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About: Healthcare Organizations [Financial Management Strategies]

Our Print Mission Statement

[By Dr. David Edward Marcinko; MBA, CMP™]

Publisher-in-Chief

dem25As Editor-in-Chief of a two volume – 1,200 pages – premium quarterly print journal, I am often asked about our mission statement; or the journal’s raison d’etra.

A Two-Volume Guide

As so, Healthcare Organizations: [Financial Management Strategies], with its quarterly updates, will promote and integrate academic and applied research, and serve as a multi-disciplined communications forum for the dissemination of financial, managerial, business and related economic information to decision makers in hospitals, outpatient centers, clinics, medical practices and all mature and emerging healthcare organizations. 

Target Market and Ideal Reader

Healthcare Organizations [Financial Management Strategies] and its quarterly updates should be in the hands of all:

* CFOs, CEOs, COOs, CTOs, VPs and CIOs from every type of hospital and healthcare organization including: public, federal, state, Veteran’s Administration and Indian Health Services hospitals; district, rural, long-term care and community hospitals; specialty, children’s and rehabilitation hospitals; diagnostic imaging centers and laboratories; private, religious-sponsored, and psychiatric institutions.

*  Physician Hospital Organizations, Management Services Organizations (MSOs), Independent Practice Associations (IPAs), Group Practices Without Walls (GPWWs), Integrated Delivery Systems (IDSs) and their administrators, comptrollers, cost accountants, budget directors, cash managers, auditors, healthcare attorneys and consultants,  and actuaries, and all endowment fund directors, executives, consultants and strategic financial managers.

*  Ambulatory care centers, hospices, and outpatient clinics; skilled nursing facilities, integrated networks and group practices; academic medical centers, nurses and physician executives; business school and health administration students, and all economic decision-makers and directors of allopathic, dental, podiatric and osteopathic healthcare organizations.

Assessment

After publication, my suggestion is to read, study and act upon the guide in this way:

1. First, browse through the entire text.

2. Next, slowly read those chapters and sections that are of specific interest to your professional efforts.

3. Then, extrapolate portions that can be implemented in specific strategies helpful to your healthcare setting.

4. Finally, use its’ ME-P updates as a reference manual to return to time and time again; and enjoy!

Conclusion

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Impact of Size on Mutual Fund Performance

Vital Information for Doctors to Consider

[By Dr. David Edward Marcinko; FACFAS, MBA, CMP™]

[By Professor Hope Rachel Hetico; RN, MHA, CMP™]dave-and-hope3

The actual size of a mutual or index fund, in terms of amount of assets, and the growth rate of a fund are the two aspects of size to consider. The impact of size on mutual fund performance varies—it can be negative, neutral, or positive. Size affects different types of funds differently; it also affects the manager’s ability to achieve objectives. Monitor size changes and make investment decisions accordingly.

Economies of Scale

A relatively large amount of assets available to a portfolio manager presents various economies. The costs at most funds (e.g., expense ratios) are reduced as a percentage of net asset value as the fund grows. Expense ratios can have a major impact on performance. In addition to being an effect of size, low fees can cause size changes. Funds do at times waive some fees to attract assets.

Asset Base

A larger asset base provides more liquidity to a fund. With more assets, the manager can buy more shares and more stocks. Transaction costs are reduced if higher trading volumes are achieved. A larger asset base also can reduce relative tax costs. Realized but undistributed capital gain can be spread over more shares at the time of year-end distribution. A larger asset base and manager success attracts higher-caliber managers to the management team.

fp-book20

Fund Growth

Growth of fund assets impairs certain funds more than others. Generally, bond funds are less affected by asset growth and size than equity funds. Growth may have a positive impact on bond funds because buying bonds of similar characteristics further diversifies credit, event, and other risks. Equity funds that invest in larger capitalization stocks can be less affected than funds buying less liquid small-cap stocks. (This is so because funds usually limit their investments in a single company, i.e., many funds will not buy more than 5% of a specific company. Five percent of a small company uses up less cash than 5% of a large company. Therefore, a small-cap fund is more likely to exhaust its choice of available companies sooner than a large-cap fund. A large-cap fund could increase its investment to a 5% level, whereas a small-cap fund may already be fully invested in the companies the manager likes to own.)

Growth Rate

The rate of growth can affect performance. Rapid growth may mean that a large portion of the portfolio remains un-invested. A rapidly growing growth-type equity fund with a high percentage of cash earns lower returns in a rising market than a fully invested fund. With rapid growth, the fund may not provide pure exposure to the desired asset class. At a certain point, however, fund asset growth impairs the manager’s ability to achieve objectives. For this reason, funds often close to new investors or to new investment once they have reached a certain size. Growth affects managers in many ways. Many fund managers or teams of managers direct a number of funds and possibly even private accounts. As the fund grows, managers are spread thin and may have difficulty in reacting quickly or efficiently to changing market conditions. Managers may need to hire assistant portfolio managers or delegate work to analysts or other employees. As a result, the manager manages people, administration, or internal quality control systems rather than studying companies or investment strategies. Also, a manager may become complacent in periods of rapid asset growth. Such growth can mean their own compensation is substantially greater, which may in turn change the manager’s motivation. Rapid growth often changes a fund because there are not enough opportunities to invest in the targeted securities. For example, a fund can change from aggressive to conservative, small cap to large cap. Managers may have to slow trading or increase liquidity in the portfolio to prevent this occurrence.

Meaningful Positions Difficult

Rapid growth or a large asset base can prevent managers from taking meaningful positions in market sectors they believe will outperform others. Smaller funds are more flexible and may take advantage of opportunities or liquidate unwanted positions faster than larger funds. A large fund that owns a significant position will negatively affect a security’s market price if it unloads shares all at one time. Rapid growth also impairs research of funds, affecting an investor’s choice of funds. A fund with outstanding performance over the past 5 years and a $150 million asset base may be much different when its base grows to $1 billion; at that point, it may no longer be the “right choice” for an investor.

insurance-book9Asset Declinations

Just as rapid asset growth affects performance, a rapid decline of fund assets also may impact performance. Significant quantities of redemptions over short periods force managers to liquidate security positions, often at the wrong time (i.e., they would rather be buying in a declining market than selling to accommodate redemptions). To prevent this scenario, some funds have redemption charges to discourage investors from such short-term decisions. Such environments can negatively impact bond funds as easily as equity funds. Large redemptions compound the effect of declining fund net asset values.

What a Doctor-Investor Can Do?

What can physician-investors do to avoid negative effects on investment? Avoid overloading a portfolio with hot, rapidly growing funds, if possible. Generally, size should be a neutral factor for most bond funds. Small and/or aggressive equity funds can be affected by growth, however. Emphasize funds that promise to close to new investors after assets reach a certain size. Once a fund becomes large, monitor it closely for problems caused by the growth. If there is a better, smaller fund, it may be wise to change. Also, closed-end funds are always a possibility. These funds have a major advantage in that their asset base is a factor of growth in security values, not new investment (unless the fund makes a secondary stock offering). Closed-end managers work with a finite portfolio, which reduces the problem of sudden asset growth.

Assessment

To the extent that a lack of SEC and FINRA over-sight, and the recent financial, insurance and banking meltdown has affected the above; such investing is left up to the doctor’s discretion and personal situation.  When it comes to the financial services product sales industry; always remember “caveat emptor” or “buyer-beware.”

Disclaimer: Both contributors are former licensed insurance agents and financial advisors.

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Independent Medical Practitioner as Solo Primary Care Surrogate

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Doctors Facing a Bleak Future Business and Financial Planning Model

By Dr. David Edward Marcinko; MBA, CMP™

[Publisher-in-Chief]dem2

According to Physicians News, on March 19, 2009, the demand for family physicians is growing. Proposals for health system reform focus on increasing the number of primary care physicians in America. Yet, despite these trends, the number of future physicians who chose family medicine dipped this year, according to the 2009 National Resident Matching Program. What gives?

NRMP

The National Resident Matching Program [NRMP] recently announced that a total of 2,329 graduating medical students matched to family medicine training programs. This is a decrease in total student matches from 2008, when 2,404 family medicine residency positions were filled.

Primary Care Demand Explodes

Meanwhile, demand for primary care physicians continues to skyrocket. For example, in its most recent recruitment survey, Merritt Hawkins, a national physician recruiting company, reported primary care physician search assignments had more than doubled from 341 in 2003 to 848 last year. 

The Decline of Solo Medical Practitioners

Regular readers and subscribers to this Medical Executive- Post are aware of the declining number of solo medical practitioners; we have been sounding the alarm here, in our books, journal, speaking engagements and elsewhere for years now.dhimc-book4

In fact, the statistic that we often cite is that more than 40% of the nation’s physicians are employed doctors; not employers as in the past. This business model shift has occurred over the past decade or so, and has accelerated of late. The decline in solo and independent doctors has occurred elsewhere as well, but much more slowly [i.e., dentistry, podiatry and osteopathy] as these specialties have been somewhat isolated from the traditional allopathic mainstream.

Going forward, this solitary model seems to be a good thing, and a fortunate result of the un-intended consequence of previously keeping these folks out of the healthcare mainstream.

The Decline of Independent Medical Practitioners

Now, in the March 2009 issue of Healthcare Finance News, we learn that the number of hospital owned physician practices has been climbing over the last four years, according to the Medical Group Management Association [MGMA]. Think: PHOs back-in-the-day. ho-journal3

And, while this trend only marginally affects patients and patient care, it is quite disruptive to physicians, their families, personal wealth accumulation, retirement and estate planning endeavors.

For example, according to Professor Hope Rachel Hetico, RN, MHA, CMP™ of our firm www.MedicalBusinessAdvisors.com

“The professional good-will valuation component of a medical practice is being decimated. Today, some practices are being bought and sold for tangible asset value, only.

Assessment

Therefore, allow me to identify this emerging trend which suggests independent medical practice as reflective of solo primary medical care. In other words, as independence goes the way of the “dodo-bird”, so goes primary care practitioners precisely at a time when the later is needed more than the former.

Why? Employed doctors stay that way by making money for their employer and hospital-bosses. Specialists make more money than primary care doctors. So, if you want to stay an employed doctor; which specialty would you pursue?

Answer: The NRMP class this year spoke out loud and clear. Any specialty but primary care!

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