Guest guest Posted December 21, 2011 Report Share Posted December 21, 2011 [image: Posterous Spaces] [image: Your daily Update] December 21st, 2011 10 Things Medicare Won't Tell You - SmartMoney.com<http://ptmanagerblog.com/10-things-medicare-wont-tell-you-smartmo\ neyco> Posted 1 day ago by [image: _portrait_thumb] Kovacek, PT, DPT, MSA <http://posterous.com/users/1l1oCkDWEWjv> to PTManager<http://ptmanagerblog.com> [image: Like this post]<http://posterous.com/likes/create?post_id=87495789> 10 Things Medicare Won't Tell You The government's massive entitlement program is full of costly glitches. Embedded media -- click here to see it.<http://ptmanagerblog.com/10-things-medicare-wont-tell-you-smartmoneyco> Email Embedded media -- click here to see it.<http://ptmanagerblog.com/10-things-medicare-wont-tell-you-smartmoneyco> Print Yahoo! Buzz--> LinkedIn MySpace--> Fark del.icio.us Viadeo--> Reddit Orkut--> Facebook--> X - ARTICLE<http://www.smartmoney.com/retirement/planning/10-things-medicare-wont-te\ ll-you-1324333528533/#article_tab_article> - Comments (1)<http://www.smartmoney.com/retirement/planning/10-things-medicare-wont-tell-y\ ou-1324333528533/#article_tab_comments> - QUOTES<http://www.smartmoney.com/retirement/planning/10-things-medicare-wont-tel\ l-you-1324333528533/#article_tab_quotes> - - By CATEY HILL 1. " We fork over millions for unproven procedures. " Medicare spends millions of dollars each year on treatments that many medical experts deem unnecessary. One example: Digital mammograms. These are often more expensive than traditional mammograms but not necessarily better for older women. A five-year clinical trial conducted by the National Cancer Institute found that digital mammograms were no more effective in finding cancers in women 50 and older than traditional mammograms. But the number of digital mammograms that Medicare paid for has risen from 426,000 in 2003 to nearly 6 million in 2008 -- a jump that increased the cost of breast cancer screening by more than $350 million, according to an analysis by The Center for Public Integrity, a nonprofit investigative news organization. Also See - 10 Things Social Security Won't Tell You<http://www.smartmoney.com/retirement/planning/10-things-social-security-wont\ -tell-you-1314999788631/> - 10 Things Vacation-Rental Sites Won't Say<http://www.smartmoney.com/spend/travel/10-things-vacationrental-sites-wont-s\ ay-1323712196480/> - 10 Things Life Insurers Won't Tell You<http://www.smartmoney.com/plan/insurance/10-things-life-insurers-wont-tell-y\ ou-1308333194735/> Medicare also often pays significantly more for liquid-based cytology, a screen for cervical cancer, than it does for routine pap smears, even though a large 2009 study found that the expensive test is no more effective than the traditional procedure when it comes to detecting cancer. Using the newer, more expnsive test costs Medicare an extra $90 million since 2003, according to The Center for Public Integrity. Another point of contention is that Medicare pays for screening colonoscopies for people over 75 despite the fact that the United States Preventative Task Force " recommends against routine screening for colorectal cancer in adults age 76 to 85 years. " Medical experts argue that testing shouldn't always come down to cost. " One person's 'unnecessary' care is another person's necessary, " says Joe Baker, president of the Medicare Rights Center. " Medicare pays for most tests or procedures that a doctor orders. " Still, there are many unnecessary procedures that Medicare pays for each year that are outside or clinical guidelines, some of which could be eliminated with better doctor and consumers education, he adds. A spokesman for the Center for Medicare and Medicaid Services (CMS) says that it " pays for services that are reasonable and necessary " though it does try to " provide physicians as much flexibility as possible in using their judgment to design a treatment plan that meets the patient's needs. " 2. " Think Social Security is broke? Just look at Medicare. " With the debate raging over the astronomical cost of entitlement programs, experts say it's easy to forget that Medicare and Social Security are two different programs with different financial strains. In the short-term, at least some parts of Medicare are worse off than Social Security, according to a 2011 report by the Social Security Administration. The report concludes that the Medicare Hospital Insurance Fund or Medicare Part A, which pays for hospital insurance, " faces a more immediate funding shortfall " because it is projected to run out of money in 2024, compared to 2036 for Social Security. (Note that Medicare Part B and Part D, although expensive, " remain adequately financed into the indefinite future because current law automatically provides financing each year to meet the next year's expected costs, " the report says.) It's easy to see why Medicare is in such bad shape, experts say. Consider an average couple, both earning an average $43,500 per year. Upon retiring in 2011, they would have paid $119,000 in Medicare payroll taxes during their careers, but they can expect to receive medical services worth $357,000, according to an analysis by the Urban Institute, a research institute that educates Americans on social and economic issues. What the average person puts into Social Security versus what he or she gets out is more balanced. The same couple would have paid $598,000 in Social Security taxes and received an estimated $556,000 in benefits. The picture doesn't look much better going forward. In 2010, Medicare costs represented 3.6% of gross domestic product for the United States. That number is expected to jump to 5.6% in 2035 and 6.2% in 2085 -- the result of " continuing growth in the volume and intensity of services provided per beneficiary, " according to the CMS, the government agency that administers Medicare. Baby boomers are a big part of that growth. In the last year alone, more than 7,000 boomers turned 65 every single day a total of 2.5 million in 2011, according to AARP. It's this rapid aging of the boomer population that contributes to the fact that the Medicare-eligible population will more than double by 2050, according to projections from the Census Bureau. A spokesman for CMS says that thanks to the Affordable Care Act -- which was signed into law last year and designed to make health care more affordable and expansive for Americans and hold insurers accountable -- CMS is " implementing many initiatives that will help reduce long-term costs while improving the quality of care that a patient receives. " 3. " We pay for dead people. " It's not just for the living. In 2010, the Center for Medicare and Medicaid Services paid more than $3.6 million for Medicare Part D (the prescription drug benefit) to deceased beneficiaries, according to testimony from Levinson, the inspector general of the U.S. Department of Health & Human Services. Between 2004 and 2008, CMS paid for 142,000 procedures at 2,119 hospitals or clinics on nearly 5,000 dead patients, at a cost of roughly $33 million, according to an analysis by PearlDiver, a medical database management company. In 2008, the Senate Permanent Subcommittee on Investigations found that Medicare had paid tens of millions of dollars to suppliers who were using the identification numbers of dead doctors when filing claims. The total amount paid for these claims is estimated to be between $60 million and $92 million, according to the subcommittee report. What's going on here? Sometimes it's fraud -- the doctor, hospital, medical group or supplier knowingly uses a deceased person or doctor's identification number -- and sometimes it's a mistake, experts say. However, it's usually clerical error on the part of Medicare that they actually pay these claims, says Ben Young, president of PearlDiver. " It's hard for [CMS] to manage its large database effectively. " A May 2011 report from the Office of the Inspector General regarding the $3.6 million in improper Part D payments comes to a similar conclusion: " CMS's systems categorized these enrollees as alive or as having different dates of death than those listed in the SSA death master file, " the report says. This happened because " its systems did not always identify and prevent improper payments. " With regards to the $3.6 million in payments to dead beneficiaries, a spokesman for CMS says the organization has now " recouped the entire amount of improper payments. " In addition, it says that it " has installed modifications to its data systems to further reduce the likelihood of improper payments. " 4. " Don't expect a five-star plan. " Medicare's Five-Star Quality Rating System is designed to rank Medicare sold by private insurers. Often called Medicare Advantage plans, these policies offer Medicare Part A (hospital insurance) and Part B (medical insurance) coverage and sometimes extras like vision and dental coverage. They also often come with prescription drug coverage, or Medicare Part D. The star system is designed to recognize the best private policies with five stars. Medicare enrollees who couldn't find a five-star program during the open enrollment period that ended Dec. 7 can still sign up for one through Feb. 14. But that's if you can find one of these policies in your area. " There are not a lot of these to choose from, " says Adrienne Muralidharan, the senior Medicare specialist at Allsup, a site that provides Medicare resources. In fact, as of Nov. 30, five-star Medicare Advantage plans were available in just 10 states, according to an analysis by Allsup. The reason: It's hard to earn five stars. Plans are graded on several counts including customer service, how many doctors are in your network and prescription drug coverage. A spokesman for CMS offers a similar explanation saying that " achieving a 5-star rating is Medicare's highest mark of excellence, and can only be obtained by those plans that are truly providing the highest quality care to beneficiaries. " Despite that fact that there aren't many five star plans now, Medicare is now creating new incentives and systems to increase the number of higher rated plans, says Baker of the Medicare Rights Center. " You see how consumers flock to cars that Consumer Reports rates highly, " he says. " The expectation is that will happen in the Medicare Advantage market as well. " 5. " We're not popular with many doctors. " Many doctors limit the number of Medicare patients they will treat, according to a new study. Roughly one in five physicians across all disciplines restrict the number of Medicare patients they will take on at a given time, according to a 2010 study by the American Medical Association. For primary care physicians, this number jumps to 31%. These doctors often restrict the number of Medicare patients they will accept because they feel Medicare payment rates are too low (85% of overall physicians and 83% of primary care physicians, according to the study) and that the " ongoing threat of future payment cuts makes Medicare an unreliable payer " (78% and 82%, respectively), the AMA study showed. " A lot of doctors are just sick of hearing about these rate cuts, " says Muralidharan. " They figure it's not worth it. " But despite the restrictions, Baker points out that most doctors do take Medicare. Typically doctors who won't accept Medicare are concentrated in specialties like neurology. And, they are often located in urban areas like New York and San Francisco, where a large number of consumers can afford to pay medical bills out of pocket. " Some doctors leave, but it's often the same doctors who stop taking insurance entirely, " Baker says. " We haven't seen a significant number of doctors across the board stop taking Medicare entirely. " A spokesperson for CMS says that " the number of doctors currently participating in the Medicare program is at an all-time high. " 6. " We get ripped off a lot. " Last year, the Centers for Medicare and Medicaid Service saw " improper payments " for Medicare totaling $47.9 billion, according to testimony by R. Levinson, the inspector general of the U.S. Department of Health and Human Services. True many of these mistakes are due to clerical snafus such as eligibility errors and miscoded claims. But there is a growing body of evidence that shows fraud is a major contributor. The National Health Care Anti-Fraud Association estimates that at least 3 percent of the total spending on health care -- or more than $60 billion each year -- is lost to fraud. " Although it is not possible to measure precisely the extent of fraud in Medicare and Medicaid, everywhere it looks the Office of the Inspector General continues to find fraud against these programs, " Levinson said in his testimony. Medicare fraud takes many forms. Some of the most common include health-care providers manipulating payment codes to inflate reimbursement amounts or to bill for unnecessary or never-performed services. One of the costliest Medicare rip-offs involves pharmaceutical or medical technology companies " knowingly selling unsafe or ineffective pharmaceuticals, medical equipment, devices and other technologies, " says Ken Nolan, a partner at Nolan & Auerbach, a health-care fraud law firm with offices in three states. " Medicare is susceptible to fraud not only because of its size and complexity, but because the system itself makes it easy to defraud the government, " says Nolan. " Most of the scrutiny, if any, is made after payment is made -- not before as in traditional business transactions. " A spokesman from CMS says that the " Administration is doing a great deal to fight fraud and errors " and notes that this week the Department of Justice announced that it has recovered more than $2.9 billion from health-care fraud. 7. " We don't cover a lot of the care seniors need most. " If your aging mother needs full-time care in a nursing home or a significant amount of home health care, she will have to meet some strict criteria to make it happen. For the most part, Medicare doesn't pay for nursing home care except for people who were hospitalized for at least three days within the previous 30 days and require " skilled " care, which is care that only a medical professional like a registered nurse could provide. Even then, it only covers up to 100 days per benefit period. Qualifying to get reimbursement for home health care is also difficult, as you must meet all of following criteria: Be homebound (which means that a doctor has advised you not to leave home due to your condition, that leaving home takes considerable effort or you need help like special transportation to leave home); require skilled nursing care, physical therapy, speech-language pathology services or continued occupation therapy; and be getting regular services from your doctor under a plan of care that he or she has ordered. Medicare does not cover meals delivered to a home, cleaning and laundry services or, in most cases, personal care like help bathing, dressing and using the bathroom. " A lot of people don't realize it but these kinds of care are very limited, " says Muralidharan. A spokesperson for CMS notes that the organization wants to engage with members of Congress, aging/disabled community members and experts to " explore solutions to the nation's long term care needs. " This gap in Medicare coverage can be financially devastating for many families. The average nursing home, for example, costs about $77,000 per year, according to a study by the MetLife Mature Market Institute. Home health care is also expensive, with rates ranging from about $17 to almost $30 per hour, according to the American Association for Long-Term Care Insurance, significantly more for a trained nurse or therapist. 8. " Paws off that cash, grandpa: Your settlement is ours. " Let's say something goes terrible wrong, you sue your doctor for malpractice and you win. Don't go counting the money just yet. If Medicare paid some of your doctor bills, it has a claim against any damages for expenses, says Joan , a partner at elder law firm Kassoff, & Lerner. (Medicare only gets money for what it paid, not a percentage of punitive damages, she says.) A spokesperson for CMS says that claims are handled in this manner " in order to protect the Medicare trust funds when other sources of payment are available. " Most people don't realize this is the way it works, says . What's more, Medicare often doesn't collect its share of a payout until months or even years later, Baker says. At that point, many people have already spent that money on other things. To prevent this, " ask your lawyers to build this into what they're asking for in the settlement and make sure your lawyer understands the Medicare recovery process, " Baker says. 9. " Complain all you want ... " The Center of Medicare and Medicaid Services is supposed to notify the group that that accredits hospitals, typically the Joint Commission, of all complaints they receive concerning hospitals. But according to an October 2011 report<http://www1.macys.com/registry/wedding/guest/?registryId=607618>by the Office of the Inspector General, CMS rarely does so. CMS regional offices notified accreditors of only 28 of the 88 sampled complaints against hospitals, " according to the report. That's fewer than one third. The lack of reporting " compromises Medicare's quality oversight system, " says the Office of the Inspector General. Non action also impedes the ability of accreditors to respond to complaints that may be related to adverse events or other problems at hospitals they oversee, the report says. " This in turn can deprive overseers important information when deciding whether to renew a hospital's accreditation. " Bottom line: If the accreditors don't know about all of the complaints that a hospital receives, they may continue approve a facility where significant errors occur. A spokesperson for CMS says that they are now " clarifying the existing policy for ROs [regional offices] and are working with them to enhance compliance. " 10. " Want Your Way? Just ask. " When Medicare denies a claim, experts say often the recipient will simply pay out of pocket, even if they can't afford it. That's the wrong strategy. Oftentimes, it's better to appeal, says Judith Stein, the executive director of the Center for Medicare Advocacy. " People are denied Medicare like any other kind of insurance, " she says. " Insurance wants your money and doesn't want to give it back. " Only 1% to 2% of people with denied claims appeal, but of those that do, more than half either receive more care or get a higher payment, according to research from the Medicare Rights Center. " If you appeal, you may very well get your claim approved, " says Stein. Filing an appeal is oftentimes pretty easy, experts say. For those who have original Medicare, they only need to fill out a Redetermination Request Form<https://www.cms.gov/cmsforms/downloads/CMS20027.pdf>, and send it to their Medicare administrator within 120 days of the date of getting their Medicare Summary Notice (the form that Medicare sends when it pays or denies a claim). Those in a Medicare plan administered by private organizations need to read the materials the plan sends you each year to learn how to appeal. Another strategy, say advisers: Call the plan directly for this information. You may also want to contact your doctor's billing staff for help with your appeal. A spokesman for CMS notes that when a denied claim in appealed, in 44% of the cases those denials were overturned. via smartmoney.com<http://www.smartmoney.com/retirement/planning/10-things-medicare-\ wont-tell-you-1324333528533/#printMode> Structure for Strategic Planning<http://ptmanagerblog.com/structure-for-strategic-planning> Posted 1 day ago by [image: _portrait_thumb] Kovacek, PT, DPT, MSA <http://posterous.com/users/1l1oCkDWEWjv> to PTManager<http://ptmanagerblog.com> [image: Like this post]<http://posterous.com/likes/create?post_id=87506721> Structure for Strategic Planning So, how do we talk about the long term future? Most long term (strategic) planning discussions falter. Managers seldom work through long term planning scenarios. *Long Term* is a discussion outside the bounds of tangible concrete circumstances. It is a conceptual discussion. For years, I have used a planning template and approach which I recently found compiled and published by Osterwalder<http://alexosterwalder.com/>in an open source project called Business Model Generation. The central piece of the project is a long term planning template called the Business Model Canvas<http://en.wikipedia.org/wiki/Business_Model_Canvas#The_Business_Model_Can\ vas> .. In its one page form, it allows a group to deconstruct the elements of its business model into nine elements. - Key Partners - Key Resources - Key Activities - Cost Structure - Value Proposition - Customer Segments - Customer Relationship - Customer Channels - Revenue Streams This Business Model Canvas provides the structure for an orderly discussion, an orderly conceptual discussion about the way the business is put together. And that’s our Inventory, as of today. <http://fosterlearning.files.wordpress.com/2011/12/businessmodelcanvas.jpg> The second step of this process is to examine external forces (trends, competitive pressure, economics, demographics, regulatory pressures) that will impact on each of the nine elements. The third step is to redefine the nine elements in response to those external forces. This third step is the work product of the long term planning discussion. A structured conceptual discussion, strategic planning. Rewards for patients to switch care<http://ptmanagerblog.com/rewards-for-patients-to-switch-care> Posted 1 day ago by [image: _portrait_thumb] Kovacek, PT, DPT, MSA <http://posterous.com/users/1l1oCkDWEWjv> to PTManager<http://ptmanagerblog.com> [image: Like this post]<http://posterous.com/likes/create?post_id=87512460> Rewards for patients to switch care Harvard Pilgrim plan seeks to reduce costs [image: C. Lord, the president of Associated Industries of Massachusetts, said, & lsquo;We & rsquo;ve been talking about getting consumers more engaged in making their own health care decisions. & rsquo;] C. Lord, the president of Associated Industries of Massachusetts, said, ‘We’ve been talking about getting consumers more engaged in making their own health care decisions.’ Told they need a routine medical test, such as a colonoscopy or a mammogram, most patients go wherever the doctor recommends. But under a program being rolled out next month by Harvard Pilgrim Health Care, they could be paid to seek care somewhere else. The health insurer plans to introduce a rewards program through which its Massachusetts members who have been given referrals will be asked to call a “clinical concierge’’ service that can direct them to hospitals or medical facilities that charge less for the same tests. In return, they will receive a check from Harvard Pilgrim, ranging from $10 to $75. The program, called SaveOn, is intended to help patients make smarter health care choices, according to Harvard Pilgrim, and to rein in the runaway prices of imaging tests and other procedures that have contributed to steadily rising premiums. “It’s the kind of decision patients aren’t making today because they don’t have the information,’’ said H. Schultz, chief executive of Harvard Pilgrim, the state’s second-largest health insurer. “Doctors are still referring patients for diagnostics based on the way they’ve always done it, without regard for the cost. But we can’t sit around and accept behavior that drives costs up with little or no impact on quality.’’ By throwing down the gauntlet before the state’s powerful medical care providers, Schultz said Wellesley-based Harvard Pilgrim is responding to the demands of financially pressed customers and administration officials, who have called on insurers to create incentives to contain the escalating price of care. But some doctors are skeptical of anything that would take away from them decisions about where to refer patients. They say they are in the best position to vouch for the quality of medical test providers and have longstanding relationships with testing companies that get them data quickly and accurately. “I do have concerns about this,’’ said Dr. Rick , a primary care internist and chief medical officer of Newton’s Atrius Health, an alliance of six community-based doctors groups, including Harvard Vanguard Medical Associates. “When I refer a patient for a test or an imaging, I’m taking into account what the patient needs and I’m referring the patient to a place where there’s quality. And I know that from experience.’’ also noted that if something goes wrong with a patient’s care, “The doctors are liable.’’ Insurers have been pushing to slow the rate of cost increases in recent years, both through products they offer and the ways they reimburse doctors and hospitals. Several carriers, including Harvard Pilgrim, have been negotiating so-called global payments, which give providers annual budgets to cover patient care instead of paying providers for every visit, test, and procedure. On the customer side, health insurers have been selling employer groups limited-network plans, which restrict which providers patients can see, and tiered-network plans, which require them to pay more to visit higher-priced physicians or medical centers. But SaveOn, which has already been introduced as a pilot on a limited scale in New Hampshire, will be the first in Massachusetts structured as a rewards program, similar to those offered by online retailers for shopping at their stores. Harvard Pilgrim officials are expected to meet this week with regulators from the state Division of Insurance, which must approve the program before it can be marketed as an add-on to the insurance products the company sells to businesses and other employers. “Conceptually, it’s a move in the right direction,’’ said C. Lord, president of Associated Industries of Massachusetts, a trade group representing 6,000 businesses. “We’ve been talking about getting consumers more engaged in making their own health care decisions. Up until now, there’s been no incentive to a consumer to shop around.’’ The role of employers in educating their workers will be key to the adoption of SaveOn because employers typically pick up the largest share of health insurance costs. But if the program succeeds in moderating reimbursements for everything from MRIs and CT scans to ultrasounds and sleep studies, employers will probably want their own financial reward. “Ultimately, the savings should be reflected in premiums employers pay,’’ Lord said. While consumers are often unaware of the costs of tests and procedures because their insurers are billed, soaring premiums have forced many employers to redesign policies with higher deductibles and co-pays, meaning individuals are paying more on their own. Switching to lower-cost test and imaging services recommended by Harvard Pilgrim’s concierge subcontractor, Tandem Care of Manchester, N.H., could reduce those out-of-pocket expenses, Harvard Pilgrim executives said. The company said bills for procedures vary widely, depending on where they are performed. For instance, potential savings on colonoscopies can total $1,700 per procedure, they said, while the price variation for mammograms is sometimes as much as $285. Two reports from Attorney General Martha Coakley over the past two years have documented disparities in what hospitals and doctors are paid by insurers for the same services. Several of Boston’s Harvard-affiliated teaching hospitals and hospitals with geographic monopolies have been among the highest paid. Lower-priced providers, including community hospitals in competitive markets, have called for more openness on pricing. “This is pretty positive,’’ J. Thieme, executive director of the Massachusetts Council of Community Hospitals, said of the SaveOn program. “It contributes to transparency, which we would hope for. It helps consumers to make rational decisions,’’ he said. Harvard Pilgrim’s Schultz said he hopes SaveOn will help the insurer sell products and gain market share while driving down health care costs, one procedure at a time. “This becomes a conversation at the watering hole - ‘I just got a check for $75,’ ’’ he said. Medicare SGR: Short memories vs Groundhog Day<http://ptmanagerblog.com/medicare-sgr-short-memories-vs-groundhog-day> Posted 1 day ago by [image: _portrait_thumb] Kovacek, PT, DPT, MSA <http://posterous.com/users/1l1oCkDWEWjv> to PTManager<http://ptmanagerblog.com> [image: Like this post]<http://posterous.com/likes/create?post_id=87515288> Short memories When the health care reform bill was pending, and the Congressional Budget Office was asked to opine on its financial impact, one of the " givens " in the cost equation was the annual sustainable growth rate (SGR) formula included in the 1997 Balanced Budget Act. The was a provision that would reduce physician Medicare rate schedules each year. The SGR adjustment was to save hundreds of millions of dollars during the ten-year analysis period used by the CBO. It was included in the calculation because it was a sure thing prescribed by law. The problem is that, since 2003, Congress has postponed the rate reduction. Each year, thousands of doctors from around the country, directly and through their trade associations, lobby hard -- and they are successful. The SGR formula works this way: If spending due to increased use of services by Medicare patients rises faster than the nation’s gross domestic product, Medicare must compensate by cutting reimbursement rates for physicians enough to bring spending back in line with GDP growth. This year, the SGR adjustment would hit doctors with a 27.4 percent pay cut for their Medicare patients in January unless Congress steps in. As noted in this *Washington Post* article<http://www.washingtonpost.com/national/health-science/medicares-sgr-form\ ula-has-snowballed-to-budget-busting-juggernaut/2011/12/13/gIQAXaq3wO_print.html\ > : *Postponing the cuts . . . would cost $21 billion for a one-year delay and $38.6 billion for two years. Fully repealing the formula would add nearly $300 billion to the deficit, according to the Congressional Budget Office.* Rest assured, the cuts will be postponed again, kicking the can<http://runningahospital.blogspot.com/2010/11/do-i-hear-someone-kicking-can.h\ tml>further down the road. But this year, the whole thing is mixed up with the controversy about extending the payroll tax cut. Here is an explanation from *Politico*<http://www.politico.com/politicopulse/>that should make the whole thing clear: *After a very long Monday, House Republican leaders announced last night they would not hold an up-or-down vote on the Senate’s two-month payroll tax cut and SGR patch. Instead the House plans to take a series of mostly show votes today, including one on the motion to reject the Senate's version and instruct conferees, and another on a " majority resolution " that restates the House Republicans' priorities when it comes to a two-year " doc fix " and other parts of the year-end package. Little is certain, and GOP leaders were careful not to overpromise on the slate of votes today. Majority Leader Cantor (R-Va.) said the endgame is to appoint a conference committee " so we can actually work the differences out. " He added: " We can resolve this situation and the people of this country can get what they deserve — certainty on tax policy and health care policy going forward. " Minority Leader Pelosi said she would not appoint members to a conference.* via runningahospital.blogspot.com<http://runningahospital.blogspot.com/2011/12/short\ -memories.html> Changing Medicare Plans After the Open-Enrollment Deadline - Total Return - WSJ<http://ptmanagerblog.com/changing-medicare-plans-after-the-open-enroll> Posted 1 day ago by [image: _portrait_thumb] Kovacek, PT, DPT, MSA <http://posterous.com/users/1l1oCkDWEWjv> to PTManager<http://ptmanagerblog.com> [image: Like this post]<http://posterous.com/likes/create?post_id=87518768> Medicare Buyer’s Remorse By Greene The so-called open-enrollment<http://online.wsj.com/article/SB10001424052970204450804576623023\ 096755498.html?KEYWORDS=kelly+greene>period – when people enrolled in Medicare can make changes to their coverage – ended earlier this month. But there are still some options for people who didn’t make changes or have buyer’s remorse. One possibility: For some types of coverage, people using Medicare can opt one time next year into a plan with Medicare’s highest rating of five stars. And people who enrolled in a Medicare Advantage plan can “disenroll” from Jan. 1 through mid-February, according to Allsup, a Belleville, Ill., firm that advises Medicare recipients and their families. Two other situations in which you can enroll or change plans are when you turn 65 – or when you move. When that momentous birthday approaches, it’s important to learn about the window for enrollment, and the penalties if you miss it. There’s a good list of questions and answers here<http://www.allsup.com/portals/4/AMA-turning-65-brochv3nc.pdf> .. Also, if you move – even if it’s to be closer to children or to move into assisted-living or a nursing home – it’s important to revisit your Medicare plans to make sure your coverage continues, and change it if it doesn’t. via blogs.wsj.com<http://blogs.wsj.com/totalreturn/2011/12/20/medicare-buyers-remors\ e/> The Ten Happiest Jobs - PT #3 - But #1 in our hearts<http://ptmanagerblog.com/the-ten-happiest-jobs-pt-3-but-1-in-our-heart> Posted 1 day ago by [image: _portrait_thumb] Kovacek, PT, DPT, MSA <http://posterous.com/users/1l1oCkDWEWjv> to PTManager<http://ptmanagerblog.com> [image: Like this post]<http://posterous.com/likes/create?post_id=87526762> The Ten Happiest Jobs In my article on the Ten Most Hated Jobs<http://www.forbes.com/sites/stevedenning/2011/08/11/think-your-job-is-bad-t\ ry-one-of-these/>, there were some surprises. There are also some surprises in the ten happiest jobs, as reported a General Social Survey by the National Organization for Research at the University of Chicago<http://www.forbes.com/colleges/university-of-chicago/>. (I am indebted to Lew Perelman for drawing my attention to the Christian Science Monitor article<http://www.csmonitor.com/CSM-Photo-Galleries/In-Pictures/The-10-happiest\ -jobs> ..) 1. *Clergy*: The least worldly are reported to be the happiest of all 2. *Firefighters*: Eighty percent of firefighters are “very satisfied” with their jobs, which involve helping people. 3. *Physical therapists*: Social interaction and helping people apparently make this job one of the happiest. 4. *Authors*: For most authors, the pay is ridiculously low or non-existent, but the autonomy of writing down the contents of your own mind apparently leads to happiness. 5. *Special education teachers*: If you don’t care about money, a job as special education teacher might be a happy profession. The annual salary averages just under $50,000. 6. *Teachers*: Teachers in general report being happy with their jobs, despite the current issues with education funding and classroom conditions. The profession continues to attract young idealists, although fifty percent of new teachers are gone within five years. 7. *Artists*: Sculptors and painters report high job satisfaction, despite the great difficulty in making a living from it. 8. *Psychologists*: Psychologists may or may not be able to solve other people’s problems, but it seems that they have managed to solve their own. 9. *Financial services sales agents*: Sixty-five percent of financial services sales agents are reported to be happy with their jobs. That could be because some of them are clearing more than $90,000 dollars a year on average for a 40-hour work week in a comfortable office environment. 10. *Operating engineers*: Playing with giant toys like bulldozers, front-end loaders, backhoes, scrapers, motor graders, shovels, derricks, large pumps, and air compressors can be fun. With more jobs for operating engineers than qualified applicants, operating engineers report being happy. *In Pictures: 10 Happiest Jobs*<http://www.forbes.com/pictures/egee45hfif/clergy#gallerycontent> It’s interesting to compare these jobs with the list of the ten most hated jobs<http://www.forbes.com/sites/stevedenning/2011/08/11/think-your-job-is-bad-t\ ry-one-of-these/>, which were generally much better paying and have higher social status. What’s striking about the list is that these relatively high level people are imprisoned in hierarchical bureaucracies. They see little point in what they are doing. The organizations they work for don’t know where they are going, and as a result, neither do these people. 1. Director of Information Technology 2. Director of Sales and Marketing 3. Product Manager 4. Senior Web Developer 5. Technical Specialist 6. Electronics Technician 7. Law <http://www.forbes.com/law/> Clerk 8. Technical Support Analyst 9. CNC Machinist 10. Marketing Manager The meaningfulness of lives Why were these jobs with better pay and higher social status less likely to produce happiness? Todd May writing in the New York Times<http://opinionator.blogs.nytimes.com/2011/09/11/the-meaningfulness-of-live\ s/?hp>argues that “A meaningful life must, in some sense then, *feel* worthwhile. The person living the life must be engaged by it. A life of commitment to causes that are generally defined as worthy — like feeding and clothing the poor or ministering to the ill — but that do not move the person participating in them will lack meaningfulness in this sense. However, for a life to be meaningful, it must also *be** *worthwhile. Engagement in a life of tiddlywinks does not rise to the level of a meaningful life, no matter how gripped one might be by the game.” This is what underlies the difference between the happiest jobs and the most hated jobs. One set of jobs feels worthwhile, while in the other jobs, people can’t see the point. The problems in the most hated jobs can’t be solved by job redesign or clearer career paths. Instead the organizations must undertake fundamental change to manage themselves in a radically different way<http://www.forbes.com/sites/stevedenning/2011/09/12/the-ten-happiest-jobs/?v\ iew=pc/../2011/07/08/the-five-big-surprises-of-radical-management/>with a focus on delighting the customer through continuous innovation and all the consequent changes that are needed to accomplish that. The result of doing this in firms like Amazon<http://www.forbes.com/sites/adamhartung/2011/07/28/amazons-4-secrets-to-s\ pectacular-revenue-growth/>, Apple <http://www.forbes.com/sites/stevedenning/2011/06/17/apples-retail-stores-more-t\ han-magic/>and Salesforce.com<http://www.forbes.com/sites/stevedenning/2011/09/12/the-ten-happi\ est-jobs/?view=pc/../2011/04/14/how-marc-benioff-of-salesforce-com-became-the-mo\ st-valuable-ceo-of-all/>is happy customers, soaring profits and workers who can see meaning in their work. via forbes.com<http://www.forbes.com/sites/stevedenning/2011/09/12/the-ten-happiest-\ jobs/?view=pc> California Hospital Chain Eyed for Possibly Bilking Medicare for Millions | PBS NewsHour | Dec. 19, 2011 | PBS<http://ptmanagerblog.com/california-hospital-chain-eyed-for-possibly-b> Posted about 19 hours ago by [image: _portrait_thumb] Kovacek, PT, DPT, MSA <http://posterous.com/users/1l1oCkDWEWjv> to PTManager<http://ptmanagerblog.com> [image: Like this post]<http://posterous.com/likes/create?post_id=87570405> http://www.pbs.org/newshour/bb/health/july-dec11/medicare_12-19.html Kovacek, PT, DPT, MSA Sent from my iPad [image: App] On the go? *Download Posterous Spaces* for your phone <http://posterous.com/mobile> Sent by Posterous. 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