Randomly Placed Haiku…Great!

So, in my prolific web/headline surfing I have become fond of, I often find myself viewing items I wouldn’t have expected. Today, I was reading through hundreds of reader-entered Haiku poems for a contest. The poems are for, and supposed to be about, Font. Typeset. For a dictionary. The Helvetica documentary to be specific.

Most were like this (by Dan):

Windows user feels
Confused by Helvetica
loves Times New Roman

Some were good (by Meg):
arial, my love
plain, yet fresh… glass of cold milk.
drink you in ten point.

About mid-way down the list I found this (by Sean):

Dale Earnhardt so sad
Helvetica not on car
Mullets at half mast

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Why I Don't Feel Bad About Medicare Fraud

In the past week, I’ve noticed two different reports of instances where an individual has defrauded Medicare for millions of dollars through billing for Physical Therapy Services.

This guy in Trenton, NJ.

And this guy in Detroit.

Now, according to reports, the prevalence of this crime is growing. But what does Medicare know about opporunities for fraud within its system?

An Example: In May 2006, a report was issued by the The Department of Health and Human Services, Office of Inspector General regarding Medicare Billing for Physical Therapy by Physicians and the “incident to” rule.

Here are some excerpts from that report:

  • “Physical therapy billed directly by physicians represented approximately $158 million out of a total of approximately $528 million for physical therapy claims billed to the Part B carriers and allowed by Medicare in the first 6 months of 2002. Medicare allows physicians to submit claims for physical therapy that they do not perform personally, as long as the services are an “integral, although incidental, part of the physicians’ personal professional services in the course of diagnosis or treatment of an injury or illness.”2 The total allowed for physicians’ physical therapy claims has increased from $353 million in 2002 to $509 million in 2004, and the number of physicians who billed for more than $1 million in physical therapy has more than doubled, from 15 to 38 in the same 2-year period.”

  • “Under the “incident to” rule, licensed physical therapists need not perform the services, and Medicare currently does not require licensure or certification of staff that perform “incident to” physical therapy. However, in all other settings…Medicare requires that only licensed physical therapists can render physical therapy.”

  • “78 percent of physical therapy rendered in physicians’ offices did not represent true physical therapy”

  • “Ninety-one percent of physical therapy billed by physicians and allowed by Medicare during the first 6 months of 2002 did not meet program requirements, resulting in $136 million in improper payments.”

  • “Because of inadequate documentation, reviewers had difficulty assessing the quality of the therapy services.”

  • “One beneficiary in our sample received 15 months of physical therapy for lumbago and osteoarthritis, for which Medicare allowed $39,126. The beneficiary’s physician did not document a plan of care and did not establish medical necessity for the services. The physician, a general practitioner, billed physical therapy to Medicare for 672 patients in 2002, an average of 27 patients per day. In 2002, Medicare allowed $752,531 for this physician’s physical therapy claims.”

WOW!

And, the report’s conclusions and recommendations:

“…we have decided not to issue a report that would include formal recommendations to CMS. Instead, we are transmitting this summary of our review in the event that the information will be useful CMS’ s review of the physical therapy benefit and future considerations of the “incident to” rule.”

Translation: They did NOTHING!

If Medicare doesn’t act to reduce the opportunity for fraudulent billing, how can they ever expect not to have fraudulent billing. Granted, the instances in the news were not physicians, but the point of bringing up this report was to highlight the number and type of loopholes in this system that go unchecked. If you want to attract a mouse, put out some cheese!

I am glad they caught these criminals, however.

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Media Reporting Of Research

As I was writing this post about smoking cessation and exercise for The Metro Spirit, I felt kind of cheap. The reason: I was extolling the benefits of a study “recently released.” I usually have a big problem with media reports of new studies. We know there is a problem with science literacy, and media reports often have mis-representations of the signifigance or implications of new research.

A quick search found an example of a media report entitled,

This report detailed the observation of only 32 out of the thousands of individuals who have weight loss surgery. There was no risk:benefit analyisis and the researcher even refused to comment on how common the occurence of this issue is among people treated for weight loss with surgery. The research seemed solid, but the fright-factor of the headline seems out of place.

I have decided, therefore, to pay more attention to the type of evidence I’m writing about. Type of evidence you say?

Levels of Evidence

Scientific research/evidence is broken down into levels.
Or here.

At the bottom is case reports, which are simple observations recorded objectively. Further up, there are Randomized Controlled Trials (RCTs), which are good prospective studies where one can begin to imply causality. At the top are Systematic Reviews (SR), where statistical researchers sort through only the best RCTs and hold them to high standards. The conclusions of a SR can be held in very high regard.

For what its worth, and your still reading this, the study about smoking I mentioned above was a Systematic Review. I just want everyone to know that as I do my part to advance science literacy…(and release my inner nerd energy.)

I will hereby vow from now on, to report the level of evidence in articles I’m citing when appropriate. I’ll simply tell you Good, Fair, or Less Than Solid.

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More Thoughts on Whaling

Today’s New York Times had a great article on the Japanese “tradition” of whaling. I decided to post this as a follow-up to my previous whaling post.

My favorite quote from the article:

“It’s not because Japanese want to eat whale meat,” Ms. Okubo said. “It’s because they don’t like being told not to eat it by foreigners.”

This is a well written piece that offers some great perspective and information on the subject. It’s helped me to understand why Japan is so insistent on the issue. I couldn’t beleive it when the article explained how the U.S. actually introduced this “tradition” to Japan!

Apparently whale meat is “strong smelling” and they need to stew it in ketchup to mask its flavor. The thing that still bothers me: Tradition or not, there is a reluctance by those favoring whaling to acknowledge these animals as highly evolved mammals, that fall a little too close to us on the evolutionary chain. Should we really eat them?

Whales, Dophins, Elephants, Gorillas, Oh my!

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Coffee = Fiber!

I guess I find it odd that no one looked for this before now, but some food chemists finally decided to stop assuming that fiber is only consumed via plants, and checked out my cup of coffee for fiber. They found it!

“A “grande” (medium size) cup at Starbucks, for instance, is 473 milliliters (or 16 ounces) and could pack as much as three grams of fiber, about the same as a raw apple and 20 percent or more of the average American’s daily intake.”

I guess my body knows what it’s doing each morning when I crave massive amounts of the stuff.

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A Glimmer of Marketing Hope…

In a news release today, the American Physical Therapy Association reported that its Board of Directors had voted to create a grant program to help state chapters market the profession.

“The grants program will include, but not be limited to, public relations and advertising initiatives and activities — such as airing of APTA’s television/radio/print advertisements, National Physical Therapy Month efforts, booths for state events, direct mailings, public speaking on physical therapy professional topics, and other community awareness initiatives. Through the activities and initiatives supported by these grants, consumers will learn more about the services provided by physical therapists…”
Now, if the APTA could just make cooler commercials…

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The Unspoken Legacy

In earlier posts I have mentioned some instances where scientists have felt “limited” in their ability to speak freely about climate change. Today, a report in the Seattle Post-Intelligencer outlines another such instance. Scientists from the Fish and Wildlife Service were told on two separate occasions not to discuss the effect climate change has on polar bears. This, in reference to their upcoming meetings in Norway and Russia about polar bears. A third memo says the policy will apply for trips to those two nations as well as Canada and “any northern country.”

You see, polar bears are being considered for addition to the endangered species list. While their numbers are still fairly strong, there is mounting evidence that speaks to changes in the ice sheets they use seasonally for hunting. There has also been reports of polar bears showing up in odd places hunting. From what I can tell, ANY discussion of value about polar bear conservation must include discussion of climate change. I’m not learned in diplomatic protocol, so perhaps I am mistaken, but when administration officials report, “the memos were written to ensure that U.S. representatives wouldn’t stray outside the agenda of meetings, which they said would be a violation of diplomatic protocol,” I grow even more skeptical.

Any censoring of free speech is dangerous. And I understand the US has to tread dialogue on certain topics very carefully, but censoring of the opinions of scientists by this administration sets a frightening precedent. Scientists need complete autonomy from outside influence if we are to ever trust their facts. (And yes, it makes no sense that we should be expected to trust pharmaceutical scientists.)

If you want to learn more about Polar Bears, check out this article, written by one of the aforementioned Fish and Wildlife scientists, or Polar Bears International, which has good information, but a board of directors made up of only lawyers and marketing professionals…not scientists.

Other instances in which the administration has recently restricted scientists from discussing climate change include:

  • In June, a high-ranking official in the National Aeronauticsand Space Administration admitted in a letter to Sens. Joseph Lieberman, D-Conn., and Susan Collins, R-Maine, that the agency “inappropriately” denied a journalist’s request to interview James
    Hansen, an outspoken scientist who heads NASA’s Goddard Institute for
    Space Studies.
  • In September, news accounts revealed that the National
    Oceanic and Atmospheric Administration had suppressed an internal
    agency e-mail intended to summarize scientists’ consensus on evidence
    of a link between hurricanes and climate change.
  • In December, two scientists from NOAA said they were
    forbidden to use the term “climate change” or to mention Kyoto, the
    Japanese city where the current international treaty on global warming
    was negotiated.

Source: “P-I reporters Robert McClure and Lisa Stiffler contributed to this report, which includes information from The New York Times.”

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The American Dream

I read this NYT article about Ernest Gallo with fascination. He lived every facet of the typical American dream. Second generation Italian immigrant, parents died in tragedy, took $5,900 and, with his brother, created an entirely family run business that now sells 1 of every 4 bottles of wine in this country. Wow!
The best part, his first wine recipe: from a book at the Public Library in Modesto, CA. He died there yesterday, at 97, still in full control of his empire.

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