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Understanding Capital Investment Risks for Hospitals

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Capital Investment Risks for Hospitals

By Calvin Weise CPA and Dr. David E. Marcinko MBA CMP®

www.CertifiedMedicalPlanner.org

Capital investments create risk. Risk is the uncertainty of future events. When hospitals make capital investments, they commit to costs that affect future periods. Those costs are known and relatively fixed. What is unknown are the benefits to be realized by those capital investments.

Capital Investments

For capital investments, risk is the certainty of future costs coupled with the uncertainty of future benefits. In some cases, while the future benefits are uncertain, there is a high degree of certainty that the benefits will exceed the costs. In these cases, risk can be very low. Risk may be better defined as the degree to which the uncertainty of unknown benefits will exceed the known and committed costs.

Capital Assets

When capital assets are purchased, both the burdens and the benefits of ownership are transferred to the owner. The burdens are primarily the costs associated with acquisition and installation. The benefits are primarily the revenues generated by operating the capital assets. Risk of ownership is created to the degree that the benefits are uncertain.

Manager Tasks

Hospital managers need to be skilled at putting hospital assets at risk. Without clear knowledge and understanding of the benefits and the burdens, hospitals can quickly find themselves at unacceptably high levels of risk. Risk must be continually assessed and evaluated in order to successfully put hospital assets at risk. Hospitals require many varied capital investments; their capital investments represent a risk portfolio. An effective combination of risky assets can often create risk that is less than the sum of the risk of each asset.

***

Hospital with paper MRs

***

Modern Portfolio Theory

Of course, financial managers have know this for years as a basic principle of Modern Portfolio Theory (MPT), first introduced by Harry Markowitz, PhD, with the paper “Portfolio Selection,” which appeared in the 1952 Journal of Finance. Thirty-eight years later, he shared a Nobel Prize with Merton Miller, PhD, and William Sharpe, PhD, for what has become a broad theory for securities asset selection; and hospital assets may be viewed as little different.

Prior to Markowitz’s work, investors focused on assessing the rewards and risks of individual securities in constructing a portfolio.

Risk Measure

Standard advice was to identify those that offered the best opportunities for gain with the least risk and then construct a portfolio from them. Following this advice, a hospital administrator might conclude that a positron emission tomography (PET) scanning machine offered good risk-reward characteristics, and pursue a strategy to compile a network of them in a given geographic area. Intuitively, this would be foolish. Markowitz formalized this intuition. Detailing the mathematics of diversity, he proposed that investors focus on selecting portfolios based on their overall risk-reward characteristics instead of merely compiling portfolios of securities, or capital assets that each individually has attractive risk-reward characteristics.

In a nutshell, just as investors should select portfolios not individual securities, so hospital administrators should select a wide spectrum of radiology services, not merely machines.

Assessment

Savvy hospital managers will mitigate ownership risk by constructing their portfolio of risky assets in a manner that lowers overall risk.

Conclusion

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

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***

The Legacy of Dr. Jack Treynor

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The History Behind A Popular Investing Theory

[By Dr. David Edward Marcinko MBA CMP™]

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[Publisher-in-Chief]

In his 1959 “Portfolio Selection,” Harry Markowitz PhD [father of MPT], said that investors should diversify against market risk but that determining the required return from such a group of diversified assets was another matter. Seven years later, economist Jack Treynor PhD wrestled with the issue of how investors can measure the expected risk in a portfolio against its expected return. Meanwhile, William Sharpe developed his own measure of risk and return known as the Capital Asset Pricing Model (CAPM) first published in the Journal of Finance in 1964 and discussed elsewhere on the ME-P.

A Seminal Paper

Treynor’s 1961 paper entitled “Toward a Theory of Market Value of Risky Assets” concluded that investors expect greater compensation for the larger risk they take in the stock market than they do from risk-free assets, such as Treasury bills. He called it the “equity risk premium” and created a method to predict it.

Fisher Black Collaboration

In 1973, Treynor collaborated with Fischer Black to devise a method for predicting the risk premium and to demonstrate its overarching importance in the behavior of capital markets as well as in portfolio selection. From 1969 through 1981 he furthered the work of many leading financial theorists, including Sharpe and Black, when he edited the Financial Analysts Journal.

Intellectual Band-Aid

In an interview about a decade ago, Treynor stated his belief that modern finance is preoccupied with statistical, rather than economic, thinking about risk. He explained that beta has come under attack in recent years because it is a statistical concept of risk. An economic concept of risk would have a lot more predictive value—it would be tied more intimately into fundamental analysis of companies and portfolios. He refers to beta as “just an intellectual Band-Aid.”

The Jensen Alpha

Treynor also described Bill Jensen’s alpha as looking at a market line established by a large number of funds and identifying those that had returns above the market line. Accordingly, a portfolio manager can increase his or her alpha by simply buying and selling larger positions of the same research recommendations.

Assessment

Black and Treynor developed a ratio of alpha to residual risk (return squared /risk squared), which shows that when you have everything else equal and you increase this ratio, you improve performance. And, they actually introduced the term Sharpe ratio.

Note: “It’s All About Odds,” Jonathan Burton, Dow Jones Asset Management, July/August 1997, pp. 20–28, Dow Jones Financial Publishing Corp., (732) 389-8700.

Conclusion

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The Living Legacy of Dr. Harry Markowitz

Creating Diversified Portfolios of Uncorrelated Assets

By Dr. David Edward Marcinko MBA CMP™

[Publisher-in-Chief]

More than a half century ago, a paper appeared in The Journal of Finance written by a 24-year-old doctoral candidate in economics at the University of Chicago—Harry Markowitz. It was called “Portfolio Selection” and suggested that investors take into account risk in pursuit of the highest return—a concept that we take for granted today [Modern Portfolio Theory].

Markowitz drew a trade-off curve between risk and reward and called it the “efficient frontier.” A rational physician executive or other investor who knew his or her risk tolerance could choose an appropriate portfolio from a point on this curve. Markowitz led investors to diversified portfolios of uncorrelated investments.

Dissertation Follow-up

Markowitz followed up his dissertation in 1959 with a book entitled Portfolio Selection [Efficient Diversification of Investment]. His many contributions to finance earned him the Nobel Prize in Economic Science in 1990 along with William Sharpe and Merton Miller. He reasoned that diversification is about avoiding the covariance.

If risks are uncorrelated, you can reduce the risk of a portfolio to practically zero by sufficient diversification. This doesn’t work if risks are correlated. If one invests in a very large number of securities that are correlated, risk does not approach zero but rather the average covariance, which is a very substantial amount of risk.

Where It All Started

It was at the RAND Corporation that Markowitz met William [Bill] Sharpe who was working on his PhD at UCLA. Markowitz takes issue with Sharpe’s Capital Asset Pricing Model (CAPM), which claims that the expected return of a security depends only on its beta—ignoring fundamental analysis.

CAPM also implies that the market portfolio is efficient, even though investors in the market may not act rationally. It says that the market portfolio is a mean-variance efficient portfolio. Markowitz disputes this conclusion. He points to Fama and French and others who have found that expected returns are more closely related to book-to-price or size—not to beta.

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Assessment

The still living Markowitz fends off criticism of mean-variance analysis only being valid when probability distributions are normal by stating that he realizes that probability distributions are not normal in the real world.

But, if they are similar to a normal distribution, mean variance does a good job at approximating expected utility. He admits that when they are too dispersed, mean variance doesn’t work well.

Note: Travels along the Efficient Frontier,” an interview with Harry Markowitz by Jonathan Burton, Dow Jones Asset Management, May/June 1997, pp. 21–28, Dow Jones Financial Publishing Corp.

Conclusion

And so, your thoughts and comments on this ME-P are appreciated. Do you use MPT when investing, or CAP-M? 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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Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

***

Hospital Capital Formation, Harry Markowitz and Modern Portfolio Theory

Strategic Risk Considerations for Physician-Executives and Healthcare CXOs

[By Calvin W. Wiese; MBA, CPA, CMA]

To most all financial advisors, wealth managers and stock-brokers, the work of Harry Markowitz and Modern Portfolio Theory [MPT] is not usually discussed in terms of hospital capital formation. But, perhaps it should!

Capital Investments Create Risk

Capital investments create risk. Risk is the uncertainty of future events. When hospitals make capital investments, they commit to costs that affect future periods. Those costs are known and relatively fixed. What are unknown are the benefits to be realized by those capital investments.

Defining Risk

For capital investments, risk is the certainty of future costs coupled with the uncertainty of future benefits. In some cases, while the future benefits are uncertain, there is a high degree of certainty that the benefits will exceed the costs. In these cases, risk can be very low. Risk may be better defined as the degree to which the uncertainty of unknown benefits will exceed the known and committed costs.

Asset Burdens and Benefits

When capital assets are purchased, both the burdens and the benefits of ownership are transferred to the owner. The burdens are primarily the costs associated with acquisition and installation. The benefits are primarily the revenues generated by operating the capital assets. Risk of ownership is created to the degree that the benefits are uncertain.

Understanding Risk

Hospital managers need to be skilled at putting hospital assets at risk. Without clear knowledge and understanding of the benefits and the burdens, hospitals can quickly find themselves at unacceptably high levels of risk. Risk must be continually assessed and evaluated in order to successfully put hospital assets at risk. Hospitals require many varied capital investments; their capital investments represent a risk portfolio. An effective combination of risky assets can often create risk that is less than the sum of the risk of each asset.

Modern Portfolio Theory

Of course, financial managers have know this for years as a basic principle of Modern Portfolio Theory (MPT), first introduced by Harry Markowitz, PhD, with the paper “Portfolio Selection,” which appeared in the 1952 Journal of Finance. Thirty-eight years later, he shared a Nobel Prize with Merton Miller, PhD, and William Sharpe, PhD, for what has become a broad theory for securities asset selection; and hospital assets may be viewed as little different.

Prior to Markowitz’s work, investors focused on assessing the rewards and risks of individual securities in constructing a portfolio. Standard advice was to identify those that offered the best opportunities for gain with the least risk and then construct a portfolio from them. Following this advice, a hospital administrator might conclude that a positron emission tomography (PET) scanning machine offered good risk-reward characteristics, and pursue a strategy to compile a network of them in a given geographic area. Intuitively, this would be foolish. Markowitz formalized this intuition.

Detailing the mathematics of diversity, he proposed that investors focus on selecting portfolios based on their overall risk-reward characteristics instead of merely compiling portfolios of securities, or capital assets that each individually has attractive risk-reward characteristics. In a nutshell, just as investors should select portfolios not individual securities, so hospital administrators should select a wide spectrum of radiology services, not merely machines.

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Assessment

Savvy hospital managers will mitigate ownership risk by constructing their portfolio of risky assets in a manner that lowers overall risk

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.

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

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

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Strategic Modern Portfolio Theory Considerations in Hospital Capital Formation

Understanding Risk for Doctors and Financial Advisors

By Calvin W. Wiese; MBA, CPA

www.HealthcareFinancials.com

Hospital capital investments financial create risk. Risk is the uncertainty of future events. When hospitals make capital investments, they commit to costs that affect future periods. Those costs are known and relatively fixed. What are unknown are the benefits to be realized by those capital investments. For capital investments, risk is the certainty of future costs coupled with the uncertainty of future benefits. In some cases, while the future benefits are uncertain, there is a high degree of certainty that the benefits will exceed the costs. In these cases, risk can be very low.

Risk Re-Defined

Risk may be better defined as the degree to which the uncertainty of unknown benefits will exceed the known and committed costs. For example, when capital assets are purchased, both the burdens and the benefits of ownership are transferred to the owner. The burdens are primarily the costs associated with acquisition and installation. The benefits are primarily the revenues generated by operating the capital assets. Risk of ownership is created to the degree that the benefits are uncertain.

Managing Risk

Hospital managers and physician executives need to be skilled at putting hospital assets at risk. Without clear knowledge and understanding of the benefits and the burdens, hospitals can quickly find themselves at unacceptably high levels of risk. Risk must be continually assessed and evaluated in order to successfully put hospital assets at risk. Hospitals require many varied capital investments; their capital investments represent a risk portfolio. An effective combination of risky assets can often create risk that is less than the sum of the risk of each asset.

About MPT

Of course, financial managers have know this for years as a basic principle of Modern Portfolio Theory (MPT), first introduced by Harry Markowitz, PhD, with the paper “Portfolio Selection,” which appeared in the 1952 Journal of Finance. Thirty-eight years later, he shared a Nobel Prize with Merton Miller, PhD, and William Sharpe, PhD, for what has become a broad theory for securities asset selection; and hospital assets may be viewed as little different. Prior to Markowitz’s work, investors focused on assessing the rewards and risks of individual securities in constructing a portfolio. Standard advice was to identify those that offered the best opportunities for gain with the least risk and then construct a portfolio from them.

Following this advice, a hospital administrator might conclude that a positron emission tomography (PET) scanning machine offered good risk-reward characteristics, and pursue a strategy to compile a network of them in a given geographic area. Intuitively, this would be foolish. Markowitz formalized this intuition. Detailing the mathematics of diversity, he proposed that investors focus on selecting portfolios based on their overall risk-reward characteristics instead of merely compiling portfolios of securities, or capital assets that each individually has attractive risk-reward characteristics. In a nutshell, just as investors should select portfolios not individual securities, so hospital administrators should select a wide spectrum of radiology services, not merely machines.

Assessment

Savvy hospital managers will mitigate ownership risk by constructing their portfolio of risky assets in a manner that lowers overall risk.

Conclusion

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The Active v. Passive Investing Dichotomy

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The Controversy Continues

[By Amaury S. Cifuentes CFP® CMP®]

Physician and all investors are often overloaded with information regarding this debate, and many advisors differ in the conclusion of which strategy is best.

Stock Picking

Stock picking is typically a waist of time and few investors or advisors demonstrate the constant ability in picking winning stocks. Timing the market also becomes difficult and typically has negative effects in a portfolio. Investors will also find that they will usually have very little luck finding money mangers that can consistently out perform the market. Investors over a long period of investing time horizon would benefit from passive investing vs. active trading, with some exceptions.

Active Investors

Active investors spend time analyzing stocks or mutual funds based on a mismatch of the price relative to its value. In an efficient market, there is little or no mismatch between the current price and the true value of the investment. Also, real cost and expenses of active management are rarely calculated;  some consider the stock market a zero sum game, if the total market returns eleven percent then the investors must deduct the cost of the transaction, which would lower their return relative to the market.

Mutual Fund Performance

For example, Mark Carhart’s comprehensive study of 1,892 mutual funds title “On Persistence in Mutual Fund Performance” showed that on average mutual fund manager under performs by 1.8% to their relative index.  In addition, William Sharpe Nobel laureate article “The Arithmetic of Active Management” stated that after cost, the return of active management dollars would be less than passive dollars.

Market Timing

Timing of markets is also very difficult. Timing the market can be defined by moving your asset from risky to non risky assets before negative events happen. The Random Walk Theory basically states that there are no patterns in the stock market prices. Basically, information moves the markets and information is random, so logic would suggest that timing the markets effectively is futile. Many reports demonstrate this effect, for example, a report form Javier Estrada, a finance professor at IESE Business School in Barcelona, Spain. He studied the DJIA form 1900-2008 and concluded that if you subtracted the ten best days from the market two thirds of the cumulative gains would disappear (10/29694 or .03%), almost impossible to predict even by the most astute investors. Much more extensive research showing that market timing does not work, Wei Jiang paper “A Nonparametric Test of Market Timing” concluded that timing ability on average is negative. There are countless of studies showing that there is no evidence that timing the markets can produce superior returns.

***

technology-medicine

***

Investing Difficulties Continue

To make thing even more difficult, investors that seek profession help cannot guarantee that the active managers they hire can consistently over long period of time outperform their benchmarks.  Obviously, it is evident that past performance is no indication of future results as advertised by all financial institution, and most active managers who outperform their bench market do not do consistently over long periods of time. John Boggle’s comprehensive study in 1992 of the Forbes Honor Roll title “Selecting Equity Mutual Funds” concluded that after commissions loads were taken into account the honor roll under performed the market between 1974 and 1990 by a difference of 193.75% cumulative.

Of Professor Burton Malkiel

Furthermore, investors over long periods of time will find that stock picking, timing the market and selecting active managers do not produce superior returns. John Stossel of ABC’s 20/20 interview Professor Burton Malkiel of Princeton University and stated in the interview that “All the information an analyst can learn about a company, from balance sheets to marketing material, is already built into the stock price, because all of the other thousands of analysts have the same information. What they don’t have is the knowledge that will move the stock, knowledge such as a news event, which is unpredictable and impossible to forecast.”

Assessment

Physicians and all investors may be better off concentrating on asset allocation, picking low cost investment, deciding on tactical or strategic rebalancing and implementing models like the three factor model as pioneered by Professor Eugene Fama and Professor Kenneth French in lieu active management.

Conclusion

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