Health Nuts and Bolts

Cited: Environmental News Network

Did you ever imagine and efficient gas furnace providing energy to your home while it is heating it?  Well, the North American market today is in for a new reality from Marathon engine.  Generating electricity produces enormous amounts of heat that is typically wasted when it goes right at the chimney.  Now there is cogeneration or “Combined Heat and Power” systems that make use of that otherwise wasted heat to warm buildings and homes.  Several Con-Edison plants in the vicinity of Manhattan help to heat Manhattan’s buildings.  It’s brilliant solution will help urban areas to improve energy efficiency.  Although, it does not work as good in less urban areas.  Typically, there are still people who use their own natural gas to heat their homes.

But what if you could reverse the cogeneration idea? Imagine taking an already efficient gas furnace and generating a home’s electricity directly from it, while it heats?

That is the reality that Marathon Engine has in store for the North American market today. While not quite a start-up (they have been selling units in Europe for 5 years), the company’s “EcoPower MicroCHP” units look set to sell well, despite, or perhaps because of the economy downturn.

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The EcoPower unit is not only capable of generating all of a sizable home’s heating and electric needs – it can also sell excess generation back to a utility (assuming Net Metering is legal and in place). The larger the home, the better the payback which makes the system particularly suited for multi-family buildings and small businesses with strong heating needs. It is also best used in cold climates where heat is required for most months of the year – you will not find much use for it in Phoenix.

As for greenhouse gases, the company claims (see PDF here) to offer a 65% reduction in CO2 emissions vs a coal powered equivalent. In reality, it is very difficult to measure the reduction because there are so many factors that might go in to what the device replaces and what kind of heating and electric demand is called for.

On the other side of the coin, EcoPower is not cheap.  The average person will not have $35,000 laying around to purchase.  However, for larger homes, the device could possibly pay for itself in about a half a dozen years or so.  If it works, despite the cost, with a high energy prices, economics of scale will probably bring the equal power within reach for many people.  Housing developers, of course, could very possibly start incorporating EcoPower into their building plans of houses and then the cost would be easier for people to afford because it would be spread out over the life of the mortgage.

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My Take: This is fantastic!  However, it is not a new idea.  People in cold country have been doing something similar to this for years.  I know several people that take their dryer exhaust from their dryers and aim it into their heating vent system to save money on heating during winter.  It works expiration point

The idea to take that extra heat and create energy makes the same idea even better.  Those people that do this could easily use that same heat to run their dryer.  Therefore, it is a fantastic idea!  It is even better that it cuts down on the CO2 emissions in the air, we get enough of that from the cars and trucks on the road.

Now if they could just manage to use the heat in the summer in Phoenix to do the same thing they are doing with this equipment, they would really have something then.  This year it has been running right at 115° the day for almost a month.  That means you could fry eggs on the sidewalk.  Why can’t someone create something to capture that he and create clean energy?

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Cited Flanders-NJ.com

In today’s society, people are extremely fashion and style conscious.  Wanting to look your best may not always be the best thing for you.  Creating unique looks is the job of clothing designers and stylists and maintained please, however they may not always be practical or comfortable clothing when they are manufactured.  You see what models in high form heels and tight skirts or pants and fashion shows, to the more comfortable?  They probably do because they have perfected that “runway walk” to make things look comfortable and easy to wear.  Frequently, the items they are wearing our impractical and have the possibility of creating leg, back spine or neck problems.  “Sometimes I see a woman walking down the street with high heels and a two-ton bag, and I want to stop her and make her aware of what she is doing to her body,” says Dr. Jerome McAndrews.

Women generally wear high heels to complement an outfit, not for comfort, but some might not realize that these shoes can cause serious discomfort in the feet and can also exacerbate back pain. High heels alter the balanced position of a person’s body. When a woman wears high heels, a new dynamic equilibrium occurs.

Dr. McAndrews compared the musculoskeletal system to a mobile, hanging in dynamic equilibrium, each part balancing the other. If one part becomes ‘fixed,’ the whole system will compensate with a movement or restriction. Essentially, wearing high heels for any length of time increases the normal forward curve of the back and causes the pelvis to tip forward. This alters the normal configuration of the pelvis and spine necessary for the body to maintain a center of gravity.

“The legs are the foundation of the musculoskeletalsystem, and a person standing flat-footed or bare-footed would be completely balanced,” said Dr. McAndrews. “While standing, the ham strings are taut and both parts of the pelvis are stabilized so that the support is normal. By bringing the heel up, you encourage the shortness of the hamstring muscles.

”Women and men alike fall into the fashion trap. However, women, more than men, tend to wear clothes that are too tight. Stylish tight tube skirts and tight pants can be attractive, but are often too restrictive. Clothing that is too tight can throw a person off-balance, and can make simple everyday tasks such as bending, sitting and walking become difficult . “Tight clothes restrict a person from moving comfortably, resulting in poor posture and misalignment of the spine,” said Dr. McAndrews. Another unhealthy fashion statement is the use of heavy purses, backpacks and handbags.

Women and men tend to carry too many items in one bag, or brief-case, and are often not aware of the potential health risks associated with toting an excessive amount of “stuff.” Carrying a bag with detectable weight more than 10 percent of your body weight can cause improper balance. When hiked over one shoulder, it interferes with the natural movement of the upper and lower body. “The person carrying the bag will hike one shoulder to subconsciously guard against the weight, holding the other shoulder immobile,” said Dr. McAndrews. “This results in the unnatural counterbalance movement of one shoulder and little control over the movements of the arms and legs. Even worse, the spine curves toward the shoulder.

For those who want to have a more relaxed fashion style at work. . . You could try a comfortable classic sport shirt that is anything but ordinary for work.  A corporate tee shirt with superior wrinkle and shrink resistance, a silky soft and an incredible range of styles, sizes and colors, is a first-rate choice for any office.  There are many vendors that specializing in custom corporate apparel, promotional products, college t shirts and marketing materials available online.

”More and more people carry their credit cards, ATM cards and personal identification in the back pocket of their pants. This might be a convenient way of carrying the necessary items with you each day, but carrying your wallet in the back pocket of your pants can cause discomfort. Dr. McAndrews suggested men and women remove their wallets or other items before sit-ting for long periods of time. “Sitting on your wallet or card holder for the entire day will create a pocket in the muscle lying underneath the wallet, and whether your pants are tight or loose-fitting; this can result in discomfort or pain.”

In today’s society, it might be important to you to look fashionable, but it is more important to choose clothes, shoes and bags that are comfortable and that suit your style. By following and remembering these simple steps, it is possible to look and feel your best.

• Choose comfortable shoes. If you must wear high heels, bring a pair of flat shoes along with you to change into should you become uncomfortable. If you walk to work, wear flat shoes and change into your more fashionable shoes when you arrive to alleviate any pain or discomfort.
• If the shoe is uncomfortable while standing, chances are it will not be any more comfortable while walking. The wrong shoe can affect the body’s center of gravity.
• Choose supportive shoes. Designer spikes or non-supportive loafers may look nice but do not allow for easy, symmetrical walking.
• While sitting, whether or not you are wearing heels, it is important to take frequent stretch breaks to alleviate a trophy of the hamstring muscles.
• Avoid excessive wear of tight pants or clothing. If you prefer tighter clothes, choose styles that allow you to perform daily tasks with ease.
• Select a briefcase or purse with a wide adjustable strap. Ideally, the strap should belong enough to place over the head. This evenly distributes the bulk of the weight across the body.
• When carrying a bag, or briefcase, switch sides frequently to avoid placing the burden of the weight on one side of your body.
• Take the time to empty unnecessary items from your bag.
• Place all necessary items such as wallets and cellular phones in the front pockets of the bag. Stretching around to reach for your wallet can result in a pulled neck or back.
• If you are driving or sitting for long periods of time, remove your wallet or card holder from the back pocket of your pants.

Fashion designers and stylists do not concern themselves about how clothing deals.  They are more concerned about the way it looks.  People need to listen to their body and not the designers.  People need to maintain a healthy judgment when thinking about being in style and looking your best.  Being fashionable can be comfortable by following these simple suggestions.

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My Take: I definitely agree with Dr. McAndrews!  Women especially need to take this advice.  You do not see men running around at work wearing skintight clothes.  Women restrict their blood circulation as well by wearing tight pants or skirts.  You need that blood flow to the brain to outdo the guys.

It amazes me that women in the corporate world still feel that they need to attract their bosses to get attention.  Because, that is exactly what they are doing when they are wearing those short tight skirts and low neckline blouses to work.  They need to realize that they can look beautiful and be comfortable at the same time.

My thought is very simple, if you cannot breathe when you sit down; your pants are too tight.  They are definitely too tight if you cannot even sit down.  Then you have the women who buy shoes 1-2 sizes too small.  Not only are they high heels but they are too small for their feet.  So now, they are not only causing problems for their legs and back, their feet are sore as well.

There is no set rule that says a woman has to be beautiful to have brains.  A woman can still look beautiful without wearing skintight clothing or shoes that cause pain in their feet.  A woman can be comfortable, beautiful, and smart, all at the same time!

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Cited: MedPage Today

European guidelines have changed to allow patients a shorter waiting.  Get back on the road after receiving an implantable cardioverter defibrillator (ICD).  They only have to wait three months after the ICD placement for secondary prevention of sudden cardiac arrest according to new European Heart Rhythm Association (EHRA) guidelines

This update cuts in half the length of time before a return to driving previously recommended by the EHRA and still recommended by the American Heart Association and Heart Rhythm Society.  Richard L. Page, MD, president of the Heart Rhythm Society, said that the change is reasonable and follows a general trend to reduce the duration of driving restrictions, although no changes in the AHA/HRS guidelines are expected.

Action Points

Explain to interested patients that American guidelines recommend waiting six months to return to driving after implantation of an ICD for secondary prevention and one week after implantation for primary prevention.

Note that the guidelines do not reflect national or state regulations or law enforcement on driving restrictions after ICD placement.

“It can be very frustrating for patients who have this sort of limitation on driving when it’s much longer than this,” he said, “especially in comparison to previous years when patients were required to wait six or 12 months if they were allowed to resume driving at all.”

Compliance with the recommendations has been a problem, he noted.  The EHRA taskforce behind the guideline update — led by Johan Vijgen, MD, of Virga Jesse Hospital in Hasselt, Belgium — agreed that improving adherence is a pivotal issue along with adequate education at discharge and follow-up.

The taskforce emphasized that the risk of sudden incapacitation in these patients while driving — which could pose a public safety threat — stems mainly from their underlying condition rather than the ICD itself.

The taskforce’s review of the literature in the secondary prevention population turned up retrospective and survey- or interview-based studies suggesting no higher risk of patient fatality or traffic accident risk than seen in the general population.

Nevertheless, the most influential evidence in making the six-month recommendation was from a prospective study of patients largely treated with antiarrhythmic drug therapy rather than ICDs.  It showed that most syncope, sudden death, and recurrent ventricular fibrillation or hemodynamically-compromising tachycardia events occurred in the first month after discharge from the hospital and was only moderately elevated for the next seven months.  Compelling evidence came out to challenge these recommendations, though, in 2007.

The prospective TOVA study revealed that the absolute risk of an ICD shock within one hour of driving was low and occurred primarily in the 30 minutes after driving (relative risk 4.46, 95% confidence interval 2.92 to 6.82) rather than during driving itself (RR 1.05, 95% CI 0.48 to 2.30).

Based on those findings, the guidelines taskforce decided to shorten the driving restrictions but not below three months, “since patients resuscitated for cardiac arrest very often need extensive time to recover from the event,” they said.

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“Patients should have an assessment of their functional class and cognitive functions before resumption of driving,” they added.  The literature review for risks after ICD implantation for primary prevention confirmed the generally lower risk for sudden incapacitation while driving; leading the taskforce to conclude that there is no need for driving restrictions after recovery from the procedure.

However, because patients need to refrain from extensive use of the arm on the side of implantation in the first weeks after the procedure to prevent complications, the updated guidelines recommend delaying driving until after a system integrity check at least four weeks post implant.

This is a more conservative recommendation than the one-week restriction imposed by the AHA/HRS guidelines, Dr. Page noted.  Other recommendations in the European guideline update include:

• A three-month driving restriction after an appropriate ICD shock
• No driving after an inappropriate ICD shock until measures are taken to prevent another
• A one-week delay in return to driving after replacement of the ICD
• A four-week driving restriction after replacement of the lead system
• No restriction for patients refusing an ICD for primary prevention
• A seven-month restriction for patients refusing ICD implantation for secondary prevention

Of course, these guidelines are for noncommercial drivers and not professional drivers of commercial vehicles who were recommended to have permanent restrictions.  The guidelines, hopefully, will serve to unify the varying national driving policies across Europe; at least that is what the taskforce hopes for.  It was noted by Dr. Page that in the US, individual states do not have consistent regulations, but they do have uniform national guidelines.

“In every case, I would just recommend that doctors be aware of their local regulations and that they advise their patients to make sure that they are aware and abide by the local rules regarding driving,” he said.

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My Take: These guidelines sound very reasonable to me.  I just wonder why the US has not followed their example.  Do we hear in the US know something your does not?  Maybe a little research into the matter might reveal a few things.

I do know that the US has many restrictions for people who have any kind of medical problem.  I also understand the reasoning behind those restrictions.  If someone, who has a severe disability, has the chance of causing an accident, it is best to restrict that person’s ability to drive.  I for one, have a disability that could conceivably result in a car accident.  However, I beat my Dr. to the punch and stop driving before they could restrict me.  I know, that there is a possibility of not being able to use my hands to properly steer the vehicle and avoid an accident.  However, many people are too stubborn to admit that they may not be able to drive.

As teenagers, we fight hard to get that driver’s license because it is a symbol of adulthood.  Once we have it, we do not want to lose it because it is part of being an adult.  I think many people who face the possibility of losing their license because of a disability or impairment seem to think it reduces their status as an adult.  Others, lose their license because of simple stupidity like driving while intoxicated or not paying all of their tickets.

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Cited: New York Times

Democrats and the AMA have been battling for a long time about protecting doctors from malpractice lawsuits.  According to Association officials, during a private meeting at the White House they may have found one Democrat willing to entertain the idea, President Obama.  It seems that Mr. Obama believes that reducing malpractice suits may help drive down health costs and should be considered part of the overhaul of healthcare according to the lawmakers of both parties and the AMA officials.  This is been a goal of many doctors and Republicans.

It is a position that could hurt Mr. Obama with the left wing of his party and with trial lawyers who are major donors to Democratic campaigns. But one Democrat close to the president said Mr. Obama, who wants health legislation to have broad support, views addressing medical liability issues as a “credibility builder” — in effect, a bargaining chip that might keep doctors and, more important, Republicans, at the negotiating table.

Mr. Obama went to the annual medical association meeting to face a group that has come out against a central component of his broader health care proposal — his call for a new public insurance program that would compete with the private plans. The White House says he will make the case that “reform is the single most important thing we can do for America’s long-term fiscal health,” and how important it is to have the cooperation of doctors.

But whether he can get them on board is an open question. The speech comes as the president’s ideas on health reform are facing mounting criticism — not only from the A.M.A. and Republicans, who also vehemently oppose a new public plan, but also from the hospital industry, which is up in arms over a proposal Mr. Obama announced on Saturday to pay for his health care overhaul in part by cutting certain hospital reimbursements.

Medical liability is an important component of the debate, but that, too, is controversial. White House officials said Mr. Obama was likely to refer to the issue in his speech to the medical association, but would not offer any specific proposal.

Mr. Obama has not endorsed capping malpractice jury awards, as did his predecessor, President George W. Bush. But as a senator, he advanced legislation aimed at reducing malpractice suits. And Dr. J. James Rohack, the incoming president of the medical association, said Mr. Obama told him at a meeting last month that he was open to offering some liability protection to doctors who follow standard guidelines for medical practice.

“If everyone is focused on saying, ‘How do we get rid of unnecessary costs,’ ” Dr. Rohack said, recounting the conversation, “if we as physicians are going to say, ‘Here’s our guidelines, we will follow them,’ then we need to have some protections. He listened and he said, ‘Clearly, that concept is worthy of discussion.’ ”

Health care experts estimate that preventable medical errors kill more than 100,000 Americans each year, yet doctors and hospitals, fearing lawsuits, do not openly discuss their mistakes — an impediment to improving quality of care. At the same time, doctors complain that “defensive medicine” — ordering tests and procedures out of fear of being sued — drives up health costs.

On Capitol Hill, Democrats drafting health legislation have so far shown little appetite for tackling the liability issue. But one Republican who met with Mr. Obama in April recalled that the president said he was willing to go against his party to get medical malpractice reforms into a health bill — but that he would expect Republican support for the legislation if he did so.

Mr. Obama also raised the issue at a recent meeting with two dozen Senate Democrats, some who attended said.

“He’s touched on this issue at a number of meetings,” said Senator Ron Wyden, Democrat of Oregon, who is also a proponent of liability reform. Mr. Wyden said the president articulated “the common sense message that if doctors act in line with their own professional guidelines, that ought to create a certain presumption that they have acted reasonably.”

As a senator, Mr. Obama joined Senator Hillary Rodham Clinton in 2005 in proposing legislation aimed at reducing both medical errors and lawsuits through a program known as Sorry Works, rooted in the idea that injured patients value an apology as much as money. Their bill encouraged doctors and hospitals to investigate errors and apologize for mistakes, to facilitate what Mr. Obama described as “a reasonable settlement that keeps the case out of court.”

Although the A.M.A.’s highest legislative priority is capping jury awards, highly unlikely under the Obama administration, it does favor legislation like that proposed by Senators Obama and Clinton. Dr. Rohack said the group’s legislative experts were also working over the weekend to draft a bill that would set out a way to protect doctors who are sued if they have followed professional practice guidelines.

“We are supportive of anything that may reduce liability,” Dr. Rohack said, adding that he was heartened by Mr. Obama’s “recognition that defensive medicine contributes to unnecessary health costs.”

But to deliver a deal with doctors, Mr. Obama would probably have to defy senior members of his party in both houses of Congress. Many Democrats oppose putting limits on medical lawsuits because they believe it is ineffective and unfair to patients.

Senator Max Baucus of Montana, the chairman of the Senate Finance Committee, is expected to outline his proposal for a health care overhaul this week, and aides said liability protection for doctors is not part of the plan.

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Senator Harry Reid of Nevada, the Democratic leader, resisted medical malpractice legislation when it was pushed by Republicans in the past. “The whole premise of a medical malpractice ‘crisis’ is unfounded,” Mr. Reid said on the Senate floor in 2006, in a speech that quoted extensively from a book titled “The Medical Malpractice Myth.”

And any effort to restrict patients’ legal rights to sue will face tough opposition from the American Association for Justice, which represents trial lawyers and has met with Nancy-Ann DeParle, Mr. Obama’s point person for health reform, to express its concerns. Linda Lipsen, the association’s chief lobbyist, said practice guidelines were established by unregulated medical societies and “should not be conclusive” in a court of law.

The association may have an ally in Mr. Obama’s health secretary, Kathleen Sebelius, who is a former director of the Kansas Trial Lawyers Association. But Mr. Obama’s first choice for health secretary, Tom Daschle, who advised the president throughout the campaign, was a strong proponent of linking evidence-based medicine with protections against lawsuits.  And another top health adviser to Mr. Obama, Dr. Ezekiel J. Emanuel, has written extensively on liability reform.

“There is no doubt that comprehensive health care reform requires a monumental change to the current malpractice system, which not only hurts both doctors and patients, but also is far too expensive,” Dr. Emanuel, the brother of the White House chief of staff, Rahm Emanuel, wrote in a 2008 book, “Healthcare Guaranteed: A Simple, Secure Solution for America.”

In March, Mr. Obama spoke to a group of chief executives and stated that malpractice law changes need to be part of the health care debate, he also conceded that it would not be an easy sale.  This is an indication that the solution may not be all that simple.

“Medical liability issues — I think all those things have to be on the table,” Mr. Obama said. “And I won’t lie to you that everybody agrees on this theoretically until you start getting into the specifics.”

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My Take: I believe they definitely need to do something about malpractice lawsuits against doctors.  Very few doctors do not have malpractice insurance.  Those that do have to charge more for their services, which means fewer patients.  This in turn, means that less people can get medical attention because they cannot afford.

There are many people who will suit a doctor over something trivial and they will win.  That means the malpractice insurance premium the doctor pays goes up and his fee goes up.  Many people do not realize that many doctors are in debt when they start their practice.  It takes thousands of dollars in school loans to get the education they need to become a doctor.  That means their fees are high to begin with and then they have to get malpractice insurance that costs an arm and a leg.

I can understand putting a cap on what someone can get in and malpractice suit.  There are so many things that need to be considered in doing that like what were the reasons that started the malpractice suit.  Is the patient alive?  Can the patient still work?  If a patient is still alive and is still able to work, they should not get as much as someone who sues because a family member is dead or the patient is permanently disabled.

There are even some people who believe that if a doctor caused a patient’s death because of a medical error, that the doctor should face criminal charges.  Maybe this is one of the options in this big discussion.  A doctor needs to trust the patient to do their job.  This is why many doctors and hospitals do not say anything when they discover a medical error.  They do their best to correct that error if at all possible.  However, sometimes that error cannot be corrected and this is the main issue in a malpractice suit.

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Cited: AMNews

J. James Rohack, MD. outlined his goals for the next year during an interview.  They Texas cardiologist is just as comfortable working his 23-acre ranch as he is caring for the hearts of his patients.  He plans to use a down to earth work ethic and compassion for patients to tackle the challenges facing medicine and the nation’s physicians.  Dr. Rowe hack was initiated as the president of the AMA during the organization’s annual meeting this June.

The first in his family to attend college, the medical graduate of the University of Texas Medical Branch at Galveston charted a path toward a career in cardiology at Scott & White Clinic in Temple. These days, his routine consists of a pre-dawn, two-hour drive from his home in Bryan through Central Texas to the community-based, multispecialty clinic.

As he embraced the Lone Star state’s culture and diversity, Dr. Rohack, 55, has worn many hats, including the occasional ten-gallon one. An affinity for education led him to a professorship at the Texas A&M University System Health Science Center College of Medicine. His roots at UTMB — whose primary mission until the late 1990s was caring for the state’s uninsured and indigent — and at Scott & White Clinic — which started as a prepaid health care system for railroad workers — now drive Dr. Rohack to help usher in health system reform, one of his top priorities.

His other goals include Medicare payment reform, eliminating waste and redundancy in the health care system, and eradicating racial and ethnic disparities.  Despite a full agenda, he doesn’t plan to sacrifice too much time on the ranch with his wife of 30 years, Charli, and stepdaughter, Elisha. He’s committed to toiling the land, often while catching a football game on the radio.

AMNews: What are some highlights of your career that helped define you as a physician?

Dr. Rohack: Since I was the first one to go to college, I didn’t have specific aspirations of getting into the medical profession. Clinical psychology was something that interested me. When I finished at the University of Texas El Paso, the president of UTMB came on campus and he talked about the mission. And at the time, if anyone didn’t have health insurance they were sent to UTMB for their health care. So as the major referral center for the state, it highlighted to me what the mission of giving back really was.

I also had the opportunity as an intern to start a continuity clinic, something new at the time. It was a way you could start seeing patients in your first year and then follow them over time. So I actually had patients that I had cared for, for six years. So it gave me the important lesson that, if the education system teaches about the body parts and not the whole person, then patients get frustrated because they are not sure who their physician is.

AMNews: What particular passions in medicine do you want to see realized this year?

Dr. Rohack: We have to make sure people have health care access and insurance coverage. We also recognize that we, as physicians, have to be part of the stewards of the health care dollar. And who best to know when one is talking about technology or different therapies, what really is the best for patients on an evidence basis. So in this next year, I’m convinced that with the $2.3 trillion we’re spending in health care and [a predicted] increase of 6.7% per year, we can slow that curve by getting rid of some of the waste we have in our system.

And clearly we have to do more on racial and ethnic disparities. … Just like cardiologists have to break through the barriers that heart disease is a man’s problem, physicians also need to break through the barriers that racial and ethnic disparities are solely due to a lack of health insurance. … In Texas, we are going to become a Hispanic majority state in a very short period of time. Every day I have patients in minority populations come in, and because they are not aware of certain medications or ways I’m talking about disease, they go home and they don’t take their medications or they may not have access to medications.

AMNews: Health system reform seems to be at the top of many lists. Where is the AMA in that conversation?

Dr. Rohack: Health system reform that doesn’t have the physicians as part of the solution is doomed to fail. … If physicians aren’t at the table, we’ve got 1993/1994 all over again where physicians were excluded. And when it came out, it was clearly something that was not going to be implementable or acceptable. Now as opposed to the past, the AMA is involved in coalitions with other groups — the business community, insurance community, hospital community — saying, how do we continue to evolve our system so we can meet these basic principles of affordable, quality care and choice … without stifling innovation. …

I’m excited. The first nine months of presidency are going to be crucial ones, because it appears the stars are lining up in Congress, as well as in the White House and the private sector, and businesses, patients, physicians are all saying keeping our current health sector status quo is unacceptable. …

Clearly, the [May 11] meeting at the White House with the president and the other components of the health sector highlight the AMA’s representation of America’s physicians to assure patients have affordable high quality health care. It also signaled that the private sector, when focused on a common goal, can achieve that goal when working together with the public sector as a facilitator and not a barrier. … Our pledge was to try to reduce [health care spending] to a 5.2% growth. We want to make sure that, with this whole process of quality improvement and focus on variation tools we really didn’t have 30 years ago, that we can put that into action to reduce unnecessary costs.

AMNews: Where does the discussion on Medicare payment reform stand?

Dr. Rohack: We have to fix a broken Medicare physician payment system. The danger of that is, at the time we’re talking, there’s a proposal in the Senate to not have this changed and just kick the can down the road another couple of years. That’s just fiscally irresponsible, because three years down the road, the first of the 4 million baby boomers are going to hit Medicare. We already have silos where if I, as a physician, see that patient with heart failure five times a year to keep them out of the hospital, the hospital payment actually gets the reward and the physician doesn’t get any share in saving the Medicare system as a whole. So it’s a [contradictory] message when, on the one hand, the Medicare program is saying we want to improve care, control certain chronic diseases … and oh, by the way doctor, when you do that, we’re going to cut your payment.

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AMNews: Texas has touted the successes of its 2003 tort reform measures, yet national activity seems to have quieted.

Dr. Rohack: The reason medical liability reform was successful in Texas is that people who normally would not vote that way saw the impact of [having] no doctor. … We’ve had a change in Congress, and the discussion on medical liability reform has taken a different way. [It's] a recognition that reform has to be part of the solution in controlling health care costs. But it may not be a global cap, like we have in Texas. It may be some alternative mechanism like health courts, expert witness qualifications, alternative dispute resolutions. Mechanisms that still try to provide efficiency if someone is injured, but also recognize that the current jackpot justice lottery system doesn’t really drive improvement in quality and safety.

AMNews: How have you adapted to the transition to the AMA presidency?

Dr. Rohack: This year I stopped seeing new patients, because I felt it wasn’t good for patients for me to see them once and then not see them again for a few weeks. But my nurses always have access to me, so every day I get e-mails. We are also blessed with an electronic medical record system … so if a patient has a problem and I don’t recall the fine details, I can go through our Web system. … Some patients I’ve been seeing for over 20 years, so many were concerned I was no longer going to be their physician. It reminded me very tangibly that we are put in a trusted place with our patients.

AMNews: Are there any family activities you will miss during this time?

Dr. Rohack: Elisha and Charli are very important to me. Elisha is a special child. She’s 41. She’s mentally handicapped and she is like pure love. That’s another reason in my travels … I try to be home for her because mentally handicapped kids don’t have abstract thought, so she’ll get depressed if I’m not there.

The other big thing I’m going to try to make sure I have time for is the manual labor on the ranch. I help my wife on our wildlife rehabilitation facility. And I thoroughly enjoy mowing the grass and cutting down trees … It’s fun. It’s relaxation to me. Charli has evolved her [animal rehabilitation] practice to specializing in birds of prey, hawks, vultures … so yes, you have the president-elect of the AMA transporting animals to the Texas A&M [University] College of Veterinary Medicine. Charli has been taloned more than me because obviously she deals with this all the time. The other thing is, out on the ranch, I also protect my ears when using a mower, things like that, because as a cardiologist that’s very important.

AMNews: Texas is a big football state. Any particular loyalties?

Dr. Rohack: There are five seasons in Texas: winter, spring, summer, fall and football. So I am a proud graduate of UTEP. … And as a faculty member [at Texas A&M University] I live in the community and I’m supportive of the Aggies. If A&M ever plays UTEP, I’m for UTEP. But when it comes to the rivalry games, the University of Texas in Austin is the big gorilla. … so any time A&M can beat Texas, I feel UTEP is vicariously supported.

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My Take: Well, he seems to talk a good game.  If he means what he says, he might be able to do something.  However, they have been talking about Medicare reform for years.  The government has done very little on this front so far.  I am a Medicare recipient and I know what I get and what I do not get, like dental care.

There are so many aspects of Medicare that can be confusing to anybody, including those who consider themselves experts.  Everybody on Medicare needs to learn what is connected to his or her condition.  You cannot leave it up to the doctors or the Medicare HMO.  Some doctors will actually fight for their patients’ rights and others have too many patients to do it.  The Medicare HMO is only concerned in getting their money and how much they spend, not for the patient.

Each person on Medicare needs to read their patient rights.  That is the key to getting the benefits that they allow.  However, to understand all these rights, you practically have to be a lawyer who specializes in medicine.  The government needs to make these rules and regulations in a form that is understandable by the average person and not just lawyers.

The main problem with Medicare is that most of the people on it are also on a limited income.  They cannot afford to pay extra for the things that they need such as dental care.  They cannot afford some of the co-pays that are required by Medicare or the HMO.  This means that they do not get the medical care that they want or need.  However, there are those people who are eligible for Medicare because of age and really do not need it because they have plenty of money.  There are many rich people who are on Medicare simply because they are eligible.  Maybe if these rich people, who could afford the best medical care, were not on Medicare, Medicare could afford to help those who do not have the money for the medical care they need.

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Cited: Bio-medicine.org

Two popular scents were utilized in one of the most comprehensive investigations done today on aromatherapy.  It failed to show any improvement in pain control, healing or immune response among people that were exposed to them.  These scents were lemon, which appeared to enhance people’s moods positively and the other lavender, which did not seem to affect subjects’ moods at all, at least based on three psychological tests.  Alternative practitioners use these two aromas most often.

Neither lemon nor lavender showed any enhancement of the subjects’ immune status, nor did the compounds mitigate either pain or stress, based on a host of biochemical markers.  In some cases, even distilled water showed a more positive effect than lavender.

The study, published online in the journal Psychoneuroendocrinology, looked for evidence that such aromas go beyond increasing pleasure and actually have a positive medical impact on a person’s health. While a massive commercial industry has embraced this notion in recent decades, little, if any, scientific proof has been offered supporting the products health claims.

We all know that the placebo effect can have a very strong impact on a person’s health but beyond that, we wanted to see if these aromatic essential oils actually improved human health in some measurable way, explained Janice Kiecolt-Glaser, professor of psychiatry and psychology at Ohio State University and lead author of the study.

The researchers chose lemon and lavender since they were two of the most popular scents tied to aromatherapy. Recently, two other studies focused on these same two scents.

For the study, Kiecolt-Glaser; Ronald Glaser, a professor of molecular virology, immunology and medical genetics, and William Malarkey, professor of internal medicine, assembled a group of 56 healthy volunteers. These men and women were screened beforehand to confirm their ability to detect standard odors. Some were proponents of the merits of aromatherapy while others expressed no opinion on its use.

Each person took part in three half-day sessions where they were exposed to both scents. Participants were monitored for blood pressure and heart rate during the experiments, and the researchers took regular blood samples from each volunteer.

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Researchers taped cotton balls laced with either lemon oil, lavender oil or distilled water below the volunteer’s noses for the duration of the tests.

The researchers tested volunteers ability to heal by using a standard test where tape is applied and removed repeatedly on a specific skin site. The scientists also tested volunteer’s reaction to pain by immersing their feet in 32-degree F water.

Lastly, volunteers were asked to fill out three standard psychological tests to gauge mood and stress three times during each session. They also were asked to record a two-minute reaction to the experience, which was later analyzed to gauge positive or negative emotional-word use.

The blood samples were later analyzed for changes in several distinct biochemical markers that would signal affects on both the immune and endocrine system. Levels of both Interleukin-6 and Interleukin-10 two cytokines were checked, as were stress hormones such as cortisol, norepinephrine and other catacholomines.

While lemon oil showed a clear mood enhancement, lavender oil did not, the researchers said. Neither smell had any positive impact on any of the biochemical markers for stress, pain control or wound healing.

This is probably the most comprehensive study ever done in this area, but the human body is infinitely complex, explained Malarkey. If an individual patient uses these oils and feels better, there is no way we can prove it doesn’t improve that persons health.

However, we still failed to find any quantitative indication that these oils provide any physiological effect for people in general.

The wound healing experiments measured how fast the skin could repair itself, Glaser said. Keep in mind that a lot of things have to take place for that healing process to succeed. We measured a lot of complex physiological interactions instead of just a single marker, and still we saw no positive effect, he said.

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My Take: I do not get it!  I have never heard that aromatherapy is something that helps your health other than relieving stress by helping you to relax.  I was under the impression that that is what aromatherapy was all about, relaxation.  When did they start saying that it could alleviate pain, and make you healthier?

This is like saying that leather chokers with a specific symbol will prevent headaches!  It is true that many cultures have tribal symbol pendants that they wear to prevent disaster or improve luck, but that does not mean it really works.

Now scientists are putting money into research to prove that it “does not work”?  I am sure that there is a better way to waste money!  They could easily have taken that money and put it into research on how to correct chemical imbalances in the brain that cause many of the psychological problems that people have, like schizophrenia.

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Rings with Meaning

Legend has it that the Claddagh jewelry was originated by Richard Joyce, a Galway seafarer kidnapped by pirates and sold into slavery in North Africa where he learned the art of a goldsmith.  When he was released, nothing could keep him from his beloved Galway where he returned to become a master goldsmith and where he created the Claddagh ring and other Celtic jewelry. For centuries, this was used as a wedding ring by the fisher folk of Claddagh village, which nestled outside the walls of Galway city in the west of Ireland.

Claddagh rings are still worn as friendship, engagement or wedding rings today.  It depends on how they are worn as to what their purpose is.  For friendship, it should be placed anywhere on your right hand.  As an engagement ring, it should be placed on the third finger of your left hand with the heart pointing outwards.  As a wedding ring, it typically placed on the third finger of the left hand with the heart pointing towards your own heart.

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Cited: LA Times

When Jean called the other day from Palm Springs, she stated that the state was cutting her aid and that she was worried. She was notified that California was cutting back again on the aid for the disabled. Of course, Jean is not her real name. She did not want her friends in LA to know of her living conditions. She thought she would be embarrassed if they knew and considered it to be because of her pride. She is correct in stating that nobody wants to admit that they are down and out.

She suffers from fibromyalgia, a disease of the connective tissues. Several years ago, Jean says, she was a buyer for the old Bullock’s department stores in L.A. but became afflicted with the painful ailment and finally couldn’t work anymore.

She moved to the desert. It was cheaper living and she’d be closer to her aging mother. Jean is 63, her mother 86. “Turns out she helps me more than I help her.”

On good days, Jean uses crutches. Other days, she’s in a wheelchair. “The pain never goes away.” I hadn’t talked to Jean in more than three years, since the first time she called expressing concern about the state ripping off federal cost-of-living boosts for the impoverished aged, blind and disabled. Yes, that’s legal.

She’s one of nearly 1.3 million Californians receiving federal Supplemental Security Income, augmented by a State Supplementary Program. They’ve always been an easy target — too poor to throw big bucks at political candidates. But, of course, practically anyone who draws a state buck these days is vulnerable.

Faced with what he calculates to be a potential $24-billion budget deficit in the fiscal year starting July 1, Gov. Arnold Schwarzenegger has proposed cutting state supplemental payments for the elderly and disabled down to the minimum allowed by federal law. It would be their third cut this year.

The Legislature already has approved a $20 monthly cut beginning July 1, lowering the grant for single people to $850. That’s it: No food stamps, and that includes any Social Security.

This was the cut Jean had read about. But the governor also is seeking another $20 trim starting in September, reducing the benefit to $830.

The rent for her one-bedroom condo is $850. But “I consider myself lucky,” Jean says, because after a long wait, she finally received a federal rental subsidy administered by a local housing authority.

That’s not the end of her financial woes, however. Jean has a broken tooth and badly needs a crown. But Medi-Cal, she says, will only pay for a type of crown that “dentists don’t even use anymore.” And things are about to get worse: On July 1, Medi-Cal will stop paying for adult dental care altogether.

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Around the time Jean was calling, I got an e-mail from Marta Russell, an Encino-based freelance journalist who has written widely about the disabled. Russell has had cerebral palsy from birth but made good money in the film industry, working on special effects, until she also contracted fibromyalgia and landed in a wheelchair. “I am in chronic pain,” she says.

She’s not poor enough to be on SSI but does need help at home “to empty trash, do laundry, pick up things that are heavy — to stay out of an institution.”

Schwarzenegger has proposed reducing caregiver pay under the In Home Support Services program — used by 446,000 Californians with disabilities — from a maximum of $10.10 per hour (including benefits) to $8.60. That will make it tougher to find help.

Worse for Russell, she wouldn’t be deemed sufficiently impaired under the new rules to qualify for IHSS. “I can’t imagine how I’m really going to deal with it,” she says.

“I expect suicides, premature deaths, a horrible disruption of the social fabric. . . . We’re headed toward market-based social Darwinism where only the fittest will survive.”

The governor hopes to save $402 million during the next fiscal year with his latest SSI-SSP cut. Reducing caregivers’ wages would save $124 million, and disqualifying the majority of current IHSS recipients would pocket $385 million.

Of course, Schwarzenegger’s proposed cutting goes much deeper than that. He also wants to completely eliminate the state’s main welfare program, which benefits 1.3 million people, and save $1.4 billion. And he’s trying to scuttle the Healthy Families program that provides medical insurance for 930,000 children of low-income families, netting $369 million.

“I know we all have to sacrifice something, but are the wealthy sacrificing anything?” Jean asked.

They’d say they’re paying hefty taxes.

State budget director Mike Genest was asked another version of Jean’s question by a reporter: “Why are all the poor people being cut?”

Genest: “The government doesn’t provide services to rich people. We don’t provide very many services even to the middle class. . . . You have to cut where the money is.”

That’s a little stretch. But Genest is mostly correct as it relates to the hemorrhaging general fund. Public schools serve students whose young parents are usually just starting up the economic ladder.

Of the current general fund, roughly 40% goes to K-12 schools and 32% to health and welfare. The next highest expenditures are higher education and prisons, each 11%. Everything’s getting whacked, including employees.

Jean and Russell are among many Californians who are scared after Schwarzenegger “scare tactics” after the failed budget propositions when he warned voters what would happen if the measures did not pass.

Here are some predictions:

Legislature will not allow the governor to completely wipe out welfare and children’s healthcare by targeting aged, blind and disabled. Republicans will not allow him to raise taxes and get Democrats will try to raise them with a majority vote. The $24 billion deficit includes a $4.5 billion reserve the Democrats not allow the governor to record so the deficit will be termed $20 billion. The disabled, blind and aged will suffer because of what may come to pass.

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My Take: I am always amazed at how government can reduce something that is so needed and still collect so much money themselves. For example, the governor of California is reducing the pay of caregivers that are needed by thousands of people. What about the governor taking a cut in pay? Oh, that cannot happen, he does not make enough as it is! NOT!

The government keeps talking about reducing costs to reduce a deficit and get out of the red and back into the black. Yet, they reduce things that are needed and the payee of those that cannot afford a cut in pay. I have read that many cities are cutting the pay of their police force and their fire department! That is ridiculous because they are not paid enough as it is.

I wonder, what would happen if “the government” took a cut in pay. I do not mean deducing taxes, of course that would be fantastic, I mean the senators, governors, mayors, representatives, Congressman and even the president taking a cut in pay. Everybody knows the Congress always votes a pay increase when they start their session every year. Why not make history and vote for a cut in pay instead. They could also stop using limousine services and private jets to reduce costs.

Of course, this is just too simple of an idea for them to think up, isn’t it? They would rather put the common American further in debt with less payee and less healthcare benefits. Yet, they’re trying to tell us this is not what they are doing. Think again!

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Cited: AP/MedPage Today/Los Angeles Times/Fox News

According to the Los Angeles County coroner’s office, the initial findings from the autopsy did not identify the cause of death of Michael Jackson. Craig Harvey, chief coroner investigator, said there was no final determination until additional toxicology, neuropathology and pulmonary tests could be completed in 4-6 weeks. So far, it seems that supplementary results have ruled out foul play.

But he added that the police have put a hold on the investigation, limiting what can be disclosed about additional findings until the final determination has been made. Harvey refused to comment on whether drugs may have played a role in Jackson’s death.

“We know he was taking some prescription medications,” Harvey said. “I can’t comment on any specific drugs Mr. Jackson may have had or used.”

Jackson, 50, collapsed at about noon Thursday at his rented home in the Los Angeles area and stopped breathing. Attempts to revive him there and at a local hospital were unsuccessful.

A physician was present when Jackson collapsed and led the initial resuscitation effort, according to the unidentified man who called 911 from Jackson’s home to request an ambulance. The man who called 911 said Jackson had stopped breathing and that the physician was desperately trying to apply cardiopulmonary resuscitation, without success. News reports identified the physician as Conrad Robert Murray, MD, a cardiologist with practices in Las Vegas and Houston.

According to one source of the Los Angeles County coroner, investigators were surprised to find that the pop star was actually healthy when he died. The source also revealed the Fox news that he appeared to be stronger than expected. The corner did find bruises that indicated someone had tried CPR, however there was no sign of a heart attack.

A source told the Associated Press on Friday that Jackson had suffered a heart attack. But the Fox News source said investigators believe that wasn’t the case and that drugs may have indeed played a role in stopping Jackson’s heart and/or lungs.

The Fox News source also mentioned that investigators saw significant scarring on Jackson’s face as this was the first time they saw him without makeup on. His body was being kept in its own private locked crypt at the morgue to prevent any photos from being leaked.

After hearing of Michael Jackson’s death on June 25, 2009, Janet Jackson caught a flight to LA from Atlanta. Earlier that day it is rumored that moving vans arrived with dollies and equipment, loaded and left within an hour of arrival.

Meanwhile, Michael Jackson’s family is looking into performing an independent autopsy of their own to determine what caused the death of the legendary King of Pop, Michael Jackson, according to civil rights activist Rev. Jesse Jackson.

It is undetermined what actually caused the death of Michael Jackson as the L.A. County Coroner’s office has deferred the cause and is awaiting for a number of tests which can take weeks or even a month or more. However, reports are circulating that an injection of Demerol and/or other prescription medicine may have played a part in the death of the celebrity star.

For those Michael Jackson fans who want to dress like him . . . Music was Michael’s foundation. If it were not for music bringing us together than what would it be! Music is the universal language that only a few superstars can speak. You should strive to learn, question, and break through those glass ceilings and look deeper into the meaning inspirational designs of music t shirts. Words of wisdom that have been passed down for generations. Many of these cool t shirts can be purchased online.

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At the time, Janet Jackson learned of her brother, Michael Jackson’s death, the singer and actress was in pre-production for a film her manager has stated.

As of now, the Jackson family and Michael Jackson’s three children are currently stated to be at the home he was renting in Encino neighborhood in Los Angeles, CA (Holmby Hills estate) where the Pop, R&B singer experienced cardiac arrest before his death and are talking over funeral arrangements.

A police spokesman said detectives had spoken briefly with the physician at the hospital where Jackson was taken and planned to interview him again more thoroughly. The spokesperson emphasized that the police were assisting the coroner’s investigation, not conducting a criminal inquiry at this point.

At present, police are investigating Michael Jackson’s prescription drug history and trying to talk to numerous former doctors. Joe Jackson, Jackson’s father, reportedly told ABC news that he believed that foul play was involved in his son’s death. However, on “Good Morning America” he did not elaborate on his earlier statement.

Los Angeles Police Chief William Bratton told CNN that police are waiting for the coroner’s report before ruling out any possibilities in their “comprehensive” investigation into the sudden death of the 50-year-old pop star two weeks ago. The coroner’s report will determine the cause of death and hinges on time-consuming toxicology tests.

“Based on those we’ll have an idea of what we’re dealing with,” Bratton said Thursday. “Are we dealing with homicide? Are we dealing with an accidental overdose? What are we dealing with?”

Bratton said detectives are gathering evidence, including items seized from Jackson’s rented home and arranging interviews with his many physicians, but the police chief deferred to the coroner to determine the cause of death.

“The next move really is his,” Bratton said. “We’re not marking time waiting for his report.” The Drug Enforcement Administration and the state attorney general’s office, which keeps a database of prescription drugs, are assisting investigators. An attorney for Dr. Arnold Klein, one of Jackson’s many physicians, told the Los Angeles Times that the dermatologist was subpoenaed for medical records, which he turned over to the county coroner’s office. Bratton refused to discuss details of the case.

Jackson, who died June 25, had a well-known history of using prescription medications, especially painkillers. Following his death, Cherilyn Lee, a registered nurse who had worked for Jackson, told The Associated Press she repeatedly rejected his demands for the potent anesthetic Diprivan, also known as Propofol.

Jackson had multiple doctors, friends and staff who came in and out of his life. Which people were being interviewed by police was unclear because the LAPD has said virtually nothing about the probe. Joe Jackson said he did not know anything about drugs his son was involved in.

“I don’t even know the name of them,” he said. “I do know that whatever he was taking was to make him rest because he had been working so hard.”

Police towed a doctor’s car from Jackson’s home hours after he died and said later it could contain medication or other evidence. Coroner’s officials also said Jackson was taking prescription medication but declined to elaborate.

Meanwhile, Joe Jackson told ABC that he and his wife, Katherine, should have custody of Michael’s three children. “They’ll grow up to be strong Jacksons,” he said. He told ABC that Michael’s daughter, Paris, was taking his death hard and cried every time his name was mentioned. They also mentioned that she may have a future in the entertainment business along with her younger brother, Blanket, who “can really dance”.

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My Take: I am not one of the biggest Michael Jackson fans around. However, I did enjoy much of his music as many people did. I am a diehard Elvis Presley fan. Michael’s death makes me remember Elvis and all the mystery and conflict that came with it.

I am sure that like Elvis, Michael did not have to worry about whole life insurance quotes, more than likely, he got universal life insurance quotes before you purchased his life insurance policy. Even if his estate was worth millions, this ensures that his children would be cared for financially.

It is his children that I feel sorry for, because they will not have a father as they grow up. They will miss all of those special things that kids usually do with their fathers. What really bothers me are the rumors and the reports that his family is arguing over who will raise them including their own mother. If Michael did not state in his will or would raise them, they should choose themselves.

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Michael Jackson on Halloween

Interested in decorations for your home? There are all kinds of decor, from props large and small that hang, move, light up and talk, to inflatable’s for your lawn or inside your home. You will find rats, bats, cats, snakes, spiders and webs, coffins and tombstones of every description and so much more. If you have seen an item in a store near you but it’s sold out, you may find it online and it can be on it is way to you tomorrow. This Halloween season will see a lot of Halloween party costumes from Michael Jackson’s “thriller”. There will be adult Halloween costumes everywhere for people who want to look like Michael Jackson this year.

Entertainment Staging

There is one thing for sure, if Michael had to provide his own staging equipment, he would have utilized a staging skirt and a folding bridge system for his stage. It is a functional frame that provides bridging between platforms. The frame, which is available in fixed and adjustable heights, folds flat and is also self-contained. It takes a great reputation to offer the finest in modular, lightweight, portable performance stage platforms, seating risers and accessories to customers worldwide. We portable stage platforms are the best value in the industry and is used at a portable stage deck and also an elevated platform riser. Michael definitely would have needed the Crowd Control Barricade that is the leading heavy-duty barricade manufactured to withstand the most demanding circumstances of both indoor and outdoor venues.

Cited: NWHerald.com

Doctors across the country are struggling with the economy just like everyone else. In McHenry County, private practices are struggling with a weak economy just like others across the country. Some doctors are even having problems with fewer patients coming in and many of those that have insurance. It does not help the government agencies and insurance companies can be slow with their payments and patients have a tendency to put medical bills at the bottom of the pile.

“Doctors are struggling just like everyone else,” said Dr. Gunnar Thors, a surgeon at Midwest Plastic Surgery Specialists in Algonquin.

Physicians might not be joining bread lines, but some practices are foundering. In addition to overhead costs such as leasing office space and paying staff, medical professionals also have to pay for costly malpractice insurance. Add student loans to the mix and it becomes even more difficult. Even during boom times, many doctors have to deal with delays in payments from patients and insurers, Thors said. Poor economic conditions have exacerbated such problems.

“There is always difficulty in collecting medical bills,” he said. “Not so much from patients, but from insurance companies. Increasingly, they are being more reticent in paying what they owe.” Collecting unpaid medical debts isn’t an easy task. And it puts the doctor in the middle of disputes between patients and their insurance companies.

“We try to collect what we can,” Thors said. “However, we’re put in an uncomfortable situation by the insurance companies. All of a sudden we are the bad guys for wanting to get paid.”

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A. credit card receivable financing company can help a small business owners succeed by offering a variety of small business loan financing options. It can provide small businesses with an alternative to the traditional bank financing like business cash advance, which is very difficult to obtain and out of reach for most merchants or doctors. We understand that as a small business owner, traditional bank financing may simply not be an option.

In Illinois, government payments also have been unreliable. Family Medicine Specialists – a general practitioner with 33 employees and offices in Richmond, Waukegan, Wauconda and Antioch – nearly went out of business because the state wasn’t paying its bills promptly. While waiting on more than $300,000 in outstanding payments from the Illinois Department of Healthcare and Family Services last November, several employees, including physicians, had to go without paychecks.

When medical bills are not paid, “the losers are the doctors,” Thors said. General practitioners have been especially hard hit by what Joseph Fojtik called “a very broken and dysfunctional system.” Fojtik, general internist at Mercy Clinic in Cary, spends much of his time outside the clinic researching and learning about medical policy in America. He said insurance companies have lowered the amount they reimburse doctors for performing many medical procedures. At the same time, malpractice costs have skyrocketed, he said.

Things have gotten so bad that Fojtik wasn’t surprised by a recent survey he saw on the American College of Physicians Web site that showed 2 percent of freshman medical students wanted to go into general internal practice. The rest want to become specialists.

The average overhead costs for an office visit is about $40 for each patient, Fojtik said, pointing out that public aid such as Medicaid would only reimburse doctors about $25 for each visit. That means some doctors are losing money each time they see a public aid patient, Fojtik said.

It is difficult to determine how much business doctors have lost and how much uncollected debts have increased. Several doctors interviewed for this article declined to give specific information regarding their business finances.

Pediatric Associates, which has offices in Crystal Lake and Barrington, tries to help its patients pay bills via payment plans and other options, Dr. Johnathan Kaufman said.

“With the economy, we are understanding and we take a proactive approach,” he said.

That often means working with insurance companies and making sure that patients are pre-qualified before their visit. Kaufman said he also tries to avoid going to collections, which can damage a person’s credit.

“We don’t want to go to collections; it’s not good for anyone,” he said.

Kaufman described pediatric care as a “volume business” with an emphasis on quality care. He said it has become more difficult for many families to afford vaccines and routine check-ups, which are not always covered by insurance. Some private practices, like other small businesses, cannot stay in business without prompt payments.

“We’re a shoe-string operation,” Thors said. “And these are hard times.”

Thors stated that he would continue to help women with breast cancer to get needed breast reconstructive surgery despite any difficulties he may be having. “We’re willing to write that off as a service to the community,” he said. “Many of these women have been through so much. It’s sad and it’s scary, so we do what we can to help.”

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My Take: Well, maybe if doctors did not buy brand name office furniture for their offices, they would have more money. Have you seen some of the furniture a doctor has in his/her office? Leather bound chairs, mahogany desks, fancy statuettes and all those leather bound medical books. Of course, a medical office does need office supplies to carry out the business.

However, the doctor in this article seems like someone who would actually be concerned about their patients. And I know at least one other doctor that is concerned about her patients, my doctor! Today, there are not that many doctors who are actually concerned about their patients’ personal well-being and not just their health. If you can find a doctor like that, do not change to a different doctor!

One thing doctors might consider usually is real estate notes to increase the money they have on hand. If they had some, they could sell cash flow notes to keep their practice or facility afloat. This would help alleviate the problem of waiting for payments from insurance companies or government agencies.

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Cited: Advance Magazine

In response to Pres. Obama’s provisions and mandate for EHR adaption under the recent HITECH Act, the transcription sector took a message to Capitol Hill on June 3-4. With Pres. Obama pushing for definition and criteria are for “meaningful use” by July, the Medical Transcription Industry Association (MTIA) and the Association of Health Care Documentation Integrity (AHDI) believe that the window is narrowing for the opportunity for that sector to ensure the criteria includes provisions for the evolution of transcription in hybrid capture. There is complex narrative is that need to be preserved and quality outcomes, not just fiscal savings, that drive adoption and integration of systems. The determination of “meaningful use” lies in a hands of the Department Of Health and Human Services (HHS) and each IT vendors are getting ready for those key decision-makers to make up their mind. That message to the legislators was that the HHS needs others involved in that decision-making who are interested in tearing it more towards the technologies that will be deployed and not whether they will be deployed.

Defining “meaningful use” is not the role of HIT but rather of clinicians and experts in health care documentation who can speak to the document workflow process and the complexities of capturing health stories in a way that informs clinical decision-making and promotes coordination of care. If the “meaningful use” definition is shaped only by the vendor community, there is great risk for EHR deployment to fall short of health care’s goals for capturing and consuming health information. All stakeholders, most importantly the patient, lose under such an imprudent integration approach.

More than 120 legislative appointments were held during the 2-day summit through collaborative dialogue from both MTIA business owners and AHDI health care documentation workers who met together with Senate and House members to share the importance of our quality-focused sector in accurately capturing patient health stories. We visited with legislators from 26 states and delivered letters from AHDI members to their respective legislators for 28 states. Each person had an opportunity to share the key talking points and messages prepared for the event, as well as to engage in dialogue with legislators and their aides about the role transcription can and does play in accurate capture. Likewise, we stressed the need to preserve complex narrative in the EHR so that the important nuances of a patient’s story are captured outside of restrictive point-and-click templates. Consideration must be given, as well, to the impact on clinicians who are inefficiently deployed to capture health care encounters rather than engaging in provision of care. And we talked about the value of a knowledge worker positioned in partnership with physicians to ensure the accurate, secure capture and repurposing of health information.

A lobbying firm will be hired by MTIA and AHDI that will help push this message to the right people on the HELP committee (Health, Education, Labor and Pensions) in HHS. These people are the ones who are responsible for the “meaningful use” definition. The lobbying firm will also help get the message and recommendations to David Blumenthal, the National Coordinator for Health IT, to make sure that transcriptionists are not left out of the EHR integration regulations, recommendations and standards. The opportunity to contribute to and participate in this advocacy effort is what both medical transcription service organizations (MTSOs) and MTs are looking for.

You can find out more about the AHDI/MTIA Advocacy Summit by visiting the Summit Web page at www.ahdionline.org. You can just click on “Networking” and “Events.”

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My Take: As a former medical transcriptionist, I think this is great. I only call myself a former Transcriptionist because too many MTSOs have gone out of business because of “outsourcing”. Thus, I am now writing needs comments to you about the above article.

Then as now, I do not have to worry about time and attendance because I work from home at my own speed and when I want. I also never had to worry about making sure that my time got into an online payroll service so that I could be paid because it was all calculated by me in an invoice. To clarify, I was a subcontractor as I am now.

MTs are paid a very good rate. That does not mean that they are able to get a maid VA to do their housework. That does not mean that some of the better ones cannot avail themselves of professional cleaning services Fairfax. The faster you work and the fewer errors you have determine what pay rate you get per line and whether you can afford VA cleaning.

I think that having both the MTSO’s and MTs involved in the decision-making is a good thing. I equate this with having a firefighter involved in purchasing protective gear that he uses to fight fires. It makes sense for everybody to get a fair break with EHRs.

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I do not mean role-playing games, I mean casinos online. Like medical transcription, this is something you can do from the comfort of your home. You can even play online poker from your home. There are many online casino gaming sites that actually offer you bonuses for signing up. Those bonuses are the equivalent of dollars. If you are any good at gambling, it might be something to look into.