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Friday, August 14, 2009

goodbye blue sky


"...When the promise of a brave new world / Unfurled beneath a clear blue sky?" Although Pink Floyd isn't exactly known for its sunshiny demeanor, and leaving room S220 for the last time after this morning's final lecture was anything but depressing, that was the song that popped into my head anyway.

Considering the slightly-more-than-a-hint of bittersweetness that this morning's class was shadowed by, it's a slightly appropriate song, although it begs to be followed up with something like Fleetwood Mac's "Don't Stop Thinking About Tomorrow". We sat together--Burke, Karen, Jeremy, Kylie, Jay, and myself--in our usual longitudinal tight-knit 6-pack in what was probably the quirkiest room on campus, we did what we always did--the comments, the laughter, the half falling asleep, and our newfound pasttime of someone always having to get the last clap in.

This was a day I'd been looking forward to for a long time. I had been growing to resent having to scan a chapter in a book for vocab words or numerical factoids or labor over a simplistic Power Point presentation containing bulleted list that lacked meaning and cohesion, just because these things might make good test questions. Now I can crack the books for real, books that I have chosen, versus the less-than-ideal textbooks too often chosen for us. I can read in-depth, at my pace, the subjects I deem necessary, applying the main concepts to real live patients. I now have the spare time to devote to my own learning based on my judgment of what's important rather than having to base my reading on someone else's. And when I feel tired, I no longer have to press on so I can say I made it through all the material, all the while remembering next to nothing the next day because I was too tired to actually absorb any of it.

That's not to say that there wasn't some wistfulness, though. I have to admit, I'm going to miss parts of this. Like making innocent side comments, some of them mildly cynical, but all of them in relatively good fun. Or ripping on the slackers in the back - again, better natured than that sounds. I'll miss the people who thought to put bottled water at every single seat in preparation for the hard-assed prof who broke school policy by saying we couldn't have so much as water during class. I'll miss the innocent Southern belle with the soft voice and a hilarious not-so-innocent inner layer. Or the wouldn't-hurt-a-fly straight-up Mormon guy who also studies witchcraft because he has so many Wiccan friends. Or the other big good-natured guy who belted out the Happy Birthday song louder than the other 96 people put together. Or the people who always said, "isn't it (so-and-so's) birthday?" when it really wasn't, inciting the profs to initiate the Happy Birthday song to the same person about 50 times during Tri 7 alone, all the while without realizing it was the same kid every time. I'll miss the differing opinions and honest discussions, the philosophy debates, the mood swings, the jokes, and the laughs.

I never thought I'd say this, but I'll actually miss our room. The first thing our prof on the first day of Tri 1 said is, flat-out, point-blank, "you guys got screwed. Your room sucks." He was being funny, but serious. At first we couldn't really stand our room. It was oddly shaped, oddly lit, and lacking in a way I never figured out. One thing I did notice was that we lacked a center aisle. If you wanted to sit in the middle of a row and not out to the side, you had to make your way past a lot of people, a task that got much trickier if you weren't in the first couple rows in front and couldn't just hop over the table. Over time, though, our room grew on us, became part of us, shaped the general personality of the class as a whole, and pretty soon it amused us, as our profs often hated our room more than we did. They'd bitch and moan about not having a center aisle, as it was harder to keep tabs on our in-class activities, and they'd burn off their frustrations by walking laps around the perimeter or pacing back and forth across the front like caged lions. The more intense the professor's baseline personality, the more comical it got to watch.

But the fact is, that chapter is done. We're no longer students in class, but rather full-fledged residents, living practically full-time in the clinic, exclusively treating real patients, and functioning as doctors in a matter of months. We keep thinking that it's only some time in early summer and that graduation is something like 9 months away, but it's not. We have to stop and remind ourselves how fast time has flown and how fast it will continue to fly. I can only imagine what this surreal vibe is going to feel 4 months from now, when we walk across the stage for real, with, as mentioned before, "...the promise of a brave new world / Unfurled beneath a clear blue sky".

Saturday, August 8, 2009

For Massage Therapists: Just Getting Started?

I remember graduating from massage therapy school. It was a little surreal that, for all practical purposes, I held the title of massage therapist. I stepped out into the residual heat from the Texas July day, and the gathering humidity of the impending nightfall. It was already dark, and the parking lot was only illuminated by the single streetlamp. Since our class of about 20 or so graduated all at different times (it was all about how fast we got through internship), I didn't have anyone to share the moment with, so I basked in it by myself on the way to the truck. What I felt hung somewhere between elation and bittersweet wistfulness. I realized that as much as I had looked forward to getting done, I was going to miss this place.

So what about you, newlygrads? No longer are you your maternal instructor's massage puppies; you're out in the real world now, and it's sink or swim. Since the average career lifespan of a massage therapist is a meager 2 years, I decided to post, in no particular order, some of what I learned, both in school and during the past several years in practice, to stack some more cards in your favor.

First, do what you love. If you really hate giving relaxation rubdowns in a yuppie spa-like setting, and you'd really rather do sports massage for acute and chronic injuries for athletes, then by all means, head for the playing field instead of the spa. If you don't feel like digging your elbow into the paraspinal muscles for an hour, you don't have to do deep tissue. If you want to do energy work, cleansing, or infant massage, do it. If your calling is end-of-life palliative massage for the terminally ill, go for it! Don't chase the money, even if you perceive one avenue to be more prosperous than others. Do what you love, because life is too short not to. The financial security will follow. If you're doing the right thing from the right spot in your heart and head, the Universe will make sure you have what you need.

Next, decide whether or not you want to work for yourself or someone else. Sure, this was covered in business class, and some schools teach this subject much better than others, but give it some thought from another angle, if you haven't already. Deciding whether to start your own practice or contract with someone else seems simple, but it's not. Unless you have a strong business background (i.e. you've owned a business before or you grew up in a self-employement climate), you're going to have to shift your way of thinking to a mode you've never been in before. Working for yourself is all kinds of awesome, and I'll probably expound upon its joys and rewards in a separate future post. But suffice it to say that although it seems like a slacker's paradise (you get to set your own hours and write your own policies and whatnot), it's exactly the opposite. Since you don't have a supervisor micromanaging your every move, you have to do that yourself, which takes serious discipline. In the beginning, the business will consume your every waking moment. You'll have a lot to plan, and it's always more work than you ever imagined. The benefits pay off big, though, if you're the right personality type to drive the business to succeed long enough to reap the rewards.

Next, if you decide to open your practice, start off cheap. You really only need a table, which usually runs under a grand, some office supplies (stapler, file folders, perforated business cards, etc) which will most likely run you a couple hundred, massage oil, which can be bought in bulk cheaply, and a schedule book, which can be found for under $10. You'll probably find that you need a computer, but you can do a lot on this and the money you'll save in the long run is well worth the initial investment. While you're at it, get a printer, too - color laser, if you can swing it. Our computer was a screaming-fast top-of-the-line machine, and we custom-picked the parts and then had it assembled. Going this route cost us $1100 for the computer and $700 for the color laser printer, but you can most likely find a better deal. We do everything on that computer, including keep records, schedule appointments, communicate via email, do research, create and print newsletters, and we created our own intake forms and policy sheets as well, and we print what we need, only when we need it. We even built, wrote, and still continue to update, our website with web software we purchased at a local hole-in-the-wall shop that sells software at educationally-discounted prices to students with a simple show of a student ID. Our URL costs us around $10 per year, and thanks to a friend with a reliable, always-on networked computer, our web hosting (i.e. space to store our website such that it's always online) is free. We added a cell phone to our existing plan so that we could keep all business separate from our personal life. Sheets at Ross ended up to be $10-12 per twin set, even for trendy designer brands, and if you don't mind doing laundry fairly often, you can start with 4-8 sets. We make our own newsletter for the cost of only our time, and we design and print our own business cards. It's nothing fancy, but they are professional-looking and down-to-earth, avoiding the glitzy vibe.

If you work for yourself, I strongly encourage you to write a policy manual, even if the only person that ever sees it is yourself. This gives you a chance to dream up all the "what ifs" you can muster. Don't worry about thinking up every possible scenario now; you can always add as you go along. This will be a work in progress, changing drastically over time as clients present challenges and dilemmas to you and you learn from the mistakes you'll definitely make. Having a policy manual also gives you a bit more ground to stand on in a difficult situation. Trust me, there will be clients who will try to take advantage of you, by trying to strong-arm you into giving them a deal, working outside of your usual hours, taking an appointment on what is normally a day off, or trying to get around some other policy you've set. Certain situations will invariably come up early on in your practice, and you'll want to be armed with effective ways to handle them that are fair for everyone. Situations such as late cancellations, no-shows, strange requests from people with dubious and slimy intentions, late arrivals, etc, are unfortunately facts of life for practically every MT out there, and the more prepared you are to face these headon and stand your ground, the healthier you and your practice will be.

If you decide to work for someone else, you get to do your job, log your hours, and then go home, bypassing the all-consuming brainstorming sessions that invariably await the self-employed at the "end" of the day. Life is simpler for you in some ways, and more difficult in others. For one, you don't have as much of a say in a lot of matters. Everything is negotiable, but you're not just negotiating with yourself and your prospective clientele; you're also negotiating with owners of businesses who possess a legitimate desire to make a profit off of your efforts. Notice that I did say "legitimate". Yes, these people will charge the clientele more than they're going to pay you, and yes, they're going to keep the difference. Yes, that is OK. They're providing you with a place to work, staff to support you, utilities, equipment, some supplies, and most important of all, clientele. Heck, they may even do some marketing for you. It's give and take; the more they provide and the less you have to do yourself, the more of the fee for services they get to keep. On the other hand, the more you're responsible for doing or furnishing, the more generous the terms should be in your favor. There are a lot of bad deals out there, and contracts are generally binding. Be prepared to walk away if you can't live with the terms you're being asked to sign your name to, because it's a lot tougher to come back and claim foul play months or years later. If a term in the contract bothers you or rubs you the wrong way, ask about it, and/or try to negotiate your way out of it--before you sign. The truth is, the "employer" may already have the contract printed up, and they may insist that it's their standard contract that everyone signs, and they may even state that no one else has had a problem or question regarding it, but that doesn't mean you're relegated to following suit; every term is ultimately negotiable. This doesn't mean that the other side has to budge, but it does mean you're not prohibited from asking. And like I said, if the contract contains too many dealbreakers for you, it's OK to walk away. The right thing will come along at the right time.

This next point piggybacks on the last one, regarding business relationships--specifically independent contractor (IC) versus a W-2 style (W-2) employee. These two statuses are NOT interchangeable; in fact, they're almost opposites. It's common for an established business to want it both ways; they seek out workers and attempt to call them ICs, and then turn around and try to treat them like W-2s. The advantage to an IC is that you, the worker, retain control. You do your job (i.e. give a massage) as you see fit, you pick your own days and hours, you schedule yourself time off giving advance notice but not having to seek approval from anyone, you use your own supplies, and you pay your own income taxes. The last part is what the host business is really after; by keeping you on IC status, they save a bundle in the withholding taxes that they don't have to pay out every quarter. Who does? You. There are few advantages to W-2 status as I see it. Like any other such employer, they pretty much own you. They can set your schedule and dictate how you do massage. The advantage is that you have a few protections, such as the right to a safe environment (and retribution against the establishment if they fail to provide it), and they pay half your income taxes. Being an employee also typically does not call for a contract, some of the terms of which can be rather unfavorable to therapists. As an IC, watch out for things like non-compete clauses - if there is one and a radius and/or time frame are specified, do the math and realize the full ramifications of those specifics. A measly-sounding 5-mile radius can easily bar you from practicing anywhere else in your hometown and put you into the next suburb or town over, creating a daily drive for you.

Be professional. Don't wear skimpy or unclean clothes. Don't wear high heels. Dress for comfort and professionalism. I personally like business casual attire from places like Ross or Kohl's. I choose my clothing carefully, but I can look really good without spending much money. Business casual is a great way to set yourself apart from other therapists, showing that you're more serious and mature. Scrubs, although more typical for therapists, are good, too. They're loose (thus allowing you to move freely and comfortably) without being skanky, they're clinical without being mistaken for sexy, and they dry fast should you spill water on yourself or forget to throw them in the dryer until 10 minutes before your appointment. You could even wear a scrub shirt and jeans. My favorite outfit for the longest time was clean jeans, a white turtleneck, and a long-sleeved scrub jacket that I wore open (I dressed in layers because I got cold easily).

Go the extra mile. Warm up your hands before starting a masage. People love warm hands. Offering water afterward is an absolute must (and a glass of tap water doesn't cut it at all); people really appreciate being able to choose between chilled and room temperature water. Not everyone likes cold water; some have very cold-sensitive teeth, or they just plain may not like the taste of cold water. Make a newsletter. It doesn't have to be weekly, or even monthly. I came out with a new issue every 4 months. Make appropriate referrals. (Plan well ahead by seeking out, meeting with, and building a select network of, practitioners from various other healthcare fields. A variety is best, because you never know what a client will present to you with.) If you think someone may benefit from the services of a chiropractor or an acupuncturist, give them the names of several from your trusted network. Show them how to stretch properly, if you know this information, or perhaps give them simple, relatively risk-free exercises they can do themselves at home in between visits. They'll do better in between visits and they'll thank you for it.

Always practice good boundary management. There will be clients who test your boundaries, but engaging in conversation about iffy topics, or by dictating how various aspects of your practice apply to them. There will be other therapists who have poor boundary issues and judgment, and you'll hear stories about them from your clients who have had such therapists in the past. Boundaries indeed can mean anything from conversation matter to cancellation policies to a therapist sharing too much personal information to puncturality. So, again it's the little things. Be on time. Check your voicemail often, but I wouldn't make it a habit of answering your phone whenever, because doing so tells clients your boundaries are loose and they can just call you whenever they want. Decide on a work schedule and stick to it. Have certain days and hours that you are available for massage, and that's it. You might also designate some abbreviated evening or weekend hours for which you don't do massage but you do return phone calls or emails.

Last but not least (at least for now), never give your work away! Do not do free chair or table masage at public events just for publicity. The hosts of these events will solicit your services with the intention of getting them for free, because enough therapists in the past have done it for free, and the general public has come to expect this and takes full advantage of it. They act like they're doing you a favor by "allowing" you to "get your name out there". This largely doesn't work. Free massage at a public event does not translate to paid massage in your office. Do not think that just because these clients got on your chair or table at an event and signed up for your newsletter and promised to come see you and acted all excited about it that you will actually see these people and that they will pay you your price for your services. It just doesn't happen. Instead, when people solicit your services, thank them for choosing you and offer them a price quote. The only deal I've given for these events is a slightly discounted rate per hour when I know I'll be there all day - kind of like cheaper bulk pricing. Also, do not give your first massage away, or offer a deal to first-time clients. All this does is encourage the headachy phenomena of window-shopping and bargain-hunting, both of which can be annoying and even possibly insulting. Come up with a price that resonates with you, that you can ask for with a straight face, and stick to it. Don't apologize, don't waver, and don't backpedal. Those who appreciate your services and talents and your time will gladly pay you for it; the rest, you simply don't need--they're usually more headache than they're worth anyway.

I hope this helps. Go forth and effleurage!

Friday, August 7, 2009

so you want a free lunch...read the fine print!


CONGRESSMAN____________________________________
If you aren’t going to read the entire HealthCare bill, here is a summary:
PG 22 MANDATES the Government will audit books of ALL EMPLOYERS that self insure!!
PG 24 Line 116 Government effectively sets prices for ALL private health plans.
PG 30 Line 123 THERE WILL BE A Government COMMITTEE that decides what treatments/benefits you get.
PG 37 Line 132 The Government will be reviewing grievances about themselves and will decide on appeals for rejected claims.
PG 29 Line 4-16 YOUR HEALTHCARE IS RATIONED!!! Additionally you can reference PG 15 Line 19-25.
PG 42 The Health Choices Commissioner will choose your HealthCare Benefits for you. You have no choice!
PG 50 Line 152 HealthCare will be provided to ALL non US citizens, illegal or otherwise.
PG 58 Government will have real-time access to individuals’ finances & a National ID HealthCare Card will be
issued!
PG 59 Line 21-24 Government will have direct access to your banks accounts for electronic funds transfer!
PG 61 Line 22-24 Congress has no clue what Electronic Medical Records will cost. Asks for estimate.
PG 62 Protection of Data, Government shows they will have database of your personal & financial info.
PG64 L 21-25, pg65 L 1-5 which refers to processing payment transactions by financial institutions
PG 65 Line 164 is a payoff subsidized plan for retirees and their families in Unions & community organizations (ACORN).
PG 72 Line 8-14 Government is creating an HealthCare Exchange to bring private HealthCare plans under Government
control.
PG 84 Line 203 Government mandates ALL benefit packages for private. HealthCare plans in the Exchange.
PG 85 Line 7 Specs for of Benefit Levels for Plans = The Government will ration your HealthCare! #AARP members –
your Health care Will be rationed.
PG 89 Line 6-10 The FAR is not applicable. Government can write contracts any way they want.
PG 95 Line 8-18 The Gov. will use groups i.e., ACORN & Americorps to sign up individuals for Government HealthCare plan.
PG 98 Line 8 Americans - You will be paying for others HealthCare while paying for your own.
PG 100 Line 15-19 The Government Will be using ACORN and other community groups to promote & enroll.
PG 102 Line 12-18 Medicaid Eligible Individual will be automatically enrolled in Medicaid. No choice.
PG 109 Line 207 Health Trust Fund. The Government will raise taxes on EVERYONE to fund HealthCare as they see fit.
PG 110 Line 7-12 Employment taxes on ALL employers NOT offering Government HealthCare. No choice.
PG 110 Line 13-18 An excise tax on ALL goods from companies not offering Government HealthCare. ALL Americans pay.
PG 110 Line 19-24 the Treasury can take $$ from Soc Line to pay HealthCare.
PG 111 Line 208 The Federal Government will usurp all State powers in State Based HealthCare Exchange. Violation of 10th
Amendment.
PG 119 Line 1-3 establish geographically-adjusted premium rates for public option Can you say ACORN census?
PG 121 Line 223 PAYMENT RATES FOR ITEMS AND SERVICES. Can you say Government price fixing & monopoly?
PG 124 Line 24-25 No company can sue Government on price fixing. No “judicial review” against Government Monopoly.
PG 126 Line 10-15 The Government can make up prices for anything at anytime for any reason.
PG 126 Line 22-25 Employers MUST pay for HealthCare for part time employees AND their families.
PG 127 Line 1-16 Doctors: The Government will tell YOU what you can make.
PG 129 The public option will be subsidized. Credits = your tax dollars. Redistribution of wealth.
PG 130 Line 10-23 Federal Government will subsidize State Medicaid = Even Higher State & Federal taxes for ALL.
PG 145 Line 15-17 An Employer MUST auto enroll employees into public option plan. NO CHOICE.
PG 149 Line 16-24 ANY Employer with payroll 400k & above who does not provide public option pays 8% tax on all payroll.
PG 150 Line 9-13 Biz with payroll btw 251k & 400k who doesn’t provide public option pays 2-6% tax on all payroll.
PG 151 Line 1-3 Aggregate Rules-tax on employers payroll not on public option include payroll of other biz.
PG 167 Line 18-23 ANY individual who doesn’t have acceptable HealthCare according to Government will be taxed 2.5% of inc.
PG 170 Line 1-3 Any NONRESIDENT Alien is exempt from individual taxes. (Americans will pay)
PG 195 officers & employees of HealthCare Administration (Government) will have access to ALL Americans
financial/personal records.
PG 198 Line 1-3 1.5% ADDITIONAL TAX on peeps who have income of 500k to 1mil. Redistribution of Wealth.
PG 198 Line 4-6 5.4% ADDITIONAL TAX on peeps who have income of 1mil+. Redistribution of Wealth
PG 199 Line 1-4 Surtax rates on raised AGAIN on Americans in 2012.
PG 201 Line 12-19 Government will ignore whatever costs they see fit to show savings. (Cooking the books)
PG 203 Line 14-15 “The tax imposed under this section shall not be treated as tax” Yes, it says that.
PG 202-215 is a Government rewrite of the tax code ensuring more taxes for EVERYONE, Everywhere.
PG 239 Line 14-24 Government will reduce physician services for Medicaid. Seniors, low income, poor affected.
PG 241 Line 6-8 Doctors, doesn’t matter what specialty you have, you’ll all be paid the same.
PG236 L22-25, 237 L1-3 National rate of uninsured defined by Census. Can you say ACORN corruption?
PG 239 Line 10-12 Medicare DSH payments will be increased. Can you say even higher taxes for all?
PG 238-249 Line 1121 Doctors-Government mandates your growth, costs, value, services, & income. Welcome to rationing
PG 253 Line 10-18 Government sets value of Dr’s time, prof judg, etc. Literally value of humans. We’re next.
PG 260 Line 1125 Fed Government will adjust Medicare Payment Localities for California based on Census. ACORN?
PG 265 Line 1131 Government mandates & controls productivity for private HealthCare industries.
PG 268 Line 1141 Fed Government regulates rental & purchase of power driven wheelchairs.
PG 270 Line 1144 Government Mandates that all private ambulatory surgical centers submit cost data & other data
PG 272 Line 1145 TREATMENT OF CERTAIN CANCER HOSPITALS – Cancer patients – welcome to rationing!
PG 276 Line 3-20 Oxygen Equipment & Supply Companies - Government MANDATES you will provide supplies NO
MATTER where individual is.
PG 287 Line 14-25 PROOF that Government will ration HealthCare by mandating waiting periods for readmission.
PG 298 Line 9-11 Drs, treat a patient during initial admission that results in a readmission - Government will penalize you.
PG 303 Line 12-25 Post Acute Care Services Data – Government will collect data including personal information as they see fit.
PG 304 Line 17-19 BIG ONE HERE: Expedited Data Collection – Chapter 35 o… Read More: http://www.twitlonger.com/
show/c5bcfdae ... 6be70918ac
PG 304 Line 17-19 Government does NOT have to protect your private information, share with anyone, & is not resp
Expedited Data Collection - Chapter 35 of Title 44 of USC SHALL NOT APPLY. Folks this gives the govt
the right to access ur data any way the see fit.
Here is link to the chapter: http://www.law.cornell.edu/uscode/html/uscode44/usc_sec_44_00003501----
000-.html
Look at number 8 THE GOVT IS SAYING THAT THEY DONT HAVE TO DO THIS!!!
(8) ensure that the creation, collection, maintenance, use, dissemination, and disposition of information by or
for the Federal Government is consistent with applicable laws, including laws relating to—
(A) privacy and confidentiality, including section 552a of title 5;
(B) security of information, including section 11332 of title 40 [1] ; and
(C) access to information, including section 552 of title 5;
PG 306 Line 3-6 The Government can expand the scope & size of Post Acute Program Services anytime & as they see fit.
PG 313 Line 9-14 Government MANDATES Health Services providers will state ownership, invest, & compensation
arrangements.
PG 317 Line 13-20 PROHIBITION on ownership/investment. Government tells Drs. what/how much they can own.
PG 317-318 L 21-25,1-3 PROHIBITION on expansion- Government is mandating hospitals cannot expand.
PG 318-319 Government is mandating how hospitals & physicians conduct business & investments. We’re next!
PG 321 2-13 Hospitals have opportunity to apply for exception BUT community input required. Can you say ACORN?!!
PG 328 Line 1157 Government study disguised. Its a HealthCare workforce study mandated by law for unionization.
Pg335 L16-25,PG 336-339 Government mandates estab. of outcome based measures. HealthCare the way they want. Rationing.
PG 341 Line 3-9 Government has authority to disqualify Medicare Adv Plans, HMOs, etc. Forcing into Government plan.
PG 354 Line 1177 Government will RESTRICT enrollment of Special needs people!
PG 355-369 Line 1181 Government disguises tax on Drug Companies as rebate to Government to subsidize Drugs. We pay in the end.
PG 379 Line 1191 Government creates more bureaucracy – Telehealth Advisory Committee. Can you say HealthCare by phone?
PG 399 If your a subsidy eligible individual under Medicare part D and you don’t enroll, the Government will auto
enroll you.
PG 401 Section 1221 Americans will fund Medicare Language & Translation Services Program. Can you say MORE taxes?
PG 404 Lines 12-16 Government exempts itself again from - Chap 35 of title 44, USC including privacy of Americans.
PG 404 Lines 17-19 Government doesn’t know the cost of Language services but states that money is there.
PG 425 Lines 4-12 Government mandates Advance Care Planning Consult. Think Senior Citizens end of life.
PG 425 Lines 17-19 Government will instruct & consult regarding living wills, durable powers of atty. Mandatory!
PG425 L22-25, 426 L1-3 Government provides approved list of end of life resources, guiding you in death.
PG 427 Lines 15-24 Government mandates program for orders for end of life. The Government has a say in how your life ends.
PG 429 Lines 1-9 An “advance care planning consultant” will be used frequently as patients health deteriorates.
PG 429 Lines 10-12 “advance care consultation” may include an ORDER for end of life plans. AN ORDER from Government.
PG 429 Lines 13-25 The Government will specify which Doctors can write an end of life order. Logan’s Run anyone?
PG 430 Lines 11-15 The Government will decide what level of treatment you will have at end of life.
PG 432 Lines 18-21 The Government will publish “quality measures” for individual’s end of life in Federal Register.
PG 434 Section 1234 Military Active, Reservists, Families - If you’re not enrolled in Tricare it is mandated.
PG 434 Section 1234 Military Active, Reservists, Families - Once HealthCare bill is passed your premiums will go up.
PG 438 Section 1236 The Government will develop a patient decision making aid program that you & Dr. WILL use.
PG 443 Lines 7-24 Government at taxpayers expense test out an “Accountable Care Org” program (Government doesn’t have plan.)
PG 444 Lines 1-6 Government’s Accountable Care Program will mandate services & infrastructure thru reward/penalty system.
PG 448 Lines 4-17 Government will set performance targets for ALL Accountable Care Organizations including private.
PG 455 Lines 3-4 Government exempts itself from Chapter 35, Title 44 Paperwork Reduction & Citizens Privacy Protection Act
PG 460 Section 1302 Knock Knock - It’s the Government and I’m here with the Medical Home Program - YOUR home.
PG 460 Section 1302 The Government WILL provide medical services in your home. Paging Nurse Pelosi!!
PG 464 Lines 17-22 Independent Patient Center Home Medical Services - Drs. don’t have to be at your home just some directed by D
PG 469 Community Based Home Medical Services=Non profit organizations. Hello, ACORN Medical Services here!!?
Page 472 Lines 14-17 PAYMENT TO COMMUNITY-BASED Organization - 1 monthly payment to a community-based
organization Like ACORN?
PG 476 19-20 Chapter 35/ title 44, (Privacy of personal records) shall not apply Home Medical Services. ACORN ACCESS
PG 489 Section 1308 Government will cover Marriage & Family therapy. Which means they will insert Govt into your marriage.
PG 494-498 Government will cover Mental Health Services including defining, creating, rationing those services.
PG 502 Section 1181 Center for Comparative Effectiveness Research Established. - Hello Big Brother - Literally.
PG 502 Line 5-18 Government builds the “Center” to conduct, support, & synthesize research to define our HealthCare Services.
PG 503 Line 13-19 Government will build registries and data networks from YOUR electronic medical records.
PG 503 Line 21-25 Government may secure data directly from any department or agency of the US including your data.
PG 504 Line 6-10 The “Center” will collect data both published & unpublished (that means public & your private info)
PG 506 Line 19-21 The Center will recommend policies that would allow for public access of data
PG 518 Line 21-25 The Commission will have input from HealthCare consumer reps - Can you say unions & ACORN?
PG 524 18-22 Comparative Effectiveness Research Trust Fund set up. More taxes for ALL.
PG 525-620 deals with the Government basically taking over nursing homes, PGs 525-620 deals with the Govt
basically taking over nursing homes,long-term care facilities (think assisted living) through regulations of
the facilities, the owners of sd facilities, the employees of sd facilities and even the land owners of that sd
facilities reside on.
Additionally as you read these 90+ pages you can come to the conclusion that any Health related svcs will be
determined and rationed by the Govt for our senior citizens and others in nursing homes.
This one post should do enough to raise awareness of the control the Govt is exerting over the older
population of American citizens.
PG 620 Line 1-9 The Government will define, prioritize, and nationalize your Health Care Services.
PG 621 Lines 20-25 Government will define what Quality means in HealthCare. Since when does Government know about quality?
PG 622 Lines 2-9 To pay for the quality Standards Government will transfer $$ from to other Government Trust Funds. More Taxes.
PG 624 “Quality” measures shall be designed to assess outcomes & functional status of patients.
PG 628 Section 1443 Government will give “Multi-Stake Holders” Pre-Rule Making input into Selection of “Quality” Measures.
PG 630 9-24/631 1-9 Those Multi-stake holder groups including Unions & groups like ACORN deciding HealthCare quality.
PG 632 Lines 14-25 The Government may implement any “Quality measure” of HealthCare Services as they see fit.
PG 633 14-25/ 634 1-9 The Secretary may issue non-endorsed “Quality Measures” for Physician Services & Dialysis Services.
PG 635 - 653 Physicians Payments Sunshine Provision - Government wants to shine sunlight on Docs but not Government.
PG 654-659 Public Reporting on Health Care-Associated Infections - Looks okay.
PG 660-671 Doctors in Residency - Government will tell you where your residency will be, thus where you’ll live.
PG 676-686 Government will regulate hospitals in EVERY aspect of residency programs, including teaching hospitals.
PG 686-700 Increased Funding to Fight Waste, Fraud, and Abuse. You mean the Government with an $18 mil website?
PGs 701-704 Section 1619 If your part of HealthCare plan that isn’t in Government HealthCare Exchange but you qualify
for Federal aid, no payment.
PG 705-709 SEC. 1128 If Secretary gets complaints (ACORN) on HealthCare provider or supplier, Government can do background check.
PG 711 Lines 8-14 The Secretary has broad powers to deny HealthCare providers/suppliers admittance into HealthCare Exchange.
Pg 719-720 Section 1637 ANY Doctor who orders durable medical equipment or home medical services MUST be enrolled in Medicare.
PG 722 Section 1639 Government Mandates Doctors must have face-to-face with patient to certify patient for Home Health Services.
PG 724 Lines 16-22 Government reserves right to apply face-to-face certification for patient to ANY other HealthCare service.
PG 724 23-25 PG 725 1-5 The same Government certifications will apply to medicaid & CHIP (your kids)
Pg 735 lines 16-25 For law enforcement purposes, the Secretary of Health & Human Services will give Attorney General access to
ALL data.
PG 740-757 Government sets guidelines for subsidizing the uninsured (That’s your tax dollars peeps)
Pg 757-762 Fed Government will shift burden of payments to Disproportionate Share Hospitals (DSH) to States. (Taxes)
Page 763 1-8 No DS/EA hospitals will be paid unless they provide services without regard to national origin
Pg 765 Section 1711 Government will require Preventative Services including vaccines. (Choice?)
Pg 768 Section 1713 Government - Nurse Home Visitation Services (Hello union paybacks)
Pg 769 3-5 Nurse Home Visit Services - “increasing birth intervals between pregnancies.” Government Abortions anyone?
Pg 769 11-14 Nurse Home Visit Services include-economic self-sufficiency, employment advancement, school-readiness.
Pg 769 3-5 Nurse Home Visit Services - “increasing birth intervals between pregnancies.” Government ABORTIONS anyone?
Pg 770 SEC 1714 Federal Government mandates eligibility for State Family Planning Services. Say abortion & State Sovereign.
Pg 789-797 Government will set & mandate drug prices, controlling which drugs will brought to market. Bye innovation
Pgs 797-800 SEC. 1744 PAYMENTS for grad medical education. The government will now control Drs education.
PG 801 Sec 1751 The Government will decide which Health care conditions will be paid. Say RATION!
Pg 810 SEC. 1759. Billing Agents, clearinghouses, etc. required to register. Government takes over private payment system.
Page 820-824 Sec 1801 Government will identify individuals ineligible for subsidies. Will access all personal finances.
Pg 824-829 SEC. 1802. Government Sets up Comparative Effectiveness Research Trust Fund. Another tax black hole.
PG 829-833 Government will impose a fee on ALL private health insurance plans including self insured to pay for Trust Fund!
PG 835 11-13 fees imposed by Government for Trust Fund shall be treated as if they were taxes.
Pg 838-840 Government will design & implement Home Visitation Program for families with young kids & families
expecting kids.
PG 844-845 This Home Visitation Program includes Government coming into your house & telling you how to parent!!!
Pg 859 Government will establish a Public Health Fund at a cost of $88,800,000,000. Yes thats Billion.
Pg 865 The Government will MANDATE the establishment of a National Health Service Corps.
PG 865 to 876 The NHS Corps is a program where Drs. perform mandatory HealthCare for 2 years for part loan repayment.
PG 876-892 The Government takes over the education of our Medical students and Drs.
PG 898 The Government will establish a Public Health Workforce Corps. to ensure supply of public health
professionals.
PG 898 The Public health workforce corps shall consist of officers of Regular & Reserve Corps of Service.
PG 898 The Public health workforce corps shall consist of civilian employees of the U.S. as Secretary deems.
PG 900 The Public Health Workforce Corps includes veterinarians.
PG 901 The Public Health Workforce Corps WILL include commissioned Regular & Reserve Officers. HealthCare Draft?
PG 910 The Government will develop, build & run Public Health Training Centers.
PG 913-914 Government starts a HealthCare affirmative action program thru guise of diversity scholarships.
PG 915 SEC. 2251. Government MANDATES Cultural & linguistic competency training for HealthCare professionals.
Pg 932 The Government will establish Preventative & Wellness Trust fund - intial cost of $30,800,000,000-Billion.
PG 935 21-22 Government will identify specific goals & objectives for prevention & wellness activities. Control You!!
PG 936 Government will develop “Healthy People & National Public Health Performance Standards” Tell me what to eat?
PG 942 Lines 22-25 More Government? Offices of Surgeon General -Public Health Services, Minority Health, Women’s Health
PG 950- 980 BIG Government core public health infrastructure includes workforce capacity, lab systems; health information
systems, etc
PG 993 Government will establish school based health clinics. Your kids wont have a chance.
PG 994 School Based Health Clinic will be integrated into the school environment. Say Government Brainwash!
PG 1001 The Government will establish a National Medical Device Registry. Will you be tracked?
PG 1003 9-11 National Medical Dev Reg ‘‘(iii) other postmarket device surveillance activities” you WILL be tracked.
PG 1018 States give up some of their State Sovereignty.
(From Peter Fleckenstein’s Twitter Account: http://twitter.com/fleckman)