11 Temmuz 2012 Çarşamba
Social Security is the Most Common Source of Income for Older Black Women
10 Temmuz 2012 Salı
9 Temmuz 2012 Pazartesi
Blind & Vision Rehabilitation Services Offers Evening Hours
Starting in October, Blind & Vision Rehabilitation Services of Pittsburgh’s low vision program will have evening appointments available on Tuesdays at our Homestead office, 1800 West Street. For more information or to schedule an appointment, call 412-368-4400.
BVRS’s low vision program provides services to people who have some usable vision. Our specially trained optometrist performs an exam to determine the person’s level of vision, and then prescribes optical aids designed to maximize remaining eyesight. The new hours are Monday, Wednesday and Thursday from 8:00 a.m. to 4:30 p.m.; Tuesday 8:00 a.m. to 7:30 p.m., and Friday 8:00 a.m. to 1:00 p.m.
MORE ABOUT BVRS
Blind & Vision Rehabilitation Services of Pittsburgh, a 101-year-old private nonprofit, has been a leader in programs and services for people of all ages who are blind, vision impaired or have other disabilities. We believe in independence through rehabilitation. Our mission is to change the lives of persons with vision loss and other disabilities by fostering independence and individual choice.
We offer comprehensive and personalized computer instruction, employment and vocational services, personal adjustment to blindness and deaf blindness training, independence skill building, in-home instruction, and low vision services for persons with vision loss. BVRS is a United Way Agency of Excellence in Health and Human Services formerly known as Pittsburgh Vision Services of Oakland and Bridgeville, and is accredited by The National Accreditation Council for Agencies Serving People with Blindness or Vision Impairments (NAC).
Contact:
Debra Meyer
dmeyer@PghVis.org
412-368-4400, ext. 2287
Diabetes Expo on November 5, 2011
Visitors to the Expo can choose to follow a "Pathway For Better Health" at the event. Choose what pertains to you: prevention/pre-diabetes, type I, or type II diabetes. Each Pathway has specific workshops and topics related to healthy eating, active living, and motivation, among other things!
This event is located at the David L. Lawrence Convention Center on November 5, 2011. Contact Terri Seidman at 412.824.1181 ext. 406 or tseidman(at)diabetes.org for more information.
Book Websites
If you love to keep up with new books, or if you follow a series by an author, these websites are great tools to help you stay current and informed! Maybe you will be inspired to read something new, or share your new finds with a book club!
GO DIRECT
With electronic payments you can count on your money despite severe weather
Source: U.S. Department of the Treasury, Financial Management Service
If you get federal benefit payments by paper checks, you should know that you are required by the U.S. Department of the Treasury to switch to an electronic payment method. By getting your money electronically, you will help save taxpayers millions of dollars each year. You must make the switch by March 1, 2013, but you don’t have to wait for the deadline. The winter months are the perfect time to switch and take advantage of the reliability and ease of electronic payments.
Ice, snow and subzero temperatures can leave you trapped in your home and temporarily interrupt important services like mail delivery. If you rely on paper checks for your federal benefit payments, a winter storm can leave you without access to your money at a time when you need it most.
Last winter was a record-setter for many parts of the Northeast. Accuweather.com predicts above normal winter precipitation for most of the Northeast during January and February 2012.It’s important to take action now to protect your money before a winter storm hits.
Winterize Your Money Today
Switching to electronic payments is a simple step you can take to ensure your money gets to you on time, every time. With electronic payments, your money won’t be slowed down by winter weather and you won’t need to leave your home to cash or deposit a check. The Treasury Department recommends two electronic payment options:
- Have a bank or credit union account? Sign up to get your money by direct deposit to a checking or savings account. Your federal benefit payment will go straight into your account on payment day each month. On time, every time.
- Prefer a prepaid debit card? Switch to the Direct Express® Debit MasterCard® card. You money will be posted to the card account on payment day each month. You can make purchases and get cash back with purchases at no charge anywhere Debit MasterCard® is accepted. There are no sign-up fees, overdraft fees or monthly fees. Some fees for optional services may apply. For information on card fees and features, visit www.GoDirect.org. No bank account or credit check is needed.
Switching is Fast, Easy and Free
To switch to direct deposit or the Direct Express® card, contact your federal benefit agency office, visit the Treasury Department’s Go Direct® campaign website at www.GoDirect.org, or call the U.S. Treasury Electronic Payment Solution Center at (800) 333-1795. For direct deposit to a checking or savings account, you can also make the switch at your local bank or credit union.
Winterize your federal benefit payments now before a winter storm gets between you and your money. Switch to direct deposit or the Direct Express® card today. For more information, including an instructional video on how to sign up, visit www.GoDirect.org.
Social Security Administration Updates
8 Temmuz 2012 Pazar
GOP Obamacare Lies: The Affordable Care Is Not the ‘Largest Tax Increase in the History of the World’ – Not Hardly #p2 #tcot @gop
The silver lining in the Supreme Court's upholding of the Affordable Care Act for Republicans was the court's ruling that the fine to be paid by people who can afford it but choose not to buy insurance was a "tax" not a "penalty."
And what we have there is a big, fat lie:
But when you compare the projected revenue effect of the individual mandate to the actual revenue effects of other, actually large tax increases, the claim becomes laughable.
We used the Treasury Department's four-year data on the revenue effects of large tax increases signed by Ronald Reagan, George H.W. Bush and Bill Clinton; along with CBO projections of the revenue effect of the mandate adjusted for its GDP projections during the mandate's first four years.
The mandate is tiny by comparison.
And, from Kevin Drum:
This is so stupid it hurts…
rest at
http://www.pensitoreview.com/2012/07/05/gop-obamacare-lies-the-affordable-care-is-not-the-largest-tax-increase-in-the-history-of-the-world-not-hardly/
Obama campaign: Tax vs. penalty argument shows Romney can't take a position and stick with it #p2 #tcot
David Axelrod on Twitter yesterday, talking about Mitt Romney's latest flip-flop over whether the individual mandate is a tax or a penalty administered through the tax code:
Mitt: Fed freerider penalty is "tax," identical MA law is not.If he were in WH, parsley would be official veg: Twister, national pasttime.
— @davidaxelrod via Twitter for iPhone And Deputy Campaign Manager Stephanie Cutter to Chuck Todd on MSNBC:
The difference the Obama administration and Mitt Romney is that we've been consistent. This is a penalty administered through the tax code.In other words, the issue here doesn't really have anything to do with the substantive merits of Obamacare: it's that while President Obama has consistently said one thing, Mitt Romney has been twisting in the wind.
More from Cutter:
At the end of the day, it doesn't matter what we're calling this. We've been consistent about what it is. ... Contrast that with Mitt Romney. ... Mitt Romney could call it a tax, he could call it a penalty. We don't particularly care. We just hope he chooses one and sticks to it.And why is that important?
Look at what's happened over the past five days. His spokesperson calls it a penalty. A couple of days later, the right wing of his party rises up and criticizes him. He's suddenly calling it a tax. So that's what this debate is all about: whether Mitt Romney can take a principled position and stick with it. That's the question.As David Axelrod put it this morning:
If Tea Party and Cong Rs can pull Mitt's chain, and get him to do a 180 on the mandate he championed, imagine what they'd do with him in WH!— @davidaxelrod via Twitter for iPhone So it's clear that the Obama campaign doesn't see this debate as being about health care policy (which is good because the tax vs. penalty debate has nothing to do with the benefits of Obamacare). Instead, they see it as yet another indictment of Mitt Romney's lack of backbone because while they've been consistent about how they view it, Romney has been shifting all over the place. And it's not just that he's been shifting all over the place, it's that Romney's doing it for obviously political reasons, not the least of which is his need to satisfy his party's right-wing base.
rest at http://www.dailykos.com/story/2012/07/05/1106406/-Obama-campaign-Tax-vs-penalty-argument-shows-Romney-can-t-take-a-position-and-stick-with-it?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+dailykos%2Findex+%28Daily+Kos%29&utm_content=Google+Reader
.@RepJoeWalsh Today In "Rep. Joe Walsh Says Stupid Things:" Double Amputee Veteran Duckworth Talks Too Much About Her Military Service #p2 #tcot
Illinois Eighth District Rep. Joe Walsh set off another round of verbal fireworks around the Independence Day Holiday when he suggested his Democratic opponent Tammy Duckworth campaigns too much on her military service.
Walsh was recorded at yet another town hall meeting getting a good taste of his foot when he comparedDuckworth's mentions of her military service to Arizona Sen. John McCain's during his 2008 presidential campaign.
Understand something about John McCain. His political advisers, day after day, had to take him and almost throw him against a wall and hit him against the head and say, "Senator, you have to let people know you served! You have to talk about what you did!" He didn't want to do it, wouldn't do it. Day after day they had to convince him. Finally, he talked a little bit about it, but it was very uncomfortable for him. That's what's so noble about our heroes. Now I'm running against a woman who, my God, that's all she talks about. Our true heroes, it's the last thing in the world they talk about. That's why we're so indebted and in awe of what they've done.
rest at http://chicagoist.com/2012/07/05/today_in_joe_walsh_says_stupid_thin_1.php
Look, up in the Sky! It's a Tax! It's a Penalty! It's a Stupid Argument over Semantics! #p2 #tcot
Since not much campaign news happens over the July Fourth holiday, Mitt Romney took the opportunity tochange his campaign's tune on whether the penalty in the Affordable Care Act for those who can afford health insurance but refuse to get it is a "tax."
To review, the Supreme Court said that the government has the authority under its taxing power to penalize those who refuse to get insurance, leading Republicans to cry, "Tax! Tax! Tax!" with all of their usual policy nuance and rhetorical subtlety. The only problem this poses for Romney is that calling it a tax means that Romney imposed a tax with his health-care plan in Massachusetts, which means admitting that Romney sinned against the tax gods. First his spokesman came out and said that no, it's really just a penalty, but then Romney came out and said, well, if the Supreme Court said it's a tax, then it's a tax, but it wasn't a tax when I did it, because the Supreme Court didn't call it that.
What does all this arguing over semantics tell us? It tells us that the press and public are both complicit in creating the hurricane of stupidity into which all presidential campaigns devolve.
As for the press, they could treat this as the inconsequential semantic quibble it is. The fact is it doesn't matter whether you call it a "tax," a "penalty," a "freedom fee," or a "Lenin levy." It's the same thing. For the record,according to the Urban Institute, only 2 percent of Americans will be subject to the tax/penalty. The whole idea is that most of them will be motivated by the tax/penalty to get health insurance, so the whole idea of the tax/penalty is that almost no one will end up paying it.
But the press has treated the question of what Mitt Romney will call the fee as though it matters. Because of some weird nostalgia, I get the dead-tree editions of both The New York Times and The Washington Post, and when I went outside into the 150-degree heat to get my papers this morning (note to self: get time machine, go back and convince George Washington to put the nation's capital in someplace cold and rainy like Seattle), I found that both front pages had stories about this virtually meaningless issue.
rest at http://prospect.org/article/look-sky-its-tax-its-penalty-its-stupid-argument-over-semantics
Romney's "Rich Man" Problem Just Got Worse #p2 #tcot
For the Fourth of July, the Obama campaign released a new Web video, highlighting a recent Vanity Fair look at Mitt Romney's tax shelters and offshore accounts. It's brutal:
The key line: "I've never heard of a president having an overseas bank account." This is a Web video, so it has limited circulation, but these interviews—and others, I'm sure—will certainly make it into swing-state and other general-election advertising. Moreover, they will play well with the Obama campaign's attempt to hinder Mitt Romney by defining him as an out-of-touch plutocrat.
rest at http://prospect.org/article/romneys-rich-man-problem-just-got-worse
7 Temmuz 2012 Cumartesi
Look, up in the Sky! It's a Tax! It's a Penalty! It's a Stupid Argument over Semantics! #p2 #tcot
Since not much campaign news happens over the July Fourth holiday, Mitt Romney took the opportunity tochange his campaign's tune on whether the penalty in the Affordable Care Act for those who can afford health insurance but refuse to get it is a "tax."
To review, the Supreme Court said that the government has the authority under its taxing power to penalize those who refuse to get insurance, leading Republicans to cry, "Tax! Tax! Tax!" with all of their usual policy nuance and rhetorical subtlety. The only problem this poses for Romney is that calling it a tax means that Romney imposed a tax with his health-care plan in Massachusetts, which means admitting that Romney sinned against the tax gods. First his spokesman came out and said that no, it's really just a penalty, but then Romney came out and said, well, if the Supreme Court said it's a tax, then it's a tax, but it wasn't a tax when I did it, because the Supreme Court didn't call it that.
What does all this arguing over semantics tell us? It tells us that the press and public are both complicit in creating the hurricane of stupidity into which all presidential campaigns devolve.
As for the press, they could treat this as the inconsequential semantic quibble it is. The fact is it doesn't matter whether you call it a "tax," a "penalty," a "freedom fee," or a "Lenin levy." It's the same thing. For the record,according to the Urban Institute, only 2 percent of Americans will be subject to the tax/penalty. The whole idea is that most of them will be motivated by the tax/penalty to get health insurance, so the whole idea of the tax/penalty is that almost no one will end up paying it.
But the press has treated the question of what Mitt Romney will call the fee as though it matters. Because of some weird nostalgia, I get the dead-tree editions of both The New York Times and The Washington Post, and when I went outside into the 150-degree heat to get my papers this morning (note to self: get time machine, go back and convince George Washington to put the nation's capital in someplace cold and rainy like Seattle), I found that both front pages had stories about this virtually meaningless issue.
rest at http://prospect.org/article/look-sky-its-tax-its-penalty-its-stupid-argument-over-semantics
Romney's "Rich Man" Problem Just Got Worse #p2 #tcot
For the Fourth of July, the Obama campaign released a new Web video, highlighting a recent Vanity Fair look at Mitt Romney's tax shelters and offshore accounts. It's brutal:
The key line: "I've never heard of a president having an overseas bank account." This is a Web video, so it has limited circulation, but these interviews—and others, I'm sure—will certainly make it into swing-state and other general-election advertising. Moreover, they will play well with the Obama campaign's attempt to hinder Mitt Romney by defining him as an out-of-touch plutocrat.
rest at http://prospect.org/article/romneys-rich-man-problem-just-got-worse
.@gop House Republicans Reject Food Stamp Compromise In Favor Of Reform They Admit Is ‘Out Of Date’
House Agriculture Committee Chairman Frank Lucas (R-OK), in an effort to push food stamp reform that would have a fighting chance in the Senate, made sizable changes to SNAP in the House version of the farm bill. Lucas' draft reins in state eligibility requirements by ending what is known as "categorical eligibility" for all non-cash-assistance food programs. The Lucas version of the bill would save billions but kick nearly two million people out of the program, following the footsteps of Republican efforts over the last two years. But that isn't enough for his fellow Republicans, who want to make deeper, "symbolic" cuts that have no chance of passing the Senate, Politico reports:
Yet for all this, according to persons familiar with the negotiations, Lucas ran into a buzz saw at recent member meetings with committee Republicans. His compromise was rejected in favor of the symbolism of ending categorical eligibility outright — without risking any adjustments.
The upshot is that the committee's draft bill will go back to the prior House position of ending cat-el in all cases but cash assistance. This will save $11.5 billion but could drive at least 1.8 million people off the rolls and has twice been rejected by the Senate. [...]
The biggest impact of ending categorical eligibility is the reinstatement of the $2,000 asset test requiring families to spend down their savings before qualifying for help.
rest at
http://thinkprogress.org/economy/2012/07/05/511172/house-republicans-food-stamp-deal/
.@RepJoeWalsh Rep. Joe Walsh: All Tammy Duckworth Does Is Talk About Her Service#p2 #tcot
Rep. Joe Walsh (R-IL) backed off his claim that his opponent, Tammy Duckworth, a double amputee who lost both her legs in Iraq when insurgents hit her helicopter with an RPG, is not a "true hero," in an interview with CNN's Wolf Blitzer yesterday. Walsh continued his attacks on Duckworth, complaining that "all she does is talk about her service." Veterans "don't throw [their service] in your face," said Walsh. Watch the interview:
rest at http://thinkprogress.org/security/2012/07/05/511193/rep-joe-walsh-all-tammy-duckworth-does-is-talk-about-her-service/
TSA continues to harass passengers with medical conditions
the TSA, despite its claims in public and on its website, routinely harasses passengers who have medical conditions and/or who are carrying prescription medicines.
In yet another story, a woman was traveling with her husband and children this week and had called ahead to both the airlines and the TSA to double-check the regulations governing travel with liquid medication, syringes, and the cooler in which they must be stored. She was told no problem.
But when she got to the checkpoint, surprise, surprise, there was a problem. As she had been instructed by the TSA over the phone before she left, she told the screeners at the checkpoint what she was carrying and requested that the medication not go through the x-ray machine. They told her to send it through.
rest at http://tsanewsblog.com/3826/news/tsa-continues-to-harass-passengers-with-medical-conditions/
5 Temmuz 2012 Perşembe
LifeSaver/Ttest Products–Rapid Saliva Based Testing for HIV, Drugs, Alcohol and More–2 Seconds to Administer and 2 Minutes for Results
By now you have probably read the news about the HIV test
approved by the FDA and in case you missed it, you can read about it here. The OraQuick Home-Use HIV stick now has the approval of the FDA. It has been used in clinics for a while now and comes with some precise instructions on how to use the test. Technology doesn’t stop for a minute today and it seems as soon as a product is released that it’s not very long before a new product is around the corner and this is the story with LifeSaver Ttest Products. It’s great that the FDA is giving consumers an opportunity to test for the virus in the privacy of their own home.
In addition to HIV testing Ttest also has the same simple process available for drug and alcohol testing. Being that the FDA approved the HIV test I’m going to focus on this process first. If you have read any of the many announcements in the news today, then you can see there is a process to go through to ensure the test is
done properly, swabbing for 2 minutes is the first item that you need to be sure to read, as otherwise the accuracy of the test could be compromised. In addition, there’s a bit of a waiting time for the results.
In addition to home testing, CDC (Center for Disease Control and Prevention) is also bringing the test to pharmacies and the program was announced last week to where pharmacists and retail store clinics to 24 sites. Counseling will be a big part of their training to guide consumers on where to go if they have a positive test and to discuss with their doctor. This is a pilot program to develop a tool kit for the clinics and pharmacies to implement testing at their locations.
Now that you have read the above and probably much of the other media that is out there about the FDA approved test, don’t you wish the
test could possibly be a little simpler in nature? This is where Ttest comes in. Instead of swabbing for 2 minutes, a 2 second swipe for saliva on the tongue would be enough, so no worries about the amount of time to ensure you have enough saliva collected for the test. The Ttest website announced the creation of this simple technology last year. An image of the Stik below shows either a plus or a minus sign when the test has completed. If nothing appears, you could grab another stick and test again. This would show the test had been compromised but somewhat unlikely with normal handling procedures.
“Due to the protective properties of the patented packaging system and the proprietary formulation used by Ttest, antibody and enzyme-based tests can be protected in environments that may otherwise prove destructive to them. Ttest’s product stability and shelf life allow for accurate diagnostic tests in most places where onsite testing is done such as in clinics, the workplace, public areas, law enforcement situations and at home. “
Here’s a comparison of the two HIV testing products and you can make your own determination on which one might be easier to use. As you can see the Stik product is very simple and easy to use and it’s easy to get the results without accidentally compromising the test. All compounds used in the production of the product are already FDA approved.
Stik Test for HIV
“Much of the development has been completed and Ttest’s HIV Stik is scientifically proven to work in a lab setting. Additional lab work and clinical trials will be completed upon funding and a Fast-Track application will immediately be submitted for FDA approval.”
So now we can move on a bit and talk about a couple other 
neat things about the product. As you can see there’s no liquid involved in the testing material, which means a longer shelf life, and the Stiks can withstand some pretty warm conditions with no special storage or handling required. The cost for each test is estimated to be around $12 retail for each Stik which is certainly very affordable. When you stop and think, a simple test as such could be distributed world wide and again make it simple and easy for all concerned whether it’s a clinic or an individual taking their own test. Let’s take a look at what the Stik technology could do for the Red Cross. You may or may not be aware that the FDA has inspected and fined the Red Cross here in the US for compliance failure and right now as I read recently, there’s a shortage of blood in supply. This was in January of this year and instead of a fine would it not be better to have the situation corrected?
FDA Fines Red Cross Again for $9.59 Million–Where Does That Money Go?
The document below shows a perspective on how Stiks could help the Red Cross and expedite screening potential donors.
LifeSaver & Stik Products Can Help the Red Cross
Alcohol and Drug Testing:
Now let’s move on to another topic with LifeSaver Stik 
products, drug and alcohol testing. This is also an exciting area of development. How often have you wondered after enjoying alcohol if you are safe to drive. LifeSaver has a simple solution for that as well and it’s the same process as above, lick the Stik and wait two minutes. If one is over the legal limit of .08 a plus sign will show and if below, the minus sign will show. Just this simple test can give you a quick answer and would it be nice if restaurants, pubs, etc. made these available?
“The Alcohol Stik can be made with any alcohol cut-off value between 0.02% and 0.30% or with a simple Pass or Fail to meet various market needs. Clinical trials have been completed and Ttest has received certification from Norton Medical Industries that the Alcohol Stik meets or exceeds DOT, FAA and FDA requirements. Upon funding, a 510(k) application will immediately be submitted for FDA approval.”
What is My Blood Alcohol Content - Stik Testing
Now let’s talk about drug testing and if you are like me and have worked for any large or even a smaller company you have probably had to go for a drug test. In my former life I worked in logistics and we had random tests from time to time for everyone at the facility so that routine has been around for a while and the trips to a lab are not a lot of fun, so what if this process were made easier. Let’s talk about pre-employment, take your drug test at the interview/offer process perhaps? A total of 7 tests can be loaded on one stick.
“Ttest’s Drug Stik provides a scientifically reliable indicator of the presence of drug metabolites and alcohol in the test subject in seconds, simply by wiping the indicator stick across the tongue. A minus sign (-) 
indicates the subject is negative and a plus sign (+) positive for each of the targeted drugs and alcohol. The Drug Stik tests for DOT and FAA mandated drug screening also known as NIDA-5, which include: phencyclidine (PCP); opiate metabolites (heroin, morphine and other similar drugs); marijuana and marijuana metabolites (THC); cocaine and cocaine metabolites; amphetamines (including methamphetamine) and alcohol. Much of the development has been completed and Ttest’s Drug Stik is scientifically proven to work in a lab setting. Clinical trials will be completed upon funding and a 510(k) application will immediately be submitted for FDA approval.”
Again with all the news today about HIV testing, it seems as if this was a good time to talk about LifeSaver Products and all the possibilities at hand.
If you would like to see some additional information, please check out the Ttest website or you can email me for a link where a business plan and projections are further explained. This looks to be the next step in providing simple and inexpensive testing services that could have a big impact worldwide.
Disclaimer: I provide consulting services to LifeSaver/Ttest products.
California Doctors Sue Aetna For Routinely Denying Out of Network Patient Access–Grading on the Curve Algorithms Versus Individual Patient Assessments?
This lawsuit should be interesting indeed as I’m sure there’s a little of both sides in here, relative to Aetna claiming over charging at surgical centers and then again there are those situations to where the Out of Network charges were in line but didn’t meet the Aetna Algorithms for quality and cost control. I think the over billing by facilities by facilities owned by doctors exists but in reality is probably a small portion of this entire case. 
Like everything there are those out there that find loopholes and milk it. Aetna is probably correct on a case by case basis on some of the billing that takes place with way beyond normal customary fees but again you can’t use this as a “whole” perception when you look at all of it. I read one example here about a kidney stone fragmentation questioned to where Aetna claims $7,612 should have been the appropriate charge and they were billed $73,536 and there’s certainly enough in between those two numbers to question.
It’s also again a case by case situation as we don’t have more information than the numbers quoted so what else was in the bill I think anyone would ask, were there complications, etc.? Obviously Aetna has some pressure here with first quarter results and answering to shareholders.
Aetna First Quarter Results for 2012 Down 13% As Medical Claims Rise And Retail Marketing Efforts Continue With More Algorithm and Extensive Parameters Set for Qualification and Risk Assessments
The link above is actually pretty interesting as there are a couple other links that describe some strange events. This one in particular is kind of odd…with patients being told their doctor is no longer in network, but yet was a mistake? Yup we come right back around to accounting and business intelligence algorithms here setting the stage. Aetna States Letters Mailed to Thousands of California Customers Were A Mistake–Their Doctors Are Still In Network–”Rogue Algorithms and Flawed Data”–Attack of the Killer Algorithms Chapter 25
I think they are having a hard time with some of this and granted there are some way out of whack charges that they should contest but when running analytics in some areas on percentage points, I think this
is where we get down to some tit for tat issues. Doctors are graded in the Aetna system just like all other do and an MD maybe staying right within the suggested areas until it happens, one very sick patient who needs care outside of what the in network specialists can provide. That patient gets referred to a “specialist’s specialist” and none of those folks are on the “approved in network” lists anywhere for the most part. The patient goes and receives treatment and the big bill comes back and analytically even though it was approved, the “out of network” algorithm catches it, just looking at the amount of the bill.
In yet another area an analyst might see this and “flag” the doctor for going outside of the normal and customary charges without perhaps looking at the entire case, numbers “say”. So you do have this situation that arises and one sick patient skews the numbers the insurer states he/she should stay within.
I understand trying to keep costs in control and it’s not easy, but it requires skills that go beyond “grading on a curve” if you will and this just goes to further explain the needs for each case to be investigated on it’s own. This is a throw back to the HMOs when they first started here in California years ago.
In Texas several doctors were removed from contract by Aetna and again it may have caught some over billing but how many were caught in the “one sick patient” scenario that created the situation for them to fall out of favor relative to cost control? Furthermore if the referral was initially approved and debated later, do we go back and look at what substantiated the referral in the first place?
Aetna Notifies 130 Texas Doctors That It Will Terminate Their Contracts on July 1 – E & M Codes Primary Levels 4 and 5 Billing Analytics For Peer Comparison Used To Substantiate the Decision – Video
One other item worth a mention too is that insurers are branching into other types of businesses as well, like Health IT with purchasing subsidiary companies. Here’s an example below of one of Aetna’s companies below that provides services to connect electronic records.
Aetna to Acquire Medicity-Health IT Connectivity Vendor-Former CEO Takes Position on Board at Boeing
In August of this year folks in Colorado will no longer
be able to purchase Individual Health insurance policies, so I am guessing they ran out of ideas and algorithms to keep this area profitable, but they will still continue to work with employer provided insurance plans.
Aetna pulls Out of Individual Health Insurance Policies in Colorado as of August of 2012-Risk and Profit Algorithms At Work
With the complex medical billing system we have today this is probably not something that will go away any time soon as on the other side there are consultants who help the folks submitting claims to maximize their income so we have the battle of the algorithms for profit and cost duking it out once again. One doctor in New Jersey was so upset that he made a video about it and again I am assuming he might be one of those caught up in the “grading on the curve algorithm”, but again this shows how each case should be treated as it’s own to get to the bottom of why the doctor slipped out of grace with the insurer. BD
Aetna and the Doctor
(Reuters) - Thousands of doctors in California are suing the health insurance company Aetna Inc claiming the company routinely denies patients access to out-of-network doctors even when the patient has purchased a policy giving them the right to choose providers.
The lawsuit, filed in the Los Angeles County Superior Court, accuses Aetna of threatening patients with denial of coverage if their members visit doctors outside the Aetna network of providers, and of threatening doctors with having their Aetna contracts terminated if they refer patients outside the network.
http://in.reuters.com/article/2012/07/03/us-aetna-lawsuit-idINBRE86214F20120703?feedType=RSS&feedName=health&utm_source=dlvr.it&utm_medium=twitter&dlvrit=309303
Bill Gates With Charlie Rose Talks India, China, Tablets, Microsoft And How US Politics Slow Down Innovation -The Philanthropist
Here’s a clip from YouTube that is a small portion of the interview. It’s worth your while to go over and listen to the full interview when you can.
He talks quite a bit about India and China relative to technology
and his opinion of where each excels etc. Sometime he says in the next 10 years we will be able to cut the existence of malaria. He also discusses HIV and how to attack the disease and what has been done thus far and says it will be a while before we really can reduce the numbers. Bill Gates was always a science fan and with his work with the Foundation he’s been able to expand his learning.
He talks a bit about software and it has evolved and gets around to talking tablets and pcs. Funny when he talks about Apple and Steve Jobs and admits they did something better than he did. He also says Microsoft has something with Surface that could change the rules again with fusing the pc and tablet worlds. He says competition among software companies is a positive thing and states he’s not starving, so Apple, Google Microsoft and others competing is good. Bill Gates still does get to suggest new project that Microsoft works on, but he would never go back full time.
On Facebook, he says “Steve bought” and does see it as having importance. In the end he says it’s all about the applications. Again a very good interview and the first half is more about the Foundation and the second half deal with his thoughts and comments on technology. He calls drugs and vaccines that are created but that are too expensive for people to afford a failure in referring to “markets”. Philanthropy is still very necessary.
Gates says there’s a real contrast between politics and science and he hopes it changes as that’s all that is generally is seen he says in the news and so forth and steels the focus. Politics slow down innovation he states. He hopes that some middle ground is found in politics and talks about the same disappointments that we all have. He should know as for many years he testified about better education in Congress and has faced many deaf ears. BD
Bill Gates–Charlie Rose
http://www.youtube.com/watch?v=HotLyazUiWw&list=UUwBUwaTxztTPuSzIi2cjimw&index=1&feature=plcp
India’s Public Doctors Will Soon Be Able to Prescribe “Free” Generic Drugs–Up To Half of the Population To Benefit–Big Pharma Could Be Seeing Less Business In the Future With Brand Names
Just a few months ago India announced they were authorizing 
a local drug company to make a generic copy of a cancer drug made by Bayer. This opened a lot of eyes and Roche for one looked into their pricing on cancer drugs and is reducing prices on some of their drugs too. It appears the move is on to make drugs affordable.
India Authorizes Local Drug Manufacturer to Make and Sell Generic Copy of Patented Bayer Cancer Drug To Make It Affordable
Part of the response has been with big pharma buying generic drug companies. The new policy is slated to begin before the end of this year. This certainly is good news for patients in India who are in the poverty levels that have not been able to get treatment, especially with cancer drugs. BD
(Reuters) - India has put in place a $5.4 billion policy to provide free medicine to its people, a decision that could change the lives of hundreds of millions, but a ban on branded drugs stands to cut Big Pharma out of the windfall.
From city hospitals to tiny rural clinics, India's public doctors will soon be able to prescribe free generic drugs to all comers, vastly expanding access to medicine in a country where public spending on health was just $4.50 per person last year.
The plan was quietly adopted last year but not publicized. Initial funding has been allocated in recent weeks, officials said.
But the initiative would overhaul a system where healthcare is often a luxury and private clinics account for four times as much spending as state hospitals, despite 40 percent of the people living below the poverty line, or $1.25 a day or less.
Under various existing programs, around 250 million people, or less than a quarter of India's population, now receive free medicines, according to the health ministry. "If doctors are found to be prescribing medicines which are not on the list, or which are branded, then disciplinary action will be initiated," he said.
http://www.reuters.com/article/2012/07/05/us-india-drugs-idUSBRE8630PW20120705?feedType=RSS&feedName=healthNews&utm_source=twitterfeed&utm_medium=twitter&utm_campaign=Feed%3A+reuters%2FhealthNews+%28Reuters+Health+News%29
Walgreens is Making Another Purchase From LaFrance Holdings To Include USA Drug, Super D Drug and May’s Drug Stores Located in the US Southeast
Sales are down so buy some more drug stores? It certainly 
seems like this is what we are seeing out there. If we go back to the split with Express Scripts and the loss of revenue in prescriptions there, well that might shed some light on the size of the loss of revenue and maybe it’s bigger than anyone thought.
Anthem Blue Cross Members Will No Longer Be Able to Fill Prescriptions at Walgreens After January 1, 2012
Just a few weeks ago they bought into Boots in the UK with an option to completely own the chain in a few years too.
Walgreens to Invest in Alliance Boots Drug Chain in Europe With Option to Buy in Full in 3 Years
Along with the purchases comes another source of profit and that is more data potentially for sale which is becoming almost like oil these days and companies are making billions. On their 2010 SEC
statement, Walgreens made just short of $800 million, selling data alone, so when you add up all these acquisitions, just think of how much data for sale they might be getting access too and what additional dollars that could mean. I keep saying we need to tax banks, companies, etc. that make billions of dollars from selling data as it has behind the scenes crept in to where it “is” part of doing business today.
Walgreens And CVS Accused of Selling Customer Prescription Data in 2 Separate Law Suits-Sales for Marketing Data Continues and the Data Bases Gets Larger with Technology
They are spending $438 million on this purchase. The store has also been busy getting liquor licenses in the last year in stores where they have not sold it before to add to the number of products they carry.
Walgreens Applying For and Getting Liquor Licenses Across the US – Be Healthy and Get Your Alcohol Here Too
In addition to all of the above, they are also expanding their efforts into social networking to send ads to your cell phone to for promotional sales and there were several news items in the last year speculating on whether or not the drug stores will start selling insurance too. Back a couple years ago they announced that they were working with Orbitz travel services too so that those booking travel through the company could also get coupons for discounts at the store, in other words promoting “travel healthy”.
Walgreens Using Social Networks to Send Ads To Mobile Phones for Promotional Sale Items When You Check In at the Store –Will Sperm Check Make the List?
In view of all of the above, one certainly can gather the impression that profits may not specifically be found in selling prescriptions, but rather in all the other entities that are combined efforts with what we are seeing out there with acquisitions and promotions. BD
Walgreen also said Thursday it will spend about $438 million to buy a 144-store chain focused on the mid-South from the privately held Stephen L. LaFrance Holdings Inc., which is based in Little Rock, Ark.
Stores in the chain include USA Drug, Super D Drug and May's Drug. They are located in Arkansas, Kansas, Mississippi and Missouri, among other states.
http://www.usnews.com/news/business/articles/2012/07/05/walgreen-plans-new-acquisition-june-sales-fall
