What Mothers Teach Us

I OWE MY MOTHER

1. My mother taught me TO APPRECIATE A JOB WELL DONE.
"If you're going to kill each other, do it outside. I just finished cleaning."

2. My mother taught me RELIGION.
"You better pray that will come out of the carpet."

3.. My mother taught me about TIME TRAVEL .
"If you don't straighten up, I'm going to knock you into the middle of next week!"

4. My mother taught me LOGIC .
" Because I said so, that's why."

5. My mother taught me MORE LOGIC.
"If you fall out of that swing and break your neck, you're not going to the store with me.."

6. My mother taught me FORESIGHT.
"Make sure you wear clean underwear, in case you're in an accident."

7. My mother taught me IRONY.
"Keep crying and I'll give you something to cry about."

8. My mother taught me about the science of OSMOSIS .
"Shut your mouth and eat your supper."

9.. My mother taught me about CONTORTIONISM.
"Will you look at that dirt on the back of your neck!"

10. My mother taught me about STAMINA.
"You'll sit there until all that spinach is gone."

11. My mother taught me about WEATHER .
"This room of yours looks as if a tornado went through it."

12. My mother taught me about HYPOCRISY.
"If I told you once, I've told you a million times. Don't exaggerate!"

13. My mother taught me the CIRCLE OF LIFE.
"I brought you into this world, and I can take you out."

14. My mother taught me about BEHAVIOR MODIFICATION..
"Stop acting like your father!"

15. My mother taught me about ENVY .
"There are millions of less fortunate children in this world
who don't have wonderful parents like you do."

16. My mother taught me about ANTICIPATION.
"Just wait until we get home."

17. My mother taught me about RECEIVING.
"You are going to get it when you get home!"

18. My mother taught me MEDICAL SCIENCE.
"If you don't stop crossing your eyes, they are going to get stuck that way."

19. My mother taught me ESP.
"Put your sweater on; don't you think I know when you are cold?"

20.My mother taught me HUMOR.
"When that lawn mower cuts off your toes, don't come running to me."

21. My mother taught me HOW TO BECOME AN ADULT.
"If you don't eat your vegetables, you'll never grow up."

22. My mother taught me GENETICS.
"You're just like your father."

23. My mother taught me about my ROOTS.
"Shut that door behind you. Do you think you were born in a barn?"

24. My mother taught me WISDOM .
"When you get to be my age, you'll understand."

25. And my favorite: My mother taught me about JUSTICE.
"One day you'll have kids, and I hope they turn out just like you……………They did!!!!

***This was passed on to me by a very good friend who happens to be a mother of 5.

Predicting Flu Virus Strains

The flu vaccine is produced every year in part by guessing and partly by science.

Professionals in the field meet under the auspices of the FDA on a yearly basis to try and predict which flu virus strains are most likely to spread across the U.S. in next yearly flu season.

They start by using samples from the Far East, where yearly flu strains typically start.

The flu vaccine contains three separate flu strains and is therefore referred to as a trivalent vaccine.

Most years experts manage to match their vaccine design in the spring to the strains that actually circulate throughout the country later in the year.

But this year, they had problems finding samples and being able to grow a strain referred to as the H3N2.

This year, the particular H3N2 strain that was left out of the vaccine wound up being the dominant influenza A virus which has accounted for more than 60% of flu cases.

Influenza A typically makes up about 85% of all flu cases and this year, it simply missed the boat.

A government scientific advisory board is now recommending for the first time a complete overhaul of the makeup of the flu vaccine for next year.

This move would replace all three flu virus strains in this year's vaccine with three new strains for next year.

This change could potentially cause delays for next year as vaccine makers grow the new strains and produce new flu shots.

Even though this year’s flu shot wasn’t all that helpful, it is still recommended yearly, especially for the very young, the very old and those with chronic illnesses.

FBI raid on WellCare

It was recently announced that three top executives at WellCare Health Plans have resigned and their resignations were effective immediately.

WellCare provides managed care to 2.3 million Medicare and Medicaid patients.

The company said that Todd Farha, chairman of the board, chief executive officer and president; Paul Behrens, chief financial officer; and Thaddeus Bereday, general counsel, all resigned from their positions but will stay on with the company as nonexecutive employees until March 31.

They have been replaced by Charles Berg, 50, as executive chairman and Heath Schiesser, 40, as president and CEO.

The problems began last October when federal and state agencies conducted a raid on the company’s headquarters in Tampa, Fla.

A Spokesman said the agents began their search in three to four of the buildings, but he declined to comment on what the search was about and said that the search warrant involved was sealed.

Agencies involved included the U.S. Federal Bureau of Investigation, the U.S. Department of Heath and Human Services Office of Inspector General, and the Florida attorney general's Medicaid Fraud Control unit

George Soros was the largest investor in a private equity fund that cashed out of WellCare in August of ‘06, bringing in a total of $870 million for an investment that originally cost $220 million.

WellCare said in a statement it continues to cooperate with the U.S. Justice Department, the Florida attorney general’s office, and the other agencies involved in the ongoing investigation.

Florida has a very aggressive antifraud division that investigates overcharging or fraudulent billing for medical services.

It is likely the investigation has something to do with this type of activity.

Cyber Visits

Two insurance companies may begin paying doctors for cyber visits.

There have been a few insurers paying doctors for the so-called “virtual visits” if they were conducted through secure electronic messaging systems but it was on a limited basis.

Cigna and Aetna announced in December that they were reimbursing online visits on a nationwide basis beginning in 2008 as long as the services were performed through RelayHealth.

Cigna will pay $25 for a typical online consultation and $35 for more complicated consultations but Aetna has not announced what it will pay.

Patients would pay his or her usual co-pay online at the RelayHealth website with a credit card and the insurer would pay the remainder of the charge.

Physicians must subscribe to RelayHealth (http://www.relayhealth.com/) at a cost of $100 a month.

The online consultation involves a structured interview with all communications between doctor and patient encrypted and password-protected.

The online service also allows patients to request appointments, prescription renewals, and referrals as well as view lab results.

Are patients willing to pay for this service and are physicians willing to pay the $100/month fee.

Time will tell.

Robots rounding

Where are we headed in the 21st century with medicine and interpersonal relationships?

In a recent study published in the Archives of Surgery they looked at the use of robotic "telerounding" at three academic medical centers.

This involved the use of the 5-foot-5-inch robot consisting of a computerized motor base, a flat-screen monitor, a microphone, and a digital camera that can zoom in to read a chart, study a wound or pick up facial expressions.

A physician operates the robot by remote control at a computer workstation equipped with a digital camera, microphone, and joystick. This technology gives live, two-way audio and visual communication between doctor and patient.

This study involved 270 patients who had undergone a urologic procedure and were than divided into two groups; one group received a bedside visit from their attending surgeon and the other group was rounded on by their attending surgeon using the robot.

The study found that telerounding proved no better or no worse than traditional rounding in terms of patient safety.

Each group had the same level of post-surgical complications and pain and the surgeons who rounded on patients remotely didn't miss any complications, nor were they late in identifying them.

The average length of hospital stay for each group was 2.8 days.

A surprising finding for the researchers was the patient-satisfaction scores.

The scores for the telerounding group basically matched those for the group seen in person by their surgeon.

Two-thirds of patients who encountered the rounding robot said it should become a regular part of hospital care and the same percentage said they'd prefer telerounding by their regular doctor over an in-person visit by a partner.

Continuity of care is one of the arguments that are used for this kind of videoconferencing.
Proponents also tout the technology as a way to extend the expertise of big-city medical specialists to outlying hospitals.

Critics counter that a rounding robot dehumanizes patient care.

There were some commentaries with the study that think the importance of human touch is not as important as a familiar face and voice on the other end.

Could the results of this study just be a novelty factor of the robot and will patients really not miss the true human interaction?

I believe we are relational beings and deep down, we strive for real interpersonal relationships with caregivers we trust.

The Real Hillary

One of my very good democratic friends sent me these. You have to appreciate the creativity!

Here is what we are really getting when and if Hillary gets elected.

FDA Rule Changes

Eight lawmakers, all democrats, (Sens. Christopher Dodd (D-Conn.), Edward Kennedy (D-Mass.) and Patrick Leahy (D-Vt.) and in the House by Reps. John Dingell (D-Mich.), Rosa DeLauro (D-Conn.), Edward Markey (D-Mass.) Frank Pallone Jr. (D-N.J.) and Henry Waxman (D-N.Y.)) hammered the Food and Drug Administration over a recent proposal that would require drug and device makers to first get FDA approval before they can update their manufacturer labels with new safety information.

They feel the real intent of this proposal is to protect companies in the pharmaceutical and device industry from being held liable for marketing products they know are unsafe.

In a summary from FDA Proposes Labeling Rule Change to Codify Long-Standing Position on "Changes Being Effected" Supplements and to Strengthen Federal Preemption Defense in Product Liability Cases

The article states “The Food and Drug Administration (FDA) today published proposed revisions to the agency's drug and medical device labeling regulations, entitled "Supplemental Applications Proposing Labeling Changes for Approved Drugs, Biologics, and Medical Devices." 73 Fed.Reg. 2848 (Jan. 16, 2008). The proposed rule limits the circumstances under which a manufacturer may unilaterally change its product labeling via a "changes being effected" (CBE) supplement in advance of the agency's review and approval of those changes. As the law currently stands, there is some uncertainty as to when and under what circumstances a manufacturer may initiate labeling changes under a CBE supplement prior to FDA approval. In the products liability context, plaintiffs have typically argued that manufacturers always have the right (and duty) under existing CBE regulations to make changes that add or strengthen warnings, and that the failure to do so exposes them to tort liability under state law. Manufacturers, on the other hand, have claimed that the FDA's approval of a package insert should preempt claims based on a failure to warn, and that the right to make changes in advance of FDA approval is strictly limited. The FDA's proposed rule, if finalized, clarifies any existing uncertainty and should significantly strengthen a manufacturer's preemption defense.”

These lawmakers believe the policy change comes at the expense of consumers and violates the mission of the FDA.

The proposal amends current regulations that allow a company to quickly update their drug and device labels without the agency’s approval. The FDA now allows manufacturers to change their labels to add or strengthen a contraindication, warning and other precautions without waiting for the agency’s approval. Those guidelines are set in the FDA’s “changes being effected” regulations.

But the FDA now says that doing so—“even if done to add new warnings”—undermines its approval process as set out by Congress.

Permitting a sponsor to unilaterally rewrite the labeling for a product following FDA’s approval of a product and its labeling would disrupt FDA’s careful balancing of how the risks and benefits of the product should be communicated.

Who ultimately would benefit from this rule change remains controversial; but these democrats believe it will be the manufacturers.

Time to Quit

With Flu season in full swing, this would be an excellent time to quit smoking.

Here is a recent announcement for anyone who may be interested.

The public is invited to a Fast Track Quit Clinic presented by the Clark County Tobacco Prevention and Cessation Coalition-a program of Clark Memorial Hospital, at:
The Ogle Virtual Library
Wednesday February 20th from 6:30 - 8:30pm.

Points of discussion include:
• Identify your physical and psycho-social triggers
• Learn state-of-the-art techniques for smoking and spit tobacco cessation
• Establish your own plan

Call 283-2649 to register

Be smoke free in a week!

For more information Call 246-3301 ext. 4225

Questionable new Vaccine Risk

On Friday February 15, it was announced that the investigational rotavirus vaccine (Rotarix), manufactured by GlaxoSmithKline Plc's, is associated with increased pneumonia-related deaths and other adverse reactions.

Rotavirus is a winter gastrointestinal virus that afflicts many young children, but even a very bad case of diarrhea is less worrisome than the increased risks they are seeing in these studies.

This announcement comes ahead of a Food and Drug Administration advisory meeting scheduled for Wednesday to consider approval of the oral vaccine.

The analysis looked at 11 studies and they showed a statistically significant increase in deaths related to pneumonia with the vaccine compared with placebo.

That largest study enrolled about 63,000 children and it also found an increase in convulsions in children given the vaccine.

Another study found an increased rate of bronchitis compared with placebo.

The FDA advisory panel will weigh the staff review of these studies and the data but the panel makes its own recommendation which is then followed by an official FDA announcement.

We'll have to wait and see what their decision will be.

Do we know Collaboration and Cooperation??

Mergers are happening in all areas of business, but they are fairly common in Healthcare.

Recently , St. Mary Mercy Hospital in Livonia, Mich., announced it will merge its books and governance into St. Joseph Mercy Health System which is a three-hospital system based in Ann Arbor, Mich.

Both of these entities are already owned by Trinity Health which owns and manages 43 hospitals in seven states.

This particular merger isn’t a traditional asset merger as seen in other markets, but one in which it provides each respective organizations the opportunity to support their communities through collaboration rather than through competition.

Collaboration and cooperation are wonderful words that could help our hospitals locally.

Now that we have selected a new CEO, collaboration and cooperation with Clark Memorial Hospital could go a long way in providing better care to each of our counties. The cost savings in sharing services and/or employees in certain key areas could help the bottom lines of each organization.

The merger in Michigan will keep the St. Joseph Mercy name, will have a single operating budget, and its governance will be reconstituted to include board members from both hospitals. The executive team of each will remain intact for both hospitals.

Both of these Michigan hospitals are facing increasing competition from Detroit much like we do from Louisville. The enhanced cooperation should give both hospitals some economy of scales for competing.

Do you think our political leaders and others with the power to consider a potential arrangement to cooperate and collaborate will do so?

Breaking News on a Wonder Drug

I always say, "never be the first on a drug and never be the last on a drug", but in this case, I may make an exception.

This video clip was sent by a friend that I am sure does not always see things from my political viewpoint, but the humor is still pretty funny.

Controversial New Book

A good friend of mine has certainly stirred things up in southern Indiana with her recently published and released book titled "Keeping His Pants On......Until He Comes Home"

As you can see from this link: Author of 'Pants' dares to get a little cheeky: The Corydon Democrat, Joyce has created a little controversy and has given the town something to talk about.

The fact that Joyce is a minister’s wife and writing about such a “taboo” topic seems to evoke some strong sentiments based on the comments.

The cover of the book is what seems to be most controversial to many of the detractors, but it does not appear that many of them have actually read the book.

The book is a great read and would be very helpful to many couples having some marital discord.
It is based on Christian principles and this will unfortunately turn some off, but no one is forced to read it.

But whether you value Christian principles or not, this could be a very helpful book.

I council many couples who struggle with pornography, infidelity, and other marital issues and this book would be beneficial for many of them.

The old adage, “Don’t judge a book by its cover” is very appropriate related to this new publication.

For those interested the book can be obtained at the following site:

We present to you: The Amazing Joyce Oglesby!!!

Hospitals Beware

Insurance companies are getting even more creative in their legal language to avoid paying for services.

Aetna is incorporating language on serious medical errors into its hospital contracts and will attempt to avoid paying for so-called “never events.”

These “never events” are 28 medical errors identified by the National Quality Forum that are so egregious to patient safety that they should never happen. Some of these include operating on the wrong body part, leaving a foreign object inside a patient after surgery or a patient death or disability associated with a fall.

Aetna’s newest template for hospital contracts mandates that hospitals report these “never events” to an accrediting agency within 10 days. Hospitals are then asked to take steps to ensure the error won’t be repeated, waive all costs related to the event and apologize to the affected patient and family members.

Aetna says it is the first health plan to endorse this approach to never events.

Since the CMS announced last fall it would halt reimbursements for some never events, payers such as the Blue Cross and Blue Shield Association have said they will follow suit.

Hospitals will need to be cautious and review their new contracts closely for these new hidden clauses. Physician contracts will likely follow with similar language.

New CEO Announcement

The official announcement was finally made last week. Floyd Memorial has a new CEO selected who will assume his duties in March.

As a member of the selection committee, I want to personally thank Kerry Stemler for chairing the committee and Jerrol Miles as Chairman of the Board. Everyone on the committee spent hours of their personal time during this process but these two individuals were instrumental in the process and it has been a great experience.

Everyone is excited about the change and we look forward to moving the hospital in a more positive direction related to morale, atmosphere, services and quality.

Will 2008 be the year for Health Courts

As we begin 2008, this could be the year that health courts really get some publicity and some backing.

Many people are slowly learning that ever-increasing malpractice premiums hurt patients and communities as more specialist are choosing not to practice in certain states and the quality of physicians that remain may not be up to standards.

Health courts have been talked about for a long time but they have not gotten much publicity for various reasons. With these specialized courts, the judgments are made outside the regular tort system by specially trained judges who only hear medical related cases. They make decisions on an avoidability standard that awards injuries if they could have been avoided with best practice care.

Negligence, by contrast, focuses on whether care fell below customary practice.

Attorneys would no longer have to find jurors and then educate them on the increasingly complex medical situations to determine if negligence occurred.

Juries would no longer be making mega-awards based on sympathy for the plaintiff. The health experts would award compensation based on uniform guidelines as in done workers comp type of cases.

Why these courts have not caught on is no surprise.

The legal lobby as well as many legislators are attorneys with much to lose. Voting against the trial lawyers is never a politically good move.

Benefits of health courts include ease of filing, speed and greater reliability in decisions, and much less red tape. This would help curb healthcare costs and malpractice premiums.

Health courts would encompass a no-fault system that encourages physicians to report medical errors without fear of lawsuits or retribution.

The reporting would enable people to identify and correct workplace and system deficiencies, so that the same types of errors don't recur.

According to Paul Barringer, executive director of Common Good ( http://www.cgood.org), he believes the public has become more aware of the connection between patient safety, quality, and medical liability and his organization is leading the charge for health courts.

He believes that health courts will probably come from small state pilot programs like the one in New York and then grow from there.

Finding ways to make healthcare more error-free should be the goal rather than continuing this defensive medicine strategy currently being practiced.

Halitosis Descrimination

Is this suspension discrimination or legitimate?

According to the New York Daily News, A Manhattan doorman has been suspended for having bad breath.

Jonah Seeman worked ushering tenants into a four-building complex on East 89th Street for the past 40 years and was told not to come to work because of halitosis.

Mr. Seeman supports his 81-year-old mother and had been suspended twice before for bad breath.

Many of the apartment dwellers at the Gracie Gardens complex expressed surprise over Seeman's suspension and some came to his defense saying his job, which he does well, is opening the door, not to be opening his mouth.

Officials with the management company that oversees the property made no official comment related to the incident.

But the letter received from the company by the doorman stated: "We can no longer tolerate the fact that you have severe breath odor while on duty."

There is a union that represents Mr. Seeman and they have filed a grievance in the case.

Meta-analysis on Alcohol

When talking about alcohol consumption, there was a recent meta-analysis of prospective studies on alcohol dosing and total mortality performed and published in the Archives of Internal Medicine.

The researches looked at thirty-four studies on men and women, for a total of 1,015,835 subjects and 94,533 deaths.

The results showed a J-shaped relationship between alcohol and total mortality in both men and women.

Consumption of alcohol, up to 4 drinks per day in men and 2 drinks per day in women, was inversely associated with total mortality.

Higher doses of alcohol were associated with increased mortality.

The inverse association in women disappeared at doses lower than in men.

The findings of this meta-analysis confirm the hazards of excess drinking and continue to indicate a potential window of alcohol intake that may confer a net beneficial effect of drinking in terms of survival.

The analysis did not look at any other negative effect of alcohol such as legal problems, interpersonal and family problems, job performance or other addictions; so let’s keep the results in perspective.

Moderation, moderation, moderation!!!

The Obscenity of Humana

The courier published this article in yesterday’s business section: Humana posts 4th-quarter gain

Net income was up 71 percent for the year and 57 percent in the 4th quarter.

This is when most other businesses especially those in healthcare were struggling.

It is extremely displeasing to providers and patients when Humana continually denies care, denies drugs and makes medical offices and patients jump through hoops to get the care they need.

In addition, Humana being paid more than traditional Medicare amounts by the government for the Medicare managed care plans all while paying providers less.

There is something rather obscene about this business practice!

Physician owned Hospital Controversy

As the controversy over physician owned hospitals continue, the report that came out from the HHS’ inspector general’s office regarding the emergency-care policies has now been able to be reviewed and the so-called facts challenged and refuted.

What follows is a summary by Molly Sandvig of Physician Hospitals of America

The hospitals in the report have now been contacted and the Physicians Hospital Association (PHA) and they state that virtually all of the report’s “facts” and conclusions that relate to hospital compliance with federal staffing requirements and emergency policies are wrong.

The inspector general’s office suggests that certain policies regarding emergency response and patient transfers might violate Medicare’s conditions of participation but this suggestion is without merit.

All of the hospitals have been surveyed and inspected as part of the process of obtaining Medicare certification and review of policies is part of the survey process.

The real question is that if these policies were acceptable to the CMS and other independent accrediting bodies; on what basis does the inspector general now challenge their legitimacy?

PHA also stated that the inspector general’s office concluded that 37 of these hospitals allegedly use 911 as a substitute for the hospital’s ability to stabilize its patients.

But so far, 29 of these hospitals have challenged this conclusion and provided documentation to PHA that supports this reaction.

These hospitals said the inspector general’s office made no effort to allow these facilities to answer these allegations prior to the report’s publication.

In addition, the inspector general’s office listed eight hospitals that had supposedly violated Medicare conditions of participation due to improper staffing and once again, all eight of the named hospitals have come forward with documentation showing that they were, in fact, properly staffed according to CMS guidelines during the times in question.

Other criticisms of the report are that the inspector general’s office reported the number of hospitals with emergency rooms and the size of those ERs, however, the report made no mention of the fact that these issues are controlled by state law and each met their state requirements.

Many of the hospitals named are five-star ranked and/or listed by independent quality authorities as the No. 1 hospital in their specialty and state.

The inspector general’s report does a disservice both to the medical professionals of these hospitals and, more critically, to the patients who are served by them.

In the PHA’s opinion, the inspector general’s report is either an example of lazy reporting, failure to understand standard hospital policies and procedure, or blatant and purposeful misrepresentation.

The PHA and physician-owned specialty hospitals are outraged by the inspector general’s willingness to release such an erroneous report and by the failure of many in the media to seek independent confirmation of the report’s allegations.

So what was the real motivating factors behind the report?

The Death of Common Sense

This has been circulating recently in emails and I thought it might be appropriate to start out the week. With Super Tuesday tomorrow and all the other daily activities, it is just a nice reminder.

Today we mourn the passing of a beloved old friend by the name of Common Sense who has been with us for many years.

No one knows for sure how old he was since his birth records were long ago lost in bureaucratic red tape.

He will be remembered as having cultivated such value lessons as knowing when to come in out of the rain, why the early bird gets the worm and that life isn't always fair.

Common Sense lived by simple, sound financial policies (don't spend more than you earn) and reliable parenting strategies (adults, not kids, are in charge).

His health began to rapidly deteriorate when well intentioned but overbearing regulations were set in place.

Reports of a six-year-old boy charged with sexual harassment for kissing a classmate; teens suspended from school for using mouthwash after lunch; and a teacher fired for reprimanding an unruly student, only worsened his condition.

It declined even further when schools were required to get parental consent to administer aspirin to a student; but, could not inform the parents when a student became pregnant and wanted to have an abortion.

Finally, Common sense lost the will to live as the Ten Commandments became contraband; churches became businesses; and criminals received better treatment than their victims.

Common Sense finally gave up the ghost after a woman failed to realize that a steaming cup of coffee was hot, she spilled a bit in her lap, and was awarded a huge settlement.

Common Sense was preceded in death by his parents, Truth and Trust, his wife, Discretion; his daughter, Responsibility; and his son, Reason.

He is survived by two stepbrothers; My Rights and I am a Whiner.

Not many attended his funeral because so few realized he was gone. If you still know him pass this on, if not join the majority and do nothing.

Men and Women

As we have talked about men and women and their inherant differences, here is a video that explains the differences much better than the medical sciences ever will.