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lauramalchowblog · 5 years ago

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Immediate Changes Needed for Physicians to Stay in Business During the Pandemic

Practices cannot survive the COVID-19 cash flow crisis

By JEFF LIVINGSTON, MD

Will doctors be able to keep their practices open during the worst pandemic in our lifetime? Our country needs every available doctor in the country to fight the challenges of Covid-19. Doctors working in independent practices face an immediate cash flow crisis threatening their ability to continue services.

The CARES Act was signed into law on Friday, March 27, 2020. The law offers much-needed help to the acute needs of hospitals and the medical supply chain. This aid will facilitate the production of critical supplies such as ventilators and PPE. The law failed to consider the needs of the doctors who will run the ventilators and wear the masks.

Cash flow crisis

Private-practice physician groups experienced an unprecedented reduction in in-office visits as they moved to provide a safe and secure environment for patients and staff. In compliance with CDC guidelines, practices suspended preventative care, nonurgent visits, nonemergent surgery, and office procedures.

These necessary practice changes help keep patients safe and slow the spread of Covid-19. The unintended consequence is an unreported and unrecognized cash flow crisis threatening the viability of physician practices.

The number of self-employed physicians in the US is decreasing. The AMA’s annual Physician Practice Benchmark Survey showed that 47% of all physicians in 2018 were employed. This statistic is misleading as only a fraction of the employed physicians are employed by large hospital systems and health conglomerates who will have the cash flow and resources to manage through the crisis. Physician-owned practices employ the rest.

Many feel physicians are wealthy and do not need assistance. Some doctors are financially well-off and others are not. The personal net worth of a business owner is not relevant in the balance sheet of a business. A catastrophic drop in cash flow is the issue requiring corrective action.

We ask physicians to fight on the front lines, risking their lives without PPE and equipment. Doctors and nurses are getting sick. Some will die. We know it, and we are proud to put our life on the line in service to our nation.

As a society, we must stop and take a moment to think about what we are doing. The majority of US physicians are committed to serving and risking their lives. We are also asking them to lose their livelihoods.

New revenue opportunities

CMS removed restrictions to allow expansion of virtual care through Waiver 1135. Many practices have rapidly expanded their services to implement Telehealth. The harsh reality is that many practices in our country do not have the IT capacity to implement a complicated solution in an expedited manner. Even for those who are able, the revenue generated by virtual care will not offset the lost revenue from the reduction of services.

Telehealth alone is not enough to save healthcare workers jobs. It is a tiny drop in an empty bucket.

Who is at risk?

Practice managers scramble to evaluate options offered through the SBA disaster programs. Provisions in the CARES act prohibit the inclusion of those making above $100,000 in the forgiveness programs for SBA loans. Most practices employ physicians through long term contracts.

Contractual obligations extend beyond doctors. Providers affected include all non-physician providers who extend service and are critical to the health team. This includes Nurse Practitioners, Physician Assistants, Certified Nurse Anesthetists, and Certified Nurse-Midwives.

There is a domino effect that follows physician job loss. Staff in supporting roles for these providers will lose their jobs. A good rule of thumb is three staff members are employed for each physician or non-physician provider. The reduction of one non-physician provider causes three more people to lose their job. Staff falls below the forgiveness threshold, but if the provider is unemployed then staff reductions will follow.

Every contracted health care provider in America who falls above the forgiveness threshold is at risk of losing their jobs. This transcends physician specialty.

Let this sink in. In the middle of the Covid-19 crisis, every doctor and healthcare worker in every specialty in America is imminently at risk of unemployment.

Why is this happening so fast?

Private medical practices function similarly to others in the services industry. Revenue is generated through services rendered. Like any business, revenue is used to make payroll, purchase medical equipment and supplies, software dues, rent, and utilities. Medical practices also must pay for janitorial services, electronic medical records licenses, practice management systems, and equipment leases. While health insurance, phone systems, and retirement plans were covered in the CARES act, the above list was not.

Unlike traditional service industry companies, medical practices are not compensated for services rendered at the time of the transaction. Instead, charges are filed through a third-party payer (Medicare, Medicaid, or an insurance company). When we go to a drive-thru restaurant, we order and pay for our food on the spot. Healthcare services do not function this way.

Red tape associated with our country’s revenue cycle management system creates a lag in payment. Payments are not received for up to 3 months. In my field of obstetrics, no fees are collected until weeks after delivery as pregnancy is paid globally. This lag in payment exacerbates the cash flow crunch for medical practices.

Action is needed now

Medical providers need coordinated action now. We can not wait for private industry solutions. It is not practical for every practice in the country to negotiate terms with each landlord and vendor individually. It is not possible to evaluate all agreements with each pharmaceutical, device, medical supply, and every insurance company. This is not a scalable solution.

Here is the reality. Without immediate governmental action, practices around the country will fail. The US will be faced with an unprecedented crisis of unemployed physicians right at the potential peak of the Covid-19 pandemic.

Today CMS took positive steps with the Accelerated Advanced payment system. This corrective measure only applies to Medicare payments and does not apply to Medicaid or third-party insurance.

Here are actionable items that will help allow doctors to stay in business and help the US health system navigate through the pandemic.

1. Expedited health care provider credentialing process. Allow immediate authorization of any licensed provider, in good standing with their state’s medical board, to provide all services for Medicare, Medicaid, and any third-party insurance plans. The credentialing process can take between 90–120 days. As doctors get sick and die, there is no time for bureaucratic red tape. CMS expedite credentialing nationally for Medicare and third-party payers. Governors can mandate expedited credentialing for state-run Medicaid plans. This simple step will allow providers to contribute immediately and keep patients alive as physicians get sick and die.

2. Moratorium on medical office evictions. Commercial protection against eviction is needed for medical practice office leases during the pandemic. Texas Governor Greg Abbott passed protection for residential leases. Medical practices need similar protection. A mandate could be identical to the executive action announced by California Governor Gavin Newsome.

3. Suspend out-of-network penalties. It is not safe to enforce network restrictions during the pandemic. Allow physicians and patients to seek care in hospitals and medical sites of service not experiencing capacity limitations. We need the freedom to direct care where it is safe and where there is room. This will reduce the burden on hospital capacity.

This logical and necessary action will save lives. CMS can enact this simple step for Medicare and third-party payers. Governors can mandate this step for state-run Medicaid plans. Failure to do so will cost lives.

4. Suspend the reduction in reimbursement for nonphysician providers. Nonphysician providers are a critical part of the health team. Nonphysician providers include Nurse Practitioners, Physician Assistants, Certified Nurse Anesthetist, and Certified Nurse-Midwives. Currently, they are reimbursed at a lower rate than physicians for the same services.

As physicians begin to contract Covid-19, all available providers will be needed. Care provided by nonphysician providers should be reimbursed at the standard physician rate.

5. Waive Clia restrictions to allow and encourage point of care testing Physician practice sites will be essential to scaling up widespread Covid-19 testing. New FDA approved point of care Covid-19 tests are coming to market. Waiving restrictions will allow for an orderly rollout. Containment of the virus is dependent on our ability to test. We can not lose lives while we wait for Clia certifications.

6. Extend Postpartum Medicaid benefits to one year Medicaid coverages vary by state. Currently, in Texas women transition off Medicaid sixty days postpartum. Extending benefits will provide healthcare access to low-income women and reduce hospital burden by avoiding ER visits.

Tubal ligations are not being scheduled due to the mandated postponement of elective surgery. Low-income women will not have family planning coverage when the pandemic is over. Each state must determine eligibility for Medicaid for postpartum women. The result of this action will be fewer unwanted pregnancies, give women control over their bodies, and reduce abortions.

7. Remove restrictions on Ambulatory Surgery Centers The idea of reducing elective surgery was sound. Unfortunately, broad statements by the CDC lead to a variety of conflicting resolutions by various medical specialty governing boards. ASC utilization decisions should be made locally by their medical board and medical directors. Ambulatory surgery centers play a key role in reducing hospital burden and preventing local hospitals from reaching surge capacity. Medical directors need the freedom to work with local hospitals to guide patients to the safest possible treatment options.

8. Exempt Healthcare providers from the $100K threshold for debt forgiveness One of the purposes of the CARES act is to maintain a functional healthcare system to save lives during this pandemic. Allowing healthcare providers to be included in the SBA disaster relief debt forgiveness program would help us achieve the goal.

9. Mandate extended payment plans Physicians were hoping to see legal requirements in the CARES act requiring vendors to extend payment options to medical practices. Unfortunately, this did not occur. Practices need extended terms for all items in the medical supply chain including vaccines, devices, equipment leases and pharmaceutics to allow us to function during the pandemic.

There is no easy solution to this problem. I suggest Congress enact the mandated matching receipts of physician practices with payments to vendors for supplies and equipment. For example, physicians are reimbursed by insurance carriers on a delayed revenue cycle. Reimbursement is typically delayed up to 3 months. Congress could mandate vendors are not paid until the practice is reimbursed by Medicare, Medicaid or third-party payers.

Time is crucial

Medical practices across the country need a lifeline to stay in business. The United States passed 139,000 Covid-19 cases today. When this article is published, that number will be higher. The death toll will rise. I can’t believe I have to say it, but doctors and non-physician providers are needed to help manage the Covid-19 pandemic.

We will put on our lives on the line for our patients.

Isn’t our Government willing to save ours?

Jeff Livingston, MD is an OBGYN practicing in Texas.

The post Immediate Changes Needed for Physicians to Stay in Business During the Pandemic appeared first on The Health Care Blog.

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kristinsimmons · 5 years ago

Text

Immediate Changes Needed for Physicians to Stay in Business During the Pandemic

Practices cannot survive the COVID-19 cash flow crisis

By JEFF LIVINGSTON, MD

Cash flow crisis

New revenue opportunities

Telehealth alone is not enough to save healthcare workers jobs. It is a tiny drop in an empty bucket.

Who is at risk?

Every contracted health care provider in America who falls above the forgiveness threshold is at risk of losing their jobs. This transcends physician specialty.

Let this sink in. In the middle of the Covid-19 crisis, every doctor and healthcare worker in every specialty in America is imminently at risk of unemployment.

Why is this happening so fast?

Action is needed now

Today CMS took positive steps with the Accelerated Advanced payment system. This corrective measure only applies to Medicare payments and does not apply to Medicaid or third-party insurance.

Here are actionable items that will help allow doctors to stay in business and help the US health system navigate through the pandemic.

As physicians begin to contract Covid-19, all available providers will be needed. Care provided by nonphysician providers should be reimbursed at the standard physician rate.

Time is crucial

We will put on our lives on the line for our patients.

Isn’t our Government willing to save ours?

Jeff Livingston, MD is an OBGYN practicing in Texas.

The post Immediate Changes Needed for Physicians to Stay in Business During the Pandemic appeared first on The Health Care Blog.

Immediate Changes Needed for Physicians to Stay in Business During the Pandemic published first on https://wittooth.tumblr.com/

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stephenmccull · 5 years ago

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Call For FDA To Withdraw Preterm Birth Drug Divides Doctors and Insurers

Doctors fear that the only drug approved to prevent preterm birth, the nation’s leading cause of infant mortality and disability, will no longer be available to expectant mothers.

The drug, sold under the brand name Makena, has been in limbo since October, when an expert panel convened by the Food and Drug Administration reviewed the accumulated evidence and concluded that Makena is not effective in preventing preterm birth.

In a close vote, the panel recommended the FDA withdraw approval and pull the drug off the market.

That recommendation has sparked a fierce debate within the health care community. Doctors are torn between two clinical studies of the drug that had differing results: An older trial of American patients at high risk of having a preterm delivery showed Makena’s active ingredient seemed to be effective. But, more recently, a larger trial of lower-risk, international patients — a study conducted by the drug’s manufacturer after the FDA’s request — suggested that the medicine did not work.

Complicating matters is the possibility that even if the FDA decides to let Makena remain for sale, or permits pharmacies to create their own versions of the drug for use, insurers might well refuse to pay.

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Insurers are generally under no obligation to cover drugs just because the FDA approves them. And Cathryn Donaldson, a spokesperson for America’s Health Insurance Plans, said AHIP is convinced by the larger, more recent trial. “Now it is clear it is not effective,” she said.

This puts the FDA in a bind.

Many practicing obstetricians have been prescribing some form of the drug as standard treatment since around 2003, when the smaller clinical trial — a National Institutes of Health study — showed that the synthetic hormone 17-hydroxyprogesterone caproate, or “17P,” was effective in preventing preterm delivery in women with a history of preterm labor.

In 2011, sensing a market opportunity, a drug manufacturer jumped in to offer Makena — the only branded, FDA-approved version of 17P.

Makena has since effectively cornered the market. And if the FDA complies with the recommendation of its advisory panel to order Makena off the market, the action might remove all options for treating premature labor. By law, if the FDA withdraws its approval for Makena, generic versions of 17P must be pulled, too, and the FDA could decide to also stop specialty pharmacies from compounding Makena’s active ingredient.

That’s why seven of the 16 members of the FDA panel have argued that removing Makena’s FDA approval could do more damage than simply leaving a drug on the market that may, or may not, work.

Cutting off all access to the drug, whether it is Makena or its compounded versions, would be “a big disaster,” especially for women in disadvantaged communities who are at a higher risk of preterm birth, said Dr. George Saade, the director of maternal-fetal medicine and chief of obstetrics at the University of Texas Medical Branch at Galveston. (Saade has chaired panels awarding research grants from Makena’s manufacturer.)

“It’s not like, Oh, they’re going to be fine,” he said. “No, they’re not.”

If Makena stays on the market, doctors and insurers will be left to haggle over prescribing a drug that can cost an average of more than $10,000 per pregnancy. If the FDA blocks further sales, a treatment that many doctors and patients rely on will disappear overnight.

Giving Infants Their Best Start

Babies born prematurely can have problems breathing or digesting food or experience bleeding in their brains, among other life-threatening risks. Some of the children who survive struggle with lifelong disabilities. Giving them an extra few days or weeks in the womb can be transformative.

So it was considered a major breakthrough when the NIH released the results of its study in 2003, showing 17P was effective at preventing delivery before 37 weeks’ gestation for many women who had previously experienced preterm birth and were carrying a single baby.

That clinical trial, which studied more than 450 women in the United States, showed that about 37% of participants who received 17P had given birth before 37 weeks — contrasted with about 55% of participants who received the placebo. Researchers found no major safety concerns.

The drug seemed so clearly effective that researchers ended the study early. And the American College of Obstetricians and Gynecologists recommended that all pregnant women who fit that criteria be given 17P.

“The only problem was, no one was making it,” said Dr. Alan Peaceman, the chief of maternal-fetal medicine at Northwestern University’s Feinberg School of Medicine and a researcher on the 2003 study.

Thus, for more than a decade, compounding pharmacies — specialty pharmacies that typically make prescription drugs for patients who have allergies or other conditions — created cheap injections of 17P for use by pregnant women.

At the time, a weekly dose of the compounded drug cost about $10-$20. For the same dose, Makena, the branded version that emerged in 2011 and cornered the market, cost about $1,500 from the get-go.

In 2017, a study of the drug’s cost by researchers from Harvard University found no notable difference between the outcomes of women who took Makena and women who took compounded 17P — even though the mean per-pregnancy cost of Makena was $10,711 more than that of 17P.

How Makena Cornered The Market

In less than 10 years, the makers of Makena pushed its competition, particularly low-cost compounding pharmacies, out of the market.

Many of the women at risk of preterm birth, and the babies they have, are on Medicaid. Compounding facilities can be difficult to find. The drug was rendered inaccessible to many of the women who doctors thought needed it most.

When Makena first arrived, doctors, advocates and, eventually, members of Congress objected to its high price. Insurers, including government programs like Medicaid, refused to cover it.

At the time, Makena’s manufacturer struggled to compete with the cheaper, compounded 17P. In 2012, it sued the FDA in an unsuccessful attempt to stop compounding — gaining some ground later that year when a meningitis outbreak caused by a different compounded drug drew federal scrutiny of specialty pharmacies.

In 2014, the manufacturer went bankrupt and sold Makena to AMAG Pharmaceuticals, which owns the drug today.

But compounding of 17P continued until 2016, when the FDA approved a preservative-free version of Makena and, in doing so, handed AMAG Pharmaceuticals the exclusive right to make the drug, ending the compounding of 17P.

In a press release noting its victory, AMAG said at the time that about 38% of patients were taking compounded 17P instead of Makena.

“Ultimately, we felt pressured into prescribing the Makena because it was FDA-approved,” Peaceman said. “And especially in big systems, you are discouraged from using non-FDA-approved medicines when there is an FDA-approved medicine available.”

A Second Clinical Trial Muddies The Waters

For years, the results of the NIH’s 2003 study reassured many doctors, insurers, health officials and patients: 17P, Makena’s active ingredient, had been proven to prevent preterm birth.

When Makena’s original manufacturer sought FDA approval, it cited the NIH’s results to vouch for the drug’s safety and effectiveness. But while the FDA granted it approval to market Makena, the agency also ordered the company to conduct its own trial to confirm it was safe and effective, though with stricter requirements: Among other things, the company would have to prove the drug was effective at preventing preterm birth before 35 weeks, rather than 37.

Nearly a decade later, AMAG released the long-awaited findings of that nine-year scientific study: Although the company also turned up no major safety issues, researchers said last fall they could not prove Makena is effective at preventing preterm birth.

With more than 1,700 women participating, AMAG’s study was much larger than the NIH’s. But critics said, for a clinical trial ultimately intended to prove whether Makena works for American women at high risk of preterm birth, AMAG’s trial was deeply flawed.

For one thing, 35% of participants in the NIH trial had experienced preterm birth more than once, putting them at higher risk, compared with just 15% in AMAG’s trial.

Also, the majority of participants in the NIH trial — about 59% — were black, while the vast majority in AMAG’s trial — about 89% — were white. According to the Centers for Disease Control and Prevention, preterm birth is more common among babies born to black mothers.

AMAG told the FDA that it had had difficulty enrolling enough women who fit its criteria in the United States — because if a woman was already taking 17P, generally speaking, then she was not eligible for the study. And because the drug was already considered the standard of care, a lot of American women were taking it.

Instead, 61% of women involved in the trial were from Russia and Ukraine — countries that have notably different demographics than those of the United States. Patients from the United States made up just 23% of participants in the study.

Awaiting A Final Verdict

Based largely on AMAG’s findings, the FDA’s expert panel recommended in October, in a 9-7 vote, that the FDA withdraw its approval of Makena. The seven dissenting members recommended keeping the drug on the market while conducting further study.

So far, pending a final FDA decision, Makena is still on the market. The FDA does not have to accept the recommendations of its expert panels, though typically it does. Amanda Turney, a spokesperson of the agency, said there is no established timeline for when the FDA will announce whether it will withdraw its approval of Makena.

But the about-face from the expert panel about the drug’s usefulness has left all sides trying to figure out their next steps.

On Jan. 9, AMAG announced that because of “uncertainty” over Makena, it would divest itself of two of its other drugs, including one that was approved by the FDA last summer. In a statement in which the drugmaker also announced plans for its chief executive, William Heiden, to step down, Heiden was quoted as saying that the ambiguity about Makena’s future revenue “makes it challenging to invest in both our promising pipeline and in the physician and consumer marketing required to support these two new products.”

The American College of Obstetricians and Gynecologists has said it will continue to monitor the issue but has not changed its guidance to doctors in the meantime. Makena remains the standard of care for many pregnant women who have given birth prematurely in the past.

As doctors stand by for the FDA’s decision on withdrawing Makena from the market, many have suggested they will turn to compounding again if Makena disappears.

However, many withdrawn drugs are added to a federal list of drugs that may not be compounded due to failures of safety or efficacy — and if Makena is withdrawn, 17P could end up on that list, too.

That decision would also be made by the FDA, after receiving the recommendation of a different panel of experts on compounding, said Jeremy Kahn, an FDA spokesperson.

Dr. Kimberly Hickey, chief of maternal-fetal medicine at Walter Reed National Military Medical Center in Bethesda, Maryland, and a member of the FDA panel that voted for Makena to be withdrawn, said even if the drug is pulled from the market, obstetricians will seek out whatever version of its active ingredient remains for sale.

“People will look for progesterone wherever they can find it,” she said during the panel’s meeting, referring to the hormone 17P mimics. “They’re not just going to say, ‘I’m not going to treat you.'”

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gordonwilliamsweb · 5 years ago

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Call For FDA To Withdraw Preterm Birth Drug Divides Doctors and Insurers

Doctors fear that the only drug approved to prevent preterm birth, the nation’s leading cause of infant mortality and disability, will no longer be available to expectant mothers.

In a close vote, the panel recommended the FDA withdraw approval and pull the drug off the market.

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Subscribe to KHN’s free Morning Briefing.

Please confirm your email address below:

This puts the FDA in a bind.

In 2011, sensing a market opportunity, a drug manufacturer jumped in to offer Makena — the only branded, FDA-approved version of 17P.

That’s why seven of the 16 members of the FDA panel have argued that removing Makena’s FDA approval could do more damage than simply leaving a drug on the market that may, or may not, work.

“It’s not like, Oh, they’re going to be fine,” he said. “No, they’re not.”

Giving Infants Their Best Start

At the time, a weekly dose of the compounded drug cost about $10-$20. For the same dose, Makena, the branded version that emerged in 2011 and cornered the market, cost about $1,500 from the get-go.

How Makena Cornered The Market

In less than 10 years, the makers of Makena pushed its competition, particularly low-cost compounding pharmacies, out of the market.

When Makena first arrived, doctors, advocates and, eventually, members of Congress objected to its high price. Insurers, including government programs like Medicaid, refused to cover it.

In 2014, the manufacturer went bankrupt and sold Makena to AMAG Pharmaceuticals, which owns the drug today.

In a press release noting its victory, AMAG said at the time that about 38% of patients were taking compounded 17P instead of Makena.

A Second Clinical Trial Muddies The Waters

For years, the results of the NIH’s 2003 study reassured many doctors, insurers, health officials and patients: 17P, Makena’s active ingredient, had been proven to prevent preterm birth.

For one thing, 35% of participants in the NIH trial had experienced preterm birth more than once, putting them at higher risk, compared with just 15% in AMAG’s trial.

Awaiting A Final Verdict

But the about-face from the expert panel about the drug’s usefulness has left all sides trying to figure out their next steps.

As doctors stand by for the FDA’s decision on withdrawing Makena from the market, many have suggested they will turn to compounding again if Makena disappears.

However, many withdrawn drugs are added to a federal list of drugs that may not be compounded due to failures of safety or efficacy — and if Makena is withdrawn, 17P could end up on that list, too.

That decision would also be made by the FDA, after receiving the recommendation of a different panel of experts on compounding, said Jeremy Kahn, an FDA spokesperson.

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dinafbrownil · 5 years ago

Text

Call For FDA To Withdraw Preterm Birth Drug Divides Doctors and Insurers

Doctors fear that the only drug approved to prevent preterm birth, the nation’s leading cause of infant mortality and disability, will no longer be available to expectant mothers.

In a close vote, the panel recommended the FDA withdraw approval and pull the drug off the market.

Email Sign-Up

Subscribe to KHN’s free Morning Briefing.

Please confirm your email address below:

This puts the FDA in a bind.

In 2011, sensing a market opportunity, a drug manufacturer jumped in to offer Makena — the only branded, FDA-approved version of 17P.

That’s why seven of the 16 members of the FDA panel have argued that removing Makena’s FDA approval could do more damage than simply leaving a drug on the market that may, or may not, work.

“It’s not like, Oh, they’re going to be fine,” he said. “No, they’re not.”

Giving Infants Their Best Start

At the time, a weekly dose of the compounded drug cost about $10-$20. For the same dose, Makena, the branded version that emerged in 2011 and cornered the market, cost about $1,500 from the get-go.

How Makena Cornered The Market

In less than 10 years, the makers of Makena pushed its competition, particularly low-cost compounding pharmacies, out of the market.

When Makena first arrived, doctors, advocates and, eventually, members of Congress objected to its high price. Insurers, including government programs like Medicaid, refused to cover it.

In 2014, the manufacturer went bankrupt and sold Makena to AMAG Pharmaceuticals, which owns the drug today.

In a press release noting its victory, AMAG said at the time that about 38% of patients were taking compounded 17P instead of Makena.

A Second Clinical Trial Muddies The Waters

For years, the results of the NIH’s 2003 study reassured many doctors, insurers, health officials and patients: 17P, Makena’s active ingredient, had been proven to prevent preterm birth.

For one thing, 35% of participants in the NIH trial had experienced preterm birth more than once, putting them at higher risk, compared with just 15% in AMAG’s trial.

Awaiting A Final Verdict

But the about-face from the expert panel about the drug’s usefulness has left all sides trying to figure out their next steps.

As doctors stand by for the FDA’s decision on withdrawing Makena from the market, many have suggested they will turn to compounding again if Makena disappears.

However, many withdrawn drugs are added to a federal list of drugs that may not be compounded due to failures of safety or efficacy — and if Makena is withdrawn, 17P could end up on that list, too.

That decision would also be made by the FDA, after receiving the recommendation of a different panel of experts on compounding, said Jeremy Kahn, an FDA spokesperson.

from Updates By Dina https://khn.org/news/call-for-fda-to-withdraw-preterm-birth-drug-makena-divides-doctors-and-insurers/

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lashandrahcanatoliamp43insu-blog · 5 years ago

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hrpdfrisco · 2 years ago

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Preeclampsia

Preeclampsia is one high blood pressure (hypertension) disorder that can occur during pregnancy. Other disorders can happen, too: Gestational hypertension is high blood pressure that begins after 20 weeks without problems in the kidneys or other organs. Some women with gestational hypertension may develop preeclampsia.

#Preeclampsia #high risk pregnancy doctor #high risk pregnancy obgyn near me #diabetes in pregnancy #best obgyn near me #best gynecologist near me #best pregnancy clinic near me #best obstetrical specialist in north texas

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anupsingh11-blog · 6 years ago

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Infertility in recent times has come to be a not unusual scientific issue. Dealing with infertility possibly is something a pair would by no means need to experience of their lives. The infant-rearing segment is like a dream come actual for a pair. This is the segment when you begin attempting to find those ‘early signs of pregnancy’. The failure to conceive leaves a deeply poignant impact on the couple. In the sort of situation, travelling the first-rate IUI Centres in Hyderabad is the satisfactory manner out to deal with this stress.

What is Intrauterine Insemination (IUI)?

Intrauterine Insemination additionally referred to as artificial insemination, is an Assisted Reproductive Technology (ART) usually used for infertility treatment. IUI treatment is a system in which washed sperm is transferred directly into the uterus the usage of a skinny catheter. The treatment is done to growth the number of sperm that enters the uterus.

Intrauterine Insemination (IUI) Procedure

The Intrauterine Insemination (IUI) procedure is conducted on the IUI centres in Hyderabad. The method is pretty easy. Male associate sperm or the donor’s sperm may be thawed and organized. The semen then goes thru a bathing manner. This process is used to take out the impurities.

A skinny catheter is then positioned in the cervix that would cause slight cramping similar to what you feel throughout Pap smear. The washed sperm is transferred to the uterus.

You may be prescribed by the doctor to remain mendacity horizontally for as a minimum half-hour.

You can go to the nice IUI centres in Hyderabad to have a higher know-how of all of the options and risks concerned within the procedure.

Main Causes of Female Infertility

Female infertility is primarily based on bodily and social traits that vary via lifestyle and scenario. Female infertility is whilst a lady fails to conceive even after having unprotected sexual sex for a year. There can be a few traditional hormone imbalances, which intrude being pregnant. Cervical problems are different most important motives for female infertility, a condition that does not permit sperm to pass through the cervical canal.

IUI Treatment Cost in Hyderabad

The cost of IUI in Hyderabad varies from one case to another. IUI fee in India is nominal than that of different international locations. It depends at the clinical parameters of couples that how a great deal the treatment will value. The treatment fee additionally depends on the IUI achievement price. Higher the fulfillment rate, better might be the fee of IUI. The Fair Treatment Cost (FTC) calculator on elawoman.Com assist you to calculate the winning IUI cost in Hyderabad. The FTC calculator works on an algorithm that calculates the price of IUI based totally on the success costs. The IUI success quotes range from Fair, Good to High class. You can go to your nearest IUI centres in Hyderabad to get a detailed IUI treatment plan and fee.

IUI Success Rate

There is a plethora of things on which IUI achievement charge relies upon. The IUI technique performed at the proper time i.E, simply earlier than a woman ovulates, boosts the IUI achievement costs. You can be requested either to perform (HPT) Home Pregnancy Test or to go to the IUI centres in Hyderabad for ultrasound monitoring in an effort to ascertain the nice time for being pregnant. Another reason, that is directly proportional to IUI achievement rate, is the fee of IUI in Hyderabad. You can check the IUI price based at the success prices at elawoman.Com.

Risks Involved in IUI Treatment

In order to boom the IUI success fee, your doctor at the IUI centres in Hyderabad will prescribe a few fertility medications for ovarian-stimulation.

The fertility medicinal drugs can cause following facet effects:

Mood swings

Headaches and Nausea

Painful and swollen ovaries

Ovarian Cysts

Multiple pregnancies

Premature shipping

Surya Fertility Centre

Surya Fertility Centre, set up in 2010, is led through a group of extraordinarily certified and experienced healthcare professionals, who specialize in the area of Assisted Reproductive Technologies (ART) with the objective of obtaining wonderful results, primarily based on current protocols and advanced scientific strategies. Surya Fertility Centre has been started out with the aid of a group of extraordinarily certified healthcare specialists, who're professionals in the subject of ART. Having been skilled at a number of the nice centers overseas and in India, the team brings with it a unique aggregate of competence and revel in that is honestly specialised and advanced in the Infertility treatment in and other services and it is one of the IUI Centres in Hyderabad.

Surya Fertility Centre Vision: To become called the maximum reliable institution for infertility care, in which requirements adopted by using us would be considered because the benchmarks in phrases of fine, achievement rates, generation adoption and price effectiveness.

Services: In Vitro fertilization (IVF - Test Tube Baby),Intrauterine Insemination (IUI),TESA (Testicular Sperm Aspiration),Blastocyst Culture and Transfer,Intracytoplasmic Sperm Injection (ICSI)

IVF Cost: 104,400 to Rs. 231,600

Location: Banjara Hills, Hyderabad

Timings: Mon-Sat, 10:00 AM- 5:00 PM

Rating: 4.3 / 5

Dr. Jayashree Reddy

Dr. Jayashree Reddy is a one of the best Infertility Specialist and Gynecologist, Laparoscopic Surgeon (Obs & Gyn) in Kondapur, Hyderabad and has an revel in of 40 years in these fields. She completed her MBBS from Kakatiya Medical College, Warangal in 1979,DGO from Gandhi Medical College, Hyderabad in 1982 and now she is one of the . Obstetrician & Gynecologist Society Hyderabad.

Dr. Jayashree Reddy is Member Federating Obstetrician & Gynecologist. Member of Indian Menopause Society. And Life Member of Indian Medical Association.. Some of the offerings provided with the aid of the doctor are: High Risk Pregnancies,Obstetrics Problems,Cosmetic labiaplasty,Laparoscopy & Hysteroscopy and Unilateral Salpingo-Oophorectomy and many others and she has work in one of the IUI Centres in Hyderabad.

Services: In Vitro fertilization (IVF - Test Tube Baby),Intrauterine Insemination (IUI),TESA (Testicular Sperm Aspiration),Blastocyst Culture and Transfer,Intracytoplasmic Sperm Injection (ICSI)

IVF Cost: 104,400 to Rs. 231,600

Location: Raghavendra Colony, Banjara Hills, Hyderabad

Timings: Mon-Sat, 10:00 AM- 5:00 PM

Rating: 4.3 / 5

Dr. Sunitha Ilinani

Dr Sunitha Ilinani M.B.B.S, M.D is a consultant in assisted idea and infertility and scientific director at Surya fertility center. Dr. Sunitha Ilinani has scientific experience of round 18 years and acquired great education infertility and assisted concept at a number of the excellent middle in India and overseas consisting of Houston's fertility institute Texas and she has work in one of the IUI Centres in Hyderabad. She has special interested by reproductive endocrinology and constantly updates herself in assisted duplicate by way of collaborating in each countrywide and worldwide conferences. She has been a speaker at various CME programs and also performed infertility workshops.

Dr. Ilinani is a fairly certified health practitioner who were given her MBBS and MD from Kasturba Medical College in 1997 and 2001 respectively. Dr. Sunitha Ilinani (surya Fertility Centre) in Hyderabad treats the numerous ailments of the patients by means of assisting them go through high-quality treatments and strategies. The doctor is also listed under Gynaecologist & Obstetrician Doctors, Infertility Doctors.

Services: In Vitro fertilization (IVF - Test Tube Baby),Intrauterine Insemination (IUI),TESA (Testicular Sperm Aspiration),Blastocyst Culture and Transfer,Intracytoplasmic Sperm Injection (ICSI)

IVF Cost: 104,400 to Rs. 231,600

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larryland · 6 years ago

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LENOX, MA (March 7, 2019) — After the record breaking success of WAM Theatre’s fall 2018 production of ANN by Holland Taylor, WAM is thrilled to announce that Arena Stage in Washington, DC, and Dallas Theatre Center are presenting a new co-production of ANN in July and October of this year. WAM’s Artistic Director, Kristen van Ginhoven, will again direct the production, and Jayne Atkinson returns to star in the title role.

A one-woman tour-de-force, ANN is a hilarious and spirited portrait of Ann Richards, legendary Governor of Texas, that brings us face to face with Richards’ complex, colorful, and captivating character, with a personality bigger than the state she governed. Ticket sales for WAM’s 2018 co-production of ANN with Dorset Theatre Festival broke all box office records.

Jayne Atkinson will reprise her starring role as Texas Governor Ann Richards.

WAM Artistic Director Kristen van Ginhoven will direct once again at Arena Stage and Dallas Theatre Center.

“As a new citizen of this country, and as the Artistic Director of WAM, I cannot imagine a better way to contribute to the civic dialogue leading up to the 2020 election,” van Ginhoven said. “All of us at WAM are thrilled that our work at the intersection of arts and activism will have a life outside of the Berkshires where it will reach even larger audiences. And personally, I am delighted to be able to continue work on this play with Jayne at these two acclaimed regional theaters.”

“I am thrilled and proud to be continuing the journey – joining with Kristen to take ANN on the road and share the brilliance and humor of Ann Richards,” Atkinson added.

Molly Smith, Artistic Director of Arena Stage in Washington DC

Kevin Moriarty, Enloe/Rose Artistic Director of Dallas Theater Center

“ANN is a whip-smart play, perfect for the times we’re living in. Governor Ann Richards was so far ahead of her time, she was a rocket!” Molly Smith, Artistic Director of Arena Stage enthused. “We at Arena are excited about this co-production and bringing Jayne Atkinson’s fantastic portrayal of Governor Richards, along with Kristen van Ginhoven’s wonderful direction, to Washington DC. There really is no better place for a play about a strong woman politician. We’re tossing rocks at that glass ceiling! And reminding our audiences of those who went before.”

“We are thrilled to welcome Kristen van Ginhoven to Dallas to direct ANN,” said Kevin Moriarty, Enloe/Rose Artistic Director of Dallas Theater Center. “Under Kristen’s leadership, and with Jayne Atkinson in the title role, audiences will love this inspiring and hilarious play that brings us face to face with the complex, colorful and captivating character of Ann Richards.”

The original design team will also return to design the co-production. WAM Associate Artist Juliana von Haubrich returns as scenic designer, Andi Lyons as lighting designer, M. L. Dogg as sound designer, Jess Goldstein as costume designer and Paul Huntley as wig designer.

The production will run July 11-August 11 at Arena Stage and in Dallas from October 15-November 10. Tickets and information can be found on those companies’ Websites: arenastage.org and dallastheatercenter.org

Back in the Berkshires, WAM is launching its 10th anniversary season this year. There will be two Mainstage productions – the world premiere of Lady Randy by Anne Undeland, running April 18-May 5, and Pipeline by Dominique Morisseau, running October 25-November 9, presented in partnership with Multicultural BRIDGE. Two Fresh Takes Play Readings – Native Gardens by Karen Zacarías (May 4) and Paradise by Laura Maria Censabella (November 2) – will correlate directly to each Mainstage production; and an expanded Education program will include a new Elder Ensemble for women 65 and older, along with the successful, established Teen Ensemble, both of which will debut their original devised theatre pieces at the WAM Gala in July.

For more information about WAM Theatre and the 2019 season, visit: https://www.wamtheatre.com/2019-season/

ABOUT ARENA STAGE

Arena Stage at the Mead Center for American Theater, under the leadership of Artistic Director Molly Smith and Executive Producer Edgar Dobie, is a national center dedicated to American voices and artists. Arena Stage produces plays of all that is passionate, profound, deep and dangerous in the American spirit, and presents diverse and ground-breaking work from some of the best artists around the country. Arena Stage is committed to commissioning and developing new plays and impacts the lives of over 10,000 students annually through its work in community engagement. Now in its seventh decade, Arena Stage serves a diverse annual audience of more than 300,000. Arenastage.org

ABOUT THE DALLAS THEATER CENTER

One of the leading regional theaters in the country, Dallas Theater Center (DTC) performs to an audience of more than 90,000 North Texas residents annually. Founded in 1959, DTC is now a resident company of the AT&T Performing Arts Center and presents its mainstage season at the Dee and Charles Wyly Theatre in the Dallas Arts District. DTC also presents at its original home, the Kalita Humphreys Theater, the only freestanding theater designed and built by Frank Lloyd Wright. DTC engages, entertains and inspires a diverse community by creating experiences that stimulate new ways of thinking and living by consistently producing plays, educational programs and community initiatives that are of the highest quality and reach the broadest possible constituency. Dallastheatercenter.org

WAM 10th Anniversary Sponsors

Our 2019 sponsors include Adams Community Bank, Annie Selke, Berkshire Gas, Berkshire Hand to Shoulder Center, Berkshire Magazine, Berkshire Sterile Manufacturing, Blue Q, Blue Spark Financial, Brabson Library & Educational Foundation, Canyon Ranch, Chez Nous, Custom Business Solutions, Dr, Jay Wise, DDS and Dr. Casey Jones, DMD, The Dylandale Foundation, Frankie’s Ristorante Italiano, Greylock Federal Credit Union, Guido’s Fresh Marketplace, Haven Cafe and Bakery, Health Professional Coaching, Heller & Robbins, Interprint, J.H. Maxymillian, Inc., Lee Bank, Maggie Barry, NEPR, Massachusetts Cultural Council, Only in My Dreams Events, Onyx Specialty Papers, OUTPOST, RB Design Co., The Rogovoy Report, The Rookwood Inn, Salisbury Bank, T Square Design Studio, Toole Insurance, and a. von schlegell & co.

WAM Theatre is also supported in part by grants from the Alford-Egremont Cultural Council, Cultural Council of Northern Berkshires, Hinsdale-Peru Cultural Council, Lenox Cultural Council, New Marlborough Cultural Council, Otis Cultural Council, Richmond Cultural Council, Sandisfield Cultural Council, Sheffield Cultural Council, West Stockbridge Cultural Council– local agencies that are supported by the Massachusetts Cultural Council, a state agency.

LADY RANDY is sponsored in part by an anonymous donor and PIPELINE is sponsored in part by Carolyn Butler.

ABOUT WAM THEATRE

Based in Berkshire County, Massachusetts, WAM Theatre is celebrating its 10th anniversary of being a place Where Arts and Activism Meet. The company was co-founded in 2010 by director, actor, educator, and producer Kristen van Ginhoven. WAM’s vision is to create opportunity for women and girls through the mission of theatre as philanthropy.

Inspired by the book Half the Sky: Turning Oppression into Opportunity for Women Worldwide by Nicholas Kristof and Sheryl WuDunn, WAM donates a portion of the proceeds from its theatrical events to organizations that benefit women and girls.

Since 2010, WAM Theatre has provided paid work to more than 200 theatre artists and donated more than $56,500 to fifteen local and global organizations taking action for women and girls in areas such as girls education, teen pregnancy prevention, sexual trafficking awareness, midwife training and more. In addition to the main stage productions and special events, WAM Theatre’s activities include a comprehensive educational outreach program and the Fresh Takes Play Reading Series. For more information, visit www.WAMTheatre.com

“ANN” Starring Jayne Atkinson to be Presented in Dallas & Washington, DC LENOX, MA (March 7, 2019) — After the record breaking success of WAM Theatre’s fall 2018 production of…

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addictionrecoveryassistance · 6 years ago

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Contents

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kristinsimmons · 5 years ago

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Immediate Changes Needed for Physicians to Stay in Business During the Pandemic

Practices cannot survive the COVID-19 cash flow crisis

By JEFF LIVINGSTON, MD

Cash flow crisis

New revenue opportunities

Telehealth alone is not enough to save healthcare workers jobs. It is a tiny drop in an empty bucket.

Who is at risk?

Every contracted health care provider in America who falls above the forgiveness threshold is at risk of losing their jobs. This transcends physician specialty.

Let this sink in. In the middle of the Covid-19 crisis, every doctor and healthcare worker in every specialty in America is imminently at risk of unemployment.

Why is this happening so fast?

Action is needed now

Today CMS took positive steps with the Accelerated Advanced payment system. This corrective measure only applies to Medicare payments and does not apply to Medicaid or third-party insurance.

Here are actionable items that will help allow doctors to stay in business and help the US health system navigate through the pandemic.

As physicians begin to contract Covid-19, all available providers will be needed. Care provided by nonphysician providers should be reimbursed at the standard physician rate.

Time is crucial

We will put on our lives on the line for our patients.

Isn’t our Government willing to save ours?

Jeff Livingston, MD is an OBGYN practicing in Texas.

The post Immediate Changes Needed for Physicians to Stay in Business During the Pandemic appeared first on The Health Care Blog.

Immediate Changes Needed for Physicians to Stay in Business During the Pandemic published first on https://wittooth.tumblr.com/

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lovenerdywinnerbouquetfan-blog · 7 years ago

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I live in pensacola fl and just bought a car how much will the tag and insurance cost?

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How do I get health insurance for myself? My work doesn't offer health insurance. My husband and all his younger siblings (over 18) are now covered under my mother-in-law's insurance from her work.

Will I considered to drive a car without insurance?

Hi. I been driving without insurance for months because my mom told me to wait until her insurance expired and will add me to her policy in june. My mom add me to her policy a few days ago and my car insurance will only start valid on june 2, 2013. Yesterday, I was pulled over and got a ticket. Will I considered to drive a car without insurance? My mom was very mad at me because I didn't get any ticket for months and not involve in any accidents and now only 10 days until my car insurance valid, I got a ticket. Please help, I don't want to have 2 violation case especially drive without car insurance""

About how much car insurance does a first time 26 year old driver have to pay?

I need to know I lived in the city for many years and got by with public transportation so I never needed a car no that I have moved I need to buy a car, I hear folks says new drivers pay more..is this true of so how much more I plan to buy a used car for around 5-8 k directly no car loans""

Car Insurance?

The car is in my name and I have insurance on the car, but I want to add my 16 year old brother as a driver. He will be driving the car most of the time. He is covered under my moms but i am wondering if I can add him as a driver for mine also?""

Motorcycle insurance rate estimation?

I want basic liability insurance for a lower cc Honda Phantom, 700 cc tops. I am a 21 year old male who committed a DUI 2.5 years ago and is now alcohol-free. For that reason, I feel ...show more""

Good Insurance Policy for Newly Married Couple?

Me and my wife just for married. We are both 21 years of age and are in college. We know what having a good health insurance policy should be our highest priority. Is there any affordable and good insurance policy someone can recommend? Thank you.

I dont get what to do about car insurance?

Im 16, and ive had my permit since last august, and im gonna go for my license. I lived with my dad, but i have been living with my mom for a while. Im probably going to go on my dads insurance. But, can i drive my moms cars. So my questions are 1. Can I drive my moms cars when if i am on my dads insurance, is there a policy where I can drive other peoples cars? 2. Can I go on my dads insurance if I dont live with him? 3. Im not on any insurance now, I drive with my parents. They are on the insurance and their cars are covered, so do I already have to be covered with just a permit. 4. Im going to use my moms car for the driving test, do I have to be on insurance by then? I know they check for proof of insurance but i dont know if im supposed to be on it. My parents are divorced and I live in illinois and they have different insurance companies.""

What is best landlord insurance policy or company?

what is best landlord insurance policy or company?

Can you buy multiple life insurance policies?

If one had a whole life insurance policy valued at $1M, and through a life settlement company sold it for $455K; could you essentially use those same funds to purchase another life insurance such as a universal life insurance policy for $1M?""

What are some car insurance companys?

would love to know ones that are cheap???

Cheap auto insurance in maryland ?

i bough a 1993 honda civic and i need insurance before i can go pick it up which is gonna be on sat wats the lowest rate im 19 with a full dl never been stopped or gotten a ticket im looking only for liability not full covered

Life Insurance - Can I insure my mom?

I am 34 years old. My mom is in her late 60's and in good health. Can I get a life insurance policy on her and collect on it when she passes? I can't imagine this being so - how could insurance companies stay in business if it were this easy? The monthly rates that I'm seeing seem to good to be true - I'd be stupid to not do it. I'm thinking I must be missing something. Is life insurance only for accidental death? Thank you.

Do you have health insurance?

what kind of deducatable do you have?? how much per month? how old are you?

How much would it cost to insure a 17 year old driver with a 2003 corvette?

i should say how much more? right noq i drive a 2005 chevy avalanche LT and i have always wanted a corvette. i found one from a dealer that i might be able to afford if insurance isnt too much. i have usaa insurance and ive never had an accident or ticket, im not an honor role student but i pass with c's ans b's(I've herd honors affects insurance), i live in ct ( ive herd the state affects insurance), and i've done the minimal drivers ed (only the drug and alcohol courses which are required atleast in Connecticut). my insurance allows me to drive all the cars i want that are connected to that insurance plan. thank you!!!""

Is the Nissan 300zx (1991) a good first car for a teenager?

I just want to know, I'm shopping for my first car. I have about $3500 and I want a car that is sporty. I like the nissan 300zx, and I need to know if its a reliable enough car and a good buy for my first car. I f anyone has any advice or knows about the car, let me know. Thank you!""

How Much Do You Pay For Car Insurance?

And Whats On Your Driving Record?

Which Insurance company is better to take Mediclaim cover?

Which Insurance company is good to take health policy in India? India there are 24 non life insurance companies are there. Which one is better response at the time of claim. Give some suggestion to take medi claim insurance cover...

""It's mandatory in California to have auto insurance at ALL times, am I right?""

If yes, to whom can I go to, in order to check the validity of the car's insurance policy? A car hit me last Tuesday (I was a pedestrian). I am gonna be reporting the incident to a DMV office tomorrow. Will they give me the insurance information of the car? The other party didn't give me insurance information on the vehicle.""

Is there a cheap car insurance place in New Jersey for a 17 year old girl to get insurance?

Im 17 and I turn 18 in July and I bought my own car, its a 1992 toyota and I want my own insurance, I know it's going to be pricey a lot but I don't want to be under my parents insurance. I don't mind only getting liability but I need some help finding a cheaper insurance place in New Jersey on the upper east coast. Thanks!!""

""What's the cost of insurance on Porsche's, BMW's Ferrari's, etc?""

What's the cost of insurance on Porsche's, BMW's Ferrari's, etc?""

Will a suspended license affect my insurance?

I just found out my license is suspended in another state from a ticket I don't remember getting from 2003. They just put in on my record because I've been to the DMV several times after 2003 and no one ever said anything about a suspension. I have an opportunity to get a new job, but they have to check with their insurance as I will be driving a company vehicle. Will the suspension affect the insurance? My personal insurance rate has not been affected nor has my current company's insurance said anything about it.""

If i dont have insurance and i drive a friends car in which he has insurance on it.?

What would happen? would my friend be liable, and would he have to pay everything? or would his insurance cover his car?""

""I'm 19, have a permit, but do I need insurance to drive with my mom?""

Ok I got a permit, I got it last year..it expires on April 30th. So I was wondering..if i go out and drive with my mom who has a license, do I need to get my own insurance as well? My moms car is insured. I live in California. I haven't driven a whole year because i can't afford my own insurance right now. Lol so do I need to get my own insurance even though my mom and her car are insured? If I get stopped by the cops will I get in trouble? Thnx in advance""

Car insurance INCREASE every 6 months with no accidents/tickets? wtf!?

Last year I had Unitrin Direct....they were charging me $85 a month...this is with NO tickets or accidents for the last 5 years of my driving record....this is also with the BASIC ...show more

What would the premiums cost for government health insurance?

How much will people have to pay to be covered by Obama care? Are there estimates? Do many people believe it will be free? It's good to know the price of things before you buy them.

I wanna buy a car but don't have insurance?

What is the best auto insurance?

What would be the cheapest auto insurance for someone who is an eighteen year old female with a clean record looking to get insurance for the first time?

16 year old boy need insurance in CA?

I just got my license and I am planning to buy a toyota or a honda type of car. I want to know how much would car insurence would cost if i do get one and which company would give me a great coverage and a great deal. I need numbers and name people!!!

Car insurance?

I just bought a brand new car and recently changed my car insurance company. Today after leaving a meeting I hit a fire hydrin while backing up leaving a nice hole in my back bumper. I called my insurance company and submitted a claim but am more concered with the my insurance premium going up. Does anybody know if it will go up or not. I have not submitted a claim in more then 5 years and only pay 86.00 a month for full coverage including collision and renters insurance for my house. Does anybody know about this kind of stuff??

Delaware Auto Insurance (Uninsured / Under-insured) What does this Mean?

4) An insured who executes a release of a single tortfeasor owner or operator of an underinsured motor vehicle in exchange for payment of the entire limits of liability insurance afforded by the tortfeasor's liability insurer shall continue to be legally entitled to recover against that tortfeasor for the purposes of recovery against the insured's underinsurance carrier. An insured who executes a release of 1 of multiple tortfeasors shall have rights against that tortfeasor and the insured's underinsurance carrier determined in accordance with the Uniform Contribution Among Joint Tortfeasors Act and paragraph (3) of this subsection.

Health Insurance Deductible Q?

Does doctor visits count towards insurance deductible? My deductible is 2500 and doctors usually charge 100s of dollars per visit to the company even though i pay small co payments, do those count towards the deductible amount? I may need a mri soon which cost a lot and my insurance charges %80 after the deductible has been met""

How much insurance cost for 350z?

how much does it cost for insurance on a 350z for a 19yr old guy clean driving record in Texas?

""If a deer hits me, how fast can insurance get me a rental car?""

I have a 97 Ram 4x4, full coverage at geico (I'm on my parents insurance), $500 deductible. How fast can insurance get me a rental if one hits me, will it raise my rates, (I work 3-11:30 PM, and travel mainly back roads since there aren't many other ways to get home if it helps). I've been driving for 6 months.""

Is there affordable insurace for me?

I am currently employed at a wonderful job with great insurance, but my baby is due in January and my husband and I would really love for me to be able to stay home. The only problem with that is, my husband is self-employed and we would not have insurance if I quit my job. We live in Missouri, is there affordable insurance out there for us. I have looked into Medicaid, but I believe that my husband makes just a little too much too qualify. Any help would be greatly appreciated""

I am Looking for a Best site for Comparing HEALTH INSURANCE Quotes Online?

Are there reasonable car insurance quotes comparison sites online that someone can link me?

How do I find out if my insurance covers Mirena?

I have Blue Advantage/MN Care for my health insurance and have been looking into getting the Mirena IUD.. I am on daily birth control pills now, but would like to switch to something more effective/semi permanent.""

Do i need insurance to drive with my license with my parents?

so i have had my permit for a little over 6 months and my dad doesnt want me to get my license yet (he wants me to wait an extra 6 months). I want to get my license now, but treat it the same as a permit so that I will not have all those extra rules that your supposed to have for the first year of driving with a license. So my question is... Do I need to have insurance if I am driving my parents car with my parents in the car when I have my license? I know it is not required when I have my permit but is it required when I have my license? I live in california by the way.""

Should Keep or Look into term Life Insurance Quotes?

I have a whole life policy which I have been paying 45.00 per month for 16 yrs. I have to pay this amount until age 99 so they say. The amount it was for when I bought it was 50,000. It builds cash value. I am now 62. Should I keep this policy or look into term insurance?""

""Buying a car with rebuild, or salvage title?""

I live in Texas, what is the policies/laws for buying a Salvage title or rebuild title car? What exactly is a Salvage title, and am i allow to have it insure by insurance company? ...show more""

Where can i get low cost motorcycle insurance ?

i live in ontario canada ,, i want to buy a honda cbr 250 , and would like to find a low cost insurance for my bike , so far i got some way off price quote with a difference of $280.00 ,so i suspect they are over charging ,even at the low end , they say i'm covered for 12 months months but a motorcycle is not meant to ride in cold and snow and salty streets as the salt would ruin the chain and other parts of the motorcycle .""

Is a scraped car door handle worth the rise in insurance rates?

If someone scraped against your car door and the only thing damaged was the handle on the passenger side door, would you file an insurance claim and risk a rise in insurance? The scrape is only about 1-2 inches long.""

""Motorcycle trip in california, suggestions?""

hello fellow rider, I was going to do a trip to mainland mexico (im in cabo, baja), but mainland is kind of dangerous right now, so plan b is california, so I ran into this web site and was thinking of copying one of their tours, could you tell me which one is the best to do, or if you have any suggestions, please let me know, I appreciate your help. ramon bmw r1150gs adv http://www.best-motorcycle-gear.com/guided-motorcycle-tours.html By the way, besides: motorcycle drivers license, registration, visa, insurance, what other thing do I need to drive there?""

Can somebody explain to me what LP means in home insurance?

For example, I know that there is a classification in homes that's called LP3 . What does that mean??""

Would you say my insurance is going to right my car off......?

i had a crash the other day where i got hit in the passanger side door and the car then bounced up an fell down on a high curb aon the drivers side. so after everything was sorted out i drove it home. the insurance have said it was my fault anyway. so i have got a fiat punto evo 60 plate, 4500 miles on clock 3 door. it cost me in april 10,995 to buy. So its been in a body shop got an estimate of 5300 to fix it and i have an excess of 1150. The body shop thinks its going to be a right off?? i am just wondering what your veiws are? thanks""

How much does on average do people pay for health insurance?

I'm doing a debate on weather or not obese people should pay more for health premium or not but thats not the important part, the important part is how much does the average person pay for health insurance?""

What is the cheapest health insurance for low income people?

my kids father had a stroke two days ago and i am trying to help him find health insurance. he is having a hard time getting any insurance because he is unemployed and receives unemployment payments but they won't see him at the clinic because he has too many assets. He owns a trailer and has two cars. If any one can help i really would appreciate it. He also has high blood pressure, high colesterol, and diabetes. He had a stroke because he couldn't afford to buy his medications for his high blood pressure and colesterol.please help . i dont want anything bad to happen to him.""

Auto insurance settlement offer too low?

We were in an accident in September, my 4 y/o son and i went to see a chiropractor and i also seen a physical therapist a few times, (i actually still have pain from time to time in ...show more""

Which is better car insurance?

$500 per year with an excess of $1150 or $560 per year with an excess of $900 These are the 2 best insurance quotes i can find. Both are big reliable companies.

Car insurance question?

I'm 17 and still living with my parents. I just got a car and now I need to find insurance. My dad doesn't want me on his because then, if I got in an accident, his rates would go up. My question is, if I were to cause his rates to go up and then got kicked off his plan, would his rates go back down? I'm curious because I really would rather not get my own insurance, being on my dad's would be much much much more affordable.""

Cheap car with cheap insurance?

Im 18 and Ive just passed my driving test and im looking for a good car for around 2500. The cars with cheap insurance are more expensive and the cheap cars have a relatively high insurance cost. The budget for the insurance is not set but I don't want to pay a ridiculous price. Any suggestions on a perfect car which is in my budget but with a low insurance cost? P.S. I understand because im young the insurance will be expensive but if anyone has any advice on how to get cheaper insurance please let me know.

Would a 1.4 honda civic be an ideal car for a new driver?

17 year old. Male. Would it be wise getting a 1.4 civic say 1999 plate for a first car?

I wanna buy a car but don't have insurance?

Can anyone tell me how much insurance would be for a 16yr old driving a black 1997 toyota supra?

Is there affordable private health coverage available?

My husband lost his job and my autistic son takes strattera($640) and abilify($220) a month. Is there any programs that help with cost or a good private insurance plan out there?

How old do you have to be to start driving lessons?

Does anyone know a good affordable health insurace that offers maternity coverage? if so please help?

Why is my insurance quote 10 times higher than last year?

So, i got my motorcycle license last summer and bought a 2003 Kawasaki ZX6R for $5000. My insurance from Progressive was $1700 for the year (full coverage). I rode it for two months before it got stolen. In those two months i got one ticket for straddling lanes. Once the bike got stolen i got all my money back. Now, I'm looking to get the same bike again. I just called Progressive and they want $6056 per year for full coverage!!!! And if i were to buy a brand new 2007 model it would be $10000!! So, $6056 for a $5000 bike? And $10000 for a $9000 bike? What gives? One ticket and the theft did this? I don't get it. What are my options?""

Does having a motorcycle license effect your car insurance rates?

I've been looking at taking the course, wondering if theres any other implications I havent considered. Anyone have some experience with this? Assume I'll have my motorcycle endorsement on my license, but not own a motorcycle. I live in RI, by the way.""

I need car insurance in broomfield co?

I have one speeding ticket and i'm 19 years old where can i go to get car insurance cheap i get min wage. and i need full coverage and if you know what full coverage consists of please let me know i have a 2003 dogde neon se

Will auto insurance be cheaper If i'm on my parent's plan?

I'm 17. I graduated college early, so i'm now a sophomore in college. I have a job, where I make generally $600 a month. Not much but i'll be graduating soon so I can deal ...show more""

What is cheap car insurance for a new driver?

I am a new driver and I need insurance for a Jeep Grand Cherokee 2000. I am a student and I need cheap insurance

What is the cheapest and most affordable auto insurance?

i live in illinois

Insurance Cost?

I'm 18 and I have a 3.0+ GPA and I'm a male. I'm looking to get a new 2007 Honda Accord two door manual transmission. I live in California in the L.A. area. Does anyone know the price range of my insurance?

""What is the definition of a total loss car by the insurance company?, Is it possible to get my car back?""

Florida-A couple of months ago I was involved in an car accident that my insurance said they would not fix, due to certain circumstances. The insurance company told me the car was a total loss. The buy here Pay here who financed the vehicle told me to bring in the police report info and that was it. you have to get a new car is simply what I was told, I asked about payments and he told me to call him in a few days- few days turn into weeks and he is never available to discuss with me payments. Almost 2 months and there is still noone willing to talk to me?, looking through some car ads yesterday I saw the car listed at a different location owned by the same Buy Here Pay Here it was all like new, Fixed and being sold? If my car was fixable couldnt I have just paid out of pocket to fix it? what is the definition of a total loss from the insurance's view? Is it possible to get my car back? BTW I have no issues with paying the finance company- I just cant get anyoone to talk to me. Please try and answer all of the questions here, so I dont have to repost separately Thanks in advance for the advice.""

Does anyone know in detail what no fault car insurance is?

I am having a problem understanding no fault car insurance. Can somebody explain how it works?

My husband and I have 3 kids and we're in our early 50's. Do we need life insurance at this point?

We own our home and have approximately $75 000 invested.

Does MY CAR INSURANCE cover!?!?

I crashed my friends car. She has liability on her car so now she is screwed with a beat up car. I have full coverage on my car, now would I be able to use my insurance to cover her vehicle that I crashed?""

Can I rent a Car if I don't have Insurance?

I am wanting to go to Vegas for the weekend and I currently don't have a car. Which means I don't have car insurance. I am getting a bunch of mixed messages telling me that I am unable to rent a car because I currently don't have car insurance. Is this true?

Are BMW more expensive to insure?

Specifically a White 2006 BMW 325i. I'm 21, never had any traffic violations, had my license since I was 17. I'm looking to get rid of my old 1994 Crappy Mustang, and getting a White 06 3 Series BMW. Will my insurance be expensive? Additional Details: I plan on financing, which means it will require me to get full coverage.""

Cheap or free help with medical insurance?

I need health insurance for myself my children are covered under medicade and I need health insurance that is free or cheap

Which of these is the correct Republican opposition to universal healthcare?

A. The government can't run anything right B. Government-run healthcare will be too successful, and private insurance companies won't be able to compete As with the Obama is simultaneously a Muslim, a Radical Black Christian, and Godless Communist argument, sooner or later you are going to have to pick one and go with it...at least in this place some of us like to call reality ...""

Which car insurance companies insure electric cars?

My insurance company will not insure electric cars. Which will?

Which would have cheaper insurance a 06 charger or 06 bmw 330i?

Cheapest saturn sky insurance for a 16 year old?

I am about to turn sixteen and i was wndering how much insurance would cost for a Saturn sky?

Where is a company that offeres life insurance to felons?

My husband commited a felony nine years ago when he was nineteen years old and has not been in trouble since. He is now a foreman, owns his own home and is just a regualr citizen, but he has been denied life insurance through 3 companies. Any suggestions?""

Teen insurance cost on a leased c300?

i just got my license, and i am 16 going to be 17 in 2 months :) i wanted to know how much insurance is for a new leased c300 mercedes.""

What the youngest age someone can get auto insurance?

I wanna buy a car but don't have insurance?

https://www.linkedin.com/pulse/what-do-cant-afford-automobile-insurance-17-year-old-male-varnado"

0 notes

isaacscrawford · 7 years ago

Text

Questioning the Link Between Sports-Related Concussions and CTE

By JASON CHUNG, PETER CUMMINGS and UZAMA SAMADANI

On Jan. 18, an article by Dr. Lee Goldstein of Boston University and colleagues in Brain, a leading neurological journal, was released and touted as proving the link between subconcussive hits to the head and chronic traumatic encephalopathy (CTE) (“Real risk of CTE comes from repeated hits to the head, study shows,” Feb. 4). That same day the CTE advocacy group — the Concussion Legacy Foundation — announced a national campaign called F14G Football to convert all under-14 football into flag football, thereby eliminating tackle football.

The message sent to assembled media and onlookers was that eliminating tackle football for youth is the key to safeguarding the brains and futures of America’s youth.

The truth is not so simple.

The scientific evidence linking youth casual sports play to brain injury, brain injury to CTE, and CTE to dementia is not strong. We believe that further scientific research and data are necessary for accurate risk-benefit analysis among policymakers for two reasons.

First, evidence-based science calls for research to be conducted under generally accepted principles. The case series presented by the Boston University group, primarily due to its ascertainment bias, is weaker than the evidentiary standard sufficient to demonstrate an association or causation and conflicts with pathologic findings in other studies.

CTE pathology in the brain has been shown by British pathologists to be present in approximately 12 percent of normal healthy aged people who died at an average age of 81 years (Ling et al. Acta Neuropathologica). The presence of CTE pathology in the brain on autopsy has not been shown to correlate with neurologic symptoms before death.

To be clear, CTE pathology could be present in a normal person.

Indeed, even Dr. Goldstein’s article was more measured than his press. His article speaks in terms of likelihoods and qualifiers in noting that “the causal mechanisms, temporal relationships, and contextual circumstances that link specific brain pathology to a particular antemortem insult are impossible to ascertain with certainty based solely on post-mortem neuropathology.”

There is a disconnect between the categorical rhetoric in media and news releases describing “concussion” research on the one hand, and the muddled and contentious scientific reality on the other. As noted by Dr. Goldstein’s own research, the pathology and link between head impacts and long-term neurological conditions such as CTE is still unclear, with questions of causation yet to be settled.

This is not to say that head impacts or injuries are desirable — far from it. But there is scientific ambiguity about the prevalence of CTE in the general population in comparison to professional athletes and also about the significance of its presence. In fact, after reviewing all available evidence, the consensus statement from the international conference on concussion in sports states:

“A cause-and-effect relationship has not yet been demonstrated between [CTE] and sport-related concussions or exposure to contact sports. As such, the notion that repeated concussion or subconcussive impacts cause CTE remains unknown.”

Nothing in Dr. Goldstein’s recent study changes this ambiguity, which brings us to our second point. Before enacting sweeping legislation or policy spurred by fears of CTE, policymakers must conduct a risk-benefit analysis based on a holistic survey of public health concerns.

American youth are currently more sedentary than ever before. Compelling evidence from multiple sources shows that organized sports offer youth a way off the couch and promote the adoption of an active lifestyle, thereby mitigating the risks of, among other conditions, obesity, high blood pressure, diabetes, depression, osteoporosis, cardiovascular disease, stroke, drug use, teen pregnancy and, ironically, dementia.

The uncomfortable truth is that tackle football is the number one participation sport among high schoolers in America; it is accessible to children with diverse physiology in ways that other sports are not, and greater public consultation should take place to see if participation rates would remain as high for alternatives to tackle football.

Three recently published major studies found no increased risk for later-in-life brain diseases in men who played high school football (Jannsen et al., Mayo Clinic Proceedings; Savica et al., Mayo Clinic Proceedings, Deshpande et al., Jama Neurology). One might also speculate that children who engage in football would seek other less organized risk-taking behaviors if football were not an option.

Setting legislation and public policy is already a tricky process and overstating the degree to which scientific consensus exists may lead to pyrrhic victories. What we seek to establish are meaningful and durable standards based on validated and replicated diagnostic criteria so that the public health response to head impacts and CTE are not emotive or political, but data-driven. The political winds being as fickle as they are, laws and policies enacted without such scientific support will be vulnerable to backlash from those with deep economic and cultural ties to contact sports such as tackle football, to rejection by the scientific community, and to general confusion and misunderstanding by the public.

In the drive to protect young brains, there are not just two sides. Not everyone is a moral crusader or an NFL stooge. No reasonable person, least of all the professionals signing this letter, want to see youth injured. But when arguing for intervention based on public health or scientific principles, the data must inform the recommendation.

Additional data is required to make a truly informed decision regarding banning of sports. What is desperately needed are 1) funding from federal and private sources to launch longitudinal, multicenter statistically sound studies, 2) consistent coordinated measures and standards, and 3) facilitation from either government or a consortia of concussion research centers.

Only then will we know whether the perceived neurological risks of tackle football outweigh the benefits. And only then can we more confidently say that we are acting in the public interest.

Jason Chung is senior researcher and attorney at New York University Sports and Society. Peter Cummings is a forensic pathologist and neuropathologist and assistant professor of anatomy and neurobiology at the Boston University School of Medicine. Uzma Samadani is an associate professor in neurosurgery at the University of Minnesota and Rockswold Kaplan endowed chair for traumatic brain injury at Hennepin County Medical Center. This article is submitted on behalf of 26 brain injury experts in neurosurgery, neuropsychology, neurology, neuropathology and public policy at 23 universities and hospitals in the United States and Canada.

The additional signatories are:

Lili-Naz Hazrati, associate professor of neuropathology at the University of Toronto; clinician-scientist at the Hospital for Sick Children, Toronto.

John Leddy, professor of clinical orthopaedics and rehabilitation sciences at the SUNY Buffalo Jacobs School of Medicine and Biomedical Sciences.

Barry Willer, professor in the Department of Psychiatry at the SUNY Buffalo Jacobs School of Medicine and Biomedical Sciences.

Rocco Armonda, president of ThinkFirst, a brain injury prevention foundation; director, neuroendovascular surgery and neurotrauma, and co-director, neurocritical care; professor of neurosurgery, Georgetown University Hospital and Washington Hospital Center.

Jason H. Huang, chair, Department of Neurosurgery at Baylor Scott and White Medical Center in Temple, Texas, and professor of surgery at Texas A&M University College of Medicine.

Kenneth Blumenfeld, adjunct clinical faculty, Department of Neurosurgery at the University of California, San Francisco; immediate past president of the California Association of Neurologic Surgeons; AANS delegate to the AMA.

Richard B. Rodgers, assistant professor of clinical neurosurgery and director of neurotrauma at the Indiana University School of Medicine.

James MacDonald, clinical associate professor of pediatrics and family medicine at the Ohio State University College of Medicine, Division of Sports Medicine, Nationwide Children’s Hospital.

Michael W. Kirkwood, founder and co-director of the Children’s Hospital Colorado Concussion Program and associate clinical professor of Physical Medicine and Rehabilitation at the University of Colorado School of Medicine.

David R. Howell, lead researcher for the Sports Medicine Center at Children’s Hospital Colorado and assistant professor of orthopedics at the University of Colorado School of Medicine.

Gary S. Solomon, professor of neurological surgery, associate professor of orthopedic surgery and rehabilitation and psychiatry and behavioral sciences; co-director, Vanderbilt Sports Concussion Center at the Vanderbilt University School of Medicine.

Mark E. Halstead, associate professor of pediatrics and orthopedics at Washington University in St Louis and director of the Sports Concussion Clinic at St Louis Children’s Hospital.

Francis X. Shen, associate professor of law at the University of Minnesota and senior fellow in law and neuroscience at the Harvard Massachusetts General Hospital Center for Law, Brain and Behavior and the Harvard Law School Petrie-Flom Center.

Mark Herceg, director of the Center for Brain Health and the Center for Concussion at Gaylord Specialty Healthcare in Wallingford, Conn.

William B. Barr, director of the neuropsychology division, Department of Neurology, at New York University Langone Health.

Arthur Maerlender, associate research professor and director of clinical research, Center for Brain, Biology and Behavior at the University of Nebraska-Lincoln; research director for the Big Ten-Ivy League Traumatic Brain Injury Research Collaboration.

Mayumi Prins, professor, UCLA Department of Neurosurgery and Brain Injury Research Center and associate director of the UCLA Steve Tisch BrainSPORT program.

Gregory Murad, associate professor and residency program director at the University of Florida Lillian S. Wells Department of Neurosurgery.

Peter Le Roux, neurosurgeon at the Brain and Spine Center at the Lankenau Medical Center in Pennsylvania.

Vernon B. Williams, director, Center for Sports Neurology and Pain Medicine at the Kerlan-Jobe Orthopaedic Clinic, an affiliate of Cedars-Sinai.

Michael G. Fehlings, professor of neurosurgery and vice chair of research, Department of Surgery, Halbert Chair in Neural Repair and Regeneration, co-chairman of spinal program, University of Toronto, Head Spinal Program; senior scientist, McEwen Centre for Regenerative Medicine, Toronto Western Hospital, University Health Network.

P. David Adelson, director, Barrow Neurological Institute at Phoenix Children’s Hospital, Diane and Bruce Halle Endowed Chair in Pediatric Neurosciences; chief, pediatric neurosurgery.

Shelly Timmons, neurosurgeon and professor, Department of Neurosurgery; vice chair, administration, and director of neurotrauma at the Pennsylvania State University Milton S. Hershey Medical Center; president, American Association of Neurological Surgeons.

Article source:The Health Care Blog

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