Gyms and clubs use rear drive elliptical trainers that can cost three thousand dollars or more. They use the highest quality of elliptical trainer available on the market because of the number of people regularly using the trainer. It makes perfect sense for gyms and clubs to invest in the best elliptical trainers on the market, but do you still need to make that same sort of investment for a machine you plan to use at home? It depends on who else will be using that machine, how many hours per day you’ll be using the machine, and the weight of the users.

For example, if one person plans to use the machine for an hour per day, and that person is under two hundred pounds, then a machine in the range of three hundred to five hundred dollars is perfectly appropriate. However, that same machine is not going to be appropriate for heavier users, especially if there are several heavier users who plan to work out daily. If two people over two hundred pounds each decide to use the elliptical trainer daily, then it is best to go up a step in quality to the one thousand price range. For every fifty pounds over two hundred, you should go up a step in quality, which means up a step in the price range.

At a certain weight, it almost seems far too cost prohibitive to consider purchasing an elliptical trainer and using it at home. This might be the case, however, good health and exercise is not completely out of your reach. You can always begin with a gym membership, a class at the local junior college, or a membership to a community recreation center, and once you’ve lost the weight, reconsider your purchase of the elliptical trainer.

Medicinal herbs are those that are used in Traditional Chinese Medicine, Alternative Medical Systems and naturopathy. As drug companies and big pharmaceutical corporations keep increasing the prices of drugs, making them unaffordable to average people, and as concerns about side effects over standard pharmaceuticals rise, people turn to medicinal herbs in order to treat their conditions.

Of course, even prescription drugs are usually derived from both inorganic and organic herbs, and just because bulk herbs are organic and “natural” doesn’t mean that they shouldn’t be used cautiously and with prudence. After all, the heart medication digitalis when administered properly can treat serious heart conditions, but the plant from which it comes - foxglove - will surely have fatal results if taken as an herbal infusion.

Used properly however, there are many organic herbs that can be effective in relieving minor symptoms. Purchasing bulk organic herbs can result in significant savings as well; when you, either as a consumer or retailer buy your herbs in bulk, you are able to take advantage of large quantity discounts on the organic bulk herbs you use and/or sell the most.

For professional naturopaths, purchasing herbs in bulk makes a great deal of sense, especially if you prescribe and administer medicinal herbs frequently. When you use certified organic herbs, you are assuring your patients that the product you are giving them is pure and free of the toxins that work their way into the leaves and stems as the result of using chemical fertilizers and pesticides.

Farmers who produce organic herbs and other produce must be familiar with organic standards, comply with these standards, keep copious written records, and submit to annual inspections. These standards are enforced at the state level, not the federal government however, although the agencies responsible for enforcement are supposed to be approved by the U.S. Department of Agriculture. These requirements, as well as the fact that there is a smaller quantity produced, are what have made bulk organic herbs more expensive than the inorganic variety. However, as the cost of fuel, petroleum-based fertilizers and pesticides increase, locally produced organic bulk herbs should become increasingly competitive in price. Legally, any product that is made from at least 95% organic ingredients can be sold as “organic” and carry the USDA organic seal.

For less than a thousand dollars a registered nurse or RN can start up his or her own nursing agency. Having the license of an RN, you are already standing on a firm ground and all you need to be doing is stretch out the possibilities of having bigger opportunities and success in life. New and possible opportunities available need some try out and see where it will take you as you grab it and work on it.

A nursing agency can be put up not only by large companies but also by a single individual. On a contract basis, nursing services are given to private groups or individuals. Services takes place in medical centers, hospitals or right in their homes and all these can be done right after you secure your contracts between an individual or nurse related institutions.

Agreements before contracts are signed are necessary to be able to give a professional and healthy relationship between each other. Contracts are very important as this is where both parties will expect on the outcome of the services needed and given. Every successful contract is not limited to one. As your service gives a good and lasting impression to the other party, this will result to networks of possible contracts in the future.

Having your own nursing agency is no different compared to the multi-billion dollar industry. With the shortage of nurses, services are much needed and there’s no worry for a greater competition. Having your skills and knowledge as a registered nurse is a step towards opening a new window for success. Your abilities to earn and grow are not limited as you start pushing yourself to the limit and aim higher than you have aimed before.

One step at a time and you’ll never know how you have reached the top of success by acting upon the possibilities of opportunities.

If you think that you can be in a nursing home for long-term care and be as happy as you might be in your own home, you are slightly mistaken. The long -term care units of some rehabilitation and care centers are the most horrible places inside these buildings. Sure you might find one that is good, but for the most part, from what I have observed, one long-term care unit is worse than the next one.

If you are seeking long-term care, you might be better off checking out each and every facility rather than just checking out one or two places. And the most important information and inside scoop you can get is from residents who have left there already. Have you seen any residents at all who are actually happy with the care that they received in those places? Do some unofficial surveys, some verbal surveys. Ask around; ask in the hospitals, ask in your neighbhorhoods. Find out if there is any happiness anywhere in long-term care facilities.

Usually your happiness goes out the window when you are transferred to the long-term care unit when you should be in the short-term care unit. That’s where the happiness is. It is not in your spirit -because you thought you were just “visiting” there and the facility and the red-tape turned you into a long-time resident -against your will and against the will of your family.

How do you gain your happiness back?

Here is how you can stop the facility from taking your happiness, from taking advantage of you and your family ,and here’s how you can stop the facility from doing things to you and your family that they should not be able to do.

Follow these steps -for an improved life - at physical rehabilitation centers and nursing homes:

1. Know what you are there for! And make sure the staff knows what you are there for. If you came into the nursing home /rehab for short term care, make sure that they know that and are reminded of that. One resident I know was accidentally transferred upstairs to the long-term floor and that transfer set his therapy back for weeks or months. Never allow a transfer to another floor until you agree to the transfer and until you have made a thorough inspection of the new floor.

2. Make your family and friends visible at the facility. (Residents who have visitors or family’s seem to be treated better and have more attention paid to them WHEN the family speaks up about what is happening). Let staff know that you are not alone. In good nursing homes you will be treated fairly , whether you have visitors or not, but in those nursing homes that are horrible, you will be treated better when they see that you have friends and family visiting. Have people visit you. Call your local Priests or Rabbis and have them visit. Call your Avon person and have them come visit while you look at their catalog and choose your items.

3. Once you have discovered that you are in a bad nursing home (bad meaning no care, lack of care or negligent care) when you have important communications for the facility about important resident or life decisions, put that in writing to the facility. This way they cannot deny that you stated it clearly to them, when they fail to take proper actions.

4. If you or your friend/family member develops new bedsores while at the facility, clearly note this and make sure the staff acts on handling the bedsores-making them heal rather than allowing them to grow into large scabs and life-threatening medical problems. (Just recently there was a news note where a man died of maggots in his eyes and bedsores -while his facility didn’t notice till he was dead).

5.Know that bedsores develop from spending too much time in bed or wheelchairs, so be active and do your exercise and therapy when needed. Check the resident or patient for bedsores before they are admitted to the nursing home. Yes, you might even want to take pictures of the elbows or knees and other body parts. This might sound odd, but knowing what the resident was like before entering home will surely let you know what kind of care the patient is receiving. (For example, when the patient enters the nursing home with clean, uninjured elbows, and knees or other body parts and they begin to develop sores all over their body, that might be a sign that someone is not doing their job correctly and it might be a sign of gross negligence.

6. Know that you need to bring these sores to the attention of the staff right away and if the staff does nothing, put your complaint in writing immediately. Have family members write for you if you have no access to writing supplies.

7. ALWAYS be persistent. If staff member tells you something that you know is wrong, never doubt yourself, keep on keeping on, and be persistent in your complaints and follow-up. Remember that listening to your own inner instinct is better than listening to staff that is telling you something that is obviously incorrect. Sometimes the staff will stick together and even back up a staff member who is doing wrong. (This does not happen in all places but only happens in the places that have something to hide from the public).

8. Try and use all the recreation props and items that are available at the facility. If there is a recreation room or coffee room that has books or videos or television, take advantage of this room and take advantage of these things. For some of them will bring more joy and happiness into your life. You can meet with other residents there also, so you can become more social ,even while in the nursing home.

9. Always have hope. You know that you are going home; you know that you came there for short-term therapy, so keep that attitude and keep up with your daily therapy.

10. Never be isolated inside a nursing home or rehabilitation center: always have a phone whether a regular phone or cellular phone so that you can always communicate with your family and friends who are outside the facility. If you have a family member inside of a nursing home and you are unable or not allowed to visit, make it your business to telephone the patient to have that patient connected with people outside of the nursing home. When a nursing home isolates a patient it is usually for something that the nursing home is hiding. Most reputable nursing homes will want the family and friends to visit the patients and residents. I learned from one family member that they were stopped from visiting solely because they reported that the patient has bedsores (that were acquired inside of the nursing home). This is a rehab and care center in Staten Island. Always question why a patient is stopped from having visitors, especially if the patient or family reported bedsores before the visits were stopped. That would seem the obvious reason.

11. Make changes in the place where you are. If you are in a facility and you or your family members are lawyers or journalists or investigators, seek their help in any area of trouble inside the of rehabilitation center or nursing home. If you have a voice , a radio show, then do a radio show right there, from your room in the facility and speak out. VOICE your opinions. Never sit quietly if things are happening that shouldn’t be happening.

12. Connections: Connections are one of the things most vital in your quest for gaining your happiness back. Always connect with people, both inside and outside the rehabilitation center and nursing homes.

13. From time to time during the month, have your priest, rabbi or pastor visit you in the nursing home. Call your community centers and have any of the spiritual people visit you. These visits would be just social visits. Tell them that you lack enough visitors in the daytime and that you would like someone from the church or synogogue to just come and visit with you from time to time. This will let your hospital, medical center or nursing home know that you are not alone and that there are other people concerned about the treatment that you receive.

Remember, when you are in nursing homes and in bad rehabilitation and care centers, one of the best safeguards for your health, sanity and well-being is your ability to stay visible, stay heard and to have as many visitors as you can have in any given day or week. Keep up the pace, and try to always have visitors. Always stay visible. That means instead of hiding in your room all day — go out of your room and be with other people during the day. Be with other residents and with other visitors but just be out there. The more visible you are, the more witnesses you have, the better off you are. Just stay visible and have your family, relatives, friends and co-workers visit you as much as possible for your own health and well-being.

Home medical alert systems are medical alert systems designed to help individuals and senior citizens who are often at home alone.

Home medical alert systems consist of a medical alarm pendant, medical alarm console (also called medical alert base unit), and monitoring center. The alarm pendant is worn around the neck, on wrist, or even on the belt and features a transmitter. On pressing the help button of the transmitter, the signal transmits to the console, which in turn passes through the telephone line. The signal then reaches the person at the medical monitoring center or a neighbor, depending on how the system is set up.

If connected to the monitoring center, the dispatcher immediately communicates with the person who pressed the button. The console has a loud speaker and a sensitive microphone for communication. The dispatcher determines the need of the user and acts accordingly. The monitoring center will charge a small monthly fee for this service.

Some of the models come with built-in accelerators, which automatically relay a distress signal. These models are useful in situations such as when people are incapacitated by a fall.

When home medical alert systems are set up for elderly persons, it is better to have a lockbox at the front door. These lock boxes are small and secure boxes with home keys inside. Hence, it is easier for the neighbor or a trusted person to enter the house and provide necessary help.

Home medical alert systems guarantee safety to disabled or senior citizens while providing them with a sense of independence. In general, these systems serve as emergency equipments and provide confidence and security to those individuals who lead a lonely life at homes.

Caption: John R Klopp, CEO of Capital trust, was the honoress at the annual Winter’s Eve Gala benefiting National Jewish Medical and research center. Pictured above are, l-r: Tom Flexner, Dr Lynn Taussig, John Klopp, Marc Holliday and John Kukral.

Downey Regional Medical Center has promoted Kenneth Strople to president and chief executive. Strople was previously the hospital’s executive vice president and chief administrative officer.

The University of California Irvine (UCI) Medical Center and St. Vincent Medical Center in Los Angeles transplant programs are once again in the public spotlight following press reports of poor patient survival rates, high organ turndown rates and inadequate staffing.

Here are some of the charges being levied at the two Southern California institutions:

*The Los Angles Times, on Dec. 17, 2005, reported that kidney patients at St. Vincent had an exceptionally high death rate, according to information compiled by the United Network for Organ Sharing (UNOS).

*The Orange County Register, on Jan. 11, 2006, reported that the UCI Medical Center’s Bone Marrow Program had only met California state standards once since the program was founded in 1995. According to the report, the state requires a BMT program to perform at least 10 autologous and 10 allogeneic bone marrow transplants a year.

*The Los Angeles Times, on Jan. 24, reported that the UCI Medical Center had turned down kidneys offered to the institution “at an exceptional rate over the last five years.” An analysis of UNOS turndown data found that between July 2000 and June 2005 UCI accepted only 8.7% of kidneys offered for its patients. The UNOS data revealed that the annual kidney acceptance rate in the country during that time was 25.9% to 31.2%, the Times said.

The newspaper reports, especially the LA Times, have resonated nationwide and the transplant community is scrambling to address what appears to be inadequate oversight of US transplant program allocation procedures and outcomes.

To its credit the Organ Procurement and Transplantation Network (OPTN)/UNOS Board of Directors moved quickly and aggressively at its November meeting to address the issues after UCI closed its liver transplant program after the Times reported 35 patients had died over the past two years while on the liver transplant waitlist. (Transplant News, Nov. 30, 2005).

“The Board was very clear in its recognition that it is a ‘new day’ when it comes to member responsibility for policy compliance and the provision of high quality patient care in organ transplantation,” Francis Delmonico, MD, OPTN/UNOS board president, said in a summation memo to the board. “This was true not only in deceased donor organ allocation and transplantation but in the provision for living donor transplantation.”

Tom Mone, president and CEO of OneLegacy, the organ procurement organization covering the Los Angeles area, told Transplant News that the scandals have not gotten “a lot of traction” with the local public and did not affect the public’s willingness to donate.

“Last year was hugely successful and that didn’t change one way or the other when the Times articles hit,” Mone said. “We’re 10% ahead of last year and it might have even helped. The average families don’t appear to have paid much attention.”

However, Mone believes it is his responsibility and that of the transplant community to take a strong public stance on the findings.

“Someone needs to speak up for the public trust,” Mone explained. “The aberrations at St. Vincent were extreme and UCI’s problem is that it’s a small center with staffing problems and isn’t emblematic of the entire system. We need to explain that their problems do not undermine the gift of organ donation.”

UNOS declined a request to comment on the Los Angeles situation.

However, Transplant News did obtain a copy of a set “talking points” which were widely distributed to the transplant community in the past few days. The talking points follow this article.

Here is a brief overview of each of the press reports

St. Vincent Medical Center kidney recipient death rate

The Times reported on Dec. 17 that 36 patients who received a kidney transplant from Jan. 2002 to 2004 had died within a year of surgery. According to UNOS, that is 15 more than expected based largely on the quality of donated organs and the condition of recipients, the paper said. St. Vincent is one of only four programs nationwide whose death rate was consistently higher than expected for patients dating back to 1999.

St. Vincent was the ninth busiest kidney transplant program in the US last year with 216 transplants performed. There are more than 1,100 patients on its waiting list for a kidney.

The transplant administrator for the program Deborah Maurer and co-medical director Robert Mendez, MD, told the Times the hospital’s statistics had suffered because the program had been deliberately aggressive, treating sicker, older patients who have fewer options for care. They also said the program serves the less educated and non-English speaking who may have difficulty following doctors’ orders in the months following their transplant.

Health insurers have pulled out. Aetna stopped sending patients to St. Vincent in Dec. 2004. Humana followed suit in July 2005. United HealthCare and PacifiCare Health Systems suspended coverage for kidney and liver transplants this year after the liver scandal was reported.

Florida-based medical center reduces its claims denial rate by 70 percent.

“Leaving money on the table” seems to be this year’s catch phrase. But when you’re not collecting $1 million or more per month that is owed you because of claims denials, that translates to Big Money.

That was the case for West Florida Medical Center Clinic (WFMCC) of Pensacola, FL, with its 145 physicians and 13 satellite facilities in Florida and Alabama. With almost 50 percent of its patients covered by Medicare, ongoing denial of claims by Medicare posed a serious cash flow problem.

“As we got further into lower reimbursements, insurance companies and the federal government created more hoops for us to jump through to get paid for services. One of our challenges was to identify covered diagnosis- and carrier-specific rules related to coding so we could prevent claims denials,” says Lin Dworshak, associate administrator for business services at WFMCC.

Do the Math

With the clinic generating between $13 million and $15 million in charges every month, the 10 percent of claims consistently denied by carriers for coding issues amounted to substantial uncollected revenues. “Denials came from diagnostic errors, procedure code incompatibility, unbundling and inclusive denials,” Dworshak says, noting that West Florida Medical officials had begun tracking the denial rate as early as 1998, in the days when most reimbursements flowed more freely than today.

Income due but not received was bad enough. But it was the correction process itself that steadily depleted the medical center’s resources. The process of correcting coding errors after the fact–after a physician determined a diagnosis code, after the claim was submitted and denied, after the WFMCC staff had to investigate, correct the codes and resubmit the claims–kept five FTE staff very busy and just as frustrated.

“We wanted to move the entire process back to the point of service,” Dworshak says, “back to the point of the physician or nurse who was making the decision about codes–and who would know, as those charges were entered at the point of service, whether or not those services were likely to be paid. Big bang happens at the point of service.”

While there were companies with batch programs that loaded the charges into accounts receivable (AR) and could identify the errors on a report, most solutions available at the time were still back-end solutions, Dworshak says.

Dovetailing Advances

“Making error corrections on your AR is a nightmare to deal with. You want to make as few corrections as possible to keep your AR as clean as possible,” she says. “We had the vision in 1998 to move the decision-making process back to the point of service, to the physician’s office where that charge originates.”

With few options available for front-end editing with a point-of-care focus, Dworshak and her colleagues were intrigued by the Claims Editor Professional (CEP) from ADP Context of Westmont, IL. It was one of the few that could take charges at the point of service, transaction by transaction, online and in a paperless process–while also determining, on the front end, whether the charges would be paid. Choosing ADP Context’s CEP product was a risk for West Florida Medical since the company was relatively new.

Because West Florida Medical was then upgrading its practice management system from a mainframe system to a UNIX-based product with true Windows, installing CEP at the same time seemed a good opportunity to dovetail two necessary technology advances into one action step.

The clinic made its purchasing decision soon after the vendor showed them proof. “They ran a batch of claims we had already filed through the editing product and proved that their edits would have stopped these claims prior to submission. In each case, it would have fixed the incorrect data and sent the claim through as clean–allowing us to be paid after the first submission.”

Installation and Beyond

In times past, Dworshak says, reimbursements were higher and rules were fewer. Cash flow was generally good, and although healthcare organizations did experience claims denials, they didn’t have to pay nearly as much attention as they are forced to today. “With greater emphasis on coding rules and with lower reimbursements, institutions are driven to get it right the first time to keep cash flow up.”

In addition to reducing the rate of claims denials, the clinic had three objectives in selecting the CEP solution:

1 reduce FTEs in the business office;

2 increase accountability with physician offices;

3 integrate the interface of the product with the clinic’s own practice management system.

“Throwing FTEs at a problem never solved the problem,” Dworshak says. More importantly, the business office continued to fix mistakes that were created in physician offices with very little feedback to those offices to prevent further occurrences.

CEP is client-server technology, which affords West Florida Medical more flexibility in customizing the product to the needs of the practice management system. Instead of keying into the AR system, “we keyed directly into CEP,” says Dworshak. “We would use that as our transaction entry product, have it scrub the claims online, review them for errors, fix those errors and then move them to our AR as clean claims–knowing they will be paid correctly the first time.”

Electronic medical alert system is an emergency monitoring system for seniors and frail persons. It serves as an invaluable security and safety device for seniors living alone, and those who are suffering from chronic diseases such as arthritis, diabetes, and osteoporosis. Remote call answering, automatic voice-to-voice communication, adjustable volume controls, and monthly test call reminders are the technical features of an ideal electronic medical alert system.

An electronic medical alert system consists of a simple transmitter (button), a communication device (console), and a rechargeable back-up battery. A medical alert monitoring response center is also a part of this system. The alert button is a small, water resistant device that weighs approximately an ounce. It can be worn on the wrist as a watch or around the neck like a necklace. The button sends signals to the console and activates it. The console, equipped with a loud speaker and a supersensitive microphone, communicates over telephone line and contacts the medical alert center when activated. It establishes a two-way voice communication between the subscriber and emergency operators. The emergency operators identify the necessary information regarding the subscriber’s previous medical history and act accordingly. The built-in rechargeable battery works continuously up to 16-18 hours without electricity. If the battery is unable to work properly, the alert system automatically informs the monitoring center.

Fall detection sensor is an additional facility, specially designed to alert the monitoring personnel in case the wearer has a fall or accident. The fall detection sensor is connected to the public phone network to transmit the activity data and alert people at a remote site.

Many monitoring centers provide comprehensive training programs for both subscribers and operators on how to handle emergency situations. The call management system (CMS), a part of monitoring center, monitors the call flow traffic and provides proper assistance with utmost accuracy.