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Late spring is one of the best times to give your workout schedule a shock in light of the fact that you can do a large portion of your exercises outside while appreciating the delightful climate. Yet with the mid-year months additionally comes extremely hot climate. On the off chance that you aren’t cautious, you could be doing your body more mischief than great. These late spring wellbeing tips will help you stay safe while getting the activity you require when the climate begins to high temperature up.

Practice Early in the Morning

heart picAmid the late spring, its best to do your activity routine at a young hour in the morning. That is on account of the temperature is much cooler before the sun is the distance up. Get in the propensity now of awakening or 45 minutes sooner than typical so you can get your workout in. In the event that you can’t do that, have a go at doing your activity regimen at night when you return home from work. When the sun begins to go down, the temperatures will cool and you’ll have the capacity to do your normal with to a lesser degree a shot of overheating your body.

Drink Plenty of Water

Water is the backbone of anyone and it keeps the body working appropriately. Tragically, numerous individuals imagine that any sort of fluid checks to their water admission, yet this basically isn’t genuine. A standout amongst the most imperative summer wellbeing tips is that you ought to be drinking around 16 ounces of plain (ideally purged) water in the recent past, after and amid your workout. You ought to likewise be drinking water for the duration of the day to keep your body hydrated. For those thorough workouts, games beverages like Gatorade ought to additionally be incorporated on the grounds that they help supplant vitamins, minerals and electrolytes that you lose when your body sweats vigorously.

Consume Plenty of Fresh Fruits and Vegetables

Amid the mid-year, you can promptly discover a lot of crisp foods grown from the ground at your nearby supermarket at extraordinary costs. On the off chance that you don’t make a propensity of consuming these nourishments amid the colder months, this is the ideal opportunity to get used to these new sustenance’s when they are at their top. You can purchase crisp strawberries and add them to your morning grain or simply consume the new sustenance without anyone else present as snacks. They are stuffed with supplements that will help keep your vitality up and help your body work legitimately in the hotter climate.

Bug Bites
One of the things that can destroy a mid-year evening for children is a bug chomp. On the off chance that you have more seasoned children, you can utilize bug repellent on them to help keep bug chomps from happening. For more youthful kids, be that as it may, you shouldn’t utilize repellent. Rather, verify they are secured however much as could be expected. They ought to wear lightweight apparel with long sleeves and jeans. This may not be a good time for them as it might be hot amid the late spring, yet it will help keep the bugs far from their skin. You ought to additionally keep unfavorable susceptibility solutions available in the event that your kid does get chomped, and they are susceptible to those specific sorts of chomps.


Within an auto can get hot quick. A few folks will leave their children in the auto amid the late spring when they are simply running into the store. However this is perilous. Regardless of the possibility that it’s a cool summer day, the sun can warm the inside of an auto to risky temperatures. In simply a couple of minutes, it could be hot enough to cause cerebrum harm or even demise. One of the best summer wellbeing tips for children is to never abandon them in the auto unattended, regardless of the fact that its only for a couple of minutes.

Noxious Plants

Whether you live close to the forested areas or in the event that you are anticipating taking a climb, you ought to show your children about what the toxic plants look like. Poison ivy and different sorts of noxious plants have unique appearances, so they ought to be not difficult to figure out whether you comprehend what you are searching for. Anyhow nothing is secure. That is the reason you ought to bring along solution intended for treating presentation to noxious plants just on the off chance that you or your children incidentally interact with these sorts of plants.

Assurance from the Sun

yogaGetting sunburned could be amazingly terrible. This is particularly valid for children on the grounds that their skin is regularly more delicate to the sun’s beams. You ought to verify they are secured in sunscreen with in any event a SPF of 30 to help secure their skin. Regardless of the fact that the sun isn’t sparkling, they can at present get a sunburn, so make sure you get them secured notwithstanding.

These mid-year wellbeing tips for children will help everybody appreciate the warm months by keeping a portion of the calamities that can happen.

These essential summer wellbeing tips are perfect for helping you stay fit and consume nutritiously amid the hotter months. Before the end of the mid-year, you’ll feel incredible and be trimmed down and you’ll need to keep up those solid propensities amid until the following summer season moves around.

An Ehic card is a very important card that makes sure that your health is kept in check by insuring your health and that of your family members in case of accidents or other illnesses.

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Screen-ShotSix months ago from Thursday, Kindred Healthcare CEO Paul Diaz and Gentiva Health Services Chairman Rod Windley were eating salads in Windley’s office in Atlanta. That was when Diaz first floated the idea of combining the two post-acute-care companies.

Several rejected offers, a shareholder protection plan and an unnamed buyer later, a deal is now done. Kindred said Thursday it will acquire Gentiva for $720 million in cash and stock and take on Gentiva’s $1.1 billion of debt. Kindred, based in Louisville, Ky., is set to become a post-acute behemoth with roughly $7.1 billion in annual revenue.

Windley told Modern Healthcare that although there was a lot of public back-and-forth between the two companies—Windley called Kindred’s June proposal of $14.50 per share “grossly inadequate”—both sides negotiated in good faith.

“Paul and I are friends. There was no animosity over this deal,” Windley said. “It was all a process to drive maximum value for our shareholders.”

Kindred’s initial takeover attempt came at a time when Gentiva was highly vulnerable. The company was hemorrhaging money like many others in the Medicare-dependent home health and hospice industry. The Patient Protection and Affordable Care Act calls for cuts to home health payments over four years. Those reimbursement challenges partially spurred Gentiva to lay off many employees and close 46 facilities in the fourth quarter of last year.

Additionally, Gentiva was still in the process of integrating post-acute company Harden Healthcare, which it acquired last year.

The turning point of negotiations was when the new suitor entered the fray in July, Windley said. (Due to confidentiality agreements, he said he still could not disclose who the bidder was.) At the time, the mystery buyer was willing to pay about $635 million in cash to take over Gentiva, far above Kindred’s offer. From there, Kindred matched, and the three parties entered due diligence to figure out what deal made the most sense.

“We finally got to a point where I believe that we had maximized value for our shareholders,” Windley said.

In a separate interview, Kindred Chief Operating Officer Ben Breier said the company “never really paid much attention to the other suitor” and that their focus was how Kindred and Gentiva could find the right value of the deal.

Pending Gentiva shareholder approval, and perhaps a couple more salad lunch meetings, the transaction is expected to close in the first quarter of 2015.

Follow Bob Herman on Twitter: @MHbherman

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Screen-Shot-2014-09-18-at-2.28.53-PMNot accustomed to visiting hospital executive suites, I took my seat in the waiting room somewhat warily.

Seated across from me was a handsome man in a well-tailored three-piece suit, whose thoroughly professional appearance made me – in my rumpled white coat, sheaves of dog-eared paper bulging from both pockets – feel out of place.

Within a minute, an administrative secretary came out and escorted him into one of the offices. Exhausted from a long call shift and lulled by the quiet, I started to doze off. Soon roused by the sound of my own snoring, I started and looked about.

That was when I spotted the document on an adjacent chair. Its title immediately caught my eye: “How to Discourage a Doctor.”

No one else was about, so I reached over, picked it up, and began to leaf through its pages. It became apparent immediately that it was one of the most remarkable things I had ever read, clearly not meant for my eyes. It seemed to be the product of a healthcare consulting company, presumably the well-dressed man’s employer. Fearing that he would return any moment to retrieve it, I perused it as quickly as possible. My recollection of its contents is naturally somewhat imperfect, but I can reproduce the gist of what it said.

“The stresses on today’s hospital executive are enormous. They include a rapidly shifting regulatory environment, downward pressures on reimbursement rates, and seismic shifts in payment mechanisms. Many leaders naturally feel as though they are building a hospital in the midst of an earthquake. With prospects for revenue enhancement highly uncertain, the best strategy for ensuring a favorable bottom line is to reduce costs. And for the foreseeable future, the most important driver of costs in virtually every hospital will be its medical staff.

“Though physician compensation accounts for only about 8% of healthcare spending, decisions that physicians strongly influence or make directly – such as what medication to prescribe, whether to perform surgery, and when to admit and discharge a patient from the hospital – have been estimated to account for as much as 80% of the nation’s healthcare budget. To maintain a favorable balance sheet, hospital executives need to gain control of their physicians. Most hospitals have already taken an important step in this direction by employing a growing proportion of their medical staff.

“Transforming previously independent physicians into employees has increased hospital influence over their decision making, an effect that has been successfully augmented in many centers by tying physician compensation directly to the execution of hospital strategic initiatives. But physicians have invested many years in learning their craft, they hold their professional autonomy in high esteem, and they take seriously the considerable respect and trust with which many patients still regard them.

As a result, the challenge of managing a hospital medical staff continues to resemble herding cats.

“Merely controlling the purse strings is not enough. To truly seize the reins of medicine, it is necessary to do more, to get into the heads and hearts of physicians. And the way to do this is to show physicians that they are not nearly so important as they think they are. Physicians have long seen the patient-physician relationship as the very center of the healthcare solar system. As we go forward, they must be made to feel that this relationship is not the sun around which everything else orbits, but rather one of the dimmer peripheral planets, a Neptune or perhaps Uranus.

“How can this goal be achieved? A complete list of proven tactics and strategies is available to our clients, but some of the more notable include the following:

“Make healthcare incomprehensible to physicians. It is no easy task to baffle the most intelligent people in the organization, but it can be done. For example, make physicians increasingly dependent on complex systems outside their domain of expertise, such as information technology and coding and billing software. Ensure that such systems are very costly, so that solo practitioners and small groups, who naturally cannot afford them, must turn to the hospital. And augment their sense of incompetence by making such systems user-unfriendly and unreliable. Where possible, change vendors

“Promote a sense of insecurity among the medical staff. A comfortable physician is a confident physician, and a confident physician usually proves difficult to control. To undermine confidence, let it be known that physicians’ jobs are in jeopardy and their compensation is likely to decline. Fire one or more physicians, ensuring that the entire medical staff knows about it. Hire replacements with a minimum of fanfare. Place a significant percentage of compensation “at risk,” so that physicians begin
to feel beholden to hospital administration for what they manage to eke out.

“Transform physicians from decision makers to decision implementers. Convince them that their professional judgment regarding particular patients no longer constitutes a reliable compass.

Refer to such decisions as anecdotal, idiosyncratic, or simply insufficiently evidence based. Make them feel that their mission is not to balance benefits and risks against their knowledge of particular patients, but instead to apply broad practice guidelines to the care of all patients. Hiring, firing, promotion, and all rewards should be based on conformity to hospital-mandated policies and procedures.

“Subject physicians to escalating productivity expectations. Borrow terminology and methods from the manufacturing industry to make them think of themselves as production-line workers, then convince them that they are not working sufficiently hard and fast. Show them industry standards and benchmarks in comparison to which their output is subpar. On the off chance that their productivity compares favorably, cite numerous reasons that such benchmarks are biased and move the bar
progressively higher, from the 75th

“Increase physicians’ responsibility while decreasing their authority. For example, hold physicians responsible for patient satisfaction scores, but ensure that such scores are influenced by a variety of factors over which physicians have little or no control, such as information technology, hospitality of staff members, and parking. The goal of such measures is to induce a state that psychologists refer to as “learned helplessness,” a growing sense among physicians that whatever they do, they cannot meaningfully influence healthcare, which is to say the operations of the hospital.

“Above all, introduce barriers between physicians and their patients. The more directly
physicians and patients feel connected to one another, the greater the threat to the hospital’s control.

When physicians think about the work they do, the first image that comes to mind should be the hospital, and when patients realize they need care, they should turn first to the hospital, not a particular physician. One effective technique is to ensure that patient-physician relationships are frequently disrupted, so that the hospital remains the one constant. Another is. . . .”

The sound of a door roused me again. The man in the three-piece suit emerged from the office, he and the hospital executive to whom he had been speaking shaking hands and smiling. As he turned, I looked about. Where was “How to Discourage a Doctor?” It was not on the table, nor was it on the chair where I had first found it. “Will he think I took it?” I wondered. But instead of stopping to look for it, he simply walked out of the office. As I watched him go, one thing became clear: having read that document, I suddenly felt a lot less discouraged.

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In recent weeks and months a number of articles have delved into the issue with a sense of seriousness and purpose that the doctor crisis deserves. Progress on reducing unnecessary pressures on physicians is painfully slow, but the broadest possible recognition of the problem is an important step toward dealing with it effectively.

We hold a basic belief about the future of health care: Solving the doctor crisis is a prerequisite to transforming our delivery system to improve access, equity, quality, and affordability. How can we possibly achieve the overall excellence and affordability in health care if large numbers of doctors are alienated and burned out?

Let’s be very clear: This is not about coddling doctors.

It is about preserving the ideals of the physician as healer and enhancing the professional experience – essential elements to optimizing care for patients and families. It is about acknowledging an honorable profession whose members deserve an environment in which they can serve patients to the best of their ability; an environment in which physicians can aspire to continuous improvement as engaged learners who embrace their role as active members of the Learning Coalition.

Traced Back to Medical School

The problem begins as early as medical school. Richard Gunderman, MD, recently authored an article in the Atlantic arguing that medical students:

are suffering from high rates of emotional exhaustion, depersonalization, and a diminished sense of personal accomplishment. College students choose careers in medicine because they care, because people matter to them, and because they want to make a difference. What is happening to the nearly 80,000 U.S. medical students to produce such high rates of burnout?

Dr. Gunderman argues that we “need to understand not only the changes taking place in medicine’s external landscape but the internal transformations taking place in minds and hearts. … In what ways are we bringing out the best elements in their character — courage, compassion, and wisdom — as opposed to merely exacerbating their worst impulses — envy, fear, and destructive competitiveness?”

Another physician, Sandeep Jauhar, writing in The Wall Street Journal, suggests that medicine is experiencing “a sort of midlife crisis. … American doctors are suffering from a collective malaise.”

What has caused this malaise – this sense of disturbing unease? Dr. Jauhar cites a number of reasons but gets to the heart of the matter when he writes that

our profession’s woes include a labyrinthine payer bureaucracy. U.S. doctors spend almost an hour on average each day, and $83,000 a year… dealing with the paperwork of insurance companies. Their office staffs spend more than seven hours a day. And don’t forget the fear of lawsuits; runaway malpractice-liability premiums; and finally the loss of professional autonomy that has led many physicians to view themselves as pawns in a battle between insurers and the government.

Dr. Juahar suggests some remedies including replacing the fee-for-service payment system with value-based care (see our recent post on payment reform). The comments on Dr. Juahar’s article (nearly 1,000!) reveal the level of anger and bitterness among some physicians. The toxicity of many of the comments is jarring.

A fascinating article called “Physician Burnout: It’s time to Take Care of Our Own,”*** reports on an experimental program designed to help physicians suffering from burnout. Samantha Meltzer-Brody, MD, a psychiatrist at the University of North Carolina, writes that

burnout impacts nearly half of all seasoned physicians in practice and up to 75% of resident physicians in training … more and more physicians report anxiety, stress, and emotional exhaustion. … These good doctors are in crisis in increasingly high numbers — an epidemic that requires immediate attention.

The form of that attention at the UNC School of Medicine comes as a program called Taking Care of Our Own, which “offers educational programs about burnout and mental health for resident physicians, and strategies for avoiding and/or addressing it. … We offer multiple different forms of mental health treatment that include evidence-based therapies for burnout, depression, and anxiety, and have developed a comprehensive referral base of providers who have experience caring for this patient population.”

Treating Doctors’ Mental Health

The program is in its early stages, but early on Dr. Meltzer-Brody reports that there has been a “deluge” of physicians seeking help.

The overall goal of the program, she writes, “is to provide timely, cost effective, and efficient care to identify and treat physician mental health issues ensuring improved performance and professionalism. Ultimately, this is good for the doctors, great for the patients, and critical for the health care system. We strongly believe that this type of program needs to be offered at all institutions involved in training the next generation of physicians.”

The program shows promise but what about steps to head off burnout – including steps to enhance the lives of physicians and substantially increase their level of professional satisfaction?

Are you aware of wellness programs that are working well inside or outside of the medical field? What other solutions do you recommend? Let us know.

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Put the question in 1880: Will technology replace farmers? Most of them. In the 19th century, some 80% of the population worked in agriculture. Today? About 2% — and they are massively more productive.

Put it in 1980: Will technology replace office workers? Some classes of them, yes. Typists, switchboard operators, stenographers, file clerks, mail clerks — many job categories have diminished or disappeared in the last three decades. But have we stopped doing business? Do fewer people work in offices? No, but much of the rote mechanical work is carried out in vastly streamlined ways.

Similarly, technology will not replace doctors. But emerging technologies have the capacity to replace, streamline, or even render unnecessary much of the work that doctors do — in ways that actually increases the value and productivity of physicians. Imagine some of these scenarios with me:

· Next-generation EMRs that are transparent across platforms and organizations, so that doctors spend no time searching for and re-entering longitudinal records, images, or lab results; and that obviate the need for a separate coding capture function — driving down the need for physician hours of labor.

· Deep and automated real-time cost analysis per case, per work unit, and per procedure that allows healthcare organizations to offer single-price bundles for much of the work that they do, from hips and knees to births to diabetes control. This would help eliminate much of the 1/3 of all healthcare that is simply wasted in an attempt to drive revenue streams in a fee-for-service code-driven medical world. It would also eliminate the enormous amount of physician and staff time devoted to arguing with insurance companies (estimated cost across healthcare: $80,000 per physician per year).

· Mobile healthcare through Bluetooth patches, embedded chips, wrist bands, smart jewelry, and handheld devices that allows physicians and healthcare organizations real-time monitoring of at-risk and chronic patients, improving their health, driving down the need for acute interventions, and driving down costs — partly by driving down the need for physician labor hours in both the chronic and acute phases.

· Deep Big Data ability to aggregate de-personalized data across organizations, functions, and regions into distributed virtual n-dimensional queriable databases that allows healthcare managers to determine what’s working, what’s efficient, what’s waste, combined with lean initiatives to drive iterative process change throughout the organizations as a normal constant part of doing business.

· A similar ability on the part of purchasers across the system to better determine real quality and real efficiency among providers, as large purchasers are able to do with their suppliers in most industries. This would also drive out waste and lower the need for physician labor hours.

In this ideal vision of technohealth, the one thing that is not attenuated is the need for doctors doing good, real, hands-on doctoring. Healthcare at its core is inalterably retail, putting the physician’s expertise, insight and persuasive power together in a trusted relationship with a single patient with their single body and their individual decision-making power. Ideally, the tech that clears away wasteful procedures and unnecessary administrative tasks and streamlines the monitoring of at-risk and chronic patients will actually leave more physician time and more bandwidth for that strong, trusted patient relationship that is by far the most efficient communication structure in all of medicine.

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he journal Health Affairs recently published an article titled “Medication Affordability Gains Following Medicare Part D Are Eroding Among Elderly With Multiple Chronic Conditions.” The article is about changes in and problems with affordable access to medication for all Medicare enrollees who are 65 and over, not just those with chronic conditions. It focuses on two different time periods, 2007 to 2009 and 2009 to 2011. The data shows that while Medicare Part D initially improved access to affordable medication, some of those gains were lost, and for seniors taking the most medications, the most vulnerable, improvements may have disappeared entirely.

In 2005, before Part D plans were available, the study noted that an estimated 14.9% of seniors experienced cost-related problems accessing prescription drugs (meaning they did not take medicine as prescribed due to cost), also called cost-related prescription non-adherence (CRN). CRN decreased to 11.3% in 2007. Then, surprisingly, following the worst economic downturn since the Great Depression (during which the average wealth of the elderly dropped 20%), the number decreased further to 10.2%.

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Specialty drugs have been in the news for their exorbitant prices lately. Gilead Sciences’ Hepatitis C cure Sovaldi has received media exposure for costing $84,000 and in 2012, when Memorial Sloan-Kettering Cancer Center refused to use the colon cancer medication Zaltrap because of its $11,000 a month price, the manufacturer responded by offering discounts of 50%. Will these high prices come way down once the medications go generic?

A new study from the National Bureau of Economic Research, examined costs and utilization of specialty drugs (specifically cancer meds) as generic versions are introduced. Generally, prices for generic drugs drop as more manufacturers produce them due to price competition. This should presumably happen for specialty drugs, but there’s a catch. Many specialty drugs have a small user base and some of them are formulated as solutions or injection, which may require more specialized and expensive manufacturing processes compared to traditional oral drugs (i.e pills, liquids). For those reason, the drugs price discrepancy between brands and generics is not as great among specialty medications compared to regular medications.

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Drug Companies Front and Center at PSM Interchange Conference

Drug Companies Front and Center at PSM Interchange Conference

Two weeks ago I brought you some highlights of the PhRMA-led Partnership for Safe Medicines (PSM) Interchange propaganda show, which was held on September 18th. Look over to the left. See that picture. Those logos of big pharmaceutical companies make it abundantly clear who is pushing the distorted message of PSM about personal drug importation and online pharmacies.

I’m not joking about the word “propaganda” applied to the PSM event. The online Merriam Webster dictionary provides the following definition for that word: “ideas or statements that are often false or exaggerated and that are spread in order to help a cause, a political leader, a government, etc.” In this case, as I see it, the “cause” of PSM is the commercial agenda of the pharmaceutical and U.S. pharmacy industries cynically couched behind terms of patient safety. A central message of PSM is that Americans are risking their lives buying medication online from other countries and that there is no way to do so safely. Those are false and exaggerated messages that are potentially leading lawmakers and regulators to overreact and scare Americans from a potential lifeline of affordable prescription drugs. Evidence shows that this has been PhRMA’s communications strategy for more than a decade.

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