#Have to account money for both the short term AND the long term :PP
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Real thing that happened
Us actively going through a LOT of. Panic? Fear? Idk. But very quick to cry and stuff so ykyk.
It hurts a LOT that we can't. Express ourselves. (It causes B distress and he ended up getting hurt in his distress)
We went out :( and still had a lot of trouble with. Existing without feeling like SHIT.
Whoever existed, in panic, said they can't be here, they can't stay out (in front/irl and stuff) so. Yk. Insert visualization innerworld/headspace of someone indiscernable trying to run to the back, the void, to whatever AWAY. And trying to get, well, SOMEONE out. Called 🦊 by name at one point while repeatedly saying they need help, but rlly who knows what happened. Then it was. Mostly ok, for a little bit.
So that was fun.
#sepiasys.txt#Rlly rlly sensitive and like. quick to panic/hurt. I'm gonna blame pms /lh#Idk who I is who is writing but meh. my left thumb keeps sticking weirdly to the phone screen -._-.#Man am I really NOBODY who was out when we were outside??????? ALL of those memories are fuzzy 🤨???#Idk but my stomach hurts and I'm like not allowed to. ig talk. So this sucks.#Atleast we made the decision to get a drink that would maybe last a while that everyone can drink probably#Gonna go get pizza rolls tmr. Also wanna go to local farmers market to see it and stuff 👍 not sure if buy anything or not#Btw yes I'm/we're following that monthly budget :P If we dont use ANY money and dont get any extra randomly then we can get cheap laptop :3#Should probably like. get a PO box first so that gets added to the cost tbh tbh. THEN can order stuffs <:3#Have to account money for both the short term AND the long term :PP#Dunno what will happen pos or neg tho so yk :P#Anyways uh yeah :3 Who am I -._-.#I FEEL BETTER AND THIS FEELS WEIRD thank god we/I took a headache pill in advance after the crying 🫠 itll probably only do so much tho#My feet hurt :< Also am scared of having applied for delivery from food bank 😞 but cant undo make form#ughhhhhhh how many ppls is heeerrreee 😞 How many me is me ;-;#Why are all memory bad/fuzzy -I would ask if this is normal but I KNOW ITS NOW#NOT*
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IS THE QURAN THE WORK OF THE PROPHET MUHAMMAD?: Part 2
The Qur’an is the Word of the All-Knowing and All-Seeing, who knows His creation inside as well as outside, forward as well as backward in time. The Qur’an therefore comprehends the human beings it addresses, it tests them as it teaches-indeed, if we may so put it, the Qur’an reads’ its readers. For believers, the consciousness of being before the Divine Message can, in the words of the Qur’an, make their skins shiver, so suddenly and fully does the atmosphere around them, the climate within them, change, like an abrupt alteration in body temperature.
Thus far, I have discussed only the general fact of the Qur’an, and its general perspective, in order to explain that it can only be of Divine authorship. But the substance of the Qur’an is no less compelling an argument. Those who, with good or bad intentions, allege that it is a work of human authorship cannot sustain their allegation. Scriptures other than the Qur’an, precisely because, as above mentioned, they have been tampered with by human hands, make claims that we know to be untrue. For example, in these scriptures a particular account is given of the creation of the world, or of a natural phenomenon (for example, of the great flood), which we know, from modem investigation of the stars or, on the earth, from investigation of fossil records, to be false. Human beings altered those scriptures to suit their own understanding and so, as science has progressed, it has made their understanding and their now corrupted scriptures irrelevant and, for the most part, obsolete. The Qur’an by contrast is preserved by Divine Decree against any consequence of human neglect or human misunderstanding.
How, except on account of its Divine authorship is it possible for The Quran to be literally true on matters of which people had not the least inkling at the time when the Qur’an was revealed? Do not the unbelievers realize that the heavens and the earth were one unit of creation before we split them asunder’? (al-Anbiya’, 21.20). It is only in the last few years that we have been able to con template this verse about the first moment of the universe in its literal meaning. Similarly, when we now read-God is He who raised the heavens without any pillars that you can see. Then He established Himself on The Throne [of authority]. He has subjected the sun and moon [to a law]; each runs its course for a term appointed. He does regulate all affairs, explaining the signs in detail that you may believe certainly in the meeting with your Lord. (al-Ra’d, 1 3.2)-we can understand the invisible pillars, without elaborate exposition, as the vast centrifugal and centripetal forces which maintain the balance amid the heavenly bodies; we can understand from this and related verses (e.g. al-Rahman, 55.5; al-Anbiya’, 21.33, 38, 39; Ya Sin, 36.40) that the sun and moon are stars with a fixed life-span, that their force of light has or will fade, that they follow a track in the heavens determined with the most minute exactness. The literal understanding of these verses does not diminish the responsibility that comes with understanding-that you may believe certainly in the meeting with your Lord-in other words, the purpose of the verses has not changed, only the circumstance of our knowledge of the phenomenal world has changed. In the case of the former scriptures, the advance of the sciences has meant that the inaccuracy of those scriptures has become ever more visible, with growing irrelevance of the beliefs associated with them. In the case of the Qur’an, by contrast, the advance of knowledge about the phenomenal world has not made even a single verse harder to believe or to understand; on the contrary many verses are now understood more fully and more clearly. (We have given many more examples of such verses in other pieces more specifically addressed to the subject of the Qur’an and science: see Gulen, M. F. Questions This Modem Age Puts to Islam, pp. 86-94.)
Yet there are people who still allege that the authorship of the Qur’an belongs not to God but to an inspired Prophet Muhammad, upon him be peace. While asserting that they are on the side of sense and reason, these people allege what is humanly impossible. How could a man utter, some fourteen hundred years ago, what have since been recognized, by a different route, as scientifically established truths? How is that humanly possible? How is it on the side of reason and sense to claim such a thing? By what means did the Prophet discover, with an anatomical and biological accuracy only recently confirmed, how milk is produced in mammal tissues? How did he discover how rain clouds and hailstones form; or determine so correctly the fertilizing quality of the winds; or explain how land-masses shift and continents form and deform? With what giant telescopes from what observatory did he find out about the physical expansion of the universe? By what equivalent of X-ray vision was he able to describe in the most careful, unmistakable detail, the different stages of an embryo’s evolution within the uterus?
Another miraculous aspect of the Qur’an to be mentioned concerning its Divine origin is that lust as the information it gives about the past is absolutely true, so too its predictions are very significant For example, at a time when the Companions considered the articles of the Hudaybia Treaty are quite adverse, the Qur’an gave the good tidings that they would enter the Sacred Mosque (al-Masjid al-Haram) in full security, and the Religion of Islam would prevail over all other religions. (Surah al-Fath, 48:27-28) The Qur’an also clearly pronounced that the Romans would be victorious against the Persians in nine years from their utter defeat in 615, but the believers would destroy both of those, the greatest powers of the then world. (Sura al-Rum, 30:2-5) When the Qur’an gave this good tiding, there were scarcely forty believers and they were all being made groaned under the pitiless tortures of Makkan chiefs.
Those who make that allegation about the authorship of the Qur’an have abandoned their reason when they do so, and they place their souls in the greatest danger. The Being of God is One, and there are no sharers in it, none, not in any degree. The Prophet, upon him be peace, was the best of men, the ideal, and yet never more than a man. The Qur’an itself so addresses him, so admonishes him, so consoles him, so reproaches him. When the Prophet, for example, had exempted certain of the hypocrites from jihad, the Qur’an criticized him: God forgive you! Why did you give them leave to stay behind before it became dear which of them were truthful and which were liars? (al-Tawba, 9.43). With regard to the taking of captives after the Battle of Badr, he was rebuked in these terms: You (the believers) merely seek the gains of the world whereas God desires [for you the good] of the hereafter. God is All-Mighty, All-Wise. Had there not been a previous decree from God, a stern punishment would have afflicted you for what you have taken (al-Anfal, 8.67-8). When on an occasion the Prophet said that he would do such-and-such a thing the following day without adding insha’-Allah that is, without expressing his reliance upon God, he was warned: Nor say of anything, I shall be sure to do so-and-so tomorrow, without adding ‘if God will And call your Lord to mind when you forget, and say, ‘I hope that my Lord will guide me ever closer than this to the right way’ (al-Kahf, 18.23-4). Another example: You did fear the people, but God has a better right that you should fear Him (al-Ahzab, 3337). As a result of some private matter related to his household the Prophet undertook to never again use honey, never again drink a honey-based sherbet; the Qur’an admonished him: O Prophet! Why do you hold to be forbidden what God has made lawful to you? You seek to please your wives. But God is Oft-Forgiving, Most Merciful (al-Tahrim, 66.1). In other verses also, when the higher duties and responsibilities of the Prophet, upon him be peace, are brought into clear focus in the Qur’an, the limits of his authority are clearly pronounced. There is a clear space between the Messenger and the Message revealed to him, as clear as between man and his Creator.
Why do the orientalists and their supporters allege, in the face of all the evidence, that the authorship of the Qur’an belongs to the Prophet? The reason is their fear of Islam. There are many miracles associated with the Qur’an we could not mention them all here-one of the most striking of which is that by the Qur’an was established, in an astonishingly short time, a civilization which has proved both distinctive and enduring. The Qur’an was the constitution, the all-providing, all-generous framework for that civilization. The Qur’an required the administrative, legal and fiscal reforms necessary to sustain a vast state of different cultural communities and several religions. The Qur’an inspired a genuinely scientific curiosity to study nature, to travel and study different peoples and cultures. The Qur’an urged people to lend money for commercial ventures and to eradicate fully the institution of interest, so that while wealth grew (which it did) it would circulate among the whole community. The Qur’an inspired the first ever public literacy and public hygiene programmes (so that the believers could read the Book and prepare for worship). The Qur’an commanded the organized redistribution of surplus wealth to the poor and needy, to widows and orphans, for the relief of captives and debtors, the emancipation of slaves, and for the support of new converts to Islam. One could expand this list considerably; the important point is that only the Qur’an has ever achieved what many world-famous but human works have longed, and completely failed, to achieve. Do we not, each of us, know at least one human account of how to establish or run an ideal society, at least one system or ‘formula’ for solving equitably the problems of social or cultural or political differences between people? And which of these ever succeeded, even in part, even for a short time?
Those who allege that the Prophet is the author of the Qur’an, fear the Qur’an, fear its power and authority for Muslims, fear that the Muslims might again obey its command and restore the civilization of Islam. They would prefer it if the leading people in Islamic countries believed their allegation and so came to believe that the Qur’an is a human work from a certain past century and is, therefore, no longer relevant. Then indeed the dream of those who hate and fear Islam would come true.
Muslims would hold to their religion just as the majority of Christians do in secular Western societies-that is, as a tender memory of something long gone.
They would have us believe that the Qur’an belongs to the seventh century. They will admit, in order to beguile the believers, that the Qur’an was very advanced for its time. But now, they say, it is they who are advanced, they who offer a lifestyle of intellectual and cultural freedom, they who are civilized, while the Qur’an and Islam are backward! But the truth is that, just as advances in the physical sciences have established the accuracy of the Qur’an on questions to do with the merely phenomenal world, and provided the knowledge to enable us to understand the Qur’an more fully, so also improvements in our understanding of human relationships and human psychology will establish the truth of the Qur’an on these questions also.
It may seem mat we have digressed widely from our subject, the authorship of the Qur’an. But indeed we have not lost sight of it. The allegation that the Qur’an is a work of human inspiration is but an instance, and image, of the failure to reflect with sincerity and due humility upon the reality of our being as indebted creatures to whom everything is given. We do not create ourselves. Rather, we are given our lives; we are given our powers of contemplation, comprehension, and compassion; and we are given this extraordinarily subtle, varied and renewable world in which to exercise those powers. So also the miracle of the Qur’an is a gift of mercy to us; it could not have been originated by mankind any more than mankind could have originated themselves. God says in the Qur’an that even if all mankind banded together and got the jinn to help them, they could not so much as create a fly; and likewise, He says, we could not create a likeness of even a part of the Qur’an.
#allah#god#muhammad#prophet#sunna#hadith#quran#ayah#islam#muslim#muslimah#hijab#help#dua#salah#pray#prayer#revert#convert#reminder#religion#welcome to islam#how to convert to islam#new muslim#new revert#new convert#revert help#convert help#islam help#muslim help
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Sex Workers To Get HIV Treatment, ARVs
Sex Workers To Get HIV Treatment, ARVs
South Africa has embarked on Africa’s first strategy to treat and prevent HIV among sex workers. South Africa will soon begin providing HIV treatment to HIV-positive sex workers upon diagnosis as part of its new announced national plan. Currently, most people living with HIV must wait until their CD4 counts - a measure of the immune system’s strength - fall to 500 before they can start treatment. At least 3 000 HIV-negative sex workers will also receive the combination ARV Truvada to prevent contracting HIV. When taken daily as https://www.2nd-circle.com/escorts-madrid/ -exposure prophylaxis, Truvada can reduce a person’s risk of contracting HIV by about 90 percent. In December, South Africa became the first country in southern Africa to register Truvada, which combines the ARVs emtricitabine and tenofovir, for use as prevention in December.
South Africa National AIDS Council (SANAC) CEO Dr Fareed Abdullah credited Health Minister Dr Aaron Motsoaledi for driving the plan’s creation. The plan comes on the heels of research released that found about 72 percent of Johannesburg sex workers surveyed were living with HIV. “The good news is that sex workers are showing a lot of responsibility and about three-fourths of sex workers are using condoms with their clients,” said South Africa National AIDS Council (SANAC) CEO Dr Fareed Abdullah. The bad news is although more than 90 percent of sex workers surveyed had tested for HIV, less than a third of those who were living with HIV had received treatment - far less than the national average, Abdullah added. Sex work is estimated to account for as much as 20 percent of new HIV infections in South Africa, according to Deputy Health Minister Joe Phaahla.
The three-year national plan also aims to reach 70 000 sex workers with a standardised package of services, including PrEP adherence support, delivered in part via a network of 1 000 of their peers. Deputy President and SANAC Chair Cyril Ramaphosa called the plan a chance for South Africans to affirm their rights. “This plan is about the human rights, about the rights of ordinary people,” he said. “Sex work is essentially work,” said Ramaphosa, who ended his address by embracing national leader of the Sisonke sex worker movement Kholi Buthelezi. Buthelezi joined other sex workers in calling for decriminalisation of sex workers to remain on the national agenda. “We are the vanguards of pleasure,” said Mpumalanga sex worker Lesly Mntambo. “Stop criminalising my adult body and what it is capable of doing.
In order to set them apart from "decent" women and avoid confusion, the church required that prostitutes adopt some type of distinctive clothing, which each particular city government was allowed to select. Those who argued against prostitution suggested all sorts of reasons for its existence. Andreuccio in II.5. This young woman is presented as extremely clever and exceedingly cruel. Boccaccio, Giovanni. The Decameron. Trans. G. H. McWilliam. Brundage, James A. Law, Sex, and Christian Society in Medieval Europe. Bullough, Vern L. "Prostitution in the Later Middle Ages." Sexual Practices and the Medieval Church. Ed. Vern L. Bullough and James Brundage. Buffalo: Prometheus Books, 1982, pp.176-86. Karras, Ruth Mazo. "Prostitution in Medieval Europe." Handbook of Medieval Sexuality. Ed. Vern L. Bullough and James A. Brundage. New York: Garland Publishing, Inc., 1996, pp. Richards, Jeffrey. Sex, Dissidence and Damnation: Minority Groups in the Middle Ages.
Getting a gang tattoo is about as smart as getting your girlfriend's name tattooed on your arm. Like you're never going to break up. Another thing to consider is what you want to take pride in representing. Is selling crack or date rape drug really something to brag about? What about Otis Garret and Dave Picton? The Hells Angels deny everything and keep secrets from their own members. They only reveal things on a need to know basis. Otis Garret was incarcerated for running a Hells Angels prostitution ring in San Fransisco. The woman who testified against him was murdered along with her twin seven year old daughters. There is nothing there to be proud of. I know a guy who wears Big Red Machine support gear. I asked about them selling crack and he just said he didn't ask about that part of the business. To me wearing support gear is like wearing a T-shirt that says I support Clifford Olsen and getting a Hells Angels tattoo is like saying I support Dave Picton. Something they did but deny.
When researchers taught capuchin monkeys how to use money, it didn’t take long for one of the male monkeys to offer a female one of the coins in exchange for sex. Prostitution is often called “the world’s oldest profession” with good reason; it is a form of exchange that predates the human species, and has even been observed among chimpanzees. Males tend to want sex much more frequently than most females are willing to accommodate, and where a demand exists it is inevitable that some individuals will choose to meet it for a price. The terminology used to discuss this subject is probably unfamiliar to some readers, so a short summary may be in order.
First and foremost is “sex work,” an umbrella term for all forms of labor in which the sexual gratification of the customer is the primary focus. Prostitution, stripping, acting in adult movies, providing phone sex, and the like are included. As you can probably guess, the boundaries are somewhat fuzzy; some dominatrices and burlesque dancers consider themselves sex workers, while others vociferously insist they aren’t. But in general, a “sex worker” is one whose job is specifically focused on the customer’s gratification, not merely tangential to it. As with the term “sex work” itself, there is some controversy regarding the exact meanings and extent of the terms for the various models of legislation.
I find that the simplest and most useful categorization divides all of the individual legal schemes into three broad categories. In the first, criminalization, the act of selling sex itself is illegal; despite the common American perception that this model is nigh-universal, it is actually the least common in the developed world. The United States and several communist and recently-communist countries are the only large nations which have full criminalization, but in the Swedish model (also called the Nordic model), only the act of paying for sex is de jure prohibited. The most common system, found in the majority of European, Commonwealth, and Latin American countries, is legalization. The act of taking money for sex is not illegal in and of itself; rather, certain activities associated with it are.
The specific activities prohibited under legalization schemes vary widely and arbitrarily; for example, while brothels are illegal in Canada, in Nevada they are the only legal venue for selling sex. Specific regimes also vary widely in extent: while in some there are so many prohibitions the act itself becomes de facto illegal, others differ from decriminalization by only the narrowest of margins. The third model, decriminalization, is at present found only in New Zealand and the Australian state of New South Wales. Under this system, sex work is recognized as a form of work like any other, and therefore not subject to any laws that do not bind other businesses. For example, brothels are regulated by zoning laws and the like rather than subjected to special criminal laws; sex workers are responsible for taxes and covered by workers’ compensation programs, and so forth.
For most of history, sex work was generally unregulated; exceptions to that rule were frequent, but nearly always local and temporary. ” And in the Far East, most of the laws were designed to maintain the rigid social order and class structure of those societies, rather than to police the private sexual arrangements of individuals. Indeed, up until the nineteenth century almost nobody imagined that prohibition could be done, let alone that it should. By the beginning of the twentieth century, the “white slavery” hysteria was in full swing. Yet despite this complete failure, Swedish-style rhetoric has been heavily marketed to other countries. …International authorities regard the NSW regulatory framework as best practice. Contrary to early concerns the NSW sex industry has not increased in size or visibility…Licensing of sex work…should not be regarded as a viable legislative response.
New Zealand decriminalized in 2003, with similar results; neither jurisdiction has had a credible report of “sex trafficking” in years. The reason for this should be obvious: despite the claims of prohibitionists to the contrary, the strongest hold any exploitative employer has over coerced workers is the threat of legal consequences such as arrest or deportation. Remove those consequences by easing immigration controls and decriminalizing the work, and both the motive and means for “trafficking” vanish. There is a popular belief, vigorously promulgated by anti-sex feminists and conservative Christians, that sex work is intrinsically harmful, and therefore should be banned to “protect” adult women from our own choices. But as the Norwegian bioethicist Dr. Ole Moen pointed out in his 2012 paper “Is Prostitution Harmful? ”, the same thing was once believed about homosexuality; it was said to lead to violence, drug use, disease, and mental illness.
These problems were not caused by homosexuality itself; they were the result of legal oppression and social stigma, and once those harmful factors were removed the “associated problems” vanished as well. Dr. Moen suggests that the same thing will happen with sex work, and evidence from New South Wales strongly indicates that he is correct. Sex worker rights activists have a slogan: “Sex work is work.” It is not a crime, nor a scam, nor a “lazy” way to get by, nor a form of oppression. It is a personal service, akin to massage, or nursing, or counseling, and should be treated as such.
The sex industries around the world are associated with serious forms of marginalisation, violence, exploitation, and even forced labour. Media, research, and fiction tell stories of sex workers being abused, exploited, and trafficked. They do it so often that we become almost indifferent to it, as almost always happens in front of horror. A sex worker killed in the Italian countryside, a sex worker robbed in Rio de Janeiro during a transaction, a sex worker leaping to her death from a brothel in Seoul. Poor people, what a life. Gendered, racist, classist, homophobic, and transphobic violence haunts the world of sex work, and many of us believe that states, intergovernmental organisations, and NGOs should do more to help.
Yet a lot is being done. Indeed, one finds that, especially following the 2000 UN Palermo Protocol, the last decade has seen a multiplication of interventions ‘against sex trafficking and exploitation in prostitution’ (see for instance UNODC). The problem is the efficacy of these interventions, as it is abundantly clear that the situation has not demonstrably improved in the intervening time. Poor people, what a world. But is there something more to know? We believe there is. This series addresses the violence, exploitation, abuse, and trafficking present in the sex industries, but it does so from the perspective of sex workers themselves. These are the women, men, and transgender people who are directly touched by the abuse, exploitation, and trafficking under discussion, and they are the people who actively and collectively resist all forms of violence against them.
By publishing their voices directly we hope to help readers resist indifference, on the one hand, and to become more critical of states’ interventions, which are widely regarded and legitimated as necessary to combat ‘trafficking’, on the other. All the authors of this series are involved in sex workers’ organising or have been in the past. This means that they are or have been part of organisations composed of, or at least led by, people who have direct experience selling sex. It is our hope that their contributions over the next two weeks will convey some of the radical richness and diversity of knowledge produced within the contemporary sex workers movement.
This movement is fragmented, stigmatised, and under-funded, yet it has continued to expand since its birth in the mid 1970s in Europe, the US, and Latin America. It now involves at least 273 groups that are part of the Network of Sex Work Projects (NSWP), and many more individuals all over the continents. They have organised despite the fact that speaking out as a sex worker puts your relationships and families at risk. It exposes you to threats from your ‘employers' and may lead to harassment or arrest by the police, especially if you are an undocumented migrant. You may lose your political credibility, and even be accused of representing the interests of ‘pimps’ and taking money from them.
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Buy Imo verification number. The Future Of Tokenized Stocks - What They Can Replace And What To Watch Out For. INEC creates 1,235 polling units in Imo.
I spoke to billionaire FTX CEO and Bitcoin investor Sam Bankman-Fried, who described tokenization as a growing trend. “Accessing equities markets is spotty country by country,” he says. “You don’t see 24/7 access to most stock Buy Imo verification code markets but FTX’s markets are always open.” For most U.S. investors the need to tokenize stocks like Apple AAPL or Amazon AMZN , whose shares are already tradeable in fractional amounts, seems puzzling. However, outside of the United States, it is a different story. In many countries, investors don’t have easy access to U.S. securities markets or, if they do, it is a costly proposition.
It gets technical very quickly, however, and a key point is to understand not all tokenized stocks are created equal.
One of the most important points is that, depending on the exchange, tokenized stock may or may not have collateral behind it. The tokenized stock without collateral is a synthetic security that the crypto exchange or intermediary writes into existence on a blockchain somewhere. This matters because if that ‘somewhere’ is in Minsk, Ukraine or some remote tiny island. Investors may not have much recourse if the service provider hurts investors. Crypto exchanges offering tokenized stocks without collateral include Currency.com and others.
Today, we dig deeper into the offering of crypto exchanges with collateralized stock tokens, such as: FTX, Binance, and Bittrex Global.
There are other important nuances for would-be Buy Imo verification number investors, such as whether or not owning a tokenized stock gives you ownership rights to get paid stock dividends and be able to vote as a shareholder. For example, Binance states on its website that “holding stock tokens does not transfer any shareholder rights to you” whereas FTX and Bittrex report being committed on a ‘best-efforts’ basis to see tokenized stock holders receive stock dividends.
So, what exactly does one own when clicking ‘buy’ for these novel tokenized stocks?
The short answer is you own a collateralized digital derivative product that can be traded much like the spot instrument, i.e. the share or ‘real thing’. A derivative security references its value from a separate security that trades in the cash market. Both the derivative and spot instrument can generate profits and losses in lockstep in someone’s trading account.
The Demise of CFDs?
One way to understand the significance of collateralized asset issuance is to compare it to what it might be replacing. One of the potentially disruptive qualities of tokenized securities is that they could steamroll the large retail FX and Contract for Difference (CFD) industry, which is well established and generally offers tradable instruments that are not saved to a blockchain. Broadly speaking, CFD brokers also lag crypto exchanges in terms of crypto sophistication and product depth. For example, CFD’s - which are not available in the United States - have long let users trade a synthetic instrument mimicking Apple or Microsoft MSFT stock prices, but are, at heart, IOUs issued by a retail broker, not traded on exchange, and non-transferable. The adaptability of well capitalized CFD retail brokerage firms such as IG, CMC Markets, and Plus500 should not be underestimated, however.
Tokenized Stocks Trading Conditions
The price of a tokenized stock is not necessarily the same price seen for the actual stock in a regulated exchange. The price is higher or lower depending on a number of factors, such as whether or not the stock market is open. Another factor is latency, which exists due to potential internet communication delays depending on where the trader is located, or the actual liquidity for that security at the crypto exchange.
While on the surface a tokenized Apple stock is traded in multiple exchanges, you should know that any tokenized stocks can only be traded in one crypto exchange. For example, AAPL/USD is the ticker name in the FTX platform, while Binance uses the AAPL/BUSD ticker, and Currency.com the AAPL.cx ticker. Try to transfer your AAPL/BUSD or AAPL.cx securities to FTX and you will be informed that the stock token is not portable to other crypto exchanges or to your local brokerage firm where you have your securities portfolio. “It would be really powerful to be able to freely move tokenized stocks on the blockchain, but as of now FTX and [German financial services firm] CM-Equity do not support that. They remain on FTX, a tied agent to CM-Equity,” indicated FTX’s Bankman-Fried.
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What You Required To Understand About Quote Bonds in Building And Construction
Our surety bonds group is a full-service, nationwide surety bonding business, accredited in every U.S. state. The total amount of a quote bond is figured out in relation to the quantity of the agreement. A quote bond’s complete amount generally does not go beyond 5-10% of the overall amount of the contract.
You’ll not lose your bond if you withdraw your quote earlier than the developer opens it. You will lose your Quote Bond in case you withdraw your quote after you have actually gotten been awarded the contract.
A Guide to bid bonds in the U.S.
Nice American’s appeal for financial power and stability and its dedication to private and consistent service is especially essential to brokers with construction accounts. The majority of quote bonds comprise a cash deposit, which is topic to full or partial forfeiture if the successful specialist stops working to both execute the contract (or develop an expense bond or performance bond – depending on how the bid course of is structured). The quote bond assures that, must the bidder accomplish success, they’ll indicate the deal and supply the needed surety bond.
To put it simply, these bonds are utilized as monetary security for contract bid propositions– especially for giant tasks such as industrial advancements. With out sending the required bond, a contractor’s bid will consistently be disqualified from the bidding course of.
For the Professional just in search of building bond help, South Coast Surety will provide you the instruments and information required to understand a surety bond credit line score.
Information To Quote Bonds For Contractors
A bid guarantee is a type of security ensuring that the bidder will not withdraw a quote throughout the interval specified for acceptance and will perform a written agreement and provide required bonds, together with any obligatory coinsurance or reinsurance contracts, inside the time specified within the quote, unless a longer time is enabled, after invoice of the desired types. A quote assurance typically include a firm dedication similar to a quote bond, accredited validate, or different negotiable instrument accompanying a bid as assurance that the bidder should, upon acceptance of the bid, execute such contractual documents as might be needed inside the time specified. Quote warranties are typically needed to be in a quantity equivalent to 5 p.c of the quantity quote.
As talked about above, the needed quote request kind asks for contract details such since the task value breakdown, that includes income, products, labor, subcontractors and overhead. Presenting these details can be bothersome and confusing when trying to record in a paper system. That is the location building bid software program is readily available in; it can be utilized to approximate your agreement costs and think about and manage your organization’s most essential metrics Utilizing the power of software will provide you with a better likelihood at winning the efforts you need.
What Business Required To Learn About Contracts and Bid Bonds
A Bid Bond, issued by a Surety in your behalf, is for the great thing about an Obligee. Generally Bid Bonds are low-cost. Typically, the performance bond costs between 1% and 5% of the worth of the “chastening amount,” which is the amount that the surety will require to pay to the obligee in case the professional breaches the agreement.
Research On Permission of Surety for a Bid Bond
Private building contracts seldom need specific bond language. Rather, they typically need bonds in a specified amount with a surety acceptable to the proprietor, general specialist or other obligee. The AIA’s bond kinds, AIA Documents A-311 and A-312, are well-liked and instructive; hence their provisions benefit a short dialogue.
Additionally used at the Tender Phase, the Consent of Surety (in some cases referred to as an Settlement to Bond) is an enterprise by the Surety to provide Performance and Labor & Material Payment Bonds for the Specialist if their tender is accepted by the Owner and a written agreement entered into. The Approval of Surety is a commitment entirely made by the Surety. It is really essential observe, nonetheless, this does not guarantee the Contractor will participate in the contract.
A Guide For You about Bid Bonds and Building Contracts
Within the United States, underneath the Miller Act of 1932, all Building and construction Contracts released by the Federal Authorities need to be backed by Performance and cost bonds. States have enacted what is called” Little Miller Act” statutes requiring efficiency and fee bonds on State Moneyed initiatives as properly. If, upon investigation, the surety states the power of lawyer to have actually been genuine at the time of bid opening, the contracting officer may need correction of any technical error.
One other way surety firms can stay inside their approved surety underwriting limitation, and spread their danger, is to obtain coinsurance or reinsurance, in which they basically receive an agreement from one other surety company to cowl a part of their threat on the bond they have issued. When a surety acquires reinsurance for part of its threat under a Miller Act bond, it needs to undergo the contracting officer a reinsurance settlement for a Miller Act performance bond and a reinsurance settlement for a Miller Act cost bond. The terms of both reinsurance contracts are stated in the regulations.
Construction Surety Bonds In Plain English
Normally used within the construction market, but additionally applicable to several non-construction contractual relationships, agreement surety bonds protect the Owner (referred to as the Obligee” or beneficiary) from financial loss in case the Professional (the Principal”) fails to fulfill their contractual commitments with the Proprietor. A bid bond does not noting the United States as obligee, but properly identifies the offeror, the solicitation number, and the recognize and place of the endeavor involved, as long as it is appropriate in all various aspects.
At the Building Phase, upon execution of a written contract between the Contractor and the Owner, an Efficiency Bond secures the Proprietor from monetary loss ought to the Professional fail to bring out the Contract in accordance with the legal obligation. While normally requested by the Owner within the amount of 50% of the special agreement worth, the bond will also be provided for up to one hundred%. The Surety is just not accountable for more than the entire amount of the bond.
Why Business Requirements To Be Worried With Quote Bonds and Construction Arrangements
(b) When a brand new surety bond is licensed, the contracting officer shall alert the principal and surety of the distinct bond of the efficient date of the new bond.
The post An Examination Of The Strategies When Thinking Of P&P Bonds appeared first on Special Attorney.
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Obsessive Measurement Disorder: Etiology of an Epidemic
By KIP SULLIVAN JD
Review of The Tyranny of Metrics by Jerry Z. Muller, Princeton University Press, 2018
In the introduction to The Tyranny of Metrics, Jerry Muller urges readers to type “metrics” into Google’s Ngram, a program that searches through books and other material published over the last five centuries. He tells us we will find that the use of “metrics” soared after approximately 1985. I followed his instructions and confirmed his conclusion (see graph below). We see the same pattern for two other buzzwords that activate Muller’s BS antennae – “benchmarks,” and “performance indicators.” [1]
Muller’s purpose in asking us to perform this little exercise is to set the stage for his sweeping review of the history of “metric fixation,” which he defines as an irresistible “aspiration to replace judgment based on personal experience with standardized measurement.” (p. 6) His book takes a long view – he takes us back to the turn of the last century – and a wide view – he examines the destructive impact of the measurement craze on the medical profession, schools and colleges, police departments, the armed forces, banks, businesses, charities, and foreign aid offices.
Foreign aid? Yes, even that profession. According to a long-time expert in that field, employees of government foreign aid agencies have “become infected with a very bad case of Obsessive Measurement Disorder, an intellectual dysfunction rooted in the notion that counting everything in government programs will produce better policy choices and improved management.” (p. 155)
Muller, a professor of history at the Catholic University of America in Washington, DC, makes it clear at the outset that measurement itself is not the problem. Measurement is helpful in developing hypotheses for further investigation, and it is essential in improving anything that is complex or requires discipline. The object of Muller’s criticism is the rampant use of crude measures of efficiency (cost and quality) to dish out rewards and punishment – bonuses and financial penalties, promotion or demotion, or greater or less market share. Measurement can be crude because it fails to adjust scores for factors outside the subject’s control, and because it measures only actions that are relatively easy to measure and ignores valuable but less visible behaviors (such as creative thinking and mentoring). The use of inaccurate measurement is not just a waste of money; it invites undesirable behavior in both the measurers and the “measurees.” The measurers receive misleading information and therefore make less effective decisions (for example, “body count” totals tell them the war in Viet Nam is going well), and the subjects of measurement game the measurements (teachers “teach to the test” and surgeons refuse to perform surgery on sicker patients who would have benefited from surgery).
What puzzles Muller, and what motivated him to write this book, is why faith in the inappropriate use of measurement persists in the face of overwhelming evidence that it doesn’t work and has toxic consequences to boot. This mulish persistence in promoting measurement that doesn’t work and often causes harm (including driving good teachers and doctors out of their professions) justifies Muller’s harsh characterization of measurement mavens with phrases like “obsession,” “fixation,” and “cult.” “[A]lthough there is a large body of scholarship in the fields of psychology and economics that call into question the premises and effectiveness of pay for measured performance, that literature seems to have done little to halt the spread of metric fixation,” he writes. “That is why I wrote this book.” (p. 13)
A short history of Obsession Measurement Disorder in medicine
I read Muller’s book because I share his astonishment at the persistence of the measurement craze in the face of so much evidence that it is not working. Over the three decades that I have studied health policy, I have become increasingly baffled by people who promote various iterations of managed care in the face of evidence that they don’t work. In search of an explanation, I have, as Muller has, read books and news stories about the misuse of measurement in other fields, particularly education and banking. I have been especially baffled by the managed care movement’s enthusiasm for measuring the cost and quality of all actors in the health care system, an enthusiasm that emerged in the late 1980s when it was obvious that the propagation of HMOs, the movement’s founding project, was failing to control inflation. [2]
By the 1990s the enthusiasm for documents that handed out grades to insurance companies and providers on “consumer satisfaction,” mortality rates, etc. had become an obsession. Proponents of “report cards,” as these documents were called, hoped that “consumers” would read them and reward the good actors with their business and punish the bad actors by leaving them. That, of course, did not happen.
Frustrated by consumer disinterest in report cards, managed care proponents, such as the Medicare Payment Advisory Commission (MedPAC) and the Institute of Medicine (IOM), declared in the early 2000s that it was time to punish doctors and hospitals directly by rewarding them if they got good grades on crude measurements and punishing them if they didn’t. The term they used to describe this direct method of punishment was “pay for performance,” a phrase borrowed from the business world. By about 2004, that phrase had become so common in the health policy literature it was shortened to “P4P.”
The complete absence of evidence that P4P would improve the quality of medical care didn’t matter to MedPAC and other P4P advocates. [3] As evidence has piled up over the last decade indicating P4P doesn’t reduce costs and has mixed effects on quality, P4P proponents, true to form, have ignored it. [4]
Taylorism: Ground zero of the epidemic
It is impossible to identify a single Typhoid Mary responsible for the metrics-fixation epidemic, but it is fair to say a very important Typhoid Mary was Frederick Winslow Taylor. Muller identifies the rise of “Taylorism” in manufacturing in the early 1900s as a primary cause of the epidemic. Taylor, an American engineer, studied every action of workers in pig iron factories, estimated the average time of each action, then proposed to pay slower workers less and faster workers more. According to Taylor, determining who was slow and who was fast and paying accordingly required “an elaborate system for monitoring and controlling the workplace,” as Muller puts it. (p. 32) Taylor called his measurement-and-control system “scientific management.”
“Scientific management” assumed that managers with clipboards could distill the wisdom of their work force into a set of rules (later called “best practices,” another buzzword catapulted to stardom in the 1990s) and enforce those rules with pay-for-performance. The outcome of “scientific management,” according to Taylor, was that “all of the planning which under the old system was done by the workmen, must of necessity under the new system be done by management in accordance with the law of science.” (Muller, pp. 32-33) Here we see the beginning of the double standard now prevalent in health policy: People who flog faith-based P4P schemes hold themselves out as the bearers of “scientific” values (“evidence-based medicine,” to use the lingo invented in the early 1990s), while doctors who criticize metrics madness are said to be stuck in a “paternalistic culture.” [5]
The obvious corollary to “scientific management” was that leaders of corporations didn’t need any hands-on experience or training in the production of whatever it was their corporation produced. If you had a degree from a business school that taught “scientific management,” it shouldn’t matter to Sunbeam, for example, that “Chainsaw” Al Dunlap had no knowledge of how appliances are made. As long as he knew “management,” he was qualified to be Sunbeam’s CEO. Decades after Taylorism arose, this same logic would justify allowing managers of insurance company executives, Fortune 500 companies, and government insurance programs who never went to medical school to measure and micromanage doctors.
By the 1950s, this notion that standardized data in the hands of managers trumped experience had become deeply embedded in American business culture. By the 1960s, reports Muller, it had spread to the US military (Robert MacNamara’s background in accounting got him a job running a car company, and from there he jumped to the Pentagon where he and his “whiz kids” told the generals to count enemy corpses). By the 1980s it had infected other government agencies and much of the non-profit world, and by the late 1990s it had infected the services sector, including medicine.
Measuring the doctor and patient from afar
“Nowhere are metrics in greater vogue than in the field of medicine,” writes Muller. (p 103) The following statement by report-card and P4P guru Michael Porter, which Muller took from an article Porter co-authored for the Harvard Business Review, is a good illustration of how P4P proponents think and talk.
Rapid improvement in any field requires measuring results – a familiar principle in management…. Indeed, rigorous measurement of value (outcomes and costs) is perhaps the single most important step in improving health care. Wherever we see systematic measurement of results in health care … we see those results improve. [p. 107]
From this excerpt plus other sections of the Harvard Business Review article, we learn that Porter is absolutely convinced it’s possible to measure “outcomes and costs” accurately, and then divide cost into quality to derive “value.”
Note first the voice-of-God tone. God doesn’t have to document anything, and neither does Porter; there are no footnotes in this lengthy essay. Note next the grand assumption that improvement is only possible if “results” are measured. How do we know this? We just do. It’s a “principle of management,” says Porter (no doubt going all the way back to Frederick Taylor). Third, note the misrepresentation of the evidence. It simply isn’t true that “wherever” managers conduct “systematic measurement” of “performance” by doctors and hospitals, costs go down and/or quality goes up.
Muller compares the groupthink represented by Porter with research on both report cards and P4P schemes. The small body of research on report cards finds they have no impact on “consumer” behavior or patient outcomes. The large body of research on P4P indicates it may be raising costs when the costs providers incur to improve “performance” is taken into account, and it has at best a mixed effect on measured quality.
Muller suggests that the net effect of P4P on the health of all patients, that is, those whose care is measured and those whose care is not measured, is negative. Sicker patients are the ones most at risk in a system where P4P is rampant. Because the measures of cost and quality upon which P4P schemes are based are so inaccurate (because scores cannot be adjusted with anything resembling accuracy to reflect factors outside provider control), it induces a variety of “gaming” strategies, the worst of which are avoiding sicker patients and shifting resources away from patients whose care is not measured to those whose care is measured (“treating to the test”).
To illustrate how P4P damages sicker patients, Muller devotes two pages to the damage done by Medicare’s Hospital Readmissions Reduction Program (HRRP). This program, which began in 2012, punishes hospitals that have an above-average rate of 30-day readmissions (admissions that occur within 30 days of a discharge from a hospital) for patients with a half-dozen diagnoses. Muller reports that the HRRP has clearly had two negative effects. First, it has incentivized hospitals to keep sick patients away for at least 30 days after discharge, and if that’s not possible, to let them in but to put them on “observation” status, which means they are not counted as “readmitted.” [6] Second, it has led to the punishment of hospitals that treat sicker and poorer patients.
When Muller publishes a second edition of this book, he’ll no doubt add a page describing research done since his book was published showing that the HRRP appears to be killing patients with congestive heart failure (CHF). CHF was one of the three diagnoses that has been measured by the HRRP since it began (readmissions for heart attack and pneumonia were the other two).
Reversing the epidemic
Muller ends his book with a series of recommendations. He suggests, for example, that measures be developed from the bottom up and that financial rewards and penalties should be kept low if they are to be used at all. He does not attempt to offer political solutions. For this I do not criticize him. His book, which must have required years of research, is a valuable contribution to the largely one-sided debate about P4P in medicine, a debate which has only recently become more audible.
Here are my two cents on the politics of this issue. Groups representing doctors and nurses must take the lead in rolling back measurement mania. Doctors and nurses have great credibility with the public, and they have to cope every day with the consequences of measurement mania. They should focus on rolling back the P4P schemes now inflicted on the fee-for-service Medicare program because Medicare is so influential (“reforms” inflicted by Congress on Medicare are typically mimicked by the insurance industry). Groups working to reduce the cost of health care or improve quality of care for patients should also join the fight. They too have an interest in undermining the tyranny of metrics.
Of course, it would be nice if those who make a living promoting the inappropriate use of measurement would practice what they preach and examine their own behavior to see how it could be improved. Here’s a question that people in that business might pose to themselves now and then: Would you like your work to be subjected to measurement of its cost and quality by third parties, and would you like those third parties to alter your income based on the grades they decide to give you?
Footnotes:
[1] Just to test NGram, I entered other terms. “Automobile,” for example, rises up from zero mentions just before 1900 to a peak during about 1938-1942, then declines rapidly so that the rate by 2000 (the last year on the graph) is equal to the rate of 1910. “Database,” on the other hand, stays at zero mentions until about 1970, then skyrockets in the late 1970s.
[2] Accurate measurement of the cost and quality of insurance companies and providers was an essential element of “managed competition,” a proposal introduced in 1989 by Alaine Enthoven and enthusiastically promoted by Paul Ellwood (the “father of the HMO”), insurance industry executives, Bill and Hillary Clinton, and the editors of the New York Times, to name just a few of Enthoven’s most influential disciples.
[3] A 2006 edition of Medical Care Research and Review devoted entirely to the emerging P4P fad stated, “P4P programs are being implemented in a near-scientific vacuum.”
[4] We are seeing rare exceptions to the P4P groupthink only in the last two or three years. In January 2018, MedPAC formally voted to reverse its decision to recommend P4P at the individual physician level. Donald Berwick, a leading proponent of measurement, announced in 2016 that it was time to reduce the reporting burden on doctors by 50 to 75 percent and to eliminate P4P at the individual level.
[5] The IOM, for example, has peddled measurement and control of providers for decades on the basis of no evidence, yet it maintains a “roundtable” of P4P disciples the IOM deems to be “science-driven.”
[6] “Observation stays” were designed for Medicare beneficiaries who were not clearly in need of inpatient care but who were not clearly ready to go home either. Such patients are typically placed on the same wards with admitted patients but not treated.
Kip Sullivan is a member of the Health Care for All MN advisory board, and of MN Physicians for a National Health Program.
Obsessive Measurement Disorder: Etiology of an Epidemic published first on https://wittooth.tumblr.com/
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Obsessive Measurement Disorder: Etiology of an Epidemic
By KIP SULLIVAN JD
Review of The Tyranny of Metrics by Jerry Z. Muller, Princeton University Press, 2018
In the introduction to The Tyranny of Metrics, Jerry Muller urges readers to type “metrics” into Google’s Ngram, a program that searches through books and other material published over the last five centuries. He tells us we will find that the use of “metrics” soared after approximately 1985. I followed his instructions and confirmed his conclusion (see graph below). We see the same pattern for two other buzzwords that activate Muller’s BS antennae – “benchmarks,” and “performance indicators.” [1]
Muller’s purpose in asking us to perform this little exercise is to set the stage for his sweeping review of the history of “metric fixation,” which he defines as an irresistible “aspiration to replace judgment based on personal experience with standardized measurement.” (p. 6) His book takes a long view – he takes us back to the turn of the last century – and a wide view – he examines the destructive impact of the measurement craze on the medical profession, schools and colleges, police departments, the armed forces, banks, businesses, charities, and foreign aid offices.
Foreign aid? Yes, even that profession. According to a long-time expert in that field, employees of government foreign aid agencies have “become infected with a very bad case of Obsessive Measurement Disorder, an intellectual dysfunction rooted in the notion that counting everything in government programs will produce better policy choices and improved management.” (p. 155)
Muller, a professor of history at the Catholic University of America in Washington, DC, makes it clear at the outset that measurement itself is not the problem. Measurement is helpful in developing hypotheses for further investigation, and it is essential in improving anything that is complex or requires discipline. The object of Muller’s criticism is the rampant use of crude measures of efficiency (cost and quality) to dish out rewards and punishment – bonuses and financial penalties, promotion or demotion, or greater or less market share. Measurement can be crude because it fails to adjust scores for factors outside the subject’s control, and because it measures only actions that are relatively easy to measure and ignores valuable but less visible behaviors (such as creative thinking and mentoring). The use of inaccurate measurement is not just a waste of money; it invites undesirable behavior in both the measurers and the “measurees.” The measurers receive misleading information and therefore make less effective decisions (for example, “body count” totals tell them the war in Viet Nam is going well), and the subjects of measurement game the measurements (teachers “teach to the test” and surgeons refuse to perform surgery on sicker patients who would have benefited from surgery).
What puzzles Muller, and what motivated him to write this book, is why faith in the inappropriate use of measurement persists in the face of overwhelming evidence that it doesn’t work and has toxic consequences to boot. This mulish persistence in promoting measurement that doesn’t work and often causes harm (including driving good teachers and doctors out of their professions) justifies Muller’s harsh characterization of measurement mavens with phrases like “obsession,” “fixation,” and “cult.” “[A]lthough there is a large body of scholarship in the fields of psychology and economics that call into question the premises and effectiveness of pay for measured performance, that literature seems to have done little to halt the spread of metric fixation,” he writes. “That is why I wrote this book.” (p. 13)
A short history of Obsession Measurement Disorder in medicine
I read Muller’s book because I share his astonishment at the persistence of the measurement craze in the face of so much evidence that it is not working. Over the three decades that I have studied health policy, I have become increasingly baffled by people who promote various iterations of managed care in the face of evidence that they don’t work. In search of an explanation, I have, as Muller has, read books and news stories about the misuse of measurement in other fields, particularly education and banking. I have been especially baffled by the managed care movement’s enthusiasm for measuring the cost and quality of all actors in the health care system, an enthusiasm that emerged in the late 1980s when it was obvious that the propagation of HMOs, the movement’s founding project, was failing to control inflation. [2]
By the 1990s the enthusiasm for documents that handed out grades to insurance companies and providers on “consumer satisfaction,” mortality rates, etc. had become an obsession. Proponents of “report cards,” as these documents were called, hoped that “consumers” would read them and reward the good actors with their business and punish the bad actors by leaving them. That, of course, did not happen.
Frustrated by consumer disinterest in report cards, managed care proponents, such as the Medicare Payment Advisory Commission (MedPAC) and the Institute of Medicine (IOM), declared in the early 2000s that it was time to punish doctors and hospitals directly by rewarding them if they got good grades on crude measurements and punishing them if they didn’t. The term they used to describe this direct method of punishment was “pay for performance,” a phrase borrowed from the business world. By about 2004, that phrase had become so common in the health policy literature it was shortened to “P4P.”
The complete absence of evidence that P4P would improve the quality of medical care didn’t matter to MedPAC and other P4P advocates. [3] As evidence has piled up over the last decade indicating P4P doesn’t reduce costs and has mixed effects on quality, P4P proponents, true to form, have ignored it. [4]
Taylorism: Ground zero of the epidemic
It is impossible to identify a single Typhoid Mary responsible for the metrics-fixation epidemic, but it is fair to say a very important Typhoid Mary was Frederick Winslow Taylor. Muller identifies the rise of “Taylorism” in manufacturing in the early 1900s as a primary cause of the epidemic. Taylor, an American engineer, studied every action of workers in pig iron factories, estimated the average time of each action, then proposed to pay slower workers less and faster workers more. According to Taylor, determining who was slow and who was fast and paying accordingly required “an elaborate system for monitoring and controlling the workplace,” as Muller puts it. (p. 32) Taylor called his measurement-and-control system “scientific management.”
“Scientific management” assumed that managers with clipboards could distill the wisdom of their work force into a set of rules (later called “best practices,” another buzzword catapulted to stardom in the 1990s) and enforce those rules with pay-for-performance. The outcome of “scientific management,” according to Taylor, was that “all of the planning which under the old system was done by the workmen, must of necessity under the new system be done by management in accordance with the law of science.” (Muller, pp. 32-33) Here we see the beginning of the double standard now prevalent in health policy: People who flog faith-based P4P schemes hold themselves out as the bearers of “scientific” values (“evidence-based medicine,” to use the lingo invented in the early 1990s), while doctors who criticize metrics madness are said to be stuck in a “paternalistic culture.” [5]
The obvious corollary to “scientific management” was that leaders of corporations didn’t need any hands-on experience or training in the production of whatever it was their corporation produced. If you had a degree from a business school that taught “scientific management,” it shouldn’t matter to Sunbeam, for example, that “Chainsaw” Al Dunlap had no knowledge of how appliances are made. As long as he knew “management,” he was qualified to be Sunbeam’s CEO. Decades after Taylorism arose, this same logic would justify allowing managers of insurance company executives, Fortune 500 companies, and government insurance programs who never went to medical school to measure and micromanage doctors.
By the 1950s, this notion that standardized data in the hands of managers trumped experience had become deeply embedded in American business culture. By the 1960s, reports Muller, it had spread to the US military (Robert MacNamara’s background in accounting got him a job running a car company, and from there he jumped to the Pentagon where he and his “whiz kids” told the generals to count enemy corpses). By the 1980s it had infected other government agencies and much of the non-profit world, and by the late 1990s it had infected the services sector, including medicine.
Measuring the doctor and patient from afar
“Nowhere are metrics in greater vogue than in the field of medicine,” writes Muller. (p 103) The following statement by report-card and P4P guru Michael Porter, which Muller took from an article Porter co-authored for the Harvard Business Review, is a good illustration of how P4P proponents think and talk.
Rapid improvement in any field requires measuring results – a familiar principle in management…. Indeed, rigorous measurement of value (outcomes and costs) is perhaps the single most important step in improving health care. Wherever we see systematic measurement of results in health care … we see those results improve. [p. 107]
From this excerpt plus other sections of the Harvard Business Review article, we learn that Porter is absolutely convinced it’s possible to measure “outcomes and costs” accurately, and then divide cost into quality to derive “value.”
Note first the voice-of-God tone. God doesn’t have to document anything, and neither does Porter; there are no footnotes in this lengthy essay. Note next the grand assumption that improvement is only possible if “results” are measured. How do we know this? We just do. It’s a “principle of management,” says Porter (no doubt going all the way back to Frederick Taylor). Third, note the misrepresentation of the evidence. It simply isn’t true that “wherever” managers conduct “systematic measurement” of “performance” by doctors and hospitals, costs go down and/or quality goes up.
Muller compares the groupthink represented by Porter with research on both report cards and P4P schemes. The small body of research on report cards finds they have no impact on “consumer” behavior or patient outcomes. The large body of research on P4P indicates it may be raising costs when the costs providers incur to improve “performance” is taken into account, and it has at best a mixed effect on measured quality.
Muller suggests that the net effect of P4P on the health of all patients, that is, those whose care is measured and those whose care is not measured, is negative. Sicker patients are the ones most at risk in a system where P4P is rampant. Because the measures of cost and quality upon which P4P schemes are based are so inaccurate (because scores cannot be adjusted with anything resembling accuracy to reflect factors outside provider control), it induces a variety of “gaming” strategies, the worst of which are avoiding sicker patients and shifting resources away from patients whose care is not measured to those whose care is measured (“treating to the test”).
To illustrate how P4P damages sicker patients, Muller devotes two pages to the damage done by Medicare’s Hospital Readmissions Reduction Program (HRRP). This program, which began in 2012, punishes hospitals that have an above-average rate of 30-day readmissions (admissions that occur within 30 days of a discharge from a hospital) for patients with a half-dozen diagnoses. Muller reports that the HRRP has clearly had two negative effects. First, it has incentivized hospitals to keep sick patients away for at least 30 days after discharge, and if that’s not possible, to let them in but to put them on “observation” status, which means they are not counted as “readmitted.” [6] Second, it has led to the punishment of hospitals that treat sicker and poorer patients.
When Muller publishes a second edition of this book, he’ll no doubt add a page describing research done since his book was published showing that the HRRP appears to be killing patients with congestive heart failure (CHF). CHF was one of the three diagnoses that has been measured by the HRRP since it began (readmissions for heart attack and pneumonia were the other two).
Reversing the epidemic
Muller ends his book with a series of recommendations. He suggests, for example, that measures be developed from the bottom up and that financial rewards and penalties should be kept low if they are to be used at all. He does not attempt to offer political solutions. For this I do not criticize him. His book, which must have required years of research, is a valuable contribution to the largely one-sided debate about P4P in medicine, a debate which has only recently become more audible.
Here are my two cents on the politics of this issue. Groups representing doctors and nurses must take the lead in rolling back measurement mania. Doctors and nurses have great credibility with the public, and they have to cope every day with the consequences of measurement mania. They should focus on rolling back the P4P schemes now inflicted on the fee-for-service Medicare program because Medicare is so influential (“reforms” inflicted by Congress on Medicare are typically mimicked by the insurance industry). Groups working to reduce the cost of health care or improve quality of care for patients should also join the fight. They too have an interest in undermining the tyranny of metrics.
Of course, it would be nice if those who make a living promoting the inappropriate use of measurement would practice what they preach and examine their own behavior to see how it could be improved. Here’s a question that people in that business might pose to themselves now and then: Would you like your work to be subjected to measurement of its cost and quality by third parties, and would you like those third parties to alter your income based on the grades they decide to give you?
Footnotes:
[1] Just to test NGram, I entered other terms. “Automobile,” for example, rises up from zero mentions just before 1900 to a peak during about 1938-1942, then declines rapidly so that the rate by 2000 (the last year on the graph) is equal to the rate of 1910. “Database,” on the other hand, stays at zero mentions until about 1970, then skyrockets in the late 1970s.
[2] Accurate measurement of the cost and quality of insurance companies and providers was an essential element of “managed competition,” a proposal introduced in 1989 by Alaine Enthoven and enthusiastically promoted by Paul Ellwood (the “father of the HMO”), insurance industry executives, Bill and Hillary Clinton, and the editors of the New York Times, to name just a few of Enthoven’s most influential disciples.
[3] A 2006 edition of Medical Care Research and Review devoted entirely to the emerging P4P fad stated, “P4P programs are being implemented in a near-scientific vacuum.”
[4] We are seeing rare exceptions to the P4P groupthink only in the last two or three years. In January 2018, MedPAC formally voted to reverse its decision to recommend P4P at the individual physician level. Donald Berwick, a leading proponent of measurement, announced in 2016 that it was time to reduce the reporting burden on doctors by 50 to 75 percent and to eliminate P4P at the individual level.
[5] The IOM, for example, has peddled measurement and control of providers for decades on the basis of no evidence, yet it maintains a “roundtable” of P4P disciples the IOM deems to be “science-driven.”
[6] “Observation stays” were designed for Medicare beneficiaries who were not clearly in need of inpatient care but who were not clearly ready to go home either. Such patients are typically placed on the same wards with admitted patients but not treated.
Kip Sullivan is a member of the Health Care for All MN advisory board, and of MN Physicians for a National Health Program.
Article source:The Health Care Blog
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These Are The Top 50 Hedge Fund Long And Short Positions
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These Are The Top 50 Hedge Fund Long And Short Positions
In Goldman’s latest quarterly hedge fund trend monitor – a survey of 808 hedge funds with $2.1 trillion of gross equity positions ($1.5 trillion long and $649 billion short) – which analyzes hedge fund holdings as of Dec. 31, the bank makes some interesting observations about the current state of the hedge fund industry.
First and foremost, it finds that the “average” hedge fund is up a paltry 1% YTD as of Feb 20, underperforming the S&P for the 8th consecutive year. This follows on the heels of a 13% return for equity funds in 2017, the strongest annual absolute return since 14% in 2013
In terms of holdings, hedge funds stuck with the deflationary themes of growth and momentum despite 4Q tax and interest rate volatility. Tax reform and rising Treasury yields weighed on Technology and other fund favorites in late 4Q. Although funds trimmed their Tech overweight, Goldman found that the tech sector remains the largest net portfolio weight (24%) and the bulk of Goldman’s VIP list (38%). Financials remained the largest net underweight (-445 bp); even as hedge fund paralysis, first noted last quarter, remained as portfolio turnover hovered near record lows.
Below are Goldman’s 5 key observations from this edition of the HF Trend monitor:
PERFORMANCE AND SENTIMENT: The average equity hedge 1. fund has returned 2% YTD, matching the S&P 500. The most popular hedge fund long positions have resumed their 2017 outperformance in early 2018. Funds returned 13% in 2017. Our Hedge Fund VIP basket of most popular long positions has returned 4% YTD, outperforming the S&P 500 during the recent correction in contrast to its typical drawdown behavior. Our growth and momentum factors and the Info Tech sector have outperformed alongside our VIP basket, aiding fund returns following weakness in late 2017.
LEVERAGE: Hedge funds entered 2018 with near-record leverage and maintained risk despite the correction. Funds added nearly $20 billion of net exposure in two index ETFs alone (SPY and IWM) as ETF exposure rose to 3% of long portfolios. Although the S&P 500 suffered its first 10% decline in two years, funds maintained conviction in their positions. Portfolio turnover rose slightly but remained near recent record lows at 28%.
VERY IMPORTANT POSITIONS: Our Hedge Fund VIP list (ticker: GSTHHVIP) of the most popular long positions has led the S&P 500 by 170 bp YTD after outperforming by 450 bp in 2017 (26% vs. 22%). The VIP list contains the 50 stocks that appear most often among the top 10 holdings of fundamentally-driven hedge funds. The list’s top 5 stocks are AMZN, FB, TWX, GOOGL, and MSFT. The basket has outperformed the S&P 500 in 64% of quarters since 2001, generating an average quarterly excess return of 59 bp. 13 new constituents this quarter: AET, AGN, ATVI, BA, COL, CZR, JD, LSXMK, MA, NOW, PCLN, QCOM, and ZAYO.
SECTORS: Hedge fund sector allocations remained largely stable, with funds declining to rotate toward perceived “winners” of tax reform and rising interest rates. Information Technology remains the largest sector weight (24%) although funds trimmed the overweight tilt relative to the Russell 3000 to +107 bp from +307 bp last quarter. Consumer Discretionary is the largest overweight tilt (+432 bp), but positions in the Consumer Discretionary and Energy sectors remain near the smallest tilts that funds have held in those sectors during the last five years. Funds added to their overweight in Health Care (+354 bp) while Financials remains the largest net underweight (-445 bp).
HIGHLY CONCENTRATED STOCKS: The most concentrated hedge fund stocks have lagged the S&P 500 by 200 bp YTD following unusually weak returns in 2017. The basket of 20 firms with the largest share of market cap owned by hedge funds (ticker: GSTHHFHI) lagged the S&P 500 by 11 pp in 2017, its worst annual performance since 2007. The weakness was driven primarily by two Health Care firms (EVHC and INCY). The basket had outgained the S&P 500 by an average of 9 pp in each of the five years from 2012-16.
One especially interesting observation is that the most crowded hedge fund positions, i.e. Goldman’s Hedge Fund VIP basket, outperformed, as it appears that hedge funds rushed to the “safety” of crowded positions during the recent market swoon, hoping that others had done their homework and that these stocks would not get sold. So far, this assumption has proven correct.
The outperformance of the most popular hedge fund positions during the recent correction underscores the technical nature of the drawdown and the resilience of investor sentiment. As the S&P 500 suffered its first 10% decline in two years, our Hedge Fund VIP basket declined in absolute terms but outperformed both the broad market and the largest short positions. This outperformance stands in contrast to the basket’s typical “high beta” behavior; the most popular stocks typically underperform during market drawdowns as investor selling weighs most heavily on their top positions
Goldman also touches on a topic we discussed earlier in the context of the Fed’s Monetary Policy Report, which warned about record hedge fund leverage.
To be sure, hedge funds continued the trend observed last quarter, as elevated investor positioning at the start of 2018, including hedge fund leverage, remained and according to Goldman’s David Kostin helped explain the sharp S&P 500 drawdown. Specifically, funds added net leverage entering 2018, “anticipating continued strength in equities following the passage of tax reform and a 7% S&P 500 return in 4Q 2017.”
Our analysis of fund filings and short interest data suggests that funds carried a net long exposure of 56%, above the long term average and nearly the highest level on record.
Furthermore, data from Goldman’s Prime Services on exposures showed extremely elevated net and gross leverages prior to the market correction. And although net leverage dropped briefly during the correction, Goldman Prime attributed the decline to mark-to-market dynamics in options positions. Meanwhile, both gross and net exposures currently remain close to recent highs.
Record hedge fund leverage occurred alongside unprecedented net length in US equity futures, historically low mutual fund cash allocations, and all-time high margin debt as a share of market cap.
Also notable: the lack of trading volumes continues to be explained with one simple observation: hedge funds continue to boycott turnover – and trading even as they concentrate even more into the top 10 positions. The average hedge fund held 68% of its long portfolio in its top 10 positions, just below the record “density” of 69% in 1H 2016. The increase in hedge fund portfolio density in recent years mirrors the growing share of S&P 500 market cap accounted for by the 10 largest index constituents, which now sits just above the average level since 1990 (22%).
Separately, while hedge fund portfolio turnover rose slightly from a record low during 4Q, funds clearly remained committed to their top positions. “Across all portfolio positions, turnover registered 28%. Turnover of the largest quartile of positions, which make up the vast majority of portfolios, also rose slightly to 14% but remained near historical lows.”
* * *
So putting it all together, below are the 50 hedge fund positions compiled by Goldman which make up the latest GS VIP list, i.e., the 50 most popular hedge fund longs, also known as the “Hedge fund Hotel California.”
What is notable about this basket, is that it tends to outperform the S&P in most periods, and did so by 170 bp YTD (3.5% vs. 1.9%) and in 64% of quarters since 2001. But this outperformance comes at a cost: if the selling begins, as it has in the recent past, the basket tends to get hit especially hard: quote Goldman, “although the basket has been a strong historical performer, it suffered its worst historical underperformance vs. the S&P 500 in late 2015 and 1H 2016 (-17% vs. -3%). However, the basket then rallied back to outperform the S&P 500 by 21 percentage points (+52% vs. +31%) between 2H 2016 and early 4Q 2017.”
Conversely, below are the 50 most shorted positions, i.e., the stocks which represent the most important short positions.
And here are the 20 stocks with the highest positive and negative changes in popularity
Finally, beware entering extremely crowded “smart money” positions: Goldman writes that the most concentrated hedge fund stocks – those who have the highest portion of their market cap held by hedge funds- have lagged the S&P 500 by 200 bp YTD following unusually weak returns in 2017.
The basket of 20 firms with the largest share of market cap owned by hedge funds (ticker: GSTHHFHI) has lagged the S&P 500 by 11 pp in 2017, its worst annual performance since 2007. The weakness was driven primarily by two Health Care firms (EVHC and INCY). The basket had outgained the S&P 500 by an average of 9 pp in each of the five years from 2012-16.
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EdgeSecure’s Paul Puey: “Digital Security Will Take Place on the Edges” Security is one of the hottest topics in today’s ever-evolving digital world. A steady flow of debate continues to take place at tech forums worldwide on topics like encryption, passwords, two-factor authentication, hardware wallets and the like. As cryptocurrencies and the tools being used to manage them take shape, questions loom about the most efficacious ways to protect both user assets and privacy. One individual who is at the epicenter of this active space is Paul Puey. He is co-founder and CEO of EdgeSecure, a blockchain-inspired, decentralized, open-source, zero-knowledge, global information security solution platform. Airbitz, his signature enterprise was birthed in 2013 as a bitcoin wallet provider and merchant directory. Today, he’s orchestrating a rebrand of this wallet, now called EdgeSecure. In an interview with Bitcoin Magazine, Puey talks about the tricky balance between new security and privacy measures being introduced and user experience. He also explores an emerging theme called “securing the edges” that forms the basis of his current work BM: What sort of problems are you attempting to solve these days? PP: The aspect of cryptocurrency we initially wanted to address revolved around how to effectively use secure keys. That was the impetus behind our decision to build a feature rich, functionally rich wallet at Airbitz over the years. We feel like this has really differentiated us in the whole area of key management. BM: How does your concept of EdgeSecure fit in here? PP: Our goal has been to broaden Airbitz by turning our key management standard into a platform for other apps. Even before we rebranded, we were already using the term Edge Security to examine how to come up with a solution that’s different from enterprise security. We view our approach as fundamentally different in the sense that we’re not trying to make a router or server more secure. Rather, our aim is to take data and secure it before it ever hits a device. In short, we are able to secure data before it goes out onto a network or server. People and their devices are what we are trying to secure. That’s where the term Edge comes from — before a user’s data ends up on their device, goes out to a network, goes onto a server — the encryption of that data happens first, as we say, “on the edges.” BM: But what about server networks? PP: We still believe that server security is important. But the visibility and encryption of that data all happens first before the data gets saved, broadcast and sent out on the network or gets onto a server. The concept of making data private and secure to the point where only the user can access it “on the edges” has never been an area of focus for cybersecurity companies. BM: So, in a nutshell, how does all of this actually work? PP: It works through a combination of technologies we’ve had for decades but have never been packaged the way we are seeking to. The technology that we’ve developed involves encrypting data on the client side. Most of the software out there doesn’t do this. Rattle off any app that you are running on your computer or your phone, and the data you generate and create is not encrypted, let alone automatically backed up. BM: Are there other security measures you’ll be employing? PP: We’ve also added two-factor authentication, although I fundamentally hate it from a user experience point of view. Two-factor is particularly problematic and a poor approach if the second factor for authorizing access is a phone number or email address. It’s better than nothing, but it’s not what one would consider to be “good two-factor.” BM: Is there a solution to this? PP: Yes, since 2015, we’ve been employing what we call “one touch, two-factor,” where we take two-factor and make it invisible by baking it in our Airbitz app. This eliminates the need for notification by SMS or email, or via an app like Authy or Google Authenticator. BM: Can you talk a bit about password recovery? This can be a big issue with crypto users. PP: It is indeed. Think about this for a moment: If you lose your mobile phone or other type of device, in the Google Authenticator world you have just lost your access completely. So, it’s up to the service you are using to determine a recovery mechanism. What’s interesting is that some services don’t give you one. Others offer recovery via email, SMS, or other similar mechanism which then introduces the same issue. We, therefore, believe in recovery via time lock, where your account is locked for a period of time before you can reset it. BM: In the meantime, are there ways to prevent users from losing their password in the first place? PP: There is some psychology involved here. Part of our philosophy at EdgeSecure is to carefully align technology with humanity. This involves a recognition of the fact that we’re all fallible beings, that we do forget passwords. One step we employ to help people not forget passwords is to ask them to voluntarily enter it from time-to-time when they go to access their app. Our intent is to give them the opportunity to change it if they forget it at that moment. BM: How exactly does this work? PP: We have an algorithm inside of the app that has what we call a reminder “step off,” based on users actually entering it. This “step off” is how frequently we remind you based on how many times you’ve actually entered the password in the past. Obviously, you can get into the app with a pin, thumbprint and now facial ID. But if you lose that device, the password is the only way to get back on. BM: This seems like an idea that other tech solution providers will likely want to pick up on. PP: No doubt. We fashion ourselves as the world’s only password recovery for encrypted data. While that, in and of itself, is a patentable idea, we’ve opted to not patent, in the name of open source, open collaborative effort. BM: What sort of criticism do you hear from the crypto community? PP: One of the main ones we get is that we are not as secure as a hardware wallet. These criticisms come from people that often harbor the biggest fears of something that I have yet to see happen, namely, a person losing crypto from a device attack. Sure, you might hear of publications espousing theoretical exploits. But I haven’t seen evidence of a mass exploit with cryptocurrency taken on a device with encrypted data. Yet there are millions, if not billions, of dollars being poured into solutions for that problem. BM: Aren’t hardware wallets a great resource then for those who have these concerns? PP: They can be. But it’s important to keep in mind that with hardware wallets, the attack vector isn’t someone getting into it digitally over the internet. Rather, the attack vector is the individual user. I can’t count the number of people who say to me after purchasing a hardware wallet, “Now, I’m secure!” I then ask them, what did you do with the backup information? Often they’ll say, “I put it on Google Drive.” My response: “You did what? That’s the worst thing you could possibly do with the private key.” BM: Finally, what are your thoughts regarding security vulnerabilities among centralized exchanges? PP: It’s a big concern, no doubt. Coinbase is obviously the most recognizable example in the crypto world, but I don’t think that their model can survive long term. I’d describe them as a $15 billion piñata for hackers. Yes, they haven’t been hacked and I believe a combination of luck and skill has prevented that from occurring. BM: So do you believe that it’s just a matter of time before a serious hack occurs? PP: Let me say this. One of the hardest aspects of centralized security is that it doesn’t scale. In other words, the bigger you get, the harder it is for you to secure. And as the pot becomes bigger, you have to hire and entrust more and more people inside the company. So it takes just one bad apple with access and there goes a lot of user money. BM: Where do you see this security space headed? PP: In the next 3–5 years, we should actually see a trend where users will seek out what I call Edge-secured apps, where people can control their own data. These encryption and Edge solutions will be invisible to those using the app, which will go a long way toward enhancing user experience along with security and privacy. This article originally appeared on Bitcoin Magazine. from My Bitconnect Journey https://bitcoinmagazine.com/articles/edgesecures-paul-puey-digital-security-will-take-place-edges/ via Bitcoin News https://s3.amazonaws.com/fs.bitcoinmagazine.com/img/images/Puey_Interview.width-800.jpg REGISTER HERE: http://bit.ly/goN4bcc
from My Bitconnect Journey l Why Invest in Bitcoin http://www.facebook.com/pages/p/1734453723240677 via Rodrigo M. Palacio Tumblr
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The Art of Short Selling - Kathryn F. Staley
All ideas belong to Kathryn F. Staley, and I do recommend reading them for yourself. Some ideas represented here are from various other blogs and websites. Short sale candidates are in three categories 1. When management lies to investors and obscure events that affect earnings 2. Companies with inflated stock prices 3. Companies that will be affected in significant ways from external events Signs that a company might be a good candidate for a short 1. Accounting gimmickry 2. Insider problems: insiders using the company as a personal bank or are selling the stock 3. Company has a consumes too much cash 4. Assets are overvalued or balance is in terrible condition Three sins of short selling: sloth, pride and timing Sloth: Doing too little work is always a problem for investing -- without proper doing the proper work (spreadsheets, notes, readings) you'll lose conviction when the position runs against you and you'll inevitably take a loss. "Shorting's easy. You short a stock, watch it double, cover in panic, then wait for the inevitable bankruptcy" Pride: The pride problems comes out in two different areas (1) using formulaic analysis to short companies. An example of that would be seeing six great savings & loan shorts and shorting the seventh without deeper analysis. The real estate or economic environment might be different for the seventh bank causing your thesis to be proven wrong. (2) shorting good companies. Julian Robertson and Jim Chanos have both identified this error. This is another way of saying don't short just based on valuation. Good management is tends to fix problems, which when solved cause already overvalued stocks to shoot higher. Timing: There is no solution for this. You find a great short selling candidate only only to see it turn into a 2% annualized rate of return because you were too early. First reason for bad timing is underestimating the insanity of the public market. Horrible companies can continue to exist on the promise of great products. Drug companies tend to have this problem. The second reason for bad timing is the investment bankers ability to raise money to keep bad companies on life support. Sometimes companies end up resolving their problems before the market realizes the fatal flaw. Sometimes the macroeconomic environment changes and lifts the company out of its problems, such as a change in interest rates. Short sellers might also underestimate a company's ability to grow out of their debt load. When the business environment is good -- business might survive a surprisingly long time with a crushing debt load. Short sellers have several techniques to try to remedy the timing problem. Michael Murphy covers automatically after a 25% price run-up and waits to short again. Other managers wait until the stock cracks, after the first drop when earnings and price momentum have slowed. Joe DiMenna never shorts a stock with great relative strength. Other small problems with short selling: 1. Don't short commodities through a stock. It is easier to short companies based on their financials than it is based on their commodity production. If you do short a company that is highly influenced by the commodity, make sure you understand the commodity cycle of that product, for example if you are a short a chicken stock make sure you understand how weather and corn feed prices will affect chickens. Sometimes you'll find companies that are growing their inventories faster than revenue, but if that is the case your thesis should be built on bad financials but not the underlying commodity of the inventories. 2. Many short sellers avoid technology stocks. Normal signs of a good short do not apply to these companies. Often inventories will rise when a new products is coming. Insiders will own and sell stock without regard to the company's condition. Margins can fluctuate based on product cycles and pricing curves. Tech stocks have infamously caused problems with short portfolios -- American Online, US Robotics and Iomega. 3. Squeezes tend to be a self-inflicted wound for short sellers when they don't recognize the importance of float. Since short sells are based on getting loans for stock, when shares are no longer available for a lend it is inevitable you'll have a buy-in. Companies who want to be aggressive toward short sellers may ask their shareholders to take theirs take their shares out of a margin account (therefore hard to borrow) and into a cash account. They could also issue cash dividends or preferred shares that could make short selling more expensive. These tactics don't work well for companies with large float but might work well for companies with a small float. The books gives examples of infamous short squeezes such as Total Systems, General Development and Chase Medical. 4. Leveraged buy-outs s can cause stocks to be bought out at ridiculous valuations. Especially be worried during a flurry of deals -- private equity groups can start paying outrageous prices. 5. Fear causes short sellers to buy back their positions after a large run up. Generally if it scares you to death to short more of a company, the better move is to short more. 6. Be able to change your outlook if the facts change. Don't stick with the same thesis if the facts change. 7. It is easy to fall in love with your own analysis if the problem is highly complex. If you spent loads of time in the analysis it is easy to say you must have an opinion on the stock, when one might not be recommended. 8. Crowded short positions are also a problem. Amateur short sellers might buy a position when one might not be recommended. 10. Last but not least, shorting a company that is going through a "hiccup", instead of shorting a company that's having it's core business being overwhelmed. When a company is growing you can hide bad accounting practices for a while. Never short a good company. Six Pillars of Fundamental Short Selling 1. The Pessimist's Guide to Financial Statements. Short sellers attempt to discover the meaning behind the numbers and what drives the business. Books to read to increase your understanding of financial statements include: Leopold Bernstein's Financial Statement Analysis, anything written by Abraham Briloff, and Thornton O'Glove's Quality of Earnings. Short sellers should research the company's last six 10Qs; the last two 10Ks, proxies and annuals, and any 8Ks. After studying these documents a short seller might need to go back farther chronologically. The most useful part of the financials will be the footnotes. Start with the last dated balance sheet and look for assets of suspicious value: i) Securities not marked to market. ii) Inflated real estate values, iii) Obsolete inventories iv) Aggressively booked receivables v) Receivables with low loss provisions vi) Bad loans vii) Fuzzy or empty assets Accounts receivables and inventories should be tested by looking at the growth in receivables and inventories versus previous year and comparing that to the growth in sales and cost of goods. If receivable growth is substantially greater than growth in revenues, problems with earnings will be likely. Growth in inventory versus growth in cost of goods is the single most reliable sign that a manufacturer or retail company will stumble. Goodwill and other intangible costs might be signs a company has overpaid for acquisitions, failing to expense drilling costs or software development. Check footnotes for the schedule of expenses for policy manuals which might have capitalized over too long of a period. If accumulated depreciation drops when gross PP&E rises, the company might have changed average life assumption and run a reversal through in the income statement. On the liability side of the balance sheet, look for odd descriptions or uncommon types of liabilities. Be especially suspicious of liabilities approximated or the present valued with assumptions made by management. Check footnotes for and notes on financial conditions to see if the company has any off-balance-sheet liabilities, any debt guarantees, or recourse-factored receivables. Check for growth in short term and long term debt. Note all lines of revenue that appear to be nonrecurring: i) Sale of equipment, land, and real estate ii) Sale of securities iii) Interest on securities or cash equivalents iv) Tax credits v) Currency gains as a reduction in cost of goods sold vi) One-time credits from manufacturers vii) Reduction in provision for doubtful accounts viii) One-time license agreements viv) Change in account Check the assumptions the company makes to book revenue and read the notes that explaining earnings in the current period. Check for any odd sources of revenue. Readjusted earning per share for fully diluted shares. Adjusting for the fully diluted shares can be a bit tricky, add in all convertible shares if they close to conversion or likely to be converted and any options and warrants. Important Ratios Check to see if company is trying to appease the street by giving a nice trend for earnings per share growth, and if so, see if they are trying to massage the numbers. Look at capitalization: long-term debt to equity, total debt to total capital, long-term debt to capital. Compare several years of balance sheets to see the trend in these ratios. Check ROE, ROA and ROIA. ROIA (Return on invested assets) is calculated by income before interest and taxes divided by equity plus all interest-paying debt. Look for trends and volatility of returns over time. It also tells, by comparison how the company does relative to other companies in the same industry, whether the company returns more than its average and marginal cost of debt, currently and historically. Key valuation ratios are Price to Earnings, price to book, price to revenue and price to cash flow. If a takeover occurs in a similar company, these ratios calculate quick comparables. Certain ratios are better for comparison in different industries. Price to revenue is higher for retail than for manufacturing. Price to earnings reflect growth potential. Price to cash flow is a buy-out indicator. Minimum list of ratios include the following: i) Checklist of Ratios ii) Capital Structure iii) Return Ratios iv) Valuation Ratios v) Long-term debt to equity vi) Return on equity vii) Price to earnings viii) Total debt to total capital viv) Return on assets x) Price to revenues xi) Total debt to equity xii) Return on invested assets xiii) Price to operating cash flow Go to the income statement to common size the statement: put everything in percentage of revenues to see if the percentage relationships are changing. R&D or Advertising as a percentage of revenue declining? Compare anomalies to the balance sheet. If SG&A is declining as a percent, are prepaid expenses or other assets rising? Is depreciation flat while fixed assets increase? Compare pretax operating profits. What is the sequential trend, as well as the annual one? Does it make sense for the business? Look for deviations and trends. Cash Flow is King It is often difficult to determine what the necessary cost from a business point of view is. The quickest check is to look at the "Cash Flows from Financing." See if the company is constantly going to the markets to keep afloat. Is short and long term debt escalating? Is there a stock or convertible issue every year? Find out what the companies spends to do business. This can be calculated in different ways but here is one. Net income + depreciation, amortization, deferred taxes - non-recurring items (tax-adjusted, if possible) +/- changes in current assets (without cash, but broke out by lines to see what specifics are causing the cash drain) +/- changes in other items perceived to be relevant (like some portions of capital expenditures). Check how cash flows and capital expenditures change year of year. Check up on any anomaly. If the company able to meet their debt repayments? Check the PIK (payment in kind), zero-coupon bonds and other odd instruments. Reading the Sleep-Inducing Verbiage Read the 10K description of the business and the competition. Try to understand the financials in relation to that business plan. Try to drive the company, what the two or three most relevant numbers are. What is the most important number to watch to identify a developing problem? If it is a low-margin business, the key is probably revenues and inventory-turnover ratios. If it's a franchisor, it might be system sales or same-store sales. Does the financial structure make sense for the business? (do not leverage a cyclical company too much, do not build inventories too high if there is potential product obsolescence.) Think About It Think of the three financial statements as a 3-D chess game, see how they interact and see what tugs and pulls on what. Determining the key variable in the health of a company is the most complex part of analysis. If this skill could be mastered, finding great ideas in the long and short side will come easier. Read Qs and Ks from first to last to see how things change over time. Read the annual report and see if the executives say what you saw in the 10Ks and Qs. Watch out for near meaningless buzzwords like synergism. Look for any oddities in the annual report like pictures of babies in a defense or drilling company -- suggesting the executives are a bit clueless. Watch for auditor turnover which can truly be indicative of trouble. What was not in the financials but you did not understand? Look for the lack of: i) description of nonrecurring revenues ii) information on explicit valuation iii) procedures of odd assets iv) clear disclosure of revenue-booking procedures v) fuzzy liabilities vi) comprehensible breakout of divisions: revenues, income, assets vii) description of effect of an acquisition on inventories and receivables Determining what the relevant piece of information is the most part of analyzing a company. What runs or ruins the business. 2. In Search for Greed and Sleaze Useful forms provided by the Securities and Exchange Commission (SEC)Form 144. Key officers of a company are required to file this form when placing a sell order of their company stock. Barron' and the Wall Street journal report some insider sales. Vickers and the Insider's Report, also publish a list. [www.dataroma.com is a good source for this material now] Form 4. Insiders of the company must file this form if purchasing or selling shares. The list needs to be published 10 days after the last day of the month in which positions are increased or decreased. 13-D When an entity purchases 5% or more of a stock, they must file with the SEC in 10 days. These publicized in the news Barron's, Vickers, and the Insider Report, as well as the proxy. Proxies: The annual meeting is the trigger for this publication. The publication tells the stockholders what they can vote on during the annual meeting. It also reveals how much stock is owned by management, what their salaries and employment contracts are (including options, bonuses, and some perks) and the stockholders who own over 5 percent. The proxy tells who the accounts are, if there are any pending lawsuits, and other relationships and related transactions are pertinent. It is a great source for information about management philosophy. Look under "certain transactions" for some possible hidden information about creative management contracts Benchmark Proxies: Pantheon of Stars or Pigs at the Trough? Watch out for companies with excessive executive compensation relative to net income. Plenty of good short candidates come from executives who pilfer the shareholder's coffers with excessive compensation, benefits or related party transactions.If you need to read a proxy three times to understand it, chances are you have hit a likely short candidate.
Checklist of Proxy Questions 1. Lookout for exorbitant executive salaries. Look at cash compensation relative to company earnings. 2. Does the company pay out large bonuses? Why do they pay out large bonuses, was it for doing an abnormally good job or that was just a normal bonus. Is the bonus based on increased sales, return on equity, or some measure or combination of measures? 3. Does the company pay a percentage of pretax profits to the primary offers in the form of bonuses? Are executives paid a percentage of revenues? Is the bonus calculated on a quick stock price appreciation.
Stock Options 4. Stock grants, stock options and stock appreciation rights (SARs). SARs are the most generous because they guarantee cash money and are bankable immediately with no stock price appreciation necessary. 5. Does the company pay for stock options? 6. Does the company pay a bonus for taxes on options? 7. Do executives get special deals if there stock/rights offering of company or a sub's stock? 8. What percentage of the stock is owned by the primary officers? Parachutes 9. Does the company have an unusual severance pay contract, especially in case of merger or buy-out? 10. What are the terms of retirement contracts? 11. Are there extra perks such as large insurance policies, apartments, automobiles use, plane us? "Certain Transactions" 12. Does the company allow primary officers to do business with the company by owning other businesses? Does the company give those officers favorable terms in those contracts? 13. Are many of the officers related to each other? 14. Does the company deal with any relatives of the officers? 15. Does the company loan money to the officers? Does the company charge interest? 16. If the company engages with limited partnerships does it pay the officers to become general partners or limited partners? Does it grant bonuses for the participation in those partnerships? Does it give those partners the tax loss? Miscellaneous 17. Are there many lawsuits, what is the liability? 18. What is the age range of the officers? Are they all young or all old? 19. Who else owns the stock? 20. Check the board biographies? Is it a "good ol' boy" club? Is it an independent board? (Quaker Oats used to pay their board members $1,000 for each action taken by unanimous written consent) Make sure officers are getting paid for doing things before the stockholders. See what the top employee's total packages are relative to income. Check proxies over the year see how many executives have left the company. Attrition is not always free available data and requires research. 3. The Bigger Puzzle Research Review the industry -- the 10K should give you a good overview of the competitors, customers and suppliers. Check value line and Stand & Poor's Industry Survey's for the industry fundamentals. Check trade publications and if see if any government office tracks data relevant to that industry. Services like Washington Researchers can provide comprehensive information on any topic. Read other publicly traded company's financial is a useful source of information. You can check a competitor's financials to compare margins, return on invested assets, growth rates, and inventory and receivable turns can give an analyst what is out of line and what looks different. Store Checks After you have decided what the business of the company is and what were the important/relevant metrics. Use this information for checking out the market place. "If the key is store volume, visit a store and count customers, check average ticket size, talk to the store manager. If it is a hot new company with a to-die-for product, see if competitors have heard of the product yet. If it is an oil & change franchise, count cars at peak hours to see if franchisees are hitting break-even assumptions" Do not make conclusions on one store alone. Outliers due (possibly to do geographic area) might be an outliers on volume. Observing will give you an idea on the company's execution. 4. Who Owns It? High institutional ownership and high Wall Street coverage can make for quick collapse if something unexpected happens. Always follow short-sale numbers to tell you when a squeeze might develop so that the relative impact on a portfolio can be monitored. Watch option volume and relative pricing to note takeover speculation. Pay attention to 13Ds and 144s. 5. Check the Water Temperature Accumulate brokerage reports to provide the company-think and Wall Street's attitude. Brokerage reports can provide pertinent industry data. Often companies will send brokerage reports if you ask. Brokerage reports sent from the company bound to be positive. "As you read Wall Street reports, remember the job description of analysts: They are not paid to make waves or disagree or to be on the cutting edge of stock analysis. Analysts are relative: They are supposed to do a little better than their peers and charm the institutional clients who vote on the Institutional Investor all-star list. The problem is that some misinformed clients expect analysts to read the financials, even their bosses do not. Use analysts for indications of Street-think and as conduits of management information. It is not good guys versus bad guys, shorts versus analysts; the point is how effectively you use the information presented to you. Forbes and Barron's do good, strong, analytical fact-finding. Nobody fires them if they make waves. Many indexes carry only two or three years of references, but make sure you have at least five because ancient history is relevant to corporate hanky panky or to the firm's cultural tradition of hanky panky" 6. Pay Attention If you decide not to short a stock based on your preliminary analysis, it might be a good idea next year. if you short now, watch it. Events move slowly in the financial world, it can be hard to maintain concentration. First watch for earnings releases. Note when they are expected to be published and what Street expectations are. The date of the earnings release is also statistically relevant: the later they are, the worse the numbers. Many companies will fax the PR release, together with the income statements and balance sheet. Quick information is important. If it is a large, Street-covered stock small investors are at a disadvantage because Street analysts get the faxes and phone calls first, little players sometimes not until days later. Next, know when financials are expected out. The 10Qs and 10Ks are read slowly by Wall Street, so quick attention can yield important data -- little players can make up for the delay on receipt of earnings-release information. Waiting for new financials is like waiting for Christmas. It is fun to see if you were right and how things are developing. Go first to the key numbers, then the cash flow statement, finally the verbiage. Read the Qs carefully. Keep watching -- once a potential target, always a possibility. If you know a company well, you might recognize trigger, like the Zises' selling their Integrate stock, or HBJ selling Shamu, or J. Billder's closing stores or running over expected costs and out of money. Be quick to admit defeat. If you are shorted the stock because the investors were too high and the 10Q shows the company has corrected the problem, cover--NOW. Do not cover just because of price movements; wait until the resolution of the scenario. If Integrated looks like death, wait till it is buried. Short selling can be much like a cat waiting outside a mouse hole - the level of persistence, patience, and attentiveness is not for everyone, especially over sustained periods of time. Concept Recap The short seller's credo can be summarized into several points: 1. Dissent is Okay. 2. The facts are somewhere, free for the digging. 3. Hard work is old fashioned, so if you do a little, you will be far ahead. Analyst look at company PR rather than fundamentals and financials, and that provides opportunities and longer periods of market inefficiencies. 4. Computers confuse and build false confidence in portfolio managers, and that also provides opportunities. 5. Some accountants sanction everything, and that helps a lot, too. 6. Finally, Wall Street ices the inefficient cake with compulsive conformity. Everyone gets on the bandwagon and stays until the evidence is too compelling, then they all fall off with a jolt. Conclusion The key points to remember about selling, short selling or simply not buying are several. Never assume that a certain investment theme applies to all stocks. Each company and industry is different, so it is lazy to measure by the same scale if the yardstick is not relevant. If a company owns land at 1932 prices, do not worry about earnings or price/earnings. Think about the business and decide what the market wants you to pay for (cash flow, assets, earning). Then, after thoughtful consideration of the prospects, value the company according to your own analysis.Do not genuflect in front of a business, an executive, or an analyst. Keep your distance and you objectivity. The stock market is about people disagreeing over stock prices. Short sellers are entitled to their opinions, as are executives and analysts. And so are you. Do not take it seriously; it is only money. A short seller is a skeptic with a constructive, optimistic bent. If you are appalled when an executive lies about earnings prospects, do not just sell the stock, consider shorting it. When the short interest peaks at a staggering percentage of total volume and the marked has embraced pessimism. This might be a good time to go long and cover short positions.
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BAFFLING OR NOT, LET’S LEARN THE LESSONS FROM VOLSWAGEN
I have been observing the Volkswagen diesel emissions fraud case and its aftermath over the past couple years. The magnitude of the scheme on so many levels and the questions it raises are enormously significant in our increasingly complex society. As is so often the case, the original understanding of the crime turned out to be just the proverbial scratch on the surface. The picture became gloomier as the investigators dug deeper.
US District Judge Sean Cox ordered Volkswagen to pay a criminal penalty of $2.8 billion. Meanwhile, separate from that tidy sum, Volkswagen is paying $1.5 billion to settle the civil litigation case filed by the environmental regulators. Oh, and by the way, the carmaker is also spending $11 billion to settle with John Q. Public by buying back cars or providing other compensation for the losses.
Criminal charges have been levied against seven employees, but five of those persons are in Germany and extradition is not probable. Nevertheless, Judge Cox has strongly encouraged the German government to prosecute those persons as criminals.
What follows are some observations and questions I ponder:
Basic Is Best. Basic is best, especially when it comes to the honesty and integrity of doing business. The very basics of business, technology, group dynamics, public relations, and crime clearly communicate to us that hidden dark crimes of fraud will always find their way to the light of day. Private crime never remains private for long. What is private becomes public and then the penalties pound relentlessly. I realize we live in a complex world. Nevertheless, certain elements of navigation within that world will always remain basic. It is tragic and equally baffling when a major corporation such as Volkswagen displays a complete ignorance of the fact that basic is best.
Counting Coins Correctly. Volkswagen did what it did to save money. Although the chief purveyors of the emissions scheme may have been counting coins, they sure weren’t counting coins correctly. $13.3 billion later, I’m sure Volkswagen would agree it could find much better ways to spend those coins. Unfortunately, it won’t get the chance to do so.
Whatever Happened To Ethics? Absolute laws will supersede and override relativistic laws. I have always been as much of a realist as I am an idealist. It is both spheres of thought that lead me to ask the question whatever happened to ethics? Whether a realist or an idealist, ethics holds an intrinsic presence and power throughout our world that can never be silenced. Granted, many people try, but in the end they are the losers, and when you lose on ethics, the penalties can be painful and permanent.
As the case and its consequences continue to unfold, it is my hope that we as individuals, businesspersons, leaders, and organizations are paying attention. We can learn as much from a tragedy as we can a triumph.
[If you are interested, here is the original analysis article I first published September 23, 2015.]-----
GETTING BACK ON THE ROAD: HOW VOLKSWAGEN RECOVERS
Last week the Environmental Protection Agency accused Volkswagen of integrating a defeat device into nearly half a million cars’ software to fool emissions testers. The software programming allegedly affects numerous diesel models such as the 2009–15 Jetta, the 2009–15 Beetle, the 2009–15 Golf, the 2014–15 Passat, and the 2009–15 Audi A3. Please note that this involves seven consecutive model years.
Jack Ewing reports on exactly what the software does (The New York Times in The Kansas City Star. “Scandal Weights on Volkswagen.” September 22, 2015, pp. A6–A7):
“The software measured factors such as the position of the steering wheel, the vehicle’s speed and even barometric pressure to sense when the car was being subjected to testing, the EPA said. The car then configured itself to reduce emissions of nitrogen oxide, a gas that is a major contributor to smog and is linked to an array of respiratory ailments including asthma, emphysema and bronchitis, the EPA said Friday.” (p. A7)
Volkswagen executives have already admitted to the deception. The investigation, of course, is ongoing. A couple days ago, I identified four major ethical concerns connected to this situation:
Ethically Indefensible Corporate Decisions. It would appear that Volkswagen made a major technical decision that may have created a certain consumer benefit—improved motor vehicle performance. However, intrinsic to that decision is the perpetration of fraud against the government, the consumer, and society. It is fraud against the government because the implication and expectation of the passed emissions test is that the vehicle is meeting specific technical parameters of exactly how much it is polluting the atmosphere. It is fraud against the consumer and against society because individually and collectively, consumers believe that their vehicles are satisfying antipollution standards. Ethically, this is an indefensible position for Volkswagen.
Personal Integrity Violations. Regardless of how large the corporation, it remains comprised of individual people who make individual decisions. That means that at multiple steps over several years, specific persons knew that something bad was happening and they actively supported it or they chose to look the other way. In terms of personal integrity, this is a clear constellation of multiple failures.
When The Short Term Only Works In The Short Term. When it comes to corporate success, personal success, and ethical standards, if the short term only works in the short term, then we have a problem. You want the short term to work in the long term too. This translates to corporate success, personal success, and ethical efficacy.
When Public Relations Ignores Future Outcomes. I remain baffled when cases like this arise in which it is so obvious that people are not thinking about eventual public relations difficulties. First, with all our capabilities in technology and communications, it is foolish to believe even for a moment that poor ethical decisions will never see the light of day. After due time, they always hit the headlines. Second, once that happens, the public relations damage to the organization is always immense and irrevocable. Sometimes it is unrepairable. For a very long time, anyone considering doing business with Volkswagen will directly or indirectly ask the question do I want to do business with a company that intentionally tried to deceive? How do I know that this company will not try to deceive me?
In the wake of this corporate debacle, it will be most interesting to observe Volkswagen’s response. There is a right way and a wrong way to do this. If Volkswagen wants to do it the right way, then we should see a response that involves a convincing combination of these essential elements:
A Serious Apology. Consumers have a right to be frustrated and angry. Those emotions only intensify when the company demonstrates no remorse. On the other hand, consumers can be very forgiving when they perceive that a company is moving in the right direction. The opportunity to win in the marketplace is huge. But that is not the fundamental reason for the apology. The fundamental reason for the apology is that it is the right thing to do, and that is enough reason. Marketplace wins are incidental at this point.
Personnel Housecleaning. As quickly yet sensitively as possible, a company must investigate the misdeeds, determine who was responsible, and exercise its internal disciplinary process. Depending on the nature and severity of the circumstances, that will of course mean job terminations. With authority comes responsibility, with responsibility comes accountability, and with accountability comes consequences.
Technical Housecleaning. With the personnel housecleaning, a technical housecleaning must occur. All appropriate technical, procedural, process, product, and inventory changes that are needed to repair the damages must be executed immediately.
Corporate Culture Revision. Corporate culture can be difficult to change. Nevertheless, if the company is serious about permanent solutions instead of Band-Aid fixes, then it will do the difficult work. From the top leadership to the bench level, the company must ruthlessly evaluate all aspects of its being that enabled it to step down to such a level of inappropriate behavior and ethical compromise.
A Study Of Lessons Learned. As painful as the process might be, the company must invest the resources to engage every employee on the introspective journey of lessons learned. Only by studying the past can the company avoid the same errors in its future.
Volkswagen presents us with a textbook case study of a tragically common corporate disaster. Let’s hope we are all satisfied with how it responds.
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How Cybercrooks Put the Beatdown on My Beats
Last month Yours Truly got snookered by a too-good-to-be-true online scam in which some dirtball hijacked an Amazon merchant’s account and used it to pimp steeply discounted electronics that he never intended to sell. Amazon refunded my money, and the legitimate seller never did figure out how his account was hacked. But such attacks are becoming more prevalent of late as crooks increasingly turn to online crimeware services that make it a cakewalk to cash out stolen passwords.
The elusive Sonos Play:5
The item at Amazon that drew me to this should-have-known-better bargain was a Sonos wireless speaker that is very pricey and as a consequence has hung on my wish list for quite some time. Then I noticed an established seller with great feedback on Amazon was advertising a “new” model of the same speaker for 32 percent off. So on March 4, I purchased it straight away — paying for it with my credit card via Amazon’s one-click checkout.
A day later I received a nice notice from the seller stating that the item had shipped. Even Amazon’s site seemed to be fooled because for several days Amazon’s package tracking system updated its progress slider bar steadily from left to right.
Suddenly the package seemed to stall, as did any updates about where it was or when it might arrive. This went on for almost a week. On March 10, I received an email from the legitimate owner of the seller’s account stating that his account had been hacked.
Identifying myself as a reporter, I asked the seller to tell me what he knew about how it all went down. He agreed to talk if I left his name out of it.
“Our seller’s account email address was changed,” he wrote. “One night everything was fine and the next morning our seller account had a email address not associated with us. We could not access our account for a week. Fake electronic products were added to our storefront.”
He couldn’t quite explain the fake tracking number claim, but nevertheless the tactic does seem to be part of an overall effort to delay suspicion on the part of the buyer while the crook seeks to maximize the number of scam sales in a short period of time.
“The hacker then indicated they were shipped with fake tracking numbers on both the fake products they added and the products we actually sell,” the seller wrote. “They were only looking to get funds through Amazon. We are working with Amazon to refund all money that were spent buying these false products.”
As these things go, the entire ordeal wasn’t awful — aside maybe from the six days spent in great anticipation of audiophilic nirvana (alas, after my refund I thought better of the purchase and put the item back on my wish list.) But apparently I was in plenty of good (or bad?) company.
The Wall Street Journal notes that in recent weeks “attackers have changed the bank-deposit information on Amazon accounts of active sellers to steal tens of thousands of dollars from each, according to several sellers and advisers. Attackers also have hacked into the Amazon accounts of sellers who haven’t used them recently to post nonexistent merchandise for sale at steep discounts in an attempt to pocket the cash.”
Perhaps fraudsters are becoming more brazen of late with hacked Amazon accounts, but the same scams mentioned above happen every day on plenty of other large merchandising sites. The sad reality is that hacked Amazon seller accounts have been available for years at underground shops for about half the price of a coffee at Starbucks.
The majority of this commerce is made possible by one or two large account credential vendors in the cybercrime underground, and these vendors have been collecting, vetting and reselling hacked account credentials at major e-commerce sites for years.
I have no idea where the thieves got the credentials for the guy whose account was used to fake sell the Sonos speaker. But it’s likely to have been from a site like SLILPP, a crime shop which specializes in selling hacked Amazon accounts. Currently, the site advertises more than 340,000 Amazon account usernames and passwords for sale.
The price is about USD $2.50 per credential pair. Buyer scan select accounts by balance, country, associated credit/debit card type, card expiration date and last order date. Account credentials that also include the password to the victim’s associated email inbox can double the price.
The Amazon portion of SLILPP, a long-running fraud shop that at any given time has hundreds of thousands of Amazon account credentials for sale.
If memory serves correctly, SLILPP started off years ago mainly as a PayPal and eBay accounts seller (hence the “PP”). “Slil” is transliterated Russian for “слил,” which in this context may mean “leaked,” “download” or “to steal,” as in password data that has leaked or been stolen in other breaches. SLILPP has vastly expanded his store in the years since: It currently advertises more than 7.1 million credentials for sale from hundreds of popular bank and e-commerce sites.
The site’s proprietor has been at this game so long he probably deserves a story of his own soon, but for now I’ll say only that he seems to do a brisk business buying up credentials being gathered by credential-testing crime crews — cyber thieves who spend a great deal of time harvesting and enriching credentials stolen and/or leaked from major data breaches at social networking and e-commerce providers in recent years.
SLILPP’s main inventory page.
Fraudsters can take a list of credentials stolen from, say, the Myspace.com breach (in which some 427 million credentials were posted online) and see how many of those email address and password pairs from the MySpace accounts also work at hundreds of other bank and e-commerce sites.
Password thieves often then turn to crimeware-as-a-service tools like Sentry MBA, which can vastly simplify the process of checking a list of account credentials at multiple sites. To make blocking their password-checking activities more challenging for retailers and banks to identify and block, these thieves often try to route the Internet traffic from their password-guessing tools through legions of open Web proxies, hacked PCs or even stolen/carded cloud computing instances.
PASSWORD RE-USE: THE ENGINE OF ALL ONLINE FRAUD
In response, many major retailers are being forced to alert customers when they see known account credential testing activity that results in a successful login (thus suggesting the user’s account credentials were replicated and compromised elsewhere). However, from the customer’s perspective, this is tantamount to the e-commerce provider experiencing a breach even though the user’s penchant for recycling their password across multiple sites is invariably the culprit.
There are a multitude of useful security lessons here, some of which bear repeating because their lack of general observance is the cause of most password woes today (aside from the fact that so many places still rely on passwords and stupid things like “secret questions” in the first place). First and foremost: Do not re-use the same password across multiple sites. Secondly, but equally important: Never re-use your email password anywhere else.
Also, with a few exceptions, password length is generally more important than password complexity, and complex passwords are difficult to remember anyway. I prefer to think in terms of “pass phrases,” which are more like sentences or verses that are easy to remember.
If you have difficult recalling even unique passphrases, a password manager can help you pick and remember strong, unique passwords for each site you interact with, requiring only one strong master password to unlock any of them. Oh, and if the online account in question allows 2-factor authentication, be sure to take advantage of that.
I hope it’s clear that Amazon is just one of the many platforms where fraudsters lurk. SLILPP currently is selling stolen credentials for nearly 500 other banks and e-commerce sites. The full list of merchants targeted by this particularly bustling fraud shop is here (.txt file).
As for the “buyer beware” aspect of this tale, in retrospect there were several warning signs that I either ignored or neglected to assign much weight. For starters, the deal that snookered me was for a luxury product on sale for 32 percent off without much explanation as to why the apparently otherwise pristine item was so steeply discounted.
Also, while the seller had a stellar history of selling products on Amazon for many years (with overwhelmingly positive feedback on virtually all of his transactions) he did not have a history of selling the type of product that thieves tried to sell through his account. The old adage “If something seems too good to be true, it probably is,” ages really well in cyberspace.
from https://krebsonsecurity.com/2017/04/how-cybercrooks-put-the-beatdown-on-my-beats/
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How Cybercrooks Put the Beatdown on My Beats
Last month Yours Truly got snookered by a too-good-to-be-true online scam in which some dirtball hijacked an Amazon merchant’s account and used it to pimp steeply discounted electronics that he never intended to sell. Amazon refunded my money, and the legitimate seller never did figure out how his account was hacked. But such attacks are becoming more prevalent of late as crooks increasingly turn to online crimeware services that make it a cakewalk to cash out stolen passwords.
The elusive Sonos Play:5
The item at Amazon that drew me to this should-have-known-better bargain was a Sonos wireless speaker that is very pricey and as a consequence has hung on my wish list for quite some time. Then I noticed an established seller with great feedback on Amazon was advertising a “new” model of the same speaker for 32 percent off. So on March 4, I purchased it straight away — paying for it with my credit card via Amazon’s one-click checkout.
A day later I received a nice notice from the seller stating that the item had shipped. Even Amazon’s site seemed to be fooled because for several days Amazon’s package tracking system updated its progress slider bar steadily from left to right.
Suddenly the package seemed to stall, as did any updates about where it was or when it might arrive. This went on for almost a week. On March 10, I received an email from the legitimate owner of the seller’s account stating that his account had been hacked.
Identifying myself as a reporter, I asked the seller to tell me what he knew about how it all went down. He agreed to talk if I left his name out of it.
“Our seller’s account email address was changed,” he wrote. “One night everything was fine and the next morning our seller account had a email address not associated with us. We could not access our account for a week. Fake electronic products were added to our storefront.”
He couldn’t quite explain the fake tracking number claim, but nevertheless the tactic does seem to be part of an overall effort to delay suspicion on the part of the buyer while the crook seeks to maximize the number of scam sales in a short period of time.
“The hacker then indicated they were shipped with fake tracking numbers on both the fake products they added and the products we actually sell,” the seller wrote. “They were only looking to get funds through Amazon. We are working with Amazon to refund all money that were spent buying these false products.”
As these things go, the entire ordeal wasn’t awful — aside maybe from the six days spent in great anticipation of audiophilic nirvana (alas, after my refund I thought better of the purchase and put the item back on my wish list.) But apparently I was in plenty of good (or bad?) company.
The Wall Street Journal notes that in recent weeks “attackers have changed the bank-deposit information on Amazon accounts of active sellers to steal tens of thousands of dollars from each, according to several sellers and advisers. Attackers also have hacked into the Amazon accounts of sellers who haven’t used them recently to post nonexistent merchandise for sale at steep discounts in an attempt to pocket the cash.”
Perhaps fraudsters are becoming more brazen of late with hacked Amazon accounts, but the same scams mentioned above happen every day on plenty of other large merchandising sites. The sad reality is that hacked Amazon seller accounts have been available for years at underground shops for about half the price of a coffee at Starbucks.
The majority of this commerce is made possible by one or two large account credential vendors in the cybercrime underground, and these vendors have been collecting, vetting and reselling hacked account credentials at major e-commerce sites for years.
I have no idea where the thieves got the credentials for the guy whose account was used to fake sell the Sonos speaker. But it’s likely to have been from a site like SLILPP, a crime shop which specializes in selling hacked Amazon accounts. Currently, the site advertises more than 340,000 Amazon account usernames and passwords for sale.
The price is about USD $2.50 per credential pair. Buyer scan select accounts by balance, country, associated credit/debit card type, card expiration date and last order date. Account credentials that also include the password to the victim’s associated email inbox can double the price.
The Amazon portion of SLILPP, a long-running fraud shop that at any given time has hundreds of thousands of Amazon account credentials for sale.
If memory serves correctly, SLILPP started off years ago mainly as a PayPal and eBay accounts seller (hence the “PP”). “Slil” is transliterated Russian for “слил,” which in this context may mean “leaked,” “download” or “to steal,” as in password data that has leaked or been stolen in other breaches. SLILPP has vastly expanded his store in the years since: It currently advertises more than 7.1 million credentials for sale from hundreds of popular bank and e-commerce sites.
The site’s proprietor has been at this game so long he probably deserves a story of his own soon, but for now I’ll say only that he seems to do a brisk business buying up credentials being gathered by credential-testing crime crews — cyber thieves who spend a great deal of time harvesting and enriching credentials stolen and/or leaked from major data breaches at social networking and e-commerce providers in recent years.
SLILPP’s main inventory page.
Fraudsters can take a list of credentials stolen from, say, the Myspace.com breach (in which some 427 million credentials were posted online) and see how many of those email address and password pairs from the MySpace accounts also work at hundreds of other bank and e-commerce sites.
Password thieves often then turn to crimeware-as-a-service tools like Sentry MBA, which can vastly simplify the process of checking a list of account credentials at multiple sites. To make blocking their password-checking activities more challenging for retailers and banks to identify and block, these thieves often try to route the Internet traffic from their password-guessing tools through legions of open Web proxies, hacked PCs or even stolen/carded cloud computing instances.
PASSWORD RE-USE: THE ENGINE OF ALL ONLINE FRAUD
In response, many major retailers are being forced to alert customers when they see known account credential testing activity that results in a successful login (thus suggesting the user’s account credentials were replicated and compromised elsewhere). However, from the customer’s perspective, this is tantamount to the e-commerce provider experiencing a breach even though the user’s penchant for recycling their password across multiple sites is invariably the culprit.
There are a multitude of useful security lessons here, some of which bear repeating because their lack of general observance is the cause of most password woes today (aside from the fact that so many places still rely on passwords and stupid things like “secret questions” in the first place). First and foremost: Do not re-use the same password across multiple sites. Secondly, but equally important: Never re-use your email password anywhere else.
Also, with a few exceptions, password length is generally more important than password complexity, and complex passwords are difficult to remember anyway. I prefer to think in terms of “pass phrases,” which are more like sentences or verses that are easy to remember.
If you have difficult recalling even unique passphrases, a password manager can help you pick and remember strong, unique passwords for each site you interact with, requiring only one strong master password to unlock any of them. Oh, and if the online account in question allows 2-factor authentication, be sure to take advantage of that.
I hope it’s clear that Amazon is just one of the many platforms where fraudsters lurk. SLILPP currently is selling stolen credentials for nearly 500 other banks and e-commerce sites. The full list of merchants targeted by this particularly bustling fraud shop is here (.txt file).
As for the “buyer beware” aspect of this tale, in retrospect there were several warning signs that I either ignored or neglected to assign much weight. For starters, the deal that snookered me was for a luxury product on sale for 32 percent off without much explanation as to why the apparently otherwise pristine item was so steeply discounted.
Also, while the seller had a stellar history of selling products on Amazon for many years (with overwhelmingly positive feedback on virtually all of his transactions) he did not have a history of selling the type of product that thieves tried to sell through his account. The old adage “If something seems too good to be true, it probably is,” ages really well in cyberspace.
from Amber Scott Technology News https://krebsonsecurity.com/2017/04/how-cybercrooks-put-the-beatdown-on-my-beats/
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Obsessive Measurement Disorder: Etiology of an Epidemic
By KIP SULLIVAN JD
Review of The Tyranny of Metrics by Jerry Z. Muller, Princeton University Press, 2018
In the introduction to The Tyranny of Metrics, Jerry Muller urges readers to type “metrics” into Google’s Ngram, a program that searches through books and other material published over the last five centuries. He tells us we will find that the use of “metrics” soared after approximately 1985. I followed his instructions and confirmed his conclusion (see graph below). We see the same pattern for two other buzzwords that activate Muller’s BS antennae – “benchmarks,” and “performance indicators.” [1]
Muller’s purpose in asking us to perform this little exercise is to set the stage for his sweeping review of the history of “metric fixation,” which he defines as an irresistible “aspiration to replace judgment based on personal experience with standardized measurement.” (p. 6) His book takes a long view – he takes us back to the turn of the last century – and a wide view – he examines the destructive impact of the measurement craze on the medical profession, schools and colleges, police departments, the armed forces, banks, businesses, charities, and foreign aid offices.
Foreign aid? Yes, even that profession. According to a long-time expert in that field, employees of government foreign aid agencies have “become infected with a very bad case of Obsessive Measurement Disorder, an intellectual dysfunction rooted in the notion that counting everything in government programs will produce better policy choices and improved management.” (p. 155)
Muller, a professor of history at the Catholic University of America in Washington, DC, makes it clear at the outset that measurement itself is not the problem. Measurement is helpful in developing hypotheses for further investigation, and it is essential in improving anything that is complex or requires discipline. The object of Muller’s criticism is the rampant use of crude measures of efficiency (cost and quality) to dish out rewards and punishment – bonuses and financial penalties, promotion or demotion, or greater or less market share. Measurement can be crude because it fails to adjust scores for factors outside the subject’s control, and because it measures only actions that are relatively easy to measure and ignores valuable but less visible behaviors (such as creative thinking and mentoring). The use of inaccurate measurement is not just a waste of money; it invites undesirable behavior in both the measurers and the “measurees.” The measurers receive misleading information and therefore make less effective decisions (for example, “body count” totals tell them the war in Viet Nam is going well), and the subjects of measurement game the measurements (teachers “teach to the test” and surgeons refuse to perform surgery on sicker patients who would have benefited from surgery).
What puzzles Muller, and what motivated him to write this book, is why faith in the inappropriate use of measurement persists in the face of overwhelming evidence that it doesn’t work and has toxic consequences to boot. This mulish persistence in promoting measurement that doesn’t work and often causes harm (including driving good teachers and doctors out of their professions) justifies Muller’s harsh characterization of measurement mavens with phrases like “obsession,” “fixation,” and “cult.” “[A]lthough there is a large body of scholarship in the fields of psychology and economics that call into question the premises and effectiveness of pay for measured performance, that literature seems to have done little to halt the spread of metric fixation,” he writes. “That is why I wrote this book.” (p. 13)
A short history of Obsession Measurement Disorder in medicine
I read Muller’s book because I share his astonishment at the persistence of the measurement craze in the face of so much evidence that it is not working. Over the three decades that I have studied health policy, I have become increasingly baffled by people who promote various iterations of managed care in the face of evidence that they don’t work. In search of an explanation, I have, as Muller has, read books and news stories about the misuse of measurement in other fields, particularly education and banking. I have been especially baffled by the managed care movement’s enthusiasm for measuring the cost and quality of all actors in the health care system, an enthusiasm that emerged in the late 1980s when it was obvious that the propagation of HMOs, the movement’s founding project, was failing to control inflation. [2]
By the 1990s the enthusiasm for documents that handed out grades to insurance companies and providers on “consumer satisfaction,” mortality rates, etc. had become an obsession. Proponents of “report cards,” as these documents were called, hoped that “consumers” would read them and reward the good actors with their business and punish the bad actors by leaving them. That, of course, did not happen.
Frustrated by consumer disinterest in report cards, managed care proponents, such as the Medicare Payment Advisory Commission (MedPAC) and the Institute of Medicine (IOM), declared in the early 2000s that it was time to punish doctors and hospitals directly by rewarding them if they got good grades on crude measurements and punishing them if they didn’t. The term they used to describe this direct method of punishment was “pay for performance,” a phrase borrowed from the business world. By about 2004, that phrase had become so common in the health policy literature it was shortened to “P4P.”
The complete absence of evidence that P4P would improve the quality of medical care didn’t matter to MedPAC and other P4P advocates. [3] As evidence has piled up over the last decade indicating P4P doesn’t reduce costs and has mixed effects on quality, P4P proponents, true to form, have ignored it. [4]
Taylorism: Ground zero of the epidemic
It is impossible to identify a single Typhoid Mary responsible for the metrics-fixation epidemic, but it is fair to say a very important Typhoid Mary was Frederick Winslow Taylor. Muller identifies the rise of “Taylorism” in manufacturing in the early 1900s as a primary cause of the epidemic. Taylor, an American engineer, studied every action of workers in pig iron factories, estimated the average time of each action, then proposed to pay slower workers less and faster workers more. According to Taylor, determining who was slow and who was fast and paying accordingly required “an elaborate system for monitoring and controlling the workplace,” as Muller puts it. (p. 32) Taylor called his measurement-and-control system “scientific management.”
“Scientific management” assumed that managers with clipboards could distill the wisdom of their work force into a set of rules (later called “best practices,” another buzzword catapulted to stardom in the 1990s) and enforce those rules with pay-for-performance. The outcome of “scientific management,” according to Taylor, was that “all of the planning which under the old system was done by the workmen, must of necessity under the new system be done by management in accordance with the law of science.” (Muller, pp. 32-33) Here we see the beginning of the double standard now prevalent in health policy: People who flog faith-based P4P schemes hold themselves out as the bearers of “scientific” values (“evidence-based medicine,” to use the lingo invented in the early 1990s), while doctors who criticize metrics madness are said to be stuck in a “paternalistic culture.” [5]
The obvious corollary to “scientific management” was that leaders of corporations didn’t need any hands-on experience or training in the production of whatever it was their corporation produced. If you had a degree from a business school that taught “scientific management,” it shouldn’t matter to Sunbeam, for example, that “Chainsaw” Al Dunlap had no knowledge of how appliances are made. As long as he knew “management,” he was qualified to be Sunbeam’s CEO. Decades after Taylorism arose, this same logic would justify allowing managers of insurance company executives, Fortune 500 companies, and government insurance programs who never went to medical school to measure and micromanage doctors.
By the 1950s, this notion that standardized data in the hands of managers trumped experience had become deeply embedded in American business culture. By the 1960s, reports Muller, it had spread to the US military (Robert MacNamara’s background in accounting got him a job running a car company, and from there he jumped to the Pentagon where he and his “whiz kids” told the generals to count enemy corpses). By the 1980s it had infected other government agencies and much of the non-profit world, and by the late 1990s it had infected the services sector, including medicine.
Measuring the doctor and patient from afar
“Nowhere are metrics in greater vogue than in the field of medicine,” writes Muller. (p 103) The following statement by report-card and P4P guru Michael Porter, which Muller took from an article Porter co-authored for the Harvard Business Review, is a good illustration of how P4P proponents think and talk.
Rapid improvement in any field requires measuring results – a familiar principle in management…. Indeed, rigorous measurement of value (outcomes and costs) is perhaps the single most important step in improving health care. Wherever we see systematic measurement of results in health care … we see those results improve. [p. 107]
From this excerpt plus other sections of the Harvard Business Review article, we learn that Porter is absolutely convinced it’s possible to measure “outcomes and costs” accurately, and then divide cost into quality to derive “value.”
Note first the voice-of-God tone. God doesn’t have to document anything, and neither does Porter; there are no footnotes in this lengthy essay. Note next the grand assumption that improvement is only possible if “results” are measured. How do we know this? We just do. It’s a “principle of management,” says Porter (no doubt going all the way back to Frederick Taylor). Third, note the misrepresentation of the evidence. It simply isn’t true that “wherever” managers conduct “systematic measurement” of “performance” by doctors and hospitals, costs go down and/or quality goes up.
Muller compares the groupthink represented by Porter with research on both report cards and P4P schemes. The small body of research on report cards finds they have no impact on “consumer” behavior or patient outcomes. The large body of research on P4P indicates it may be raising costs when the costs providers incur to improve “performance” is taken into account, and it has at best a mixed effect on measured quality.
Muller suggests that the net effect of P4P on the health of all patients, that is, those whose care is measured and those whose care is not measured, is negative. Sicker patients are the ones most at risk in a system where P4P is rampant. Because the measures of cost and quality upon which P4P schemes are based are so inaccurate (because scores cannot be adjusted with anything resembling accuracy to reflect factors outside provider control), it induces a variety of “gaming” strategies, the worst of which are avoiding sicker patients and shifting resources away from patients whose care is not measured to those whose care is measured (“treating to the test”).
To illustrate how P4P damages sicker patients, Muller devotes two pages to the damage done by Medicare’s Hospital Readmissions Reduction Program (HRRP). This program, which began in 2012, punishes hospitals that have an above-average rate of 30-day readmissions (admissions that occur within 30 days of a discharge from a hospital) for patients with a half-dozen diagnoses. Muller reports that the HRRP has clearly had two negative effects. First, it has incentivized hospitals to keep sick patients away for at least 30 days after discharge, and if that’s not possible, to let them in but to put them on “observation” status, which means they are not counted as “readmitted.” [6] Second, it has led to the punishment of hospitals that treat sicker and poorer patients.
When Muller publishes a second edition of this book, he’ll no doubt add a page describing research done since his book was published showing that the HRRP appears to be killing patients with congestive heart failure (CHF). CHF was one of the three diagnoses that has been measured by the HRRP since it began (readmissions for heart attack and pneumonia were the other two).
Reversing the epidemic
Muller ends his book with a series of recommendations. He suggests, for example, that measures be developed from the bottom up and that financial rewards and penalties should be kept low if they are to be used at all. He does not attempt to offer political solutions. For this I do not criticize him. His book, which must have required years of research, is a valuable contribution to the largely one-sided debate about P4P in medicine, a debate which has only recently become more audible.
Here are my two cents on the politics of this issue. Groups representing doctors and nurses must take the lead in rolling back measurement mania. Doctors and nurses have great credibility with the public, and they have to cope every day with the consequences of measurement mania. They should focus on rolling back the P4P schemes now inflicted on the fee-for-service Medicare program because Medicare is so influential (“reforms” inflicted by Congress on Medicare are typically mimicked by the insurance industry). Groups working to reduce the cost of health care or improve quality of care for patients should also join the fight. They too have an interest in undermining the tyranny of metrics.
Of course, it would be nice if those who make a living promoting the inappropriate use of measurement would practice what they preach and examine their own behavior to see how it could be improved. Here’s a question that people in that business might pose to themselves now and then: Would you like your work to be subjected to measurement of its cost and quality by third parties, and would you like those third parties to alter your income based on the grades they decide to give you?
Footnotes:
[1] Just to test NGram, I entered other terms. “Automobile,” for example, rises up from zero mentions just before 1900 to a peak during about 1938-1942, then declines rapidly so that the rate by 2000 (the last year on the graph) is equal to the rate of 1910. “Database,” on the other hand, stays at zero mentions until about 1970, then skyrockets in the late 1970s.
[2] Accurate measurement of the cost and quality of insurance companies and providers was an essential element of “managed competition,” a proposal introduced in 1989 by Alaine Enthoven and enthusiastically promoted by Paul Ellwood (the “father of the HMO”), insurance industry executives, Bill and Hillary Clinton, and the editors of the New York Times, to name just a few of Enthoven’s most influential disciples.
[3] A 2006 edition of Medical Care Research and Review devoted entirely to the emerging P4P fad stated, “P4P programs are being implemented in a near-scientific vacuum.”
[4] We are seeing rare exceptions to the P4P groupthink only in the last two or three years. In January 2018, MedPAC formally voted to reverse its decision to recommend P4P at the individual physician level. Donald Berwick, a leading proponent of measurement, announced in 2016 that it was time to reduce the reporting burden on doctors by 50 to 75 percent and to eliminate P4P at the individual level.
[5] The IOM, for example, has peddled measurement and control of providers for decades on the basis of no evidence, yet it maintains a “roundtable” of P4P disciples the IOM deems to be “science-driven.”
[6] “Observation stays” were designed for Medicare beneficiaries who were not clearly in need of inpatient care but who were not clearly ready to go home either. Such patients are typically placed on the same wards with admitted patients but not treated.
Kip Sullivan is a member of the Health Care for All MN advisory board, and of MN Physicians for a National Health Program.
Obsessive Measurement Disorder: Etiology of an Epidemic published first on https://wittooth.tumblr.com/
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Text
Obsessive Measurement Disorder: Etiology of an Epidemic
By KIP SULLIVAN JD
Review of The Tyranny of Metrics by Jerry Z. Muller, Princeton University Press, 2018
In the introduction to The Tyranny of Metrics, Jerry Muller urges readers to type “metrics” into Google’s Ngram, a program that searches through books and other material published over the last five centuries. He tells us we will find that the use of “metrics” soared after approximately 1985. I followed his instructions and confirmed his conclusion (see graph below). We see the same pattern for two other buzzwords that activate Muller’s BS antennae – “benchmarks,” and “performance indicators.” [1]
Muller’s purpose in asking us to perform this little exercise is to set the stage for his sweeping review of the history of “metric fixation,” which he defines as an irresistible “aspiration to replace judgment based on personal experience with standardized measurement.” (p. 6) His book takes a long view – he takes us back to the turn of the last century – and a wide view – he examines the destructive impact of the measurement craze on the medical profession, schools and colleges, police departments, the armed forces, banks, businesses, charities, and foreign aid offices.
Foreign aid? Yes, even that profession. According to a long-time expert in that field, employees of government foreign aid agencies have “become infected with a very bad case of Obsessive Measurement Disorder, an intellectual dysfunction rooted in the notion that counting everything in government programs will produce better policy choices and improved management.” (p. 155)
Muller, a professor of history at the Catholic University of America in Washington, DC, makes it clear at the outset that measurement itself is not the problem. Measurement is helpful in developing hypotheses for further investigation, and it is essential in improving anything that is complex or requires discipline. The object of Muller’s criticism is the rampant use of crude measures of efficiency (cost and quality) to dish out rewards and punishment – bonuses and financial penalties, promotion or demotion, or greater or less market share. Measurement can be crude because it fails to adjust scores for factors outside the subject’s control, and because it measures only actions that are relatively easy to measure and ignores valuable but less visible behaviors (such as creative thinking and mentoring). The use of inaccurate measurement is not just a waste of money; it invites undesirable behavior in both the measurers and the “measurees.” The measurers receive misleading information and therefore make less effective decisions (for example, “body count” totals tell them the war in Viet Nam is going well), and the subjects of measurement game the measurements (teachers “teach to the test” and surgeons refuse to perform surgery on sicker patients who would have benefited from surgery).
What puzzles Muller, and what motivated him to write this book, is why faith in the inappropriate use of measurement persists in the face of overwhelming evidence that it doesn’t work and has toxic consequences to boot. This mulish persistence in promoting measurement that doesn’t work and often causes harm (including driving good teachers and doctors out of their professions) justifies Muller’s harsh characterization of measurement mavens with phrases like “obsession,” “fixation,” and “cult.” “[A]lthough there is a large body of scholarship in the fields of psychology and economics that call into question the premises and effectiveness of pay for measured performance, that literature seems to have done little to halt the spread of metric fixation,” he writes. “That is why I wrote this book.” (p. 13)
A short history of Obsession Measurement Disorder in medicine
I read Muller’s book because I share his astonishment at the persistence of the measurement craze in the face of so much evidence that it is not working. Over the three decades that I have studied health policy, I have become increasingly baffled by people who promote various iterations of managed care in the face of evidence that they don’t work. In search of an explanation, I have, as Muller has, read books and news stories about the misuse of measurement in other fields, particularly education and banking. I have been especially baffled by the managed care movement’s enthusiasm for measuring the cost and quality of all actors in the health care system, an enthusiasm that emerged in the late 1980s when it was obvious that the propagation of HMOs, the movement’s founding project, was failing to control inflation. [2]
By the 1990s the enthusiasm for documents that handed out grades to insurance companies and providers on “consumer satisfaction,” mortality rates, etc. had become an obsession. Proponents of “report cards,” as these documents were called, hoped that “consumers” would read them and reward the good actors with their business and punish the bad actors by leaving them. That, of course, did not happen.
Frustrated by consumer disinterest in report cards, managed care proponents, such as the Medicare Payment Advisory Commission (MedPAC) and the Institute of Medicine (IOM), declared in the early 2000s that it was time to punish doctors and hospitals directly by rewarding them if they got good grades on crude measurements and punishing them if they didn’t. The term they used to describe this direct method of punishment was “pay for performance,” a phrase borrowed from the business world. By about 2004, that phrase had become so common in the health policy literature it was shortened to “P4P.”
The complete absence of evidence that P4P would improve the quality of medical care didn’t matter to MedPAC and other P4P advocates. [3] As evidence has piled up over the last decade indicating P4P doesn’t reduce costs and has mixed effects on quality, P4P proponents, true to form, have ignored it. [4]
Taylorism: Ground zero of the epidemic
It is impossible to identify a single Typhoid Mary responsible for the metrics-fixation epidemic, but it is fair to say a very important Typhoid Mary was Frederick Winslow Taylor. Muller identifies the rise of “Taylorism” in manufacturing in the early 1900s as a primary cause of the epidemic. Taylor, an American engineer, studied every action of workers in pig iron factories, estimated the average time of each action, then proposed to pay slower workers less and faster workers more. According to Taylor, determining who was slow and who was fast and paying accordingly required “an elaborate system for monitoring and controlling the workplace,” as Muller puts it. (p. 32) Taylor called his measurement-and-control system “scientific management.”
“Scientific management” assumed that managers with clipboards could distill the wisdom of their work force into a set of rules (later called “best practices,” another buzzword catapulted to stardom in the 1990s) and enforce those rules with pay-for-performance. The outcome of “scientific management,” according to Taylor, was that “all of the planning which under the old system was done by the workmen, must of necessity under the new system be done by management in accordance with the law of science.” (Muller, pp. 32-33) Here we see the beginning of the double standard now prevalent in health policy: People who flog faith-based P4P schemes hold themselves out as the bearers of “scientific” values (“evidence-based medicine,” to use the lingo invented in the early 1990s), while doctors who criticize metrics madness are said to be stuck in a “paternalistic culture.” [5]
The obvious corollary to “scientific management” was that leaders of corporations didn’t need any hands-on experience or training in the production of whatever it was their corporation produced. If you had a degree from a business school that taught “scientific management,” it shouldn’t matter to Sunbeam, for example, that “Chainsaw” Al Dunlap had no knowledge of how appliances are made. As long as he knew “management,” he was qualified to be Sunbeam’s CEO. Decades after Taylorism arose, this same logic would justify allowing managers of insurance company executives, Fortune 500 companies, and government insurance programs who never went to medical school to measure and micromanage doctors.
By the 1950s, this notion that standardized data in the hands of managers trumped experience had become deeply embedded in American business culture. By the 1960s, reports Muller, it had spread to the US military (Robert MacNamara’s background in accounting got him a job running a car company, and from there he jumped to the Pentagon where he and his “whiz kids” told the generals to count enemy corpses). By the 1980s it had infected other government agencies and much of the non-profit world, and by the late 1990s it had infected the services sector, including medicine.
Measuring the doctor and patient from afar
“Nowhere are metrics in greater vogue than in the field of medicine,” writes Muller. (p 103) The following statement by report-card and P4P guru Michael Porter, which Muller took from an article Porter co-authored for the Harvard Business Review, is a good illustration of how P4P proponents think and talk.
Rapid improvement in any field requires measuring results – a familiar principle in management…. Indeed, rigorous measurement of value (outcomes and costs) is perhaps the single most important step in improving health care. Wherever we see systematic measurement of results in health care … we see those results improve. [p. 107]
From this excerpt plus other sections of the Harvard Business Review article, we learn that Porter is absolutely convinced it’s possible to measure “outcomes and costs” accurately, and then divide cost into quality to derive “value.”
Note first the voice-of-God tone. God doesn’t have to document anything, and neither does Porter; there are no footnotes in this lengthy essay. Note next the grand assumption that improvement is only possible if “results” are measured. How do we know this? We just do. It’s a “principle of management,” says Porter (no doubt going all the way back to Frederick Taylor). Third, note the misrepresentation of the evidence. It simply isn’t true that “wherever” managers conduct “systematic measurement” of “performance” by doctors and hospitals, costs go down and/or quality goes up.
Muller compares the groupthink represented by Porter with research on both report cards and P4P schemes. The small body of research on report cards finds they have no impact on “consumer” behavior or patient outcomes. The large body of research on P4P indicates it may be raising costs when the costs providers incur to improve “performance” is taken into account, and it has at best a mixed effect on measured quality.
Muller suggests that the net effect of P4P on the health of all patients, that is, those whose care is measured and those whose care is not measured, is negative. Sicker patients are the ones most at risk in a system where P4P is rampant. Because the measures of cost and quality upon which P4P schemes are based are so inaccurate (because scores cannot be adjusted with anything resembling accuracy to reflect factors outside provider control), it induces a variety of “gaming” strategies, the worst of which are avoiding sicker patients and shifting resources away from patients whose care is not measured to those whose care is measured (“treating to the test”).
To illustrate how P4P damages sicker patients, Muller devotes two pages to the damage done by Medicare’s Hospital Readmissions Reduction Program (HRRP). This program, which began in 2012, punishes hospitals that have an above-average rate of 30-day readmissions (admissions that occur within 30 days of a discharge from a hospital) for patients with a half-dozen diagnoses. Muller reports that the HRRP has clearly had two negative effects. First, it has incentivized hospitals to keep sick patients away for at least 30 days after discharge, and if that’s not possible, to let them in but to put them on “observation” status, which means they are not counted as “readmitted.” [6] Second, it has led to the punishment of hospitals that treat sicker and poorer patients.
When Muller publishes a second edition of this book, he’ll no doubt add a page describing research done since his book was published showing that the HRRP appears to be killing patients with congestive heart failure (CHF). CHF was one of the three diagnoses that has been measured by the HRRP since it began (readmissions for heart attack and pneumonia were the other two).
Reversing the epidemic
Muller ends his book with a series of recommendations. He suggests, for example, that measures be developed from the bottom up and that financial rewards and penalties should be kept low if they are to be used at all. He does not attempt to offer political solutions. For this I do not criticize him. His book, which must have required years of research, is a valuable contribution to the largely one-sided debate about P4P in medicine, a debate which has only recently become more audible.
Here are my two cents on the politics of this issue. Groups representing doctors and nurses must take the lead in rolling back measurement mania. Doctors and nurses have great credibility with the public, and they have to cope every day with the consequences of measurement mania. They should focus on rolling back the P4P schemes now inflicted on the fee-for-service Medicare program because Medicare is so influential (“reforms” inflicted by Congress on Medicare are typically mimicked by the insurance industry). Groups working to reduce the cost of health care or improve quality of care for patients should also join the fight. They too have an interest in undermining the tyranny of metrics.
Of course, it would be nice if those who make a living promoting the inappropriate use of measurement would practice what they preach and examine their own behavior to see how it could be improved. Here’s a question that people in that business might pose to themselves now and then: Would you like your work to be subjected to measurement of its cost and quality by third parties, and would you like those third parties to alter your income based on the grades they decide to give you?
Footnotes:
[1] Just to test NGram, I entered other terms. “Automobile,” for example, rises up from zero mentions just before 1900 to a peak during about 1938-1942, then declines rapidly so that the rate by 2000 (the last year on the graph) is equal to the rate of 1910. “Database,” on the other hand, stays at zero mentions until about 1970, then skyrockets in the late 1970s.
[2] Accurate measurement of the cost and quality of insurance companies and providers was an essential element of “managed competition,” a proposal introduced in 1989 by Alaine Enthoven and enthusiastically promoted by Paul Ellwood (the “father of the HMO”), insurance industry executives, Bill and Hillary Clinton, and the editors of the New York Times, to name just a few of Enthoven’s most influential disciples.
[3] A 2006 edition of Medical Care Research and Review devoted entirely to the emerging P4P fad stated, “P4P programs are being implemented in a near-scientific vacuum.”
[4] We are seeing rare exceptions to the P4P groupthink only in the last two or three years. In January 2018, MedPAC formally voted to reverse its decision to recommend P4P at the individual physician level. Donald Berwick, a leading proponent of measurement, announced in 2016 that it was time to reduce the reporting burden on doctors by 50 to 75 percent and to eliminate P4P at the individual level.
[5] The IOM, for example, has peddled measurement and control of providers for decades on the basis of no evidence, yet it maintains a “roundtable” of P4P disciples the IOM deems to be “science-driven.”
[6] “Observation stays” were designed for Medicare beneficiaries who were not clearly in need of inpatient care but who were not clearly ready to go home either. Such patients are typically placed on the same wards with admitted patients but not treated.
Kip Sullivan is a member of the Health Care for All MN advisory board, and of MN Physicians for a National Health Program.
Obsessive Measurement Disorder: Etiology of an Epidemic published first on https://wittooth.tumblr.com/
0 notes
Text
Obsessive Measurement Disorder: Etiology of an Epidemic
By KIP SULLIVAN JD
Review of The Tyranny of Metrics by Jerry Z. Muller, Princeton University Press, 2018
In the introduction to The Tyranny of Metrics, Jerry Muller urges readers to type “metrics” into Google’s Ngram, a program that searches through books and other material published over the last five centuries. He tells us we will find that the use of “metrics” soared after approximately 1985. I followed his instructions and confirmed his conclusion (see graph below). We see the same pattern for two other buzzwords that activate Muller’s BS antennae – “benchmarks,” and “performance indicators.” [1]
Muller’s purpose in asking us to perform this little exercise is to set the stage for his sweeping review of the history of “metric fixation,” which he defines as an irresistible “aspiration to replace judgment based on personal experience with standardized measurement.” (p. 6) His book takes a long view – he takes us back to the turn of the last century – and a wide view – he examines the destructive impact of the measurement craze on the medical profession, schools and colleges, police departments, the armed forces, banks, businesses, charities, and foreign aid offices.
Foreign aid? Yes, even that profession. According to a long-time expert in that field, employees of government foreign aid agencies have “become infected with a very bad case of Obsessive Measurement Disorder, an intellectual dysfunction rooted in the notion that counting everything in government programs will produce better policy choices and improved management.” (p. 155)
Muller, a professor of history at the Catholic University of America in Washington, DC, makes it clear at the outset that measurement itself is not the problem. Measurement is helpful in developing hypotheses for further investigation, and it is essential in improving anything that is complex or requires discipline. The object of Muller’s criticism is the rampant use of crude measures of efficiency (cost and quality) to dish out rewards and punishment – bonuses and financial penalties, promotion or demotion, or greater or less market share. Measurement can be crude because it fails to adjust scores for factors outside the subject’s control, and because it measures only actions that are relatively easy to measure and ignores valuable but less visible behaviors (such as creative thinking and mentoring). The use of inaccurate measurement is not just a waste of money; it invites undesirable behavior in both the measurers and the “measurees.” The measurers receive misleading information and therefore make less effective decisions (for example, “body count” totals tell them the war in Viet Nam is going well), and the subjects of measurement game the measurements (teachers “teach to the test” and surgeons refuse to perform surgery on sicker patients who would have benefited from surgery).
What puzzles Muller, and what motivated him to write this book, is why faith in the inappropriate use of measurement persists in the face of overwhelming evidence that it doesn’t work and has toxic consequences to boot. This mulish persistence in promoting measurement that doesn’t work and often causes harm (including driving good teachers and doctors out of their professions) justifies Muller’s harsh characterization of measurement mavens with phrases like “obsession,” “fixation,” and “cult.” “[A]lthough there is a large body of scholarship in the fields of psychology and economics that call into question the premises and effectiveness of pay for measured performance, that literature seems to have done little to halt the spread of metric fixation,” he writes. “That is why I wrote this book.” (p. 13)
A short history of Obsession Measurement Disorder in medicine
I read Muller’s book because I share his astonishment at the persistence of the measurement craze in the face of so much evidence that it is not working. Over the three decades that I have studied health policy, I have become increasingly baffled by people who promote various iterations of managed care in the face of evidence that they don’t work. In search of an explanation, I have, as Muller has, read books and news stories about the misuse of measurement in other fields, particularly education and banking. I have been especially baffled by the managed care movement’s enthusiasm for measuring the cost and quality of all actors in the health care system, an enthusiasm that emerged in the late 1980s when it was obvious that the propagation of HMOs, the movement’s founding project, was failing to control inflation. [2]
By the 1990s the enthusiasm for documents that handed out grades to insurance companies and providers on “consumer satisfaction,” mortality rates, etc. had become an obsession. Proponents of “report cards,” as these documents were called, hoped that “consumers” would read them and reward the good actors with their business and punish the bad actors by leaving them. That, of course, did not happen.
Frustrated by consumer disinterest in report cards, managed care proponents, such as the Medicare Payment Advisory Commission (MedPAC) and the Institute of Medicine (IOM), declared in the early 2000s that it was time to punish doctors and hospitals directly by rewarding them if they got good grades on crude measurements and punishing them if they didn’t. The term they used to describe this direct method of punishment was “pay for performance,” a phrase borrowed from the business world. By about 2004, that phrase had become so common in the health policy literature it was shortened to “P4P.”
The complete absence of evidence that P4P would improve the quality of medical care didn’t matter to MedPAC and other P4P advocates. [3] As evidence has piled up over the last decade indicating P4P doesn’t reduce costs and has mixed effects on quality, P4P proponents, true to form, have ignored it. [4]
Taylorism: Ground zero of the epidemic
It is impossible to identify a single Typhoid Mary responsible for the metrics-fixation epidemic, but it is fair to say a very important Typhoid Mary was Frederick Winslow Taylor. Muller identifies the rise of “Taylorism” in manufacturing in the early 1900s as a primary cause of the epidemic. Taylor, an American engineer, studied every action of workers in pig iron factories, estimated the average time of each action, then proposed to pay slower workers less and faster workers more. According to Taylor, determining who was slow and who was fast and paying accordingly required “an elaborate system for monitoring and controlling the workplace,” as Muller puts it. (p. 32) Taylor called his measurement-and-control system “scientific management.”
“Scientific management” assumed that managers with clipboards could distill the wisdom of their work force into a set of rules (later called “best practices,” another buzzword catapulted to stardom in the 1990s) and enforce those rules with pay-for-performance. The outcome of “scientific management,” according to Taylor, was that “all of the planning which under the old system was done by the workmen, must of necessity under the new system be done by management in accordance with the law of science.” (Muller, pp. 32-33) Here we see the beginning of the double standard now prevalent in health policy: People who flog faith-based P4P schemes hold themselves out as the bearers of “scientific” values (“evidence-based medicine,” to use the lingo invented in the early 1990s), while doctors who criticize metrics madness are said to be stuck in a “paternalistic culture.” [5]
The obvious corollary to “scientific management” was that leaders of corporations didn’t need any hands-on experience or training in the production of whatever it was their corporation produced. If you had a degree from a business school that taught “scientific management,” it shouldn’t matter to Sunbeam, for example, that “Chainsaw” Al Dunlap had no knowledge of how appliances are made. As long as he knew “management,” he was qualified to be Sunbeam’s CEO. Decades after Taylorism arose, this same logic would justify allowing managers of insurance company executives, Fortune 500 companies, and government insurance programs who never went to medical school to measure and micromanage doctors.
By the 1950s, this notion that standardized data in the hands of managers trumped experience had become deeply embedded in American business culture. By the 1960s, reports Muller, it had spread to the US military (Robert MacNamara’s background in accounting got him a job running a car company, and from there he jumped to the Pentagon where he and his “whiz kids” told the generals to count enemy corpses). By the 1980s it had infected other government agencies and much of the non-profit world, and by the late 1990s it had infected the services sector, including medicine.
Measuring the doctor and patient from afar
“Nowhere are metrics in greater vogue than in the field of medicine,” writes Muller. (p 103) The following statement by report-card and P4P guru Michael Porter, which Muller took from an article Porter co-authored for the Harvard Business Review, is a good illustration of how P4P proponents think and talk.
Rapid improvement in any field requires measuring results – a familiar principle in management…. Indeed, rigorous measurement of value (outcomes and costs) is perhaps the single most important step in improving health care. Wherever we see systematic measurement of results in health care … we see those results improve. [p. 107]
From this excerpt plus other sections of the Harvard Business Review article, we learn that Porter is absolutely convinced it’s possible to measure “outcomes and costs” accurately, and then divide cost into quality to derive “value.”
Note first the voice-of-God tone. God doesn’t have to document anything, and neither does Porter; there are no footnotes in this lengthy essay. Note next the grand assumption that improvement is only possible if “results” are measured. How do we know this? We just do. It’s a “principle of management,” says Porter (no doubt going all the way back to Frederick Taylor). Third, note the misrepresentation of the evidence. It simply isn’t true that “wherever” managers conduct “systematic measurement” of “performance” by doctors and hospitals, costs go down and/or quality goes up.
Muller compares the groupthink represented by Porter with research on both report cards and P4P schemes. The small body of research on report cards finds they have no impact on “consumer” behavior or patient outcomes. The large body of research on P4P indicates it may be raising costs when the costs providers incur to improve “performance” is taken into account, and it has at best a mixed effect on measured quality.
Muller suggests that the net effect of P4P on the health of all patients, that is, those whose care is measured and those whose care is not measured, is negative. Sicker patients are the ones most at risk in a system where P4P is rampant. Because the measures of cost and quality upon which P4P schemes are based are so inaccurate (because scores cannot be adjusted with anything resembling accuracy to reflect factors outside provider control), it induces a variety of “gaming” strategies, the worst of which are avoiding sicker patients and shifting resources away from patients whose care is not measured to those whose care is measured (“treating to the test”).
To illustrate how P4P damages sicker patients, Muller devotes two pages to the damage done by Medicare’s Hospital Readmissions Reduction Program (HRRP). This program, which began in 2012, punishes hospitals that have an above-average rate of 30-day readmissions (admissions that occur within 30 days of a discharge from a hospital) for patients with a half-dozen diagnoses. Muller reports that the HRRP has clearly had two negative effects. First, it has incentivized hospitals to keep sick patients away for at least 30 days after discharge, and if that’s not possible, to let them in but to put them on “observation” status, which means they are not counted as “readmitted.” [6] Second, it has led to the punishment of hospitals that treat sicker and poorer patients.
When Muller publishes a second edition of this book, he’ll no doubt add a page describing research done since his book was published showing that the HRRP appears to be killing patients with congestive heart failure (CHF). CHF was one of the three diagnoses that has been measured by the HRRP since it began (readmissions for heart attack and pneumonia were the other two).
Reversing the epidemic
Muller ends his book with a series of recommendations. He suggests, for example, that measures be developed from the bottom up and that financial rewards and penalties should be kept low if they are to be used at all. He does not attempt to offer political solutions. For this I do not criticize him. His book, which must have required years of research, is a valuable contribution to the largely one-sided debate about P4P in medicine, a debate which has only recently become more audible.
Here are my two cents on the politics of this issue. Groups representing doctors and nurses must take the lead in rolling back measurement mania. Doctors and nurses have great credibility with the public, and they have to cope every day with the consequences of measurement mania. They should focus on rolling back the P4P schemes now inflicted on the fee-for-service Medicare program because Medicare is so influential (“reforms” inflicted by Congress on Medicare are typically mimicked by the insurance industry). Groups working to reduce the cost of health care or improve quality of care for patients should also join the fight. They too have an interest in undermining the tyranny of metrics.
Of course, it would be nice if those who make a living promoting the inappropriate use of measurement would practice what they preach and examine their own behavior to see how it could be improved. Here’s a question that people in that business might pose to themselves now and then: Would you like your work to be subjected to measurement of its cost and quality by third parties, and would you like those third parties to alter your income based on the grades they decide to give you?
Footnotes:
[1] Just to test NGram, I entered other terms. “Automobile,” for example, rises up from zero mentions just before 1900 to a peak during about 1938-1942, then declines rapidly so that the rate by 2000 (the last year on the graph) is equal to the rate of 1910. “Database,” on the other hand, stays at zero mentions until about 1970, then skyrockets in the late 1970s.
[2] Accurate measurement of the cost and quality of insurance companies and providers was an essential element of “managed competition,” a proposal introduced in 1989 by Alaine Enthoven and enthusiastically promoted by Paul Ellwood (the “father of the HMO”), insurance industry executives, Bill and Hillary Clinton, and the editors of the New York Times, to name just a few of Enthoven’s most influential disciples.
[3] A 2006 edition of Medical Care Research and Review devoted entirely to the emerging P4P fad stated, “P4P programs are being implemented in a near-scientific vacuum.”
[4] We are seeing rare exceptions to the P4P groupthink only in the last two or three years. In January 2018, MedPAC formally voted to reverse its decision to recommend P4P at the individual physician level. Donald Berwick, a leading proponent of measurement, announced in 2016 that it was time to reduce the reporting burden on doctors by 50 to 75 percent and to eliminate P4P at the individual level.
[5] The IOM, for example, has peddled measurement and control of providers for decades on the basis of no evidence, yet it maintains a “roundtable” of P4P disciples the IOM deems to be “science-driven.”
[6] “Observation stays” were designed for Medicare beneficiaries who were not clearly in need of inpatient care but who were not clearly ready to go home either. Such patients are typically placed on the same wards with admitted patients but not treated.
Kip Sullivan is a member of the Health Care for All MN advisory board, and of MN Physicians for a National Health Program.
Obsessive Measurement Disorder: Etiology of an Epidemic published first on https://wittooth.tumblr.com/
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