DAILY UPDATE: Stocks, Commodities and Trade as Stock Markets End Mixed

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  • Stocks: Investors cheered the news of an EU & US trade deal over the weekend, pushing the S&P 500 above 6,400 for the first time ever. But the index gave up most of its gains late in the day as attention turned to a huge week of data ahead (more on that in a minute).
  • Trade: Today was the first day of discussions between US and Chinese negotiators in Stockholm to keep the trade war truce alive. Elsewhere, President Trump foresees a baseline 15% to 20% tariff rate for the rest of the world.
  • Commodities: Gold fell as trade deal hopes heightened investors’ risk appetite, while oil spiked higher after Trump gave Russia a 10- to 12-day deadline to sign a truce with Ukraine.

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According to Bloomberg, 83% of the S&P 500 companies that have reported earnings have outpaced Wall Street’s estimates, putting the index on pace for its best season of beats since the second quarter of 2021.

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

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EMOTIONAL INTELLIGENCE & ORGANIZATIONAL BEHAVIOR: Economic Risk Management Classification for Medical Professionals

BY DR. DAVID EDWARD MARCINKO, MBA MEd CMP®

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ORGANIZATIONAL BEHAVIOR AND CLASSIFICATION OF RISKS

DEFINITION EMOTIONAL INTELLIGENCE: Emotional intelligence [EI] refers to the ability to identify and manage one’s own emotions, as well as the emotions of others. Emotional intelligence is generally said to include a few skills: namely emotional awareness, or the ability to identify and name one’s own emotions; the ability to harness those emotions and apply them to tasks like thinking and problem solving; and the ability to manage emotions, which includes both regulating one’s own emotions when necessary and helping others to do the same.

DEFINITIONAL ORGANIZATIONAL BEHAVIOR: Organizational behavior (OB) is the study of how individuals, groups, and organizations interact and influence one another. Though it is largely used within the field of business management as means to understand–and more effectively manage–groups of people. The reason businesses look to OB is because it can help organizations increase employee performance, while also creating a positive working environment.

CITE: Eugene Schmuckler; PhD MBA MEd CTS®

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And so, as we review the concept of Emotional Intelligence and Organizational Behavior, it is possible to set up five EI/OB risk classes, based on the economic consequences of the occurrence of specific individual risks:

1. Prevented risks: Risks whose cost of occurrence is higher than their cost of management and whose occurrence may invoke additional legal sanctions. This class would include intentional torts and injuries caused by gross negligence.

2. Normally prevented risks: Risks whose cost of occurrence is greater than the cost of their management but whose occurrence will be considered only as negligent. This class includes most negligent injuries
and most types of product liability actions.

3. Managed risks: Risks whose cost of occurrence is only slightly greater than their cost of management. The plaintiff usually has the burden of showing that the defendant owed the plaintiff a special duty to recover for one of these risks.

4. Un-Prevented risks: Risks whose cost of occurrence is less than their cost of management. The classic example of this class is the cost of railroad crossing barriers compared to the cost of people being hit by
trains.

5. Un-Preventable risks: Risks whose occurrence is unmanageable. The assignment of a risk to one of these classes is a major problem in medical and healthcare quality control, because the class of a risk determines how much effort must be expended to prevent the risk. The misclassification of a prevented or normally prevented risk as a managed or un-prevented risk can result in large financial losses.

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For example: A medical clinic that does not update obsolete equipment, such as inaccurate oxygen monitors, would be liable for any injuries attributable to the obsolete equipment. The classifications of risk must be reviewed periodically to determine if the cost of the risk-taking behavior has changed, thereby altering the classification.

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For example: A small hospital in a rural area would not be expected to have the sophisticated equipment as a major hospital in a city. If an accident victim is brought into the rural facility, the hospital’s duty may be to transfer the patient to a better-equipped facility. The patient will face the risk of dying because of the delay in treatment, but the risk of insufficient treatments outweighs the risk of transfer. If the same victim were brought into a hospital in a major metropolitan center, the duty would be to treat the patient without a transfer. The risk of transfer has not changed, but the risk of insufficient treatment has disappeared.

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PODIATRIST: Types, Specialization and Salary

THE FOOT & ANKLE DOCTORS

By A.I.

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Podiatry offers a promising career with a balanced mix of specialization and income. By understanding the factors that influence salaries—such as location, experience, and practice type—a doctor can strategically enhance his/er earning potential. Staying informed about healthcare policies and market trends is crucial for maximizing income.

With an aging population and advancements in technology, the demand for podiatrists is expected to grow, making it a rewarding field both professionally and financially. Investing in specialized training and adapting to policy changes will help doctors remain competitive and successful in the evolving healthcare landscape.

MORE: https://medicalexecutivepost.com/2024/12/03/12-investing-mistakes-of-physicians/

Frequently Asked Questions

What is a podiatrist?

A podiatrist is a healthcare professional specialized in diagnosing and treating conditions related to the feet and ankles. Their responsibilities include performing surgeries, prescribing orthotics, and providing preventive care.

MORE: https://medicalexecutivepost.com/2024/03/20/is-a-podiatrist-a-physician/

What education is required to become a podiatrist?

To become a podiatrist, one must complete a Doctor of Podiatric Medicine (DPM) degree, which typically takes four years after earning a bachelor’s degree. Following this, a residency program lasting 2-3 years is required for practical training.

What factors influence the salary of a podiatrist?

Geographic location, level of experience, specialization, and type of practice significantly affect a podiatrist’s salary. Areas with a higher cost of living or demand for services usually offer higher salaries.

How does the salary of a podiatrist compare to other medical professions?

Podiatrists generally earn more than general practitioners but less than specialty surgeons. This disparity is due to differences in training length, specialization, and practice complexity among these professions.

Can the salary of a podiatrist increase over time?

Yes, a podiatrist’s salary can increase with additional experience, further specialization, and strategic practice location choices. Continuing education and staying updated on healthcare policies can also enhance earning potential.

What impact do healthcare policies have on podiatrist salaries?

Healthcare policies, including changes in insurance reimbursement rates and government health initiatives, can affect podiatrist salaries. Adapting to these policy shifts is crucial for maximizing earning potential in the field.

What are the future trends in podiatry salaries?

Future trends suggest potential salary growth due to increasing demand from an aging population, technological advancements, and geographic disparities in healthcare access. Keeping informed about these trends can help podiatrists plan their careers strategically.

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EDUCATION: Books

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

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PHYSICIANS: Do You Use A Financial Planner?

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TO: All Physicians and Dentists

QUESTION?

Do you use a financial advisor?

What has been your experience with him or her?

THANK YOU

EDUCATION: Books

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

PARADOX of Financial Health

By Dr. David Edward Marcinko MBA MEd

SPONSOR: http://www.CertifiedMedicalPlanner.org

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FINANCIAL HEALTH

Classic Definition: Research from Ernst-Young [Nikhil Lele and Yang Shim] uncovered a chasm between how consumer patients think they’re doing financially, and the actual state of their finances. Even more striking, their study suggested that improving consumers’ financial health will become one of the top imperatives in reframing consumer financial services.

Modern Circumstance: For example, the study asked consumers to rate their own financial health, and 83 percent rated themselves “good,” “very good” or “excellent.”  Now, contrast this figure with what is known about their actual situation:

  • 60 percent of Americans say they are financially stressed.
  • 56 percent of Americans have less than $10,000 saved for retirement.
  • 40 million American families have no retirement savings at all.
  • 40 percent of Americans are not prepared to meet a $400 short-term emergency.

Paradox Example: Fortunately, even though the vast majority of consumers rate themselves as financially healthy, the study found that most still want to improve. Importantly for health economists, the attractive 25-34 and 35-49 year-old age groups were most likely to be extremely or very interested in improving their financial and economic health.

Paradox Example: Massively affluent consumer patients are even more interested in improving this paradox than their mass market counterparts.

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DAILY UPDATE: United Health Investigated as Stock Markets Climb

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UnitedHealth confirmed it’s being investigated. The healthcare giant said in a securities filing that it’s cooperating with the Justice Department in civil and criminal investigations following recent reports from the Wall Street Journal that the DOJ was looking into the company’s Medicare billing practices. WSJ reported that UnitedHealth had added unnecessary diagnoses to Medicare patients’ records that increased payments. It’s the latest setback for a company that ousted its CEO in May after its stock price cratered.

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What’s up

  • Tesla arrested its latest decline and gained 3.52% on the news that it will roll out its new robotaxi program in San Francisco as soon as this weekend.
  • Palantir rose 2.54% to become the 20th most valuable company in the country by market value.
  • Deckers Outdoor, the maker of Hoka and Ugg shoes, soared 11.35% on the back of stronger-than-expected earnings thanks to impressive international sales.
  • Newmont climbed 6.89% after a quarter of surging gold prices helped propel the miner’s earnings to new heights.
  • Managed care provider Centene added 6.09% despite marked declines in its Medicaid and Medicare membership, as well as soaring costs.
  • Boston Beer rose 6.54% as shareholders raised a toast to management’s effort to keep tariff costs low.

What’s down

  • Intel fell 8.53% on the news that it’s cutting costs by laying off 15% of its workforce and scaling back its chip foundry plans.
  • Puma plummeted 15.67% after the European footwear company warned of the high cost of tariffs.
  • Charter Communications plunged 18.49% in its worst day of trading ever after reporting that it lost 117,000 broadband subscribers last quarter. It was so bad that other cable stocks like Comcast sank 4.78% and Altice lost 9.46%.
  • Lyft announced it’s rolling out new autonomous shuttles, but shares still fell 0.56% as shareholders realized it’s just trying to keep up with Uber.

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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: Medicare Advantage Payment Delays as Stock Markets Split

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Stat: $3+ million. That’s how much Medicare and Medicare Advantage drug plans have been ordered to pay for “inappropriately delaying or denying” services in the first four months of this year—more than the past four years combined, one analysis finds. (Healthcare Dive)

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What’s up

  • Las Vegas Sands added 4.31% after crushing analyst estimates last quarter.
  • Deutsche Bank rose 7.83% to a decade high after shareholders applauded the financial firm’s turnaround efforts.
  • T-Mobile US gained 5.8% thanks to a better-than-expected quarter for the telecom giant.
  • Bloom Energy popped 22.95% on the news that it made a deal with Oracle to provide the tech company’s AI data centers with power.
  • Enterprise software maker ServiceNow jumped 4.16% on management’s promise of more AI growth ahead.
  • West Pharmaceutical Services soared 22.78% on the news that demand for GLP-1 products remains strong.

What’s down

  • IBM dropped 7.62% despite beating analysts expectations on the top and bottom lines last quarter. Shareholders didn’t like to hear management warn of slowing software sales.
  • UnitedHealth Group fell 4.76% on reports that the health insurer is cooperating with the DOJ’s investigation into its Medicare billing practices.
  • Tough day for airlines: American Airlines sank 9.62% after lowering its forward guidance, and Southwest Airlines lost 11.16% after missing analyst earnings estimates.
  • Luxury goods maker LVMH sank 3.66% after sales fell 4% last quarter as the high-fashion industry gets hit with tariff turmoil.
  • Union Pacific fell 4.43% after it confirmed it’s in talks to acquire smaller rival Norfolk Southern, which also lost 0.81%.
  • Honeywell International beat-and-raised earnings last quarter, but the stock still stumbled 6.18% lower.

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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: Both ACA Premiums and Stock Markets Rise

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What’s up

  • Krispy Kreme and GoPro got caught up in the new meme stock craze—the donut maker jumped 4.60%, while the wearable camera company leaped 12.41%.
  • Nintendo rose 2.36% after the company’s new Switch 2 console sold 1.6 million units in June, making it the fastest-selling console in US history.
  • GE Vernova gained 14.58% thanks to an impressive beat-and-raise earnings report for the power equipment manufacturer.
  • USANA Health Sciences soared 12.37% after the nutritional supplement maker crushed earnings estimates.
  • Cal-Maine Foods, the biggest egg producer in the country, added 13.80% after profiting from the high cost of eggs over the previous quarter.
  • Lamb Weston sizzled 16.31% higher as shareholders applauded the french fry giant’s strong earnings report and new cost-cutting program.

What’s down

  • Texas Instruments tumbled 13.34% after the semiconductor company revealed a disappointing third-quarter earnings forecast.
  • Enphase Energy plunged 14.16% thanks to weak earnings guidance, with the solar company’s management blaming tariffs for squeezing its margins.
  • SAP lost 5.03% after the enterprise software company missed Q2 revenue estimates.
  • Fiserv may have beaten analyst forecasts last quarter, but the fintech still sank 13.85% due to weaker-than-expected financial guidance.
  • Going down: Otis Worldwide dropped 12.38% after the elevator manufacturer lowered its fiscal guidance due to weak demand.

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Insurers selling plans on ACA exchanges are expected to hike premiums next year as subsidies on them are set to expire, with the average person expected to be paying 75% more, according to an analysis from the nonpartisan research group KFF.

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PARADOXES: Beware Financial and Investing Contradictions

By Staff Reporters

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As we plan for our financial future, I think it’s helpful to be cognizant of these paradoxes. While there’s nothing we can do to control or change them, there is great value in being aware of them, so we can approach them with the right tools and the right mindset.

Here are just seven of the paradoxes that can bedevil financial planning and investment decision-making:

  • There’s the paradox that all of the greatest fortunes—Carnegie, Rockefeller, Buffett, Gates—have been made by owning just one stock. And yet the best advice for individual investors is to do the opposite: to own broadly diversified index funds.
  • There’s the paradox that the stock market may appear overvalued and yet it could become even more overvalued before it eventually declines. And when it does decline, it may be to a level that is even higher than where it is today.
  • There’s the paradox that we make plans based on our understanding of the rules—and yet Congress can change the rules on us at any time, as it did just a few weeks ago.
  • There’s the paradox that we base our plans on historical averages—average stock market returns, average interest rates, average inflation rates and so on—and yet we only lead one life, so none of us will experience the average.
  • There’s the paradox that we continue to be attracted to the prestige of high-cost colleges, even though a rational analysis that looks at return on investment tells us that lower-cost state schools are usually the better bet.
  • There’s the paradox that early retirement seems so appealing—and has even turned into a movement—and yet the reality of early retirement suggests that we might be better off staying at our desks.
  • There’s the paradox that retirees’ worst fear is outliving their money and yet few choose the financial product that is purpose-built to solve that problem: the single-premium immediate annuity.

Assessment

QUESTION: How should you respond to these paradoxes? As you plan for your financial future, embrace the concept of “loosely held views.” In other words, make financial plans, but continuously update your views, question your assumptions and rethink your priorities.

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DAILY UPDATE: “Crypto-Week” as Stock Markets End Mixed

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“Crypto Week” got back on track after House GOP lawmakers convinced the holdouts in their party to help advance a series of crypto-friendly bills.

Crypto: Although bitcoin fell after the president signed the GENIUS Act into law, ether rose to its highest price in six months today, while enthusiasm for the new legislation pushed total crypto assets above $4 trillion.

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What’s up stocks

  • Talen Energy soared 24.48% on the news that the independent energy producer is acquiring two new power plants.
  • Interactive Brokers surged 7.77% after the broker increased the number of customer accounts by 32% last quarter as traders played market volatility.
  • Speaking of trading, Charles Schwab gained 2.87% after opening more than 1 million new brokerage accounts last quarter gave it a 23% boost in trading revenue.
  • Burberry popped 4.42% thanks to a turnaround in the luxury goods maker’s business, including a 4% increase in American sales last quarter.
  • Quantumscape continued to climb yet again, rising another 7.65% as investors pour money into the battery maker.
  • Invesco jumped 15.28% on reports that the asset manager is asking shareholders of its popular QQQ fund to let it revamp its fund structure to increase fee revenue.
  • Crypto companies continued to have a great week as key legislation passed its final barrier in Congress. Coinbase climbed 2.2%, Robinhood Markets rose 4.07%, and Galaxy Digital gained 4.19%.

What’s down stocks

  • Netflix fell 5.1% after the streaming giant reported a strong quarter but warned that its operating margin will take a hit in the second half of the year.
  • Sarepta Therapeutics plunged 35.94% after the biotech reported a third patient death during its Phase 1 study of its new gene therapy.
  • American Express sank 2.35% despite a strong quarter of spending among cardholders that helped the credit card company notch record quarterly revenue.
  • 3M also fell 3.65% in spite of beating Wall Street’s forecasts and raising its earnings guidance.

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DAILY UPDATE: Private Market Investment Retirement Plans Up Along with Stock Markets

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Stocks up

  • Lucid exploded 36.24% higher on the news that the EV maker is partnering with Uber to roll out the ridesharing company’s new robotaxis.
  • PepsiCo popped 7.45% thanks to a strong quarter for the snack and soda giant, while shareholders cheered the details of its turnaround plan.
  • United Airlines may have missed Wall Street’s revenue forecast, but its profits were enough to impress investors. Shares rose 3.11%.
  • Reports that Union Pacific is thinking about acquiring a rival sent shares of fellow train operators CSX and Norfolk Southern up 3.73% and 3.65%, respectively.
  • Sarepta Therapeutics soared 19.53% after the biotech announced it will lay off 500 employees and restructure its entire business.
  • Quantumscape continued its hot streak, rising yet another 19.82% thanks to its recent battery breakthrough.
  • Speaking of hot streaks, OpenDoor Technologies rose another 10.74% as retail traders pour into what is quickly becoming the next big meme stock.

Stocks down

  • GE Aerospace crushed earnings expectations and raised its fiscal guidance, but it still wasn’t enough to impress investors, who pushed shares of the engine maker down 2.10%.
  • US Bancorp sank 1.03% after revenue and net interest income missed forecasts last quarter.
  • Abbott Laboratories beat on both top and bottom line guidance, but still fell 8.53% after the pharma company narrowed its fiscal forecasts.
  • Elevance Health tumbled 12.22% af

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President Trump is expected to sign an executive order in the coming days designed to help make private-market investments more available to U.S. retirement plans, according to people familiar with the matter. The order would instruct the Labor Department and the Securities and Exchange Commission to provide guidance to employers and plan administrators on including investments like private assets in 401(k) plans.

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DOCTORS AND LAWYERS: Often Aren’t Millionaires

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DAILY UPDATE: Medicaid Cuts as Stock Markets Rise

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US measles cases have reached a 33-year high. A little more than halfway into 2025, the US has reported 1,288 measles cases, marking the highest yearly total since 1992, according to data from the Centers for Disease Control and Prevention.

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What’s up

  • VC powerhouse and diehard Tolkien fan Peter Thiel revealed he’s taken a 9% stake in bitcoin miner BitMine Immersion Technologies. Shares popped 12.11%, while fellow miners that have also recently invested in ether soared in tandem: SharpLink Gaming added 29.03%, and Bit Digital gained 19.45%.
  • In fact, most crypto stocks had a good day thanks to renewed optimism that Crypto Week isn’t over in Congress. MicroStrategy climbed 3.07% and MARA Holdings jumped 3.62%.
  • Johnson & Johnson rose 6.19% after the consumer goods giant reported impressive earnings last quarter and raised its forward guidance.
  • BrightHouse Financial popped 6.23% on reports that the insurer may be bought by private equity firm Aquarian Holdings.
  • Tesla gained 3.50% after the EV maker revealed the new six-seat Model Y it will begin selling in China this fall.

What’s down

  • ASML dropped 8.33% after the chipmaker warned that growth might be completely flat next year.
  • Ford fell 2.85% on the news that the automaker is recalling nearly 700,000 crossover SUVs due to fuel leaks.
  • GrabAGun Digital Holdings, the online gun seller backed by Donald Trump, Jr., made its market debut today. Investor reception was scathing, and the stock slid 24.19%.

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Though Medicaid cuts in the Trump administration’s budget bill shocked hospitals, providers may start singing its praises after learning they’re due for a pay bump next year. On Monday, the Centers for Medicare and Medicaid Services (CMS) shared its proposed 2026 physician fee schedule, which determines Medicare payments based on the amount of resources in provider services like office visits, hospice, diagnostic testing, ambulance care, and more.

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DAILY UPDATE: CPI Up as Sock Markets End Mixed

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The consumer price index, a broad-based measure of goods and services costs, increased 0.3% on the month, putting the 12-month inflation rate at 2.7%, the Bureau of Labor Statistics reported Tuesday. The numbers were right in line with the Dow Jones consensus. Excluding volatile food and energy prices, core inflation picked up 0.2% on the month, with the annual rate moving to 2.9%, also matching the respective estimates.

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Stocks up

  • Citigroup gained 3.68% after the big bank reported better-than-expected earnings.
  • CoreWeave climbed 6.21% on the news that it will build a $6 billion AI data center in Pennsylvania.
  • Trade Desk jumped 6.59% thanks to its inclusion in the S&P 500, replacing the outgoing Ansys.
  • The Trump administration has launched a probe into drone imports. Drones use polysilicon, a key ingredient for solar panels, and tariffs on the material could help boost profitability for domestic manufacturers like First Solar, which rose 6.90%.
  • National Fuel Gas rose 5.65% after the energy company caught a rare double upgrade from Bank of America analysts, who like the energy company’s improved productivity.

Stocks down

  • BlackRock fell 5.86% after the world’s largest asset manager reported that a single client pulled $52 billion last quarter.
  • It wasn’t a great day for other big banks: Wells Fargo sank 5.43% after cutting its 2025 net interest income guidance, while JPMorgan Chase lost 0.74% despite beating sales and profit estimates.
  • Albertsons tumbled 5.02% even though the grocer reported a solid quarter thanks to strong pharmacy sales and digital revenue.
  • Newmont dropped 5.71% on the news that CFO Karyn Ovelmen is leaving the gold miner.

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DAILY UPDATE: Big Pharma Payouts as Stock Markets Eke Out Rise

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Drug and medical device companies paid at least $13.2 billion to medical professionals in 2024, according to CMS data released June 30th. There’s been steady growth in these payments over the last few years, which include everything from research payments to free meals to promotional or conference fees. Drug and medical device companies paid out $13.1 billion in 2023, $13.1 in 2022, and $12.6 in 2021. If you’re a medical provider, you’ve probably gotten one of those perks from a drug or medical device company and thought it wouldn’t affect your decision-making.

But research suggests physicians are more likely to prescribe drugs from companies that pay them, with some studies specifically associating this with drugs that are costlier to patients. “Really well-trained people who affirm an oath to do no harm can be influenced, and are,” Neil Jay Sehgal, associate professor of health systems and population health at the University of Washington School of Public Health, told Healthcare Brew.

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Stocks Up

  • Bitcoin is booming, and crypto stocks climbed along with it. MicroStrategy rose 3.86%, Robinhood Markets added 1.67%. and Coinbase gained 1.80%.
  • Boeing rose 1.64% on preliminary reports that investigators have found no evidence of malfunction in the plane that crashed in India last month. Engine-maker GE Aerospace also gained 2.71%.
  • Warner Bros Discovery climbed 2.39% thanks to a strong opening weekend for the new Superman movie.
  • Autodesk popped 5.05% on the news that it is not pursuing an acquisition of rival software maker PTC. PTC fell 1.25%.
  • Kenvue, the company behind Band Aids and Listerine, gained 2.18% after kicking its CEO to the curb.
  • PayPal climbed 3.55% despite the news that JPMorgan will start charging the fintech fees for access to customer data.

Stocks Down

  • Starbucks sank 1.60% on news that employees will have to return to the office four days a week. Shareholders were also unimpressed with the coffee giant’s new secret menu.
  • Synopsys stumbled 1.74% after getting regulatory approval from Chinese authorities to acquire software designer Ansys for $35 billion. Ansys rose 3.03% on the news.
  • Waters plunged 13.81% on the news that it will merge with Becton Dickinson’s bioscience and diagnostic solutions business in a $17.5 billion deal.
  • Rivian Automotive lost 2.15% thanks to a downgrade from Guggenheim analysts, who forecast soft sales for the automaker’s latest models.

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ADLs versus IADLs

DEFINITIONS

By Staff Reporters

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Activities of Daily Living (ADLs)

According to Leslie Kernisan MD MPH, these are the basic self-care tasks that we initially learn as very young children. They are sometimes referred to as “Basic Activities of Daily Living” (BADLs). They include:

  • Walking, or otherwise getting around the home or outside. The technical term for this is “ambulating.”
  • Feeding, as in being able to get food from a plate into one’s mouth.
  • Dressing and grooming, as in selecting clothes, putting them on, and adequately managing one’s personal appearance.
  • Toileting, which means getting to and from the toilet, using it appropriately, and cleaning oneself.
  • Bathing, which means washing one’s face and body in the bath or shower.
  • Transferring, which means being able to move from one body position to another. This includes being able to move from a bed to a chair, or into a wheelchair. This can also include the ability to stand up from a bed or chair in order to grasp a walker or other assistive device.

If a person is not fully independent with ADLs, then we usually include some information about the amount of assistance they require. ADLs were originally defined in the 1950s by a geriatrician named Sidney Katz, who was trying to define what it might look like for a person to recover to independence after a disabling event such as a stroke or hip fracture. So these measures are sometimes called the “Katz Index of Independence in Activities of Daily Living.”

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Instrumental Activities of Daily Living (IADLs)

These are the self-care tasks we usually learn as teenagers. They require more complex thinking skills, including organizational skills. They include:

  • Managing finances, such as paying bills and managing financial assets.
  • Managing transportation, either via driving or by organizing other means of transport.
  • Shopping and meal preparation. This covers everything required to get a meal on the table. It also covers shopping for clothing and other items required for daily life.
  • Housecleaning and home maintenance. This means cleaning kitchens after eating, keeping one’s living space reasonably clean and tidy, and keeping up with home maintenance.
  • Managing communication, such as the telephone and mail.
  • Managing medications, which covers obtaining medications and taking them as directed.

Because managing IADLs requires a fair amount of cognitive skill, it’s common for IADLs to be affected when an older person is having difficulty with memory or thinking. For those older adults who develop Alzheimer’s disease or a related dementia, IADLs will usually be affected before ADLs are.

IADLs were defined about ten years after ADLs, by a psychologist named M.P. Lawton. Dr. Lawton felt there were more skills required to maintain independence than were listed on the original Katz ADL index, and hence created the “Lawton Instrumental Activities of Daily Living Scale.”

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DAILY UPDATE: CVS & Merck as Stock Markets Struggle

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CVS has threatened to close 23 pharmacies in Arkansas after the state passed a law banning companies that own pharmacy benefit managers (PBMs) from also operating pharmacies starting in 2026.

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What’s up stocks

  • Kraft Heinz jumped 2.53% following a WSJ report it was preparing to break itself up (but not back to Kraft and Heinz).
  • Companies in the drone sector rose after the Pentagon introduced measures to supercharge production and deployment. Red Cat rose 26.40%, AeroVironment 11.04%, and Kratos Defense & Security Solutions 11.76%.
  • Performance Food Group jumped 4.84% to a record after reportedly being eyed by US Foods Holding for a takeover. A combined company would become the top foodservice distributor in the US with combined sales of ~$100 billion.
  • AMC Entertainment popped 11% on an upgrade from Wedbush. It’s tired of IMAX hogging the Brew Markets spotlight…

What’s down stocks

  • Delta (-0.23%) and United (-4.34%) took a breather after their big celebration on Thursday post-Delta earnings.
  • Penn Entertainment got hit 7.62% when gaming revenue for Iowa and Indiana came in soft.
  • Sunrun’s up-and-down week ended…down, with the solar stock falling 7%.

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Stat: $10 billion. That’s how much Merck is paying to buy UK-based biopharmaceutical Verona Pharma. (CNBC)

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DAILY UPDATE: Measles Cases Up as Stock Markets Rise

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US measles cases have reached a 33-year high. A little more than halfway into 2025, the US has reported 1,288 measles cases, marking the highest yearly total since 1992, according to data from the Centers for Disease Control and Prevention.

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Stocks up

  • Cereal legend WK Kellogg popped 30.57% after chocolate giant Ferrero agreed to acquire it for north of $3 billion.
  • Tesla (+4.73%) continued to rebound from its plunge on Monday. Elon Musk said that Tesla’s robotaxi service would expand into the Bay Area “probably in a month or two” and that his AI chatbot Grok is coming to Tesla vehicles by next week.
  • Estée Lauder gained 6.32% after Bank of America slapped a buy rating on the stock, implying a 27% upside from Wednesday’s closing price. 
  • ProKidney continued its remarkable rally, rising another 19.35%, after the biotech announced positive trial results for its diabetes treatment. It’s gone from a penny stock to a $1.55 billion market cap in the past four days.
  • Copper companies Freeport-McMoRan (+3.51%) and Southern Copper (+2.34%) gained thanks to Trump’s announcement that copper tariffs would begin on August 1.

Stocks down

  • Biotech partners Ultragenyx (-25.11%) and Mereo BioPharma Group (-42.52%) plunged after issuing a disappointing update on their trial of a treatment for a rare genetic bone condition.
  • Vertiv, the maker of liquid cooling equipment, declined 5.96% when Amazon said it was rolling out a new liquid cooling system for its AI servers.
  • Hydro Flask owner Helen of Troy tumbled 22.71% after reporting a $450 million loss in its fiscal first quarter. CEO Brian Grass said “tariff-related impacts” were its Achilles heel.
  • Autodesk fell 6.89% after Bloomberg reported on Wednesday it was weighing a takeover of rival engineering software company PTC.

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What is a “Market-Neutral” Fund?

Market Neutral Funds Demystified

[A Special Report]

By Dimitri Sogoloff MD MBA & Dr. David E. Marcinko MBA MEd CMP

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Introduction

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It’s hard to believe that just 30 years ago, physician investors had only two primary asset classes from which to choose: U.S. equities and U.S. bonds.

Today, the marketplace offers a daunting array of investment choices. Rapid market globalization, technology advancements and investor sophistication have spawned a host of new asset classes, from the mundane to the mysterious.

Even neophyte medical investors can now buy and sell international equities, emerging market debt, mortgage securities, commodities, derivatives, indexes and currencies, offering infinitely more opportunities to make, or lose, money.

Amidst this ongoing proliferation, a unique asset class has emerged, one that is complex, non-traditional and not easily understood like stocks or bonds. It does, however, offer one invaluable advantage; its returns are virtually uncorrelated with any other asset class. When this asset class is introduced into a traditional investment portfolio, a wonderful thing occurs; the risk-return profile of the overall portfolio improves dramatically.

This asset class is known as a Market-Neutral strategy. The reason few medical professionals have heard of market neutral strategies is that most of them are offered by private investment partnerships otherwise known as hedge funds.

To the uninitiated, “hedge fund” means risky, volatile or speculative. With a market-neutral strategy however, just the opposite is true. Funds utilizing market-neutral strategies typically emphasize the disciplined use of investment and risk control processes. As a result, they have consistently generated returns that display both low volatility and a low correlation with traditional equity or fixed income markets. 

Definition of Market-Neutral

All market-neutral funds share a common objective: to achieve positive returns regardless of market direction. Of course, they are not without risk; these funds can and do lose money. But a key to their performance is that it is independent of the behavior of the markets at large, and this feature can add tremendous value to the rest of a portfolio.

A typical market-neutral strategy focuses on the spread relationship between related securities, which is what makes them virtually independent of underlying debt or equity markets. When two related securities are mispriced in relation to one another, the disparity will eventually disappear as the result of some external event. This event is called convergence and may take the form of a bond maturity, completion of a merger, option exercise, or simply a market recognizing the inefficiency and eliminating it through supply and demand.

Here’s how it might work

When two companies announce a merger, there is an intended future convergence, when the shares of both companies will converge and become one. At the time of the announcement, there is typically a trading spread between two shares. A shrewd trader, seeing the probability of the successful merger, will simultaneously buy the relatively cheaper share and sell short the relatively more expensive share, thus locking in the future gain.

Another example of convergence would be the relationship between a convertible bond and its underlying stock. At the time of convergence, such as bond maturity, the two securities will be at parity. However, the market forces of supply and demand make the bond underpriced relative to the underlying stock. This mispricing will disappear upon convergence, so simultaneously buying the convertible bond and selling short an equivalent amount of underlying stock, locks in the relative spread between the two.  

Yet another example would be two bonds of the same company – one junior and one senior. For various reasons, the senior bond may become cheaper relative to the junior bond and thus display a temporary inefficiency that would disappear once arbitrageurs bought the cheaper bond and sold the more expensive bond.

While these examples involve different types of securities, scenarios and market factors, they are all examples of a market-neutral strategy. Locking a spread between two related securities and waiting for the convergence to take place is a great way to make money without ever taking a view on the direction of the market.

How large are these spreads, you may ask? Typically, they are tiny. The markets are not quite fully efficient, but they are efficient enough to not allow large price discrepancies to occur.

In order to make a meaningful profit, a market-neutral fund manager needs sophisticated technology to help identify opportunities, the agility to rapidly seize those opportunities, and have adequate financing resources to conduct hundreds of transactions annually.  

Brief Description of Strategies

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The universe of market-neutral strategies is vast, spanning virtually every asset class, country and market sector. The spectrum varies in risk from highly volatile to ultra conservative. Some market-neutral strategies are more volatile than risky low-cap equity strategies, while others offer better stability than U.S Treasuries.

One unifying factor across this vast ocean of seemingly disparate strategies is that they all attempt to take advantage of a relative mispricing between various securities, and all offer a high degree of “market neutrality,” that is, a low correlation with underlying markets.

[A] Convertible Arbitrage

Convertible arbitrage is the oldest market-neutral strategy. Designed to capitalize on the relative mispricing between a convertible security (e.g. convertible bond or preferred stock) and the underlying equity, convertible arbitrage was employed as early as the 1950s.

Since then, convertible arbitrage has evolved into a sophisticated, model-intensive strategy, designed to capture the difference between the income earned by a convertible security (which is held long) and the dividend of the underlying stock (which is sold short). The resulting net positive income of the hedged position is independent of any market fluctuations. The trick is to assemble a portfolio wherein the long and short positions, responding to equity fluctuations, interest rate shifts, credit spreads and other market events offset each other.  

A convertible arbitrage strategy involves taking long positions in convertible securities and hedging those positions by selling short the underlying common stock. A manager will, in an effort to capitalize on relative pricing inefficiencies, purchase long positions in convertible securities, generally convertible bonds, convertible preferred stock or warrants, and hedge a portion of the equity risk by selling short the underlying common stock. Timing may be linked to a specific event relative to the underlying company, or a belief that a relative mispricing exists between the corresponding securities.

Convertible securities and warrants are priced as a function of the price of the underlying stock, expected future volatility of returns, risk free interest rates, call provisions, supply and demand for specific issues and, in the case of convertible bonds, the issue-specific corporate/Treasury yield spread.

Thus, there is ample room for relative misvaluations. Because a large part of this strategy’s gain is generated by cash flow, it is a relatively low-risk strategy. 

[B] Fixed-Income Arbitrage

Fixed-income arbitrage managers seek to exploit pricing inefficiencies across global markets.

Examples of these anomalies would be arbitrage between similar bonds of the same company, pricing inefficiencies of asset-backed securities and yield curve arbitrage (price differentials between government bonds of different maturities). Because the prices of fixed-income instruments are based on interest rates, expected cash flows, credit spreads, and related factors, fixed-income arbitrageurs use sophisticated quantitative models to identify pricing discrepancies.

Similarly to convertible arbitrageurs, fixed-income arbitrageurs rely on investors less sophisticated than themselves to misprice a complex security.

[C] Equity Market-Neutral Arbitrage

This strategy attempts to offset equity risk by holding long and short equity positions. Ideally, these positions are related to each other, as in holding a basket of S&P500 stocks and selling S&P500 futures against the basket. If the manager, presumably through stock-picking skill, is able to assemble a basket cheaper than the index, a market-neutral gain will be realized.

A related strategy is identifying a closed-end mutual fund trading at a significant discount to its net asset value. Purchasing shares of the fund gains access to a portfolio of securities valued significantly higher. In order to capture this mispricing, one needs only to sell short every holding in the fund’s portfolio and then force (by means of a proxy fight, perhaps) conversion of the fund from a closed-end to an open-end (creating convergence).

Sounds easy, right?

In considering equity market-neutral, you must be careful to differentiate between true market-neutral strategies (where long and short positions are related) and the recently popular long/short equity strategies.

In a long/short strategy, the manager is essentially a stock-picker, hopefully purchasing stocks expected to go up, and selling short stocks expected to depreciate. While the dollar value of long and short positions may be equivalent, there is often little relationship between the two, and the risk of both bets going the wrong way is always present.

[D] Merger Arbitrage (a.k.a. Risk Arbitrage)

Merger arbitrage, while a subset of a larger strategy called event-driven arbitrage, represents a sufficient portion of the market-neutral universe to warrant separate discussion.

Merger arbitrage earned a bad reputation in the 1980s when Ivan Boesky and others like him came to regard insider trading as a valid investment strategy. That notwithstanding, merger arbitrage is a respected stratagey, and when executed properly, can be highly profitable. It bets on the outcomes of mergers, takeovers and other corporate events involving two stocks which may become one.

A textbook example was the acquisition of SDL Inc (SDLI), by JDS Uniphase Corp (JDSU). On July 10, 2000 JDSU announced its intent to acquire SDLI by offering to exchange 3.8 shares of its own shares for one share of SDLI.

At that time, the JDSU shares traded at $101 and SDLI at $320.5. It was apparent that there was almost 20 percent profit to be realized if the deal went through (3.8 JDSU shares at $101 are worth $383 while SDLI was worth just $320.5). This apparent mispricing reflected the market’s expectation about the deal’s outcome. Since the deal was subject to the approval of the U.S. Justice Department and shareholders, there was some doubt about its successful completion. Risk arbitrageurs who did their homework and properly estimated the probability of success bought shares of SDLI and simultaneously sold short shares of JDSU on a 3.8 to 1 ratio, thus locking in the future profit.

Convergence took place about eight months later, in February 2001, when the deal was finally approved and the two stocks began trading at exact parity, eliminating the mispricing and allowing arbitrageurs to realize a profit. 

Merger Arbitrage, also known as risk arbitrage, involves investing in securities of companies that are the subject of some form of extraordinary corporate transaction, including acquisition or merger proposals, exchange offers, cash tender offers and leveraged buy-outs. These transactions will generally involve the exchange of securities for cash, other securities or a combination of cash and other securities.

Typically, a manager purchases the stock of a company being acquired or merging with another company, and sells short the stock of the acquiring company. A manager engaged in merger arbitrage transactions will derive profit (or loss) by realizing the price differential between the price of the securities purchased and the value ultimately realized when the deal is consummated. The success of this strategy usually is dependent upon the proposed merger, tender offer or exchange offer being consummated.  

When a tender or exchange offer or a proposal for a merger is publicly announced, the offer price or the value of the securities of the acquiring company to be received is typically greater than the current market price of the securities of the target company.

Normally, the stock of an acquisition target appreciates while the acquiring company’s stock decreases in value. If a manager determines that it is probable that the transaction will be consummated, it may purchase shares of the target company and in most instances, sell short the stock of the acquiring company. Managers may employ the use of equity options as a low-risk alternative to the outright purchase or sale of common stock. Many managers will hedge against market risk by purchasing S&P put options or put option spreads. 

[E] Event-Driven Arbitrage

Funds often use event-driven arbitrage to augment their primary market-neutral strategy. Generally, any convergence which is produced by a future corporate event would fall into this category.

Accordingly, Event-Driven investment strategies or “corporate life cycle investing” involves investments in opportunities created by significant transactional events, such as spin-offs, mergers and acquisitions, liquidations, reorganizations, bankruptcies, recapitalizations and share buybacks and other extraordinary corporate transactions.

Event-Driven strategies involve attempting to predict the outcome of a particular transaction as well as the optimal time at which to commit capital to it. The uncertainty about the outcome of these events creates investment opportunities for managers who can correctly anticipate their outcomes.

As such, Event-Driven trading embraces merger arbitrage, distressed securities and special situations investing. Event-Driven managers do not generally rely on market direction for results; however, major market declines, which would cause transactions to be repriced or break, may have a negative impact on the strategy. 

Event-driven strategies are research-intensive, requiring a manager to do extensive fundamental research to assess the probability of a certain corporate event, and in some cases, to take an active role in determining the event’s outcome. 

Risk and Reward Characteristics

To help understand market-neutral performance and risk, let’s take a look at the distribution of returns of individual strategies and compare it to that of traditional asset classes.

 Table 1:  Average Return / Volatility of Market Neutral Strategies And Selected Traditional Asset Classes 

 

Strategy Average Return Annualized Volatility
Convertible Arbitrage 11.95% 3.57%
Fixed Income Arbitrage 8.33% 4.90%
Equity Market-Neutral 11.62% 4.95%
Merger Arbitrage 13.29% 3.51%
Relative Value Arbitrage 15.69% 4.31%
   Traditional Asset Classes:    
S&P 500 12.62% 13.72%
MSCI World 8.57% 13.05%
High Grade U.S. Corp. Bonds 7.26% 3.73%
World Government Bonds 5.91% 5.96%

The most important observation about this chart is that the Market Neutral funds exhibits considerably lower risk than most traditional asset classes.

While market-neutral strategies vary greatly and involve all types of securities, the risk-adjusted returns are amazingly stable across all strategies. The annualized volatility – a standard measure of performance risk – varies between 3.5 and 5 percent, comparable to a conservative fixed-income strategy.     

Another interesting statistics is the correlation between Market Neutral strategies and traditional asset classes and traditional asset classes

Table 2: Correlation between Market Neutral Strategies and Traditional Asset Classes

 

Asset Class/Strategy S&P500 MSCI World GovBonds CorpBonds

The correlation of all market neutral strategies to traditional assets is quite low, or negative in some cases. This suggests that these strategies would indeed play a useful role in the ultimate goal of efficient portfolio diversification.

To test the “market neutrality” of these strategies, we asked, “How well, on average, did these strategies perform during bad, as well as good, market months?”

It turns out, in good times and bad, these strategies displayed consistent solid performance. From 12/31/91, in months when S&P 500 was down, the average down month was 3.03 percent. Market Neutral strategies performed as follows:

  

Strategy Average Monthly Return
Convertible Arbitrage + 0.65%
Fixed Income Arbitrage + 0.50%
Equity Market-Neutral + 1.19%
Merger Arbitrage + 0.88%
Relative Value Arbitrage + 0.81%

In months when S&P 500 was up, the average up month was +3.24 percent.  Market Neutral strategies performed as follows:

  

Strategy Average Monthly Return
Convertible Arbitrage +1.17%
Fixed Income Arbitrage +1.20%
Equity Market-Neutral +1.37%
Merger Arbitrage +0.60%
Relative Value Arbitrage +1.25%

Clearly, a compelling picture emerges. While these strategies, on average, underperform during good times, they show a positive average return during both good and bad markets.

Inclusion of Market-Neutral in a Long-term Investment Portfolio

A critical concern for any medical investor considering a foray into a new asset class is how it will alter the long-term risk/reward profile of the overall portfolio. To better understand this, we constructed several hypothetical portfolios consisting of traditional asset classes:

·  US Treasuries (Salomon Treasury Index 10yrs+)

·  High Grade Corporate Bonds  (Salomon Investment Grade Index)

·  Speculative Grade Corporate Bonds  (High Yield Index)

·  US Blue chip equities  (Dow Jones Industrial Average)

·  US mid-cap equities  (S&P 400 Midcap Index)

·  US small-cap equities (S&P 600 Smallcap Index)

Portfolios varied in the level of risk from 100 percent U.S Treasuries (least risky) to 100 percent small-cap equities (most risky), and are ranked from 1 to 10, 1 representing the least risky portfolio.Each portfolio was analyzed on a Risk/Return basis using monthly return data since December 1991. The results are shown in Chart 1.Predictably, the least risky portfolio produced the smallest return, while the riskiest produced the highest return. This is perfectly understandable – you would expect to be compensated for taking a higher level of risk.

Chart 1: Risk/Return characteristics of traditional portfolios vs. Market Neutral strategies 

Clearly, the risk-return picture offered by Market Neutral strategies is much more compelling (lower risk, higher return) than that offered by portfolios of traditional assets. What happens if we introduce these market-neutral strategies into traditional portfolios? Let’s take 20 percent of the traditional investments in our portfolio and reinvest them in market-neutral strategies.

The change is dramatic: the new portfolios (denoted 1a through 10a) offer significantly less risk for the same return. The riskiest portfolio, for instance (number 10) offered 20 percent less risk for a similar return of a new portfolio containing market-neutral strategies (number 10a).   
 
Chart 2:  Result of inclusion of 20% of Market Neutral strategies in traditional portfolios 

This is quite a difference.  Everything else being equal, anyone would choose the new, “improved” portfolios over the traditional ones.

How to invest

The mutual fund world does not offer a great choice of market neutral strategies. 

Currently, there are only a handful of good mutual funds that label themselves market-neutral (AXA Rosenberg Market Netural fund and Calamos Market Neutral fund are two examples).

Mutual fund offerings are slim due to excessive regulations imposed by the SEC with respect to short selling and leverage, and consequently these funds lack flexibility in constructing truly hedged portfolios. The dearth of market-neutral offerings among mutual funds is offset by a vast array of choices in the hedge fund universe. Approximately 400 market-neutral funds, managing $60 billion, represent roughly 25% of all hedge funds.

Therefore, further focus will relate to the hedge fund universe, rather than the limited number of market-neutral mutual funds.

Direct investing in a market-neutral hedge fund is restricted to qualifying individuals who must meet high net worth and/or income requirements, and institutional investors, such as corporations, qualifying pension plans, endowments, foundations, banks, insurance companies, etc.

This does not mean that retail investors cannot get access to hedge fund exposure. Various private banking institutions offer funds of funds with exposure to hedge funds. Maaket-neutral funds are nontraditional investments. They are part of a larger subset of strategies known as alternative investments, and there is nothing traditional in the way doctors invest in them.

Hedge funds are private partnerships, which gives them maximum flexibility in constructing and managing portfolios, but also requires medical investors to do a little extra work.

[A] Lockup Periods

One of the main differences between mutual funds and hedge funds is liquidity. Market-neutral strategies have less liquidity than traditional portfolios. Quarterly redemption policies with 45- or 60-days notice are common. Many funds allow redemptions only once a year and some also have lock-up periods. In addition, few of these funds pay dividends or make distributions. These investments should be regarded strictly as long-term strategies.

[B] Managerial Risks

Success of a market-neutral strategy depends much less on the market direction than on the manager’s skill in identifying arbitrage opportunities and capitalizing on them.

Thus, there is significantly more risk with the manager than with the market. It’s vital for investors to understand a manager’s style and to monitor any deviations from it due to growth, personnel changes, bad decisions, or other factors.

[C] Fees

If you are accustomed to mutual fund fees, brace yourself; market-neutral investing does not come cheap.

Typical management fees range from 1 to 2 percent per year, plus a performance fee averaging 20 percent of net profits. Most managers have a “high watermark” provision; they cannot collect the performance fees until investors recoup any previous losses. Look for this provision in the funds’ prospectus and avoid any fund that lacks it. Even with higher fees, market-neutral investing is superior to most traditional mutual fund investing on a risk-adjusted return basis.

[D] Transparency

Mutual funds report their positions to the public regularly. This is not the case with market-neutral hedge funds. Full transparency could jeopardize accumulation of a specific position. It also generates front running: buying or selling securities before the fund is able to do so. While you should not expect to see individual portfolio positions, many hedge fund managers do provide a certain level of transparency by indicating their geographical or sector exposures, level of leverage and extent of hedging.

It does take a bit of education to understand these numbers, but the effort is definitely worthwhile. 

[E] Taxation

The issue of hedge fund taxation is quite complex and is often dependent on the fund and the personal situation of the investor. Advice from a competent accountant, specialized financial advisor, tax attorney with relevant experience is worthwhile. The bottom line is that investing in market-neutral funds is not a tax-planning exercise and it will not minimize your taxes.

On the other hand, it should not generate any more or fewer taxes than if you invested in more traditional funds.

From the medical investor’s perspective, the principal advantages of market-neutral investing are attractive risk-adjusted returns and enhanced diversification.

Ten years of data indicate that market-neutral portfolios have produced risk-adjusted returns superior to traditional investments. In addition, the correlation between the returns of market-neutral funds and traditional asset classes has been historically negligible.

Adding exposure of market-neutral return strategies to the asset mix within a consistent, long-term investment program offers a medical investor the opportunity to improve overall returns, as well as achieving some protection against negative market movements.

Now, after all of the above, has your impression of hedge funds in general or MN funds in particular, changed?

APPENDIX:  

Asset class weighting in traditional portfolios:
Portfolio US Treasuries US High Grade Corp Bonds US Low Grade Corp Bonds Large Cap Stocks Mid Cap Stocks Small Cap Stocks
1 50% 50%        
2   50% 50%      
3 10% 30% 50% 40%    
4   50%   50%    
5   10% 10% 50% 30%  
6     10% 50% 20% 20%
7     10% 30% 20% 40%
8       20% 20% 60%
9         20% 80%
10           100%

 

Conclusion

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DAILY UPDATE: Stock Markets Surge!

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Nvidia: Worth 4-trillion dollars.

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Stocks up

  • Hims & Hers Health gained 4.62% after announcing it will sell generic semaglutide in Canada when Novo Nordisk’s patent for Ozempic and Wegovy expires in January.
  • Merck shareholders applauded its move to buy respiratory drugmaker Verona Pharma for $10 billion, sending its stock up 2.88%.
  • Rhythm Pharmaceuticals popped 36.63% thanks to a promising new trial for its oral obesity treatment.
  • AES, a renewable power company that counts Microsoft among its clients, jumped 19.87% after Bloomberg reported it was considering a sale.
  • Fashion names Ralph Lauren (+2.10%) and Coach owner Tapestry (+3.31%) hit record highs.

Stocks down

  • WPP cut its guidance and watched its stock fall 18.11% as a result. The ad giant is dealing with a laundry list of challenges, from AI disrupting the industry to clients spending less to finding a new CEO.
  • Medical device maker RxSight plunged 37.84% after slashing its full-year revenue forecast.
  • T-Mobile ticked 1.55% lower after getting a downgrade from KeyBanc, which said its weakness in fiber internet would prevent it from catching up to rival AT&T.
  • Mobileye, which makes self-driving tech and was spun out of Intel, fell 7.08% when Intel said it was selling 45 million shares.

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DAILY UPDATE: Women’s Health, and Commodities, as Stock Markets Struggle

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Record VC investments for women’s health: Venture-backed women’s health startups experienced unprecedented investment last year, according to a new SVB report. The report examines the factors driving such record-breaking funding—like growing recognition of how various health conditions affect women differently and disproportionately, plus the causes and biological drivers behind this imbalance. Read it here.

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  • Stocks: Investors mostly yawned and the major indexes held steady a day after President Trump reignited his trade war by announcing higher tariffs would go into effect on 14 countries starting August 1st. Wall Street banks don’t seem concerned either, as Goldman Sachs and Bank of America became the latest strategists to raise their year-end target for the S&P 500.
  • Commodities: Copper futures popped as much as 17% to a new record, the largest intra-day gain since at least 1988, after Trump said he plans to place a 50% tariff on copper imports.

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DAILY UPDATE: FBI and FDA as Stock Markets Crash

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  • The FBI has uncovered $14.6 billion worth of fraudulent claims submitted to Medicare, Medicaid and other government health care programs, the agency said on Monday in conjunction with the Department of Justice (DOJ). The investigation resulted in 324 defendants being charged, including 96 medical professionals.
  • Now, the DOJ, FBI and HHS say they are collaborating to create a health care data fusion center that will help them identify, investigate and prosecute health care fraud.
  • And yesterday, the entities announced a DOJ-HHS False Claims Act Working Group, in which HHS will refer potential False Claims Act violations to the DOJ. Read more about the working group, its members and its goals here.

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Stocks: US equities tumbled from record highs, dragged down by megacaps, as President Trump reignited the dormant trade war with fresh tariff warnings against major trading partners (more on that in a sec). Meanwhile, the dollar bounced 0.5% against a basket of other currencies.

Commodities: Oil gained despite OPEC+ deciding to raise crude production by 548,000 barrels per day beginning in August, a larger-than-expected increase. Ultimately, Wall Street analysts expect oil futures to drop below $60 a barrel by the end of the year due to the increase in production.

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Read: FDA Commissioner Marty Makary MD is revamping the agency, with plans to use more AI assistance. (the Wall Street Journal)

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BEWARE: July Fourth Fireworks PLUS Helpful Weekend Reading List

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Happy Fourth of July! It’s a good day to avoid the emergency department, so leave the fireworks shows to the pros—and perhaps use your extra hands to double-fist some BBQ instead.

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DAILY UPDATE: OpenAI & Microsoft as Stock Markets Surge

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OpenAI is giving its employees a mandatory week long vacation to stave off a poaching spree launched by Meta.

Microsoft announced another round of layoffs—its largest in years—expected to impact thousands of workers across Xbox and other divisions, including 830 from its Redmond, Washington, HQ.

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The S&P 500 and NASDAQ Composite tallied fresh record closing highs on Thursday, buoyed by a stronger-than-expected jobs report that helped dampen expectations for a Federal Reserve interest-rate cut in July. But after lagging their trendier rivals earlier in the year, the Russell 2000 and Dow Jones Industrial Average are finally starting to play catch up. On Thursday, the Russell 2000 turned positive for 2025 for the first time since February, as a rally that started in June has accelerated in July.

Many investors have been waiting patiently for small-cap stocks to break out. But aside from a few false starts over the past two years, they have mostly continued to lag their large-cap rivals. However, some investors believe things could finally be changing.

A team of strategists at Barclays pointed out on Wednesday that a proposed increase to interest-expense tax deductions in President Trump’s budget bill could boost small-cap companies’ earnings by double digits, due to their higher interest burdens. “This market broadening out is a heathy sign,” said Craig Johnson, chief market technician at Piper Sandler, during an interview with MarketWatch on Thursday. More small-cap participation inevitably means investors are developing more of a taste for stocks beyond information technology, which powered much of the market’s gains in 2023 and 2024.

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Friday, July 4, 2025

  • All U.S. markets will be closed in observance of Independence Day.
  • There will be no Pre-Market or After-Hours trading sessions.

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Stocks, Bonds & Commodities

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DAILY UPDATE: Human Genome Project as the Dow and NASDAQ Diverge

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When it comes to scientific achievements that have advanced the practice of medicine, you’d be hard-pressed to find one more influential than the Human Genome Project. The project, a federally funded collaboration between scientists around the globe, began in October 1990 with the goal of improving our knowledge of human biology by sequencing an entire human genome, which is the complete set of DNA in a cell. Nearly 13 years and $2.7 billion later, the project wrapped up in April 2003, and scientists around the world now use the reference human genome to study genetics, biology, and more. Today, the entire human genome can be sequenced in as little as five hours and costs as little as $600. Learn more about the Human Genome Project’s impact here.

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🟢 What’s up

  • Jack in the Box popped like a…well, you know…after activist investor Biglari Capital reportedly accrued a 10% stake in the fast-food company. Shares rose 7.86%.
  • Robinhood Markets climbed 6.12% on speculation that it may be added to the S&P 500 to fill the spot left by Juniper Networks.
  • Rigetti Computing rose 15.45% after Cantor Fitzgerald analysts initiated their coverage of the quantum computing company with an “overweight” rating.
  • Verint Systems jumped 15.33% on reports that the customer service software maker may be acquired by Thoma Bravo.
  • Corona parent company Constellation Brands gained 4.48% after it reiterated its fiscal guidance, assuring shareholders that aluminum tariffs will only cost the company about $20 million.
  • Crypto companies gained across the board after bitcoin miner BitMine Immersion Technologies announced it’s pivoting to ethereum. BitMine rose 21.17%, MARA Holdings gained 13.38%, and CleanSpark climbed 12.64%.

What’s down

  • Centene plunged 40.37% after the health insurer rescinded its fiscal 2025 guidance, warning that EPS will come in lower than anticipated.
  • Centene’s news pulled the rest of the health insurance industry down with it. UnitedHealth Group lost 5.70%, CVS Health fell 4.28%, Elevance Health stumbled 11.50%, and Molina Healthcare dropped 21.97%.
  • Paramount Global sank 2.43% after the company settled its 60 Minutes lawsuit with President Trump for $16 million.
  • Marvell Technology slipped 2.61% on reports that Microsoft is cutting back on manufacturing AI chips in-house.
  • Intel lost 4.25% on the news that it may be shifting the strategy behind its foundry business.

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BEWARE FIREWORKS: Money to Burn on the Fourth of July

The Complete Guide to July 4th Fireworks

Gather your novelty flag apparel and preheat your grills: Independence Day 2024 is upon us. And, what’s a July 4th celebration without some explosions in the sky?

Assessment

This info-graphic takes a closer look at the less glamorous side of fireworks — from the dollars that go up in smoke to the fingers we burn.

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Happy Fourth ME-P readers; please light responsibly!

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DAILY UPDATE: Crude Oil Prices Reverse as Stock Markets Diverge

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Power station: Crude oil prices reversed as tensions in the Middle East cooled, but AI likely raises electricity demand over the longer term, creating investment opportunities and risks.

Oil supplies now exceed demand, noted Michelle Gibley, director of international research at the Schwab Center for Financial Research, in her latest analysis, though “AI is transforming the energy sector,” raising power shortage concerns.

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🟢 What’s up

  • Solar stocks got a reprieve today after the Senate dropped the excise tax on clean energy projects. Sunrun soared 10.51%, Enphase Energy rose 3.18%, SolarEdge Technologies popped 7.16%, and Array Technologies climbed 12.54%.
  • Apple tumbled this summer after investors were disappointed by its AI rollout, but rose 1.29% on the news that the company may pivot to using Anthropic or OpenAI in iPhones instead of building something in-house.
  • Wolfspeed, the best name for a company that makes computer chips, exploded 98.09% after the company officially filed for Chapter 11 bankruptcy.
  • Hasbro got a nice 4.29% bump thanks to Goldman Sachs analysts, who are big old nerds who think Magic: The Gathering will boost the toymaker’s sales.
  • Ford popped 4.61% after the automaker reported an impressive 14% increase in sales last quarter.
  • Casino stocks soared on the news that gaming revenue in Macau rose 19% in June. Wynn Resorts climbed 8.85%, Las Vegas Sands added 8.95%, and MGM Resorts gained 7.24%.

What’s down

  • AMC Entertainment tumbled 9.03% after the one-time meme stock announced its new debt restructuring plan.
  • Progress Software sank 13.03% after the business application software company reported mixed results last quarter, beating on profit but missing on revenue.
  • Joby Aviation fell 7.01% after traders took profits following the air taxi company’s big pop yesterday.
  • AeroVironment dropped 11.42% after defense contractor announced it’s offering $750 million in common stock and $600 million in convertible senior notes to pay off its debt.
  • Diabetes device makers tumbled on the news that the government may change the reimbursement rate for glucose monitors and insulin pumps. Insulet lost 4.52%, Dexcom fell 4.25%, and Beta Bionics sank 4.26%.

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DAILY UPDATE: 23andMe as Stock Markets Rise

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Stat: $305 million. That’s how much 23andMe co-founder and former CEO Anne Wojcicki’s nonprofit paid to acquire the genetics company. (CNN)

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What’s up

  • Building products distributor GMS soared 11.73% on the news that Home Depot will acquire the company for $4.3 billion. Home Depot fell 0.50%.
  • Moderna climbed 1.58% after reporting positive late-stage trial results for its experimental flu vaccine.
  • Palantir rose 4.27% after announcing that Accenture will help federal government clients implement the defense tech company’s AI offerings. Accenture rose 1.16% as well.
  • Joby Aviation flew 11.76% higher after the eVTOL company delivered its first flying taxi to the UAE.
  • Oracle jumped 3.99% thanks to regulatory filings that revealed a new $30 billion annual cloud deal that should prop up its finances quite nicely.
  • Hewlett Packard Enterprise popped 11.08% after the Department of Justice settled its lawsuit with the server maker, clearing the way for it to acquire Juniper Networks for $14 billion. Juniper jumped 8.45% on the news.
  • Robinhood Markets rose 12.77% as the trading app makes a big international push with tokenized equities for European investors.

What’s down

  • Tesla tumbled 1.84% on the news that the Senate version of the tax bill will end credits for EV purchases after September. Elon Musk was not pleased.
  • Gotta pay for that wedding somehow: Amazon sank 1.75% after founder Jeff Bezos announced he’s selling $5.4 billion worth of shares.
  • Boeing’s financial outlook was upgraded to “stable” by Fitch, but the stock still fell 2.32% on news that its acquisition of Spirit Aerosystems faces antitrust scrutiny in the UK.

CITE: https://tinyurl.com/tj8smmes

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

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PHYSICIANS ONLY: Career Coaching and Development

MARCINKO ASSOCIATES, Inc.

SPONSOR: http://www.MarcinkoAssociates.com

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Did you Know?

Experts estimate that it can cost more than $1 million to recruit and train a replacement for a doctor who leaves the profession because of burnout. But, as no broad calculation of burnout costs exists, Dr. Tait Shanafelt [Mayo Clinic researcher and Stanford Medicine’s first Chief Physician Wellness Officer] said Stanford, Harvard Business School, Mayo Clinic and the American Medical Association (AMA) are further cost estimating the issue. Nevertheless, Shanafelt and other researchers have shown that burnout erodes job performance, increases medical errors, and leads doctors to leave a profession they once loved.

Fortunately, we can help. From formal coaching to second career opinions, mentoring and advising, we can help with our remediation executive career programs. Regardless of what is happening in your life, it is wonderful to have a non-partial, confidential and informed career coach and sounding board on your side.

CITE: JAMA Internal Medicine [Effect of a Professional Coaching Intervention on the Well-Being and Distress of Physicians].

NCBI: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6686971/

THANK YOU

CONTACT US: https://marcinkoassociates.com/process-what-we-do/

***

EDUCATION: Books

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

VIX FEAR INDEX: Down

By AI

CBOE Volatility Index

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There’s a lot of confidence in markets these days, and nowhere is that more apparent than in the VIX, aka the CBOE Volatility Index, aka aka the Fear Index.

According to Brew Markets, the VIX literally measures the market’s expectation of volatility based on S&P 500 index options, but it’s become a shorthand way of quantifying investors’ fear or confidence. Any time the VIX rises above 30, it’s taken as a sign of some serious trepidation in the market—but anytime it falls below 20, the market is calm, cool, and collected.

The VIX skyrocketed to over 50 on Liberation Day as investors fretted over what tariffs meant for their portfolios, but it’s been gradually falling ever since. As the chart above shows, the VIX just fell below its key support level of 17—a mark it has failed to break below recently, and a move that underlines investors’ confidence that the good times will keep rolling.

VIX: https://medicalexecutivepost.com/2025/04/20/vix-stock-market-fear-gauge-update/

Whether or not that confidence is misplaced remains to be seen.

COMMENTS APPRECIATED

EDUCATION: Books

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ASSETS UNDER ADVISEMENT: Doctors Only

By Dr. David Edward Marcinko; MBA MEd CMP

A.U.A IS ALL WE DO!

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SPONSOR: http://www.MarcinkoAssociates.com

Assets under advisement refer to assets on which your firm provides advice or consultation but for which your firm does either does not have discretionary authority or does not arrange or effectuate the transaction. Such services would include financial planning or other consulting services where the assets are used for the informational purpose of gaining a full perspective of the client’s financial situation, but you are not actually placing the trade.

Assets under advisement could also be those which you monitor for a client on a non-discretionary basis, where you may make recommendations but where the client is the party responsible for arranging or effecting the purchase or sale.  A common example of this AUM scenario is when an advisor reviews a participant’s 401(k) allocations. If the adviser does not have the authority or ability to effect changes in the portfolio, these assets are likely considered assets under advisement rather than regulatory assets under management.

Assets under advisement are permitted to be disclosed on Form ADV Part 2A as a separate asset figure from the assets under management.  There is no requirement to disclose the assets under advisement figure, but some advisors opt to include the figure to give prospective clients a more complete picture of the firm’s responsibilities.  If you choose to report your assets under advisement, be sure to make a clear distinction between this figure and your regulatory assets under management.

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D. E. Marcinko & Associates Core Operating Values

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

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COMMENTS APPRECIATED

EDUCATION: Books

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

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STOCK MARKETS: Rally Onward!

By A.I.

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Markets: That feeling when you have a $10 trillion rally. To wit:

The S&P 500 closed at a record high this week despite a brief dip as trade tensions with Canada ratcheted up. That puts the index about 20% up from its April low, when the broad tariff announcement sent it spiraling, and up ~5% for the year.

NVIDIA also hit an all-time high, and it keeps edging closer to becoming the first company to hit a $4 trillion valuation.

COMMENTS APPRECIATED

EDUCATION: Books

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FINANCIAL COACHING: For Physicians

By Staff Reporters

SPONSOR: http://www.MarcinkoAssociates.com

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DEAR COLLEAGUES

If you are just starting out managing your finances and don’t know where to begin, a financial coach may be a good option for you. They are helpful for someone who wants to become proficient in the basics of finance, from learning how to budget or save money to building an emergency fund or creating a plan for paying off debt. If you have short-term money goals, like saving for a big purchase or just practicing better money habits, a financial coach can help you reach them by working with you to create a plan and holding you accountable. Even more for physicians and most all medical professionals.

Pros and Cons of Working with a Financial Coach
A financial coach can have a positive impact on your financial well–being and your life in a number of ways:

  • Financial coaches see the bigger picture of how you relate to money. They can help you develop better habits, resulting in positive personal growth.
  • By providing education and encouragement, they can reduce financial stress, confusion, and what it is about money that overwhelms you.
  • Through accountability and support, they can help you accomplish your goals and help you feel more confident in your finances.
  • Available 24/7/365.
  • Modest fees.

At you service.
Dr. David Edward Marcinko MBA MEd CMP

CONTACT: MarcinkoAdvisors@outlook.com

LINK: https://medicalexecutivepost.com/2025/01/23/personal-coaching-dr-marcinko-at-your-service/

COMMENTS APPRECIATED

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DAILY UPDATE: Health Insurance Options as Bull Market Edges Upward

MEDICAL EXECUTIVE-POST TODAY’S NEWSLETTER BRIEFING

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

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

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

http://www.MedicalBusinessAdvisors.com

SPONSORED BY: Marcinko & Associates, Inc.

***

http://www.MarcinkoAssociates.com

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

REFER A COLLEAGUE: MarcinkoAdvisors@outlook.com

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A June 11th report from global professional services firm Alvarez & Marsal (A&M) predicts that more beneficiaries might soon ditch insurance coverage for options like short-term, limited duration plans or healthcare sharing ministries (HCSMs), which aren’t regulated like health insurance and aren’t required to comply with ACA protections like covering maternity care or pre-existing conditions.

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

🟢 What’s up

  • Nvidia extended its winning streak to five days, rising another 1.73% as the AI trade continues to recover.
  • EchoStar climbed 13.16% after the parent company of Dish TV disclosed that President Trump did in fact prod the FCC to make a deal.
  • Cyngn soared another 20.07% following a big day of gains after the company that makes self-driving tech for industrial vehicles announced a partnership with Nvidia.
  • Strong earnings from Nike (more on that later) propelled sporting goods stocks higher today. ON Holdings rose 1.74%, while Dick’s Sporting Goods climbed 3.59%.
  • Domestic power producers popped on reports that Trump is planning to issue an executive order increasing energy production to meet AI demand. Vistra gained 2.44%, GE Vernova climbed 2.54%, and Vertiv added 2.71%.

What’s down

  • Coinbase Global ended its winning streak, tumbling 5.77% after GENIUS Act hype propelled the crypto stock skyward all week long. Traders took profits in Circle as well, pushing the stablecoin stock down 15.54%.
  • Chinese EV maker Li Auto fell 1.93% on its weaker-than-expected deliveries forecast for the second quarter.
  • Fellow Chinese EV maker Xiaomi stunned markets with reports that it received 240,000 orders for its new SUV within 18 hours of its debut, but shares still sank 4%.
  • Pony.ai lost 6.31% on a report that Uber is considering helping its founder Travis Kalanick fund his acquisition of the US subsidiary of the Chinese autonomous vehicle company.
  • Gold miners tumbled while the price of the precious metal fell as investors took a risk-on stance. Newmont lost 4.11%, Barrick Mining fell 3.44%, and Kinross Gold shed 6.18%.
  • Today’s trade deal reopens the door for Chinese rare earth imports, bad news for US producers like MP Materials (down 8.59%) and USA Rare Earth (down 12.14%).

CITE: https://tinyurl.com/tj8smmes

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

COMMENTS APPRECIATED

PLEASE SUBSCRIBE: MarcinkoAdvisors@outlook.com

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

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INVESTMENT ADVISORY: Portfolio Second Opinions for Physician Colleagues

INVESTMENT PORTFOLIO REVIEWS

By Dr David Edward Marcinko MBA MEd CMP

http://www.MarcinkoAssociates.com

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“FROM CHAOS-TO-CALM

If you’re looking at this tab, chances are you are fed up with your financial brokerage accounts, thinking of finances, investing, retirement or all of the above.

And so, we can help

An investment portfolio second opinion, also called a “ portfolio review,” is an analysis of your financial holdings and associated strategies, allocations, fees and performance to determine whether the most effective instruments and methodologies are being utilized to reach your goals.

No Worries! You may have come to the right place.

E-Mail Ann Miller RN MHA CPHQ for an Initial Appointment: MarcinkoAdvisors@outlook.com

The purpose of this initial appointment is for you to ask a lot of questions to make sure you are comfortable with potentially working with us. It also helps if you are prepared to provide a verbal summary of your current situation.

Here are some questions to consider asking us during your first meeting:

1) Can you tell us about your financial qualifications, experience, education and training; if any?

2) Can you provide some information about your current financial advisory team?

3) On what type of investments do you typically purchase and own?

5) How much do pay your financial management firm?

6) How long have you been working with your current financial management firm?

8) What other services does your financial team provide?

9) What is your own investment philosophy?

A Fiduciary Opinion At Your Service

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DAILY UPDATE: Nvidia and MSFT Reach New Highs as Stock Markets Surge!

MEDICAL EXECUTIVE-POST TODAY’S NEWSLETTER BRIEFING

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

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

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

http://www.MedicalBusinessAdvisors.com

SPONSORED BY: Marcinko & Associates, Inc.

***

http://www.MarcinkoAssociates.com

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

REFER A COLLEAGUE: MarcinkoAdvisors@outlook.com

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🟢 What’s up

  • Nvidia and Microsoft both set new record highs as the AI trade continues to revive. Nvidia rose 0.46%, while Microsoft climbed 1.05%.
  • Core Scientific exploded 33.01% on reports from the Wall Street Journal that the bitcoin miner may be acquired by AI company CoreWeave.
  • Serve Robotics gained 9.87% after the delivery robot maker launched its service on the streets of Atlanta today.
  • McCormick is looking spicy: The consumer goods company rose 5.31% after earnings outpaced analyst forecasts.
  • Penn Entertainment rose 4.94% after the gambling company was upgraded by analysts at Citizens, who think the stock’s underperformance is about to reverse.
  • Solar stocks may be thrown a lifeline by the Senate, which is considering keeping some clean energy tax credits in the spending bill. Enphase Energy popped 12.83%, SunRun rose 6.46%, and SolarEdge Technologies climbed 5.11%.
  • Copper miners popped as prices of the precious metal rose today. FreeportMcMoRan jumped 6.85%, Southern Copper Corp. climbed 7.79%, and Anglo American plc added 7.16%.

What’s down

  • Micron Technology lost 0.98% despite the chipmaker reporting fiscal third quarter results that beat Wall Street’s expectations.
  • Kratos Defense and Security Solutions sank 2.36% after the military tech company announced it will sell $500 million worth of stock to raise money for capital spending.
  • Equinix crumbled another 9.56% after a terrible fiscal outlook pushed Raymond James and BMO analysts to downgrade the internet services company.

CITE: https://tinyurl.com/tj8smmes

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

COMMENTS APPRECIATED

PLEASE SUBSCRIBE: MarcinkoAdvisors@outlook.com

Thank You

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

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DAILY UPDATE: Stock Markets Struggle

MEDICAL EXECUTIVE-POST TODAY’S NEWSLETTER BRIEFING

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

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

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

http://www.MedicalBusinessAdvisors.com

SPONSORED BY: Marcinko & Associates, Inc.

***

http://www.MarcinkoAssociates.com

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

REFER A COLLEAGUE: MarcinkoAdvisors@outlook.com

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

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🟢 What’s up

  • Nvidia rose 4.33% to hit a new all-time high today and once again become the largest company by market capitalization in the world.
  • European defense contractors climbed after NATO members agreed to increase defense spending to 5% of their GDP. Rheinmetall rose 3.43%, Leonardo SPA climbed 3.10%, and Thales SA added 2.59%.
  • QuantumScape exploded 31.40% after it revealed a solid-state lithium battery breakthrough.
  • BP jumped 1.63% on reports that the oil giant is in talks to be acquired by Shell, only for those reports to be refuted.
  • BlackBerry popped 12.47% after the cybersecurity stock (yes, that’s what they call themselves now) posted strong earnings last quarter and raised its fiscal forecast.
  • Yum Brands gained 3.14% thanks to an upgrade from JPMorgan analysts, who like the KFC and Taco Bell parent company’s strong free cash flow.
  • Drone maker AeroVironment soared 21.55% after crushing top- and bottom-line estimates last quarter.

What’s down

  • Tesla tumbled 3.79% after its EU vehicle registrations fell 41% in May, its fifth straight month of declines.
  • FedEx beat earnings expectations last quarter, but the shipping company still fell 3.27% thanks to worse-than-expected fiscal forecasts for next quarter.
  • General Mills may have just barely surpassed analyst forecasts last quarter, but sank 5.04% after management warned of a challenging year ahead.
  • Paychex lost 9.40% after the payment processor provided a mixed financial forecast for the coming quarter.

CITE: https://tinyurl.com/tj8smmes

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

COMMENTS APPRECIATED

PLEASE SUBSCRIBE: MarcinkoAdvisors@outlook.com

Thank You

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

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MORE INVESTING TERMS: All Doctors Should Know

By Staff Reporters

SPONSOR: http://www.MarcinkoAssociates.com

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Here is a list of the most common and helpful investment terms you’ll come across and should know.

  • Ask. The price that someone looking to sell stock wants to receive.
  • Bid. The price that someone is willing to pay for stock.
  • Buy. To acquire shares and thereby take a position in a company.
  • Sell. To get rid of shares whether because you’ve reached your goal or to prevent losses.
  • Bull market. Market conditions in which investors expect prices to rise.
  • Bear market. Market conditions in which investors expect prices to fall.
  • Dividend. A portion of a company’s earnings paid to shareholders.
  • Blue chip stocks. Shares of large and well-recognized companies that have a long history of solid financial performance.
  • Earning per share. A company’s net profit divided by the number of outstanding common shares.
  • Mutual fund. A collection of investments — stocks, bonds, commodities, and more — bundled together and held in common by a group of investors.
  • Asset. Something you own that could generate a return in the form of more assets.
  • Asset allocation. Your investment strategy, essentially — the mix of assets you choose to put your money into, whether that be cash, bonds, stocks, commodities, real estate or something else.
  • Broker. A person or firm — or robot — that arranges transactions between buyers and sellers in exchange for a commission (that is, a fee).
  • Capital gain (or capital loss). The money you make (or lose) on the sale of an asset.
  • Diversification. Investing in a variety of sectors, such as health care, energy and IT as well as across different geographic locations.
  • Dow Jones Industrial Average. A price-weighted list of 30 blue-chip stocks. It’s often used to help get a sense of the overall health of the stock market, even though it only reflects a small portion of the players.
  • Exchange-traded fund (ETF). A collection of investments that is traded like a stock.
  • Index fund. A type of mutual fund or exchange-traded fund that allows you to invest in a portfolio that mimics a market index, which is basically a list that tracks the performance of a group of investments either for a specific sector or the overall market.
  • Hedge fund. A type of investment partnership. Partners pool money from investors and try out a few different investing strategies. Generally, hedge funds will make riskier investments than your typical investor. They’ll also often use leverage (that is, borrowed money) or place bets against the market to get bigger returns. They make their money by charging their investors management fees based on a percentage of their profits.
  • Expense ratio. The percentage-based fee that mutual fund managers charge you to manage your investments.
  • Market price. How much it would cost right now to buy or sell an asset or service.
  • Securities and Exchange Commission (SEC). An independent government body that was created to protect investors and the national banking system. The SEC enforces laws that maintain orderly, fair and efficient markets.
  • Short selling. A tactic available to investors who predict a stock’s price is about to drop. An investor borrows a quantity of shares through a broker and then sells them, intending to repurchase them later, at a lower price, and return them to the lender.
  • Stock exchange. A place buyers and sellers come together to buy, sell and trade stock during set business hours. The New York Stock Exchange (NYSE) is the most important stock exchange in the world, but there are a total of 16 exchanges around the world.
  • Stock market. Refers in general to the collection of markets and exchanges where the buying, selling and trading of investment vehicles takes place.
  • Price per share. A simple way of calculating a company’s market value at a given moment. To find the price per share, you take a company’s most recent share price and multiply it by its total number of outstanding shares.
  • Prospectus. A legal document that contains in-depth information about anything you might be planning to invest in: stocks, bonds or mutual funds.

EDUCATION: Books

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DAILY UPDATE: SPACs Defined as Stock Markets Surge!

MEDICAL EXECUTIVE-POST TODAY’S NEWSLETTER BRIEFING

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

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

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

http://www.MedicalBusinessAdvisors.com

SPONSORED BY: Marcinko & Associates, Inc.

***

http://www.MarcinkoAssociates.com

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

REFER A COLLEAGUE: MarcinkoAdvisors@outlook.com

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SPACs, or special purpose acquisition companies, are shell companies that are created just to acquire or merge with an existing company, allowing that company to enter public markets without going through an IPO. The catch, however, is the SPAC sponsors have a small window of time—usually within two years—to find a suitable company to acquire.

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

What’s up

Carnival popped 6.91% after the cruise line reported impressive earnings and reiterated its healthy financial guidance.
If you can’t beat ‘em, join ‘em: Mastercard rose 2.80% on the news that it will integrate Fiserv’s new stablecoin into its products. Fiserv gained 1.24%.
Lyft gained 6.09% after TD Cowen analysts upgraded the stock, calling the ride-sharing company their “Best SMIDcap Idea for 2025.”
Falling oil prices helped airline stocks soar today: Frontier Group jumped 7.56%, JetBlue Airways rose 4.15%, and American Airlines added 4.31%.
Ambarella soared 20.61% on reports that the chip designer may be exploring a sale.
Nektar Therapeutics exploded 156.29% thanks to strong results in the Phase 2 trial of its new eczema treatment.
Crypto miners rose as investors took on more risk following a ceasefire in the Middle East: CleanSpark climbed 13.45%, Riot Platforms rose 8.09%, and MARA Holdings gained 4.94%.

What’s down

Oil prices fell on news of a ceasefire between Israel and Iran, pulling oil stocks down with them: Exxon Mobil lost 3.04%, Chevron dropped 2.25%, and Occidental Petroleum fell 3.34%.
The ceasefire also sent defense contractors tumbling: Lockheed Martin lost 2.59%, RTX dropped 2.72%, and Northrup Grumman fell 3.20%.
Krispy Kreme fell 0.76% on the news that its deal with McDonald’s has fallen apart due to rising costs.

CITE: https://tinyurl.com/tj8smmes

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

COMMENTS APPRECIATED

PLEASE SUBSCRIBE: MarcinkoAdvisors@outlook.com

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

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DAILY UPDATE: Stock Markets Blast Off!

MEDICAL EXECUTIVE-POST TODAY’S NEWSLETTER BRIEFING

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

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

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

http://www.MedicalBusinessAdvisors.com

SPONSORED BY: Marcinko & Associates, Inc.

***

http://www.MarcinkoAssociates.com

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

REFER A COLLEAGUE: MarcinkoAdvisors@outlook.com

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

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

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What’s up

  • Tesla climbed 8.23% thanks to a successful robotaxi debut in Austin this weekend
  • Northern Trust popped 8.01% on reports that Bank of New York Mellon is considering acquiring the financial services company.
  • The stablecoin adoption wave continues to hit markets, with Fiserv up 4.38% after announcing it made deals with Circle and PayPal to roll out a stablecoin and digital-asset platform for banking clients. Circle climbed another 9.64%.
  • Nuclear energy stocks climbed on the news that New York will build the first major new US nuclear plant in more than 15 years. Constellation Energy rose 3.37%, while Centrus Energy climbed 1.16% and Uranium Energy gained 2.01%.
  • SpartanNash exploded 50.62% higher after C&S Wholesale Grocers agreed to acquire the wholesale grocer for $1.77 billion.

What’s down

  • Tough first day at work: Stellantis sank 0.48% on the day that new CEO Antonio Filosa took the helm at the struggling automaker.
  • Novo Nordisk lost 5.49% after the pharma giant announced disappointing trial results for its newest weight-loss drug.
  • Super Micro Computer fell 9.77% on the news that it will raise money by offering $2 billion in convertible senior notes.
  • Wolfspeed plummeted 31.85% after the chipmaker said it plans to file for bankruptcy.

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

CITE: https://tinyurl.com/tj8smmes

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

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Thank You

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

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HEALTHCARE INSURANCE: Marketplace Consumer Fraud

By AI

SPONSOR: http://www.CertifiedMedicalPlanner.org

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Consumer Fraud in the Health Insurance Marketplace

Don’t be a Victim of Consumer Fraud in the Health Care Marketplace 

Beware of…

People asking for money to enroll you in Marketplace or “Obamacare” insurance. Legitimate enrollment agents will NOT ask for money.

High-pressure visits, mail solicitations, e-mails, and phone calls from people pretending to work for the government. No one should threaten you with legal action if you do not sign up for a plan. Always ask for identification if someone comes to your door.

People you did not contact who request personal information. They may be trying to steal your identity. No one from the government will call or email you to sell you an insurance plan or ask for personal identifying information. Be careful when giving out personal information, such as credit card, banking, or Social Security numbers.

Sham websites. Always look for official government seals, logos or website addresses.

Note: If you are a Medicare beneficiary, you do NOT need to buy insurance in the new Health Insurance Marketplace.

Report Marketplace Consumer Fraud: 1-800-318-2596

For more information about using the Marketplace, visit HealthCare.gov . This is the official Marketplace website.

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STOCK PERFORMANCE: Growth v. Value Investing for Physicians

BY DR. DAVID EDWARD MARCINKO: MBA MEd CMP™

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SPONSOR: http://www.MarcinkoAssociates.com

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Performance of Growth & Value Stocks

Although many academics argue that value stocks outperform growth stocks, the returns for individuals investing through mutual funds demonstrate a near match. 

Introduction

A 2005 study Do Investors Capture the Value Premium? written by Todd Houge at The University of Iowa and Tim Loughran at The University of Notre Dame found that large company mutual funds in both the value and growth styles returned just over 11 percent for the period of 1975 to 2002. This paper contradicted many studies that demonstrated owning value stocks offers better long-term performance than growth stocks. 

The studies, led by Eugene Fama PhD and Kenneth French PhD, established the current consensus that the value style of investing does indeed offer a return premium. There are several theories as to why this has been the case, among the most persuasive being a series of behavioral arguments put forth by leading researchers. The studies suggest that the out performance of value stocks may result from investors’ tendency toward common behavioral traits, including the belief that the future will be similar to the past, overreaction to unexpected events, “herding” behavior which leads at times to overemphasis of a particular style or sector, overconfidence, and aversion to regret. All of these behaviors can cause price anomalies which create buying opportunities for value investors.

Another key ingredient argued for value out performance is lower business appraisals. Value stocks are plainly confined to a P/E range, whereas growth stocks have an upper limit that is infinite.  When growth stocks reach a high plateau in regard to P/E ratios, the ensuing returns are generally much lower than the category average over time. 

Moreover, growth stocks tend to lose more in bear markets.  In the last two major bear markets, growth stocks fared far worse than value.  From January 1973 until late 1974, large growth stocks lost 45 percent of their value, while large value stocks lost 26 percent. Similarly, from April 2000 to September 2002, large growth stocks lost 46 percent versus only 27 percent for large value stocks. These losses, academics insist, dramatically reduce the long-term investment returns of growth stocks.

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However, the study by Houge and Loughran reasoned that although a premium may exist, investors have not been able to capture the excess return through mutual funds.  The study also maintained that any potential value premium is generated outside the securities held by most mutual funds.  Simply put, being growth or value had no material impact on a mutual fund’s performance.

Listed below in the table are the annualized returns and standard deviations for return data from January 1975 through December 2002.

Index                              Return                         SD      

S&P 500                            11.53%                     14.88%

Large Growth Funds         11.30%                     16.65%

Large Value Funds             11.41%                    15.39%

 Source:  Hough/Loughran Study

The Hough/Loughran study also found that the returns by style also varied over time.  From 1965-1983, a period widely known to favor the value style, large value funds averaged a 9.92 percent annual return, compared to 8.73 percent for large growth funds. This performance differential reverses over 1984-2001, as large growth funds generated a 14.1 percent average return compared to 12.9 percent for large value funds.  Thus, one style can outperform in any time period.

However, although the long-term returns are nearly identical, large differences between value and growth returns happen over time.   This is especially the case over the last ten years as growth and value have had extraordinary return differences – sometimes over 30 percentage points of under performance. 

This table indicates the return differential between the value and growth styles since 1992.

YEARLY RETURNS OF GROWTH/VALUE STOCKS

YearGrowthValue
19925.1%10.5%
19931.7%18.6%
19943.1%-0.6%
199538.1%37.1%
199624.0%22.0%
199736.5%30.6%
199842.2%14.7%
199928.2% 3.2%
2000-22.1%6.1%
2001-26.7%7.1%
2002-25.2%-20.5%
200328.2%27.7%
2004 6.3%16.5%
2005 3.6%6.1%
2006 10.8%20.6%
20078.8%1.5%
2008-38.43%-36.84%
200937.2%19.69%
201016.71%15.5%
20112.64%0.39%
201215.25%17.50%

Source:  Ibbottson.

Between the third quarter of 1994 and the second quarter of 2000, the S&P Growth Index produced annualized total returns of 30 percent, versus only about 18 percent for the S&P Value Index.  Since 2000, value has turned the tables and dramatically outperformed growth.  Growth has only outperformed value in two of the past eight years.  Since the two styles are successful at different times, combining them in one portfolio can create a buffer against dramatic swings, reducing volatility and the subsequent drag on returns. 

Assessment

In our analysis, the surest way to maximize the benefits of style investing is to combine growth and value in a single portfolio, and maintain the proportions evenly in a 50/50 split through regular rebalancing.  Research from Standard & Poor’s showed that since 1980, a 50/50 portfolio of value and growth stocks beats the market 75 percent of the time.

Conclusion

Due to the fact that both styles have near equal performance and either style can outperform for a significant time period, a medical professional might consider a blending of styles.  Rather than attempt to second-guess the market by switching in and out of styles as they roll with the cycle, it might be prudent to maintain an equal balance your investment between the two.

EDUCATION: Books

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

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DAILY UPDATE: GENIUS Act Protects Consumers

MEDICAL EXECUTIVE-POST TODAY’S NEWSLETTER BRIEFING

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

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

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

http://www.MedicalBusinessAdvisors.com

SPONSORED BY: Marcinko & Associates, Inc.

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Daily Update Provided By Staff Reporters Since 2007.
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© Copyright Institute of Medical Business Advisors, Inc. All rights reserved. 2025

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

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

GENIUS Act: https://www.banking.senate.gov/newsroom/majority/fact-sheet-the-genius-act-protects-consumers

CITE: https://tinyurl.com/tj8smmes

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

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

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DAILY UPDATE: PBM Mark-Ups as Stock Markets End Mixed

MEDICAL EXECUTIVE-POST TODAY’S NEWSLETTER BRIEFING

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

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

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

http://www.MedicalBusinessAdvisors.com

SPONSORED BY: Marcinko & Associates, Inc.

***

http://www.MarcinkoAssociates.com

Daily Update Provided By Staff Reporters Since 2007.
How May We Serve You?
© Copyright Institute of Medical Business Advisors, Inc. All rights reserved. 2024

REFER A COLLEAGUE: MarcinkoAdvisors@out.com

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

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

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

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

🟢 What’s up

  • Circle continued its stunning climb, rising another 20.69% following the Senate’s passage of the GENIUS Act earlier this week. Former toy company and soon-to-be crypto stock SRM Entertainment soared 34.63% as well.
  • Darden Restaurants, Olive Garden’s parent company, rose 1.21% after it beat earnings estimates and forecast strong growth through fiscal 2026.
  • CarMax climbed 6.61% after the auto seller reported better-than-expected earnings last quarter, thanks in no small part to a 9% increase in used car sales.
  • GMS soared 23.69% thanks to a bidding war for the specialty building materials maker between QXO and Home Depot.
  • Kroger popped 9.82% after posting mixed results last quarter, but shareholders liked that the grocery chain upped its full-year sales forecast.

What’s down

  • Credit card companies slid on the news that X may roll out a physical payment card. Mastercard lost 1.13%, and Visa sank 0.57%.
  • Chip stocks fell on reports that the US is considering canceling some waivers on semiconductors sold to China. Nvidia fell 1.12%, TSMC lost 1.87%, and Marvell Technology sank 1.92%.
  • Regencell Bioscience lost another 40% as the biotech’s rapid rally continues to fizzle out.
  • Accenture fell 6.82% after the IT company reported a 6% decline in bookings last quarter, offsetting its otherwise strong earnings report.

CITE: https://tinyurl.com/tj8smmes

Stat: $1 trillion. That’s how much one analysis says the healthcare industry could lose due to the Trump administration’s “big beautiful bill.” (Modern Healthcare)

Quote: “The evidence is mounting and indisputable that MRNA vaccines cause serious harm including death, especially among young people. We have to stop giving them immediately!”—Retsef Levi, an MIT professor and one of RFK Jr.’s newly announced CDC vaccine advisors, in a pinned 2023 X post (CNN Health)

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

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PARADOXICAL CONTRADICTIONS: All Financial Advisors Must Know to Win Clients!

The Ultimate Psychological Challenge to Influence Clients and Close More Sales

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By Dr. David Edward Marcinko MBA MEd CMP

SPONSOR: http://www.CertifiedMedicalPlanner.org

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A psychological paradox is a figure of speech that can seem silly or contradictory in form, yet it can still be true, or at least make sense in the context given.

This is sometimes used to illustrate thoughts or statements that differ from traditional ideas. So, instead of taking a given statement literally, an individual must comprehend it from a different perspective. Using paradoxes in speeches and writings can also add wit and humor to one’s work, which serves as the perfect device to grab a reader or a listener’s attention and/or persuade them to action, sales and closing statements. But paradoxes for the financial sector can be quite difficult to explain by definition alone, which is why it is best to refer to a few examples to further your understanding.

One good psychological paradox example is The Paradox of Thrift which suggests that while saving money is generally considered a prudent financial behavior, excessive saving during times of economic downturn can actually hinder economic recovery. When consumers collectively reduce their spending and increase their savings, it creates a decrease in aggregate demand. This reduction in demand can lead to lower production levels, job losses, and ultimately a decline in economic output. In other words, what may be individually rational behavior (financial saving) can have negative consequences for the overall economy.  

The following paradoxical contradictions will help financial advisors guide clients to close more sales to the benefit of both.

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In the intricate world of finance sales, advisors are often at the crossroads of various paradoxes that challenge client decision-making. While the journey towards financial security involves calculated strategies, it’s the nuanced understanding of paradoxes that can help the advisor close more sales.

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But, what seems true about money often turns out to be false, according to colleague Finance Professor John Goodell, PhD from the University Akron:

  1. The more we try to trade our way to profits, the less likely we are to profit.
  1. The more boring an investment—think index funds—the more exciting the long-run performance will probably be.
  1. The more exciting an investment—name your latest Wall Street concoction, Special Purpose Acquisition Company [SPAC] or anything crypto—the less exciting the long-term results typically are.
  1. The only certainty is uncertainty and the only constant is change. Today’s market decline will eventually become a bull market, and today’s market leaders will eventually yield to other stocks.
  1. Big market trends play a huge role in investment results, and yet trying to time macroeconomic cycles or guess which market sectors will outperform is a fool’s errand. Many big market rotations are set in motion by something wholly unanticipated, like a virus pandemic or a war.
  1. To be happy when wealthy, we also need to be happy with far less money. The fact is, above a relatively modest income level, no amount of extra money will change our level of happiness. More money might even make us miserable, as many lottery winners have discovered.
  1. The more we hate an investing trait—or any trait for that matter—the more likely it is that we’re resisting seeing that trait in ourselves. It’s what Carl Jung MD called the Shadow of Undesirable Personality Aspects that we hide from ourselves. Do prospects get irritated listening to your unsolicited financial advice? There’s a good chance that you often give unsolicited financial advice but don’t like to admit it.
  1. The more we learn about investing, the more we realize we don’t know anything. We should just buy index funds and instead spend our time worrying about stuff we can actually control.
  1. The more an investor is convinced he’s right, the more likely he is to be wrong. Short sellers, in particular, are likely to succumb to this paradoxical trap.
  1. The more options we have, the less satisfied we’ll be with each one. This is the Paradox of Choice; revised. Anyone who has spent hours “optimizing” his or her portfolio knows this all too well. Its close cousin is information overload, another frustration paradox when investing.
  1. The more afraid we are of losing money, the more likely we are to take unwitting risks that lose us money. Sitting in cash seems wise during market selloffs. But the truth is, none of us can reliably time the market. Pull up any chart of the stock market over any period longer than a decade and you’ll see that the riskiest decision is sitting in cash, which gets destroyed by inflation.

The more we think about our investments and look at our financial accounts, the more likely we are to damage our results by buying high because of greed and selling low because of fear. It can pay to look away.

ASSESSMENT

How should you respond to these financial paradoxes? As you plan for your own financial future, as well as your own client prospecting endeavors, embrace the concept of “loosely held views.”

In other words, make financial and client acquisitions plans, but continuously update your views, question your assumptions and paradoxes and rethink your priorities. Years of experience with clients certainly support the futility of trying to help them change their financial behavior by telling them what they “should” know or do.

CONCLUSION

Remember, it is far more useful to listen to client beliefs, fears and goals, and to suggest options and offer encouragement to help them discover their own path toward financial well-being. Then, incentivize them with knowledge of the above psychological paradoxes to your mutual success!

EDUCATION: Books

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

REFERENCES:

1. Goodell, J: Full publication list on Google Scholar: https://scholar.google.com/citations?hl=en&user=lJyDADsAAAAJ

 2. Jung, Carl, Gustav: Full publication list on Google Scholar: https://scholar.google.com/scholar?hl=en&as_sdt=0%2C11&q=carl+jung+publications&btnG=

READINGS:

Marcinko, DE and Hetico, HR: Comprehensive Financial Planning Strategies for Doctors and Advisors [Best Practices from Leading Consultants and Certified Medical Planners™]. CRC Productivity Press, New York, 2016.

Marcinko, DE: Dictionary of Health Economics and Finance. Springer Publishing Company, New York. 2006

Marcinko, DE and Hetico, HR: Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors [Best Practices from Leading Consultants and Certified Medical Planners™]. CRC Productivity Press, New York, 2015.

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ASSETS: Under Advisement V. Management

By Staff Reporters

SPONSOR: http://www.MarcinkoAssociates.com

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What are Assets Under Management?

Assets under management (AUM) is a significant parameter in the financial world. It answers financial questions like – how many investments does a company manage? What is the net value of the investments that the company manages? Finally, how many investors have trusted their assets with the company? The higher the answer to these three questions, the more glory to the company.

A wealthy investor who is not concerned by higher fees but wants maximum returns of their asset will probably choose an asset manager based on its AUM. Thus, the AUM indicates the financial performance of the firm. Also, based on the funds under management, the firm collects fees from other clients.

So, what are the investments which qualify as AUM? Any liquid asset of the investor they have entrusted the asset manager with monitoring and control. For example, bank deposits, cash balances, equity shares, bonds, mutual funds, and other investments.

What are the services an asset manager provides to their clients? The most important function is decision-making. With the constant fluctuations and rapid movements in the market, an asset manager has to make decisions about holding or selling an investment. The firm communicates with the investors and advises them about the necessary action.

Once the decision is taken, the firm acts on the decision, i.e., the investor does not have to enter the field. In addition, the asset management company will buy, sell, and make any other transactions on behalf of the investor. Finally, the firm also renders services like accounting, tax reporting, proxy voting (equity shares), client reporting, and other financial services.

What are Assets Under Advisement?

Assets under advisement refer to assets on which your firm provides advice or consultation but for which your firm does either does not have discretionary authority or does not arrange or effectuate the transaction. Such services would include financial planning or other consulting services where the assets are used for the informational purpose of gaining a full perspective of the client’s financial situation, but you are not actually placing the trade.

Assets under advisement could also be those which you monitor for a client on a non-discretionary basis, where you may make recommendations but where the client is the party responsible for arranging or effecting the purchase or sale.  A common example of this scenario is when an adviser reviews a participant’s 401(k) allocations. If the adviser does not have the authority or ability to effect changes in the portfolio, these assets are likely considered assets under advisement rather than regulatory assets under management.

Assets under advisement are permitted to be disclosed on Form ADV Part 2A as a separate asset figure from the assets under management.  There is no requirement to disclose the assets under advisement figure, but some advisers opt to include the figure to give prospective clients a more complete picture of the firm’s responsibilities.  If you choose to report your assets under advisement, be sure to make a clear distinction between this figure and your regulatory assets under management.

NOTE: Essay with thanks to Chat GPT.

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GLOSSARY: Health Information Technology and Security Terms

By Staff Reporters

SPONSOR: http://www.HealthDictionarySeries.org

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Much has been written and much has been opined on the topic of health information technology, electronic health records and medical security liability for physicians and healthcare providers in this textbook. But occasionally, we all still get lost in a wide array of acronyms, jargon and terms that are constantly changing in this ecosystem. And so, this brief glossary serves as a ready reference for those who want to know about these definitions in a quick and ready fashion.

Access control: The process of controlling the access of a user

Access security: To allow computer or healthcare network entry using ID / password / secure socket layer (SSL) encryption / biometrics, etc; unique identification and password assignments are usually made to medical staff members for access to medical information on a need-to-know basis, and only upon written authority of the owner of the data.

Access level authorization: Establishes a procedure to determine the computer or network access level granted to individuals working on or near protected health information, medical data or secure health data.

Accredited standards committee: Organization that helps develop American National Standards (ANS) for computer and health information technology; accredited by ANSI for the development of American National Standards; ASC X12N develops medical electronic business exchange controls like 835-Health Care Claim Payment/Advice and 837-Health Care Claim.

Accountability: The security goal that generates the requirement for actions of an entity to be traced uniquely to that entity. This supports nonrepudiation, deterrence, fault isolation, intrusion detection and prevention, and after-action recovery and legal action.

Accounting: Creating an historical record of who was authenticated, at what time, and how long they accessed the computer system.

Administrative simplification: The use of electronic standard code sets for health information exchange; Title II, Subtitle F of HIPAA gives HHS the authority to mandate the use of standards for the electronic exchange of health care data; to specify what medical and administrative code sets should be used within those standards; to require the use of national identification systems for health care patients, providers, payers (or plans), and employers (or sponsors); and to specify the types of measures required to protect the security and privacy of personally identifiable health care and medical information.

Alternative backup sites: Off-site locations that are used for transferring computer operations in the event of an emergency.

American Health Information Management Association: A large trade association of health information and medical data management professionals.

American Medical Informatics Association: An organization that promotes the use of electronic medical management and healthcare informatics for clinical and administrative endeavors.

American Telemedicine Association: Established in 1993 as a leading resource and advocate promoting access to medical care for patients and health professionals via telecommunications technology; membership open to individuals, companies, and other organizations with an interest in promoting the deployment of telemedicine throughout the world.

Anti-virus software: A software package or subscription service used to thwart malicious computer or network attacks, such as: Symantec®, McAfee®, Trend Micro®, Panda Software®, Sunbelt Software®, Computer Associates®, AVG® or MS-FF ®, etc.

Anti-Worm: A software patch, fix; glitch repairer; do-gooder virus; slang term.  

ASC X12N: HIPAA transmission standards, specifications and implementation guides from the Washington Publishing Company; or the National Council of Prescription Drug Programs.

Assurance: Grounds for confidence that the other four security goals (integrity, availability, confidentiality, and accountability) have been adequately met by a specific implementation. “Adequately met” includes (1) functionality that performs correctly, (2) sufficient protection against unintentional errors (by users or software), and (3) sufficient resistance to intentional penetration or bypass.

Asymmetric cryptology: The use of two different but mathematically related electronic keys for secure health data and medical information storage, transmission and manipulation.

Asymmetric encryption: Encryption and decryption performed using two different keys, one of which is referred to as the public key and one of which is referred to as the private key; also known as public-key encryption.

Asymmetric key: A half of a key pair used in an asymmetric “public-key” encryption system with two important properties: (1) the key used for encryption is different from the one used for decryption, (2) neither key can feasibly be derived from the other.

Attack tree: An inverted tree diagram that provides a visual image of the attacks that may occur against an asset.

Audio teleconferencing: A multi-simultaneous dual voice communications between two parties at remote locations; two way communications between physician and patient at various locations.

Authentication: The process of verifying and confirming the identity of a user.

Availability: The security goal that generates the requirement for protection against – Intentional or accidental attempts to (1) perform unauthorized deletion of data or (2) otherwise cause a denial of service or data.

Back door: A means to access to a computer program that bypasses security mechanisms, sometimes installed by a programmer so that the program can be accessed for troubleshooting or other purposes.

Back door trojans or bots: Currently, the biggest threat to healthcare and all PC users worldwide according to the MSFT Corporation.® 

Bandwidth: The amount of information that can be carried over a communications link.

Bar coding systems: Final FDA ruling issued in February 2004 that required bar codes on most prescription and non-prescription medications used in hospitals and dispensed based on a physician’s order; the bar code must contain at least the National Drug Code (NDC) number, which specifically identifies the drug; although hospitals are not required at this time to have a bar code reading system on the wards, this ruling has heightened the priority of implementing hospital-wide systems for patient-drug matching using bar codes.

Baud: A unit of digital transmission that indicates the speed of information flow. The rate indicates the number of events able to be processed in one second and is expressed as bits per second (bps). The baud rate is the standard unit of measure for data transmission capability; typical older rates were 1200, 2400, 9600, and 14,400 baud; the signaling rate of a telephone line in the number of transitions made in a second; 1/300 sec = 300 baud.

Beta test: The secondary or final stress examination of newly developed computer hardware, software or peripheral devices; site, etc.

Bibliographic database: Indexed computer or printed source of citations of journal articles and other reports in the literature; typically include author, title, source, abstract, and/or related information; MEDLINE® and EMBASE®.

Bioinformatics: The application of medical and biological science to the health information management field.

Biological Information technology: Cross industry alliance of the Microsoft Corporation to enhance the ability to use and share digital health and biomedical data.

Biometric: Personal security identity characteristics, such as a signature, fingerprints, voice, iris or retinal scan, hand or foot vein geometry, facial characteristics, hair analysis, eye, blood vessel or DNA; uses the unique human characteristics of a person as a means of authenticating.

Biometric identification: Secure identification using biometrics that identifies a human from a measurement of a physical feature or repeatable action of the individual (for example, hand geometry, retinal scan, iris scan, fingerprint patterns, facial characteristics, DNA sequence characteristics, voice prints, and hand written signature).

Biopassword: Start-up healthcare IT security pioneer of keyboarding patterns to boost online security through neural network patterns.

Bluetooth® device: Machines, like cell phone with headset, transmitting across communications channels 1 to 14, over time.

Bluetooth® technology: Wireless mobile technology standard built into millions of mobile phones, headsets, portable computers, desktops and notebooks; named after Harold Bluetooth, a 10th century Viking king; healthcare telemetry and rural data transmissions; the Bluetooth Special Interest Group (BSIG) advocates measures aimed at pushing healthcare interoperability for wireless devices and other computers designed for use in the medical field; other wireless stands include: Wi-Fi, ZigBe®, IrDA and RFID.

Buffer: A temporary storage area.

Buffer overflow: A security breach that occurs when a computer program attempts to stuff more data into a temporary storage area than it can hold

Business continuity plan: A plan that outlines the procedures to follow after a business experiences an attack on its security.

California Database Security Breach Act: A state act that requires disclosure to California residents if a breach of personal information has or is believed to have occurred.

Certification authority: An independent third-party organization that assigns digital certificates.

Chain of custody: A process that documents everyone who has had contact with or direct possession of the evidence.

Chain of trust: Suggestion that each and every covered entity and business associate share responsibility and accountability for confidential PHI. 

Chain of trust agreement: Contract entered into by two business partners in which it is agreed to exchange data and that the first party will transmit information to the second party, where the data transmitted is agreed to be protected between the partners; sender and receiver depend upon each other to maintain the integrity and confidentiality of the transmitted information; multiple two-party contracts may be involved in moving information from the originator to the ultimate recipient; for example, a provider may contract with a clearing house to transmit claims to the clearing house; the clearing house, in turn, may contract with another clearing house or with a payer for the further transmittal of those same claims.

Children’s Online Privacy Protection Act: A federal act that requires operators of online services or Web sites directed at children under the age of 13 to obtain parental consent prior to the collection, use, disclosure, or display of a child’s personal information.

Cipher lock: A combination lock that uses buttons that must be pushed in the proper sequence in order to open the door.

Clearing house: HIPAA medical invoice, healthcare data transaction exchange and medical data implementation service center that that meets or exceeds Federally-mandated standardized Electronic Data Interchange (EDI) transaction requirements.

Clinger-Cohen Act: Public Law 104-106; Information Technology Management Reform Act (ITMRA) of 1996.

Clinical data: Protected Health Information (PHI) from patient, physician, laboratory, clinic, hospital and/or payer, etc; identifiable patient medical information.

Clinical data information systems: Automatic and securely connected system of integrated computers, central severs and the Internet that transmits Protected Health Information (PHI) from patient, physician, laboratory, clinic, hospital and/or payer, etc.

Clinical data repository: Electronic storehouse of encrypted patient medical information; clinical data storage.

Clinical informatics: The management of medical and clinical data; the use of computers, networks and IT for patient care and health administration.

Clinical information: All the related medical information about a patient; Protected Health Information (PHI) from patients, providers, laboratories, clinics, hospitals and/or payers or other stakeholders, etc.

Clinical information system:  A computer network systems that supports patient care; relating exclusively to the information regarding the care of a patient, rather than administrative data, this hospital-based information system is designed to collect and organize data.

Clinical regional health information system: Electronic entity committed to securely share private patient health information among entities like medical providers, clinics, laboratories, hospitals, outpatient centers, hospice and other healthcare facilities; Community Health Management Information Systems (CHMIS), Enterprise Information Networks (EINs), Regional Health Information Networks (RHINs) and Health Information Networks (HINs).

Cold site: An alternative backup site that provides the basic computing infrastructure, such as wiring and ventilation, but very little equipment.

Compact disc – read only memory (CD-ROM): A computer drive that can read CD-R and CD-RW discs.

Compact disc – recordable (CD-R): An optical disc that contains up to 650 megabytes of data and cannot be changed once recorded.

Compact disc – rewriteable (CD-RW): An optical disc that can be used to record data, erase it, and re-record again.

Computer security: A computer or network that is free from threats against it.

Computerized Physician Order Entry System: Automatic medical provider electronic medical chart ordering system that usually includes seven features: medication analysis, system order clarity, increased work efficiency, point of care utilization, benchmarking and performance tracking, on-line alerts and regulatory reporting.

Confidential health information: Protected Health Information (PHI) that is prohibited from free-use and secured from unauthorized dissemination or use; patient specific medical data.

Counter signature: The ability to prove the order of application of signatures; analogous to the normal business practice of signing a document which has already been signed by another party (ASTM E 1762 -95); part of a digital signature.

Covered entity: 42 CFR § 164.504(e)(2)(i)(B). Any of three broadly defined entities that deal with protected health information (PHI): providers, individuals or group health plans, and clearinghouses.

Cracker: A person who breaks into or otherwise violates the system security with a malicious intent.

Cryptography: The science of transforming information so that it is secure while it is being transmitted or stored.

Cyber-terrorism: Attacks by a terrorist group using computer technology and the Internet to cripple or disable a nation’s electronic infrastructure.

Data backup: The process of copying data to another media and storing it in a secure location.

Data encryption standard: An older health or medical data private key cryptology federal protocol for secure information exchange; replaced by AES.

Data interchange standard: X12 HIPAA health data transmission standard format.

Data interchange standard association: The organization that provides X12 HIPAA transmission standards and formats.

Deadbolt lock: A lock that extends a solid metal bar into the door frame for extra security.

Decision support system: Computer tools or applications to assist physicians in clinical decisions by providing evidence-based knowledge in the context of patient-specific data; examples include drug interaction alerts at the time medication is prescribed and reminders for specific guideline-based interventions during the care of patients with chronic disease; information should be presented in a patient-centric view of individual care and also in a population or aggregate view to support population management and quality improvement.

Decryption: Changing an encrypted message back to its original form.

Definition files: Files that contain updated antivirus information.

De-identified health information: Protected health information that is no longer individually identifiable health information; a covered entity may determine that health information is not individually identifiable health information only if: (1) a person with appropriate knowledge of and experience with generally accepted statistical and scientific principles and methods for rendering information not individually identifiable determines that the risk is very small that the information could be used, alone or in combination with other available information, to identify an individual, and documents the methods and results of the analysis; or (2) the following identifiers of the individual, relatives, employers or household members of the individual are removed.

Denial of service: The prevention of authorized access to resources or the delaying of time critical operations.

Designated record set: Contains medical and billing records and any other records that a physician and/or medical practice utilizes for making decisions about a patient;  a hospital, emerging healthcare organization, or other healthcare organization is to define which set of information comprises “protected health information” and which set does not; contains medical or mixed billing records, and any other information that a physician and/or medical practice utilizes for making decisions about a patient.  It is up to the hospital, EHO, or healthcare organization to define which set of information comprises “protected health information” and which does not though logically this should not differ from locale to locale.  The patient has the right to know who in the lengthy data chain has seen their PHI. This sets up an audit challenge for the medical organization, especially if the accountability is programmed, and other examiners view the document without cause.

Designated standard: HIPAA standard as assigned by the department of HHS

Device lock: A steel cable and a lock used to secure a notebook computer.

Digital certificate: A certificate that binds a specific person to a public key.

Digital imaging and communications in medicine: Technology broadband transmission imaging standards for X-rays, MRIs, CT and PET scans, etc; health IT standard transmissions platform aimed at enabling different computing platforms to share image data without compatibility problems; a set of protocols describing how radiology images are identified and formatted that is vendor-independent and developed by the American College of Radiology and the National Electronic Manufacturers Association. 

Digital radiology: Medical digital imaging applied to x-rays, CT, PET scans and related non-invasive and invasive technology; broadband intensive imaging telemedicine.

Digital rights management: The control and protection of digital intellectual property.

Digital signature: Encrypted electronic authorization with verification and security protection; private and public key infrastructure; based upon cryptographic methods of originator authentication, computed by using a set of rules and a set of parameters so that the identity of the signer and the integrity of medical or other data can be verified.

Digital signature standard: Encryption technology to ensure electronic medical data transmission integrity and authentication of both sender and receiver; date and time stamps; public and private key infrastructure.

Digital versatile disc – recordable (DVD-R): An optical disc technology that can record once up to 3.95 gigabytes of data on a single-sided disc and 7.9 GB on a double-sided disc.

Digital versatile disc – rewriteable (DVD-RAM): An optical disc technology that can record, erase, and re-record data and has a capacity of 2.6 GB (single side) or 5.2 GB (double side).

Digital versatile disc (DVD): A technology that permits large amounts of data to be stored on an optical disc.

Disaster recovery plan: A process to restore vital health and/or critical healthcare technology systems in the event of a medical practice, clinic, hospital or healthcare business interruption from human, technical or natural causes; focuses mainly on technology systems, encompassing critical hardware, operating and application software, and any tertiary elements required to support the operating environment; must support the process requirements to restore vital company data inside the defined business requirements; does not take into consideration the overall operating environment; an emergency mode operation plan is still necessary.

Disclosure: Release of PHI outside a covered entity or business agreement space, under HIPAA; the release, transfer, provision of access to or divulging of medical information outside the entity holding the information.

Disc – rewriteable (DVD-RW): An optical disc technology that allows data to be recorded, erased, and re-recorded.

Due care: Managers and their organizations have a duty to provide for information security to ensure that the type of control, the cost of control, and the deployment of control are appropriate for the system being managed.

e-health: Emerging field in the intersection of medical informatics, public health and business, referring to health services and information delivered or enhanced through the Internet and related technologies; characterizes not only a technical development, but also a state-of-mind, attitude, and a commitment for networked, global thinking, to improve health care worldwide by using information and communication technology.

Electronic data interchange: Inter healthcare organization computer-to-computer transmission of business or health information in a standard format; direct transmission from the originating application program to the receiving, or processing, application program; an EDI transmission consists only of business or health data, not any accompanying verbiage or free-form messages; a standard format is one that is approved by a national or international standards organization, as opposed to formats developed by health industry groups, medical practices, clinics or companies; the electronic transmission of secure medical and financial data in the healthcare industrial complex; X12 and similar variable-length formats for the electronic exchange of structured health data. The Centers for Medicare and Medicaid Services (CMS) regulates security and Electronic Data Interchange (EDI).

Electronic data interchange standards: The American National Standards Institute (ANSI) set of EDI standards known as the X12 standards. These standards have been developed by private sector standards development organizations (SDOs) and are maintained by the Accredited Standards Committee (ASC) X12. ANSI ASC X12N standards, Version 4010, were chosen for all of the transactions except retail pharmacy transactions, which continue to use the standard maintained by the National Council for Prescription Drug Programs (NCPDP) because it is already in widespread use. The NCPDP Telecommunications Standard Format Version 5.1 and equivalent NCPDP Batch Standard Version 1.0 have been adopted in this rule (health plans will be required to support one of these two NCPDP formats). The standards are designed to work across industry and company boundaries. Changes and updates to the standards are made by consensus, reflecting the needs of the entire base of standards users, rather than those of a single organization or business sector. Specifically, the following nine healthcare transactions were required to use X12N standard electronic claim formats by October 16, 2003.

Electronic health record: A real-time patient health record with access to evidence-based decision support tools that can be used to aid clinicians in decision-making; the EHR can automate and streamline a clinician’s workflow, ensuring that all clinical information is communicated; prevents delays in response that result in gaps in care; can also support the collection of data for uses other than clinical care, such as billing, quality management, outcome reporting, and public health disease surveillance and reporting; electronic medical record.

Electronic medication administrative record: Electrical file keeping computerized system for tracking clinical medication dispensation and use; integrated with TPAs, PBMs, robotic dispensing devices and CPOEs, etc.

Electronic medical (media) claims: Usually refers to a flat file format used to transmit or transport medical claims, such as the 192-byte UB-92 Institutional EMC format and the 320-byte Professional EMC-NSF.

Electronic prescribing: A type of computer technology whereby physicians use handheld or personal computer devices to review drug and formulary coverage and to transmit prescriptions to a printer or to a local pharmacy; e-prescribing software can be integrated into existing clinical information systems to allow physician access to patient-specific information to screen for drug interactions and allergies.

Electronic preventive services selector: A digital tool for primary care clinicians to use when recommending preventive services for their patients unveiled by the Department of Health and Human Services’ Agency for Healthcare Research and Quality (AHRQ), in November 2006;  designed for use on a personal digital assistant (PDA) or desktop computer to allow clinicians to access the latest recommendations from the AHRQ-sponsored U.S. Preventive Services Task Force; designed to serve as an aid to clinical decision-making at the point of care and contains 110 recommendations for specific populations covering 59 separate preventive services topics; a real time search function allows a clinician to input a patient’s age, gender, and selected behavioral risk factors, such as whether or not they smoke, in the appropriate fields, while the software cross-references the patient characteristics entered with the applicable Task Force recommendations and generates a report specifically tailored for that patient.

Electronic signature: Various date and time stamped electronic security verification systems, such as passwords, encryption, ID numbers, biometrics identifiers, etc; electrical transmission and authentication of real signatories; signatory attribute that is affixed to an electronic health document to bind it to a particular entity; an electronic signature process secures the user authentication (proof of claimed health identity, such as by biometrics (fingerprints, retinal scans, hand written signature verification, etc.), tokens or passwords) at the time the signature is generated; creates the logical manifestation of signature (including the possibility for multiple parties to sign a medical document and have the order of application recognized and proven) and supplies additional information such as time stamp and signature purpose specific to that user; and ensures the integrity of the signed document to enable transportability, interoperability, independent verifiability, and continuity of signature capability; verifying a signature on a document verifies the integrity of the document and associated attributes and verifies the identity of the signer; there are several technologies available for user authentication, including passwords, cryptography, and biometrics (ASTM 1762-95).

Encryption: Changing the original text to a secret message.

Gigabytes (GB): Billions of bytes of data.

Gramm-Leach-Bliley Act: A federal act that requires private data be protected by banks and financial institutions.

Hacker: A person who possesses advanced computer skills and is adept at exploring computers and networks in order to break into them.

HEALTH 1.0This is the dying healthcare system of yesterday and today. Information is communicated from doctors to patients. It is a basic B2C [business-to-consumer] website as the internet became one big encyclopedia by aggregating knowledge silos. Some doctors maintain websites, others do not. Nevertheless, Health 1.0 has a command and control hierarchy; doctors on top of the pyramid, patients on the bottom.

HEALTH 2.0:  According to Matthew Holt [personal communication] Healthcare 2.0 may be defined as: “The foundation of healthcare 2.0 is information exchange plus technology. It employs user-generated content, social networks and decision support tools to address the problems of inaccessible, fragmentary or unusable health care information. Healthcare 2.0 connects users to new kinds of information, fundamentally changing the consumer experience (e.g., buying insurance or deciding on/managing treatment), clinical decision-making (e.g., risk identification or use of best practices) and business processes (e.g., supply-chain management or business analytics)”.

And so, if Health 1.0 was a static book, Health 2.0 is a dynamic discussion

Example: The power of the internet is illustrated in the phenomenon of “crowd-sourcing.” In this context, the term means to harvest the reach of social networking [wisdom of crowds] to solve a problem. A knowledge seeker asks a question and participants respond.  For example, readers can participate on the www.MedicalExecutivePost.com or www.BusinessofMedicalPractice.com sites to improve the administration of any medical practice. And, www.PodiatryPrep.com is an example of how podiatrists connect for global board certification assistance.

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HEALTH 2.0 Plus:The Dictionary of Health Insurance and Managed Care defines this emerging hybrid as a bridge uniting the philosophy of contemporary Health 2.0 with futuristic Health 3.0 technologies. Cisco System’s HealthPresence is one example developed in 2010, by Dr. T. Warner Hudson. Using the network as a platform, HealthPresence combines video, audio and information to create an environment similar to what patients experience when they visit their own doctor.

HEALTH 3.0: Soon, patients will not only be seeking information; but actionable intelligence – whether it is artificial or real. Patients will communicate almost as with another patient or doctor. The internet won’t just blindly do what we tell it to do – it will think and represent some amazing opportunities. For example, imagine your toilet running a SMAC 20 and then being instantly notified of the results by your smart phone? Or; use your iPhone to send pictures and streaming videos of conditions for a second opinion www.KnockingLive.com

Health information technology: The application of information processing involving both computer hardware and software that deals with the storage, retrieval, sharing, and use of health care information, medical data, and knowledge for communication and decision making.

Health information technology auditor: An expert who evaluate a health organization’s computer systems to ensure the proper safeguards are in place to protect and maintain the integrity of the firm’s data; While the position has existed since the mid-1960s, companies that previously employed just a handful of HIT auditors are now significantly adding to their ranks, sometimes doubling, tripling or quadrupling current staff levels; much current demand is due to the Sarbanes-Oxley Act and other legislation aimed at improving corporate governance in the wake of major accounting scandals earlier in the decade; publicly traded hospital systems require the expertise of HIT auditors to meet ongoing compliance requirements; the Gramm-Leach-Bliley Act and the Health Insurance Portability and Accountability Act (HIPAA), among other regulations, also are fueling the need for HIT auditors.  Health IT auditors must have a general understanding of accounting principles and the strategic vision to ensure a health organization’s HIT systems allow it to achieve its short- and long-term objectives. Many hospitals promote from within for this role. Health facilities who look outside the organization for these professionals usually seek candidates with experience, knowledge of healthcare of emerging technologies and issues, and increasingly, certifications such as the certified information systems auditor (CISA) designation.

Health information technology promotion act: Legislation to accelerate the adoption of interoperable electronic health records by ensuring uniform standards, championed by Rep. Nancy Johnson, R-Conn, (H.R. 4157) which would: codify the Office of the National Coordinator for Health Information Technology in statute and delineate its ongoing responsibilities; create exceptions to the fraud and abuse statutes to allow certain providers to fund health information technology equipment and services for other providers; and provide for a study of federal and state health privacy policies.

Health Insurance Portability and Accountability Act (HIPAA): A federal act that requires enterprises in the health sector to guard protected health information and implement policies and procedures to safeguard it.

Health level seven: An international community of healthcare subject matter experts and information technology physicians and scientists collaborating to create standards for the exchange, management and integration of protected electronic healthcare information; the Ann Arbor, Mich.-based Health Level Seven (HL7) standards developing organization has evolved Version 3 of its standard, which includes the Reference Information Model (RIM) and Data Type Specification (both ANSI standards); HL7 Version 3 is the only standard that specifically deals with creation of semantically interoperable healthcare information, essential to building the national infrastructure; HL7 promotes the use of standards within and among healthcare organizations to increase the effectiveness and efficiency of healthcare delivery for the benefit of all patient, payers, and third parties; uses an Open System Interconnection (OSI) and high level seven healthcare electronic communication protocol that is unique in the medical information management technology space and modeled after the International Standards Organization (ISO) and American National Standards Institute (ANSI); each has a particular healthcare domain such as pharmacy, medical devices, imaging or insurance (claims processing) transactions. Health Level Seven’s domain is clinical and administrative data.

Hot site: An alternative backup site that contains the same equipment as found in the organization’s actual IT center.

Human firewall: An employee who practices good security techniques to prevent any security attacks from passing through them.

Incident response team: An employee team charged with gathering and handling the digital evidence of an attack.

Individually identifiable health information: Medical information that is created or received by a covered entity; relates to the physical or mental health condition of an individual, provision of health care or the payment for the provision of health care; identifies the individual or there is reasonable belief that the information can be used to identify the individual.

Information security: A computer or network that is free from threats against it.

Integrity: The security goal that generates the requirement for protection against either intentional or accidental attempts to violate data integrity (the property that data has when it has not been altered in an unauthorized manner) or system integrity (the quality that a system has when it performs its intended function in an unimpaired manner, free from unauthorized manipulation).

Intellectual property: Works created by others such as books, music, plays, paintings, and photographs.

IT-related risk: The net mission impact considering (1) the probability that a particular threat-source will exercise (accidentally trigger or intentionally exploit) system vulnerability and (2) the resulting impact if this should occur. IT-related risks arise from legal liability or mission loss due to:

* Unauthorized (malicious or accidental) disclosure, modification, or destruction of information

* Unintentional errors and omissions

* IT disruptions due to natural or man-made disasters

* Failure to exercise due care and diligence in the implementation and operation of the IT system.

Key-in-knob lock: A basic lock that has the lock mechanism embedded in the knob or handle.

Keystroke logger: A type of hardware spyware that captures keystrokes as they are typed.

Logic bombs: A computer program that lies dormant until it is triggered by a specific event.

Lossless: To compress electronic digital data.

Malicious code: Programs that are intentionally created to break into secure computers or to create havoc after the computers are accessed.

Master patient index: Healthcare facility composite that links and assists in tracking patient, person, or member activity within an organization (or health enterprise) and across patient care settings; hardcopy or electronic identification of all patients treated in a facility or enterprise and lists the medical record or identification number associated with the name; can be maintained manually or as part of a computerized system; typically, those for healthcare facilities are retained permanently, while those for insurers, registries, or others may have different retention periods; a database of all the patients ever registered (within reason) at a facility; name, demographics, insurance, next of kin, spouse, etc.

Medically unbelievablE event: Implemented on Jan. 1, 2007, the CMS blockage of payments for medical services that make no sense based on “anatomic considerations” or medical reasonableness when the same patient, date of service, HCPCS code or provider is involved; unlike other National Correct Coding Initiative (NCCI) edits, MUEs can’t be overridden by a modifier because there will never be a scenario where the physician had a good reason to submit a claim for removing a second appendix from the same person; etc.

Megabytes (MB): Millions of bytes of storage.

Memory stick: USB flash or non-volatile storage device; Sony CompactFlash®, pen or mini-drive; flash card, smart media, slang terms.

Mesh: Medical Subject Headings, the controlled vocabulary of about 16,000 terms used for MEDLINE and certain other MEDLARS databases.

Minimum necessary: The amount of protected health information shared among internal or external parties determined to me the smallest amount needed to accomplish its purpose for Use or Disclosure; the amount of health information or medical data needed to accomplish a purpose varies by job title, CE or job classification.

Minimum necessary rule: HIPAA regulation that suggests any PHI used to identify a patient, such as a social security number, home address or phone number; divulge only essential elements for use in transferring information from patient record to anyone else that requires the information; especially important with financial information; changes the way software is written and vendor access is provided.  The “Minimum Necessary” Rule states the minimum use of PHI that can be used to identify a person, such as a social security number, home address or phone number. Only the essential elements are to be used in transferring information from the patient record to anyone else that needs this information.  This is especially important when financial information is being addressed.  Only the minimum codes necessary to determine the cost should be provided to the financial department.  No other information should be accessed by that department.  Many institutions have systems where a registration or accounting clerk can pull up as much information as a doctor or nurse, but this is now against HIPAA policy and subject to penalties.  The “minimum necessary” rule is also changing the way software is set up and vendor access is provided. 

Mirror site: A secondary location identical to the primary IT site that constantly receives a copy of data from the primary site.

National health information network: The technologies, standards, laws, policies, programs and practices that enable health information to be shared among health decision makers, including consumers and patients, to promote improvements in health and healthcare; vision for the NHII began more than a decade ago with publication of an Institute of Medicine report, The Computer-Based Patient Record. The path to a national network of healthcare information is through the successful establishment of Regional Health Information Organizations (RHIO).

National provider identifier: Originally was an eight-digit alphanumeric identifier. However, the healthcare industry widely criticized this format, claiming that major information systems incompatibilities would make it too expensive and difficult to implement. DHHS therefore revised its recommendation, instead specifying a 10-position numeric identifier with a check digit in the last position to help detect keying errors. The NPI carries no intelligence; in other words, its characters will not in themselves provide information about the provider. More recently, CMS announced that HIPAA-covered entities such as providers completing electronic transactions, healthcare clearinghouses, and large health plans, must use only the NPI to identify covered healthcare providers in standard transactions by May 23, 2007. Small health plans must use only the NPI by May 23, 2008. The proposal for a Standard Unique National Health Plan (Payer) Identifier was withdrawn on February, 2006. (According to CMS, “withdrawn” simply means that there is not a specific publication date at this time. Development of the rule has been delayed; however, when the exact date is determined, the rule will be put back on the agenda.)

Network: A group of interconnected computers.

Notebook safe: A special safe secured to a wall or the trunk of a car used for storing a notebook computer.

Operating system hardening: Steps that can be taken to make a personal computer operating system more secure.

Optical disc: A disc that uses laser technology to record data.

Password: A secret combination of words or numbers that authenticates or identifies the user.

Patch: A software update to correct a problem.

Patch management: Tools, utilities, and processes for keeping computers up to date with new software updates that are developed after a software product is released.

Pharmacy information system: Drug tracking and dispensation related health management information system for hospitals and healthcare organizations.

PhisHing: An attempt to fraudulent gather confidential information by masquerading as a trustworthy entity, person or business in an apparently official email, text message or website; carding or spoofing; video vishing; phish-tank; vish-tank; slang terms.

Physical security: The process of protecting the computer itself.

Port scanning: Sending a flood of information to all of the possible network connections on a computer.

Ports: The network connections on a computer.

Preset lock: A basic lock that has the lock mechanism embedded in the knob or handle.

Privacy: The quality or state of being hidden, encrypted, obscure, or undisclosed; especially medical data or PHI.

Privacy act: Federal legislature of 1974 which required giving patient some control over their PHI.

Privacy enhanced mail: Email message standard protocol for enhanced medical, health data or other security.

Privacy officer: A medical entity’s protected client information and security officer; required by each covered entity, to be responsible for “the development and implementation of the policies and procedures” necessary for compliance.

Privacy rule: The Federal privacy regulations promulgated under the Health Insurance Portability and Accountability Act (HIPAA) of 1996 that created national standards to protect medical records and other protected health information. The Office of Civil Rights (OCR) within the Department of Health and Human Services (DHHS) regulates the privacy rules.

Privacy standards: Any protocol to ensure the confidentiality of PHI.

Private key system: A means of cryptography where the same key is used to both encrypt and decrypt a message.

Public key system: A means of cryptography where two keys are used.

Records, medical: 20 U.S.C. 1232g(a)(4)(B)(iv), all:

* Psychotherapy notes recorded (in any medium) by a health care provider who is a mental health professional documenting or analyzing the contents of conversation during a private counseling session or a group, joint, or family counseling session and that are separated from the rest of the individual’s medical record; excludes medication prescription and monitoring, counseling session start and stop times, the modalities and frequencies of treatment furnished, results of clinical tests, and any summary of the following items: diagnosis, functional status, the treatment plan, symptoms, prognosis, and progress to date.

* Public health authority means an agency or authority of the United States, a State, a territory, a political subdivision of a State or territory, or an Indian tribe, or a person or entity acting under a grant of authority from or contract with such public agency, including the employees or agents of such public agency or its contractors or persons or entities to whom it has granted authority, that is responsible for public health matters as part of its official mandate.

* Required by law means a mandate contained in law that compels a covered entity to make a use or disclosure of protected health information and that is enforceable in a court of law; includes but is not limited to, court orders and court-ordered warrants; subpoenas or summons issued by a court, grand jury, a governmental or tribal inspector general, or an administrative body authorized to require the production of information; a civil or an authorized investigative demand; Medicare conditions of participation with respect to health care providers participating in the program; and statutes or regulations that require the production of information, including statutes or regulations that require such information if payment is sought under a government program providing public benefits.

Regional health information organization: A multi-stakeholder organization that enables the exchange and use of health information, in a secure manner, for the purpose of promoting the improvement of health quality, safety and efficiency; the U.S. Department of Health and Human Services see RHIOs as the building blocks for the national health information network (NHIN) that will provide universal access to electronic health records; other experts maintain that RHIOs will help eliminate some administrative costs associated with paper-based patient records, provide quick access to automated test results and offer a consolidated view of a patient’s history.

Risk assessment: The process of identifying the risks to system security and determining the probability of occurrence, the resulting impact, and additional safeguards that would mitigate this impact.

Risk management: The total process of identifying, controlling, and mitigating information system–related risks. It includes risk assessment; cost-benefit analysis; and the selection, implementation, test, and security evaluation of safeguards.  This overall system security review considers both effectiveness and efficiency, including impact on the mission and constraints due to policy, regulations, and laws.

Royalties: Payment to the owner or creator of intellectual property for their work.

Sarbanes-Oxley Act (Sarbox): A federal act that enforces reporting requirements and internal controls on electronic financial reporting systems.

Scanning: Locating a computer that can be broken into.

Script kiddies: Younger and less sophisticated users who break into a computer with malicious intent.

Secure virtual private network: Cryptographic tunneling protocols to provide the necessary health data confidentiality (preventing snooping), sender authentication (preventing identity spoofing), and message integrity (preventing message alteration) to achieve the medical privacy intended. When properly chosen, implemented, and used, such techniques can provide secure communications over unsecured networks.

Security: A set of healthcare information technology system characteristic and  mechanisms which span the system both logically and physically; electronic access control against unauthorized intervention, both friendly or malicious;  encompasses all of the safeguards in an information system, including hardware, software, personnel policies, information practice policies, disaster preparedness, and the oversight of all these areas; the purpose of health information security is to protect both the system and the information it contains from unauthorized access from without and from misuse from within; through various security measures, a health information system can shield confidential information from unauthorized access, disclosure and misuse, thus protecting privacy of the individuals who are the subjects of the stored data; security life cycle.

Security administration: The physical and electrical protection features of an IT health system needed to be managed in order to meet the needs of a specific installation and to account for changes in the healthcare entities operational environment.

Security compromise: Physical or electronic data, file, program or transmission error due to malicious miscreants or software interventions; health data confidentiality breach.

Security configuration: Measures, practices, and procedures for the safety of information systems that must be coordinated and integrated with each other and other methods, practices, and procedures of the organization established in order to credential safekeeping policy; provides written security plans, rules, procedures, and instructions concerning all components of a healthcare entity’s security; procedures must give instructions on how to report breaches and how those breaches are to be handled within the organization.

Security configuration management: The measurement of practices and procedures for the security of information systems that is coordinated and integrated with each other and other measures, practices and procedures of the organization so as to create a coherent system of health data security (NIST Pub 800-14).

Security domain: A set of subjects, their information objects, and a common security policy; foundation for IT security is the concept of security domains and enforcement of data and process flow restrictions within and between these domains.

Security goals: The five security goals are integrity, availability, confidentiality, accountability, and assurance.

Security information system: security is a system characteristic and a set of mechanisms that span the system both logically and physically.

Security policy: A formal written policy that outlines the importance of security to the organization and establishes how the security program is organized.

Share: An object that is shared with others over a computer network.

Signature files: Files that contain updated antivirus information.

Smart card: A device that contains a chip that stores the user’s private key, login information, and public key digital certificate.

Sniffing: Listening to the traffic on a computer network and then analyzing it.

Social engineering: Relying on trickery and deceit to break security and gain access to computers.

Spam: Unsolicited e-mail messages.

Spy: A person who has been hired to break into a computer and steal data.

Spyware: Hardware or software that “spies” on what the user is doing and captures that activity without their knowledge.

Stealth signal transmitter: Software installed on a notebook computer that sends a signal that can be traced.

Threat analysis: The examination of threat-sources against system vulnerabilities to determine the threats for a particular system in a particular operational environment.

Threat modeling: A process of constructing scenarios of the types of threats that assets face.

Threat: The potential for a threat-source to exercise (accidentally trigger or intentionally exploit) a specific vulnerability.

Threat-source: Either (1) intent and method targeted at the intentional exploitation of a vulnerability or (2) a situation and method that may accidentally trigger a vulnerability.

Token: A security device used to authenticate the user by having the appropriate permission (like a password) embedded into the device.

USA Patriot Act: A federal act designed to broaden the surveillance of law enforcement agencies to enhance the detection and suppression of terrorism.

Username: A unique identifier of a person used to access a computer system.

Virus: A program that secretly attaches itself to other programs and when executed causes harm to a computer.

Vulnerability: A flaw or weakness in system security procedures, design, implementation, or internal controls that could be exercised (accidentally triggered or intentionally exploited) and result in a security breach or a violation of the system’s security policy.

Vulnerability assessment: A process to determine what vulnerabilities exist in the current system against these attacks.

Vulnerability assessment managed services: Agencies that use scanning devices connected to probe an organization’s security to look for vulnerabilities.

War driving: A technique used to locate wireless local area networks (WLANs).

WiMax: A more powerful version of Wi-Fi that can provide wireless Internet access over wider geographic location such as a city; an acronym that stands for Worldwide Interoperability for Microwave Access, and is a certification mark for products that pass conformity and interoperability tests for the IEEE 802.16 standards. IEEE 802.16 is working group number 16 of IEEE 802, specializing in point-to-multipoint broadband wireless access.

Wireless hot spot: Specific geographic location in which an access point provides public wireless broadband network services; security is risky for PHI; hotspot.

Wireless local area networks: A computer network that uses radio waves instead of wires to connect computers.

Worm: A program that does not attach itself to other programs or need user intervention to execute.

EDUCATION: Books

ACKNOWLEDGEMENTS: To Richard J. Mata MD MS MI-CIS CMP[Hon]; Mackenzie H. Marcinko PhD of iMBA Inc., and Shahid N. Shah MS, Washington DC.

COMMENTS APPRECIATED

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