NOTIONAL Value

By Staff Reporters

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Notional Value is the face value or principal amount that an investor holds of a debt security.

This value is not subject to market pricing.

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SUPERSTITIONS: In Medicine?

By Dr. David Edward Marcinko MBA MEd

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  • Saying a patient’s name in the emergency room will almost ensure that person comes in that day.
  • A code cart next to an unstable patient is said to ward off evil spirits.
  • Traditional healers usually use superstition in their practices to manage human health problems and diseases.
  • Such practices create a conflict with the medical profession and its evidence-based practices.

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So, what exactly is a Superstition? Does superstition change a measurable patient outcome, such as decreased anastomotic leak rate, surgical site infection, or mortality? Hard to say. But does it improve the surgeon’s confidence, thereby improving their performance? Likely so.

Science is not the opposite of superstition; it is the result of superstition, the result of humans trying to make sense of the world and prove each other wrong. We keep doing the things we do to maintain some semblance of control. In further defense of superstition, ritualistic behaviors ensure that the necessary boxes are checked and that we pay attention to the details. In surgery, details matter.

“Superstition is the irrational belief that an object or behavior has the power to influence an outcome, when there’s no logical connection between them. Most of us aren’t superstitious – but most of us are a ‘littlestitious.’”
– Gretchen Rubin

So, until there is evidence to the contrary, I will keep tearing off the little patient labels and keeping their names with me in hopes that they do well after surgery.

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EARNED INCOME: Defined

By Staff Reporters

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What Counts as ‘Earned Income’?

The IRS defines earned income as money you get for working, including the following:

  • Wages
  • Commissions
  • Bonuses
  • Tips
  • Honorariums for speaking, writing or taking part in a conference or convention
  • Self-employment income

Income that doesn’t qualify includes:

  • Taxable pension payments
  • Interest income
  • Dividends
  • Rental income
  • Alimony
  • Withdrawals from Roth IRAs or other non-taxable retirement accounts
  • Annuity income
  • Welfare benefits
  • Unemployment compensation
  • Worker’s compensation payments
  • Social Security income.

Cite: https://www.irs.gov/credits-deductions/individuals/earned-income-tax-credit/earned-income-and-earned-income-tax-credit-eitc-tables

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DAILY UPDATE: United Health Owned Insurance Fined and CFPB Hides Medical Debt as Nvidia Leads Stock Markets Down

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

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Three UnitedHealth-owned insurance companies must pay over $165 million for misleading thousands of customers in Massachusetts into paying for additional health insurance, a state judge has ruled.

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Nvidia stock (NVDA) tumbled more than 6% Tuesday, a day after shares closed at a record high in anticipation of CEO Jensen Huang’s keynote at the tech industry’s annual CES trade show in Las Vegas.

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Dow ends down nearly 180 points, NASDAQ tumbles 1.9% as Treasury yields surge after job-openings, ISM services data

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The Biden administration’s Consumer Financial Protection Bureau (CFPB) issued a new rule Tuesday that will hide an estimated $49 billion in medical debt from credit reports. The rule, which is slated to affect 15 million Americans, prohibits the inclusion of medical bills on credit reports and bars creditors from using medical information in making lending decisions. The policy specifically targets national credit-reporting companies Equifax, Experian and Transunion, which provide detailed evaluations of consumer finances to banks, employers and landlords.

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

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

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

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

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

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

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

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

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

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

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

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

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MONEY Supply in Circulation

By Staff Reporters

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MONEY SUPPLY: The amount of money in circulation. The money supply measures
currently (1985) used by the Federal Reserve System are:


 M 1 – Currency in circulation + demand deposit + other check-type deposits. 35
 M2 – M 1 + savings and small denomination time deposits + overnight repurchase
agreements at commercial banks + overnight Eurodollars + money market mutual
fund shares.
 M3 – M2 + large-denomination time deposits (Jumbo CDs) + term repurchase
agreements.
 M4 – M3 + other liquid assets (such as term Eurodollars, bankers acceptances,
commercial paper, Treasury securities and U.S. Savings Bonds)

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BULLET Bond Structure

By Staff Reporters

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A Bullet bond structure is a bond portfolio structure that clusters a portfolio’s bond maturities around a single maturity (usually an intermediate-term maturity).

This structure tends to perform best when the yield curve is moving from flat to steep (long-term rates are rising faster than short-term rates, or short-term rates are falling faster than long-term rates).

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DAILY UPDATE: Dental and Medical Record Data Breaches as Stocks Jump!

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Nvidia stock (NVDA) led gains among the “Magnificent Seven” tech stocks to start the new year after a group-wide sell-off in the last days of 2024. Shares of the AI chip-maker rose 4.5% Friday after gaining roughly 3% the prior day.

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Stat: 18. That’s how many dental data breaches there were in the US in 2024. (Becker’s Dental + DSO Review)

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Quote: “If your credit card gets compromised, your bank will alert you, cancel it and send you get a new one. But your medical records have a long lifespan. They can be misused without detection for long periods of time, because it’s harder to identify malicious activity. That makes them very valuable.”—Geetha Thamilarasu, associate professor at the University of Washington Bothell, on why hackers want healthcare information (the Wall Street Journal)

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That upswing followed a 4% dip between Christmas Eve and New Year’s Eve as megacap tech stocks dropped across the board in the absence of a “Santa Claus” rally, where the stock market typically enjoys a surge between December 24th and January 2nd. Tesla (TSLA) stock plunged nearly 13% over that time frame, while Amazon (AMZN) and Microsoft (MSFT) dropped more than 4%. Meanwhile, Meta (META) and Google (GOOG) fell just under 4%, and Apple (AAPL) dropped 3%.

Even with its December decline, Nvidia shares still ended 2024 up more than 150%. Wall Street analysts have remained bullish on the stock, estimating shares will rise to roughly $173 over the next year from their current level of $138, according to Yahoo Finance data.

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DAILY UPDATE: Chinese Stocks and Wall Street Down

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China’s stock market suffered its worst start to a year in nearly a decade, as investors brace for Donald Trump to impose tariffs on the world’s second-largest economy. The CSI 300 index closed down 2.9pc on Thursday, marking its steepest drop on the first day of annual trading since 2016, while the Hang Seng in Hong Kong fell 2.2pc.

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The fall for US stocks accompanied a rally in the dollar, a popular haven, which set a fresh two-year high Thursday and opened little changed Friday. The yen climbed in early trading after a third daily decline against the greenback in the prior session. The moves are a sign the selling that has sapped US equities over the past week may be starting to turn. Investors are preparing to implement asset-allocation strategies for the 2025 year ahead after a rocky end to 2024.

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

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TRUMP INTERNATIONAL HOTEL: Vehicle Catches Fire and Explodes Outside Las Vegas Lobby

BREAKING NEWS

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LAS VEGAS (AP) — A vehicle caught fire and exploded Wednesday outside the lobby of President-elect Donald Trump’s hotel in Las Vegas, authorities said.

Las Vegas police said they are investigating the fire and explosion, but neither they nor the Clark County Fire Department immediately provided more details. A county spokeswoman said in a statement that the fire was in the hotel’s valet area and was reported at 8:40 a.m.

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DAILY UPDATE: Markets Down Closing Out Year!

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US stocks slipped Tuesday, closing 2024 with an uncharacteristic down note after a roaring year of trading. The S&P 500 (^GSPC) fell 0.4%. The Dow Jones Industrial Average (^DJI) dropped just below the flatline, while the tech-heavy NASDAQ Composite (^IXIC) led the losses at 0.9%.

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Despite the sour final stretch, the benchmark S&P 500 closed 2024 up 23%, according to Yahoo Finance data. The tech-heavy NASDAQ Composite gained almost 30%. The Dow Jones Industrial Average posted a more modest 13% win. The S&P’s annual gain roughly matches 2023’s performance, logging the highest consecutive back-to-back annual gain in nearly 30 years.

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2025: HAPPY NEW YEAR!

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DAILY UPDATE: Covid-19 Update as Stock Markets Fall Again and US Treasury Hacked

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Stat: 4 in 10. That’s about how many US nursing home residents got an updated Covid-19 vaccine in the winter of 2023–24, according to the CDC, despite the recommendation that adults 65 and older get the new shot. (KFF)

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Stocks fell on Monday, with the woes of the three major indexes continuing in the final week of the year as an otherwise strong 2024 comes to a close.

The benchmark S&P 500 (^GSPC) slipped more than 1% while the tech-heavy NASDAQ Composite (^IXIC) fell roughly 1.2%. The Dow Jones Industrial Average (^DJI) fell about 0.8%.

Stocks moved lower as the 10-year Treasury yield (^TNX) retreated from a seven-month high to hover near 4.55%. Stocks closed out last week with a Friday slide from Big Tech names like Tesla (TSLA) and Nvidia (NVDA), with the NASDAQ Composite falling 1.5% and the S&P 500 down over 1%.

The highly anticipated “Santa Claus” rally, which is statistically one of the most consistent seven-day positive stretches of the year for the S&P 500, has flopped thus far. Since 1950, the S&P 500 has risen 1.3% during the seven trading days beginning December 24th, well above the typical seven-day average of 0.3%, according to LPL Financial chief technical strategist Adam Turnquist. In the current period, the S&P 500 is down nearly 1%.

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Chinese state-sponsored hackers breached the U.S. Treasury Department’s computer security guardrails this month and stole documents in what Treasury called a “major incident,” according to a letter to lawmakers that was provided to Reuters on Monday.

The hackers compromised third-party cybersecurity service provider BeyondTrust and were able to access unclassified documents, the letter said.

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PHANTOM: Income Tax on TIPS

By Staff Reporters

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“Phantom Tax” or “Phantom Income” for direct owners of Treasury inflation-protected securities (TIPS) TIPS adjust their principal values and interest payments for inflation. As with other directly owned Treasury securities, TIPS principal, including the inflation adjustments, is not paid back to investors until the securities mature.

However, the principal adjustments are taxed by the IRS as income in the year in which they occur, even though no actual payments are made in those years to investors who own TIPS directly. This is why this income is called “phantom income” and the tax on it is known as the “phantom tax.”

Investors can avoid the phantom income/tax issue for TIPS by holding TIPS in tax-deferred retirement accounts. Mutual funds and Exchange Traded Funds (ETFs) typically take the “phantom” factor out of TIPS ownership by distributing the principal adjustments as taxable dividends.

As with direct ownership of TIPS, the tax consequences of these distributions by mutual funds and ETFs can be reduced by holding TIPS-owning instruments in tax-deferred retirement accounts

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DAILY UPDATE: Veterans Scammed as 3 Major Markets Drop

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

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

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

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

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

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PCE: Personal Consumption Expenditures

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PCE or the Personal Consumption Expenditures (“PCE”) price deflator—comes from the Bureau of Economic Analysis’ quarterly report on U.S. gross domestic product—and is based on a survey of businesses and is intended to capture the price changes in all final goods, no matter the purchaser.

Because of its broader scope and certain differences in the methodology used to calculate the PCE price index, the Federal Reserve (“the Fed”) holds the PCE deflator as its preferred, consistent measure of inflation over time.

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

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

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

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

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

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

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

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

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

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

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CORPORATE EARNINGS: Per Share, Yield and EBDITA

DEFINITIONS

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Earnings per share (EPS): The portion of a company’s profits allocated to each outstanding share of its common stock. It is as an indicator of a company’s profitability.

Earnings yield: Earnings per share for the most recent 12 months, divided by the current market price per share; it is the inverse of the price to earnings (P/E) ratio.

EBITDA: Earnings before interest, taxes, depreciation and amortization (EBITDA) is an approximate measure of a company’s operating cash flow.

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SECTOR ALLOCATION: Mutual Funds

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Sector allocation in an equity or fixed-income context refers to a portfolio managers’ decision to invest in a particular broad market sector or industry.

A sector allocation or breakdown can help an investor observe the investment allocations of a mutual or other fund. Fund companies regularly provide sector reporting in their marketing materials. Sector investing can influence investments in the fund. A fund may target a specific sector such as technology, or seek to diversify among many sectors.

Some funds may have restraints on sector investments. This may occur with environmental, social, and governance (ESG) focused funds. These funds seek to exclude industries or companies that their investors consider undesirable for various reasons such as tobacco producers or oil exploration companies.

The ultimate sector allocation decision is likely to combine macroeconomic views with judgments about inter-sector and intra-sector relative values, among other reasons.

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DAILY UPDATE: Ascension Healthcare Cyber Crime Attack as Stock Market “Christmas Rallies” On!

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MERRY CHRISTMAS and HAPPY HANUKKAH

The financial markets will close early on Tuesday, December 24th, for Christmas Eve and will be closed on Wednesday, December 25th, for Christmas Day. Brokerage firms will process transaction requests received after 1 p.m., Eastern time, on Tuesday, December 24th, as if received on Thursday, December 26th, before 4 p.m., Eastern Standard time

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Healthcare provider Ascension has revealed the sensitive data of 5.6 million patients was compromised in a massive cyberattack earlier this year. The ransomware attack occurred in May and threw the company into turmoil, with patient portals and files inaccessible, elective services postponed, and some ambulances diverted, according to a filing with the Maine Attorney General that was reported by TechRadar. Ascension did not name the hackers, but CNN reporting indicated it stemmed from a Russian-speaking cybercrime affiliate known as Black Basta. It’s not clear if Ascension paid a ransom to get their systems back online.

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US stocks rallied in the final, shortened trading session before the Christmas holiday. The benchmark S&P 500 (^GSPC) finished the session up over 1.1%, while the tech-heavy NASDAQ Composite (^IXIC) rose roughly 1.4%. The Dow Jones Industrial Average (^DJI) climbed around 0.9%.

Wall Street successfully entered its Christmas break rejuvenated, after tech stocks including AI chip giant Nvidia (NVDA) led the march higher. Markets closed at 1 p.m. ET and are off tomorrow for Christmas Day.

Sizable gains in the past three trading sessions have put the indexes back on the path toward their record highs, from which they took a Fed-fueled nosedive last week.

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

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NOMINAL YIELD: Calculation

DEFINED

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Nominal yield, for most bonds and other fixed-income securities, is simply the yield you see listed online or in newspapers. Most nominal fixed-income yields include some extra yield, an “inflation premium,” that is typically priced/added into the yields to help offset the effects of inflation.

Real yields, such as those for TIPS, don’t have the inflation premium. As a result, nominal yields are typically higher than TIPS yields and other real yields.

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MAASTRICHT Treaty

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The Maastricht Treaty, signed February 7th, 1992, in Maastricht, the Netherlands, created the European Union (EU) and led to the creation of the euro(€); the single currency adopted by most EU member states.

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DAILY UPDATE: FDIC Misconduct as Stocks Climb

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The stock market will be open on Christmas Eve 2024 but will close early at 1 p.m. ET in anticipation of Christmas Day. This early closure allows market participants to wind down ahead of the holiday.

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The Federal Deposit Insurance Corporation has suspended pay bonuses for roughly two dozen executives under investigation for misconduct, a year after a Wall Street Journal investigation revealed a toxic and sexualized workplace culture at the bank regulator.

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Stocks climbed on Monday as tech rallied and investors considered the path of interest rates next year after the Fed hinted they would stay higher for longer.

The S&P 500 (^GSPC) gained 0.7%, while the tech-heavy NASDAQ (^IXIC) rose almost 1%. The Dow Jones Industrial Average (^DJI) erased earlier losses to edge almost 0.2% higher.

Semiconductor stocks gained, as shares of chipmakers Nvidia (NVDA) and Broadcom (AVGO) rose more than 3% and 5%, respectively. And, robust gains from social media platform Meta (META) and EV giant Tesla (TSLA) also helped lead the broader market higher.

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PRIMARY MARKETS: Exchange Traded Funds

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Primary Market: The primary market is also part of the stock market but differs from the secondary market because it only sells newly issued stocks.

Primary Market for Exchange Traded Funds: The primary market is where ETF shares are created and redeemed amongst ETF issuers and authorized participants. This is where the underlying basket of securities that make up an ETF is created. Shares of ETFs are made in large batches called Creation Units—usually 25,000 to 600,000 ETF shares are created at a time through this process.

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e-BOOKS: For Doctors, Financial Advisors, CPAs, Insurance Agents, Medical Consultants and Health Law Attorneys

By Ann Miller RN MHA CMP

INTRODUCING OUR NEXT GENERATION e-BOOK LIBRARY FROM iMBA, Inc.

An e-book is an electronic or digital book that can be read on a computer or a handheld device.

Our new e-books consists of text, images, and are fixed to a specific spot on the page.

And, our e-books are a data files similar in content and structure to a word-processing document that comes in a PDF format. To use our e-books, you need to purchase and download it to a device that has a .pdf file reader app, such as ADOBE® or similar on a smartphone, tablet or computer. A PDF, also known as a portable document format, is the format most people are familiar with and used in our e-books. PDFs are known for their ease of use and ability to hold custom layouts. They are the most commonly used e-Book formats, especially by professionals and adult-learners.

You can then access the e-book and read it, or highlight pages and even take side notes.

e-Books Save Money

With no manufacturing, printing, binding or shipping costs, e-Books are cheaper than traditional hard or paper back books.The price of each specialized and highly niche focused e-Book [50-100 pages] is only $25, whereas similar paperback printed books of this type generally cost $145, or more!

Payable thru PayPal [3% courtesy surcharge applies].

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DAILY UPDATE: Winter Solstice & Endo Health Solutions as Stock Markets Rebound

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The winter solstice, also called the hibernal solstice, occurs when either of Earth’s poles reaches its maximum tilt away from the Sun. This happens twice yearly, once in each hemisphere (North and South). For that hemisphere, the winter solstice is the day with the shortest period of daylight and longest night of the year, and when the Sun is at its lowest daily maximum elevation in the sky. Each polar region experiences continuous darkness or twilight around its winter solstice.

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Stat: $200 million. That’s how much drug manufacturer Endo Health Solutions paid the federal government for profiting from the opioid crisis and racking up $4 billion in unpaid taxes. (ProPublica)

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US stocks bounced back Friday as investors digested key inflation data that showed a deceleration in price increases during the month of November.

The tech-heavy NASDAQ Composite (^IXIC) gained 1%. The Dow Jones Industrial Average (^DJI) added 1.2%, while the S&P 500 (^GSPC) rose 1.1%.

But the rebound wasn’t enough to overcome losses earlier in the week. All three major gauges finished the week lower. The NASDAQ gave up 1.8% while the Dow and the S&P both shed around 2%.

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BONDS: Revenue

DEFINITION

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Revenue bonds are one of the biggest sectors in the municipal debt market.

Unlike a general obligation (GO) bond, revenue bonds are not backed by a municipal issuer’s taxing authority. Instead, interest and principal are secured by the net revenues (tolls, fees, or other charges tied to usage) from the project or facility being financed.

Revenue bonds are issued to finance a variety of capital projects, including construction or refurbishment of utility and waste disposal systems, highways, bridges, tunnels, air and seaport facilities, schools and hospitals.

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DAILY UPDATE: Healthcare Satisfaction Poll as Stock Markets Close Flat

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Americans aren’t satisfied with healthcare.

Gallup’s annual Health and Healthcare poll released on December 6th found that the US adult rating of healthcare quality is the lowest it’s been since 2001, with 54% of respondents saying they believe the healthcare system has “major problems” and 16% saying it’s in a “state of crisis.” In 2001, 53% viewed healthcare positively.

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US stocks closed little changed as a rebound from the previous day’s sell-off flopped with a hawkish outlook from the Federal Reserve on its path for interest rates looming over markets.

The Dow Jones Industrial Average (^DJI) ended a 10-day losing streak, its longest in 50 years, as it closed just above the flat line on Thursday. Meanwhile, the S&P 500 (^GSPC) and tech-heavy NASDAQ Composite (^IXIC) both fell about 0.1%.

The 10-year Treasury yield (^TNX) continued its trek higher on Thursday, rising roughly seven basis points to hit 4.57% for its highest levels since May.

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DAILY UPDATE: Undo Medical Debt, Native American Medical Debt as Stock Markets Plummet and Plunge

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Stat: 23,000. That’s about how many Connecticut residents will get at least part of their medical debt eliminated, thanks to a state partnership with nonprofit organization Undue Medical Debt. (NBC Connecticut)

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The stock market plunged on Wednesday after the Federal Reserve scaled back its expectations for interest rate cuts next year.

The Dow Jones Industrial Average fell about 1,100 points, or 2.5%, the largest drop for the index since August. The dip marked the 10th consecutive day of losses for the Dow, its longest losing streak since 1974.

The S&P 500 fell nearly 3%, while the tech-heavy NASDAQ plummeted about 3.5%.

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Native American patients are reportedly often billed for healthcare services the government is supposed to pay for, according to an investigation. (KFF Health News)

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

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FOMC: Cuts Interest Rates

BREAKING NEWS!

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By Staff Reporters

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The Federal Reserve cut interest rates by a quarter of a percentage point just now, delivering relief for borrowers at the central bank’s last meeting before President-elect Donald Trump takes office next month. The central bank predicted fewer rate cuts next year than it had previously indicated, however, suggesting concern that inflation may prove more difficult to bring under control than policymakers thought just a few months ago.

The move marked the third consecutive interest rate cut since the Fed opted to start dialing back its fight against inflation in the fall. The FOMC has lowered interest rates by a percentage point in recent months.

However, the Fed’s forecast said it anticipates only a half a percentage point of rate cuts next year and another half-percent cut in 2026.

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CURRENCIES: Carry-Trade Oriented

By Staff Reporters

DEFINITION

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Carry-Oriented Currencies are higher-yielding currencies of countries where interest rates are generally higher than those of countries with lower-yielding currencies.

These higher-yielding currencies are targeted for “carry trades,” where investors borrow money in a low-interest rate currency and invest in a higher yielding currency, potentially profiting from the difference in interest rates.

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LINGUISTICAL SCIENCE: History and Modern Theory

By Staff Reporters

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Theory of Linguistic Sciences

Avram Noam Chomsky is an American professor known for his work in linguistics and political activism. Sometimes called “the father of modern linguistics”, Chomsky is also one of the founders of the field of cognitive science. He is a laureate professor of linguistics at the University of Arizona and an professor emeritus at MIT.

And so, modern linguists today approach their work with scientific rigor and perspective [STEM], although they use methods that were once thought to be solely an academic discipline of the humanities.

Contrary to this belief, linguistics is multidisciplinary. It overlaps each of the human sciences including psychology, neurology, anthropology, and sociology. Linguists conduct formal studies of sound structure, grammar and meaning, but also investigates the history of language families, and research language acquisition.

And, as with other scientists according to linguistical engineer and Professor Mackenzie Hope Marcinko PhD from the University of Delaware [UD], they formulate hypotheses, catalog observations, and work to support explanatory theories, etc.

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Health Information Technology Dictionary

https://www.amazon.com/Dictionary-Health-Information-Technology-Security/dp/0826149952/ref=sr_1_5?ie=UTF8&s=books&qid=1254413315&sr=1-5

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

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

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

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

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

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BBD: The Buy-Borrow-Die Tax Strategy for Physicians

DR. DAVID EDWARD MARCINKO MBA MEd

By Staff Reporters

SPONSOR: http://www.MarcinkoAssociates.com

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Here’s how the Buy, Borrow, Die strategy works step-by-step:

Step 1. Buy Assets

This step, broadly known as the accumulation phase, is about acquiring or creating valuable assets. It’s the most critical step taken by wealthy individuals to secure their wealth. Billionaires, for instance, often created startups that eventually turned into massive corporations. The asset here is the company they’ve established.

However, this isn’t the only way to accumulate assets. For professionals like doctors and lawyers, this phase involves securing a high-paying job and buying assets that have the potential to appreciate over time—like stocks, real estate, and private capital. Once an individual reaches a substantial level of wealth, they can leverage these assets in interesting ways using the next step of this strategy. 

Step 2. Borrow Against Your Assets

This where the assets you’ve acquired are used as collateral to borrow money—all without triggering a taxable event.

Suppose you’ve got a robust stock portfolio. You can then take out a Securities Backed Line of Credit (SBLOC). This kind of loan lets you tap into the value of your portfolio without having to sell off any assets and subsequently paying capital gains taxes. What makes SBLOCs attractive to lenders is the relative ease with which the securities can be seized and sold, making them a low-risk lending option.

The ceiling for such a loan is usually around 50% of your portfolio’s value. However, we often caution against borrowing more than 25% of your account balance, especially for long-term loans. This will provide a cushion against stock market volatility, much like what we experienced in 2022 and 2023.

Borrowing against assets isn’t limited to stock portfolios either. Let’s say you own a home and have built up a certain amount of equity in it. You could opt for a Home Equity Line of Credit (HELOC), using your home as collateral. Banks tend to favor real estate-backed loans due to their stability compared to the fluctuating value of stocks.

Step 3. Die and Pass Your Wealth On

The final step in the strategy is where the proverbial tax baton is handed off to the next generation.

Under the existing tax code, when you pass away, your heirs receive a “stepped-up basis” on the assets they inherit from you. This means that their cost basis—the original amount paid for an asset—is stepped up to the market value of the asset at the time of your death. Meaning once you have passed away, your heirs would be able to sell the assets without having to pay taxes on the capital gain. Imagine you had purchased a building 20 years ago for $1 million and over the years, the value of that building increased to $2.5 million. If you were to pass away at this point, your heirs would inherit the building with the stepped-up cost basis of $2.5 million. This implies that if they decide to sell the property at this valuation, they wouldn’t owe any capital gains tax. This is because for tax purposes, their gain is calculated from the $2.5 million, not the original $1 million.

By utilizing this loophole, families can pass on their wealth without incurring a hefty tax bill. This is why many wealthy families set up trusts – it’s a way to manage and pass on their wealth at a stepped-up cost basis.

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ACTIVE: Transparent Exchange Traded Funds

DEFINITION

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By Staff Reporters

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Active transparent ETFs: Daily disclosure of portfolio holdings is an attribute of traditional index-based Exchange Traded Funds (ETFs).

Active transparent exchange traded funds are actively managed by a portfolio manager or team of managers. As with index-based ETFs, their portfolio holdings are disclosed daily.

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EXPECTED: Breakeven Inflation Rate

Measure of Expected Inflation

By Staff Reporters

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The breakeven inflation rate is the difference between the nominal yield (usually the market yield, which includes an inflation premium) on a fixed-income investment and the real yield (with no inflation premium) on an inflation-linked investment of similar maturity and credit quality.

So, if inflation averages more than the breakeven rate, the inflation-linked investment will outperform the investment with the nominal yield.

Conversely, if inflation averages below the breakeven rate, the investment with the nominal yield will outperform the inflation-linked investment.

Breakeven inflation rates are also considered useful measures of inflation expectations—higher breakeven rates represent higher inflation expectations (and higher relative prices for inflation-linked investments), while lower breakeven rates represent lower inflation expectations (and lower relative prices for inflation-linked investments).

Therefore, ideally, investors want to purchase inflation-linked investments when breakeven rates are relatively low because that’s typically when prices are also relatively low.

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COMMODITIES: Futures and Intensity Types

By Staff Reporters

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DEFINITIONS

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Commodities: Commodities are raw materials or primary agricultural products that can be bought or sold on an exchange or market. Examples include grains such as corn, foods such as coffee, and metals such as copper.

Commodity Futures: Agreements to buy or sell a specific amount of a commodity or financial instrument at a particular price on a stipulated future date related to basic raw materials such as precious metals and natural resources.

Commodity Intensity: Commodity intensity refers to commodity usage per unit of economic growth. An emerging, more manufacturing-based economy will usually be more commodity intensive in terms of its growth than will a more developed, service-oriented economy.

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FINANCIAL: Rule of 20 Defined

A Dimensionless Number

By Staff Reporters

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What is the Rule of 20?

The Rule of 20 is a dimensionless number that adds the current 12-month trailing Price to Earnings Ratio to the annual change in an index of the annual consumer inflation rate. A reading below 20, while a market is trending lower, means that we could be near a bottom.

In the United States, the most common index used is the broad-based S&P 500, and CPI-U is used as a proxy for inflation.

The Rule of 20 is purportedly a rule from Peter Lynch. In chapter 39 of Graham and Dodd’s seminal Security Analysis, they mention: “We would suggest that about 20 times average earnings is as high a price as can be paid in an investment purchase of a common stock” … with no mention of inflation.

Lynch’s formulation attempts to factor the ‘gravity’ of interest rates into the fair value of a stock. And, as you can see, the measure has fluctuated quite a bit. However, it has returned to roughly the 20 level repeatedly.

MORE: https://dqydj.com/sp-500-rule-of-20-calculator/

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DAILY UPDATE: Anthem BCBS Controversy as Stock Markets End Flat

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Stocks ended the session little changed on Friday despite Broadcom’s (AVGO) jump to all-time highs driven by the chipmaker’s bullish AI-fueled sales forecast.

The S&P 500 (^GSPC) closed flat while the tech-heavy NASDAQ Composite (^IXIC) gained 0.1%. The Dow Jones Industrial Average (^DJI) slipped 0.1%

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The fight between payers and anesthesiologists isn’t over, despite Anthem Blue Cross Blue Shield (BCBS) reversing plans for a policy that would put time limits on commercial claims for anesthesia coverage. The policy would have set a time limit for claims by procedure, with the exception of maternity and pediatric care, in New York, Connecticut, and Missouri starting next year. It called for providers “requiring more time than set or recommended by these standards” to undergo the insurance company’s claim dispute process in order to get paid, according to a statement Anthem provided to FOX61 in November.

The plan received backlash from everyone, from anesthesiologists to New York Governor Kathy Hochul.

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INFORMATION RATIO: Formula of Active Investment Managers

DEFINITION

By Staff Reporters

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The Information Ratio (IR) is a risk-adjusted rate of return measure for comparing the performance of active investment managers over time. Its purpose is to help determine how much return an active portfolio manager has added per unit of active management risk.

Think of IR as a Sharpe Ratio for active investment management; the IR is more focused than the Sharpe Ratio. Starting with the Sharpe Ratio’s formula, if we replace the excess return in the numerator with a portfolio’s active return (the average annualized return of an actively managed portfolio minus the average annualized return of the portfolio’s benchmark over a given period, adjusted for the portfolio’s market risk exposure), and you replace the Sharpe Ratio’s standard deviation of excess returns in the denominator with the standard deviation of a portfolio’s active returns over the period, you have the IR.

While the Sharpe Ratio expresses the amount of excess return per unit of overall risk, the IR computes only the active management-driven (alpha) returns per unit of alpha-driven risk. And while the Sharpe Ratio’s excess returns are calculated with regard to what is considered to be a relatively risk-free asset, such as a U.S. Treasury bill, the IR’s active returns are calculated with regard to each portfolio’s specific market benchmark.

The higher the IR, the better. The IR should be measured over a meaningful period of time, typically at least three to five years. The IR is not perfect–it can be influenced by external factors such as changes in market volatility. The standard deviation of active returns in the IR’s denominator is called tracking error. Tracking error will tend to increase in volatile markets for even the best active managers.

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CMO: Collateralized Mortgage Obligations

By Staff Reporters

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Collateralized Mortgage Obligations (CMOs) are a form of securitized debt derived from mortgage-backed securities. It’s a form of derivative security. Like most MBS pass-through securities, CMOs are typically backed by pools of residential mortgages and their payments. But not all investors want to receive the monthly payments of principal and interest that “plain vanilla” MBS pass-throughs offer–some prefer just the principal, some prefer just the interest, or some want payments with other particular/special characteristics.

For them, the cash flows from MBS can be pooled and structured into many classes of CMOs with different maturities and payment schedules, creating securities with very specific characteristics and behaviors. These characteristics and behaviors can vary widely. Some CMOs can offer less risk than “plain-vanilla” MBS, or can help offset other forms of risk in a diversified portfolio, but others can be much more volatile.

CMOs typically have two or more bond classes, called tranches. Each tranche has its own expected maturity and cash flow pattern. The unique cash flow patterns of each CMO tranche allow investors to tailor their mortgage exposure to meet a range of investment objectives, since different classes can have different risk/return characteristics.

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DAILY UPDATE: Stock Markets Slide

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FRIDAY 13th = Triskaidekaphobia

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

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The Dow Jones Industrial Average (^DJI) was down and the S&P 500 (^GSPC) were both about 0.5%. The tech-heavy NASDAQ Composite (^IXIC) fell roughly 0.6% while shares of Apple (AAPL) rallied less than 1% to close at a record high.

In bonds, the 10-year Treasury yield (^TNX) added 5 basis points to hit 4.32%, its highest closing level since November 22nd.

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On a day where President-elect Donald Trump rang the opening bell at the New York Stock Exchange, Wall Street failed to build on a furious rally that has picked up steam after his election win. In focus was fresh inflation data, which helped cast doubt on investor confidence for the path of interest rates ahead.

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INCENTIVE BIAS? In Medicine and with Physicians?

DEFINITION

By Staff Reporters

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Incentives: It is broadly accepted that incenting someone to do something is effective, whether it be paying office staff a commissions to sell more healthcare products, or giving bonuses to office employees if they work efficiently to see more HMO patients.  Some experts even suggest there are five specific components1 that should be built into an overall physician incentive program:

  • Appropriate financial incentives.
  • Managed-care efficiency incentives.
  • Group citizenship.
  • Patient satisfaction.
  • Group profitability.

What is not well understood is that the incentives cause a sub-conscious distortion of decision-making ability in the incented person.  This distortion causes the affected person – whether it is yourself or someone else – to truly believe in a certain decision, even if it is the wrong choice when viewed objectively.  Service professionals, including financial advisors and lawyers, are affected by this bias, and it causes them to honestly offer recommendations that may be inappropriate, and that they would recognize as being inappropriate if they did not have this bias. 

According to colleague Dan Ariely PhD, the existence of this bias makes it important for each one of us to examine our incentive biases and take extra care when advising physician clients, or to make sure we are appropriately considering non-incented alternatives.

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DAILY UPDATE: Bitcoin and Big Technology Stocks Soar as DJIA Slips

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In crypto, bitcoin (BTC-USD) prices soared to trade above $101,300 a token in afternoon trade.

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Big Tech stocks led the market higher on Wednesday, as investors digested another month of sticky inflation data that met economists’ expectations and likely pointed to a Federal Reserve interest rate cut next week. The tech-heavy NASDAQ Composite (^IXIC) jumped about 1.7% amid a feverish rally in the “Magnificent Seven” tech stocks. Google parent Alphabet’s (GOOG, GOOGL) shares extended gains to hit a record high, rising more than 5%.

Meanwhile Tesla (TSLA), Meta (META) and Amazon (AMZN) all also surged to record highs, with Tesla notching its first record close in more than three years. The S&P 500 (^GSPC) rose around 0.8%, while the Dow Jones Industrial Average (^DJI) slipped about 0.2%.

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MEDIA HEADLINES: Financial Security Risk Management

By Staff Reporters

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Headline risk refers to the risk that a negative news media headline about one security issuer, incident or sector could affect the demand for and pricing of a much wider swath of securities, including those that have no direct relation to the securities headlined and whose fundamentals (defined above) remain intact.

Financial analyst Meredith Whitney’s appearance on “Sixty Minutes” in December 2010 was a classic example of the potential impact of headline risk, when her prediction of “a spate of municipal bond defaults” helped trigger a massive municipal bond market selloff, even though most municipal bonds actually faced no immediate default threat at that time, and the number of municipal defaults actually declined in the subsequent 12 months.

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MARCINKO ASSOCIATES: Physician Wealth Advisors and Practice Management Consultants

FIDUCIARY MEDICAL COLLEAGUES – FEE ONLY – NO PRODUCT OR SALES COMMISSIONS

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DEAR MEDICAL COLLEAGUES

Achieving your financial, wealth and medical practice management goals is important, but handling everything on your own can be overwhelming. That’s where we come in. At D. E. Marcinko & Associates, our team of dual degree experienced physician advisors and medical consultants is here to guide you every step of the way. We believe in providing unbiased, high-quality financial and business advice.

For example, we offer a one-time written financial plan with oral evaluation for a flat fee with no ongoing sales or assets under management fees or commissions. Together, we can create a personalized financial plan tailored to your unique goals, empowering you to make confident, informed decisions as you navigate your financial future.

Other Services Include:

  • Estate Planning We have a network of qualified legal professionals that we can refer you to for state specific estate planning needs.
  • Tax Strategy We can work alongside your CPA for tax planning purposes. If needed, we can refer you to a qualified tax professional.
  • Investment Analysis If you have investments, we review your accounts to make sure they are aligned with your long-term goals.
  • 401-k Allocations We evaluate your 401(k) allocations and provide recommendations that align with your goals.
  • Education Savings We help you explore the various ways to plan and save for education expenses.
  • Insurance & Risk Management We assess your insurance coverage to ensure it adequately protects you against potential risks; as well as evaluate and provide expert litigation witnesses, as needed.
  • Medical Practice Management We evaluate your current or potential medical practice to determine value and/or private equity offers or physician practice management formats [PPMC] for new, mid-career or retiring physicians, nurses and dentists.   

D. E. Marcinko & Associates is unique and fully committed to all phases of a medical professionals personal and business life cycle. We are at your service 24/7: Email MarcinkoAdvisors@outlook.com

ANN MILLER RN MHA CMP

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DAILY UPDATE: Walgreens to PE as CPI Upticks and Markets Blast Off this Morning

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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.

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According to reporting from the Wall Street Journal, the pharmacy chain Walgreen’s is discussing selling to private equity (PE) firm Sycamore Partners, a deal that could close early next year. This comes following a tumultuous year for the company, which announced it would close 1,200 stores in October and laid off more than 250 employees in November. The PE firm is allegedly considering selling off pieces of the business or working with partners, sources told the Journal. Following the news, Walgreens’s stock jumped 28%, its biggest single-day increase since 1980, according to Yahoo Finance.

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Inflation rose 2.7% on an annual basis in November, according to the latest government report on the Consumer Price Index, or CPI. Last month’s CPI was forecast to come in at 2.7%, according to economists surveyed by financial data firm FactSet. The Consumer Price Index, a basket of goods and services typically bought by consumers, tracks the change in those prices over time. 

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US stocks opened higher on Wednesday as investors digested another month of sticky inflation data that met economists’ expectations and likely pointed to a Federal Reserve interest rate cut next week. The Dow Jones Industrial Average (^DJI) increased about 0.2%, while the S&P 500 (^GSPC) jumped nearly 0.5%. The tech-heavy NASDAQ Composite (^IXIC) also added to across-the-board gains, rising roughly 0.8%.

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

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What is Mutual Fund WINDOW DRESSING?

DEFINITION

By Staff Reporters

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To most people the holiday season means decorations at home and at work, but it also can mean “window dressing” in your mutual fund.

This somewhat disparaging term is used to describe the practice of a mutual fund making cosmetic changes to its portfolio just before the end of each calendar quarter. It’s done because funds publish their exact holdings of securities four times a year based on what they own at the end of each quarter.

“The basic concept is that managers are either hiding their mistakes or adding winners to make themselves look a little smarter,” says Russ Kinnel, director of manager research at fund researcher Morningstar Inc. in Chicago. “Of course, it doesn’t necessarily help performance,” he adds.

Santa Rally: https://medicalexecutivepost.com/2021/12/16/what-is-the-santa-claus-stock-market-rally/

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Why are CERTIFIED MEDICAL PLANNER® Textbooks So DARN Popular?

 The Big Surprise

[By Dr. David Edward Marcinko MBA MEd CMP®]

http://www.CertifiedMedicalPlanner.org

OK – I was a Certified Financial Planner® before my academic team launched the Certified Medical Planner™ online and on-ground chartered education and board certification designation program a few years ago. I am now CFP reformed and in remission.

MORE: Enter CPMs

Enter the Certified Medical PlannerChartered Designation

Today, we are of course, gratified that Certified Medical Planner™ mark notoriety is growing organically in the healthcare, as well as financial services, industry.

Even uber-blogger Mike Kitces MSFS, MTAX, CFP, CLU, ChFC, RHU, REBC, CASL has taken note of us in his musings on the Nerd’s Eye View website. And, the reality is that there are a growing number of CFP educational programs at the post-CFP niche market level.

But, none for healthcare industrial complex: for doctors … by doctors!

Popularity of our Text Books

However, it is our modern, innovative and proprietary Certified Medical Planner™ textbooks and dictionaries that have exploded in the academic marketplace.

In fact, they are now redacted in thousands of medical, graduate, law and B-schools and libraries, as well as colleges and universities throughout the nation. This includes the Library of Congress, National Institute of Health and  the Library of Congress.

What Gives?

We have been told that this textbook popularity and publishing success is because of their balanced and peer-reviewed nature; something not very widespread in the financial services industry that is prone to gross and overstated advertising, salesmanship and marketing hyperbole. And, for this we are very gratified.

But, is there another reason our books are so popular?

A bit of networking and research suggests that interested folks may be eschewing the actual course work in favor of just the high quality textbooks! UGH!

Another reason may be that our books and curricula are kept fresh and updated on our corporate website: http://www.MedicalBusinessAdvisors.com

Assessment

So, what do you think? Matriculation with the professional mark versus self study without the designation mark. Please opine.

Conclusion

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

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

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