise profit last quarter rather than the loss analysts expected.
  • Affirm Holdings rose 2.31% due to an upgrade from “neutral” to “buy” from Bank of America analysts.
  • Tenable Holdings surged 9.30% after the cybersecurity company made it clear it’s willing to take acquisition offers.
  • F5 jumped 12.99% thanks to a beat-and-raise earnings report.

What’s down

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Visualize: A key measure of employer healthcare costs is poised for its biggest annual increase in more than a decade as more people use mental health care and get prescriptions for new, expensive drugs—yes, including Ozempic—according to a new PwC report.

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DAILY UPDATE: Bank Debt and Flat Stock Markets

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Here’s where the major benchmarks ended:

  • The S&P 500® (SPX) index rose 4.44 points (0.1%) to 5,463.54; the Dow Jones Industrial Average® ($DJI) slipped 49.41 points (–0.1%) to 40,539.93; the NASDAQ Composite®($COMP) gained 12.32 points (0.1%) to close at 17,370.20. 
  • The 10-year Treasury note yield (TNX) fell roughly five basis points to just under 4.18%.
  • The CBOE Volatility Index® (VIX) finished nearly steady but still elevated at 16.59.

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What’s up

What’s down

  • Abbott Laboratories sank 0.45% after it was ordered to pay $495 million in damages for failing to warn of the risks to premature infants drinking its formula, a far higher number than analysts expected. Shares of its peer Reckitt Benckiser fell 8.65% in sympathy.
  • Arm Holdings slipped 5.07% after an HSBC analyst downgraded the company due to its sky-high valuation.
  • Heineken fell 8.18% thanks to slower beer sales in key markets, as well as the poor performance of its investment in Chinese brewer CR Beer.
  • Loews slid 1.47% due to an announcement that CEO James Tisch will step down after 25 years at the helm.
  • 3M dropped 1.56%, falling back to Earth after the stock enjoyed its best day of trading ever last Friday.

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DAILY UPDATE: Technology Stocks

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A magnificent earnings week is on tap: Four of the Magnificent Seven—Microsoft, Meta, Amazon, and Apple—will drop their reports throughout this week.

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Technology stocks were down last week but investors are encouraged by signs that 2024’s rally—which had been underpinned by a handful of Big Tech companies—is spreading to a broader swath of the market. For instance, the industrial focused Dow Jones Industrial Average has gained for four straight weeks, and the small-cap Russell 3000 is now up 14% this year. All eyes will be on the upcoming Federal Reserve meeting and the busiest earnings week of the season.

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Donald Trump pledges to make the US “the crypto capital of the planet.” The former president pitched himself as the pro-crypto candidate in a keynote speech at the Bitcoin 2024 conference in Nashville. He told the audience that, if elected, he’d fire SEC Chair Gary Gensler (whom the crypto community accuses of waging a war on crypto) and install regulators friendly to digital tokens. He also said he’d create a strategic national crypto stockpile as part of a plan to make the US the “bitcoin superpower of the world.”

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Consider two numbers: $568.34 and $60.09. The first is Zoom’s highest closing stock price, from October 2020; the second is its stock price today. That’s an 89% decline, caused by more workers heading back into the office (even Zoom employees) and competition from rival products by Microsoft and Google.

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DAILY UPDATE: Hacking Hospitals and Urinary Catheter Scam as Broad Stock Markets Gain

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According to a recent report in the Washington Post, a $3 billion scam involving urinary catheters has brought to light serious flaws in Medicare, prompting strong calls for reform.

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Here’s where the major benchmarks ended:

  • The S&P 500 rose about 60 points (1.1%) to 5,459.10; the Dow Jones Industrial Average was up 654 points (1.6%) at 40,589.34; the NASDAQ Composite ended 176 points higher (1.0%) at 17,357.88.
  • The 10-year Treasury note yield (TNX) fell five basis points to 4.197%.
  • The CBOE Volatility Index® (VIX) slipped 10% to 16.56.

What’s up

What’s down

  • Dexcom plummeted 40.66% after management cut the diabetes monitoring company’s full-year revenue guidance.
  • Biogen sank 7.15% after European regulators denied marketing authorization for the pharma company’s new Alzheimer’s drug.
  • Weight Watchers fell 12.50% after Morgan Stanley analysts downgraded the company from overweight to equal weight based on the long-term headwinds it faces from obesity drugs.

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The US is raising alarm bells about a North Korean hacking group that broke into NASA, two US Air Force bases, and several defense companies.  The FBI, NSA and State Department just called out the North Korean hacking group “Andariel” for committing cyber espionage and using ransomware attacks on US hospitals to fund its operations. 

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Stat: 524. That’s how many employees Optum is laying off in California. (Becker’s Health IT)

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DAILY UPDATE: The US Economy of KH and Medicare [Part C] with Mixed Stock Markets

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The Wall Street Journal explores what Kamala Harris as president would mean for the economy. (the Wall Street Journal)

  • Q2 GDP was shockingly strong, with today’s reading of 2.8% growth outpacing the 2.1% economists expected.
  • The Japanese yen is rising while US tech stocks are falling.
  • You’re in my seat: Southwest Airlines is getting rid of its open seating arrangement and shifting to assigned seats.
  • 32 charts that tell you everything you need to know about markets midway through 2024 at a glance.
  • The Fed should cut interest rates at next week’s meeting, according to the former president of the Federal Reserve Bank of New York.
  • Bill Ackman is trying to turn social media stardom into profit.

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Here’s where the major stock market benchmarks ended:

  • The S&P 500® index (SPX) fell about 28 points (0.5%) to 5,399.22; the Dow Jones Industrial Average® ($DJI) rose 81 points (0.2%) to 39,935.07; the NASDAQ Composite ended 161 points lower (0.9%) at 17,181.72.
  • The 10-year Treasury note yield (TNX) dropped four basis points to 4.255%.
  • The CBOE Volatility Index® (VIX)declined 0.6% to 17.94.

What’s up

What’s down

  • Universal Music Group tumbled 23.54% after subscription and streaming revenues fell well short of analyst expectations.
  • Ford plummeted 18.40% for the automaker’s worst day of trading since 2009 after it missed profit expectations and provided no positive forecast for the quarters ahead.
  • Lululemon slid 9.09% thanks to a downgrade from Citi analysts from “buy” to “neutral” predicated on a sales slowdown.
  • Royal Caribbean sank 7.61% after the company indicated that it’s facing a slowdown in demand.
  • Edwards Lifesciences crashed 31.27% thanks to a mixed earnings report, as well as management’s guidance that sales for its key heart valve replacement therapy will sink next quarter.

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Thousands of seniors are losing coverage at local hospitals as problems plague Medicare Advantage. Lower payout rates for Medicare and Medicaid are sparking insurance companies to leave certain areas and change coverage options across the country.

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DAILY UPDATE: Digital Therapeutics, FSEDs, Medical Costs and the NASDAQ Collapse

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You’ve heard of an emergency department and an urgent care center, but have you heard of a freestanding emergency department (FSED)? While only 1% of FSEDs were freestanding in 2001, that figure jumped to 11% in 2016, totaling 566 facilities nationwide. The concept of FSEDs dates back to the 1970s, when these facilities provided emergency care to people in rural areas who didn’t have convenient access to hospitals. In 2001, there were only 50 FSEDs in the US—now there are about 745, according to 2018 research by the Emergency Medicine Network, which Herscovici worked on.

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Here’s where the major benchmarks ended:

  • The S&P 500 fell about 129 points (2.3%) to 5,427.13; the Dow Jones Industrial Average shed 504 points (1.3%) to 39,853.87; the NASDAQ Composite ended 655 points lower (3.6%) at 17,342.41.
  • The 10-year Treasury note yield (TNX) rose four basis points to 4.291%.
  • The CBOE Volatility Index® (VIX) surged 23% to 18.13.

What’s up

  • Enphase Energy gained 12.80% despite missing earnings estimates as investors cheered management’s very positive forecast for the solar company’s future.
  • AT&T phoned in a 5.22% pop after reporting a stronger than expected increase in its number of wireless subscribers, a key metric its competitor Verizon recently missed on.
  • Mattel rose yet another 9.80% as takeover rumors continue to swirl, with reports that rival toy maker Hasbro could place a competing bid.
  • Seagate Technology jumped 4.02% thanks to a strong earnings report from the hardware maker.

What’s down

  • Visa slid 4.01% after missing analyst estimates for revenue thanks to slower consumer spending.
  • AMC Entertainment Holdings fell 7.68% after the company tried to get ahead of bad news and released preliminary earnings that impressed nobody.
  • Vertiv Holdings sank 13.64% despite beating earnings estimates, with investors seemingly worried about the AI play’s sky-high valuation.
  • General Dynamics stumbled 3.32% thanks to fewer deliveries of its high-end jets last quarter.
  • Lamb Weston dropped like a hot potato, plunging 28.24% after the frozen food supplier announced earnings well below expectations and forecast a terrible second half of the year.

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The Centers for Medicare and Medicaid Services (CMS) proposed CPT payment codes for some digital therapeutics products for the first time, potentially paving a pathway toward widespread reimbursement for the nascent industry.

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In 2025, medical costs are projected to increase 8% in the group market and 7.5% in the individual market—the highest levels seen in 13 years—according to an analysis from consulting firm PwC’s Health Research Institute. The anticipated rise is mainly pinned on inflationary pressure, expensive pharmaceuticals, and an increasing number of patients seeking mental health care, analysts found.

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DAILY UPDATE: Ardent Health IPO, Davita Settles, Amex Reports with Choppy Stock Markets

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Stat: 13%. That’s how much millennial and Gen Z spending increased year over year, according to American Express earnings released last week. Amex reported slower growth in travel and entertainment compared to the previous quarter, but restaurant spending “remained strong.” (PYMNTS)

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

Here’s where the major stock market benchmarks ended:

  • The S&P 500 fell about 9 points (0.16%) to 5,555.69; the Dow Jones Industrial Average shed 57 points (0.14%) to 40,358.09; the NASDAQ Composite ($COMP) ended 10 points lower (0.06%) at 17,997.35.
  • The 10-year Treasury note yield (TNX) was unchanged at 4.255%.
  • The CBOE Volatility Index® (VIX) decreased about 2% to 14.62.

What’s up

What’s down

  • UPS delivered a 12.05% dip, falling to new all-time lows after missing analyst earnings expectations, as well as cutting its revenue forecast.
  • NXP Semiconductors plunged 7.58% on management’s poor revenue forecast for the coming quarter, despite meeting expectations this quarter.
  • Comcast sank 2.58% on a mixed earnings announcement that saw the company beat on earnings but miss revenue thanks to a slow theme parks segment.
  • GM stalled 6.43% despite announcing solid earnings—investors didn’t like to hear management note that the second half of the year will be a lot tougher.

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Kidney care giant DaVita has agreed to pay nearly $34.5 million to settle allegations that it paid kickbacks for referrals to its former DavitaRx subsidary.


And … Ardent Health was targeting a $300 million IPO but raised just $192 million.

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DAILY UPDATE: UnitedHealth Group and PBMs as Technology Stocks Soar

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Here’s where the major stock market benchmarks ended:

The Cboe Volatility Index® (VIX) fell sharply to 14.91.

The S&P 500® index (SPX) rose 59.41 points (1.1%) to 5,564.41; the Dow Jones Industrial Average® ($DJI) climbed 127.91 points (0.3%) to 40,415.44; the NASDAQ Composite® ($COMP)jumped 280.63 points (1.6%) to 18,007.57. 

The 10-year Treasury note yield (TNX) added two basis points to 4.26%.

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What’s up

What’s down

  • Crowdstrike withered another 13.46% as the fallout from what’s being hailed as the largest IT outage in history continues to punish the stock.
  • Trump Media & Technology Group dipped 0.83% during the trading session after President Biden’s announcement that he’s dropping out of the presidential race.
  • Verizon sank 6.04% after whiffing on its earnings report, missing on revenue thanks to customers holding on to their old phones for longer.
  • Ryanair crumbled 15.41% following an earnings report that revealed the company’s earnings after taxes sank an eye-watering 46% last quarter.
  • Starbucks dropped 3.43% on a report by the Wall Street Journal late last week that activist investor Elliott Investment Management has taken a stake in the coffee chain.

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The US House of Representatives Committee on Oversight and Accountability is holding a hearing tomorrow, bringing in PBMs from around the US to testify on “their role in rising healthcare costs.” The hearing comes soon after an FTC report found PBMs to have an “outsized influence” on drug pricing.

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The February cyberattack on a UnitedHealth Group subsidiary may have exposed the health data of one in three Americans, but the nation’s largest health insurance company by market cap and revenue returned to profitability in the second quarter, beating Wall Street expectations and reporting net income of $4.2 billion.

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DAILY UPDATE: Starbucks, Crowdstrike, US Banks and Charles Schwab

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Shares of Charles Schwab (NYSE: SCHW) fell over 15% last week, according to data from S&P Global Market Intelligence. One of the largest brokerages posted slow growth and poor earnings as the company deals with low-yielding assets on its balance sheet. As of 1:31 p.m. ET on Friday, July 19th, Charles Schwab stock was down 17.5% this week.

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Activist investor Elliott Investment Management has reportedly built up a substantial stake in Starbucks and has been pushing the coffee chain to improve its stock price.

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Markets: The S&P 500 logged its worst week since April as investors pulled back from Big Tech stocks. CrowdStrike fell because causing a global IT outage is not good (more on that in a sec).

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In a recent video, finance YouTuber Lena Petrova highlighted the troubling financial state of U.S. banks as they report significant losses and increase their reserves to cover a surge in loan delinquencies. With the second quarter results rolling in, it’s evident that the banking sector is under considerable strain.

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ECONOMICS: What is the “Golden Rule” Savings Rate?

And … the Solow capital motion growth model?

[By staff reporters]

In economics, the Golden Rule savings rate is the rate of savings which maximizes steady state level or growth of consumption, as for example in the Solow growth model.

Although the concept can be found earlier in John von Neumann and Maurice Allais‘s works, the term is generally attributed to Edmund Phelps who wrote in 1961 that the golden rule “do unto others as you would have them do unto you” could be applied inter-generationally inside the model to arrive at some form of “optimum“, or put simply “do unto future generations as we hope previous generations did unto us.”

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The Solow growth model

In the Solow growth model, a steady state savings rate of 100% implies that all income is going to investment capital for future production, implying a steady state consumption level of zero. A savings rate of 0% implies that no new investment capital is being created, so that the capital stock depreciates without replacement. This makes a steady state unsustainable except at zero output, which again implies a consumption level of zero.

Somewhere in between is the “Golden Rule” level of savings, where the savings propensity is such that per-capita consumption is at its maximum possible constant value.

Assessment

Put another way, the golden-rule capital stock relates to the highest level of permanent consumption which can be sustained.

Conclusion

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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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DAILY UPDATE: Crowdstrike Price, Banks and Healthcare

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CrowdStrike saw its share price plummet Friday, although it is still up ~24% YTD. At $74.2 billion, CrowdStrike has the second-largest market cap in the IT security industry, behind only Palo Alto Networks ($107.1 billion), and reported $900 million in revenue for the quarter ending in April, per Reuters. It’s got ~29,000 customers, which is part of why the outage caused so much havoc.

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Crowdstrike Banks: Some traders at JPMorgan Chase, UBS, Bloomberg, and other financial institutions couldn’t execute orders yesterday morning, with one unnamed senior trader telling the Financial Times that it was “the biggest upset in years.”

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Crowdstrike Healthcare: Many hospitals—including some of the largest in Europe and the US—were forced to cancel all elective operations, routine appointments, and walk-ins, and online portals for most UK general practitioners went down.

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DAILY UPDATE: Public Companies and the Stock Market Software Snafu Wraps Up Worst Week Since April

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42,500. That’s how many people died in car accidents in 2022, which experts believe was exacerbated during the Covid-19 pandemic, as reckless driving worsened and traffic enforcement decreased. (KFF)

“These attacks and breaches of data can literally mean the difference between life and death for patients, significantly impact hospital operations, and—with the average hack costing millions to address—increase healthcare prices across the board.”—Sen. Angus King about a bill he co-sponsored to improve cybersecurity in healthcare (Healthcare Dive)

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Here’s where the major benchmarks ended:

  • The S&P 500® index (SPX) dropped 39.59 points (–0.7%) to 5,505.00 and ended down 1.97% for the week, its worst weekly performance in three months; the Dow Jones Industrial Average® ($DJI) slipped 377.49 points (–0.9%) to 40,287.53 on Friday and finished up less than 1% for the week; the NASDAQ Composite® ($COMP)fell 144.28 points (–0.81%) on Friday to 17,726.94 and lost 3.65% for the week.
  • The 10-year Treasury note yield (TNX) rose four basis points to nearly 4.24% and finished up for the week, partly on worries about possible U.S. tariffs and their potential impact on inflation.
  • The CBOE Volatility Index closed at 16.47 after climbing above 17 intraday for the first time since late April.
  • Markets sagged under the weight of a massive IT outage, accentuating a selloff that was already in motion. All three indexes spent the day in the red, with the S&P 500 capping off its worst week since April and the NASDAQ snapping its six-week win streak.
  • The CBOE Volatility Index, a gauge of investor fear, rose to its highest level since April. The VIX is up over 25% in the last five days alone, as the small-cap rotation rally sputtered to a halt.
  • Oil took a big blow today as US Secretary of State Anthony Blinken said a cease-fire between Israel and Hamas is nearly complete.
  • Gold sold off as well as investors not only took profits after the commodity hit a new all-time high this week, but also began to rotate into riskier assets in light of a likely Fed rate cut.

What’s up

What’s down

  • SunPower transformed into a stock submarine, sinking 55.01% after the company made it clear it’s about to go out of business.
  • American Express fell faster than a greased pig on skates, sliding 2.68% after beating bottom line expectations but missing on revenue.
  • Plug Power turned into a lead balloon, descending 13.87% after management declared a $200 million stock offering.
  • Halliburton crumbled like a cookie, dropping 5.63% following a mixed earnings report that saw the fracking giant fall short of revenue expectations.
  • Travelers journeyed to the center of the Earth, burrowing 7.73% after beating earnings expectations, missing on revenue, and revealing that catastrophe losses came in higher than hoped.
  • Comerica sank like a stone, plummeting 10.50% due to lower net interest income last quarter and forecasts of lower interest income in the quarters ahead.

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It’s common for patients to delay or skip medical care due to high costs in the US—but data shows that fewer adults have done so in recent years.

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DAILY UPDATE: Public Companies and the Stock Market Technology Sell-Off

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The S&P 500 and NASDAQ both continued to sink under the weight of a tech selloff today, with semiconductors leading the way down. But even the Dow and Russell 2000, which have been the clear winners of the recent rally, took a beating today as investors assessed what a market rotation really means for them. 10-year Treasury yields bounced from recent lows as investors try to read between the lines of a full week of Fedspeak. Gold and oil both sold off a bit more today, though both remain near recent highs.

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What’s up

What’s down

  • Domino’s Pizza sank 13.42% after it missed earnings expectations last quarter and warned it will open fewer stores for the rest of 2024.
  • Beyond Meat tanked 10.32% on a report from the Wall Street Journal that management is in talks to restructure the company’s debt.
  • Eli Lilly slid another 6.24% as its selloff continues thanks to news that rival Roche Holdings is on its way to developing a weight-loss pill.
  • Nokia dropped 7.05% after posting its worst quarterly sales since 2015. Seems like nobody is buying phones with the shape and durability of a brick any more.

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Here’s where the major benchmarks ended:

  • The S&P 500 index fell 43.68 points (–0.78%) to 5,544.59; the Dow Jones Industrial Average® ($DJI) lost 533.06 points (–1.29%) to 40,665.02; the NASDAQ Composite gave up 125.70 points (–0.7%) to 17,871.22.
  • The 10-year Treasury note yield (TNX) rose about four basis points to 4.18%.
  • The CBOE Volatility Index climbed sharply to 15.9, its highest close since late April.

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PODCAST: Physician Entrepreneurial Tips on Opening Your Own Medical Practice

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By MEDICAL ECONOMICS

James Underberg, MD, discusses how he left a large health system to open his own practice, and provides tips for physicians considering the same move.

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DAILY UPDATE: UnitedHealth, Aetna, Long Covid and Physician Burnout as NASDAQ Collapses

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The Dow surged another 240 points as the cyclical rotation continues, sending the index to its 22nd record closing high of the year. The S&P 500 had its worst day since late April, while the NASDAQ slumped to its worst finish since December 2022. The last time the Dow rose on the same day the S&P 500 fell by more than 1% was all the way back in 1999. Gold hit a record high yesterday on hopes of a rate cut, not a hike. Oil bubbled up thanks to an Energy Information Administration report highlighting higher demand and lower crude inventories. Bond yields stayed steady throughout the trading session before sinking slightly 20-year Treasury bond auction.

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Here’s where the major benchmarks ended:

  • The S&P 500® index (SPX) fell 78.93 points (–1.39%) to 5,588.27; the Dow Jones Industrial Average added 243.6 points (0.59%) to 41,198.08; the NASDAQ Composite plunged 512.41 points (–2.77%) to 17,996.92.
  • The 10-year Treasury note yield (TNX) dropped just below 4.15%.
  • The CBOE Volatility Index jumped sharply to 14.48.

What’s up

  • VF Corp. rose 13.64% on the news that it is selling its Supreme brand to EssilorLuxottica for $1.5 billion.
  • Roche soared 7.55% after the Swiss pharmaceutical company announced it has made strides in developing a weight-loss and diabetes treatment that uses a pill rather than an injection. Competitors sank on the news, with Eli Lilly declining 3.78% and Novo Nordisk falling 3.87%.
  • GitLab popped 9.34% on a report that the software developer is exploring a sale, potentially to cloud company Datadog, whose shares fell 7.35%.
  • Johnson & Johnson rose a tepid 3.67% thanks to a mixed earnings announcement that included beating expectations this quarter but warning of lower profits ahead.

What’s down

  • Spirit Airlines descended 10.76% to a new all-time low after warning that both earnings and revenue will come in lower than expected this coming quarter.
  • Five Below plummeted 25.05% after its CEO, who has helmed the company for over a decade, announced his departure smack in the middle of a very difficult year.
  • J.B. Hunt tanked 6.88% thanks to a poor second-quarter earnings report in which earnings and revenue came in well below analyst expectations.
  • Charles Schwab fell yet another 5.34% as the hits keep coming. Today, the culprit was a price target downgrade from Bank of America analysts.
  • Elevance Health slipped 5.96% despite beating analyst expectations this quarter, but warning that Medicaid membership declined.

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UnitedHealth Group has bounced back in the second quarter, reaffirming its guidance for the year as it posts a profit of $4.2 billion


An audit of Aetna Health of Texas found significant errors in how the health plan calculated the qualifying payment amount for air ambulance services, raising more questions over broader noncompliance in the industry for the No Surprises Act.


And … clinical decision software company Regard pocketed $61 million in series B funding to scale its reach in healthcare as investors have a growing appetite for AI-powered startups.

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A study published in JAMA this month found that nearly 7% of the US population (or roughly 18 million people) have had long Covid. Symptoms of the condition vary widely, but often include fatigue, brain fog, and post-exertional malaise (meaning symptoms worsen after minimal exertion), according to the CDC. Booster shots may help protect against long Covid, the JAMA study suggested.

And, President Joe Biden tested positive for COVID-19 while campaigning in Las Vegas with ‘mild symptoms’.

Physician burnout is on the decline after spiking to unprecedented levels during the Covid-19 pandemic, according to a survey from professional group the American Medical Association (AMA).

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DAILY UPDATE: Apple, Macy’s, Goldman, Banks, Companies and the Roaring DJIA

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  • The Dow jumped 700 points at one point today, its biggest single-day surge this year. The S&P 500 spent the entire trading session in positive territory, ending the afternoon at another record close, while the NASDAQ was flat most of the day as tech stocks sat out the rally.
  • Bitcoin continued to surge, rising as high as $65,191 as predictions of a second Trump presidency helped erase the cryptocurrency’s recent losses.
  • Gold hit a new record as hopes of a rate hike continue to rise, while oil sank on the news of slower economic growth in China translating to lower demand for crude.
  • The Russell 2000 enjoyed its 5th straight gain of 1% or more for the first time since 1979 as small caps make their comeback (more on that below).

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Apple released public beta versions of the newest software for iPhone, Mac, iPad, and Apple Watch. Macy’s ended talks of a buyout with investment firms Arkhouse Management and Brigade Capital Management after months of wrangling. Goldman Sachs was the latest big bank to benefit from rebounding investment banking fees as deals start making a comeback.

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Despite such challenges as high interest rates, a sluggish M&A market, and increased regulatory scrutiny, bank executives are feeling optimistic about the road ahead. That’s according to KPMG’s 2024 US Banking Industry Outlook Survey, published last month, which polled 200 senior executives at US banks of varying sizes in March 2024.

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Here’s where the major benchmarks ended:

  • The S&P 500® index (SPX) rose 35.98 points (0.64%) to 5,667.20; the Dow Jones Industrial Average® ($DJI) climbed 742.76 points (1.85%) to 40,954.48; the NASDAQ Composite® ($COMP) added 36.77 points (0.2%) to 18,509.34.
  • The 10-year Treasury note yield (TNX) fell slightly to just under 4.17%.
  • The CBOE Volatility Index® (VIX) ticked up to 13.19, still near three-week highs.

What’s up

  • Match Group climbed 7.46% after activist investor Starboard Value revealed it has taken a 6.6% stake in the matchmaking company.
  • Bank of America rose 5.35% on strong earnings, and management’s expectation that the bank’s net interest income will rise this year.
  • UnitedHealth Group popped 6.49% after beating analyst earnings estimates, missing revenue expectations, and most importantly, avoided higher costs after a recent cyberattack.
  • Shopify surged 8.57% thanks to an analyst upgrade from “neutral” to “buy” on the company’s turnaround efforts. Shares of Etsy rose 6.33% in sympathy.
  • GRAIL boomed 24.76% on the news that it is kicking off the clinical trials of its new cancer detection test.
  • Home builders’ hot streak continues: Hopes of a rate cut are fueling a rally for home builder stocks, with D.R. Horton up 6.64%, Lennar rising 6.55%, KB Home gaining 7.17%, and Builders FirstSource popping 8.11%.

What’s down

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DAILY UPDATE: PBMs Scrutinized as Companies Report and Stock Markets Rotate

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Though the accountant shortage is still a concern, a shortage of AI and tech skills might be a more pressing issue right now. That’s according to a pulse survey by consulting firm RGP and YouGov, which polled 213 US financial professionals at the director level and above this June.

Read: What do you do when you hit your insurance deductible? Some people throw parties. (the New York Times)

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Here’s where the major benchmarks ended:

  • The S&P 500® index (SPX) rose 15.87 points (0.28%) to 5,631.22; the Dow Jones Industrial Average® ($DJI) climbed 210.82 points (0.53%) to 40,211.72, a new record-high close; the NASDAQ Composite® ($COMP) added 74.12 points (0.4%) to 18,472.57. 
  • The 10-year Treasury note yield (TNX) gained four basis points to just below 4.23%.
  • The CBOE Volatility Index® (VIX) increased to 13.14, its highest close since June 24.

What’s up

  • Bitcoin-related stocks rose alongside the crypto rally today, with Coinbase up 11.39% and Microstrategy climbing 15.36%.
  • Gun manufacturers always rise after a major shooting incident, and the assassination attempt on Donald Trump certainly meets that criteria. Sturm, Ruger & Company jumped 5.44%, and Smith & Wesson rose 11.38%.
  • Stelco Holdings rocketed 73.98% higher on the news that the Canadian steelmaker will be acquired by Cleveland Cliffs for $2.8 billion.
  • AutoNation popped 2.01% on the news that it’s cutting $1.50 off of its EPS for the latest quarter due to the CDK cyberattack. Apparently getting ahead of the bad news is actually good news?

What’s down

  • Macy’s sank 11.76% after the department store’s board voted to end acquisition negotiations with activist investors Arkhouse and Brigade.
  • Burberry fell 16.08% after a poor quarterly report, a profit warning, and the ousting of its CEO.
  • AES plummeted 10.01% thanks to a storm cutting power to thousands of the utility company’s customers throughout Ohio.
  • SolarEdge Technologies dropped 15.36% after the company announced it will lay off 400 employees to improve profitability. Shares of solar competitors slumped in sympathy: First Solar fell 8.50%, Sunrun sank 8.95%, and Sunnova Energy fell 9.96%.

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The Federal Trade Commission (FTC) frequently sets its sights on healthcare, which has previously included efforts to crack down on data privacy and ban noncompetes in contracts. Lately, the agency has turned its attention to pharmacy benefit managers (PBMs)—the groups that negotiate drug prices between insurers and pharmaceutical manufacturers—to shed light on how they impact the healthcare industry.

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Stat: 23.5%. That’s how much Covid-related emergency room visits increased in a week at the beginning of this month. (CDC)

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DAILY UPDATE: Delta Airlines with Stock Market Recap

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Americans are traveling in record numbers this summer, but Delta Air Lines said Thursday that it saw second-quarter profit drop 29% due to higher costs and discounting of base-level fares across the industry. The airline is also predicting a lower profit than Wall Street expects for the third quarter.

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Dramatic photos from the aftermath of the Trump shooting.

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  • Markets: Stocks swung upward finishing the week strong. The Dow closed above 40,000 for the second time ever. And, investors expect the stock market to get a jolt of volatility this week following the assassination attempt on former President Trump, and trades linked to his victory in November (such as a rising US dollar) could see an uptick. For example, Trump has fashioned himself into a pro-crypto candidate, and bitcoin spiked above $62,000 after the shooting.
  • Finance: Big banks kicked off the Q2 earnings season, with JPMorgan, Citigroup, and Wells Fargo reporting. Investment banking revenue was up as deals have started coming back, even as continued high interest rates took a toll on their loan and deposit businesses. Wells Fargo, which relies most on the businesses hit by inflation, saw its profit drop year over year. Investors are wary: All three banks’ stock fell.

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Alphabet is close to acquiring cybersecurity startup Wiz, according to the Wall Street Journal. The $23 billion purchase price would be the largest in the company’s history.

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DAILY UPDATE: Assassination Attempt on the President

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Good Sunday Morning

A brief note on yesterday’s shocking events at the Donald J. Trump Rally.

A shooting at a Pennsylvania rally in Butler County for former President Trump has officially been deemed an assassination attempt, the FBI confirmed. Trump said he was shot in the ear but is “fine,” according to a spokesperson, while the alleged gunman and one rally attendee are dead.

Moreover, Texas Rep. Ronny Jackson, who was former President Donald Trump‘s White House doctor, revealed that his nephew was ‘grazed in the neck’ by a bullet at the Butler, Pennsylvania rally. 

Authorities identified the gunman as a 20-year-old man from Bethel Park, a town about an hour’s drive from the site of the shooting. Leaders in the US and around the world offered their support to Trump and condemned political violence as the Secret Service faces questions about the security failure.

Therefore, we will re-post related articles on workplace violence, prisons, mental health and psychological turmoil etc; addressing our core but non-political topics. Unite and stay strong. Thank You!

David Edward Marcinko [Editor-in-Chief]

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DAILY UPDATE: Corporate Earnings, Oxendine Guilty as Stock Markets Rotate

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Here’s where the major stock market benchmarks ended:

  • The S&P 500® index (SPX) rose 30.81 points (0.5%) to 5,615.35, up 0.9% for the week; the Dow Jones Industrial Average® ($DJI) rose 247.15 points (0.6%) to 40,000.90, up 1.6% for the week; the NASDAQ Composite® ($COMP) added 115.04 points (0.6%) to 18,398.44, up 0.3% for the week. Both the SPX and $DJI set intraday record highs today.
  • The 10-year Treasury note yield closed basically unchanged just below 4.19%.
  • The CBOE Volatility Index® (VIX) fell slightly to 12.49.

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What’s up

  • Trump Media & Technology Group climbed 3.40% as President Biden’s recent stumbles seem to be breathing new life into the stock.
  • Tesla rose 2.99%, nearly recovering from yesterday’s drop over robotaxi delays, despite a UBS analyst downgrading the company to “sell.”
  • Deckers Outdoor recovered 1.14% when the board announced a 6-for-1 stock split just a few days after M Science analysts warned investors away from the company.
  • Array Technologies popped 8.69% thanks to an upgrade from Citi analysts from “neutral” to “buy” citing the company’s strong long-term prospects. Competitor Enphase Energy jumped 6.85% in sympathy.
  • Carvana soared 4.80% after BTIG analysts initiated coverage of the company with a “buy” rating and a price target 7% higher than where shares trade today.
  • Home builder stocks continued their climb today on higher hopes of rate cuts. D.R. Horton rose 2.68%, Builders FirstSource jumped 3.99%, and even Home Depot got in on the action and rose 1.70%.

What’s down

  • AT&T slid 0.21% after Ma Bell announced that hackers had stolen information about virtually every single one of the cell carrier’s customers. Shares of cybersecurity company Snowflake sank 1.74% on the news as well.
  • Delta Air Lines fell another 3.06% as turbulence throughout the airline industry continued to weigh the stock down.
  • Arbor Realty Trust plummeted 17.03% after the Justice Department announced a probe of the company due to improper lending practices.
  • Vita Coco dropped 9.07% thanks to a downgrade to “neutral” from Piper Sandler analysts. Are you telling me that a company that just sells coconut water isn’t actually worth $1.58 billion? Now that’s just vita loco!

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Here’s a list of some corporate earnings announcements next week:

  • Monday: Goldman Sachs, BlackRock.
  • Tuesday: Bank of America, Morgan Stanley, PNC Financial Services, and Charles Schwab. We’ll also hear from UnitedHealth Group, Progressive, and J.B. Hunt.
  • Wednesday: ASML, Citizens Bank, Ally Financial, Synchrony Financial, and U.S. Bancorp will wrap up the big financial names. Plus Johnson & Johnson, Kinder Morgan, United Airlines, and Alcoa.
  • Thursday: The busiest day of the week includesNetflix, Domino’s Pizza, Abbott Laboratories, Nokia, D.R. Horton, Intuitive Surgical, and much more.
  • Friday: The week wraps up with American Express, Schlumberger, and Halliburton.

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A federal judge on Friday sentenced former Georgia Insurance Commissioner John Oxendine to serve three and a half years in prison after Oxendine pleaded guilty to healthcare fraud. U.S. District Judge Steve Jones, at a hearing in Atlanta, also ordered Oxendine to pay a $25,000 fine and to share in $760,000 in restitution with Dr. Jeffrey Gallups.

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What is the PRODUCER PRICE INDEX?

By Dr. David E. Marcinko MBA MEd CMP®

CMP logo

SPONSOR: http://www.CertifiedMedicalPlanner.org

DEFINITION: The PPI is a group of indexes that measure the change, over time, in the prices received by domestic producers of goods and services. It measures price changes from the perspective of the seller rather than the consumer, as with the CPI. The CPI would include imported goods, while the PPI is relevant to U.S. producers, and therefore would not include imports.

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The PPI measures over 10,000 products and services. It reports the price changes prior to the retail level. This information is useful to the government in formulating fiscal and monetary policies. The data gathered from the PPI is often used in escalating purchase and sales contracts. That is the dollar amount to be paid at some time in the future.

NOTE: Long-term managed medical care contracts of the future will seek escalation clauses for increases in prices.

BLS: https://www.bls.gov/pPI/

full report: https://www.bls.gov/news.release/pdf/ppi.pdf

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DAILY UPDATE: Pfizer, MSFT and the NASDAQ Collapse

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As drugs like Wegovy and Zepbound that help people slim down have enlarged its competitors’ bottom lines, Pfizer has struggled to keep up. But now it’s moving forward with the development of a once-daily version.

Here’s where the major benchmarks ended:

  • The S&P 500 index fell 49.37 points (0.8%) to 5,584.54; the Dow Jones Industrial Average® ($DJI) rose 32.39 points (0.1%) to 39,753.75; the NASDAQ Composite® ($COMP) collapsed and lost 364.04 points (1.95%) to 18,283.41 but remains up 22% year to date. The SPX is still up 17% this year.
  • The 10-year Treasury note yield dropped eight basis points to 4.19%.
  • The CBOE Volatility Index® (VIX) climbed to 12.99.

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  • More specifically, the S&P 500 and NASDAQ broke their winning streaks today, closing in the red for the first time in over a week—though both did hit intraday highs at one point. The Dow finished the afternoon in the green, just barely.
  • Gold breached $2,400, and is closing in on a record high of $2,449.89 set back in May.
  • Oil rose on today’s CPI news, with the idea being that if inflation slows and the Fed cuts rates then economic activity will pick up, as will demand for crude.
  • Bond yields sank on CPI data while prices rose.

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According to the Wall Street Journal, Microsoft abandoned its post as an observer on the board after realizing it was bothering antitrust officials who were looking into the relationship between the two companies. Apple, which was expected to take a similar seat on the OpenAI board, will reportedly no longer do s

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Medical Franchises, MLM and In-Office Dispensation

BY Dr. DAVID EDWARD MARCINKO MBA MEd CMP

http://www.MARCINKOASSOCIATES.com

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Healthcare Business and Medical Franchises

The International Franchise Association (IFA) estimates that that about $1 trillion in sales, or 40% of all retail sales, were made through franchised establishment last decade. On the positive side, franchises offer a branded practice concept with management training and access to proprietary methods, marketing and advertising campaigns and a host of support. Moreover, there are franchises available for virtually every healthcare product or service, including: diet, weight loss and fitness; vein care and laser surgery; vitamins, nutriceuticals and pharmaceuticals; plastic and cosmetic surgery; dermatology, tanning and skin care; home healthcare and extended, etc.

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Some well know established healthcare and medical franchises are: Doctors Express, Being There Senior Care, Home Care Assistance, Personal Training Institute, Inches-A-Weigh, Remedy Intelligent Staffing, Visiting Angels, Unlimited MedSearch, prnYourHealth and Any Lab Test Now.

On the downside, franchises incur high start-up costs, rules and obligations, payment of franchise percentages and many contractual obligations.

Questions to consider when contemplating this business entity include:

 Franchise stability, track record, licensing and costs.
 Training, support and proximity of other franchises.
 Independence, ownership laws, contracts and dispute resolutions,
 Screening methods, market size and potential market share.
 Replacement cost and transferability?

For more information on Uniform Franchise Offerings Circulars (UFOCs) contact:

Frandata
1130 Connecticut Avenue, NW
Washington DC 20036
202.659.8640

International Franchise Association7
1350 New York Avenue, NW
Washington, DC 20005
202.628.800

Multi-Level Marketing and In-Office Dispensation


A multi-level marketing (MLM) business delivers products or services through a chain of independent distributors rather than traditional retail business outlets. Existing medical practices not only pursue income ancillary, but it is not unusual for beginning practitioners to plan for and include it in their start-up models and business plans.

The first layer is usually the distributor who must sell products/services and recruit additional members to produce a hierarchical organization with many employees. Each distributor profits from direct sales, and from a varying commission stream down-line. It may be best to investigate before you leap into these situations since some may be fraudulent pyramid schemes that sell no useful product or service, and requires only recruiting others into the scheme. Be sure to obtain a Dunn & Bradstreet or TRW credit
report about any MLM company and inquire about current litigation. Most authorities agree that it take 3-5 years before serious money is made in the MLM business.

Moreover, care must be taken with this model. According to colleague Stephen Barrett MD, writing on the Mirage of Multilevel Marketing: “Many any physicians are selling health-related multi-level products to patients in their offices. The companies most involved have included Amway (now doing business as Quixtar), Body Wise, Nu Skin (Interior Design), Rexall, and Juice Plus+. Doctors are typically recruited with promises that the extra income will replace income lost to managed-care.

Back, in December 1997, the AMA Council on Ethical and Judicial Affairs (CEJA) advised against profiting from the sale of “non- health-related products” to their patients. Although CEJA’s policy statement does
not mention products sold through multilevel marketing, CEJA’s chairman said the statement was triggered by the growing number of physicians who had added an Amway distributorship to their practice.”

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DAILY UPDATE: Tesla, PBMs, Medicare Part C and the Hot Stock Markets

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A day before the June CPI report, major indexes extended their rally amid growing demand for semiconductors and rate cut hopes.

  • The S&P 500 rose above 5,600 for the first time ever, only a few short days after breaking above 5,500, with the index hitting a new record for the last seven straight trading sessions. The NASDAQ also enjoyed a solid day as well thanks to strong performances by tech stocks, while even the Dow got in on the action and ended the session in the green.
  • Bond yields stayed almost right where they’ve been all week as investors hold their breath ahead of tomorrow’s key CPI reading.
  • Gold rose as investors hope for a strong CPI report to point the Fed toward more rate cuts, while oil rose as well thanks to a stronger-than-expected outlook on global demand from OPEC.

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The Centers for Medicare & Medicaid Services (CMS) announced in June it would recalculate 2024 Medicare Advantage (MA) star ratings for all plans after two court rulings called into question the agency’s method for determining this year’s ratings. The decision is estimated to cost the federal agency roughly $1 billion in additional bonus payments for insurers, according to healthcare analytics firm Cotiviti. The move comes after several large insurers laid off employees in late 2023 after their star ratings decreased.

HIPAA: Some groups are disputing a proposed federal rule that would require hospitals to report cybersecurity incidents, saying they want it to also include insurers and third-party vendors. (Healthcare Dive)

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What’s up

  • Taiwan Semiconductor rose 3.54% after it reported that its June revenue fell 10% month over month, but its sales rose roughly 33% year over year.
  • Advanced Micro Devices popped 3.87% on the news it is acquiring Silo AI, the largest private artificial intelligence lab in Europe, for $665 million.
  • Carvana drove 4.21% higher after Needham analysts upgraded the stock from “hold” to “buy” due in part to new features at checkout highlighting EVs. Competitor CarMax jumped 6.42% in sympathy.
  • Aehr Test Systems rocketed 24.01% after the semiconductor testing equipment maker raised earnings guidance thanks to strong AI demand.
  • Smart Global Holdings rose 26.27% thanks to earnings that beat Wall Street expectations in the third quarter and a strong outlook for the rest of the year.

What’s down

  • LegalZoom plummeted 25.35% to a new all-time low after the company cut its outlook and its CEO stepped down.
  • HubSpot sank 12.24% on a report that Alphabet is no longer interested in acquiring the company.
  • Intuit dropped 2.57% on the news that the tax prep company is cutting 10% of its workforce.
  • Deckers Outdoor fell 4.86% after M Science analysts published a note cautioning that sales for key brands UGG and HOKA fell in June.
  • Ziff Davis fell 10.32% after the digital media company tried to get ahead of the bad news and pre-announced that second-quarter earnings will fall below analyst expectations.
  • Fast-casual restaurant stocks continued to sink today as investors grow more concerned about lower consumer spending and higher valuations. CAVA Group fell 5.47%, Sweetgreen dropped 1.72%, and Dutch Bros fell 4.34%.

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Tesla’s US electric car market share fell below 50% in Q2 for the first time, according to estimates by the research firm Cox Automotive.

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In a scathing report, the Federal Trade Commission accused [PBMs] pharmacy benefit managers—the companies that act as go-betweens for drug makers and consumers—of jacking up drug prices

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Why a Physician’s Charitable Contribution was Denied

Setty Gundanna Viralam et ux. v. Commissioner

[A Case Model]

By Children’s Home Society of Florida Foundation

In Setty Gundanna Viralam et ux. v. Commissioner; 136 T.C. No. 8; No. 21355-03 (13 Feb 2011), the Tax Court denied a deduction for a charitable gift to an organization maintaining donor advised funds for doctors. In addition to not receiving the charitable deduction, the doctor was subject to capital gains tax on sale of the stock and an accuracy-related penalty.

Physician Example

Dr. Viralam is a medical practitioner. In 1998, Dr. Viralam sold his 50% interest in a medical practice for $2,262,500, producing a taxable gain of $2,261,750. Dr. Viralam had joined a membership organization of doctors named Xelan. He paid a $975 membership fee for the “Xelan tax reduction plan.”

Xelan Foundation

Based upon promotional materials that promised “a tax reduction” program, Dr. Viralam transferred appreciated stock to the Xelan Foundation (“Foundation”) in 1998. The Foundation indicated that Dr. Viralam could create an account described variously as a “donor advised fund” or “family public charity.” The fund was available for “charitable giving, income tax reduction planning, estate tax reduction, educational funding and future retirement planning.”

The Xelan Foundation had been recognized by the IRS as a public charity and was included in IRS Publication 78. In addition, the Foundation had obtained an opinion letter from the Conner & Winters law firm on deductibility of gifts. In their opinion letter, Conner & Winters suggested that gifts to the Foundation were more likely than not to be deductible. However, the opinion letter declined to issue an opinion on the specific grants or educational programs of the Foundation donor advised funds.

The Gifting Mechanism

Following Dr. Viralam’s gift of stock with fair market value of $262,433 and cost basis of $131,360, the Foundation sold the gifted stock and provided him with a receipt. The receipt included the Sec. 170(f)(8) statement that “no goods or services” were transferred in exchange for the gift.

At the recommendation of Dr. Viralam, the Foundation accountant distributed $15,500 to religious organizations for the next two years. However, his Foundation account also made distributions to the University of Pennsylvania of $70,299. Dr. Viralam’s son Vinay was at that time a student at that university. The IRS audited Dr. Viralam and issued a notice of deficiency for 1998. The IRS denied the charitable deduction, assessed a tax on the sale of the appreciated stock by Xelan Corporation and also accessed an accuracy-related penalty under Sec. 6662.

The Court and IRS Opines

The court noted that under Sec. 170(c)(2), a charitable contribution is permitted if it is given to “a foundation organized and operated exclusively for charitable or educational purposes.”

The IRS claimed that the supposed “student loan” to Vinay showed that Dr. Viralam had “never surrendered dominion and control” over the fund. When Dr. Viralam created the fund in 1998, he anticipated that his three children would receive most of the fund for their college expenses. The initial distributions for the benefit of Vinay were made and “the Foundation’s approval of petitioner’s son as a student loan beneficiary was perfunctory.”
While it was true that the Foundation had been granted exempt status and was listed in Publication 78, the issue of the operation exclusively for the benefit of charitable purposes remained. Even though the purported donor advised fund was supposedly for charitable purposes, the facts indicated that Dr. Viralam had retained dominion and control.

The Sec. 170(f)(8)(A) receipt issued by Xelan Foundation indicated that there were no “goods or services” provided in consideration of the gift. However, the “student loans” were clearly within the regulatory definition of “cash, property, services, benefits and privileges.” Because the student loans were contemplated as part of the fund benefits, the gift failed the “no goods or services” test. Under Sec. 170(f)(8), there is “no deduction” if that test is failed.

Assessment

Because there was no charitable deduction, Dr. Viralam is also taxable on the long-term capital gain produced by sale of the stock in 1998. In addition, the penalty under Sec. 6662 applied. Dr. Viralam pointed to the legal opinion by the law firm Connor & Winters. However, that legal opinion explicitly excepted a potential student loan program. In the view of the court, the arrangement fails the “too good to be true” test. In the view of a reasonable person, a taxpayer should realize that this gift to provide university-level educations for children would not be deductible.

Conclusion

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DAILY UPDATE: Mike Bloomberg, Arianna Huffington and Andreessen Horowitz as Stock Markets Tread Lightly

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Most medical students at Johns Hopkins University won’t have to pay tuition anymore thanks to a $1 billion gift from Michael Bloomberg.

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Here’s where the major benchmarks ended:

  • The S&P 500 index®(SPX) rose 4.13 points (0.1%) to 5,576.98; the Dow Jones Industrial Average® ($DJI) fell 52.82 points (0.1%) to 39,291.97; the NASDAQ Composite® ($COMP) climbed 25.55 points (0.1%) to 18,429.9.
  • The 10-year Treasury note yield increased two basis points to 4.29%.
  • The CBOE Volatility Index® (VIX) inched up to 12.49, still near recent lows.

What’s up

  • Tesla rose 3.71%, putting the company squarely in the green year to date as investors continue to celebrate the automaker’s strong delivery numbers.
  • Corning rose yet another 3.76%, extending the glassmaker’s gains as it quickly becomes the new hot AI stock du jour.
  • Kymera Therapeutics shot 23.40% higher after its partner Sanofi gave the go-ahead for further studies of its experimental skin disease treatment.
  • Jumia Technologies soared 29.79% after Benchmark analysts initiated coverage of the African e-commerce company with a “buy” rating.
  • Sony rose 4.46% on the news that it has nothing to do with the merger of Paramount and Skydance as shareholders celebrate dodging a Paramount-shaped bullet.

What’s down

  • Albemarle dropped 8.76% after Baird analysts warned that lower lithium demand will translate to lower profits for the miner in its upcoming second quarter.
  • BP sank 4.80% after management warned of lower-than-expected profits and a writedown of its German refining facility to the tune of up to $2 billion.
  • Helios Technologies fell 10.94% on the news that the CEO of the industrial manufacturer had been placed on paid leave for potentially violating the company’s code of ethics.
  • Helen of Troy plummeted 27.73% after the Hydro Flask maker announced terrible earnings and lowered its fiscal year outlook.
  • UiPath fell 6.90% on the announcement that the software company will cut 10% of its workforce.

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OpenAI’s venture fund and Arianna Huffington’s Thrive Global are jointly funding a new startup that aims to build an AI health coach to promote healthier lifestyles.


Function Health, a health tech company focused on preventive medicine, recently closed a series A round led by Andreessen Horowitz (a16z) Bio + Health along with a slew of celebrity investors.


And … made possible by the American Rescue Plan, the Biden administration is putting $27.5 million toward women’s behavioral health.

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Selecting Money Managers?

TRUST BUT VERIFY – CAVEAT EMPTOR

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Image result for money managers

By Clifton McIntire; CIMA, CFP® and Lisa McIntire; CIMA, CFP® 

Most physicians and healthcare executives do not manage their own portfolios, or those of their office or medical foundations. Most are more comfortable using outside money managers to make their investment decisions. Just as the general public does not have the facilities, equipment, staff, or training to make medical decisions, physicians generally do not have the time, education, infrastructure or temperament, to make their own investment decisions.

The Style Search 

The search for the right manager(s) begins with creating a “want” list. What kind of a manager do you want? Let’s say you want to find a large cap growth manager. That narrows the field considerably from the start. You are looking for a manger that does research in and understands the field of large growth companies like Microsoft, Walmart, Pfizer, Google, and AOL-Time Warner.   Jim Cowperthwait, Managing Partner of NewBridge Partners, LLC in New York City, is a “growth” manager.  Cowperthwait sums up this philosophy with the statement, “Earnings growth drives stock prices over the long-term. Therefore, we invest our clients’ money in companies whose earnings are expected to grow at 20 percent per year.  Over the long term, this should result in portfolio growth of 15 percent per year.” The other main investment “style” is “value.” 

Value managers buy stocks at a discount to some perceived value.  Generally these stocks pay above market dividend yield, are selling below market price/earnings ratios, and have a low price to cash flow ratio.  Examples of value stocks would be Exxon, Philip Morris, Dupont, and Texas Utilities.  Jim Landau of Berkeley Capital Management in San Francisco, California is a value manager. Landau says, “We look for quality companies with a consistent record of dividend increases and a stock price that is undervalued.” Other styles include the following:

  • Contrarian—invest in stocks that are out of favor or have little market interest
  • Small Cap Growth—small growing companies with high capital appreciation potential
  • Small Cap Value—companies that sell at a discount to some perceived value
  • Market timers
  • Asset Allocators
  • Sector Rotators

Fixed Income Managers 

Managers in the field of fixed income also have a variety of styles. Some are managers of municipal bond portfolios such as John Mousseau of Cumberland Advisors of Vineland, New Jersey.  George Shaffrey of Morgan Keegan & Company of Memphis, Tennessee manages a portfolio of high yielding (average rating “B”) corporate bonds.  Madison Investment Advisors of Madison, Wisconsin offers management of U.S. Government Bonds.  To limit the field even more let us establish some minimum requirements.  To begin with, the performance numbers must be in conformance with AIMR (Association for Investment Management and Research); now CFA Institute, standards.  After that, limit your search to firms with the following characteristics: 

  • Assets under management of at least $1 billion
  • Organization with at least four principals
  • Some independent research
  • Length of time in business  (at least 2 market cycles)
  • Consistent return performance
  • Control of risk well defined
  • Minimum account size within our reach

Software programs are available to screen the world of investment management and come up with a list of potential candidates. CheckFree Investment Services of Research Triangle Park, North Carolina has one of the best. Many others are available. Whether the Bank Trust Department, Private Money Manager or Personal Investment Consultant is being interviewed, here are a few of the questions that should be asked: 

  • Can I get a sample of that report?
  • What kind of performance measurement reporting do I get from you?
  • What due diligence work is done by your organization?
  • What investment/portfolio choices do I have?
  • Who is/are the portfolio manager(s)?
  • How experienced is the portfolio manager?
  • How is he/she compensated?
  • Are you showing me audited performance?
  • How has the performance been? (1, 3, 5 and 7 years)
  • Whose performance is it?  The same portfolio manager as five years ago?
  • Have other key personnel changes been made?
  • Will my account be a separate or commingled account?
  • What are the total costs?  Does that include the following:  ü       [Custody of assets?   Management fee?  Trustee fees?  Transaction fees?  Transaction costs?  Distribution fees?  Termination fees?, etc] 
  • Can I get the costs in writing with a statement that there are no additional costs?

stock-exchange

Decision Matrix 

Now decide what’s important to you in a money-manger and weight each matrix or category. Here are four useful qualities to assess each potential money-manager on the same criteria to be as objective as possible.  These areas are organization, philosophy, performance and fit with your overall plan.  Decide how much weight to assign each of these areas and then rank each manager on a scale of 1 (lowest) to 4 (highest) for each manager. 

1. Performance: 

Like some medical P4P initiatives, after installing your manager(s) you must monitor the performance to assure strict and complete conformance with your investment policy statement. You need to compare your returns with standard indexes, your return objectives, consumer price index, and Treasury Bills. It is also important to compare your results with other investment managers with similar investment style. Let’s not forget the very important capital market line analysis, which depicts the risk we experienced for the return we received; or manager expenses and portfolio size.                   

2. Capital Market Line Analysis:

Quarterly in depth analysis of the portfolio is a must. Most institutions require a formal presentation from the consultant quarterly. Your money is certainly as important to you as the fiduciary responsibility is to them. Some consultants let the report always reflect the account from the beginning. The theory is that the more data that we put in, the more accurate the statistics become, but this begins to distort the performance after the fifth year, and data going back to 1940 is not relative to current market environments. Many reports exclude numbers more than five to seven years old. 

3. Expenses:

Expenses can play an important role in performance. You don’t hear much about expense ratios in an up market. If your account was up +28 percent, whether the expense was 3 percent or 1 percent doesn’t seem to make much difference.  But let the market decline and the portfolio with it for a year and we change our perspective. A 10 percent portfolio decline plus charges of 3 percent equals a 13 percent decline.  Now we need a 15 percent increase net of fees just to get even.  Basically you have four cost areas: 

  • Custody—someone must hold the stocks and bonds, collect dividends and interest, prepare tax information for the government, issue monthly statements, and send checks.
  • Commissions—orders must be executed, transfer securities into and out of your account, trades settled.
  • Investment Decisions—the money manager must be paid.
  • Monitoring Performance and Advice—usually an investment management analyst is engaged to provide this service as well as write the investment policy statement and prepare the asset allocation study.

4. Size:

Naturally, size makes a difference. For a stock account with a $200,000 total value, all of the above can be accomplished for annual fees between 2.00 and 3.00 percent.  An account with $1,500,000 in total assets part bonds and part stocks would pay annual fees between 1.25 and 1.75 percent depending on the ratio of stocks and bonds.  These are annual fees and are all-inclusive. Commissions, portfolio management fees, and statements check charges are all included.  One quarter of the annual fee is charged every three months.  Family related accounts are generally grouped for a quantity fee discount. Most all fee structures are negotiable. Some consultants prefer to use mutual funds with smaller accounts.  A charge of 1 percent per year for their service with a stated minimal fee is common practice. This does not include fees deducted from the account by the mutual fund (anywhere from .50 to 2.50 percent) or commissions paid by the fund managers for trade executions.   

Assessment 

Remember, when considering money management, be sure to understand the ultimate fiscal consequences and your own personal liability? Always be sure to use a fiduciary consultant and let the competition for your business begin. 

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.

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

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DAILY UPDATE: Health Insurers & Hospital Mergers with Light Stock Market Trading

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Here’s where the major benchmarks ended:

The CBOE Volatility Index® (VIX) climbed slightly to 12.37.

The S&P 500 index®(SPX) rose 5.66points (0.1%) to 5,572.85; the Dow Jones Industrial Average® ($DJI) dropped 31.08 points (0.1%) to 39,344.79; the NASDAQ Composite® ($COMP) gained 50.98 points (0.3%) to 18,403.74.

The 10-year Treasury note yield (TNX) was roughly flat at 4.27%.

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What’s up

  • Intel popped 6.15% after an analyst at Melius Research declared the company could be one of the big AI winners in the second half of this year.
  • Morphic Holding skyrocketed 75.06% on the news that Eli Lilly will acquire the drugmaker for $3.2 billion in cash.
  • SolarEdge climbed 9.26% thanks to an upgrade from “underperform” to “neutral” by Bank of America analysts, who see big upside and few downside risks ahead.
  • Corning rose 11.98% after management raised earnings guidance for the coming quarter thanks to higher demand due to the AI boom.
  • Lucid rose 7.85% on the news that its deliveries rose 70% in the second quarter.

What’s down

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Stat: 27. That’s a tally of some of the hospital mergers, acquisitions, joint ventures, affiliations, and partnerships that have been canceled since January 2022. (Becker’s Hospital Review)

Read: Health insurers received $50 billion from Medicare for diseases that doctors did not treat over three years, according to a recent analysis. (Wall Street Journal)

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HEDGE FUNDS: Understanding Fees and Costs

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DEFINITION: A Hedge fund is an investment partnership with freer rein to invest aggressively in a wider variety of financial products than most mutual funds. A hedge fund’s purpose is to pool funds, maximize investor returns, and eliminate risk with hedging strategies. Hedge funds are generally considered more aggressive, risky, and exclusive than mutual funds. The hedge fund industry has grown tremendously since its inception. There are trillions of dollars of assets under management, more than 8,800 hedge fund managers, and over 27,000 funds globally

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

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

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How to Monitor Hedge Funds

Four Ways to Monitor after Purchase

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

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[Publisher-in-Chief]

Hedge funds (broadly defined as private investment vehicles that trade a variety of long and short equities, derivatives, futures contracts, and options in a variety of capital markets) have grown in size and importance in client portfolios because of superior performance, until late [2008-09 and 2022], and readily available investor capital.

Risk Factors

Physicians and clients often ask us to assess certain risk factors and a variety of investment entity structural characteristics associated with hedge funds. Accordingly, we must often be involved in discussing clients’ specific risk/return desires and expectations as they consider such investments.

Four Key Post-Investment Issues:

  1. A change in core investment strategies or risk postures from those which are documented in the investment policy statement—Among these are the specific markets to be traded, the degree of financial leverage to be employed or allowable, the underlying instruments or contracts to be used, and the investment strategies to be pursued under various conditions. Hence, there is no substitute for careful and regular assessment by the planner of changes in how and what an investment manager is trading and communication of such to the client.
  2. Use of financial leverage can dramatically increase returns just as poor performance can be accentuated—The key issue for the planner is whether a given investment manager’s use of leverage changes over the life of the hedge-fund investment, thereby possibly affecting the client’s initial desired risk/return profile.
  3. The composition of the performance return, particularly with respect to the long-term capital gain component.
  4. Asset growth—Regularly monitor and evaluate whether it is detrimental to performance and capable of causing an erosion of performance over a long-term horizon.

Assessment

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Often, after a hedge-fund investment has been made, if performance over time is good (or even adequate), both the doctor client and the financial advisors or planner may assume that there has been no material changes in investment strategy or structural characteristics that warrant attention or concern. Such changes often occur subtly over time and, if performance erodes, and the client may feel that the planner did not adequately monitor the investment. Hence the necessity for the above warning post

Note: “Post investment Issues Regarding Hedge Funds,” by Richard L. Fisher, Personal Financial Planning, November/December 1996, pp. 14–19, Warren, Gorham & Lamont, 1-800-950-1205.)

Conclusion

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DAILY UPDATE: Earnings Season, the FOMC, Threads and Boeing

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Wall Street is counting down the hours until Friday, which is when Q2 earnings season kicks off. Investors are hoping anyone besides Big Tech will post impressive results to keep the rally going. Although the stock market has set record after record this year, it’s mostly been the work of tech giants. As of Tuesday, about 40% of S&P 500 companies were in the red for 2024.

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Federal Reserve Chair Jerome Powell will give updates on the economy to Congress on Tuesday and Wednesday, where he’ll likely be asked about the prospect of interest rate cuts. Those plans could become clearer on Thursday, when the consumer price index inflation report drops.

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Meta’s Twitter clone, Threads, has 175 million monthly users one year after its launch, CEO Mark Zuckerberg said.

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Boeing will plead guilty to a criminal fraud charge stemming from two fatal crashes of 737 Max planes and pay an additional $243.6 million fine, allowing it to avoid a criminal trial sought by victims’ families. More here.

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OUR TAKE: Private Equity and Venture Capital

By Lon Jefferies MBA CMP™ CFP®

By Dr. David Edward Marcinko MBA CMP®

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Private equity and venture capital investments typically involve ownership of shares in a company and represent title to a portion of the company’s future earnings. However, private equity is an equity interest in a company or venture whose stock is not yet traded on a stock exchange.

Venture capital is typically a special case of private equity in which the investment is in a company or venture that has little financial history or is embarking on a high risk/high potential reward business strategy.

Like real estate, private equity and venture capital investments generally share a general lack of liquidity and a lack of comparability across different individual investments. The lack of liquidity comes from the fact that private equity and venture capital investments are typically not tradable on a stock exchange until the company has an IPO.

The lack of comparability is due to the fact that most private equity and venture capital investments are the result of direct negotiation between the investor/venture capitalist and the existing owners of the company  /venture.

With widely divergent terms and provisions across different investments, it is difficult to make general claims regarding the characteristics of private equity and venture capital investments.

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PHYSICIAN APPRAISAL ENGAGEMENTS: Investment Banking, FMV and Venture Capital

By Staff Reporters

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There are a myriad of reasons for obtaining a Fair Market Value [FMV], Venture Capital [VC} and/or Investment Banking [IB] funding appraisal engagement:

  • Outright Selling-Buying
  • Partnership and Associate buy-in / buy-out
  • Mergers and Acquisitions
  • Organic growth tracking
  • Hospital integrations
  • Private and public reporting
  • Financing and Venture Capital
  • Estate and Tax Planning

And, there are many cautions, too. On July 19, 2023, the Federal Trade Commission (FTC) and the Department of Justice (DOJ) released a draft update of its Merger Guidelines, which guides the regulatory agencies in their review of both mergers and acquisitions in evaluating compliance with federal antitrust laws.

The new Guidelines replace, amend, and consolidate the Vertical Merger Guidelines and Horizontal Merger Guidelines, which were published in 2020 and 2010, respectively.

Our Value Analysis: https://marcinkoassociates.com/fmv-appraisals/

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DAILY UPDATE: Home Health and Nurse Vacancies as Stock Markets Reach New Highs

MEDICAL EXECUTIVE-POST TODAY’S NEWSLETTER BRIEFING

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As home hospital programs continue to grow—employment in the home health industry is projected to increase by nearly 30% by 2029—so does the concern that home healthcare professionals are increasingly vulnerable to assault and harassment.

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

Here’s where the major benchmarks ended:

  • The S&P 500 index® (SPX)rose 30.17 points (0.54%) to 5,567.19; the Dow Jones Industrial Average® ($DJI) rose 67.87 points (0.17%) to 39,375.87; the NASDAQ Composite® ($COMP) climbed 164.46 points (0.9%) to 18,352.76.
  • The 10-year Treasury note yield (TNX) dropped nearly seven basis points to just below 4.28%.
  • The CBOE Volatility Index® (VIX) increased slightly to 12.45.

What’s up

  • Meta Platforms rose 5.88% a day after CEO Mark Zuckerberg posted a video of himself wearing a tux, holding an American flag and a beer, and wakeboarding. Shareholders apparently approve of such an absolute stud running the company.
  • Koss Corp. rose another 25.68% as the latest meme stock continues to rally for no reason at all.
  • Macy’s popped 9.48% after bidders looking to acquire the beleaguered retailer raised their offer from $6.6 billion to $6.9 billion.
  • Smith & Nephew rose 6.67% on the news that activist investor Cevian Capital has taken a 5% stake in the medical device maker.
  • Instructure Holdings rose 5.25% on the news that a bidding war is building for the education software company.

What’s down

  • Nvidia fell 1.91% after it received a rare analyst downgrade due to the company’s valuation.
  • Southwest sank 5.67% on the first full trading day after the company adopted a “poison pill” to fend off activist investor Elliott Management.
  • Budget airline companies took a blow after a Raymond James analyst downgraded the industry due to a “clear as mud” outlook for the third quarter. Frontier Group fell 6.79%, while Spirit Airlines dropped 8.70%.
  • Crypto-related stocks tumbled after bitcoin fell below $54,000 at one point today, though they recovered alongside the cryptocurrency later in the trading session. Coinbase Global fell 0.56%, Robinhood Markets dropped 0.98%, and MicroStrategy fell 1.56%.

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

Stat: 9.9%. That’s the current vacancy rate for nurses in the US, down from 15.7% in 2023. (2024 NSI National Health Care Retention & RN Staffing Report)

PBMs: How pharmacy benefit managers are “driving up drug costs for millions of people, employers, and the government.” (the New York Times)

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DAILY UPDATE: Non-Competes Pause as Stock Markets Rise

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Wednesday’s stock market trading was brief but sweet—the S&P 500 and NASDAQ closed at records in a half-day session. The stock market was closed yesterday for the Fourth of July, but will reopen today with all eyes on the June jobs report to be released this morning. It’s expected to show more cooling in the labor market, which would reinforce the FOMC is likely plan to cut interest rates this fall.

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

A federal court temporarily paused a ban on noncompetes from taking effect in September, ruling that the FTC overstepped its authority in April when it ordered a halt to the clauses affecting 30 million Americans. The ban on noncompetes was intended to allow workers like doctors and nurses to move jobs more easily and boost wages in the process, but businesses opposed it on the grounds that competitors could poach their employees and they’d lose valuable trade secrets.

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DAILY UPDATE: Walmart, HHS and Geriatrics as Companies and Stock Market Still 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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HAPPY JULY FOURTH

The S&P 500 broke above 5,500 yesterday and stayed there for the first time in market history, notching yet another all-time high for the index—its 32nd this year alone. With so much bullishness it’s understandable that investors may be wondering if we’re at the top yet, but chartists suggests gains tend to beget gains. The bulls have too much momentum to stop now—and if/when the FOMC cuts rates later this year, it seems likely that we’ll see more all-time highs in 2024? Any thoughts.

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

The Biden administration has awarded $206.3 million of funding to clinician training programs across 42 universities and provider organizations to bolster the nation’s geriatrics care workforce. Programs will be able to integrate geriatrics training into primary care and will work to educate older adults’ families on their care needs. Health and Human Services, in its announcement, noted that primary care providers are a crucial source of care for much of the aging population.


As Walmart shutters its primary care clinics, the retail giant inked a deal to sell its MeMD telehealth business to health tech startup Fabric. Fabric provides a telemedicine platform for a range of customers, including provider groups, with the goal of improving the clinician and patient experience, as well as operational efficiency. The acquisition will expand its provider network, add virtual behavioral health to the company’s services and build on Fabric’s employer and payer solutions.


And…The U.S. Supreme Court has overturned the Chevron deference, stripping power from federal agencies to interpret and enforce regulations. Courts no longer have to defer to reasonable agency interpretations. One healthcare attorney told Fierce Healthcare he predicts the Centers for Medicare & Medicaid Services will be under a microscope from the courts going forward, and there will be more scrutiny towards provider reimbursement cuts, drug pricing regulation and the Inflation Reduction Act.

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

Here’s where the major benchmarks ended:

  • The S&P 500 index®(SPX)rose 28.01 points (0.51%) to 5,537.02; the Dow Jones Industrial Average® ($DJI) fell 23.85 points (-0.1%) to 39,308.00; the NASDAQ Composite® ($COMP) gained 159.54 points (0.9%) to 18,188.30.
  • The 10-year Treasury note yield (TNX) dropped seven basis points to 4.36%.
  • The CBOE Volatility Index® (VIX) held steady at 12.09.

What’s up

What’s down

  • First Foundation plummeted 23.81% after the bank announced it will raise $225 million to shore up a balance sheet burdened by commercial real estate loans.
  • Constellation Brands fell 3.76% after the alcoholic beverage maker reported stronger than expected earnings but missed Wall Street’s expectations on revenue.
  • Simulations Plus slid 14.87% after it reported strong third-quarter earnings but announced it’s cutting its dividend.
  • CureVac popped then dropped 6.59% after GSK bought the rights to the smaller pharma company’s Covid-19 and flu vaccines for $1.6 billion.

CITE: https://tinyurl.com/tj8smmes

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