here.
You probably interact in some capacity with big brands on a daily basis , whether that is something as simple as getting a Coke out of the vending machine or running around the neighborhood in your Nikes. Find products you use. Find products you like and are interested in. Then see how they are using social media (if they are). This way you are placing yourself directly in the role of the customer , and you can evaluate exactly what you are getting out of their social media experience .
Since you can look at this from the customer’s perspective, you can use that to determine strategies that you feel work, and those that you feel don’t. It’s not a bad way to find concepts you can apply to your own business or at least some that you can test.
Dear Energy Professional, Dear Colleagues,
Your writer has received press releases from various resources for a new thermal power plant in Adana Tufanbeyli, in Turkey. The new 450 MWe coal fired thermal power plant investment in Adana Tufanbeyli is delayed for 3 years due to prevailing economic crisis. The project will be started in the second half of 2010 which was planned in year 2007 earlier.
The field related hydro geological studies were continuing in the field at Tufanbeyli. Plant is expected to consume 7.2 million tons of nearby local lignite per year, and will generate 3 billion kilowatt – hour of electric energy.
Investor Company officials advised that Negotiation work is in progress with companies of South Korea, Japan, for the key plant equipment supply and the construction. Plant operation will be in compliance with the latest EU environmental rules and regulations.
Local Holding company started planning to construct thermal power plant in 2006 in Adana Tufanbeyli with an investment budget of 480 million dollars. 100 hectares of land expropriation is already completed. Investment will be in build-operate model.
Coal mine has 214 million tons of proven lignite reserves in the region as reported in Turkish Coal Board reports. Available lignite coal has 1350 kcal per kg lower heating value with 44 percent humidity, 26 percent ash, 2.2 percent sulphur in average. Overburden / coal ratio is 8. Coal price is estimated to be 10.53 US Dollars per ton.
Available local coal is too difficult to fire in the steam boiler therefore special care in basic design is necessary. CFB and IGCC designs are recommended in lieu of conventional pulverized coal firing. Coal should be tested upfront.
This basic design activity cannot be left at the mercy of the foreign designers. There is no luxury to leave the design control to the vendor. Investor Company has to have basic design programs and local engineering capability to monitor completely all phases of the project execution from their home offices.
It is reported that investment will create employment for approximately 400 people in the region. Your writer is always happy to get such news on new energy investments in the local energy market, provided that
They are found/ registered/ accepted as environmentally friendly by the Ministry,
We understand that project financing is secured by the investor partners, but loan allocation will be delayed to year 2010. Project financing is difficult in Turkey, especially at this time of global financial turmoil. Public institutions have limited or almost no capability.
The good side of that is Turkey will need more local private financing, and local contracting, local engineering. Your writer sincerely feels that our local private investors deserve all our support to complete those new power plant investments.
Above article is to be presumed a sort of executive summary for an important local thermal power plant investment free-of- charge, which would otherwise cost thousands of US dollars if that job would be given to an international engineering consultancy firm.
We will be too pleased to receive your comments.
Haluk Direskeneli, Ankara based Energy Analyst
(NaturalNews) President Obama’s declaration of a national pandemic emergency is “no cause for alarm,” reported the mainstream media throughout the weekend. The declaration is nothing more than a “precaution,” they say. “It’s really more a continuation of our preparedness steps,” said Anne Schuchat, director of the Centers for Disease Control and Prevention’s National Center for Immunization and Respiratory Diseases, in a USA Today story.
In other words, there’s not really any emergency at all. So why declare a national emergency in the first place? The media reports this was done to allow hospitals to bypass federal regulations concerning the setting up of large-scale triage sites — emergency medical camps quickly constructed to deal with large numbers of sick people.
But at the same time, H1N1 isn’t causing large-scale sickness. As USA Today reported, an expert on infectious disease, P.J. Brennan (the chief medical officer for the Penn Health System at the University of Pennsylvania in Philadelphia) said, “The public ought to take some solace, some relief in this. It’s not a suggestion that things have deteriorated in any way. In no way is the virus more severe or more difficult to manage.”
So let me get this straight. The H1N1 virus remains mild. The CDC reports that swine flu infections already peaked out in mid-October. There have been no new developments in swine flu that would be cause for alarm and no reason to suspect huge numbers of sick people flooding into the hospitals. And yet, for some reason, the Obama administration has declared a national pandemic emergency specifically for the purpose of speeding the ability of hospitals to process large masses of sick people through emergency medical triage tents?
What are these people not telling us?
Something doesn’t add up here. Why would the U.S. government need to declare a national emergency to enable hospitals to handle a flood of sick people when there is no flood of sick people (and the pandemic seems to be fizzling out)?
This is more like the kind of preparation you might expect in advance of a biological terrorism attack , not for a flu that appears no more dangerous than the seasonal sniffles.
The National Emergencies Act and FEMA
The National Emergencies Act passed in 1976 has some peculiar realities attached to it. In particular, as Wikipedia reports:
A federal emergency declaration allows the United States Federal Emergency Management Agency (FEMA) to exercise its power to deal with emergency situations … Typically, a state of emergency empowers the executive to name coordinating officials to deal with the emergency and to override normal administrative processes regarding the passage of administrative rules.
Got that yet? By declaring a national emergency, Obama invokes a set of laws that not only override important sections of the U.S. Constitution, but that also activate FEMA to take charge of “responding” to the emergency.
Now we know why they need all those emergency medical tent camps near the hospitals. FEMA’s in charge! And if FEMA handles the swine flu pandemic in the same way the agency handled the Hurricane Katrina disaster, we may indeed need all those emergency triage tents after all.
Those of you who have been following the ongoing march to destroy the freedoms of the American People already know about FEMA camps. These aren’t Boy Scout field trip camps; they’re detention centers designed to hold large numbers of people for “emergency” purposes. Many theories abound on what these FEMA camps might be used for (www.campFEMA.com) (http://www.globalresearch.ca/index.php?context=va&aid=7763).
They could conceivably be used to quarantine people who are infected with a dangerous pandemic virus. On the other hand, they might also be used to isolated and detain people who refuse to be vaccinated against any declared pandemic. Under the National Emergencies Act and related U.S. law, FEMA would have two years of near-total control over the civilian population , during which people could be subjected to forced vaccinations, mandatory searches of their homes, gunpoint detainment and “involuntary transportation” to a FEMA detainment facility, and so on.
I’m not saying they’re going to do all this, but they could if they wanted to!
And that’s not freedom. Real freedom means you have the guaranteed right to be safe from being detained, or arrested without cause, or injected with a government-mandated chemical. Under a declaration of a national emergency, your “freedom” is at the whim of those who maintain police state powers over you. You’re only “free” if they decide to refrain from exercising the power they have over you. It’s the same kind of freedom you might get as a peasant in some Medieval kingdom where the king says, “You’re free to go.”
Now, some of these freedom-restricting actions might conceivably be justifiable if a truly dangerous pandemic virus were sweeping through the population killing millions, causing huge disruptions in the national infrastructure and threatening the nation with a partial or total shutdown of essential services. But that is not happening here . H1N1 is a mild virus that rates astonishingly low on the severity scale. If H1N1 were a hurricane, it would be little more than a “tropical depression.” It is not a category five hurricane, nor a phase six pandemic. Virtually everyone who is exposed to H1N1 generates their own antibodies and cures themselves naturally . According to hospital reports, those who have died from the H1N1 virus are almost exclusively people who were already suffering from preexisting conditions that compromised their health such as asthma or extreme obesity.
By any measure, H1N1 as currently configured appears to present no extraordinary threat to the health of the population . So once again, we must ask: Why declare a national emergency and initiate a FEMA response to something that’s not really an emergency?
Why I’m concerned what we don’t know might be going on behind the scenes here.
These preparations for large-scale medical triage tents and the emergency activation of FEMA have me worried that the American people aren’t being told the whole story. Perhaps a terrorist organization is planning on releasing a wildly dangerous mutation of H1N1 in some major U.S. city. Or perhaps some vaccine maker is, in fact, that terrorist organization. (The best way to sell more vaccines would be to release a mutated form of H1N1 into the population and scare up some more sales…)
Or maybe, as some creative thinkers have suggested, the vaccine itself IS a bioweapon, and the U.S. government is preparation for large-scale fatalities it expects to see soon.
Or maybe these are just fleeting, dark visions from crazy people, and the U.S. government is a benevolent organization with all our best interests in mind, and they’re jumping through these bureaucratic hoops to make sure there are plenty of hospital beds to go ’round just in case more people get really sick.
But even that explanation doesn’t hold water. A “national emergency declaration” isn’t necessary to waive hospital tent rules. Obama could have easily accomplished the same thing with an Executive Order , without having to invoke the National Emergencies Act or put FEMA in charge at all.
He chose the emergency declaration for a specific reason. I guess we’ll all have to wait and see what that real reason turns out to be.
(NaturalNews) It’s not unusual to hear about herbicides having suspected toxic effects or prescription drugs producing side effects. But a new National Institutes of Health (NIH) funded study just published in the Journal of Medicinal Chemistry has found another negative and surprising way common herbicides and fibrate drugs (which are used to lower elevated blood lipids) impact the human body: they block a nutrient-sensing taste receptor on the tongue called T1R3.
So what’s the big deal about this? It turns out there’s emerging evidence these taste receptors are also found in hormone-producing cells in the intestine and pancreas. When working properly, these internal taste receptors in the gut trigger the release of hormones involved in the regulation of normal homeostasis (the ability of the body to maintain internal physiological stability) of glucose as well as energy metabolism. Simply put, screwing up the ability of T1R3 to sense certain nutrients could possibly wreak havoc on the human body in a variety of ways — from playing a role in unhealthy blood sugar levels to causing people to gain weight .
“Compounds that either activate or block T1R3 receptors could have significant metabolic effects, potentially influencing diseases such as obesity, type II diabetes and metabolic syndrome,”
For their study, Dr. Mosinger and his research team tested the ability of two classes of chemical compounds to block the T1R3 taste receptor. These compounds were selected because they have strong structural similarities to lactisole, a sweet taste inhibitor that is known to block T1R3. Specifically, the researchers investigated fibrates (a class of drugs often used to lower blood cholesterol, especially triglycerides), and phenoxy herbicides.
Fibrate drugs are sold in the U.S. under several names including gemibrozil (brand name Lopid) and fenobribrate (brand name Tricor). Phenoxy herbicides are chemicals widely used in agricultural fields, on golf courses, rights-of-way and lawns to control broad-leaf weeds. The best known, called 2,4-D , is one of the most extensively used herbicides in the world. According to the Oregon State University Extension Service web site, popular brands of phenoxy herbicides include MCPA, Crossbow, Banvel, Garlon, Weed-B-Gone, and Brush Killer. They are also incorporated into a host of “weed and feed” and brush control products for use on grass.
In laboratory experiments, the researchers found that both classes of compounds were very potent in blocking activation of the human sweet taste receptors. Additional tests showed that this ability of both fibrates and phenoxy herbicides to block T1R3 is specific to humans.
“The metabolic consequences of short and long-term exposures of humans to phenoxy herbicides are unknown. This is because most safety tests were done using animals, which have T1R3 receptors that are insensitive to these compounds,” Dr. Mosinger said in the press statement. “Given the number of compounds used in agriculture, medicine and the food industry that may affect human T1R3 and related receptors, more work is needed to identify the health-related effects of exposure to these compounds.”
For more information:
(NaturalNews) Kava is a well-known herb that originated in the Pacific. Also scientifically known as Piper Methysticum, the roots and stem hold the key ingredient that has been used for medicinal purposes both in traditional and modern times.
Traditionally chewed or crushed to form a liquid, Kava can now be commonly found in capsules, teas and liquids aimed at reducing a variety of stress and anxiety related conditions and illnesses.
Scientific research has pinpointed its effectiveness whereby in terms of neurotransmission, feel good vibes are sent to the brain which then aids muscle relaxation, increases concentration, decreases insomnia, lowers inhibitions and can also be suitable for pain such as back aches or hyperactivity in children. Although there is no absolute evidence, it has been suggested that Kava may affect serotonin and dopamine neurotransmitters.
Extracts of the Kava root have been processed to provide the population with immediate access to the various associated health benefits. Other health benefits of this herbal remedy include help for asthma, urinary tract infections, depression and menopausal symptoms. Due to its calming and muscle relaxing qualities, it has provided a health improvement to many that would have otherwise still have been suffering.
In recent times, sports persons and business people, to significantly improve performance by reducing daily stresses, have used Kava. It is also interesting to note that the use of Kava has been employed by the military, in some parts of the world, to reduce anxiety and improve the focus of its soldiers.
Concerns have been raised as to the safety of regularly consuming Kava. One of these main concerns involves the liver, where liver toxicity and failure occurred in some patients that were found to be taking a supplement containing the Kava extract – although, this could not be clarified as the patients had also consumed alcohol and other medications.
The effects of prolonged use of this natural substance are yet to be substantiated; however, there have been suggestions that ingesting high doses of Kava can lead to headaches and skin rashes. A single dose of this herbal remedy has found little to no side effects.
Scientists have advised that Kava is not to be used in conjunction with other medicines, alcohol or by pregnant women. As with anything new, it is still recommended to consult a health care provider as your first point of call.
Some federal departments have sought to ban the use of Kava among the general population; however, they have since retracted their statements, due to the growing evidence of Kava related health benefits provided by scientists and researchers.
Sources:About the author home water filters , natural skin care , omega 3 fish oil and natural supplements . His website Colon Health , provides information on topics such as candida cleanse , hemorrhoid cure , relieving constipation , colon detox , colon cleaning , the best colon cleanse and colon cleanse products reviewed by his visitors.
reports of 360 exclusivity for Netflix have been greatly exaggerated. You could always hack it onto your console, but this is a little more official. The streaming-video service will arrive on PS3s next month , and current Netflix subscribers will be able to watch to their heart’s content at no extra charge. However, in a rather absurd turn, streaming will only be enabled when you have a special Netflix disc in your PS3. What the hell is that about?
Initially, watching movies instantly streamed from Netflix via the PS3 system will be enabled by a free, instant streaming Blu-ray disc that is being made available to all Netflix members. The free instant streaming disc leverages Blu-ray’s BD-Live™ technology to access the Internet and activate the Netflix user interface on the PS3 system, which must be online via Wi-Fi or Ethernet.
I don’t even want to speculate, it’s too weird. The content is hosted online, streamed over the internet, and the application and interface can’t take up more than a few megabytes. Yet they feel the need to next-day-air you a freaking Blu-ray disc that’s apparently the only way to access it. That’s a bit like having somebody climb the stairs in order to get to an escalator, isn’t it?
Maybe this is just a temporary thing, but maybe it really is as dumb as it sounds. We’ll know next month. At any rate, it’s a pretty awesome score for Sony. Maybe Microsoft only signed up for a two-month-long exclusive?
That didn’t take too long to confirm. A mere day after word got out of the possibility that Netflix will indeed be coming to either the PS3 or the Wii…
No, your eyes aren’t deceiving you… we’ve just rolled out a brand new redesign of BGR! There are so many amazing things we’re proud of and it just felt time that we freshened up the site. We’ve dramatically improved comments and you can vote them up or down (lowest voted comment will be hidden with an option to view them) and we’ve streamlined how posts are displayed. But that’s not it. Check out our color-coded badges for important categories like breaking news or featured posts to help you keep track of them, an improved and redesigned gallery is coming ASAP, plus we’re also introducing a brand new feature called BGR Whispers. Think of this as Twitter for BGR. You won’t find us telling you anything personal, but what it will enable us to do is post information we’re hearing that’s not confirmed. Basically its place is between something we’d tweet and something we’d post — not confirmed enough to warrant a real post, but definitely intriguing enough to share. Expect a whole heap of those.
We’re also taking this opportunity to re-brand the site as BGR. That’s how we’re referred to 99% of the time, will enable us to expand on our content while always kicking ass in the mobile/gadget space, and hey, it’s just easier to say.
Special thanks to our guys at Out:think web design and development. They put up with our crazy requests, took abuse daily, and did an awesome job.
Feedback is of course welcome in the comments. Enjoy!
Verizon Storm users have reason to celebrate tonight because they’re part of a very special user base — the first BlackBerry users to recieve BlackBerry OS 5.0. We’ve already gone over the benefits of OS 5.0 a whole bunch, so all there is left for us to do is tell you how to get the goods. Either fire up BlackBerry Desktop Manager for PC or Mac and accept the prompt to update your handheld, or visit www.verizonwireless.com/storm. We’re just in the process of updating our 9530, but in the meantime, what does everyone that has it loaded up think? Has OS 5.0 made the first-gen Storm the phone it should have been one year ago, or is it just polishing a turd since the BlackBerry 9550 is just around the corner?
Tilera , is tackling the Mount Everest of chips. His goal for decades has been to figure out how to build a general-purpose chip that offers better performance and power efficiency. Those are goals that many startups have shot for and missed, or aimed for and settled for two out of three. But like Everest’s awesome heights, the new generation of cloud computing and demand for ever more resources to power social networks, online video and devices, have created challenges for data center operators that may allow Tilera to succeed. Today, the 5-year-old startup is expected to launch a 100-core version of its chip aimed at web-scale computing.
Tilera scoffs at quad core machines. The company’s chips already are used by 75 customers, and come with 36, 64, and now 100 cores. Agarwal says, “The core is the new transistor.” By cramming so many cores onto its chips connected by a mesh network of interconnect that allows the cores to communicate without bottlenecks, Bob Doud, director of marketing, says that Tilera can sell its chips to folks wanting faster memcached servers or better performance at web-scale computing. The chips, which provide 1.25 GHz of performance, are no match for Intel’s workhorse Nehalem processor that can top out at 3.3GHz. But Tilera’s chips only burn 33-50 watts instead of 130 watts that top-of-the-line Nehalem silicon can.
Giving folks better performance per watt has an essential place in the world of web-scale computing (GigaOM Pro subscription required), as Microsoft tests Intel’s low-end Atom chips in its servers ; Dell touts servers using the low-power VIA chip ; and SeaMicro creates an 80-core Atom-based box . Doud sees this opportunity and hopes that Tilera’s unique architecture can outperform efforts by other startups (and even big chip vendors ) and get inside boxes made by large OEMs such as Dell and HP or smaller vendors using x86 chips in their cloud appliances .
But it’s this architecture issue that’s Tilera’s biggest weak point. The difficulty for most startups in the chip space when trying to build computers that deliver the most performance for the least power is the fact that they’re competing against Intel, and huge chunks of code aimed at enterprise and personal computing are written for Intel’s x86 architecture. So even as established chip providers (such as Nivida, which has had some luck getting its graphics processors into the mainstream ) try to get people to write programs for their GPUs, Tilera has to offer tools to help programmers write for its chips without learning a new programming language.
Doud says he thinks 10 percent of web-scale computing jobs don’t need to keep the old style of coding for x86 chips, and if Tilera can break in there, that would be enough for now. Tilera already sells its chips to telecommunications equipment companies and for those trying to do rapid video and voice transcoding, which Doud says helps the company diversify in a manner that other specialty chip vendors, such as the shuttered SiCortex , have not done.
As Agarwal takes Tilera up the chip industry’s version of Everest, he is betting that the huge shift that’s come about as a result of web-scale and cloud computing is a good time to challenge the need to keep writing for x86 chips. The startup has made it to base camp, with an expected $25 million funding round from computer manufacturer Quanta and undisclosed investors closing later this month (bringing its total funding to about $65 million), and a plan to become profitable without any new investment, but it’s still going to be a hard, uphill slog.
I was waxing eloquent about Netflix and its streaming video service , which has become part of my media consumption. And like me, many Netflix fans were accessing the new but fast-growing video streaming service via their DVD players, televisions, Rokus and Xboxes. Well, add Sony’s PlayStation 3 to this list. Netflix just announced that it is going to be supporting the gaming platform that’s already bundled with a Blu-ray DVD player.
Netflix will begin streaming via the PS3 system next month at no additional cost to Netflix members in the United States who have a PS3 system. For only $8.99 a month, Netflix members can instantly watch unlimited movies and TV episodes streamed to their TVs and computers via Netflix-ready devices. By the way, I will be chatting with Reed Hastings, CEO of Netflix, at our upcoming NewTeeVee Live conference on Nov. 12. You won’t want to miss it; get your tickets today !
Recommended reading: “The DVR vs. Internet Video” by Mark Cuban .
Congress is at an impasse over how to fix a perennial problem in Medicare.
Just about every year a formula glitch threatens to cut payments to doctors who treat seniors and the disabled. And just about every year Congress cancels the cut. This year lawmakers are complaining about the bill because it’s not paid for. But, despite what both Republicans and Democrats are claiming, that’s nothing new.
Permanent Fix Falls Short
New Hampshire Republican Senator Judd Gregg is among the opponents of the bill. “We’ve only done yearly fixes in this area, the doctor fix, because it’s a pretty difficult number to always pay for, but we have always paid for it,” he said on CNN last Sunday.
Except that Congress hasn’t always paid for it. In fact, when Republicans were in charge, they did cancel the Medicare cuts to doctors, but rarely paid for them. Just before turning control of Congress back to the Democrats at the end of 2006, Republicans actually tucked legislation to cancel the next year’s doctor pay cut into a catch-all tax bill that wasn’t paid for either. And then-Senate Budget Committee Chairman Judd Gregg was one of the people who complained the loudest.
“You just have to ask yourself how we, as a party, got to this point, where we have a leadership which is going to ram down the throats of our party the biggest budget buster in the history of the Congress under Republican leadership,” said Gregg back in 2006.
Bipartisan Memory Loss
Except Gibbs was only half-right. President Obama’s budget does propose to fix the payment problem in that it would cancel next year’s Medicare cut for doctors and cuts into the future. But it doesn’t propose to pay for the added costs.
In fact, back in March, White House Budget Director Peter Orszag testified before a House Committee that the proposed fix could cause the federal deficit to be as much as $400 billion higher over the next decade.
TULSA, Okla. — An hour into knee replacement surgery — with U2’s I Still Haven’t Found What I’m Looking For playing in the background — Dr. Yogesh Mittal smiles as he raises the left leg of his patient, 76-year-old Frank Morrow.
While holding Morrow’s thigh, the surgeon lets the bottom half of the leg fall. “Look at that,” he says, pointing to the wide range of motion permitted by the metallic-colored implant. “He’s going to love this new knee.”
Medicare, the government program that is paying for Morrow’s surgery, likes it, too.
The surgery at the 691-bed Hillcrest Medical Center here is part of an experiment testing a new “bundled” payment system. Medicare makes a single reimbursement for all the hospital and doctor care for heart and joint procedures, rather than making separate payments to the facility and physicians.
Such combined payments are getting close attention during the health care debate as a way to encourage hospitals and doctors to work together to hold down costs and improve care.
Related Video: An Experiment In Reducing Costs, Improving Care At Hillcrest Medical Center
Bundling payments moves medical charges away from the traditional fee-for-service system that pays providers separately for individual services — an arrangement critics of the current system say leads to doctors and hospitals delivering more care, but not better care.
“The current payment system is not designed to drive efficiency,” says Harold Miller, chief executive of the Network for Regional Healthcare Improvement in Pittsburgh. For example, he says, it rewards providers for making mistakes that require additional procedures or result in hospital readmissions.
Health-overhaul bills being debated in Congress would promote bundling by calling for more Medicare pilot projects such as the one at Hillcrest and allowing Medicare to expand the concept if they are successful. Any success in the Medicare arena could have far-reaching implications because the health program for the elderly makes up 20% of the nation’s total health spending.
Some physicians have raised concerns about the bundling experiment. Larry Martinelli, an infectious disease specialist in Lubbock, Texas, and past chairman of the Infectious Disease Society of America’s clinical care committee, says he fears that bundling payments would pressure hospitals to try to save money by bringing on fewer specialists to consult on patients. “The idea is worrisome,” he says.
Hillcrest’s Dobbs acknowledges that surgeons are looking more closely at when to bring in specialists or order tests.
“I see more focus than I saw in the past,” he says, adding that patient care has improved under the program because of closer attention to quality.
Patients paid up to $1,157
Under the pilot project, Medicare is saving 4.4 percent on the base rates for heart and joint surgeries at Hillcrest because the hospital is offering a discount. For Morrow’s knee replacement, for example, the government is paying $13,211, about $450 less than it normally would.
Meanwhile, Morrow, who is eager to get back to playing basketball, gets a portion of the savings from Medicare — $271 as an incentive for going to a hospital that participates in the program.
The three-year experiment, which began in May, is occurring at five hospitals identified by Medicare for high-quality, cost-efficient care. All competed to get in to program by offering discounts to Medicare.
Besides Hillcrest, Baptist Health System in San Antonio is taking part, while hospitals in Denver, Albuquerque and Oklahoma City are expected to begin participating later this year. Patients who use the hospitals for most heart and orthopedic procedures are paid up to $1,157 for participating, with the bigger amounts pegged to more complicated cardiac surgeries, such as heart-valve replacements.
The incentive payment is supposed to help drive higher admissions to the hospitals in the program, and the pilot is designed to test whether paying Medicare beneficiaries from $250 to $1,157 sways their choice of facilities.
For Frances Carman, 79, of Pawhuska, Okla., who had knee-replacement surgery in July, the $271 payment helped “seal the deal” to go to Hillcrest. “I live on a fixed income, so that extra money will come in useful in helping get my car fixed,” she says.
But Morrow says he didn’t know about the incentive payment until after he registered for the surgery. He says he chose Hillcrest because that’s where Mittal wanted to operate. “Getting money back will be nice,” he says, “but that is not the main reason I came here.”
François de Brantes, CEO of Bridges to Excellence, a national program focused on rewarding physicians for better quality care, credits Medicare for trying a new strategy.
He doubts whether Medicare beneficiaries will be swayed by the limited incentive payment. However, he says, “at least this sends a good signal” that the Centers for Medicare & Medicaid Services “is trying to change the status quo away from fee-for-service to integrated care.”
‘We can save a lot of money’
The health care bill that the Senate Finance Committee approved earlier this month calls on Medicare to start a “bundling” project by 2013 that could involve many different types of health providers, including hospitals, doctors, home health agencies, rehabilitation facilities and nursing homes.
President Obama also supports bundling. In a June speech to the American Medical Association, he said the Medicare payment system should be changed so “you aren’t paid for every single treatment you offer a patient with a chronic condition like diabetes, but instead are paid for how you treat the overall disease.”
“Hospitals are going to take care of themselves and their employed doctors first and then at the end of the day comes the doctors in private practice,” he says.
Hillcrest doctors, including Mittal, say that has not been an issue. The hospital says it pays its doctors under the program within 21 days, just as it did before the pilot project.
Some health experts are skeptical that bundling will have a major impact on rising costs any time soon.
“Changing the payment system and changing the delivery system is very hard,” says Bruce Vladeck, who ran the Medicare program during the Clinton administration and is now a senior advisor at Nexera Inc., a consulting service owned by the Greater New York Hospital Association. “Medicare will be broke long before we get there.” Medicare in 2017 will be paying out more money than it takes in, government projections show.
Yet proponents say bundling could make a big difference. “If we can deliver care more efficiently, we can save a lot of money,” Miller says.
Win, win, win
In the surgical pilot project, the five participating hospitals give the government discounts of 1 to 6 percent off Medicare rates for some common inpatient orthopedic and cardiac procedures. The hospitals hope to more than make up for the price cuts by lowering costs and luring more patients with the incentive payment.
At Hillcrest, hospital officials and doctors say that the project is forcing them to pay closer attention to costs. By driving tougher deals with makers of implants and other devices, for example, the hospital has cut costs for knee replacement and heart-valve surgery by 5 percent, says CEO Steve Dobbs, adding, “We see the program as a win, win, win.”
The hospital has made a slight profit on the 415 patients — 295 cardiac and 120 orthopedic — that it treated through Sept. 30, Dobbs says. Hillcrest officials say their orthopedic cases are up 2 percent this year and cardiac cases are up 27 percent, but they don’t know whether that’s because of the bonuses or the fact that the hospital just spent millions to improve its facilities.
Hillcrest’s doctors were guaranteed their regular surgical fees as part of the pilot project. But they also get a an additional 25 percent bonus payment from Medicare if they keep costs down while maintaining high-quality scores in areas such as low infection and readmission rates.
“Before, I had no incentive to get costs down,” says Mittal, chief of orthopedic surgery. “Now, I do.”
He says he helped persuade the medical staff to stop using costly antibiotic cement for hip and knee implants rather than the standard version, saying there was no evidence the more expensive adhesive worked better in preventing infections.
Hillcrest doctors also have reduced the number of surgical drapes and disposable drill pins they use and have worked with the hospital to negotiate bigger discounts on certain brands of implants, stents and other supplies.
However, some costs have gone up under the project. Hillcrest, which is owned by the for-profit Ardent Health Services, based in Nashville, estimates it has spent $480,000 on the program for claims processing, printing brochures and advertising on television and radio.
“We’ve learned a lot from this program and we are more efficient and safer than we were before,” says Wayne Leimbach, Hillcrest’s chief of cardiology. “But all the extra manpower to get there is not worth the benefit if we are only a little better financially.”
Medicare tried the bundling concept with coronary bypass surgery in the mid-1990s. The program saved $42.3 million over three years, with costs decreasing from 10 to 37 percent at the four hospitals participating in the test. But the hospitals saw no increase in business. That experiment didn’t include an incentive payment for Medicare beneficiaries to use the test hospitals.
Five weeks after his knee replacement surgery, Morrow is still in frequent pain as he waits for the swelling in his knee to go down. But there is progress, too. He’s just graduated from a walker to a cane and has started driving again.
“I didn’t think I would be in this much pain, but they said it’s like having a baby and that when it’s all over you won’t remember it,” Morrow says. “I’m hanging in there and they tell me the knee looks great.”
Top White House advisor Christina Romer said that health reform would help to ease the deficit at a speech today. Reuters reports: “While some critics say Democrats’ efforts to regulate the insurance sector should wait until the deficit is under control, they should instead see it ‘as the most significant act we could take to tackle the deficit,’ Romer said in speech to the Center for American Progress, a Washington-based think-tank” (Heavey, 10/26).
The Wall Street Journal Blog reports that Romer, who heads the president’s Council of Economic Advisors, spoke about the fiscal benefits of the White House’s health care agenda and said: “‘It is fiscally irresponsible not to do health-care reform. … To bury our head in the sand for even one more year and pretend that the problem of rising government health-care expenditures will go away is simply untenable.’”
“Earlier this month, the U.S. Treasury Department reported the fiscal year 2009 deficit was $1.4 trillion, or about 10% of Gross Domestic Product. That’s the U.S.’ biggest budget deficit since World War II. Meanwhile, in August, the Obama administration estimated that a cumulative deficit over the 10-year budget window from 2010 to 2019 would reach $9 trillion. … With deficits potentially becoming a key 2010 campaign issue, the gloomy fiscal outlook could complicate Democrats’ legislative efforts, including hopes to overhaul health care. Still, Romer on Monday defended the Obama administration’s $787 billion fiscal stimulus program and the federal government’s financial-bailout program. She pinned most of the blame for the latest projected deficit on policy actions taken during the Bush administration” (Randall, 10/26).
Meanwhile, ABC News reports that Romer touted the “Cadillac Tax” as a critical part of reform: “President Obama’s chief economic forecaster went to bat on Monday for a tax on high-priced insurance plans, the so-called ‘Cadillac tax,’ calling it ‘probably the number one item that health economists across the ideological spectrum believe is likely to stem the explosion of health-care costs.’” Romer said such a tax would encourage employers and employees to be more vigilant health care consumers. “Romer’s full-throated endorsement of the ‘Cadillac tax’ keeps the Obama administration at odds on this issue with some of its closest allies. Organized labor has made killing the ‘Cadillac tax’ a top priority and more than half of House Democrats have signed a letter to Speaker Nancy Pelosi urging her not to include a ‘Cadillac tax’ in health-care legislation.”
Romer talked about how the tax should be designed, noting that “a handful of ideas were under consideration by Congress including: (1) making special provisions for high-risk occupations such as firefighters; (2) taking regional differences in health-care costs into account “for a period of time”; and (3) making special provisions for firms with older, more costly workers. … Among the multiple ideas touted as cost savers during her speech, Romer touted the capacity of a public insurance option” (Davis, 10/26).
Heard Verizon’s DroidDoes.com webpage has had over 2.5m pageviews and around 170k email opt-ins in about three days. Entire Storm launch last year is said to have been around 350k email opt-ins.
This video here came up on YouTube earlier, and what do you know, it’s Modern Warfare 2 (Xbox 360, PS3, and PC). Or so the video claims. Game info at …
The Pennsylvania home health care company Linda Bettinazzi runs is charged about $6,800 per worker for health insurance – $2,000 more than the national average for single coverage. One reason: nearly every one of her 175 employees is a woman.
Insurers say women under the age of 55 cost more to cover because they use more health services, and not just for maternal and infant care. But Bettinazzi, the president and CEO of Visiting Nurse Association of Indiana County, believes there’s something inherently wrong in charging her company more because it hires a lot of women.
“There’s a great sense of unfairness,” Bettinazzi says. “I feel angry, and maybe betrayed would be a good word.”
Gender rating is the norm today, part of a complex formula of risk factors – including health history and age — insurers say has been necessary to fairly price policies. But advocacy groups for women argue that charging more for women than men is discriminatory and should be illegal.
The battle is playing out on Capitol Hill through the debate on health overhaul legislation. If a new law results in nearly all Americans having to carry insurance, the industry has said it would agree to end rating based on gender and health status in sales of policies to individuals and small groups. But the leading industry trade group and some of its legislative allies have balked at ending such rating in the group market where larger employers purchase coverage.
The House health care overhaul bill and legislation approved by the Senate Health, Education, and Labor Committee treat the large group market much the same as the individual and small group markets, banning insurers from setting rates based on the gender and health status of applicants, and limiting how much more insurers can charge based on age.
But the Senate Finance Committee bill would allow insurers to continue to consider the gender, health status and age of workers when setting premium rates for businesses with more than 50 or 100 employees, depending on each state’s definition of a large business. Those opposed to gender rating are putting pressure on Senate leaders as they try to blend the Finance and health panel bills. The fight may not end there as senators and House members will be able to offer amendments to health overhaul legislation once the bills reach the floor in each chamber.
“Discriminatory insurance practices, such as gender rating, should be abolished across all markets – individual and group,” says Sen. Barbara Mikulski, D-Md., a senior member of the health committee. “A woman should not face discrimination based on something arbitrary like the size of the employer she works for.”
Insurers and brokers who sell policies readily defend current rating practices in the group market. “Insurance is about risk, and we can demonstrate objectively that women are a higher risk,” says Henry Stern, an insurance broker near Dayton, Ohio. “If you don’t base it on risk, you don’t have insurance. You have income redistribution,” meaning others would have to pay more.
When setting premium rates for a large employer, insurers try to assess the overall risk of the group. They gather as much data as possible about employees, including their demographics, health status, recent health costs, geographic location and whether their jobs are high risk. All of that information is evaluated to determine how much the group is likely to cost in a given year, and therefore how much the insurer should charge the employer in premiums.
Stern, who also writes the popular InsureBlog , points to “morbidity tables” that insurers use to calculate risk, which show that, until their mid-50’s, women cost significantly more than men. For example, according to the risk chart of one major insurer, the average 25- to 29-year-old woman generates nearly three times as much medical spending as men of that age.
Studies cite, among other costs, maternity and reproductive care that requires mammograms, Pap smears and regular doctor visits. Women also use more prescription drugs and may have to contend at younger ages with cervical cancer and breast cancer.
Bettinazzi says she’s heard all this from her broker: “It was sort of like, why would you even be asking the question? You’re all women, you’re having babies, you’re getting sick, you’re hurting your backs.”
By contrast, Stern says, young men are seen as “free money to the insurance company,” because they are unlikely to use many services. But starting at about age 54, men start to show greater signs of wear and tear, such as heart attacks, prostate cancer and colon cancer, and begin to cost more than their female counterparts.
If a health care overhaul bill becomes law, insurers would potentially have millions of new customers as most Americans would be required to have insurance. And America’s Health Insurance Plans (AHIP) says in that situation they would stop rating for health status and gender in the individual and small group markets. But they want to retain the ability to rate bigger employers because they fear some otherwise will self-insure, believing that would be cheaper than buying coverage from insurers. Those employers would no longer get the discount they can get now if they have a work force that uses less health care.
Another industry group that represents insurance agents, the National Association of Health Underwriters, supports eliminating gender rating for all markets, as long as there is a strong requirement that all Americans carry insurance, says Jessica Waltman, senior vice president of government affairs. Nonetheless, she says, the costs of covering higher users of medical services “aren’t going to go away. They’ll get shifted to someone else.”
The issue of rating in the large group market is being scrutinized as senators try to merge the Finance and health committee bills, aides say. Lawmakers are under pressure from all sides.
The National Women’s Law Center has been publicizing the issue with a campaign called “Being a Woman Is Not a Pre-Existing Condition .”
Women already make less money than men, says Judy Waxman, vice president for health and reproductive rights, and to force them to also pay more for health insurance is blatantly unfair. Moreover, the extra money an employer must pay to insure a group of women often gets passed along to workers in the form of higher premiums and deductibles. “It’s time to level the playing field,” she says.
Sen. Mikulski, for her part, has gotten 24 colleagues to sign on to a letter urging a ban, in all markets, on gender rating and other practices viewed as discriminatory.
Some experts say gender rating doesn’t make sense in part because of the fine line separating legislative definitions of small and large groups. Under the Finance bill, for example, a large group can be as small as 51 employees. “A large group is just one more than a small group. It’s just 51,” says Karen Pollitz, project director at Georgetown University’s Health Policy Institute.
For Bettinazzi and her organization, insurance rate relief can’t come fast enough. This year, for the first time, VNA is asking employees, who were paying nothing, to foot a small part of the premium bill. Some members of the board of directors are advocating a change to high-deductible, less expensive policies.
Premiums now account for 8 to 10 percent of annual revenue, says Bettinazzi, and that is “unsustainable.”
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A rumor is making the rounds that the White House and Senator Reid are pursuing different strategies on the public option. Those rumors are absolutely false.
In his September 9th address to Congress, President Obama made clear that he supports the public option because it has the potential to play an essential role in holding insurance companies accountable through choice and competition. That continues to be the President’s position.
Senator Reid and his leadership team are now working to get the most effective bill possible approved by the Senate. President Obama completely supports their efforts and has full confidence they will succeed and continue the unprecedented progress that is being made in both the House and Senate.
Dan Pfeiffer is Deputy Communications Director
Take Pizza Hut for example. The company seems to appear in the social media news circles fairly often. One time it was for posting a job opening for a Twittering position. Another time it was for using Twitter as a tool to drive its efforts to help feed the hungry.