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In Health, Healthcare, Medicine on June 20, 2012 at 8:00 am


The Democrats’ desire for universal access to health insurance is not a recent desire. President Franklin D. Roosevelt hoped to include some kind of national health insurance program in Social Security in 1935. President Harry S. Truman proposed a national health care program with an insurance fund into which everyone would pay. Since then, every Democratic president and several Republican presidents have wanted to provide affordable coverage to more Americans (Health Care Reform, 2012).

The health care reform debate in the United States has been a political issue for many years, focusing upon increasing coverage, decreasing the cost and social burden of healthcare, insurance reform, and the philosophy of its provision, funding, and government involvement. Following the election of Barack Obama, who campaigned heavily on accomplishing health care reform, legislation was enacted in March 2010.

Current US Healthcare system Components
Medicare: government-funded healthcare for over 65
Medicaid: government-funded healthcare for those on low incomes
Employer-funded health insurance: paid by salary deduction
Military veterans: receive healthcare via government-run scheme
State Children’s Health Insurance Programme: coverage for children whose parents do not qualify for Medicaid
Uninsured: treated in emergency rooms only

Problem Economic Statement

The U.S. has the highest healthcare costs relative to the size of the economy (GDP) in the world, with an estimated 50.2 million citizens (approximately 15.6% of the September 2011 estimated population of 312 million) without insurance coverage. Further, an estimated 77 million Baby Boomers are reaching retirement age, which combined with significant annual increases in healthcare costs per person will place enormous budgetary strain on U.S. state and federal governments (“Health Care” n.d.). The long-term fiscal health of the U.S. federal government is primarily related to whether healthcare costs can be brought under control.

When someone without insurance (or with inadequate cover) falls ill, they are obliged to pay their medical costs out of their own pocket.

Half of all personal bankruptcies in the US are at least partially the result of medical expenses.

Rising costs also mean the government is spending more and more on Medicare and Medicaid.Medicaid now consumes almost a quarter of state budgets, crowding out investments in education and infrastructure.

US government spending on the two schemes is projected to rise from 4% of GDP in 2007 to 7% in 2025 and 12% in 2050, making rising healthcare costs one of the biggest contributing factors to the spiralling US budget deficit.

International Comparison

It is interesting to note that even though the average spending on health per capita and total expenditures on health as percent of GDP is the highest in the US, the overall ranking of the healthcare system in the lowest. In other words, there is a strong need to develop a healthcare system in US which will focus on improving the healthcare quality, while reducing the total healthcare spending costs.

Need for Healthcare reform

Based on the international comparison discussed above, US needs a healthcare reform that would attempt to do the following:

  • Broaden the population that receives health care coverage through either public sector insurance programs or private sector insurance companies
  • Expand the array of health care providers consumers may choose among
  • Improve the access to health care specialists
  • Improve the quality of health care
  • Give more care to citizens
  • Decrease the cost of health care

The bill aims to achieve the goals by:

  • designing tougher regulations for insurers
  • establishing an individual mandate – that is you must get health insurance
  • setting up insurance exchanges for those who do not have coverage provided by employers
  • offering subsidies for the less well-off – although their exact size varies from committee to committee
  • paying for most of the reforms by cutting waste in the Medicare program

Recent Proposed Ideas/Laws

A United States federal statute known as ‘The Patient Protection and Affordable Care Act’ (PPACA)  was signed into law by President Barack Obama on March 23, 2010. The law (along with the Health Care and Education Reconciliation Act of 2010) is the principal health care reform legislation of the 111th United States Congress. PPACA reforms certain aspects of the private health insurance industry and public health insurance programs, increases insurance coverage of pre-existing conditions, expands access to insurance to over 30 million Americans, and increases projected national medical spending while lowering projected Medicare spending Patient (“Protection” n.d.).

After the tumultuous debate over health care reform ended, many Americans were surprised to find that key parts of the law won’t take effect until years into the future.

The law, known as the Patient Protection and Affordable Care Act, sets up a carefully choreographed order for how its different parts will take effect to minimize disruptions to the massive health care industry and the bill’s impact on the federal deficit.

Below is the road map that helps understand when the different parts of the law will roll out.

Provisions for the ‘Affordable Care Act’

Below are the different provisions of the ‘Affordable Care Act’ from 2010 through 2015 (“Provisions of”, 2010).



  • Putting Information for Consumers Online. The law provides for an easy-to-use website where consumers can compare health insurance coverage options and pick the coverage that works for them. Effective July 1, 2010.
  • Prohibiting Denying Coverage of Children Based on Pre-Existing Conditions. The health care law includes new rules to prevent insurance companies from denying coverage to children under the age of 19 due to a pre-existing condition. Effective for health plan years beginning on or after September 23, 2010 for new plans and existing group plans.
  • Prohibiting Insurance Companies from Rescinding Coverage. In the past, insurance companies could search for an error, or other technical mistake, on a customer’s application and use this error to deny payment for services when he or she got sick. The health care law makes this illegal. After media reports cited incidents of breast cancer patients losing coverage, insurance companies agreed to end this practice immediately. Effective for health plan years beginning on or after September 23, 2010.
  • Eliminating Lifetime Limits on Insurance Coverage. Under the law, insurance companies will be prohibited from imposing lifetime dollar limits on essential benefits, like hospital stays. Effective for health plan years beginning on or after September 23, 2010.
  • Regulating Annual Limits on Insurance Coverage. Under the law, insurance companies’ use of annual dollar limits on the amount of insurance coverage a patient may receive will be restricted for new plans in the individual market and all group plans. In 2014, the use of annual dollar limits on essential benefits like hospital stays will be banned for new plans in the individual market and all group plans. Effective for health plan years beginning on or after September 23, 2010.
  • Appealing Insurance Company Decisions. The law provides consumers with a way to appeal coverage determinations or claims to their insurance company, and establishes an external review process. Effective for new plans beginning on or after September 23, 2010.
  • Establishing Consumer Assistance Programs in the States. Under the law, states that apply receive federal grants to help set up or expand independent offices to help consumers navigate the private health insurance system. These programs help consumers file complaints and appeals; enroll in health coverage; and get educated about their rights and responsibilities in group health plans or individual health insurance policies. The programs will also collect data on the types of problems consumers have, and file reports with the U.S. Department of Health and Human Services to identify trouble spots that need further oversight. Grants Awarded October 2010.


  • Providing Small Business Health Insurance Tax Credits. Up to 4 million small businesses are eligible for tax credits to help them provide insurance benefits to their workers. The first phase of this provision provides a credit worth up to 35% of the employer’s contribution to the employees’ health insurance. Small non-profit organizations may receive up to a 25% credit. Effective now.
  • Offering Relief for 4 Million Seniors Who Hit the Medicare Prescription Drug “Donut Hole.” An estimated four million seniors will reach the gap in Medicare prescription drug coverage known as the “donut hole” this year. Each eligible senior will receive a one-time, tax free $250 rebate check. First checks mailed in June, 2010, and will continue monthly throughout 2010 as seniors hit the coverage gap. 
  • Providing Free Preventive Care. All new plans must cover certain preventive services such as mammograms and colonoscopies without charging a deductible, co-pay or coinsurance. Effective for health plan years beginning on or after September 23, 2010.
  • Preventing Disease and Illness. A new $15 billion Prevention and Public Health Fund will invest in proven prevention and public health programs that can help keep Americans healthy – from smoking cessation to combating obesity. Funding begins in 2010.
  • Cracking Down on Health Care Fraud. Current efforts to fight fraud have returned more than $2.5 billion to the Medicare Trust Fund in fiscal year 2009 alone. The new law invests new resources and requires new screening procedures for health care providers to boost these efforts and reduce fraud and waste in Medicare, Medicaid, and CHIP. Many provisions effective now.


  • Providing Access to Insurance for Uninsured Americans with Pre-Existing Conditions. The Pre-Existing Condition Insurance Plan provides new coverage options to individuals who have been uninsured for at least six months because of a pre-existing condition. States have the option of running this program in their state. If a state chooses not to do so, a plan will be established by the Department of Health and Human Services in that state. National program effective July 1, 2010.
  • Extending Coverage for Young Adults. Under the law, young adults will be allowed to stay on their parents’ plan until they turn 26 years old (in the case of existing group health plans, this right does not apply if the young adult is offered insurance at work). Check with your insurance company or employer to see if you qualify. Effective for health plan years beginning on or after September 23.
  • Expanding Coverage for Early Retirees. Too often, Americans who retire without employer-sponsored insurance and before they are eligible for Medicare see their life savings disappear because of high rates in the individual market. To preserve employer coverage for early retirees until more affordable coverage is available through the new Exchanges by 2014, the new law creates a $5 billion program to provide needed financial help for employment-based plans to continue to provide valuable coverage to people who retire between the ages of 55 and 65, as well as their spouses and dependents. Applications for employers to participate in the program available June 1, 2010.
  • Rebuilding the Primary Care Workforce. To strengthen the availability of primary care, there are new incentives in the law to expand the number of primary care doctors, nurses and physician assistants. These include funding for scholarships and loan repayments for primary care doctors and nurses working in underserved areas. Doctors and nurses receiving payments made under any State loan repayment or loan forgiveness program intended to increase the availability of health care services in underserved or health professional shortage areas will not have to pay taxes on those payments. Effective 2010 .
  • Holding Insurance Companies Accountable for Unreasonable Rate Hikes. The law allows states that have, or plan to implement, measures that require insurance companies to justify their premium increases will be eligible for $250 million in new grants. Insurance companies with excessive or unjustified premium exchanges may not be able to participate in the new health insurance Exchanges in 2014. Grants awarded beginning in 2010.
  • Allowing States to Cover More People on Medicaid. States will be able to receive  federal matching funds for covering some additional low-income individuals and families under Medicaid for whom federal funds were not previously available. This will make it easier for states that choose to do so to cover more of their residents. Effective April 1, 2010.
  • Increasing Payments for Rural Health Care Providers. Today, 68% of medically underserved communities across the nation are in rural areas. These communities often have trouble attracting and retaining medical professionals. The law provides increased payment to rural health care providers to help them continue to serve their communities. Effective 2010.
  • Strengthening Community Health Centers. The law includes new funding to support the construction of and expand services at community health centers, allowing these centers to serve some 20 million new patients across the country. Effective 2010.



  • Offering Prescription Drug Discounts. Seniors who reach the coverage gap will receive a 50% discount when buying Medicare Part D covered brand-name prescription drugs. Over the next ten years, seniors will receive additional savings on brand-name and generic drugs until the coverage gap is closed in 2020. Effective January 1, 2011.
  • Providing Free Preventive Care for Seniors. The law provides certain free preventive services, such as annual wellness visits and personalized prevention plans for seniors on Medicare.  Effective January 1, 2011.
  • Improving Health Care Quality and Efficiency.  The law establishes a new Center for Medicare & Medicaid Innovation that will begin testing new ways of delivering care to patients. These methods are expected to improve the quality of care, and reduce the rate of growth in health care costs for Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP). Additionally, by January 1, 2011, HHS will submit a national strategy for quality improvement in health care, including by these programs. Effective no later than January 1, 2011.
  • Improving Care for Seniors After They Leave the Hospital. The Community Care Transitions Program will help high risk Medicare beneficiaries who are hospitalized avoid unnecessary readmissions by coordinating care and connecting patients to services in their communities. Effective January 1, 2011.
  • Introducing New Innovations to Bring Down Costs. The Independent Payment Advisory Board will begin operations to develop and submit proposals to Congress and the President aimed at extending the life of the Medicare Trust Fund.  The Board is expected to focus on ways to target waste in the system, and recommend ways to reduce costs, improve health outcomes for patients, and expand access to high-quality care. Administrative funding becomes available October 1, 2011.


  • Increasing Access to Services at Home and in the Community. The Community First Choice Option allows states to offer home and community based services to disabled individuals through Medicaid rather than institutional care in nursing homes. Effective beginning October 1, 2011.


  • Bringing Down Health Care Premiums. To ensure premium dollars are spent primarily on health care, the law generally requires that at least 85% of all premium dollars collected by insurance companies for large employer plans are spent on health care services and health care quality improvement. For plans sold to individuals and small employers, at least 80% of the premium must be spent on benefits and quality improvement. If insurance companies do not meet these goals, because their administrative costs or profits are too high, they must provide rebates to consumers. Effective January 1, 2011. 
  •  Addressing Overpayments to Big Insurance Companies and Strengthening Medicare Advantage. Today, Medicare pays Medicare Advantage insurance companies over $1,000 more per person on average than is spent per person in Traditional Medicare. This results in increased premiums for all Medicare beneficiaries, including the 77% of beneficiaries who are not currently enrolled in a Medicare Advantage plan. The law levels the playing field by gradually eliminating this discrepancy.  People enrolled in a Medicare Advantage plan will still receive all guaranteed Medicare benefits, and the law provides bonus payments to Medicare Advantage plans that provide high quality care. Effective January 1, 2011.



  • Linking Payment to Quality Outcomes. The law establishes a hospital Value-Based Purchasing program (VBP) in Traditional Medicare. This program offers financial incentives to hospitals to improve the quality of care. Hospital performance is required to be publicly reported, beginning with measures relating to heart attacks, heart failure, pneumonia, surgical care, health-care associated infections, and patients’ perception of care. Effective for payments for discharges occurring on or after October 1, 2012.
  • Encouraging Integrated Health Systems. The new law provides incentives for physicians to join together to form “Accountable Care Organizations.” These groups allow doctors to better coordinate patient care and improve the quality, help prevent disease and illness and reduce unnecessary hospital admissions. If Accountable Care Organizations provide high quality care and reduce costs to the health care system, they can keep some of the money that they have helped save. Effective January 1, 2012.
  • Reducing Paperwork and Administrative Costs. Health care remains one of the few industries that relies on paper records. The new law will institute a series of changes to standardize billing and requires health plans to begin adopting and implementing rules for the secure, confidential, electronic exchange of health information. Using electronic health records will reduce paperwork and administrative burdens, cut costs, reduce medical errors and most importantly, improve the quality of care. First regulation effective October 1, 2012. Learn how the law improves the health care system for providers, professionals, and patients.
  • Understanding and Fighting Health Disparities. To help understand and reduce persistent health disparities, the law requires any ongoing or new Federal health program to collect and report racial, ethnic and language data. The Secretary of Health and Human Services will use this data to help identify and reduce disparities. Effective March 2012.


  • Providing New, Voluntary Options for Long-Term Care Insurance. The law creates a voluntary long-term care insurance program – called CLASS — to provide cash benefits to adults who become disabledNote: On October 14, 2011, Secretary Sebelius transmitted a report and letter to Congress stating that the Department does not see a viable path forward for CLASS implementation at this time.




  • Improving Preventive Health Coverage. To expand the number of Americans receiving preventive care, the law provides new funding to state Medicaid programs that choose to cover preventive services for patients at little or no cost. Effective January 1, 2013.
  • Expanding Authority to Bundle Payments. The law establishes a national pilot program to encourage hospitals, doctors, and other providers to work together to improve the coordination and quality of patient care.  Under payment “bundling,” hospitals, doctors, and providers are paid a flat rate for an episode of care rather than the current fragmented system where each service or test or bundles of items or services are billed separately to Medicare.  For example, instead of a surgical procedure generating multiple claims from multiple providers, the entire team is compensated with a “bundled” payment that provides incentives to deliver health care services more efficiently while maintaining or improving quality of care.  It aligns the incentives of those delivering care, and savings are shared between providers and the Medicare program. Effective no later than January 1, 2013.


  • Increasing Medicaid Payments for Primary Care Doctors. As Medicaid programs and providers prepare to cover more patients in 2014, the Act requires states to pay primary care physicians no less than 100% of Medicare payment rates in 2013 and 2014 for primary care services. The increase is fully funded by the federal government. Effective January 1, 2013.
  • Providing Additional Funding for the Children’s Health Insurance Program. Under the law, states will receive two more years of funding to continue coverage for children not eligible for Medicaid. Effective October 1, 2013.



  • Prohibiting Discrimination Due to Pre-Existing Conditions or Gender. The law implements strong reforms that prohibit insurance companies from refusing to sell coverage or renew policies because of an individual’s pre-existing conditions. Also, in the individual and small group market, the law eliminates the ability of insurance companies to charge higher rates due to gender or health status. Effective January 1, 2014.
  • Eliminating Annual Limits on Insurance Coverage. The law prohibits new plans and existing group plans from imposing annual dollar limits on the amount of coverage an individual may receive. Effective January 1, 2014. Learn how the law will phase out annual limits by 2014.
  • Ensuring Coverage for Individuals Participating in Clinical Trials. Insurers will be prohibited from dropping or limiting coverage because an individual chooses to participate in a clinical trial.  Applies to all clinical trials that treat cancer or other life-threatening diseases. Effective January 1, 2014. 


  • Making Care More Affordable. Tax credits to make it easier for the middle class to afford insurance will become available for people with income between 100% and 400% of the poverty line who are not eligible for other affordable coverage. (In 2010, 400% of the poverty line comes out to about $43,000 for an individual or $88,000 for a family of four.) The tax credit is advanceable, so it can lower your premium payments each month, rather than making you wait for tax time. It’s also refundable, so even moderate-income families can receive the full benefit of the credit. These individuals may also qualify for reduced cost-sharing (copayments, co-insurance, and deductibles). Effective January 1, 2014.
  • Establishing Affordable Insurance Exchanges. Starting in 2014 if your employer doesn’t offer insurance, you will be able to buy it directly in an Affordable Insurance Exchange.  An Exchange is a new transparent and competitive insurance marketplace where individuals and small businesses can buy affordable and qualified health benefit plans.  Exchanges will offer you a choice of health plans that meet certain benefits and cost standards.  Starting in 2014, Members of Congress will be getting their health care insurance through Exchanges, and you will be able buy your insurance through Exchanges too. Effective January 1, 2014.
  • Increasing the Small Business Tax Credit. The law implements the second phase of the small business tax credit for qualified small businesses and small non-profit organizations. In this phase, the credit is up to 50% of the employer’s contribution to provide health insurance for employees.  There is also up to a 35% credit for small non-profit organizations.  Effective January 1, 2014.


  • Increasing Access to Medicaid. Americans who earn less than 133% of the poverty level (approximately $14,000 for an individual and $29,000 for a family of four) will be eligible to enroll in Medicaid. States will receive 100% federal funding for the first three years to support this expanded coverage, phasing to 90% federal funding in subsequent years. Effective January 1, 2014.
  • Promoting Individual Responsibility. Under the law, most individuals who can afford it will be required to obtain basic health insurance coverage or pay a fee to help offset the costs of caring for uninsured Americans.  If affordable coverage is not available to an individual, he or she will be eligible for an exemption. Effective January 1, 2014.
  • Ensuring Free Choice. Workers meeting certain requirements who cannot afford the coverage provided by their employer may take whatever funds their employer might have contributed to their insurance and use these resources to help purchase a more affordable plan in the new health insurance Exchanges. Effective January 1, 2014.



  • Paying Physicians Based on Value Not Volume. A new provision will tie physician payments to the quality of care they provide. Physicians will see their payments modified so that those who provide higher value care will receive higher payments than those who provide lower quality care. Effective January 1, 2015.


The law will cost the government about $938 billion over 10 years, according to the nonpartisan Congressional Budget Office, which has also estimated that it will reduce the federal deficit by $138 billion over a decade (Health Care Reform, 2012).

It was the largest single legislative achievement of Mr. Obama’s first two years in office, and the most controversial. Not a single Republican voted for the final version, and Republicans across the country campaigned on a promise to repeal the bill. In January 2011, shortly after they took control of the House, Republicans voted 245 to 189 in favor of repeal, in what both sides agreed was largely a symbolic act, given Democratic control of the Senate and White House (Health Care Reform, 2012).

Supreme Court to Hear a Challenge

With Republicans unable to repeal the bill, its fate rests in the hands of the Supreme Court, which in November 2011 agreed to hear a challenge to the law. The development set the stage for oral arguments by March and a decision in late June, in the midst of the 2012 presidential campaign (Health Care Reform, 2012).

But in the meantime vast changes have been set in motion that are likely to persist no matter what the court’s ruling. Provisions already put in place, like tougher oversight of health insurers, the expansion of coverage to one million young adults and more protections for workers with pre-existing conditions are already well cemented and popular. And the law, along with economic pressures, has forced major institutions to wrestle with the relentless rise in health care costs (Health Care Reform, 2012).


Health Reform Act Summary

After decades of failed attempts by a string of Democratic presidents and a year of bitter partisan combat, President Obama signed legislation on March 23, 2010 to overhaul the nation’s health care system and guarantee access to medical insurance for tens of millions of Americans.

The health care law seeks to extend insurance to more than 30 million people, primarily by expanding Medicaid and providing federal subsidies to help lower- and middle-income Americans buy private coverage. It will create insurance exchanges for those buying individual policies and prohibit insurers from denying coverage on the basis of pre-existing conditions. To reduce the soaring cost of Medicare, it creates a panel of experts to limit government reimbursement to only those treatments shown to be effective, and creates incentives for providers to “bundle’’ services rather than charge by individual procedure (Health Care Reform, 2012).

Major Issues

As discussed earlier in this paper, in US, the ranks of the uninsured and under-insured have skyrocketed, from insurance costs that have grown over a decade. Health coverage is employers’ most unpredictable major cost, a threat to their businesses’ competitiveness, and they have increasingly offloaded costs onto employees. So while the marginalized uninsured are an important problem, declining coverage for the mainstream is the greater worry. Most know that, even with insurance, any major health problem can spell financial ruin.

Medicare cost cutting will affect patient care as the hospitals and doctors’ offices will not have enough incentive to treat these category people because of significantly low reimbursements. That will significantly affect the quality of their care.

There is no mention of how the extra 50 million uninsured (who enter the pool of healthcare) will be treated as there is already a significant shortage of doctors in USA. This reform did not talk about how to take care of extra nurses that would be required. They won’t re-empower primary care, which other nations have found will maintain a healthy population for half the cost of our specialist-dominated approach. They fail to make care quality and cost transparent, which would let health care finally work as a market, and help identify the best health care vendors. They continue to favor fee-for-service reimbursement, which rewards delivering more products and services rather than rewarding results. And they all but ignore our capricious medical malpractice system, which most doctors say encourages defensive practice (Kibbe and Klepper, 2009). Unfortunately, patients will suffer from their diseases longer because of the wait times will go high. The current proposals expand coverage, but do little to reduce cost. For example,

My Opinion

US is already going through a major ECONOMIC CRISIS situation right now. It has affected the whole world. We as ‘American people’ should become aware of a couple of harsh truths. Introducing Healthcare Reform in 2010 has expedited the degradation of economy rather than making any better. It is not Healthcare Saving, but Healthcare Spending.


The government needs to cut down on spending and start saving to save the country. US is struggling do improve. The government is least bothered about what people of the country want. They may be thinking they are helping the people, but actually they are not. I can understand their stand to promote equality, but that reduces efficiency which is highly needed right now to get over this economic crisis.

The fundamentals in the reform are very well put in, but we wish that the economists sitting in the government would have put some effort into realizing the harms this reform will bring to US economy in coming years. To sum up, we can say that we have deeper problems than an inability to fix health care.



In Health, Healthcare, Medicine on June 19, 2012 at 9:55 am


Bed of Nails: Bed of Wonders

In Health, Healthcare, Medicine on June 18, 2012 at 8:00 am

Yogis in Asia, particularly India have been using the bed of nails for many centuries. The use and benefits of Bed of nails has been described in many ancient citations and literature. Human body has thousands of acupressure and reflexology points. The World Of Healing has always strived to generate self healing without use of any medications. With the same idea, we are introducing Magic Mat. Magic mat has over 6000 powerful acupressure points which can help rechannelize your energy and relieve stress and pain and inturn bring peace and happiness in your life. It stimulates the release of happy hormone called oxytocin and endorphins. It reduces stress hormone. Lack of sleep or poor sleep is a very big factor for elevated cortisol. Magic Mat along with healing Grip and healing ball provide healing powers even while you are working. Multiple research studies have shown significant benefit in subjects The effects are instantaneous.


Reduces stress
Helps Reducing weight
Creates positive self esteem
Improves sleep
Relieves headaches
Relieves muscle tension
Relieves back pain
Relieves neck pain
Reduces inflammation
Relieves Hot Flashes
Improves blood circulation
Promotes relaxation
Improves concentration
Improves memory
Improves Vision
Improves Digestion

It can be used anytime and anywhere
You may lie down on back or stomach
You may sit on it
You may stand on it.
It can be rolled and placed under neck for neck pain relief also.

It is advisable to use Magic Mat for 10-40 minutes a day. Initial use may be a little difficult due to sharp points. The body gradually gets used to it. A thin top can be worn during initial use. You may wear thin socks if you want to stand.
Make sure you drink plenty of water after each use as it releases a lot of toxins from the body.
Please keep out of reach of children.

Endorphins are neurotransmitters, or peptides, and the word is short for endogenous and morphine, meaning morphine-like created by the body itself. Endorphins reduce pain and create feelings of euphoria and wellbeing.

Oxytocin is a hormone that is released in the blood stream, during for example childbirth, sex or, according to some scientists, massage. When released, it helps the body recuperate, as well as create a feeling of calm and satisfaction.


The 8 Habits For Healthy Living

In Health, Healthcare, Medicine on June 16, 2012 at 8:00 am

1.Eat smaller meals every 3 hours, for a total of five to eight small meals per day, every day.
2. Eat a lean protein source with every meal (meat, chicken, fish, eggs).
3. Eat fruits, vegetables or both with every meal.
4. Make sure that almost all carbohydrate intake comes from fruits and vegetables.
5. Make sure that at least 25 percent of your calories come from fat sources, including animal fats and oils (flax, fish, coconut, and olive).
6. Drink 8 glasses of 8oz water  daily. Drink only beverages that have zero calories. Stick to just water and green tea if possible.
7. Eat only whole foods (as opposed to liquid nutrition).

8.Exercise for 30 to 60 minutes most days of the week


In Health, Healthcare, Medicine on June 16, 2012 at 8:00 am



It started while I was taking a trip to India. It was a long day before I got on the flight and I sat tired in the chair. After an hour or so of napping, I took a moment to look around myself and saw a nicely dressed man in his 60’s sitting next to me. I introduced myself and started talking. He was reading a book on motivation.  Being a speaker on motivation, I told him that I myself conduct workshops on motivation and meditation to help people. He looked at me for a second, and then said, “Let me tell you a story. Few years ago, I was a very busy executive in one of the Fortune 500 companies. One morning I was rushing to get to work as usual. I was on the beltway when I realized that my car is not moving right. I slowed down my car. I pulled it over the shoulder and realized that I had a flat tire. It was raining heavily. I had a very important meeting to attend. I started getting stressed out. I started breathing fast and shallow. I could feel my heart racing and not being able to think what I should do. Felt as if everything wrong had happened to me in life. All of a sudden I was drenched in negativity just by that one event.  A passerby stopped to see if I needed help. He saw me stressed and said, “Take it easy. Let me help you with this”. While helping me to get the tire changed, he started talking to me and told me that he had lost his job due to economic crisis and was struggling to get one. He said,”I have been through a tough stressful phase when I got laid off. I kept thinking as to why this happened to me. But on deep thinking, I realized that there are so many people going through real problems. Look at people who do not have a house to live, do not have food to eat, suffering from cancer, handicaps, etc. At least I have none of those. So, I am happy.”

It took me a few minutes to think straight. But after digesting what he said, I realized that we stress out on such minor stuff which is not even worth thinking. That day I changed my attitude towards stress and now I do not get it, because now I know Stress is a thief that steals the peace of mind. So I keep the doors of my mind locked to all such thieves to keep my peace of mind.

This story was one of the few which people tell me about them and how a few words can transform their thought process for the better or worse.





Do you have hard time focusing on things?

Do you feel occupied mentally even when you cannot think of anything particular?

Do you have bloating, heartburn or upset stomach frequently?

Do you have hard time sleeping?

Do you feel aches & pain in your body?

Do you have a constant fear of some sort?

Do you get headaches and neck pain frequently?

Do you have trouble losing weight even with aggressive diet and exercise?



Stress is an emotion that comes from OVERACTIVE thoughts, i.e., thoughts of over-concern, thoughts of disappointment, thoughts of fear, thoughts of failure, etc. It creates a multitude of chemical reactions in the whole body including brain. The chemicals released lead to subtle contractions in the body which gradually keep progressing if stress gets prolonged. Those contractions manifest in multiple ways, both physically and psychologically.

Stress reduces Immunity making you more susceptible to disease.

Physical Effects

1. Chronic Headaches.

2. Anxiety

3. Depression

4. Heartburn

5. Chronic Pains

6. Sleep disorders

7. Asthma

8. Cardiovascular diseases.

9. Irritable Bowel Syndrome.

10. Weight gain/weight loss

11. Nervous habits (e.g. nail biting, pacing)

12. Loss of sex drive

13. Frequent colds

14. Chest pain/tightness

Psychological effects

1. Irritability

2. Anger

3. Agitation

4. Poor judgment

5. Memory problems

6. Addictions to alcohol, cigarettes, or drugs to relax

Now what everyone wants to know is, ‘How to Manage Stress?’

Next page is the most important page in the book.





So, lets start the journey




Deep breathing is a must and first physiological response that one should adopt when going through an acute stress phase. Whenever we are stressed, we do not breathe right. We take very shallow breaths which do not provide sufficient oxygen to the body. Our body reacts as if we are surrounded by a lot of people who are going to harm us and we try to hide. As we do not take deep breaths when we try to hide from someone, so that they don’t find us by the noise of breathing, similarly, when stressed, we do not breathe properly. It leads to multiple contractions in the body. Our blood vessels also start contracting leading to elevation of Blood pressure. Lack of oxygen creates mental clouding as the brain needs oxygen to breathe. The stress hormone rises, leading to appetite changes. Our bowels do not absorb the food as they should, leading to symptoms of diarrhea or constipation initially, and may turn into Irritable Bowel syndrome (IBS) when stress becomes chronic. All the above mentioned physiological changes drain out a person physically and mentally within few minutes of a stress response. Lungs are one of the major organs to detoxify our body. They work by eliminating the harmful gases out of our system. Improper breathing leads to accumulation of toxic chemicals in body making it more prone to disease.

Deep breathing helps in many ways. Physiologically, it provides enough oxygen to our body, slows down heart rate, improves brain function leading to better decision making during the stress phase. The stress hormone concentration decreases and blood circulation improves.

Tip: Just take 10 deep easy and deep breaths and say to yourself “Relax” and see the difference in your body. The results are instantaneous and magical.


The first psychological response to stress is that we start thinking negative about the situation or person in context. This is part of human mind system which is very natural. It is hard to change the response as it is part of our thinking mechanism. But the thought itself is of no harm as long as you are aware of it and you do not let that negative thought turn into a negative action. Every event or happening in your life has a deeper meaning to it. We get problems in life so that we can learn how to deal with them. There is no single person in this whole world who could say that he or she did not have any stressful situation in their lives. Stress and its human response are the same for most of us. The difference is perception and the experience. A problem is a problem the first time. When we learn how to deal with it, we know how to take care of it the second time.

Tip: think of good things that happened in your life. Think of all the achievements, success and loved ones that you are proud of. Think that you will be better the next time and that this problem will never come again.


Humans are social animals. We cannot stay away from people for long. Stress leads to a fright response and the first thing we want to do is ‘hide’ ourselves as mentioned in 1. So if you try to do the opposite, you can easily null-void the stress response. Conversation, sharing, being in touch with others, gives living a purpose. Sharing with friends helps multiply the joys and divide the sorrows. Several studies report fewer colds, lower blood pressure and lower heart rates in participants with strong social ties. Statistics show that marriage, perhaps the strongest tie, adds years to life expectancy. Suicide, mental illness and alcoholism rates are much lower when people feel a sense of belonging.

Dozens of findings over the past two decades have shown how important social connections can be. In another study, University of Michigan epidemiologist James House and his team interviewed and examined 2,754 adults over a period of nine to 12 years.

Their results, published in the American Journal of Epidemiology in 1982, showed that men who reported more social relationships — going to movies, church meetings, classes, or trips with friends or relatives, for example — were significantly less likely to die during the study period. Socially active women also benefited, although not quite as dramatically.

Marriage, too, turns out to have important health benefits. In the December 1999 issue of Neurology, researchers at Bordeaux University in France reported that among 2,800 volunteers followed over a five-year period, married people were one-third less likely than the never-married to develop Alzheimer’s disease.

So stop hiding in your room or house. Go out. Meet people. Talk to people. World is beautiful out-there.


History of dancing goes a long way when human civilizations were established. It has been researched and studied over thousands of years on how dance can affect us. Dance is a body response of happiness and good mood. I have never seen person dance when they are sad/depressed. Dancing with the music you like, increases serotonin hormone in the brain which is the ‘happy hormone’. That is why depressed people are give SSRI’s(Selective serotonine Reuptake Inhibitors) which basically avoid depletion of Serotonin in the brain leading to happy feelings and enhanced mood. Dancing is a way to increase serotonin which improves your mood when you are stressed. It also increases circulation in the body leading to better oxygen consumption and detoxification.

Frequent dancing apparently makes us smarter.  A major study added to the growing evidence that stimulating one’s mind can ward off Alzheimer’s disease and other dementia, much as physical exercise can keep the body fit.  Dancing also increases cognitive acuity at all ages.

One of the surprises of the study was that almost none of the physical activities appeared to offer any protection against dementia.  There can be cardiovascular benefits of course, but the focus of this study was the mind.  There was one important exception:  the only physical activity to offer protection against dementia was frequent dancing.

Reading – 35% reduced risk of dementia

Bicycling and swimming – 0%

Doing crossword puzzles at least four days a week – 47%

Playing golf – 0%

Dancing frequently – 76%.
That was the greatest risk reduction of any activity studied, cognitive or physical.

So put on your favorite dance music and show your moves. Your stress will melt away in no time.


Did you ever heard of anyone who sat on the bicycle for the first time as a child and did not fall? Falling is part of human learning system. We can only balance ourselves when we have fallen. Those who don’t fall, don’t get success. So if you think, you have a lot of falls on your plate, I want to congratulate you because all those falls have helped you be at balance in life in many areas.

Perfection comes from practice. A 100 mile walk starts with one step. How many times do you see toddlers fall when they are learning to walk? Countless times. But does it make them stress out? Not at all. Its part of learning curve to fall.

Whether we realize it or not, we are all faced with challenges in our own lives every single day. We also frequently overcome these challenges. As adults, we long for stability and certainty, yet unintentionally fail to live out the incredible possibilities that come with uncertainty. What we don’t realize is that by putting ourselves into a position where we are forced to take action in order to succeed, we get rewarded always one way or the other.

So, take problems as challenges. Problems always go in the past. You have to go in future. Our thoughts make us who we are.


Fun is a must especially when you are stressed. I would not recommend to get high on alcohol as alcohol is also a toxic substance for body if ingested in excess. So keep it light and enjoy. The idea is to connect with friends, socialize, dance and listen to good music.



Water is the best detoxifying agent created by nature. Water’s healing properties are always underestimated. To most of my patients, I recommend drinking plenty of water as first part of my recommendations. Water is major component of human body. It constitutes over 70% of human body. Water goes into blood circulation; kidneys filter the blood and eliminate toxins from your body.

75% of Americans are chronically dehydrated. Drinking 5 glasses of water daily decreases the risk of colon cancer by 45%, plus it can slash the risk of breast cancer by 79%, and one is 50% less likely to develop bladder cancer.

Benefits of water include

*Clears body toxins

*Improves colon and bladder health

*Improves circulation

*Improves muscle strength

*Improves skin texture

*Promotes muscle growth.

*Reduces weight

*Promotes mood

*Promotes exercise capacity

*Increased productivity

*Reduces fatigue and tiredness

So, start drinking more water. Recommendations are 8 glasses, 8oz each per day.



Fresh Fruits and Vegetables have abundance of anti-oxidants which reduce the aging process accelerated by stress. Stress affects our telomeres (part of genes) leading to poor and reduced life. Antioxidants help to reduce the effects of free radicals created in the body by stress and helps cleanse our body and mind. Fruits and vegetables come in terrific colors and flavors, but their real beauty lies in what’s inside. Fruits and vegetables are great sources of many vitamins, minerals and other natural substances that may help protect you from chronic diseases.

Most people should aim for at least nine servings (at least 4½ cups) of vegetables and fruits a day. To get a healthy variety, think color. Eating fruits and vegetables of different colors gives your body a wide range of valuable nutrients, like fiber, folate, potassium, and vitamins A and C. Some examples include green spinach, orange sweet potatoes, black beans, yellow corn, purple plums, red watermelon, and white onions. For more variety, try new fruits and vegetables regularly. Stress reduces our immunity and fruits and veggies help restore that giving us the ability to fight disease.


We all have heard this multiple times from our elders that “Early to bed and early to rise, makes a person healthy, wealthy and wise.” It is very true. I know it is very hard to get up early in the morning with the kind of lifestyle we have, but once you do it, you feel so good, that you would want to do it again and again. That one extra hour in the morning is most productive part of the day. Whatever you would do in that one hour would lead to great results. There are multiple reasons for that.

a. You are fresh,

b. You are relaxed.

c. You are well rested.

d. Your mind is not racing with multiple thoughts in the first hour.

e. Highest concentration of positive hormones in the morning.

So, if you have some work which you have been wanting to do for a while, but do not get enough time to finish it off, try once to do it in that one hour. It will help boost your mood for the rest of that day. Mornings are best times to stretch, exercise and meditate.



Cleaning your room, desk or wherever you dwell is a must for each human being. Clean Homes have been proven statistically to be much more calming to mind than dirty ones. So the first thing to calm your mind is to clean your clutter. You will get instant satisfaction and peace of mind. Also, cleaning involves physical exercise. Physical exercise helps with increased motor activity leading to lowering of serum cortisol (stress hormone) and improved circulation. So gather the cleaning supplies and start this stress buster.




Organizing helps streamline our thought process and improves our problem solving skills.  Organizing closet saves time in mornings, keeps your mood right and improves your organizing skills. It is well known that people who keep their closet organized are good organizers overall.


Our belongings stay in closet. The way we carry ourselves can be easily correlated with the condition of our closet. So clean it. How we are inside is how we are outside. If inside is good, outside always turns good.

The idea is to organize. When we organize, we feel good. We get a sense of achievement. All high achievers are good organizers. Just keeping your closet organized, would lead to cleaning your subconscious mind, improving sense of well-being.

A few easy ways to do is to follow the 80/20 rule. 80% of the things we have are only used 20% of the times and 20% of the things are used 80% of the times. So put the 20% items in front where they can be easily approached and kept. The rest 80% good stuff that you piled up over time thinking that you will be using it, but as usual did not get a chance to use, needs be the one that needs sorting out soon.

Take 2 big plastic or cardboard boxes. Separate the ones that you honestly feel that you would be using in future and the ones that really fit well. Put them in the Box named MINE.

The ones that do not fit, or are now old fashioned or the ones you have used enough that you don’t feel wearing anymore, put them in a box named DONATE. Most people are able to get at least 25-40% of the stuff in Donate Box.

Organizing closet also burns up some calories and get you going. Also helps your spouse/room partner feel good about that. So your stress buster can bring a smile on someone else’s face. It is totally worth it. Now your closet is clean and very well organized. Take a picture with your digital camera to remind you of that moment.



Exercise, Exercise, Exercise. I hope I have made a point here. Exercise is a significant booster of endorphins (happy hormones).

Health Benefits of Exercise and Physical Activity:

  • Reduce the risk of premature death
  • Reduce the risk of developing and/or dying from heart disease
  • Reduce high blood pressure or the risk of developing high blood pressure
  • Reduce high cholesterol or the risk of developing high cholesterol
  • Reduce the risk of developing colon cancer and breast cancer
  • Reduce the risk of developing diabetes
  • Reduce or maintain body weight or body fat
  • Build and maintain healthy muscles, bones, and joints
  • Reduce depression and anxiety
  • Improve psychological well-being
  • Enhanced work, recreation, and sport performance

So put on your sneakers and take a run on road or treadmill. Lifting some weights would be a good idea too.


When was the last time you dressed well? Imagine how you felt at that time. When we dress well, we get more confident. Good dressing style brings style in you. You carry yourself well. You do not slouch. You stand erect and you are ready to take on to any challenge. That is why most of the corporation executives, marketing people and customer service representatives wear formal clothing. When we feel confident, we are more efficient and our face value improves.

It has been said that in the first 5 seconds after meeting a new person, they will have made a long lasting first impression of your image. 90% of your body at any time is covered in clothing. Therefore how to dress well for men IS a big deal. You don’t need to spend thousands of dollars on a new wardrobe, but you do need to put effort and thought into what you wear.

Dressing well is applicable to all areas of life (the business world, the dating world etc.) You need to look and feel your best no matter where you are going. Fashion is really an expression of yourself.

So put on your best show tonight.



The Lotus position is adopted to allow the body to be held completely steady for long periods of time. As the body steadies, the mind becomes calm. The posture applies pressure to the lower spine which may facilitate relaxation. The breathing slows down, muscular tension decreases and blood pressure decreases. The sacral nerves are toned as the normally large blood flow to the legs is redirected to the abdominal region.


Caffeine is very potent trigger for vasospasm, i.e., blood vessel contraction. It increases blood pressure and also increases irritability of bladder and colon making you more susceptible to disease. Stress when combines with caffeine is a bad combination. So avoid any caffeinated drinks like coffee and sodas. You can try decaf if you still crave for it.

For most adults, moderate doses of caffeine — 200 to 300 milligrams (mg), or about two to four cups of brewed coffee a day — aren’t harmful. But heavy use — more than 500 to 600 mg a day, or about four to seven cups of coffee — can cause a whole host of problems, including:

  • Insomnia
  • Nervousness
  • Restlessness
  • Irritability
  • Nausea or other gastrointestinal problems
  • Fast or irregular heartbeat
  • Muscle tremors
  • Headaches
  • Anxiety



Watch a comedy movie or show. You can also call up a friend or colleague who makes you laugh.  Laughter is a good way to generate series of neurochemical reactions which are helpful for mood enhancement. A lot of cultures have now adapted a system of laughter clubs. Its an idea whereby all people stand in a circle and laugh. It is way to subconsciously train the mind to stay happy even without an occurrence of stimulus to laugh.

Laughter is a good way to connect with other people. It lightens up the mood. It also gives a wonderful internal workout (especially abdomen). Increases endorphins and reduces cortisol. It distracts you from stress. Humor and laughter strengthen your immune system, boost your energy, diminish pain, and protect you from the damaging effects of stress. Best of all, this priceless medicine is fun, free, and easy to use. Humor helps you keep a positive, optimistic outlook through difficult situations, disappointments, and loss.

So start laughing.

17. LET GO

A lot of us have a hard time letting go. We keep holding on to past bad memories or thoughts about people and events in life. As discussed above, things happen in everyone’s life. There is no single person who is only blessed with happiness and no sorrow. Our subconscious mind is like the sea’s bottom surface. Over time, we keep adding layers of memories and we become who we are. Some memories are very disturbing to that surface and keep creating waves which does not let our mind settle. It not only causes us to be unhappy, but can strain or ruin relationships, distract us from work and family and other important things, make us reluctant to open up to new things and people. We get trapped in a cycle of anger and hurt, and miss out on the beauty of life as it happens.

Try to shake the memory or thought that has been shaking your mind. Imagine wiping that thought out of your mind. It will help you incredibly.


Goal setting gives you direction for future. SMART goals help you achieve the desired results that you strive for. Goals should be






It is even more important to make goals during time of stress because it gives you a morale boost. You look for the good part of future rather than looking at the past or present. Futuristic approach helps you forget your present or past issues for a while.

Goals can help you concentrate your time and effort

Goals can provide motivation, persistence and desire

Goals can help you establish priorities.

Goals can provide a roadmap to take you from where you are to where you want to be.

So always look forwards.




It would be a good idea to plan a trip with your spouse or friend to your favorite destinations. Make sure you do not spend out of pocket as that would be another stressor later. Check out travel deals over internet. You can easily save bunch of money that you can use for later in life. You feel good when you save.

When we travel, we meet variety of people. On reading biographies of highly successful people, one thing that stands out is that they all mention that their best learning experiences came while travelling and meeting people. When we plan, we look forward to it. We get a reason to be happy, especially when surrounded by so many stressors.

So take a road trip, plane trip or a sea trip and enjoy.


A 2005 study on American men and women who meditated a mere 40 minutes a day showed that they had thicker cortical walls as compared to non meditators. What this meant is that their brains were aging at a slower rate. Cortical thickness is also associated with decision making, attention and memory.


Meditation is one thing that people are scared of. Meditation is traditionally thought to as an act of ultimate mind control which is very hard to achieve. It is imagined as a very tough task to perform. I have a good news for you my friend. You have already meditated by reading this book. Reading a book is also a type of meditation. Anybody can do meditation anytime. Meditation is nothing but self awareness. You may feel your breathing, the air touching your skin, sensations in your hands and feet or whatever you want to as long as you are living in the present moment. We tend to think multiple things at the same time and are unable to achieve desired results because of lack of focus. So take a few moments and try to feel yourself.






















17. LET GO









In Health, Healthcare, Medicine on June 15, 2012 at 8:00 am


In order to address the current problems with healthcare payment systems and to avoid the concerns about existing Pay-for-Performance systems, the following are twelve goals that revised payment systems should seek to achieve:

  • Payment systems should enable and encourage providers to deliver accepted procedures of care to patients in a high-quality, efficient, and patient centered manner.
  • Payment systems should support and encourage investments, innovations, and other actions by providers that lead to improvements in efficiency, quality, and patient outcomes and/or reduced costs.
  • Payment systems should not encourage or reward over-treatment, use of unnecessarily expensive services, unnecessary hospitalization or re-hospitalization, provision of services with poor patient outcomes, inefficient service delivery, or choices about preference-sensitive services that are not compatible with patient desires.
  • Payment systems should not reward providers for under-treatment of patients or for the exclusion of patients with serious conditions or multiple risk factors. Payment systems should not reward provider errors or adverse events.
  • Payment systems should make providers responsible for quality and costs within their control, but not for quality or costs outside of their control.
  • Payment systems should support and encourage coordination of care among multiple providers, and should discourage providers from shifting costs to other providers without explicit agreements to do so.
  • Payment systems should encourage involvement of patients in decision making, and encourage patient choices that improve adherence to recommended care processes, improve outcomes, and reduce the costs of care.
  • Payment systems should not reward short-term cost reductions at the expense of long-term cost reductions, and should not increase indirect costs in order to reduce direct costs.
  • Payment systems should not encourage providers to reduce costs for one payer by increasing costs for other payers, unless the changes bring payments more in line with costs for both payers.
  • Payment systems should minimize the administrative costs for providers in complying with payment system requirements. Different payers should align their standards and methods of payment in order to avoid unnecessary differences in incentives for providers.

In addition, an overarching goal is to have improved payment systems maintain or reduce healthcare costs, rather than increase them.

Measuring Success in Current Healthcare Times: Very Important

In Health, Healthcare, Medicine on June 14, 2012 at 8:00 am

An implicit goal of an improved Healthcare structure is to create an improved system of care for patients. So in addition to measuring patient-level outcomes, it will be important to measure whether the system itself is improving in ways that are believed to result in better patient care and better outcomes in the future. Some of the questions to be answered and measures to be developed include:

Are we strengthening primary care?

• Do more patients report that they have a primary care physician or team?

• Do more patients report that they can find a primary care team easily?

• Are patients able to communicate with their primary care team more readily?

• Do more primary care physicians report “joy in work” and being “fairly paid?”

• Has access to specialists, as reported by patients and primary care physicians, improved?

• Is primary care becoming more patient-centered?

• Do more patients report that they are getting exactly the care they need, exactly when and as they need it?

• Do more patients report that they fully understand their care, understand what they need to do to stay healthy, and that the care fully reflects their preferences?

Are decisions about payment and other issues more oriented toward patients’ interests than providers’ interests?

• Do patients report that their providers coordinate services effectively?

• Is care of patients with chronic illness becoming more efficient?

• Have expenditures for specific patients and conditions met the target levels?

• Has the percentage of care managed without face-to-face contact and in single visits increased?

• Have hospitalizations been reduced?

• Has there been a decrease in the frequency of procedures that had been performed previously at a rate above the national average?

• Has the rate of test repetition decreased?

• Have patients reported any greater problems in accessing care?

Are outcomes for chronically ill patients improving?

• Have blood pressure levels improved?

• Have Hemoglobin A1c levels improved?

• Do patients experience fewer limitations affecting their quality of life?

Are data being used for management and continuous improvement?

• How many quality/outcome/cost measures are available?

• How promptly are the measures available?

• Does the managing board of the provider review the measures regularly?

• Is the CEO compensation/performance plan tied to the measures?

Ref: nrhi.org


In Health, Healthcare, Medicine on June 13, 2012 at 8:00 am

There is growing realization and agreement that in order to achieve the most efficient, effective, and sustainable improvements in quality and reductions (or slowing the growth) in costs of the healthcare system, the penalties and disincentives in current healthcare payment systems need to be eliminated or modified, in addition to adding rewards or incentives.

When Starbucks, one of the biggest employers in Seattle, realized that costs for treating back injuries were far higher at Virginia Mason Health System than they were at competing providers, the coffee retailer asked Aetna Inc. to drop the institution from its network. Because dropping providers can limit a health plan’s marketability, Aetna instead helped Virginia Mason analyze the reasons for the big cost difference. The heart of the health system’s problem was much higher use of MRIs and neurological consults, even for patients whose back pain could be readily explained by an injury. So, Virginia Mason worked with the insurer to make physical therapy the first treatment option. Almost immediately, the health system began seeing faster recovery times for patients (which, in the case of occupational injuries, meant less time on workers’ comp) and dramatically lower costs for employers because physical therapy costs so much less than MRIs and neurological workups. However, the steep reduction in MRIs and neurological consults also took a toll on Virginia Mason’s finances. Instead of generating several thousand dollars for treating a back injury, it saw its income drop to a few hundred dollars on each case, which was not enough to cover its costs. Neither Aetna nor Starbucks ever intended to put Virginia Mason out of business, so they did something that instead was a win-win. They restructured payments to reward appropriate care. Instead of staking claim to the entire savings, Starbucks and Aetna took only a portion and directed the rest toward increased reimbursement for physical therapy, which, up to that point, had been a money loser for Virginia Mason.

Ref: nrhi.org

8 Ingredients in order for Primary Care practices to become an Accountable Care Organization

In Health, Healthcare, Medicine on June 12, 2012 at 8:00 am

The core of an Accountable Care Organization is effective primary care. Although the majority of healthcare expenditures and increases in expenditures are associated with specialty and hospital care, some of the most important mechanisms for reducing and slowing the growth in specialty and hospital expenditures are prevention, early diagnosis, chronic disease management, and other tools which are delivered through primary care practices.

8 Ingredients in order for primary care practices to become an Accountable Care Organization:

1)  Complete and timely information about patients and the services they are receiving;

2)  Technology and skills for population management and coordination of care;

3)  Adequate resources for patient education and self-management support;

4)  A culture of teamwork among the staff of the practice;

5)  Coordinated relationships with specialists and other providers;

6)  The ability to measure and report on the quality of care;

7)  Infrastructure and skills for management of financial risk;

8)  A commitment by the organization’s leadership to improving value as a top priority, and a system of operational accountability to drive improved performance.

Patient Burnout: Watch out before it gets too late

In Health, Healthcare, Medicine on June 11, 2012 at 8:00 am

“Good Morning Dr Aggarwal. I am back again”, said Mr C with an innocent smile on his face. “Yeah, long time no see”, I said, just to humor the situation. “What brings you back again so soon?”, I asked. “I continue to get the fatigue and pains all over”, he said. This is after we have ruled out most of the organic disorders including thyroid issues, sleep apnea, electrolyte imbalances,lyme disease vitamin deficiencies and many others. I saw him strongly and said,”seems like you are stressed or depressed, are you?’. The wife immediately jumps from her chair and said, ‘He is always thinking about something. He does not sleep well because of that. All day long, he just sits and thinks”.

This is a very common situation in Primary care office. Patients are afraid to admit their true symptoms and continue feeling that they have something major going on. It is very hard to treat patients with such attitudes, which unfortunately are the majority of our patient population. People do not want to digest the fact that they could be stressed or depressed. It is still a taboo for many to be labelled as depressed being. Struggle to find what is wrong leads to ‘Patient Burnout’.

We all have heard of doctors being overwhelmed with their work because of long hours, stress related to performance and administrative hassles leading to ‘Burnout’.  But I feel, what goes un-noticed most of the time is patient burnout.

Burnout leads to patients being frustrated even more. They keep visiting multiple doctors to get the answers they want which does not exist. Adding frustrations and elaborate testing leads to ‘Patient Burnout’. Not that it is something that is easily fixable, but definitely needs more attention.

Factors leading to Patient Burnout

  • Repeated visits to Healthcare providers
  • Multiple tests
  • No clinical evidence of any particular disease after extensive testing
  • Difficult family situation
  • Difficult work situation
  • Retired
  • Living alone


  • Fatigue
  • Stress
  • Pains
  • Headache
  • Stomach upset

It gets overwhelming for physicians to keep doing a zillion dollar workup and find no strong evidence of any particular disease at the end. The fix to the problem is not easy. But one thing that providers can do it to engage the patients in a dialogue. Have them analyze what exactly is going on in their psychosocial arena that could be contributing to this. Encouraging patients to get into healthy habits including diet control, exercising, yoga and meditation are some of the magical things that they can teach the patients. Getting to the bottom of the problem is must.


  • Have patient summarize their thoughts on the problem
  • Have them identify their psychological makeup
  • Reassure them
  • Encourage them
  • Recommend Lifestyle Modifications
  • See them periodically to assess their progress
  • Provide self-education and stress management  materials
  • Offer support

Identifying and Managing certain psychological issues are  challenges for most  physicians. But a streamlined thought process to catch these problems help patients avoid the burnout.

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