Why [Some] Doctors Won’t Ever Work for Uncle Sam

Understanding the Medical Career Path

[circa 2024]

cropped-dem 

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

By Eugene Schmuckler PhD, MBA, CTS

www.MedicalBusinessAdvisors.com

MEDICARE FOR ALL?

Who seeks or writes about, physician careers under a M-4-Uber scenario?

When you think about careers, how many adults are truly aware of their own interests, values, strengths and weaknesses during their teen years? As with much of human behavior, career choices actually go through a series of stages.

Psychologists have for years identified stages of human development.  Kohlberg discussed stages of moral development. In the 1970’s, Daniel Levinson published The Season’s of a Man’s Life, a project he undertook when he began to look inward and tried to understand his behaviors, values and attitudes to work. Discussions with his university colleagues indicated that what he was experiencing was not unique to him.

Traditional Career Routes

For many years the prevailing thought was that the correct way to function in the labor market was to gain employment with a company progressing through the years until such time as you were eligible to receive the “gold watch”, the symbol of retirement. If you entered a professional discipline such as medicine or law, you did that for the rest of your life.

Alternate Career Paths

Today there are still individuals who follow these traditional patterns but there are other career paths that may be taken.

The most traditional career route follows a linear path, one that most of you have rejected. This entails gaining employment in a large, bureaucratic organization with a tall pyramidal structure [command-control]. It involves a series of upward (hopefully) moves in the organization until the career limit is reached. As the individual progresses upward in the organization he or she may work in different functional departments such as marketing, finance, and production. Organizations having these paths seek employees who tend to be highly oriented toward success defined in organizational terms and exhibit “leadership” skills. In general, these people demonstrate a strong commitment to the workplace. A person with this type of orientation (Organizationalist) exhibits the following tendencies:

  1. A strong identification with the organization; seeking organization rewards and advancement that are important measures of success and organizational status.
  2. High morale and job satisfaction.
  3. A low tolerance for ambiguity about work goals and assignments.
  4. Identification with superiors, showing deference toward them, conforming and complying out of a desire to advance; maintains the chain of command and compliance, and views respect for authority as the way to succeed.
  5. Emphasis on organizational goals of efficiency and effectiveness, avoiding controversy and showing concern for threats to organizational success.

As many readers of the Medical Executive-Post are aware, you have followed the expert medical career path, building a career on the basis of personal competence, or the development of a profession (legal or accounting professionals). As you are so painfully aware, you invest heavily, personally and financially in acquiring a particular skill and then you spend the major portion of your life following that skill. Unlike the pyramidal structure of the linear path, career paths are found in organizations that tend to be relatively flat, have departments in which there is a functional emphasis, emphasize quality and reliability, and have reward systems containing a strong recognition component.

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Medical Professionals are Different

Medical professionals are folks who are job-centered – not organization centered – viewing the demands of the organization as a nuisance that they seek to avoid [THINK: Gregory House MD].

However, that avoidance is impossible since the healthcare professional must have an organization in which to work. This is even more prevalent in today’s era of managed health care and e-Health 2.0, than ever before. At work, professionals experience more role conflict and are more alienated. Medical professionals exhibit these four tendencies:

  1. An experience of occupational socialization that instills high standards of performance in the chosen field; highly ideological about work values.
  2. Sees organizational authority as non-rational when there is pressure to act in ways that are not professionally acceptable.
  3. Tends to feel that their skills are not fully utilized in organizations; self-esteem may be threatened when they do not have the opportunity to do those things for which they have been trained;
  4. Seeks recognition from other professionals outside the organization, and refuses to play the organizational status game except as it reflects their worth relative to others in the organization. Professionals are very concerned with personal achievement and doing well in their chosen field. Organizational rewards serve to reflect the professional’s importance relative to others in the system. This recognition may be extremely fulfilling, especially when he or she is accorded higher status and pay than others. In the absence of organizational rewards the professional may use material objects (large homes, expensive cars) as a way of reflecting status and accomplishment.

Performance not Authority

Medical professionals are of the opinion that successful performance, not compliance with authority, is more reinforcing. With this mindset it is not surprising why many medical practitioners balk at working in the managed health care, state-run or governmental lead healthcare environment. Many professionally oriented people come from the middle class and have become successful through a higher level of education or by other efforts to acquire competence.

The Spiral Career Path

Those on the spiral career path make periodic moves from one occupation to another. Individuals who follow this career path tend to have high personal growth motives and are relatively creative. Usually these changes come after you have developed competence in the occupation you are working in and you think it is time to change what you do. The ideal spiral career path is to move from one occupation to an area related to it. This enables you to use some of the basic knowledge that you developed in your past work and to transfer it to your new occupation. The difference between this path and the linear path discussed above is that in this case the mobility pattern is lateral, not upward.

The Transitory Career Path

People who take the transitory career path cannot seem to, and perhaps do not want to settle down. The pattern is one of consistent inconsistency in their work. These are individuals who may find a great deal of satisfaction working as healthcare consultants. The work style is marked by an ability to do many things reasonably well. They value independence and variety, and they work best in relatively loose and unstructured organizations that tolerate the type of freedom they demand in their work.

Sam (1)

The Indifferents          

We have so far discussed the four types of career paths and two career orientations. A final form of career orientation is that of the indifferents, those who simply work for a paycheck. Will this be the result of Obama care? These are individuals who do their work well, but they are not highly committed to their job or the organization. Some characteristics of indifferents are:

  1. More oriented toward leisure, not the work ethic (is it Friday yet?); separates work from more meaningful aspects of life, and seeks higher-order need satisfaction outside the work organization.
  2. Tends to be alienated from work and not committed to the organization.
  3. Rejects status symbols in organizations.
  4. Withdraws psychologically from work and organizations when possible.

Assessment

Indifferents are not necessarily born that way; some are actually a product of their work experiences. People who once had an organizational orientation and were highly loyal may no longer follow orders without question.

For example, you may have had a medical officer manager who very early in his or her career was extremely committed to you and your medical practice, hospital or healthcare organization. He or she may seek rewards and want to advance. However, in later career life, after having been passed over several times for promotion, the person seeks rewards elsewhere. Thus, it is possible that through office practices, your healthcare organization may turn highly committed organizationalists (or medical professionals) into relative indifferents; HMO patsies or grunts for Uncle Sam.

Conclusion

And so, 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, be sure to subscribe. It is fast, free and secure.

Note: Dr. Gene Schmuckler is director of behavioral economics. He is an expert on physician career re-engineering, and a retired Professor of Organizational Behavior who taught Dr. Marcinko [our Publisher-in-Chief] in business school, a decade ago.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko and Dr. Schmuckler are available for seminar or speaking engagements .Contact: MarcinkoAdvisors@msn.com

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Brousseau, K.R., Driver, M.J., Eneroth, K. and Larson, R.: Career Pandemonium: Realigning organizations and individuals. Academy of Management Executive 10 (4), 52-66. 1996

Presthus, R. The Organizational Society. New York, NY: St. Martin’s Press.

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DAILY UPDATE: Telehealth Down but Stock Markets Up for the Week

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In April, UnitedHealth Group announced it was shutting down its Optum Virtual Care program. Days later, Walmart announced it would shutter both Walmart Health and Walmart Health Virtual Care.

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

And in July, Teladoc posted a net loss of $838 million in Q2. The drop was largely driven by an impairment charge of ~$800 million for BetterHelp, the virtual mental health platform it acquired in 2015, Fierce Healthcare reported. Executives attributed the decline to increased customer acquisition costs, among other factors.

CITE: https://tinyurl.com/tj8smmes

Finally, Stocks are way out of whack with reality, the WSJ argues. Nevertheless, a slew of encouraging economic data helped propel the S&P 500 to its best week of the year—a welcome change from the whiplash volatility of the week before. Bayer jumped after scoring an appeals court victory in a case over claims its Roundup weed killer causes cancer.

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

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DAILY UPDATE: Medicare Drug Price Negotiations as Stock Markets Hold Steady

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Here’s where the major stock market benchmarks ended:

  • The S&P 500® index (SPX) rose slightly, up 11 points (0.2%) to end the day at 5,554.25, finishing up 3.9% for the week; the Dow Jones Industrial Average® ($DJI) jumped 96.7 points (0.24%) to close the week at 40,659.76, up 2.9% from last Friday; the NASDAQ Composite®($COMP) gained 37.2 points (0.21%) to 17,631.72, up 5.3% for the week.
  • The 10-year Treasury note yield (TNX) fell three basis points to just above 3.89%.
  • The Cboe Volatility Index (VIX) dropped to 14.74, the lowest in three weeks.

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

What’s up

  • Bavarian Nordic, which makes an m-pox vaccine, jumped 15.64%, continuing its surge after the World Health Organization on Wednesday declared a public emergency over the disease’s spread in Africa.
  • Bayer popped 8.36% after the firm won a legal dispute against claims that its weedkiller Roundup causes cancer.
  • Rocket Lab rose 12.52% after the aerospace company announced it shipped two spacecraft to Cape Carnival in preparation for a launch to Mars.
  • H&R Block had its best day since 2022 (up 12.24%) after raising its dividend by 17% and announcing a $1.5 billion share buyback.
  • Maravai LifeSciences leaped 21.46% on reports that the drugmaker received a takeover offer from Repligen Corp.

What’s down

  • On the flip side of that last gainer, Repligen Corp. plummeted 9.26% on the takeover news.
  • Astera Labs dropped 5.52% after several investment firms, including Evercore and JPMorgan, lowered their price target for the chipmaker.
  • ReNew Energy Global dropped 5.91% after the company reported it missed earnings and revenue expectations yesterday.

CITE: https://tinyurl.com/tj8smmes

The Biden administration announced yesterday that Medicare used its newfound power to negotiate with drug makers to win landmark discounts for 10 widely prescribed drugs to treat ailments like heart disease, cancer, and diabetes. The Inflation Reduction Act, signed into law two years ago, allows the federal health insurance program to directly bargain with pharma companies for the first time.

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

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Four Percent Rule VERSUS Rule of Twenty-Five

PHYSICIAN RETIREMENT PLANNING

By Staff Reporters

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The rule of 25 is just a different way to look at another popular retirement rule, the 4% rule. It flips the equation (100/4% = 25) to emphasize a different part of the retirement planning process — withdrawing vs. saving.

The 4% rule outlines a safe rate to withdraw funds for 30 years without running out of money. On the other hand, the rule of 25 is a savings-focused approach, providing a quick estimate of how much you need to accumulate before exiting the workforce.

LINK: https://www.nerdwallet.com/calculator/retirement-calculator

Let’s consider a scenario to highlight the difference:

  • Rule of 25: After accounting for her Social Security and other sources of retirement income, Dr. Matie PhD plans to spend $40,000 a year in retirement. 40,000 x 25 = $1 million, so Matie would need $1 million invested to cover annual expenses of $40,000.
  • The 4% rule: Dr. Matie, now a retiree, has $1 million in retirement savings and follows the 4% rule. She can safely withdraw $40,000 annually (4% of $1 million).

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While the 4% rule helps plan withdrawals during retirement, the rule of 25 helps establish a savings goal before retirement begins.

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DAILY UPDATE: Cisco Lays Off as Stock Markets Blast Off

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What’s up

What’s down

  • T-Mobile US fell 0.95% after the Committee on Foreign Investment in the US fined the company after sensitive customer data was exposed.
  • Dillard’s slid 10.85% after reporting lower earnings and sales than expected as the retailer struggles to lure customers through its doors.
  • AT&T stumbled 2.78% on the news that a major shareholder sold off a large portion of its stake in the company last quarter.
  • Pilgrim’s Pride dropped 3.28% thanks to a re-rating from Bank of America analysts pushing the company from Buy to Neutral.
  • Grab Holdings sank 7.42% after the app maker reported a terrible quarter.

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

Here’s where the major benchmarks ended:

  • The S&P 500 index rose 88.02 points (1.61%) to 5,543.23; the Dow Jones Industrial Average® ($DJI) added 554.67 points (1.39%) to 40,563.06; the NASDAQ Composite advanced 401.89 points (2.34%) to 17,594.50. 
  • The 10-year Treasury note yield (TNX) rebounded about 10 basis points to nearly 3.93%, lifted by strong U.S. data. 
  • The CBOE Volatility Index® (VIX) finished at 15.45, the lowest since July 23 and back under the historic average near 19.

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Cisco will lay off 7% of its workforce to cut costs, although it projects an improvement in sales.

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DAILY UPDATE: Hospital Private Equity and AI with Upbeat DJIA

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Private equity (PE) firms might make it rain cash for investors, but hospitals under their ownership are facing an asset drought, according to a research letter published in JAMA on July 30th. While fans of PE argue it can bring much-needed financial resources to struggling hospitals, the data disagrees. “Private equity acquisitions appear to have depleted, rather than augmented, hospital assets,” the authors, a group of physicians from medical institutions across the US, wrote.

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What’s up

What’s down

  • Peloton Interactive stumbled 4.64% on the news of a deal allowing Google’s Fitbit users to have access to Peloton classes.
  • Brinker International sank 10.51% after the parent company of Chili’s announced lower-than-expected earnings last quarter.
  • Ouster plummeted 27.44% after the lidar manufacturer reported disappointing revenue last quarter and forecast for worse to come next quarter.
  • Starbucks fell 2.09% as investors took some profits after yesterday’s gigantic pop.

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

Here’s where the major benchmarks ended:

  • The S&P 500 rose 20.78 points (0.38%) to 5,455.21; the Dow Jones Industrial Average® ($DJI) added 242.75 points (0.61%) to 40,008.39; the NASDAQ Composite®($COMP) squeaked out a slight gain of 4.99points (0.03%) to 17,192.60.
  • The 10-year Treasury note yield (TNX) dropped three basis points to 3.82%, the lowest close in more than a week.
  • The Cboe Volatility Index® (VIX) fell to 16.22, the lowest since July 23.

CITE: https://tinyurl.com/tj8smmes

Stat: 21%. That’s the percentage of US physicians who are still paying off student loan debt. (Becker’s Hospital Review)

Quote: “The federal government is particularly ineffective and slow these days.”—Rep. Brianna Titone, a Colorado Democrat, on why states need to “step up” and make their own laws regulating the use of artificial intelligence in healthcare (Axios)

Read: A US Olympic athlete is taking advantage of free healthcare to catch up on preventive care while in Paris. (the Washington Post)

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

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DAILY UPDATE: United Health, CVS, Talkspace, Health Catalyst and the Rocketing Stock Markets

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The Fierce Healthcare team recapped second quarter earnings for the country’s biggest payers and health tech companies. See how UnitedHealth, CVS, Talkspace and Health Catalyst fared.


Walgreens could sell its stake in VillageMD and Roche may sell health tech startup Flatiron Health.


And … Texas Children’s Hospital reduced its workforce by 5%, or approximately 1,000 jobs. Keep up with other cuts with Fierce Healthcare’s layoff tracker.

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

What’s up

What’s down

  • Trump Media & Technology Group sank 3.62% following the Donald Trump and Elon Musk interview on X.
  • Tencent Music Group plummeted 15.18% thanks to a mixed quarter with lower revenue but a higher subscriber count.
  • ViaSat tanked 22.57% after the company revealed that some of its biggest shareholders plan to sell 11.2 million shares of the satellite company.
  • Baxter International slid 6.53% after it struck a deal with The Carlyle Group to sell its kidney-care unit for $3.8 billion.

CITE: https://tinyurl.com/tj8smmes

Here’s where the major benchmarks ended:

  • The S&P 500® index (SPX)rose 90.04points (1.68%) to 5,434.43; the Dow Jones Industrial Average® ($DJI) added 408.63 points (1.04%) to 39,765.64; the NASDAQ Composite®($COMP)rallied406.99points (2.43%) to 17,187.61.
  • The 10-year Treasury note yield (TNX) fell about six basis points to 3.85%.
  • The CBOE Volatility Index dropped nearly 13% to 18.04, its lowest close since July 31.

Every S&P sector besides energy finished higher today, with info tech and consumer discretionary in the lead and both gaining more than 2%.

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

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Why I Hate Non-Publicly Traded REITS

On Product Frustration

Lon JefferiesBy Lon Jefferies MBA CFP® CMP®

As my experience in the financial planning and investment advisory industries has grown over the years, there is one investment that I’ve seen no logical reason to own — non-publicly traded real estate investment trusts.

Josh Brown, one of my favorite analysts and author of TheReformedBroker.com nailed each of my frustrations with these products. Here is a significant excerpt from his post:

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I consider non-traded REITs or nREITS to be part of the group of investments that are just absolute murderholes for clients – they pay the brokers so much that they cannot possibly work out (and they rarely do without all kinds of aggravation and additional costs). Further, I have yet to hear a single credible explanation as to why a broker would recommend a non-traded REIT over a public REIT other than compensation. The only explanation that makes sense to me is that 7% is a lot more than the 1% commission you get doing an agency trade on a NYSE-traded REIT. A reader with experience in the industry sent this to me and I found it hilarious. Below, a fictional, transparent conversation between an indie broker and his “client” that would never occur…

If Brokers Were Transparent:

Rep:

Before we wrap up our quarterly portfolio review I would like to talk to you about a new investment I think you might be interested in.  You have been looking for more income and this is an investment vehicle that pays a 7% dividend.

Client:

Sounds great, give me the details.

Rep:

With your portfolio size and risk tolerance I would recommend a $100,000 investment.  Given that amount let’s first go over the fees. If you invest $100,000 I will be paid a commission of $7,000. My firm is going to get $1,500 – $2,000 in revenue share. My wholesaler, the salesman that works for the investment’s sponsor company, will get $1,000. He is a great guy, buys me dinner and takes me golfing. The sponsor company is going to get around $3,000 to pay for some of the costs they incurred in setting up the investment. So after Day 1 there will be around $87,000 left over to actually invest.  I bet you are getting excited.

Client:

Are you on drugs? Why would I pay 13% in fees on anything?

Rep:

Don’t worry, it won’t feel like you are paying $13,000 in fees. The rules allow my firm to report your investment at $100,000 on your statement. You never really know what its worth but you will think you never lost money. Pretty sweet huh?

Client:

You have to be kidding.

Rep:

No, this is a really good investment. Let me tell you about the income component before you jump to any conclusions. Like I said this investment pays a 7% dividend and the dividend won’t change.

Client:

That sounds high and how do you know it won’t change?

Rep:

You see, the sponsor just picks the 7% dividend number out of thin air. Here’s how it works. You see the vehicle you are going to invest in is new and it’s going to take the firm a while before your net $87,000 is actually invested. Later on, maybe 2-4 years from now they will have the money fully invested and it will generate actual cash flow. So they just pay a quarterly dividend of 7% by giving you your money back. This is great from a tax perspective because return of capital isn’t taxed as income.

Client:

Are we on hidden camera or something?

Rep:

Ha, you are funny. I bet this next benefit will change your mind.

Client:

I hope so or I should start looking for another financial advisor.

Rep:

This is the best feature. You can’t sell your investment until the sponsor has the opportunity to create liquidity. You might be locked up in this investment for 7-10 years.

Client:

This feels like the Twilight Zone. Your firm allows you to sell this crap?

Rep:

Oh yeah, our firm sells a ton of it. In fact independent broker dealer firms like mine sold over $20 billion of these investments in 2013. Think about that. Reps like me made over $140 million dollars and our firms pocketed $20-$30 million.

Client:

This is crazy, what is this investment?

Rep:

Non-traded REITs. $100,000 sound about right?

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Currency

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Josh touched on every part of these investments that I despise — excessive commission paid to the so-called “financial advisor” (salesman), a supposed “dividend” that is really just paying the investor his own money back (essentially providing an interest-free loan), and a complete lack of liquidity and transparency.

When I begin working with a new client who owns one of these products, it is impossible to obtain accurate, current information on the investment (not even a true value is apparent). Even worse, if the client wants to sell the investment he would need to do so at pennies on the dollar. For the most part, once an investor purchases one of these products he just needs to forget about it and hope that one day he can get his money back.

Assessment

The bottom line is that if your advisor ever recommends a non-publicly traded REIT, I’d strongly recommend you walk out the door and start searching for a true financial advisor with a fiduciary responsibility to act in your best interest.

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

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DAILY UPDATE: Aetna Ratings Down as Stock Markets Flatten

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Aetna, CVS’s health insurance arm and the third largest payer in the US, is struggling amid higher medical costs and lower Medicare Advantage star ratings. After CVS reported a nearly 40% YoY drop in operating income in its Q2 2024 earnings released on August 7th, President and CEO Karen Lynch announced the company will replace Aetna’s president, Brian Kane, and initiate a $2 billion cost-savings plan.

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What’s up

  • Nvidia jumped 4.08% after it was named a top “rebound” stock by Bank of America.
  • Keycorp leaped 9.24% on the news that the Bank of Nova Scotia will invest $2.8 billion in the company.
  • Robinhood Markets rose 3.46% due to an upgrade from Piper Sandler analysts who say the company’s sudden decline gives it an attractive entry point.
  • Monday.com popped 14.78% thanks to a strong earnings report from the software maker, due in no small part to sealing the largest deal in company history.
  • Barrick Gold soared 9.36% after beating earnings estimates on both the top and bottom lines thanks to the rising price of gold.

What’s down

Here’s where the major stock benchmarks ended:

  • The S&P 500®  index (SPX)added 0.23(0.00%) to 5,344.39; the Dow Jones Industrial Average® ($DJI) fell 140.53 points (–0.36%) to 39,357.01; the NASDAQ Composite rose 35.30points (0.21%) to 16,780.61.
  • The 10-year Treasury note yield (TNX) fell three basis points to just under 3.91%.
  • The CBOE Volatility Index® (VIX) increased 0.34 points (1.67%) to 20.71.

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Stat: 8.2%. That’s the percentage of people in the US without health insurance in the first quarter of 2024. (Healthcare Dive)

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

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DAILY UPDATE: Consumer Spending with Spotlight on Intel

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US consumers in the spotlight: How much have you been shopping? We’ll find out this week when crucial July retail sales data is released on Thursday, and Walmart and Home Depot report earnings. The resilience of the US consumer is at the heart of recent concerns over a potential downturn since consumer spending drives 70% of the US economy. So far this earnings season, companies have given more mixed signals than a menu offering jumbo shrimp.

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Tech giant Intel will be shedding more than 15% of its workforce—or over 19,000 employees—as part of a plan to cut $10 billion in costs after it failed to meet quarterly expectations.

Intel reported revenue of $12.83 billion on expectations of $12.94 billion in revenue in its second quarter 2024 earnings, reported CNBC. The company reported plunging from a net income of $1.48 billion in Q2 2023 to a net loss of $1.61 billion YOY.

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What is a Stock Market Index IMPLIED OPEN?

FINANCIAL TERMS AND DEFINITIONS FOR PHYSICIANS AND ALL INVESTORS

By Dr. David E. Marcinko MBA MEd CMP®

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The stock markets have been near all time highs, lately. Physician colleagues and clients are so excited that they are even checking the overnight status of favorite stocks and/or the domestic/overseas markets.

Some colleagues are even becoming a bit OCD by checking the implied open of various markets the night before. But, what exactly is the Implied Open? How is it calculated?

DEFINITION: The Implied Open attempts to predict the prices at which various stock indexes will open, at 9:30am New York time. It is frequently shown on various cable television channels prior to the start of the next business day.

Product Details

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EXAMPLE: Considering the DJIA as an example, the basis of calculating implied open is the price of a “DJX index option futures contract”. This is not the price of the DJIA itself but rather the current ticker price of an option issued by the Chicago Board Options Exchange.

CBOE: The Chicago Board Options Exchange, located at 400 South LaSalle Street in Chicago, is the largest U.S. options exchange with annual trading volume that hovered around 1.27 billion contracts at the end of 2014. CBOE offers options on over 2,200 companies, 22 stock indices, and 140 exchange-traded funds.

CALCULATION: https://www.quora.com/How-do-you-calculate-the-implied-open-from-futures

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NOTE: We would like to remind you that new amendments adopted by the U.S. Securities Exchange Commission (SEC) have gone into effect as of September 28, 2021. These amendments restrict the ability of market makers to publish OTC quotations for those companies that have not made required current financial and company information available to regulators and investors.

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DAILY UPDATE: MDMA, Stellantis & Zelle While Correlation is not Causation

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The FDA declined to approve MDMA as a PTSD treatment, which would have been a big step forward for psychedelics use in mental health care, saying further study is needed. But the agency did approve a nasal spray to treat severe allergic reactions as an alternative to shots like EpiPen.

Stellantis will lay off 2,450 factory workers this year as it phases out an older version of its Ram pickup truck.

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Scams via Zelle, the payment service you turn to when you run out of wedding gift ideas, are the subject of an ongoing inquiry by the Consumer Financial Protection Bureau (CFPB), the Wall Street Journal reported this week. Zelle was founded in 2017 by seven of the biggest US banks to compete with peer-to-peer payment apps like Venmo and Cash App. It outgrew its rivals but became a magnet for scams, which customers typically don’t get reimbursed for.

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Correlate: A website that shows spurious correlations.

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

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Appreciating the Six Types of Investment Fees

dr-marcinkoDR. DAVID EDWARD MARCINKO MBA MEd CMP

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investing

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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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

By Staff Reporters

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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

CITE: https://tinyurl.com/tj8smmes

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

cropped-dem

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:

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: 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]

BC Dr. Marcinko

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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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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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%.

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

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

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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.

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

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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)

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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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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.

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

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).

***

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.

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

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)

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

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.

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

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.

CITE: https://tinyurl.com/tj8smmes

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.

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

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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FINANCE: https://www.amazon.com/Comprehensive-Financial-Planning-Strategies-Advisors/dp/1482240289/ref=sr_1_1?ie=UTF8&qid=1418580820&sr=8-1&keywords=david+marcinko

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DAILY UPDATE: Pfizer, MSFT and the NASDAQ Collapse

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

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

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

http://www.MedicalBusinessAdvisors.com

SPONSORED BY: Marcinko & Associates, Inc.

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Daily Update Provided By Staff Reporters Since 2007.
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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.

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

  • 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.

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

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.

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

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

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

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

http://www.MedicalBusinessAdvisors.com

SPONSORED BY: Marcinko & Associates, Inc.

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Daily Update Provided By Staff Reporters Since 2007.
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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)

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

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%.

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

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.

CITE: https://tinyurl.com/tj8smmes

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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