What is a Financial CDO and CMO?

Collateralized Debt Obligations

versus

COLLATERALIZED MORTGAGE OBLIGATIONS

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BY DR. DAVID E. MARCINKO MBA CMP®

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SPONSOR: http://www.CertifiedMedicalPlanner.org

A collateralized debt obligation (CDO) is a type of structured asset-backed security (ABS). Originally developed as instruments for the corporate debt markets, after 2002 CDOs became vehicles for refinancing mortgage-backed securities (MBS).

Like other private label securities backed by assets, a CDO can be thought of as a promise to pay investors in a prescribed sequence, based on the cash flow the CDO collects from the pool of bonds or other assets it owns. Distinctively, CDO credit risk is typically assessed based on a probability of default (PD) derived from ratings on those bonds or assets.

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

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Collateralized Debt Obligation (CDO) - Assignment Point

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Collateralized Mortgage Obligation

A CMO is a debt security backed by mortgages. These mortgage pools are usually separated into different maturity classes called tranches (from the French word for “slice”). The securities were issued by private issuers, as well as the Federal Home Loan Mortgage Corporation (Freddie Mac). As the mortgages were usually government-guaranteed, CMOs usually carried AAA ratings until their current financial meltdown. The early versions of CMOs were known as “plain vanilla,” but recent developments gave us PACs (planned amortization certificates) and TACs (targeted amortization certificates); among too many others. They were all variations on how principal repayments in advance of maturity date were treated.

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

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CMO vs CDO | What is the difference between them? - Fintelligents

RELATED: https://medicalexecutivepost.com/2011/07/06/merrill-lynch-investigated-for-cdo-deal-involving-magnetar/

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Curing By Numbers

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Taking Cloud Computing to a New Level

[By GE Healthcare IT]

American healthcare has by far the most expensive system in the world, but few would argue that it’s also the most efficient. A study published in the Journal of American Medical Association found that almost 40 percent of patients are misdiagnosed in primary care1. Another report by the American College of Physicians discovered that unnecessary testing and medical procedures, and extra days in the hospital caused by wrong diagnosis could add up to $800 billion per year2.

That’s close to a third of all U.S. healthcare costs. “There is a lot of waste in the system,” says Jeanine Banks, general manager of marketing at GE Healthcare IT. “We want to help rein in the costs and make the system far more efficient.”

That’s not just talk. Engineers at GE Healthcare IT are developing a new “cloud imaging” solution that will allow doctors to create a professional profile, store patient images and data together in one place, view 3D images from anywhere, and access intuitive analytics. “It’s like LinkedIn professional networking meets diagnostic imaging,” Banks says. “It’s all about virtually limitless computing, storage and collaboration on tough cases to help healthcare teams make more informed decisions.”

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3D-ASL

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Banks says that the information physicians need to make diagnoses is often fragmented and sits in siloes. The new platform, GE’s Cloud Imaging solution, allows doctors to exchange images and use social digital tools to share cases with each other over a network instead of distributing CDs, as common practice now. “They can open their browser, click on a link and share quickly,” she says.

Banks says that GE intends to give hospitals the flexibility to host the system on their own servers, as a private cloud, or through GE’s public cloud environment. “We are committed to using industry standards to make it easy to connect medical devices, link with existing PACS (picture archiving and communication systems) and EMR (electronic medical records environments), and enable consistent access to a flourishing ecosystem of apps,” she says. “Providers don’t need more silos of data.” GE’s first Cloud Imaging pilot site is the Kadlec Health System in Washington State. Kadlec is helping evaluate the platform ahead of plans to demonstrate the new solution during the annual meeting of the Radiological Society of North America in December. “It’s an opportunity for them to use it inside their health system and give us feedback,” Banks says.

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For Banks, this is the beginning of a new healthcare revolution. “What if together with industry we could help physicians reduce waste?” she asks. “We could process that information, learn from past diagnostic decisions and store the data all in the cloud to inform future decisions. One day, we could tap into knowledge based on cases from around the world.”

Assessment

That’s just brilliant.

Citations:

1 Journal of American Medical Association 2012

2 Reuter’s, citing study by American College of Physicians  

Conclusion

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Why PACs Won’t Jeopardize a Hospital’s Tax Exempt Status?

According to IRS Private Letter Ruling

By http://www.garfunkelwild.com/

Recently, the Internal Revenue Service (“IRS”) issued a private letter ruling (the “Ruling”) that will allow the requesting tax-exempt hospital to establish and operate a social welfare organization as a means of engaging in political activities and establishing a larger presence in the political arena. The Ruling concluded that these actions will not jeopardize the hospital’s tax-exempt status under the Internal Revenue Code of 1986, as amended, (“IRC”) § 501(c)(3). Pursuant to IRC § 501(c)(3), a corporation organized and operated exclusively for religious, charitable, scientific, literary or educational purposes is exempt from federal income taxes, provided that its net earnings do not inure to the benefit of a private individual and a substantial part of its activities do not involve lobbying or related political conduct.

The Requesting Hospital

The requesting hospital is a comprehensive regional, integrated health care system that has qualified as a tax-exempt, charitable organization (the “Hospital”).  Currently, the Hospital conducts an insubstantial amount of lobbying through its government affairs department (the “Department”), in an effort to improve the cost efficiency of health care services. The Ruling serves to permit the Hospital to take a more active role in the political arena, through the formation of a separate, non-profit social welfare organization (the “Organization”) that will, in turn, establish two independent political action committees (collectively “PACs”).

Social welfare organizations are tax-exempt entities that are designed to promote the general welfare of the community. See IRC § 501(c)(4).  Social welfare organizations may conduct political campaign activities and establish political organizations, as long as political campaigning is not the primary activity. Reg. § 1.501(c)(4)-1(a)(2)(ii).  Accordingly, in order for the Hospital to create the Organization, the IRS requires that the Organization (a) remain independent from the Hospital and (b) apply for tax-exempt status as a social welfare organization.  Notwithstanding the preceding sentence, the Hospital proposed that it would remain the sole voting member of the Organization, and that the majority of the Organization’s Board of Directors would be officers, directors or employees of the Hospital.  The IRS permitted the Hospital to act accordingly, provided the Hospital complied with the IRS requirements set forth in this Legal Alert, and expanded upon in the Ruling.

More on the Private Ruling

The Ruling permitted the Organization to establish two PACs for the purpose of accepting contributions from, or making expenditures to, a political candidate or party.  See IRC § 527(e). As part of its analysis, the IRS concluded that the PACs, Organization and Hospital must operate independently, in order to ensure that the political activities of the Organization and the PACs would not be attributed to the Hospital and would not impact the Hospital’s tax-exempt status.  To comply with the Ruling, the PACs must maintain separate bank accounts and records, as well as separate addresses and phone numbers.  In addition, any leasing or sharing of employees, goods or services among the Hospital, Organization and PACs must be conducted at arms-length.

Assessment

Furthermore, the Ruling concluded that the Hospital may establish and operate a voluntary payroll deduction plan permitting Hospital employees to make political contributions through the PACs.  The Ruling provided that political contributions by employees of the Hospital will not impact the tax-exempt status of the Hospital, as long as the Hospital does not influence the employees’ choices regarding contribution.

Editor’s Note

Please note that this Private Letter Ruling is limited to the facts at issue, and should not be relied upon by anyone other than the Hospital.

Conclusion

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Criticizing Electronic Medical Records?

By Brent A. Metfessel; MD, MS

By Staff Writers

www.HealthcareFinancials.comHOFMS

Despite ARRA and the HITECH initiatives, eMRs are not without drawbacks. And, with apologies to USCTO Aneesh Chopra, we list the following.   

List of Drawbacks

The following are some of the more notable negatives:

  • Operator dependenceThe term “garbage in, garbage out” applies to eMRs as well. The computer only works as well as the data it receives. If one is resistant to computing and works begrudgingly, is not well-trained, or is rushed for time, the potential exists for significantly incomplete or error-prone documentation.
  • Variable flexibility for unique needs — When one sees a single hospital, one sees just that — a single hospital, with unique needs unlike any other facility. A “one size fits all” approach misses the target. Even within a hospital, needs may change rapidly over time given the continued onslaught of external initiatives and measurement demands. Systems vary in flexibility and the ease with which they can customize options. More flexible systems exist but cost much more.
  • Data entry errors — Although data items normally only have to be entered once, data entry errors may still occur and be propagated throughout the system. Most notably, patient data can more easily be entered into the wrong chart when there is an error in chart selection. In general, simple double-checking and “sanity checks” in the system usually catch these errors, but if the error goes through the system the impact can be significant.
  • Lack of system integration — Interconnectivity of systems becomes more important with eMRs than with any other system. Personnel use the data in many different areas. If there are isolated departmental systems without connectivity, redundant data entry occur leading to confusion in the different departments. Appropriate and intelligent clinical decision support systems can make the job of the physician easier through education, real-time feedback, and through the presentation of choices that allow for clinical judgment.
  • Costs of implementation — Intelligently applied eMR implementations may also be cost saving; long term. For example, one large east coast hospital found that eMRs saved $9,000 to $19,000 annually per physician FTE. This savings was achieved through a decrease in costs for record retrieval, transcription, non-formulary drug ordering, and improvements in billing accuracy. And, in radiology, storage of digital pictures and the use of a picture archival and communication system significantly [PACS] decreased the turnaround time for radiology image interpretation — from 72 hours to only 1 hour. However, there is significant front-loading of costs prior to achieving such costs savings. 

Link: WSJ_Letter_3M_Company_2009-10-16

Assessment

At the American Health Information Management Association [AHIMA] October 2006 conference,  panelists suggested that developing, purchasing, and implementing an EMR would cost over $32,000 per physician, with an outlay of $1,200 per physician per month for maintenance.  This is larger in economic scope, today. Also, there exists no national standard that would require compatibility between the numerous competing eMR vendor systems that may need to communicate with each other, which can escalate costs and frustration in systems that attempt to integrate the features of multiple vendors.

Some recent HIT fiascos:

 Link: http://psnet.ahrq.gov/resource.aspx?resourceID=3090

 Link: http://psnet.ahrq.gov/resource.aspx?resourceID=1905

 Link: http://psnet.ahrq.gov/resource.aspx?resourceID=5286

 Link: http://psnet.ahrq.gov/resource.aspx?resourceID=3891

 http://sanfrancisco.bizjournals.com/sanfrancisco/stories/2009/10/12/newscolumn3.html#

Conclusion

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Understanding Collateralized Mortgage Obligations

Defining Terms and Concepts for Medical Professionals

By Staff Reporters

www.HealthcareFinancials.comho-journal9

A CMO is a debt security backed by mortgages. These mortgage pools are usually separated into different maturity classes called tranches (from the French word for “slice”). The securities were issued by private issuers, as well as the Federal Home Loan Mortgage Corporation (Freddie Mac). As the mortgages were usually government-guaranteed, CMOs usually carried AAA ratings until their current financial meltdown. The early versions of CMOs were known as “plain vanilla,” but recent developments gave us PACs (planned amortization certificates) and TACs (targeted amortization certificates); among too many others. They were all variations on how principal repayments in advance of maturity date were treated.

Assessmentdhimc-book19

Link: www.HealthDictionarySeries.com

Conclusion

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Wi-Max 2 the Medical-Max

An HIT Report from the Inner City Trenches

By Dr. David Edward Marcinko; MBA, CMP™

[Publisher-in-Chief]dr-david-marcinko4

While not an IT guru by any means, I am a prudent fan of health IT where appropriate, and have always been a bit on the curious side.

A Bit about Me

OK; I am a member of the American Health Information Management Association (AHIMA) and the Healthcare Information and Management Systems Society (HIMSS). I am also a beta-tester for the Microsoft Corporation, a member of the Microsoft Health User’s Group (MS-HUG) and the Sun Executive Boardroom program sponsored by CEO Jonathan Schwartz; as well as SUNSHINE [Solutions for Healthcare Information, Networking and Education [NASD/FINRA-JAVA]. I also was fortunate to just finish editing the Dictionary of Health Information Technology and Security, with Foreword by Chief Medical Information Officer Richard J. Mata; MD MS MS-CIS of Johns Hopkins University.

And, I was incredibly lucky to have  my colleague Ahmad Hashem; MD PhD, who was the Global Productivity Manager for the Microsoft Healthcare Solutions Group at the time, to pen the Foreword to the second edition of my book, the Business of Medical Practice

And so, it was with the pleasure of potential intellectual satiety that goaded me into testing the airwaves, so to speak, on my recent visit to my home town of Bal’more. Thus, this exclusive ME-P report follows.

Location … Location … Location

If you lived in San Francisco a few years ago, during the ill-fated and costly WiFi experiment, you have my sincere condolences. If you live in Baltimore however, and want to have fast, wireless Internet speeds, then congratulations because you’ve chosen your place of residence wisely. Me, I’m an ex-patriot who was ecstatic when Sprint announced in October 2008, that Baltimore would be the first US city to have access to its new Wi-Max mobile data network; known as Xohm. I visit my home town 3-4 times, annually.

About the Wireless Xohm Data Network

Xohm is a wireless data service which, thanks to its WiMax capability, reportedly provides broadband-like speeds on a wireless PC. With this, as long as you have a WiMAX adapter and can pay for the service, the Internet should be available anywhere within the city. For home use, service for WiMAX costs $25 per month for six months, and $35 per month after that. Laptop access was to be $30 per month for the first six months. If you’re just visiting the city, single day access will cost $10, which is a bit steep, but not bad compared to the price of Wi-Fi access in some airports. Or, their unsecure networks were purported free; anywhere in the city. This was the object of my informal beta-testing activities.

computer-hardware2

City of Baltimore

My neighborhood, in Baltimore, is known as the historic Fell’s Point District. It was founded in 1670 by William Cole who bought 550 acres on the Inner Harbor, downtown. English Quaker, William Fell then bought land he named “Fell’s Prospect”. The land was also known as “Long Island Point” and “Copus Harbor”.

This area was the ideal hostile site for the Wi-Max experiment. The surrounding neighborhoods are composed of many dense, old-brick and stone-masonry buildings, with abundant large expanses of Chesapeake Bay with its related estuaries and inlets. Local gossip about the experiment suggested that if it was successful in this hostile Baltimore environment, it would like be successful in more modern American cities.

Link: http://www.fellspoint.us/history.html

Test-Laptop Specifications

I used my daughter’s [age 12, eighth-grade] Dell Latitude D600 laptop PC, running a Windows XP professional downgrade, with an Intel® P4 micro-processor [1.4 GHZ, 512 MB, 30 GIG CD with 24X CD-RW/DVD] for data only. It was originally purchased used – not new – for a few hundred bucks and badly in need of some upgrades. For the test, we added 512 MB LT DDR PC-3200, and a wireless LINKSYS PCMCIA card [WPC54GX].

Network Results

First, set up was a snap. While the network is expansive, it was not exactly blazingly fast, at least not for unsecure roaming access. The network can provide “download speeds of 2 to 4 megabits per second“. While, it is faster than most cellular networks, the service is nothing compared to some home internet connections. Although, the option to use it on a laptop is useful, the 4 Mbps is good enough for checking email or other smaller, lower bandwidth internet surfing usages. It’s hard to say if these estimates actually hold up with a lot of people using the network at once, especially if you are far from a broadcast tower – or in a funky part of the city – which is everywhere. But, they seemed to work quite well. My daughter, wife and I were suitably impressed.

Of Medical PACS

Of course, we also talked to local town folk about their free unsecured use. All were pleased with the Baltimore experience. We found business, law, nursing and graduate school students who were ferocious users. We even found medical students using open network wireless PCAS. To the uninitiated, picture archiving and communication systems (PACS) are computers or networks dedicated to the storage, retrieval, distribution and presentation of digital radiology images. The medical images are stored in an independent format. The most common format for image storage is Digital Imaging and Communications in Medicine [DICOM].

Roll-Put in Other Cities

Apparently, Sprint plans on releasing Xohm WiMAX networks in Chicago and Washington DC, this year.  While they are both major cities, it is hard to speak for just how well the WiMAX works when you’re sitting in Atlanta, GA. Should these networks actually get some decent use, perhaps the service will be released in more markets. I just don’t know.

About NETGEAR

Local Baltimore provider NETGEAR has been a worldwide leader of technologically advanced, branded networking products since 1996. Their mission is to be the preferred customer-driven provider of innovative networking solutions for small businesses and homes.

Link: federal@netgear.com

Assessment

As an old city, Baltimore has a rich medical heritage. There is the University of Maryland School of Medicine, Dentistry, Nursing and Pharmacy. Up the street from the Inner Harbor are the famed Johns Hospital School of Medicine and the Kennedy School of Public Health. It is here where I played stickball, as a child, in the parking lot. Nevertheless, given the high demands of business networking security and emerging network management in the local, State and Federal space today, NETGEAR is reported to have an end-to-end solution to meet most agency needs. This did seem to be the case in my ad-hoc experiment. We always found an open channel, and dropped links were few and far between; usually while mobile or riding in an automobile, bus, train or high-rail transportation system.

Link: http://www.freewimaxservice.net

Conclusion

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About Hiperwall.com

Cool New Video Wall Creations – for Medicine?

Staff Reporters56371220

Hiperwall software enables anyone to build a scalable, high performance video wall from ordinary computers, monitors and an ethernet network.

Many Content Types

Hiperwall allows viewing in any combination of content types:

 

  • Ordinary graphic images
  • Extremely large graphic images, up to 1 gigabyte or larger
  • Digital movies, including standard and HDTV format
  • Streaming content from cameras and other live sources
  • Live “sender” feeds that let a room full of people view the constantly changing screen displays of one or more computers

Hiperwall has the ability to resize and relocate each content object anywhere on the video wall, within a single monitor or across multiple monitors. It is as easy as moving and resizing windows on the desktop of your personal computer. Hiperwall also provides advanced capabilities like zoom, rotation, shading and transparency, enabling users to examine content with increased flexibility and effectiveness. It is based on technology originally developed by researchers from the University of California at Irvine, and is now available for use by anyone www.Hiperwall.com

Assessment

Now, what does this all have to do with healthcare? Well, think digital radiology, cardiology, PET, CT and MRI scans, and others graphically intensive specialties? For example, an early client was Stanford University Medical School and Samsung Electronics. Still, with few other clients and only a hand-full of employees, consider overall costs, viability and follow-up support. Nevertheless, on January 24, 2009 – Information Week named the company as the “Startup-of-the-Week.”

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated; especially from you daring early-adopters, out there! Think PACS [picture archiving and communication systems].

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com  or Bio: www.stpub.com/pubs/authors/MARCINKO.htm

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