Your most valuable Assets

What do you think are the most valuable assets of your business?

Look around.  Is it the equipment?  Could it be your computer?  How about that new line of products that you have?  None of these are, so think again.

Even if you were lose all of thee things tomorrow and even if you were to go bankrupt, this valuable asset would help you start over.

It’s your data base- the list of your clients, customers, fans.  What?  You don’t have a data base?!

Now is the time to start constructing one.  Right now!

Every time you have someone who has used your service or who has inquired into using your business, boom, that person makes it to your list.  Pretty soon, you have an impressive list- with some interesting statistics to boot.  You know who has bought from you (which incidentally makes them more likely to buy again) and those that need courting by you.

Now when you have a new service that you provide or a new product, you know just who to send this information to.

Perhaps you are one of the fortunate ones that already has a list.  Great!  Have you updated it lately?  Keeping up with the list will ensure that these admirers of yours still exist and still exist at this location, whether it is virtual or real.

So, get out there and make your list, checking it twice.

Don’t Wait

Napolean Hill, America’s original positive-thinking guru, said it best: “Do not wait; the time will never be ‘just right.’ Start where you stand, and work with whatever tools you may have at your command, and better tools will be found as you go along.”

If you wait until all your “ducks are in a row”, some will die while waiting.

New Site

Dear Readers,

Medical issues and healthcare reform has taken a life of its own as have sites dedicated to informing the public about them.

Therefore, for those readers who are interested in this blog for healthcare content, please grab an RSS feed to : www.TheMedicalStrategist.com/blog.

Thanks

I’ll see you over there!

Preventive Healthcare May Decline

The article below hints at the healthcare rationing to follow.

How Government Micromanagement Could Discourage Access To Some Preventive Services
Kathryn Nix | October 14, 2010

A recent letter from the Congressional Research Service (CRS) reveals how Obamacare will erode patients’ access to certain preventive services.

The new health care law requires insurers to cover all preventive measures rated “A” or “B” by the United States Preventive Services Task Force (USPSTF) with zero cost-sharing. Otherwise, “a plan or issuer has the discretion to either cover or not cover additional preventive services not recommended by the USPSTF,” according to the CRS letter.

While many of the more specific task force recommendations are already included in most health plans, some are less clear cut. Before the passage of the new law, Heritage expert Ed Haislmaier wrote that turning these general recommendations into requirements means the “HHS would need to draft and promulgate regulations detailing the type, scope, frequency, and duration of the specific services that must be covered—along with rules on which providers must be paid for providing which services, and the criteria under which specific patients qualify for specific services.”

The Human Health and Services Department so far has punted on this score. In its recent interim final regulations, the agency said,

“[If] a recommendation or guideline for a recommended preventive service does not specify the frequency, method, treatment, or setting for the provision of that service, the plan or issuer can use reasonable medical management techniques to determine any coverage limitations”

“The use of reasonable medical management techniques allows plans and issuers to adapt these recommendations and guidelines to coverage of specific items and services where cost sharing must be waived. Thus, under these interim final regulations, a plan or issuer may rely on established techniques and the relevant evidence base to determine the frequency, method, treatment, or setting for which a recommended preventive service will be available without cost-sharing requirements to the extent not specified in a recommendation or guideline.”

In addition to creating more uncertainty, requiring coverage of all “A” and “B”-rated interventions will increase costs, encouraging plans to drop any preventive measure that isn’t recommended by the task force.

The task force’s decision last November to downgrade mammograms for women aged 40 to 49 to a “C”-rating (i.e., not recommended) illustrates the type of service that may no longer be covered. Rather than providing a black-and-white threshold for mammogram screening, Drs. Kerianne Quanstrum and Rodney Hayward, write that the task force “simply recommended that routine screening mammography begin at the age of 50 years, whereas women between the ages of 40 and 49 years should make individual decisions with their doctors as to whether their preferences and risk factors indicate screening at an earlier age.”

But Congress has written the law in such a way that it is likely that some patients who might need screening would not be covered under the new rules. Why: Because Congress transfers real decision making to regulators; and regulators can affect the care of widely different patients in arbitrary ways.

Consider last year’s controversial mammogram decision. It will not initially be included in the recommendations used to determine the required preventive measures or screenings. But the CRS letter notes that if the task force makes the same recommendation in the future, it will be. And controversial recommendations for other preventive services are sure to follow.

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Fortunately the American College of OB/Gyn does not endorse the above findings nor do several organizations.  Ninety-five percent of breast cancers are cured when detected early enough.

We have made great strides in recent years.  Hopefully the above won’t be instituted.  It would be tragic to see a backslide.

Legal Challenge to Healthcare Reform Being Upheld

Wow!  A federal judge from Florida ruled that key segments of the healthcare reform legislation CAN legally be challenged as to constitutional legality and proceed in court. Arguments are centered around forcing individuals to purchase health insurance coverage or pay a fine.

Four counts were dismissed as requested by the current administration but 2 remain up for dispute. One involves the constitution’s commerce clause regarding interstate commerce regulation of which healthcare is included according to the Obama group. State officials feel that the mandate violates the 9th and tenth constitutional amendments, drafted  to safeguard individual and states’ rights.

The other point of law moving forward promotes the idea that the mandate interferes with states’ sovereignty — a violation of the 9th and 10th amendments — by forcing them to participate in the new healthcare coverage and force people to pay for premiums they cannot afford, such as the cost of expanded Medicaid programs.

Vinson stressed in his ruling that just because he was allowing the 2 counts to go forward did not mean that he had attempted to determine “whether the line between Constitutional and extraconstitutional government has been crossed.”

“I am only saying that (with respect to 2 of the particular causes of action discussed above) the plaintiffs have at least stated a plausible claim that the line has been crossed,” Vinson wrote, adding that he would make his determination based on motions for summary judgment that he expects each side to file.

Let’s wait with interest to see how this pans out.  The outcome will impact us all.

Greying Britain looks to reform assisted suicide

There was a time when Dr. Kevorkian was arrested and tried for assisted suicide. This was to help people that were terminally ill and had no cure or hope for recovery. They were in tremendous pain and helping them with their decision to end life with dignity was aided.

Yet with one out of every 3 Medicare dollars being spent for the last 2-3 years of a person’s life, President Obama and our government is now rethinking its stance on suicide.

Since Berwick, the new head of CMS- Centers for Medicare and Medicaid is so enamored with the National Health Service, it is with interest that we see this article regarding Britain’s new view toward end of life issues. This article, written by Farah Master appeared on Sept.21st.

LONDON, Sept 21 (Reuters) – It used to be an issue just for the terminally ill. Now as populations around the world age, governments are increasingly being confronted with the taboo idea of dying as something people can volunteer to do.

“The demand for the option, if not the practice, is growing rapidly,” said Dr. Philip Nitschke, 61, founder and director of the pro-euthanasia group Exit International.

The Australian doctor — nicknamed Dr Death for his work on suicide — is travelling the world to teach people how to end their lives safely with a suicide drug-testing kit.

”Very few will go down this path, but almost every 75-year old I meet now sees merit in having their own bottle of Nembutal in the cupboard as an insurance policy, in case things get bad,” Nitschke told Reuters, referring to the barbiturate used as a sedative.

Nitschke’s is an extreme view, but as the proportion of older people increases rapidly in countries such as the United States, Australia, Japan, Germany and Britain, the suggestion of an option to escape indignity could spur political tremors.

Littered with ethical red flags — particularly around the possibility that families or organisations may encourage the elderly or infirm to end their lives — the issue of assisted suicide has been forced up the British political agenda.

Calls for reform and a legal decision in July forced the government to promise to clarify the law. Draft guidelines are due this month with a final version by next spring, but Derek Humphry, former president of the World Federation of Right to Die Societies said significant changes in Britain would likely not come until after a 2010 election.

In Britain, nearly 20 percent of the population is over 65 — a proportion the Office for National Statistics predicts will have grown by 50 percent by 2020.

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Of course two issues that we will have to be wary of- one is murder- how would we know? The second is suicide due to depression. After all, there is no way back- at least none that we currently know.

States to Assume Healthcare Costs

The following is written by Dwight  Flax today, a colleague and fellow health reform information disseminator.

ObamaCare Shoves Costs Onto The States
According to the Wall Street Journal, the Medicaid expansion on which both H.R.3200 and the Baucus Bill in the Senate is predicated will create massive budget crises in all 50 states:

Max’s Mad Mandate
The Baucus health bill will break 50 state budgets via Medicaid.Article
SEPTEMBER 27, 2009

The more we inspect Max Baucus’s health-care bill, the worse it looks. Today’s howler: One reason it allegedly “pays for itself” over 10 years is because it would break all 50 state budgets by permanently expanding Medicaid, the joint state-federal program for the poor.

Democrats want to use Medicaid to cover everyone up to at least 133% of the federal poverty level, or about $30,000 for a family of four. Starting in 2014, Mr. Baucus plans to spend $287 billion through 2019—or about one-third of ObamaCare’s total spending—to add some 11 million new people to the Medicaid rolls.

About 59 million people are on Medicaid today—which means that a decade from now about a quarter of the total population would be on a program originally sold as help for low-income women, children and the disabled. State budgets would explode—by $37 billion, according to the Congressional Budget Office—because they would no longer be allowed to set eligibility in line with their own decisions about taxes and spending. This is the mother—and father and crazy uncle—of unfunded mandates.

This burden would arrive on the heels of an unprecedented state fiscal crisis. As of this month, some 48 states had shortfalls in their 2010 budgets totaling $168 billion—or 24% of total state budgets. The left-wing Center for Budget and Policy Priorities expects total state deficits in 2011 to rise to $180 billion. And this is counting the $87 billion Medicaid bailout in this year’s stimulus bill.

While falling revenues are in part to blame, Medicaid is a main culprit, even before caseloads began to surge as joblessness rose. The National Association of State Budget Officers notes that Medicaid spending is on average the second largest component in state budgets at 20.7%—exceeded only slightly by K-12 education (20.9%) and blowing out state universities (10.3%), transportation (8.1%) and prisons (3.4%).

In some states it is far higher—39% in Ohio, 27% in Massachusetts, 25% in Michigan, Rhode Island and Pennsylvania. Forcing states to spend more will crowd out other priorities or result in a wave of tax increases, or both, even as Congress also makes major tax hikes inevitable at the national level.

The National Governors Association is furious about Mr. Baucus’s Medicaid expansion, and rightly so, given that governors and their legislatures will get stuck with the bill while losing the leeway to manage or reform their budget-busters. NGA President Jim Douglas of Vermont recently said at the National Press Club that the Baucus plan poses a “tremendous financial liability” and doesn’t “respect that no one size fits all at the state level.” He added: “Unlike the federal government, states can’t print money.”

Mr. Baucus hopes to use his printing press to bribe the governors, at least for a time. Currently, the federal government pays about 57 cents out of every dollar the states spend on Medicaid, though the “matching rate” ranges as high as 76% in some states. That would rise to 95%—but only for five years. After that, who knows? It all depends on which budget Congress ends up ruining. Either the states will be slammed, or Washington will extend these extra payments into perpetuity—despite the fact that CBO expects purely federal spending on Medicaid to consume 5% of GDP by 2035 under current law.

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It does seem like we are jumping from the frying pan into the fire!

All this reform was supposed to fix the system!