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Fourth of July

 Happy Fourth Of July

                              God Bless America
 

Why Does Physical Therapy Have A Cap?

I would like someone from CMS to answer the title question?  I believe physical therapy is the only discipline that has a financial cap from Medicare. I can not understand the reason behind this decision. Physical therapy is cost effective.  If a senior can not receive physical therapy due to reaching the cap then the patient will seek other alternatives.  The other alternatives could and most likely cost Medicare more money in the end.
Medicare will allow seniors to seek treatment in a hospital outpatient physical therapy center or the ER. What's the difference financially between hospital outpatient physical therapy center vs. outpatient physical therapy center. Nothing, except the bank account of the hospital.  A patient can be treated in ER for physical therapy, what a joke.  No wonder our ER departments are in bad shape.
Our seniors should stay in outpatient physical therapy centers. Where they will receive the best care. We need to develop a better plan than the financial cap.  If Medicare or our government is worry about money then we should develop a outcome plan for continuing services. We should have a range of a flat fee, which increases each year.  After all, there are expenses such as employees, office rent, equipment leases, etc.  There is no reason to have a cap, its not fair to the seniors who need the therapy. If the cap remains then  most likely some other group was rewarded.

Senator Fails To Vote: Physical Therapy Cap Is Back

Well the Senate failed to vote on bills S 3101 and S 3118 this past weekend.  The Senate will reconvene on Monday, July 7,2008. Meanwhile Medicare will not process claims from July 1 - 10 to give the Senate time to negotiate bills S 3101 and S 3118. American Physical Therapy Association (APTA) met with senior administrators  of Medicare and Medicaid Services (CMS) to request an administrative delay for the therapy cap.  The officials of CMS denied the requested from the APTA. Which needs the therapy cap starts as of July 1, 2008.
OK, CMS will not process claims for 10 days.  The problem for physical therapy practices are twofold, first the therapists will need to inform their senior patients either you have reach the cap or near cap or over the cap. The patient will have to make a decision, do I continue therapy at my present location as a self pay or relocate to an  hospital outpatient physical therapy center. Another option for the senior patient is to end therapy session regardless of their  functional level..  Yes both party's can roll the dice and hope our"all mighty" Senate passes the bills (therapy cap exceptions intack). The senior patient will not be happy and this could affect their health ;ex patient's who had a stroke or knee replacement .  Seniors are very loyal patients. They also love coming to therapy, therapy has a positive effect on our seniors.
Oh yes, Medicare will not process claims for 10 days.  Who will  benefit the most, my vote is for Medicare. Physical Therapy practices are a small business.  Cash flow is very important, remember the insurance industry is the only business that does not paid within 30 days. Medicare's normal turn around time for processing claims and paying is 2 weeks.  The 10 days of no processing claims will turn payments into 30 days or possibility 45 - 60 days if there is a "problem" with the claim. Medicare is  in a better position than either the patient or provider.
My question to Medicare, the reason for the therapy cap was to save money but why do you allow hospital outpatient physical therapy center to be uncap?  Medicare is not saving money  by allowing this to occur.
I hope our society realizes that you can not depend on our government to take of you.  We need stand up for ourselves and make the government work for us. Right now the government is working for themselves. Seniors and providers should be calling their Senators right now.   

Update: Changes in Medicare For Physical Therapy

On Tuesday, June 24, 2008 the US House of Representatives pass the bill (HR 6331), Medicare Improvements for Patients and Providers Act. This bill will prevent a 10.6%  decrease in payment under Medicare's physician fee schedule and ensure our seniors the ability to continue their physical therapy treatment under the therapy cap exceptions process. The vote was 355 - 59. There are numerous other Medicare issues in this bill.
The legislation is now in the Senate and as of Friday, June 27, 2008, the bills S-3101 and S-3118 did not receive approval. Senator Reid inform the members of the Senate, there will be another vote on Sunday, June 29, 2008.  Hopefully the Senate will be able to negotiate a deal before Congress convenes on July 1,2008. If the bill is not pass before July 1, 2008, then there will be seniors who will not be able to continue their physical therapy treatment due to the financial cap. Yes, some seniors will be able to continue for number of reasons; they have a true secondary insurance policy or the ability to be a self pay. I'm sure there will be number of clinicians who will treat the patient for free. Of course the clinicians will receive a decrease in payment.  Now if the Senate decides to pass the bills sometime in July or after their summer vacation, the clinicians will be paid retroactive from July 1, 2008, this will be accounting nightmare. Plus the most important issue, what about the patients who did not receive treatment?   Again Congress at its finest. Can you image if we operated our businesses or companies similar to Congress....we would be out of business. This will be another topic in the future.

Healthy Recipes

                                       Chipotle Burgers with Avocado Aioli

2 tablespoons low-fat mayonnaise
1/2 small avocado, cubed
1/2 teaspoon chopped garlic
4 tablespoons canned adobo sauce, divided
2-3 medium canned chipotle peppers, seeded and minced
1 pound 95 percent-lean ground beef
1/4 cup minced yellow onion
1/2 teaspoon salt
1/2 teaspoon black pepper
Thinly sliced tomato and red onion
1. Preheat grill or broiler. In a blender,combine mayonnaise,avocado,garlic, and 1 tablespoon adobo sauce. Process until smooth.
2. In a medium bowl,combine remaining 3 tablespoons adobo sauce, minced chipotles, ground beef, onion, salt,and pepper. Mix with hands until combined well. Form into four patties and grill or broil 5-6 inches from heat, 5-7 minutes per side, turning once. Serve,topped with aioli,sliced tomato, and red onion slices.

            Greek Burger With Arugula, Tomatoes And Feta

4 whole - wheat pitas
1/4 cup skim milk
1 small onion, finely chopped
2 cloves garlic
2 tablespoon chopped fresh mint
4 teaspoon chopped fresh oregano or 1 teaspoon dried
1 tablespoon fresh lemon juice
3/4 lb lean ground lamb
2 teaspoon olive oil
3 cups arugula
1 medium tomato, cut into 1/4 inch-thick slices
1 red onion, cut into 1/4 inch-thick slices
1/3 cup crumbled feta
Dressing
2/3 cup Greek yogurt
1 tablespoon chopped fresh mint
2 teaspoon chopped garlic
2 teaspoon Dijon mustard
1 teaspoon honey
1/2 cup peeled, seeded and finely diced cucumber

1. Heat oven to 350 degrees
2.Cut 1/4 off each pita.Chop half moons,transfer to a bowl and sprinkle with milk. Drain and squeeze out excess milk.
3. Puree soaked bread,onion,garlic,herbs,and lemon juice in a blender or food processor. Transfer puree to a bowl.
4. Add lamb, season with salt and pepper and combine.
5. Form into 4 patties.
6. Wrap pitas in foil and heat until warm, about 8 minutes.
7. Heat oil in a nonstick skillet over medium-high heat until hot.
8. Cook burgers to medium, 2 - 3 minutes on each side.
9. Whisk yogurt, mint,garlic,mustard and honey in a bowl.
10. Stir in cucumber and season with salt and pepper.
11. Open each pita, stuff with arugula and drizzle with some of the dressing.
12. Add burger, tomato and red onion to pita.
13. Sprinkle with feta.

Information gather from Self and deliciousliving

Our 21st Century Healthcare System: Change or Chaos

Remodeling our health care system for the 21st century will be a challenge to say the least.  We do need to make changes to our current system. Change could be good,if you have a game plan. First you need to know how the system operates from the clinicians to business aspect of health care to the insurance companies.  I will give you a glimpse  into world of outpatient centers, which operate differently from a hospital setting.
First I will like to point out, insurance companies are in the driver seat. Insurance companies set the rules and the rules can change any time, without reasonable warning. Their reasonable warning could be an announcement in a newsletter that nobody reads or a letter that gives an unimportant appearance. When policies change, its usually in favor of the insurance company and by the time a clinician's business department adjusts to the change, the insurance company has save money and the practice has lost money.
Another important issue to understand, clinicians do not have due process to challenge insurance companies decisions concerning treatments or payments. Yes in some states you can report an insurance company to "Insurance Commission", sometimes the clinicians win,most of the time the insurance company wins.  Actually the patient is the advocate for the clinicians and for themselves.  Insurance companies have somewhat of an interest in keeping the patient a little happy, after all the patient (employer) has the contract with the company. What do you about this comment, your staff calls to verify the patient's policy and possibly obtain either an authorization or referral for treatment, the insurance  will make a statement "this is not a guarantee of payment".  Also, what company does not pay an invoice in 30 days, you guess it, the insurance company.
I don't think the general public realizes that most clinician's fee schedules from the insurance companies have either decreased or stay the same in the last 10 years.  Medicare has raised their fee schedule in the past, now its looking to decrease the fees by 10%.  By the way Medicare is the best payor for some clinicians.
Operating a health care practice is expensive, forget about the clinician's salary, there's rent, employees salaries, benefits for the employees, usual office expense, medical supplies, equipment, professional and business liability, and host of other expenses. The bottom line of a health care practice is gray , its not like the bottom line of a general business, thats more black and red.
In the future I will write articles concerning all aspects of health care, clinical, business and the insurance companies.  In some instances I will give my recommendations for remodeling our system. Changing our health care system will have a great impact on our health and the health of the economy. We need to be smart and not put the horse in front of the cart as we did with our food system.

How Do I Restart My Engine ?

I'm not writing about your car engine! I'm writing about your cellular level.  We live in a society today that is under constant stress, from the foods we ingest to no down time in our personal lives...We are always on the go.  Our bodies can not distinguish from biological stress to emotional stress.  The body is not prejudices, the body works in an equal opportunity environment, all stress is create  equal.
Now the problem ,the body becomes toxics when it can not eliminate impurities. The impurities accumulate in our bodies from pollution, unhealthy foods, inadequate exercise  and other stresses.  The  impurities weakened your body and the body stores the toxins in your fat cells. As a result your metabolism will slow down and you will gain inches and pounds.  Dieting alone will not rid your body of the impurities. Your fat cells shrink from dieting, perfect example, take a sponge out of water,the sponge will shrink but once you return the sponge to water it will become larger. That's exactly what happens to your body...this is called YO YO diet.
There's an ancient practice called cleansing.  Many cultures throughout history have fasting to cleanse their bodies.  Today people will cleanse with liquids, for example, combination of water and lemon or juices and broths.  Another way to cleanse is with a liquid that can provide nutrient to the body during cleansing.  You should look for a system that promotes a complete cleansing (not just the colon), sustain energy, rebuild health (Human Body is Amazing),prepare your body to perform at its peak and sustain a healthy weight.  You want to clean and replenish your cells naturally. With clean and replenish cells the body can reach its potential.
                                                                Positive Effects of Cleansing

• Safety lose unwanted pounds and inches
• Eliminated impurities from your system
• Burn fat and build muscle
• Reduce unhealthy cravings
• Gain energy and improve mental clarity

                                                          Signs That Your Body Needs To Cleanse

• Inability to lose weight or keep the weight off during dieting
• Sluggishness
• Poor Sleep
• Mental Fog
• Feeling Bloated 

Remember when I wrote, not your car engine, well  your car is a good example of taking care of the engine.  Most people change their car oil around every 3,000 - 5,000 miles.  If you do not change the oil in your car, what happens, the old oil will clog and the car will work less efficiently and eventually the engine will breakdown.  Guess what, this also happens to our bodies!
Its important we cleanse our bodies, eat healthy (yes diet to help lose weight), and exercise.  We need all three components to develop a healthy lifestyle and recharge our engines. A car's engine can be replaced but not the human engine.

If you have any questions or comment please contact me....Start Your engines!

Low Cal Recipes

                                                    Grilled Salmon
1 pound of salmon fillets
1tbsp. dijon mustard
1 tbsp. nonfat mayo
4 tbsp. light sesame salad dressing
1/4 tsp. wasabee (optional)

1. Rinse fillets, pat dry.
2. To make the sauce, mix remaining ingredients in bowl. Fish can be grilled or broiled.
3. Place 1/2 sauce on the fillets.
4. Cook 4-5 minutes and add remaining sauce.
5. Cook 5-6 minutes,depending on the thickness or until fish flakes when tested.

Serving Suggestions:
1/2 cup of brown rice
simple salad
asparagus


                                                  Snapper and Salsa
1 1/2 lbs. snapper
1/4 cup cilantro minced
1/2 yellow and green bell pepper,seeded minced
1 sweet onion, minced
1 cup pineapple, minced
1 tbsp. olive oil
Juice of 2 limes

1. Mix cilantro,peppers,onions and pineapple.
2. Cover and chill.
3. Combine oil and fresh lime juice.
4. On a vegetable oil sprayed grill or pan,cook snapper for approximately 4-8 minutes on each side basting with the lime juice mixture.
5. Serve with salsa over it.

Serving Suggestions:
1/2 cup brown rice
cucumber wedges

                                                Roast Beef Sandwich
3oz. extra all natural Roast Beef
2 slices Multi-grain bread
Add lettuce, onions, hot peppers or sweet pepper
Honey Mustard

Sunday Mornings Will Never Be The Same

I love Sunday mornings, a great breakfast, reading the paper and watching Tim Russert on Meet The Press.
I knew watching Tim every Sunday I would have a better understanding of a politician's views and voting record.  I also believed you gained an insight into the personality of the politician during the interview.The passing of Tim will leave a huge void in political journalism.  He was a great interviewer, well informed/prepared and educated in our government,politicians and their polices.
The other side of Tim,  down to earth, love of family,good sense of humor, came across as a caring person and the most important quality a good person, basically a great guy. Young adults and even the baby boomers can use Tim as a role model.  I don't believe we will see another Tim Russert for a long time.
Tim, thank you for your fairness, straight-forward questions and holding our politicians responsible for their actions/words. You made a different in my world and our country.  Go Buffalo Bills and Yankees
If its Sunday????????

Healthy Foods For Men

Well you want to improve your health, just go to your local supermarket and remember try to pick all natural or organic products.  Here are some foods that can help keep your body healthy.

1. Sardines - excellent source for omega-3 fatty acids.
2. Edamame - helps with  your mood, by stabilizing your blood sugar levels. This is one area you have control over, the foods you eat. Edamame is fiber rich carbonhydrates.
3. Sesame Seeds - Very good source for the amino acid arginine which combines with nitric oxide to enhance blood flow through your arteries to various male organs. Good for sex drive.
4. Blueberries - Deep color blue in the Berrie is a compound called flavonoids. Flavonoids protect the brain's memory cell from the effects of inflammation and oxidation.
5. Lentils - Great source for energy, due to several B vitamins that produce energy , carry iron and that assists the red blood cells to carry oxygen.

The saying what you eat is what you are, is very true.

Information obtain from Joy Bauer,Parade, NY Post