The Future of Technology - Software As a Service

Software as a Service: The Future of Technology Arguably one of the most important inventions of the twentieth century, the Internet has revolutionized the way we live. From communicating with friends to transacting business, shopping and paying bills, the Internet impacts almost every aspect of our lives. Yet the benefits of this massive shift are still being realized in the field of business software applications as the technology behind them evolves. Client servers vs. remote computing Put at its simplest, business software applications have at least two "tiers" - the client tier (the part that the end user sees), and the rest of the system, which consists of the hardware and software that supports it and makes it work. Until relatively recently, users have had to pay for and support both tiers, by housing and maintaining the "back end" of the system in order to use the front end. Intuitively this makes as little sense as buying a whole switchboard and miles of telephone wires just to be able to make a phone call. Not only would you have all the expense of the equipment, you would also have to pay for an in-house telecommunications specialist. Fortunately for businesses, especially the smaller and mid-sized ones, technology has now developed an alternative - remote computing. Remote computing, also sometimes known as "software as a service" (SaaS), is offered with the idea of providing a service without making the end user pay all the associated costs. To use the telephone analogy again, with this model, hundreds of thousands of customers can have a telephone service cheaply and the telephone company manages all of the hardware apart from the phone on your desk.

What are the benefits of SaaS? First, it is important to note that as with any other product or service, some remote computing models are superior to others. The basic concept of SaaS has a number of advantages over the client-server model, but before you invest in a SaaS application for your business, it is worth checking how many of the bonus criteria your potential provider meets -'y these really indicate dependable and good-quality systems. 1. Less "down time" Server faults are inevitable, whether you are using a client server or a remote server. The difference is the effect this will have upon your ability to use the application. With a client server model, server faults will cause "down time", when the application can't be accessed. With software as a service from a reliable application service provider, you can use the application as normal with minimal down time. This feature is called fault tolerance and it occurs because every component of the back end of the system has another component that can perform the same function if necessary. With a client server model, this kind of functionality is impractical for cost reasons. Ask your SaaS provider: if the system can identify and replace the faulty component automatically. This level of sophistication means that there is no delay between a fault occurring and normal operation being restored, so no down time will be experienced by the user at all.

2. Better disaster management

One of the greatest advantages of SaaS is that in the event of a disaster befalling your office, your data is safe. No foolishly-placed cup of coffee, fire or tornado will cause you to lose your data,. By contrast, if you have your data on a server in your office you are at the mercy of any disaster that impacts your server. . Ask your SaaS provider: if they have replicated computing centers at geographically distributed locations. This means that even if a disaster impacts the computer center where your data is held, nothing is lost. 3. Access from anywhere Unlike client server models, remote computing allows users to access the application from anywhere with an Internet connection. Whether you are at the office, at home or on the road, you can access your data and get your work done. Client server models generally restrict access to particular workstations that are connected to the network on location. Ask your SaaS provider: what provisions they make for PDAs. Being able to access the application from your handheld device can be very convenient!

Internet-based versus browser-based software. A common misconception is that the Internet and the World Wide Web are interchangeable terms. In fact, they are different but related. The Web is a collection of interconnected documents and other files. The Internet, on the other hand, is a series of interconnected networks through which data can flow. Essentially, the Internet is the highway and Web files are just one type of data-rich vehicle capable of traveling along it. A Web browser, whether it is Internet Explorer, Mozilla Firefox, or Safari, is a software application that allows users to view these Web files. The distinction between Internet-based and browser-based is far from pedantic. SaaS can be either, but a truly Internet-based application has fewer limitations than a browser-based application for the following reasons: 1. Security from hackers Applications that rely on browsers can only transmit data in a way that browsers will understand. That means that even if the data is encrypted, it can (with some effort) be unencrypted and the data pieced back together and read. This is disastrous if the data is of a sensitive or private nature. If your application is Internet-based without relying on a browser, the application can transmit data in any way it chooses, as no other application has to be able to interpret it. If someone hacks in and intercepts and unencrypts your data as it is being transmitted across the Internet, they will just see tiny pieces of unintelligible data. Security-wise, it is similar to the difference between tearing your bank statements in half and cross-shredding them. 2. Security from viruses

Internet-based applications create a private platform between you and your data, unlike the public Web sites that a browser-based application relies on. Truly Internet-based applications therefore are less susceptible to viruses. 3. Faster running The other benefit of the Internet-based application is speed - because it stores a small amount of unique user information on each workstation the first time a user logs in, it subsequently will run similarly to any other program on your desktop, rather than having to get that information from the server each time, as a browser-based application does. Why, then, would application providers choose a browser-based model? Often, it is because they have moved from a client server model to take advantage of the economies of scale of a remote computing model, but rather than re-engineer the architecture of the entire system, which is expensive and requires considerable technological expertise, they have gone halfway, and provided remote servers and a browser-based interface with the application running on a Web site. Not that browsers are all bad; they are, of course, convenient and easy to access, and most SaaS providers provide a way to log in to the application via a Web site. However, the application will launch securely and independently from the browser. Where is the technology headed? Gone are the days when buying software for your business meant purchasing a disk and implementing the application yourself. More and more business application providers are seeing the advantages of software as a service and jumping on the Internet bandwagon. Once you know the questions to ask, you should be able to easily find a business solution that can offer high availability, good performance and security at a fraction of the cost of "client server" competitors. Because of the benefits outlined above, it is probable that the business software landscape will be almost entirely Internet-based within a decade. If you do your research, you can take advantage of this trend sooner rather than later.



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Alternative Health Care Debate

Many people are pretty polarized on the alternative health care debate. They are either completely for or completely against it. On the one hand, there are people who stand with tradition entirely and are unwilling to compromise. They believe that normal medical health is the highest level that the treatment of diseases has ever reached. They don't believe in any alternative health treatment at all, viewing it as unscientific and probably unhelpful as well.

On the other hand, there are alternative health fanatics. I know some people who will only use holistic health services and nothing else. They won't even take prescription drugs if they believe they can get better with herbs. They believe that science is overrated and that some things can't be measured in numbers.

I always try to avoid either extreme in my own practices. I have had some great success with alternative health, and definitely wouldn't give it up. On the other hand, I think that science is very valuable. Traditional Western medicine has done a lot of great things for us. It has brought us a new understanding of the physical body, excellent drugs and treatment options, incredible scans which allow us to see inside the body, and many other helpful technologies. To throw it all away based on a vague belief in the power of herbs is foolish.

That is why I use both alternative healing and traditional medicine. I think that improving your diet and taking health supplements can do great things for you, and is often a better solution than costly medications with side effects. When you are not treating something severe and acute, you shouldn't put a lot of stress on your body during the treatment. Otherwise the cure can be worse than the illness. Using herbal treatments can remove the need to strain your body by introducing antibiotics and things like that into it.

On the other hand, I like to keep traditional medicine as an option. Sometimes, things get really bad and you just need a pretty strong treatment. You might not want to start with an operation or even prescription medication, but it might come to that in the end. This is why I have always viewed complimentary medicine as the best approach. It allows you to use both Western and Eastern medicine, combining the best of both worlds. After all, the more tools you have, the more options you have for treatment.



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What Social Security Benefits Are Available?

Types of Social Security Disability Benefits

The Social Security Administration has established a number of different types of disability programs. Although the medical rules are similar under each program, the technical rules on eligibility set each program apart. What program you may be eligible for depends on a number of factors, including your work history, age, household income and marital status. You may be eligible for more than one type of benefits, but generally SSA will pay you the higher benefit amount of any one program you may be entitled to.

Disability Insurance Benefits: This program, also known as "DIB" or Title II benefits, awards benefits to individuals who, because of a physical or mental impairment, are unable to work at a "substantial" gainful level, and their condition has existed or is expected to exist for at least a 12 month period. By "substantial," SSA means the claimant would be unable to earn over $900.00 per month because of their disability. This dollar amount increases slightly every year. To be eligible for DIB, a claimant must have worked long enough and paid enough into Social Security through their FICA taxes to be "insured." As a general rule, if a claimant worked at least five of the last 10 years, he would be "insured" for purposes of DIB. How much a claimant receives each month if found disabled and entitled to DIB is based on how much he "paid into" the system during his working life. Generally, the longer someone has worked and the higher his earnings, the more he would be paid if found disabled. Individuals found disabled and entitled to DIB benefits may be awarded retroactive benefits. Retroactive benefits can only go back one year from the date of the initial application. There is a five-month waiting period from the date the claimant is determined to be disabled until entitlement to DIB benefits begin. To illustrate this, if a claimant files a claim for DIB on January 1, 2006 alleging disability as of February 2005, and SSA determines he is disabled and his disability began February 1, 2005, he would be eligible for retroactive benefits starting in July 2005. In addition to receiving individual DIB benefits, your minor children may also qualify for auxiliary benefits based on your disability. These benefits are granted in addition to any benefit you receive. To ensure any minor children are awarded any benefits they may be entitled to, it is important you furnish the names and Social Security numbers of any minor children you have to SSA. The children do not have to live in the same household to be eligible for auxiliary benefits.

Supplemental Security Income: This program, also known as SSI or Title 16 benefits, is a "needs-based" program in which individuals with little or no resources or assets may receive disability benefits. The medical criteria for SSI eligibility is the same as that used for DIB - a physical or mental impairment which prevents you from working at a "substantial" gainful level, and the condition has existed or is expected to exist for at least a 12 month period. Effective January 2007 the SSI payment for an eligible individual is $623 per month and $934 per month for an eligible couple. There is no retroactive eligibility for SSI benefits: benefits can go back only to the month in which your claim was filed. Unlike DIB, there is no five-month waiting period for entitlement to SSI, so your eligibility would begin the month in which you filed your claim or were determined to be disabled, whichever is later. A claim for SSI benefits can also be filed on behalf of any minor children with a disability; however, as with Adult SSI claims, to be entitled to SSI benefits the household income must be below certain limits.

Disabled Adult Child: This program provides disability benefits to adult children of deceased or disabled parents. In addition to the medical requirement that you have a physical or mental impairment which prevents you from working at a "substantial" gainful level, and the condition has existed or is expected to exist for at least a 12 month period, you must also show that your condition has existed and has been disabling since before your 22nd birth date. In addition, you must be the adult child of a parent who is currently receiving DIB benefits, or the Adult child of a parent who is deceased and was "insured" for purposes of eligibility for DIB benefits. It is not necessary that the adult child ever worked because benefits are paid on the parent's earnings record. The adult child must not have worked and earned "substantial earnings" for an extended period at any point after turning 22; however, certain expenses the adult child incurs in order to work may be excluded from these earnings. An adult child already receiving SSI benefits should check to see if benefits may be payable on a parent's earnings record. Higher benefits might be payable and entitlement to Medicare may be possible.

Disabled Widow's/Widower's Benefits: If you are a disabled widow or widower age 50 or older you may be able to receive benefits off your spouse's (or former spouse's) Social Security record. If you are a widow or widower from a spouse you were divorced from, to be eligible for benefits you need to have been married to your spouse for 10 years or longer and your disability must have started before age 60 and within seven years of the date in which the worker died. If you were married to your spouse when they passed away, Social Security does not require that you were married for 10 years. In either case, you will need to provide proof of relationship in the form of your marriage certificate or divorce decree, along with your spouse's death certificate when you file for benefits. If you file a claim for Disabled Widows/Widower's benefits and DIB or SSI benefits, you will receive only the higher monthly benefit amount of the two programs.

Medical Insurance: Once you are found disabled and entitled to Social Security disability benefits, you will also be eligible for medical insurance though Medicare or Medicaid. If you filed a claim for DIB, Disabled Adult Child or Disabled Widow's/Widower's benefits, you may be eligible for Medicare. However, eligibility for Medicare does not start until you have been disabled for 25 months. If you are approved for Social Security benefits under any of the above-listed programs, SSA will contact you approximately two months before your eligibility for Medicare begins. If you have already been disabled for 25 months, be sure to keep a record of all medical bills as you may be reimbursed by Medicare for these expenses. There is no waiting period for Medicaid; however, your income and resources must be very low to qualify. If you have applied for and have been approved for SSI you probably qualify for Medicaid. You may think that Medicaid and Medicare are the same, but actually they are two different programs. Medicaid is a state-run program that provides hospital and medical coverage for people with low income and little or no resources. Each state has its own rules about who is eligible and what is covered under Medicaid. Some people qualify for both Medicare and Medicaid. For more information about the Medicaid program, contact Social Security or your local social services or welfare office.

This article has been written to give you a general overview of the Social Security disability programs and the disability process. As this article may not address all questions you might have, please contact us for further information.



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How is an Attorney Paid For Social Security Disability Claims?

Attorneys who represent Social Security disability claimants generally do so under a "contingency fee agreement." That is, the client does not pay the attorney unless and until the case is resolved and Social Security benefits have been awarded. A representative who wants to charge or collect a fee from a claimant for services provided in any proceeding before the Social Security Administration (SSA) under the Social Security Act (the Act), must first obtain SSA's authorization. To do so, a representative must use one of two mutually exclusive fee authorization processes: the fee agreement process or the fee petition process. Under the fee agreement process, an attorney can collect no more than 25% of of back benefits recovered, or $5,300, whichever is less. If the attorney is unsuccessful in obtaining benefits, there is no charge.

Fee Agreement Process Before SSA decides the claim, the representative or the claimant may file a fee agreement. Generally, SSA will approve an agreement (under § 206(a)(2)(A) of the Act) if the other statutory conditions are met and no exceptions apply. If SSA approves the fee agreement and no one requests administrative review, the fee specified in the agreement is the maximum fee the representative may charge and collect.

Fee Petition Process After the representative's services in the case have ended, he or she may petition for a fee. SSA reviews the fee petition and authorizes a "reasonable" fee (under §206(a)(1) of the Act) for the specific services provided.

A fee agreement is a written statement signed by the claimant and his or her appointed representative specifying the fee the representative expects to charge and collect, and the claimant expects to pay, for services the representative provides in pursuing the claimant's benefit rights in proceedings before the Social Security Administration (SSA). For SSA to approve a fee agreement, the representative must submit it before the date of the first favorable determination or decision SSA makes on a claim after the representative's appointment. If the representative does not submit a fee agreement by that date, SSA assumes the representative either will file a fee petition or waive a fee.

If the representative submits a fee agreement before the date SSA makes a favorable decision, SSA will approve the fee agreement at the time of the favorable decision if the statutory conditions for approval are met and no exceptions to the fee agreement process apply. Once SSA approves the fee agreement, the fee specified in the agreement is the maximum fee the representative may charge and collect for all services in the claim.

A fee petition is a written statement signed by a claimant's representative requesting the fee the representative wants to charge and collect for services he or she provided in pursuing the claimant's benefit rights in proceedings before the Social Security Administration (SSA).

SSA presumes that the representative will either file a fee petition or waive his or her fee if the representative does not file a fee agreement before the date SSA makes the first favorable determination or decision. A representative who elects to use the fee petition process generally files the petition after his or her services in the case have ended. Based on this petition, SSA will authorize a reasonable fee for the specific services provided.

The fee agreement and fee petition process are not interchangeable. However, if a representative elects the fee agreement process but SSA does not approve the agreement, or if an SSA reviewing official upholds a disapproval of a fee agreement on administrative review, the representative must file a fee petition if he or she wants to charge and collect a fee for their services.

The Social Security Act and SSA regulations prohibit representatives from charging or collecting any fee for representational services that SSA has not authorized, or that is more than the maximum amount SSA authorized. Any representative found to have charged or collected an unauthorized fee may be suspended or disqualified from practice before SSA and will be barred from appearing before SSA until full restitution is made. The representative also is subject to fines and imprisonment.



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The Internet Surfing Heart Device

Technology has proven over time that there is no problem that cannot be overcome given the will to succeed, the time to develop the appropriate knowledge, and the inherent ability for the human mind to imagine. This astonishing component of the human existence has occurred once again in the area of medical treatment.

George Woods, a 73-year-old Canadian man, has received a revolutionary device that will inevitably change the way heart healthcare is handled all over the world. The device is called the Vision 3D and is about the size of a quarter. In order to monitor the heart, it has wires that extend to specific veins and also directly to the heart.

Mr. Woods has suffered from numerous heart attacks and two bypass surgeries. His doctor decided to give him the device because of his week heart and also the long distance that he has to travel to get to the hospital.

What is remarkably unique about the device is that it links to a transmitter about the size of a keyboard. This transmitter is able to download vital information about the patient allowing the doctor to determine what to do for the next visit, or if the patient needs to come in immediately. This unique property allows the patient to do periodic check-ups with the doctor from home.

The doctor is able to even fix very minor issues remotely as well. Medtronic is the company responsible for creating this revolutionary device. The device is not for everyone, as it is recommended for individual with only very serious heart conditions.

Experts anticipates that the device will reduce wait times, the number of hospital visits throughout the year, and will also open up space for very serious and urgent conditions that require extensive medical treatment.

However this milestone could bring about concern for what lies in the future. The ability to access physiological information about an individual remotely and possibly manipulate that physiology has some people worried. Researchers have discovered that these devices are capable of delivering deadly electric shocks to the heart, which means that it could be possible for individuals to commit murder from the click of a mouse.

Even with Medtronic current devices, malfunction has been a problem. These machines are entrusted with lives, and through technical error take them away. If big companies like Medtronic are going to play the game of medical treatment, they must be held accountable for the seriousness of mistakes made.



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Medicare - Dispelling the Myths

To say that Medicare is a labyrinth of legal jargon that's beyond the comprehension of the average American is an understatement. When it comes to Medicare and a Texas Medicare supplement, what you don't know can definitely hurt you. In fact, many people simply don't have the right information to make educated decisions - something that could come to haunt them down the road. Here are some common myths about Medicare, and some facts about finding a Medicare supplement in Texas.

Myth #1: Medicare automatically covers me after I retire.

Retirement and Medicare are unrelated. Unless you receive Medicare for a disability, you must be 65 years old in order to be eligible for Medicare benefits.

Myth #2: The government will automatically enroll me in Medicare.

You won't necessarily receive automatic enrollment; rather, it depends upon your work history. If you've worked 40 quarters in the United States, you'll be automatically enrolled in Medicare Part A. If you started receiving Social Security benefits when you were 62, you'll automatically be enrolled in Part B, but have the option of declining the coverage if you're covered by, for example, a group health plan.

If you haven't worked 40 quarters, you have to enroll in Medicare through your local Social Security office. Similarly, if you aren't collecting Social Security benefits, you have to go to the Social Security office to enroll in Part B.

Myth #3: Medicare will cover all of my medical expenses.

In truth, Medicare Part A covers your room and board while you're in the hospital or in a skilled nursing facility. It doesn't cover any medical services. Plus, there's a $1,000 deductible for the length of your stay in the hospital, plus 60 days. In other words, if you spend a couple of days in the hospital in January, and have to go back in April, you'll have to pay $1,000 each time.

Medicare Part B partially covers services like doctors' fees, lab visits, costs associated with surgery, x-rays, and so forth. Typically, you have to pay a deductible each year, as well as 20 percent of your medical bills. Keep in mind that, if you receive care that is not covered by Medicare, you'll be responsible for 100 percent of the cost.

Myth #4: Medicare Parts C and D will fill in the gaps in my coverage.

Medicare Parts C and D are seemingly even more convoluted than Parts A and B. Part C is optional coverage offered by private insurance companies. In order to get Part C, you have to give up your coverage under Parts A and B. Part D is optional prescription drug coverage that has myriad variables, such as premiums, co-pays, coverage gaps, and co-insurance. You can choose which prescription drug plan best fits your needs.

Finding a Good Medicare Supplement

When you have gaps in your medical insurance, it's as though you're constantly standing on a precipice, never knowing if an illness or hospitalization is going to wipe out your life savings, force you to sell your home, or otherwise wreak havoc on your finances. With the right Medicare supplement in Texas, however, you can fill in the gaps and limit your medical expenses to your cost of Part B, Part D, and the supplement.

Fortunately, it's easy to find the best Texas Medicare supplement for your needs. While calling one insurance company after another and trying to compare apples to oranges can be a nightmare, you can easily go online to find Medicare supplement quotes. The best companies allow you to fill out your information online, and even have agents who can instantly provide you with pricing for the 10 leading companies in the state. This way, you can find the best company and rate for your supplemental plan.



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Arthroscopic Shoulder Treatment in India - Get It

Indian orthopedic surgery hospitals provide very good treatment facilities to abroad patients for their arthroscopic shoulder treatment in India. Arthroscopic shoulder surgery is most advanced surgical technique available for the treatment of shoulder disorders. As the surgical technique is performed by most expert surgeons of India, the risk involved in the process is very less and the success rate of shoulder surgery in India is also very high. Thus many abroad patients are getting attracted to India for their treatment in India at low cost. The cost of treatment in Indian orthopedic surgery hospitals is very less as compared to the cost of treatment in abroad orthopedic surgery hospitals. Getting arthroscopic shoulder surgery done from Indian orthopedic surgery hospitals has become most adoptable option for abroad patients.

Arthroscopic shoulder surgery is a common orthopedic procedure that is used to diagnose and treat problems in joints. The most common type of arthroscopy is arthroscopic shoulder surgery. Other common arthroscopic surgeries include knee, elbow, wrist, ankle, and hip arthroscopy. Arthroscopic surgery is most commonly performed on the knee and shoulder joints. The reason the knee and shoulder are the most commonly arthroscoped joints is that they are large enough to manipulate the instruments around, and they are amenable to arthroscopic surgery treatments. In technical way, any joint can be arthroscoped. The most common arthroscopic procedures include repairing cartilage and meniscus problems in the knee, and removing inflammation and repairing rotator cuff tears in the shoulder. Shoulder arthroscopy is a surgical procedure for arthroscopic shoulder repair. With this procedure complete disorders of shoulder can be removed. Shoulder arthroscopy is performed through "portals". These are small incisions, generally about half of an inch to an inch long in the skin, are located over particular areas of the joint that the orthopedic surgeon will need to operate upon. Small plastic tubes, called "cannulas" are then inserted into the portals so that instruments can easily be placed in the shoulder joint. Shoulder arthroscopy itself involves inserting a specially designed video camera with a very bright fiber optic light source into the shoulder joint so that the important parts of the joint can be seen. Once the procedure is finished, the instruments, camera, and cannulas are removed, the wounds are closed with either suture or staples. Shoulder arthroscopy is an advanced surgical procedure for the correction of shoulder disorders and highly result oriented surgery. The success rate of shoulder arthroscopy is very high worldwide and the recovery time after the surgery is very less as compared to other surgical procedures as the surgical technique is most advanced.

Arthroscopic shoulder treatment in India is a very good option nowadays for those abroad patients seeking low cost shoulder arthroscopy. With arthroscopic shoulder treatment in India patients can get free from shoulder disorders at the most affordable price. The success rate of arthroscopic shoulder treatment in India is very high as the surgical procedure is performed by most expert arthroscopic surgeons of India. The surgical technique available for the treatment of shoulder disorders are most advanced thus the risk involved in the process is reduced and the recovery time required after the surgery is very less. The cost of treatment in Indian orthopedic surgery hospitals is very less as compared to the cost of arthroscopic shoulder surgery in abroad orthopedic surgery hospitals. Thus many abroad patients are getting attracted to India for their low cost treatment.



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Why Should Health Care Be Affordable?

Access to proper health care has become a major problem in the contemporary America. Millions of people, insured or uninsured, are facing escalating medication costs. This pathetic condition affects not only the health of the individuals' but also the economy and quality of the life. A drastic rise in the health care premiums over the past decade has made health insurance not affordable for many families and has resulted in the increase of the percentage of the people who are uninsured. The number of people who are uninsured has mounted to over 47 millions in the past few years. Overall, in simpler terms, we can say that the reason why people are uninsured is because they cannot afford it.

Many people, today, are in a kind of a situation where one medical emergency can bring in financial ruin and this is mainly because of the expensive health care costs and the prescriptive medicines which take a largest share of their pocket. This situation calls for grave measures that have to be taken in providing affordable health care to everyone. In fact, it is not only the responsibility of the government but is the duty of everyone right from organizations to individuals to work together in making health care affordable to everyone.

With a motive of making health care affordable to all, some companies started offering plans that allows one save up to 80% on the medical bills. Providing huge discounts on the bills will definitely reduce the burden on the individuals.



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Hospital Acquired Conditions and Your Health System's Bottom Line

The current Medicare payment system is considered to be prospective, in that the amount paid to a hospital for a patient is fixed in advance and depends only on the diagnoses and major procedures reported at discharge. In reality, payments under this system have never been completely prospective, being influenced to some degree by what happens to an individual patient during a hospitalization. For example, higher payments are made on behalf of patients in whom clinically significant complications develop after admission than for those with the same diagnosis who have no such complications. There are also so-called outlier payments that partially compensate hospitals for the additional expenses incurred for very-high-cost cases. With regard to preventable complications, these retrospective features of the DRG payment system have harbored a perverse incentive: hospitals that improved patient safety and eliminated problems such as nosocomial infections saw their Medicare revenues, and sometimes their profits, reduced.

Believing that this counterproductive incentive should be eliminated, Congress instructed the Secretary of Health and Human Services in 2005 to "select at least 2 conditions that are (a) high cost or high volume or both, (b) result in the assignment of a case to a DRG that has a higher payment when present as a secondary diagnosis, and (c) could reasonably have been prevented through the application of evidence-based guidelines." After issuing a proposed set of measures and considering comments from stakeholders and experts, CMS decided to disallow incremental payments associated with eleven secondary conditions that it sees as preventable complications of medical care. These conditions, if not present at the time of admission, will no longer be taken into account in calculating payments to hospitals after October1, 2008.

The eleven selected conditions include:

1. Foreign Object Retained After Surgery (750 cases nationally in 2007)
2. Air Embolism (57 cases)
3. Blood Incompatibility (24 cases)
4. Stage III and IV Pressure Ulcers (257,412 cases)
5. Falls and Trauma (193,566 cases)
6. Catheter-Associated Urinary Tract Infection (12,815 cases)
7. Vascular Catheter-Associate Infection (29,536 cases)
8. Surgical Site Infection-Mediastinitis after Coronary Artery Bypass Graft (69cases)
9. Surgical site infections following elective procedures
10. Glycemic Control issues such as diabetic ketoacidosis, nonketotic hyperosmolar coma, diabetic coma, and hypoglycemic coma (16,060 cases)
11. Deep Vein Thrombosis / Pulmonary Embolism (140,010 cases)

While the new reimbursement rules present significant risk to hospitals and health systems, they also create great opportunity to develop world class quality management processes, infrastructure, and organization.

Significant Financial Impact

The new rule will result in hospitals seeing substantial reductions in payment for the care of individual patients with preventable complications. For example, if a patient were admitted to a Boston-area hospital with pneumonia and developed a urinary tract infection or bed sores during the hospitalization, the hospital would currently be paid $6,253.58, under DRG 89 ("pneumonia with complications"); under the new rule, if there were no other complications, the hospital would be paid only $3,705.38, under DRG 90 ("simple pneumonia"), a difference of $2,548.20 (a reduction of approximately 40%).

A study of the reimbursement impact on nosocomial urinary tract infections alone at one New York hospital was reported in AHIMA Perspectives online journal. The urinary tract remains a significant site for hospital-acquired infections, with 66 percent to 86 percent of UTIs being associated with urinary catheterization. The prevention of UTIs represents a potentially rich opportunity to reduce the incidence of hospital-acquired infections. Analysis of w/CC vs. without CC DRG-pair reimbursement for patients having a secondary diagnosis of UTI, and under the assumption that the UTI was the reason for upcoding to the with complication DRG, resulted in the hospital receiving $4.5 million greater reimbursement due to the nosocomial infection. Three DRGs were randomly selected for detailed chart review, and within that subset it was determined that the nosocomial infection was the sole reason for about 15% of the higher DRG assignment. Extrapolation of this to the entire population resulted in an estimation that the hospital would have received $675,000 less in Medicare reimbursement for the UTI issue alone.

Vascular catheter associated infection represents another major area of risk for hospitals. A significant number of patients rely on vascular access devices, like PICC lines, to deliver needed medication. The line has to be placed and maintained in a specific manner, or it has a potential to cause a catheter-related bloodstream infection (CRBSI.) CRBSI, along with ventilator-associated pneumonia (which CMS is considering adding to the selected conditions list for FY2009), are the two most costly infections to treat. Analysis in one Midwestern hospital identified that the average cost to treat a CRBSI was $91,000, whereas the average reimbursement was about $67,000; an operational loss of $24,000. As of Oct. 1, 2008, reimbursement will be zero. The CDC estimates 250,000 central line-associated infections occur in the United States annually, with an attributable mortality rate of 12 to 25 percent.

This reimbursement change represents the leading edge of a series of anticipated CMS reforms of provider payment, which include a shift toward pay for performance. Hospitals may therefore view the new policy as a harbinger of things to come and act in anticipation of more substantial reimbursement changes. Nine additional HACs are being considered for addition to the reimbursement exclusions in October, and 43 additional are being considered for implementation in FY 2010. Finally, as was observed with the DRG reimbursement system, private third party payers will be expected to adopt a similar approach.

Proactive Solutions

Just as advent of the Prospective Payment System revolutionized hospital Cost Management in the two decades ago, pay for performance will revolutionize hospital Quality Management over the next decade. To prepare your health system for this change in the game, we recommend you take the following steps:

* Assess your Health System Quality Management Readiness. Evaluate how your Health System stacks up in the five Critical Markers of quality management effectiveness: Strategy, Process, Infrastructure, Organization and Culture. Identify Gaps and corrective strategies.
* Estimate the impact on your Hospital or Health System. Using macro data analysis and chart sampling estimate your risk exposure by major diagnostic category and HAC.
* Identify the Gaps. Identify major problem areas and identify the required metrics, clinical and process improvements, available technology enablers, and organizational enhancements required to significantly reduce your risk exposure.
* Design the Fix. Assemble multidisciplinary process improvement teams to develop effective Present on Admission (POA) assessment processes, address the root cause of quality gaps leading to hospital acquired conditions, and to design innovative sustainable solutions.
* Implement the Fix. Test and refine the designed solutions in innovation labs and adopt a Quality Accelerator approach to integrating the solutions into the fabric of your health system.
* Measure the Results. Design and implement monitoring systems that measure the effectiveness of your efforts and provide closed loop feedback to ongoing quality management activity.

When healthcare quality is high, everything else follows. Patients are delighted. Physicians and employees are happy, efficient and effective. Market share rises. Margins increase. Your organization grows and thrives.

Scott Hodson is a Principal in Maverick Healthcare Consulting.



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How to Minimize Your Healthcare Costs?

Health is concerned with the well-being of an individual and is imperative for all of us. It gives an incisive picture of the physical, mental, and social status of one's self. Good health is a key to enduring success which reflects the status of the mind as well. To maintain a good health everyone has to take good nutritious food, do regular exercise and have a positive learning and mental attitude which can reduce the chances of falling ill. Lethargic and lassitude life style can bring in health problems. To be fit and agile everyone needs to work hard in whichever way possible.

Apart from all these, positive thinking also plays a major role in maintaining our health. One needs to maintain an optimistic approach of things and get rid of pessimism which can bring in all the good things in life. These simple changes in your life style can improve your health and make you feel strong and physically fit. Ignoring all this measures would put you in a state where you can lose your health, mental peace, and the hard earned money.

As everyone is aware of the fact that the medical costs in America are escalating more than the inflation rate which makes most of the Americans lose access to quality health care. Most of the people are uninsured or under-insured which makes the situation even worse. Still, Americans have a choice to dodge the costs of health care which comes in the form of discount plans. These plans are best judged to be an alternative to the traditional insurance plans. Discount plans usually offer huge discounts of up to 80% on the medical bills which allows one to save considerable amount of money. Discount plans also offer a lot of other benefits which provide access to complete health care for Americans. More information on these discount plans can be had by visiting http://www.health-dental-discount-plans.com



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Health Care - What Adventurous Employers Are Doing

Health care costs are an issue that every business faces-from the smallest nonprofit to the corner family-owned drug store to major corporations. A new trend is taking shape in which employers take the initiative in encouraging employees to "own" their health. Part of this strategy involves recognizing that insurance alone cannot create a healthy workforce. Employees must be encouraged to take ownership of the aspects of their health that can be impacted by their own actions.

So more and more employers are adopting innovative strategies to advise and encourage their employees to make healthy choices in life:

1) By creating intranet systems that inform employees about their health plans while providing individualized fitness and wellness advice;
2) Providing links to health information on the Web;
3) Making gym facilities and nutrition information available to employees;
4) Creating employee newsletters that deal with health issues;
5) Holding health workshops and fairs;
6) Incentivizing healthy choices among employees, such as good diet and exercise, regular medical checkups, and yearly screening.

Companies continue searching for working strategies in these areas. One Detroit-based holding company, adopting the last-named strategy above, recently embarked on an innovative program which it calls the Million Minute Challenge.

Many people know how easy it is to make resolutions about exercise-and how hard it may be to keep them. Hard-working, competitive American employees, who pour their energy into their jobs, know that career and personal demands can make it hard to dedicate the time to exercise. Still, it is important to get the doctor-recommended thirty minutes of physical activity per day. For all types of workers, including those white collar workers who may spend hours in front of a computer, sitting at a desk, taking a half-an-hour to rejuvenate may have great impacts on physical health and energy levels.

With the Million Minute Challenge, one of the foundational principles of modern business is used to encourage employees to make that sometimes-hard, healthy decision: competition. Divisions of the company are being positioned against each other, with those divisions whose employees log the highest number of hours of exercise being eligible for prizes. Individuals who log heroically high number of hours will also be awarded. Over a nearly six-month period (twenty-four weeks), working with a base of two thousand employees nationwide, the company has set the ambitious goal of logging a million total hours of exercise. No particular sport is mandated: you can walk, swim, cycle, run, lift weights ... Each company site will have a log book, where the minutes of exercise are written by each individual employee on an honor system.


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What Are Clinical Trials?

Simply put, a clinical trial is a research study that allows doctors to test new treatments on humans who agree to participate. There are many definitions but they are generally defined as biomedical or health-related studies that follow a pre-defined protocol. A protocol is a method or treatment plan that is adhered to by the doctors. The reason for a clinical trial is to find better more effective methods of treating or preventing a particular disease. You can look for clinical trials at a variety of locations including some local places like the Manhattan Illinois Healthcare facility or the Kankakee Illinois Healthcare facility but more likely you'll find them at larger facilities that have research arms like the National Institutes of Health and the Mayo Clinic. It's not to say that there aren't trials at Momence Healthcare and if not, they may know of one that your particular health situation may fit into. Often times if a researcher or investigator can't find enough people with a specific disease or condition, he or she gathers investigators at other locations and spreads the trial out over the country or the world.

There are both interventional and observational types of studies. In interventional studies the research subject, patient, is assigned a treatment or other intervention which may include a placebo, and their outcomes are measured. Observational studies are where individuals are observed and their outcomes are measured. The investigators recruit patients with predetermined characteristics and administer the treatment or intervention and collect data on the patient's health for a defined period. These statistics are then analyzed by researchers.

Some areas that a clinical trial may be designed to focus on include assessing the safety and efficacy of a new medication or device on a specific kind of patient, assessing the safety and effectiveness of a different dose of medication than is commonly used, assessing whether the new medication or device is more effective for the particular condition than the currently used medication and several other trials for assessing a variety of medications and their uses. Often clinical trials may be required before the new drug or device is approved and marketed for its use on new patients.

Speaking from family experience, the most encouraging aspect of clinical trials is they may be a last resort for treatment, especially in cancer treatments. This may not always be the case but when it is there is hope yet guarded hope. If you are lucky to be getting the treatment verses being given the placebo, you may have more hope than otherwise experienced as the treatment options seem to have been running out.



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Structured Cabling in Healthcare Facilities and TR-42.1

Gartner's Inc. independent research had shown that as much as half of network problems in the healthcare industry are due to an inadequate or substandard cabling infrastructure.

The network infrastructure represents the backbone supporting most IT functions. Today's healthcare centers' networks need to accommodate not only an enormous volume of data generated by the modernizations that technology brought to medicine but also need to comply with regulatory standards.

Telecommunications Industry Association's (TIA's), TR-42.1 Engineering Subcommittee formed in 2004 a task force group with the mission of bringing awareness within the healthcare industry of the benefits of having a comprehensive strategy for structured cabling design and installation that is unique to this industry. Most seasoned structured cabling contractors are aware that TR-42.1's developing guidelines. These guidelines are meant to assure that telecommunications infrastructures for the health-care industry are adequate and universal.

Some of the areas covered in the guidelines TR-42.1 are listed below:
# Voice, data, video network infrastructure cabling, (i.e. security alerts and surveillance, CCTV, and CATV);

# Professional, patient and asset information systems and tracking;

# Remote consultation/telemedicine, diagnostic imaging, digital transfer of X-rays, pharma applications;

# Mobile applications including nurse call and patient monitoring;

# Bio-analytical systems, clinical equipment monitoring, lighting control;

# Fire and life safety systems, (i.e. alarms, sprinkler systems, Master clock);

# Public network; and others;

The cabling infrastructure is critical in designing networks that are flexible, fully integrated and accessible. In today's healthcare environment Ethernet networks that are IP-based are most suitable to provide the transmission of the large quantities of healthcare related data in a rapid and accurate manner. They support the many applications such as voice, data, video, monitoring and control.

Transmission speed and bandwidth are important factors that determine a "high performing" network. Having a robust network infrastructure is more than a mere necessity. In healthcare facilities a network that fails can lead to far bigger problems than poor network performance, it can be life threatening. Gartner Inc. research firm concludes that "The wiring plant is arguably the most important part of the network. Spend the time and money to ensure that what is installed will be able to support the environment well into the future. ..."

Considering that hospitals are built to last for more than 50 years the cable plant needs to be built to perform adequately for its lifecycle of about 10 years. Gartner research has shown that cabling infrastructure represents a very small percent of the IT designated resources (around 2%-5%) yet it can account for up to fifty percent of the problems. This demonstrates that an incremental increase in cabling investment can lead to an exponential increase in network performance, robustness/reliability as well as productivity and patient safety, patient safety being a major driver of the healthcare facilities network design.

Given these statistics hospitals in North America should project and plan for the total cost of ownership of the network infrastructure over its expected lifespan, rather than initial installation costs as well as consider hiring contractors that comply or exceed the TIA's TR-42.1 guidelines.



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Is Fish Oil A Quick Fix For Your Memory?

A lot research has focused on omega-3 fats as good for body and brain function. Scientists have scrutinized these fats in everything from heart disease and diabetes to depression, bipolar illness, schizophrenia, ADHD and Alzheimer's. The latest papers to add to the experimental pile come from a recent edition of the American Journal of Clinical Nutrition.

The new studies evaluate omega-3s in people in their 70s and 80s and relate to cognitive function, mood and mental well-being. The bottom line to the new findings is that having higher levels of omega-3s in your blood protects you from many cognitive problems of old age. The downside is that you can't just start taking them in your 70s and expect quick results. However, longer use may still be beneficial.

So what's the best way to boost omega-3 levels in your blood. First, you have to understand that there are different kinds of omega-3s that come from different sources. The kind of omega-3s that are good for your brain are called 'long-chain' omega-3s, most commonly DHA and EPA, and fish is the best source for these.

You may have heard that things like flaxseed oil and walnuts are high in omega-3s as well. Although this is true, these foods are only high in 'short-chain' omega-3s, which are not the kind that appear to have the most brain benefit.

To complicate things even further, most animals can convert the short-chain to long chain forms, but humans are not very good at this. If we want to increase long-chain omega-3s in our blood and increase our odds of aging with a healthy brain, eating sources of long-chain omega-3s is our best bet. Fish is the #1 source.

If you don't eat about 3 servings of fish per week, you should really consider taking a fish oil supplement on a regular basis. If you are a vegetarian who does not eat fish at all, don't fret, there are also algal oil supplements out there that have the long-chain omega-3s. After all, fish can't make omega-3s either. They get them by eating marine plants (or eating other fish that eat marine plants). Fish are just good at concentrating omega-3s in their meat, so are a great source for us folks that don't like chewing on seaweed.

Fish has been considered brain food for the better part of a couple of centuries. Whether you like it or not, our bodies are designed to run best on a diet high in marine sources. If you look at the cultures around the world who enjoy longevity and vibrant health into their old age, you will find fish as a staple in all of them.

There is nothing new to this advice. Only that we are now beginning to understand why fish and the omega-3s they give us, are important for many aspects of our mood and metabolism. Once again, science finally catches up to age-old wisdom to support what we have known all along - Fish is brain food, eat it and prosper.


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Rehabilitation Hospital: What Are 7 Important Questions

When you (or a loved one) are scheduled to be released from the hospital, you may make a detour to a rehabilitation hospital before you get to go home. You may need to get stronger, and the rehab hospital will provide an intensive therapy program. Here are seven questions for you to ask first.

1. How much therapy is planned?


At a rehab hospital, each patient is placed in an intensive therapy program, based on individual needs. A patient will often receive several hours of therapy per day to aid in recovery, which may be a combination of physical therapy, occupational therapy and speech therapy.

2. Why is a rehab hospital being recommended for me?

In most cases, you are sent to a rehab hospital when you are too "well" for the acute care hospital but not yet strong enough to return home. Usually, you will receive more therapy in a rehab hospital than you would receive in a skilled nursing facility. (You will also receive more therapy in a skilled nursing facility than in an assisted living facility.)

3. How many days of insurance coverage you will have at the rehab hospital?

Do not assume that because you have Medicare and supplemental insurance that all of your days of admission will be covered. And, on the flip side, the rehab hospital may be motivated to try to use all of your days (to maximize their insurance payments) even if you do not need them. It is astounding, but sometimes family members have to argue to get a patient discharged before all of the days are used up.It is often a delicate balance to determine how much time in a rehab hospital is "enough." If you leave the hospital before staff recommends it, you may have to sign documents acknowledging that you are signing out "AMA" or "against medical advice." If you do leave "AMA," you will have to do extra planning to return safely to your home.

4. How much therapy does my insurance cover? How many visits? How much per visit?

You cannot assume that all of your therapy charges will be coveredask this before you get transferred there. See if your insurance requires therapy preapproval, and if so, how many visits will be covered. In some cases, you may end up with a bill for the unpaid therapy services. You will want to confirm whether you will be required to pay any residual balance after your insurance(s) have paid.

5. Which rehab hospital is being recommended?

You may have a choice on which rehab hospital to choose, depending on where you live. There could be a rehab hospital that specializes in brain injuries, for example. If you had head trauma, it might make more sense to reside there and get the utmost benefit available, and maybe have a shorter stay than one at a rehab hospital that does not have the same experience and expertise. If you have a choice to make about which rehab hospital to choose, you will want to gather some information about each. You will want to get the name, address, phone number, and name of the contact person for each facility. See if the facility specializes in treating people with your particular diagnosis. You will need to know what therapy services are being recommended for you, and if they are available at each facility.

6. What should I bring?

The rehab hospital will provide the medical equipment and other adaptive devices to aid in your recovery. You may want to bring other items to add to your comfort and ease. If you brought clothing and toiletries with you to the acute care hospital, you may want to bring them to the rehab hospital. Things you might consider bringing include the following: robe, socks, sweater, scarf, headband, slippers, pillow, blanket, sleep mask, ear plugs, earphones, razor, shampoo, conditioner, lotion, books, magazines, DVDs, DVD player, radio, and basic toiletries. Bring several sets of loose and comfortable clothes, and don't forget sturdy walking shoes. You have to get dressed every day, and the staff will not allow you to stay in your robe and slippers.

7. Should I bring my prescription medicines?

It is also a good idea to have a 2- to 3-day supply of your medications to bring with you to the rehab hospital. In this way, in case there is a mix-up of some kind, you are assured that you will not miss any doses of medicine.

In conclusion, a stay at a rehab hospital will give you the chance to recover from your illness to the greatest extent possible. The therapy program is designed to meet your specialized needs so that you can get as strong as possible to return to your home.



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The Benefits Of Playing Sick: Using A Doctors Excuse

More and more people are identifying a number of benefits of the doctors excuse that they can get online instead of the ones they get from their doctor. Many consider the printable fake doctors excuses instead of getting a real one from the doctor for a number of reasons which we will discuss below. Although the reasons listed below are discussed in this article, they are not the only reasons that people are turning to fake sick doctors notes. These reasons can be as varied as the people who use them.

Although there are some who are a bit uncertain about utilizing this concept, there are actually quite a few people who find them a better solution than what they've had in the past. Review the upsides below that have been reported by people who have used printable fake doctors excuses.

The First Upside - For those with no medical insurance, they are saving money on a needless visit to the doctor - whose bill can range anywhere from $55.00 to $145.00. It is a strong reason why the fake sick doctors notes becomes a solution.

Also, maybe you have insurance, but your policy is very restrictive and/or has lots of different types of things that you have to pay for. All this adds up for the worker. He needs to keep his poor insurance plan available for when he really does need to go to the doctor. So, if you use an excuse that is fake, you'll save on what you'd have to pay at the doctor, and also save your insurance for when you really need it.

The Second Upside - Don't worry about losing your job because you couldn't afford to go to the doctor. You may just find it helps you to keep your job secure when you use fake sick doctors notes.

In today's stringent workplace, there are more and more employers who fire their employees if they do not have an excuse from a doctor. The last thing you want to do is to lose your job because you had a cold, but people stopped going to the doctor every time they got a cold long ago! So, if you need to keep your job, these excuses can offer another option.

The Third Upside - Don't Get Your Pay Docked Because You Needed a Doctors Excuse - There are many companies today that seem to think you can only take sick pay if you are sick and it has been proven by the doctor. It is just getting more and more for the company and less and less about what the worker can afford. These companies demand that for you to receive the pay you produce a doctors note. So, in order to collect your sick pay, you have to spend money to go to a doctor to get your money, which just shows the company is making it easy for them to keep your wages and for you to have to spend, spend, spend to prove that they shouldn't.

When you come in with a doctors' note, you'll be able to make sure that you don't miss any pay.

The Fourth Upside: Your Time Is Valuable Too - How long does it take you to go to the doctor? If you are only out for a day and it takes you half a day at the doctor's office - especially when you really didn't feel well enough to be going out! Of course the fake sick doctors notes really solve that problem for many of us. Think too when you don't feel well enough to drive yourself to the doctor's office, then you have to take the bus and be sick around others who object.

Just make sure to avoid the far out printable fake doctors excuses as they are not really great if you need doctors excuse to get out of work or school, they may be a great way to play a prank and get a good laugh. So ensure you have quality excuses from a quality site!

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