Its Not Just Profit Wrecking American Healthcare By Maggie Mahar May 15 2017 Technology Innovation Inequality Public Private Institutions Laws Patents Institutions Policy Politics A look at Americas strange and dangerous approach to medicine and how to fix it Editors note Journalist and author Maggie Mahar has written extensively about Americas distorted approach to healthcare Her book MoneyDriven Medicine The Real Reason Health Care Costs So Much Harper Collins 2006 was made into a 2009 film by Alex Gibney In a 2part series Mahar shares her thoughts on wasteful medical spending the Affordable Care Act whats possible under Trump and more Americans can be glad that the Affordable Care Act has brought medical care to millions of the previously uninsured and underinsured Nevertheless our healthcare system remains hugely expensive and wildly inefficient Too often care isnt well coordinated Meanwhile we dont have enough unbiased research showing which treatments are most effective Everyone just assumes that the newest most expensive product or procedure must be the best As a result we now spend over 33 trillion a year or roughly 10000 per person on healthcare more than any other nation on the planet Why is our bill so high It begins with overtreatment In Medicine More is Not Better In the laissezfaire chaos that we call a healthcare system one out of three dollars is squandered on unnecessary tests overpriced drugs and treatments that provide little or no benefit to patients This may seem an outrageous statement but nearly three decades of research done by doctors at Dartmouths Medical School demonstrate the waste Others including McKinsey the New England Institute of Medicine and Dr Donald Berwick former acting director of the Centers for Medicare and Medicaid confirm their estimate 30 percent of the money we lay out for medical products and services does nothing to improve patients outcomes Part of the problem is that some providers simply order more tests and recommend more surgeries than others yet research shows that their patients fare no better It doesnt seem to matter whether a governmentcontrolled program like Medicare or private insurers are paying the bills in recent decades medical spending has headed toward the skies From 1970 to 2006 private insurers reimbursements for care soared by an average of 97 percent each and every year Medicare pays doctors and hospitals less but even so Medicare payments for medical services and products climbed by an average of 87 percent annually The point is this Neither the public sector nor the private sector has found a way to cut the waste and rein in the underlying cost of care Since the Affordable Care Act passed in 2010 health care inflation has slowed But not enough it still outpaces economic growth Follow the Money If we want to trim the tab it makes sense to ask Just where is all of that money going As the pie chart below shows in 2012 roughly 60 percent of our health care dollars flowed to a combination of hospitals 316 percent physicians 202 percent and drug makers 94 percent Since the Kaiser Family foundation published this chart doctors and hospital fees have climbed while drug prices have skyrocketed they now account for roughly 17 percent of the pie Add in the rising cost of medical devices which often are sold by pharmaceutical companies and its safe to say those companies are drawing 20 percent of our health care dollars But what about the cost of private insurance Many Americans believe that US healthcare is so costly because we rely on forprofit insurers rather the government to deliver much of our care Insurers critics suspect that a large share of our premium dollars go to fund lavish executives salaries advertising lobbyists and profits But if you take a close like at the footnotes at the bottom of the pie chart youll find that the net cost of private insurance is just one part of a rather small slice of the pie labeled other health spending 151 percent a category that also includes medical research and spending on public health In fact as a Commonwealth Fund report shows from 2012 to 2014 insurers spent 87 to 88 percent of premiums just paying claims leaving relatively little to pay the salaries of the thousands of employees who provide customer service the clerks who enroll and disenroll customers and all of the other administrative costs of a laborintensive business The truth is that health insurance is not a hugely profitable industry profit margins often run in the low single digits By contrast large drug companies regularly report doubledigit margins In 2014 the first full year of Obamacare only about 13 of insurers generated any profit the rest lost money This explains why forpofit insurers like United Healthcare are no longer participating in ObamaCare The folks who tell you that the ACA was drafted to enrich insurers just werent paying attention Insurers went along with the plan only because they assumed Obama would be a oneterm president and then they could fix it to suit their own interests I wrote about this here Under Obamacare as more Americans signed up for insurance weve seen that hospitals doctors drugmakers and devicemakers gained more customers For them more patients mean more revenues But for insurers more customers mean more claims Nevertheless many Americans have convinced themselves that the Affordable Care Act represented a windfall for the insurance industry In a 2014 Washington Post column Ezra Klein explains why this assumption is wrong Insurers are the bogeymen of American health care Thats in part because theyre the ones who say you cant get something you want who your bosses blame when they deduct more money from your paycheck to cover health costsPoliticians who routinely rail against forprofit insurers are scared to criticize those who do make money on Obamacare forprofit hospitals doctors or device manufacturers though drug companies come in for a drubbing now and then These are the people who work every day to save our lives even if they make us pay dearly for the privilege No one wants to blame Ultimately if one of the goals of reform is to reduce the cost of care the insurance industry is not the best place to look Thats simply not where the money is Klein sums up the facts In 2009 Forbes ranked health insurance as the 35th most profitable industry with an anemic 22 percent return on revenue The pharmaceutical industry was in third place with a 199 percent return and the medical products and equipment industry was right behind it with a 163 percent return Meanwhile doctors are more likely than members of any other profession to have incomes in the top 1 percent The Business of Medicine When all is said and done what makes American healthcare unique and uniquely expensive is that the US is the only country in the developed world that has chosen to turn medicine into a forprofit enterprise In Western Europe a hybrid healthcare system includes both private insurance and government plans The government regulates it deciding how much doctors drugmakers hospitals and insurers can charge but it doesnt run the system By contrast Canada the UK have single payer systems controlled by the government Everyone must have insurance and everyone must pay taxes to fund it But from the beginning our health care system was built on a freemarket platform Traditionally we have treated medicine as more of a cottage industry with individual doctors drugmakers and hospitals making their own rules In the 1940s and1950s doctors pretty much charged what they wanted though their fees were quite small and often they charged poor patients nothing After all back then doctors didnt have miracle drugs or MRIs At best they could comfort people bear witness to their suffering deliver babies and set broken bones But as technology began to advance and more and more people had access to that technology medicine would become a growth industry This was one of the unintended consequences of Medicare In 1965 President Lyndon Johnson was determined to push Medicare legislation through Congress despite violent opposition from members of the American Medical Association who wanted to keep the government from meddling in their business Physicians feared socialized medicine and price regulation In an interview with Roger Mudd one of LBJs advisors recalled a meeting where the president said Weve got to get this bill out of the Way and Means committee what will it take Larry OBrien the administrations liaison to Congress told him We have to give doctors what they want and hospitals what they want What they wanted was the freedom to set their own prices What will it cost Johnson asked Half a billion dollars a year OBrien replied Johnson said Only 500 million a year Give it to them Lets get the bill At about the same time medical school enrollments doubled thanks to a generously funded federal program and Johnson reasoned that with more doctors in the marketplace the cost of healthcare would come down Johnson was wrong As usual Medicine would ignore the laws of supply and demand Sick people dont comparison shop someone dying of cancer doesnt wait for the price of chemotherapy to fall Instinctively Americans believed that more expensive care must be better care You get what you pay for When it came to their health they wanted the best This is when healthcare inflation began to take off With the advent of Medicare and Medicaid the government put enough money on the table to seed a burgeoning industry With both Washington and private insurers greasing the wheels of commerce medicine was on its way to becoming a highly profitable business Up until that point only 70 percent of the population had health insurance and often it only covered hospital costs not doctors and drugs Now seniors and many of the poor had access to care that reimbursed for physician visits as well as hospitals stays Only Medicaid put a limit on prices this is why many doctor refused to take it Following Medicares example more employers began to offer comprehensive health insurance After all they could write off the cost on their taxes At the same time more physicians became specialists and as their numbers increased so did their fees Meanwhile a burgeoning industry attracted entrepreneurs who would invent an endless stream of new services and products Everyone knew there was money to be made Inevitably in the1960s the forprofit hospital was born From 1960 to 1970 the nations health care bill snowballed from 27 billion to 73 billion Along the way the governments share soared in 1965 taxpayers shelled out 108 billion for healthcare five years later they paid 278 billion The New New Thing In the 21st century what is the biggest factor pushing our healthcare tab higher Innovation says Princeton health care economist Uwe Reinhardt Speaking at the World Healthcare Congress Europe in 2008 he explained that our forprofit healthcare industry will continue developing new stuff Will that new stuff in the form of new drugs devices tests and procedures be worth it Some of it will be and some of it will not As medical technology advances and becomes more expensive it does not necessarily become more effective A 2006 study in the medical journal Health Affairs reveals that over the preceding decade while spending on new technologies designed to treat heart disease climbed the share of patients who survived flattened out In many areas we seem to have reached a point of diminishing returns Its time for evidencebased medicine healthcare based on objective research comparing the effectiveness of various treatments for individual patients That is what the Affordable Care Act sets out to do In Part 2 of this post I will discuss the ACA whether it will be replaced and how it can be improved Maggie Mahar Share your perspective Sorry the browser you are using is not currently supported Disqus actively supports the following browsers Firefox Chrome Internet Explorer 11 Safari Dea Hagalaz 1 year ago J Moore 1 month ago Absolutely correct I couldnt agree more ANYONE whalf a god damn brain know insurance companies make a killing killing people Older people are scared by Fox News wrationing health care or death panels while this actually happen every day in the US but it has a different name being poor waiting for approval for a procedure The profit has to be taken out of the health care system The Koch brothers funded Mercatus Institute study said the cost of Medicare for all MFA would cost 32Trillion over 10 years httpswwwmercatusorgsy Trump Paul Ryan others bold faced lied to the public saying theres no way to pay this amount even if we doubled all the taxes the government takes in Theyre misleading everyone because the study does say this but they dont say the public WILL pay nearly 35Trillion with the current system asis They conveniently leave out that very important fact the American people will pay nearly 35Trillion anyhow fear monger saying theres no way to pay I know is stated the same information twice but its very important The US citizen has a shorter life expectancy higher infant mortality Julie Epps 1 year ago Where is part 2 of this post Very interested in reading it Maggie Mahar 1 year ago kokobell616 Too often people talk about Big Money as if its a monolith of corporations and wealthy individuals who all share the same interests In fact while drugmakers devicemakers profit from high prices and lobbyists for the American Hospital Association and the AMA may favor high prices other large corporations would benefit if healthcare prices slipped Here Im thinking of corporations that are paying a large share of employees health benefits most large companies pay about 80 of premiums as well as health insurance companies who struggle when prices rise For labor intensive industries the cost of health care benefits has become a real problem They have been trying to shift costs to employee through higher deductible copays but theres a limit to what they can do If costsharing becomes too expensive for employees the healthiest simply wont participate which hikes the cost of care for everyone else Moreover if health benefits become less attractive to employees that then undermines the motive for providing benefits in the first placeto keep your best employees locked in to the company What about Wall Street Investors who invest abroad dont generally care much about medical pricesunless they are heavily invested in pharmaceutical companies Wall Street bankers have no particular reason to favor high health care prices There is just one large group that opposes trying to regulate pricesconservatives who believe that the market should set prices and no one else should interfere But at this point even Republicans are objecting to soaring drug device pricesSee what Trump has said on the topic I think these companies will come under price regulation in the next 2 or 3 years Meanwhile Medicare will continue to chip away at hospital prices by penalizing them for inefficiency preventable medical errors and rewarding them only for Valuebetter outcomes at a lower price Maggie Mahar 1 year ago JADodd The ACA did not try to directly control provider costs because the architects of the plan knew that the legislation would never pass Congress is it attempted to regulate doctors fees or hospital charges The AMA and the AHA are powerful lobbyists No one that I talked to thought that insurers would or could control provider costs Individual insurers just arent big enough to do that Though the fact that more and more insurers are excluding doctors and hospitals that overcharge from their networks is calling attention to the fact that some fee schedules are over the top Meanwhile more and more research is coming out showing that more expensive care is not necessarily better care Sometimes outcomes are worse because patients are being overtreatedputting them at greater risk without benefit As patients try outofnetwork doctors and hospitals they are discovering that these providers are just as good If you look at how other countries that control provider costs its clear that only government has the clout to negotiate with doctors hospitals and drugmakers A great many reformers recognize that fact This is why they are calling for legislation that would let Medicare bring down drug prices by refusing to pay more for a new drug unless disinterested research shows that it is truly that much effectiveat least for certain patients Electronic medical records let us see how a certain drug effect patients who fit a particular medical profile Places like the Mayo Clinic and Kaiser Permanente are using that information to decide which drugs to prescribe to which patients There are signs that Medicare with beginning negotiating drug prices in the next year or two Even Trump has targeted the drugmakers And private insurers has said that if Medicare takes the lead they will follow suit Private insurers just dont want to take the blame Meanwhile the ACA is moving us away from feeforservvice payments which encourage doctors and hospitals to do more by creating accountable care organizations that pay for value better outcomes rather than volume And more and more doctors are working for large organizations like Kaiser Permanente or for hospitals where they work on salary None of this can happen quickly For one we can not reasonably expect that specialists would accept a sudden 20 cut in their incomes Too many would simply retire Nor can hospitals suddenly slash their charges Too many would close But the ACA is encouraging them to become more efficientfor example by refusing to pay for avoidable medical errors And as hospitals become more efficient they will be able to provide better are for less By changing how we pay for carefocusing on rewarding providers for better outcomeswe can cap health care inflation at say 2 a year Former CBO director Peter Orszag has written some excellent columns about this See his pieces on Bloombergcom kokobell616 1 year ago A for profit system for Medical inovations and achievment with desired outcomes all depends on what outcomes your looking for If its profits America wins hands down Anything else meh Maggie Mahar 1 year ago kokobell616 You are too pessimistic We are already beginning to move toward a valuebased system that rewards better outcomes and punishes waste and inefficiency The best hospitals are already working on reining in costs by reducing medical errors and following up with patients after discharge to reduce the number who have to be readmitted And more primary care doctors are emphasizing preventive care while some are forming medical homes that are paid more if they manage to keep their patients out of the hospital JADodd 1 year ago The ACA did absolutely nothing to directly control provider costs The assumption was that creating a competitive market for group and individual health insurance would force the insurance companies to do that for the government This neoliberal approach simply failed kokobell616 1 year ago Liberalism in economics refers to a freeing of the economy by eliminating regulations and barriers that restrict what actors can do Neoliberal policies aim for a laissezfaire approach to economic development Read more Neoliberalism httpwwwinvestopediacom Follow us Investopedia on Facebook Im not sure I understand your point Is the outcome from the ACA what you desired or not I myself am a firm believer in a single payer type system Maggie Mahar 1 year ago Kokobelll1616 As I will explain in part 2 of this post other countries in the developed world spend far less on on healthcare per capita as a of GDP because they Regulate the Priices that drugmakers doctors devicemakers and hospitals can charge Price regulationthat is the key to their lower costs Most of these countries do not have SinglePayer This includes all of continental Western Europemany developed countries in Asia Israel etc All of these nations use a multipayer system that includes private insurers But all of the players are regulated Providers and producers can not just charge whatever they choose Insurers also are regulated Among developed countries in the West only Canada the UK have singlepayerand their systems are not as successful in terms of outcomes or as wellliked by patients as systems in Germany France Switzerland etc There are many problems with singlepayer A conservative government can gut the health care system by defunding it This happened in the UK under Thatcher If govt restricts how many procedures doctors can do waiting times can be long This has happened in Canada Long waiting times are not necessarily bad It give the patient many months to think about whether he really wants a hip replacement or other elective surgery But Americans would be very unhappy if they had to wait a year And eye surgeons would be up in arms if they were told that they could only do so many surgeries per yearwhich is the case in some Provinces in Canada In the US lobbyists would have an enormous influence on a single payer system making it impossible to reduce prices for drugs and devices specialists and brandname hospitals that charge more for a surgery simply because they can Unless we make running for office much much cheaper by barring TV advertising and shortening the election period to 6 months or less as in other countries our politicians will continue to need huge contributions from lobbyists giving them enormous power This is not going to happen anytime soon Our television industry would be crippled if it lost the revenues from election season ads Moreover a govtrun health care system would not necessarily be more efficient Medicare for example is enormously waterfall Much research reveals that 13 of Medicare dollars are wasted on ineffective overpriced treatments that provide no benefit to the patientwhile putting him at additional risk And 90 of US seniors buy private insurance to supplement Medicarebecause there are so many crucial things it doesnt cover including hospital stays over 3060 days at that point the patients Daily Copays soar Insurers like Kaiser Permanente do a much better job than Medicare at keeping people wellby emphasizing preventive treatment keeping doctors on salary so they dont have an incentive to overtreat because theyre paid feeforservice and running relatively spartan hospitals No marbled lobbies with waterfalls no spalike amenities Yet docs line up to work for Kaiser a long waiting list and in places like California patient stick with KP for generations Kaiser P is a nonprofit and there is every indication that under Obamacare nonprofit insurers will take over Froproifts are already getting out The Obamacare regulations have whacked their profits Meanwhiile Kaiser P and the nonprofit Blues are expanding in the Obama care market Some blues operate more like forprofit insurers but some are very good As Obamacare is improved I suspect well get the public option that Senator Joe Lieberman killed largely out of spite He hated Obama Lieberman had the power to kill the whole billby leading a filibuster He also had the 60th vote that was needed to pass the ACA Everyone knew that he could and would kill the whole bill if it included a public option As Lieberman put it I wont let that the public option happen To compete with insurers like Kaiser P the public option will have to be far more efficient that Medicare I hope it will be Many Americans would welcome a govt alternative to private sector insurance but they are not willing to be forced into a govtrun health care system with no other options Americans dont trust govt And rightly solook at who we just elected Would you want to be in a singlepayer system run by Trump and todays GOP kokobell616 1 year ago perhaps medicare for all as an option would be the way for the US to move forward with health care Make it available as an alternitive to private insurance Here in Michigan we have a no fault insurance Along with that fair policy which is mandated we have a fund for catistrrophic care This is about 120 per policy Collected by the insures distibuted by a commision heaed by a state employee with no oversite from the puiblic My point is what would happen to the need to have such a system Maggie Mahar 1 year ago kokobell616 As I mention in the post a great deal of research shows that 13 of Medicare dollars are wasted on ineffective procedures and products that provide no benefit to the patient Some examples most spine surgery for lower back pain practically all PSA testing Overpriced artificial hips and knees that are no better than less expensive modelsand often worse because we know less about their risks unnecessary drugs many older seniors are overmedicated Clearly it doesnt make sense to expand as program that is already wasting so much and in too many cases putting patients at risk by overtreating them Why so much waste in Medicare Congress is its board of directors and lobbyists for everyone who profits from these products and procedures wont let Congress cut anything One of the nice things about the ACA is that it specifically gives Medicare the freedom to experiment with new ways of treating patients and delivering care without have to go through Congress This has led to medicare to innovate in ways that are saving money improving the quality of care Ideally when we create a public option it will be different from Medicare and not subject to Congress deciding what it covers and how the treatment is delivered What a public option needs is an Independent Payment Advisory Board like the one that the ACA has created The folks on the board should be doctors and nurses who and unbiased medical researchers who dont take money from companies who can evaluate which treatments are most effective for patients who fit a particularly medical profile This is how much decisions are made in the UK and other countries The final l problems with Medicare there are so many holes in it It doesnt cover hospital stays that go over 3060 days at that point very very high copays kick in longterm care eye checks hearing checks glasses hearing aids This is why over 90 of people on Medicare also have to buy supplemental private insurance This is why Medicare for All would be very expensive Watch a Clip From Money Driven Medicine Your browser does not currently recognize any of the video formats available Click here to visit our frequently asked questions about HTML5 video Forget Taxes Warren Buffett Says The Real Problem Is Health Care Salvation JK Galbraith argued lies in the subversion of the conventional wisdom by the gradual encroachment of disquieting thought The emancipation of belief he writes is the most formidable of the tasks of reform the one on which all else depends

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O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O 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Clinical Interventions Hand Hygiene Aseptic Technique amp The Sterile Field Apr 01 2005 Aseptic Technique The Sterile Field Practice for Perioperative Nurses As of press time in March AORN is reviewing and updating its Recommended Practices for Maintaining a Sterile Field Go to wwwaornorg for more details P roper aseptic technique is one of the most fundamental and essential principles of infection control in the clinical and surgical setting The word aseptic is defined as without microorganisms and aseptic technique refers to specific practices which reduce the risk of postsurgical infections in patients by decreasing the likelihood that infectious agents will invade the body during clinical procedures These practices also are designed to help the surgical team avoid being exposed to blood body fluids tissue and other potentially infectious material OPIM during surgical procedures According to the organization EngenderHealth aseptic techniques are those which remove or kill microorganisms from hands and objects employ sterile instruments and other items reduce patients risk of exposure to microorganisms that can not be removed The usually harmless microorganisms found on the skin of a healthcare worker HCW may cause infection when introduced into an area of the patients body where they are not normally found such as into a clients internal organs during surgery These normal flora can also cause infection in an immunocompromised patient who is especially susceptible to infection Patients are also at risk of acquiring infections when bacteria from the patients own skin infect a wound when tissue has been damaged due to rough or excessive manipulation during surgery or when excessive bleeding makes the tissue susceptible to invasion by microorganisms According to EngenderHealth aseptic technique prepares patients for surgery safeguards against excessive manipulation and protects clients from microorganisms in the environment and on the Aseptic technique also encompasses practices performed immediately before and during a surgical procedure to reduce postoperative infection These include Handwashing Surgical scrub Using surgical barriers including sterile surgical drapes and proper personal protective equipment including head coverings surgical masks and gowns gloves and shoe coverings Patient surgical prep Maintaining a sterile field Using safe operative techniques Maintaining a safe environment in the operating room Proper preparation of the patient using an antimicrobial product prior to surgery is essential in reducing the number of microorganisms present on the patients skin The patients surgical site should be thoroughly cleaned and then an antiseptic applied to the skin The HCW should gently scrub the skin in a circular motion beginning in the center of the site and moving outward and using sterile sponges held by a sponge forceps Shaving is no longer recommended because it causes small nicks and breaks in the skin where bacteria can grow and multiply hair around the site may be clipped short Creating and maintaining a sterile field is an essential component of aseptic technique A sterile field is an area created by placing sterile surgical drapes around the patients surgical site and on the stand that will hold sterile instruments and other items needed during surgery When a HCW has donned proper sterile surgical attire the HCWs sterile area is the only area that should come in contact with the sterile field Only sterile objects and personnel may be allowed within the sterile field When a sterile field is created around a procedure site items below the level of the draped It is critical for HCWs to remember that only sterile items are free of potential infectious agents and that once a sterile object comes in contact with a nonsterile object surface or person or with dust or other airborne particles the object is no longer sterile To maintain the sterile field only sterile items should be placed within the sterile field The integrity of sterile packages should be preserved while being opened dispensed or transferred Remember that objects located below the level of the draped patient are unsterile HCWs should not reach across unsterile areas or to touch unsterile items prior to or during the surgical procedures and unsterile personnel should not reach across the sterile field or touch sterile items HCWs should recognize that a sterile or highlevel disinfected HLD barrier that has been penetrated wet cut or torn is considered to be contaminated and finally HCWs should be cognizant of how they move within or around the sterile field The sterile field may also be protected by creating a safe clean environment within the operating room Limiting the amount of foot traffic and activities in this area may help to reduce the number of bacteria that get kicked up in the atmosphere To maintain a safer environment the number of HCWs entering and exiting the OR should be limited all personnel who enter the room should wear proper PPE proper air handling and circulation should be established and before the patient is brought into the OR all surfaces that may have been contaminated during the last procedure should be There are a number of related actions that support aseptic technique The first is handwashing For more than 100 years research has shown that handwashing is the most important way to reduce the spread of infections in healthcare settings although HCWs wash their hands only about half as often as they should After all hands are the most common vehicle for transmitting infections so it is critical that HCWs understand the importance of proper handwashing practices In brief HCWs should wash their hands whenever there is a chance that they may have become contaminated they should be washed before beginning soiled the HCW may use an alcohol handrub until he or she can wash his or her hands at a sink Alcohol handrubs should be rubbed into the hands and fingernail areas and allowed to dry before resuming any activity Proper gloving technique also facilitates the aseptic process Gloves provide a barrier against potentially infectious microorganisms that can be found in blood other body fluids and waste HCWs should wear the proper type of gloves whenever they might come into contact with blood and other body fluids and whenever they perform a clinical procedure that might put the patient and the HCW at risk of infection To avoid exposing one patient to potentially infectious microorganisms acquired from another patient HCWs must use fresh gloves every time they encounter a different patient making sure to wash their hands before and after Wearing proper PPE is a third way to support aseptic technique During surgical procedures both patients and HCWs are especially at risk of exposure to potentially infectious microorganisms Along with the other elements of aseptic technique proper surgical attire helps reduce the risk of postprocedure infections by decreasing the likelihood that microorganisms will enter areas of the patients body during procedures Some elements of surgical attire are also designed to reduce HCWs risk of exposure to potentially infectious blood and tissue during surgical procedures Surgical attire includes caps gloves masks gowns protective eyewear fluidproof aprons and footwear A fourth component of aseptic technique is surgical prep The warm moist conditions inside surgical gloves provide an ideal environment for the rapid growth of microorganisms so scrubbing with antiseptics before beginning surgical procedures will help prevent this rapid growth of microorganisms for a period of time and will reduce the risk of infections to the patient if the gloves develop holes tears or nicks during surgery Antimicrobial agents are used in the surgical scrub because they inhibit the growth and development of microorganisms and are safe for use on the skin A 3to5minute surgical scrub with an antiseptic such as chlorhexidine or an iodophor and running water is recommended before a surgical procedure EngenderHealth suggests that infection control practitioners ICPs can make significant strides in educating HCWs about infectionprevention practices at their healthcare institutions It recommends that ICPs Investigate whether proper aseptic technique is being followed in the OR and whether antiseptic products such as surgical scrubs and surface disinfectants are being used properly Hold regular inservice training for HCWs and provide updates on clinicalsurgical infection control techniques Information about proper infection control and prevention practices including all aspects of aseptic technique should be a part of this inservice training HCWs are often confused about the differences between antiseptics and disinfectants and often use these solutions inappropriately ICPs should ensure that proper use of antiseptic solutions is part of any inservice training ICPs should continue to serve as exemplary role models for OR personnel and other HCWs Model aseptic behavior during the course of the day and encourage colleagues to do the same If ICPs identify practices that endanger patients or staff or may promote the opportunity for infections it is their obligation to address the improper behavior TAGS Personal Protective Equipment Infections General HAIs Archive Epidemiology Surveillance

B O O O B I O O B O O O O B I O B O O O O O O O O O O O O O O O O O O O O O O B O O O O O O O O O B I O O O O O O O O O O O O O O B O O O O O O O O O O O O B I O O O O O O O O O O O O O O O O O O O O O O O O O B O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I O O O O O O O O O O O O O O O O O O O B I O O O O O O O O O O O O O O O O O O O O O O O O B O O O O O O O O O O O O O O O O O O O O O O O B O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B O O O O O O B I O B O O O O O O O B O O O O O O O O O O O O O O B O O O O O O O O O O O O O B O O O O B O O O O O O O O O O O O B O O B O O O O O O O O B O O O B O O O O O O O O O O O O O O O O O O O O O O O B O O O O O O O O O O O B O O O O O O O O O O O O O O O O O O O O O O O B O O O B O O B O O O O O O B O O O O B O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B O O O B O O O O O O B O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B O O B O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I O O O O O O O O O O O O O O O O O O O O O O O B I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O


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US Education Higher Education Cite Most Expensive US Colleges and Universities 20152016 The 20 most expensive colleges and universities in the United States exceed 60000 per year for tuition plus room and board and other required fees Rank College Total Cost 1 Harvey Mudd College 67255 2 Columbia University 66383 3 New York University 65860 4 Sarah Lawrence College 65630 5 University of Chicago 64965 6 Bard College at Simons Rock 64519 7 University of Southern California 64482 8 Claremont McKenna College 64325 9 Oberlin College 64266 10 Scripps College 64260 11 Bard College 64254 12 Haverford College 64216 13 Duke University 64188 14 Dartmouth College 64134 15 Northwestern University 63983 16 Trinity College 63970 17 Pitzer College 63880 18 Southern Methodist University 63840 19 Amherst College 63772 20 Johns Hopkins University 63750 NOTES Includes accredited fouryear universities offering at least a bachelors degree and having at least 800 students 1 Total Cost Tuition Room and Board Required Fees for academic year 2015â2016 Source Business Insider See also Colonial American and Ivy League Colleges FEN Learning FamilyEducation TeacherVision Fact Monster About Infoplease Part of FEN Learning RSS Contact Terms of Use Privacy Site Map Partnerships Affiliate Links Disclaimer 20002018 Sandbox Networks Inc publishing as Infoplease By continuing to use this site you give your consent to our use of cookies for analytics personalization and ads

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Home Pressure Calibrators Deadweight Testers DHBudenberg CPB5800 Deadweight Tester Single or dualrange hydraulic deadweight tester accurate to 0006 of reading Your browser does not currently recognize any of the video formats available Click here to visit our frequently asked questions about HTML5 video Your browser does not currently recognize any of the video formats available Click here to visit our frequently asked questions about HTML5 video Price Starting at 331200 Select Options and Add to Cart Includes FREE Ground Shipping FREE Lifetime Tech Support Manufactured by DHBudenberg Availability Not in stock Usually ships in 34 weeks Need Help Call 18008844967 MoTh 8am to 530pm Fr 8am to 5pm ET Overview Description Documents Accessories Applications Features Primary standard for pressure ranges up to 20000 psi Reference instrument for the test adjustment and calibration of pressure measuring instruments Selfcontained complete system suitable for industrial calibration labs or production testing Uncertainty to 0006 of reading Calibration certificate is traceable to the National Institute of Standards and Technology NIST High longterm stability with a recommended recalibration cycle of 5 years Masses manufactured from stainless steel Local gravity adjustment possible at no additional charge Optional automated environmental compensation

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Home Auto Insurance Full Coverage Car Insurance Rates By State Full coverage car insurance rates by state 7 min read By Michelle Megna Posted March 13 2017 No insurance policy can cover you and your car in every circumstance But a full coverage policy covers you in most of them Insurance is meant to protect you from being sued or left financially stranded by a totaled car or ruined by an uninsured driver That doesnt mean an accident wont leave you with expenses and hassles you wouldnt face otherwise Full coverage is shorthand for policies that cover not only your liability but damage to your car as well Heres how to weigh liability vs full coverage What is full coverage What does full coverage insurance cover Do I need full coverage How much does full coverage cost When should I drop full coverage What is full coverage To most drivers full coverage means you have bought not only liability insurance which is mandatory virtually everywhere and pays for the damage you inflict on other people and property but comprehensive and collision too Ideally full coverage means you have insurance in the types and amounts that are appropriate for your income assets and risk profile The point of all types of car insurance is to keep you from being financially ruined by an accident or incident Of course you can buy a policy with every conceivable option The highest available liability limits usually 250000 per person bodily injury 500000 per accident 100000 property damage The lowest possible deductible on collision and comprehensive coverage At some companies its 0 but 100 and 250 are common Uninsured motorist coverage Uninsuredunderinsured motorist bodily injury coverage with limits matching your liability coverage Uninsured motorist property damage not available in all states All available medical coverages in the highest amounts possible personal injury protection in nofault states and medical payments coverage in most others Rental reimbursement coverage Towing and labor Preferredcustomer addons such as new car replacement programs or vanishing deductibles In reality there is no policy that will cover you and your car in every situation just most of them What does full coverage insurance cover A typical full coverage policy liability comprehensive and collision uninsured motorist and medical coverage should cover The damage you do to others up to your liability limits Your car up to its fair market value minus your deductible if you are at fault or the other driver does not have insurance or if it is destroyed by a natural disaster or stolen Your injuries and those of your passengers if you are at fault up to the amount of your medical coverage Your injuries and yours of your passengers if you are hit by an uninsured motorist up to the limits of your uninsured motorist policy Typical full coverage insurance wont pay for Racing or other speed contests Offroad use Use in a carsharing program Catastrophes such as war or nuclear contamination Destruction or confiscation by government or civil authorities Using your vehicle for livery or delivery purposes business use Intentional damage Typical comprehensive and collision policies wont cover Freezing Wear and tear Mechanical breakdown often an optional coverage Tire damage Items stolen from the car those may be covered by your homeowners or renters policy if you have one A rental car while your own is being repaired an optional coverage Electronics that arent permanently attached Custom parts and equipment some small amount may be specified in the policy but you can usually add a rider for higher amounts Do I need full coverage You are required to have liability insurance or some other proof of financial responsibility in every state Coverage comes in varying levels from the mandatory minimum to as much as 500000 You as a car owner are on the hook personally for any injury or property damage beyond the limits you selected Your insurance company wont pay more than your limit But liability coverage wont pay to repair or replace your car If you owe money on your vehicle your lender will require that you buy collision and comprehensive coverage to protect its investment After you pay off the loan the choice to buy comp and collision is yours alone We have our own rules of thumb on insuring any car When the car is new and financed you have to have full coverage Keep your deductible manageable When the car is paid off raise your deductible to match your available savings When you reach a point financially where you can replace your car without the assistance of insurance seriously consider dropping comprehensive and collision Use Insurancecoms online car insurance calculator to get our recommendation of what car insurance coverage you should buy Itll also recommend deductible limits or if you need coverage for uninsured motorist coverage medpayPIP and umbrella insurance Car insurance coverage calculator How much does full coverage cost Car insurance rates are very specific to the person who owns the car Your age driving record credit history and location count as much as the kind of car you are driving Rates also vary by hundreds of dollars from company to company Thats why we always suggest as your first step to saving money that you compare quotes Heres a comparison of the average yearly cost of the following coverage levels by state Statemandated minimum liability or barebones coverage needed to legally drive a car Liability coverage of 50000 for those injured in an accident you cause up to 300000 per accident and 50000 for property damage you cause Full coverage liability of 100000 per person injured in an accident you cause up to 300000 per accident and 100000 for property damage you cause with a 1000 deductible for comprehensive and collision Full coverage iability of 100000 per person injured in an accident you cause up to 300000 per accident and 100000 for property damage you cause with a 500 deductible for comprehensive and collision Full coverage liability of 100000 per person in an accident you cause up to 300000 per accident and 100000 for property damage you cause with a 250 deductible for comprehensive and collision Search State Liability Only State Minimum 5010050 BIPD Full Coverage 1000 deductible Full Coverage 500 deductible Full Coverage 250 deductible Alaska 426 434 1350 1533 1677 Alabama 638 695 1772 2003 2194 Arkansas 616 678 1717 1921 2089 Arizona 600 696 1467 1635 1782 California 723 911 2268 2574 2771 Colorado 646 725 1598 1783 1938 Connecticut 1097 1278 2270 2424 2555 DC 1054 1139 2209 2531 2797 Delaware 1520 1553 2528 2816 3021 Florida 1058 1372 2410 2548 2680 Georgia 743 804 1823 1988 2156 Hawaii 386 422 980 1095 1187 Iowa 403 451 1177 1347 1539 Idaho 546 601 1369 1514 1667 Illinois 543 602 1307 1499 1649 Indiana 633 691 1498 1711 1912 Kansas 526 581 1372 1603 1783 Kentucky 607 663 1641 1814 1937 Louisiana 909 1143 2626 2819 2988 Massachusetts 866 996 1678 1950 2088 Maryland 958 1023 1795 2003 2163 Maine 513 519 1192 1367 1524 Michigan 2446 2145 3208 3535 3819 Minnesota 864 868 1574 1784 1962 Missouri 506 576 1355 1534 1708 Mississippi 639 701 1684 1856 1995 Montana 467 502 1698 1987 2189 North Carolina 385 426 918 979 1030 North Dakota 512 527 1475 1793 2053 Nebraska 472 508 1269 1480 1659 New Hampshire 587 629 1331 1514 1656 New Jersey 1086 1462 2377 2550 2735 New Mexico 612 652 1513 1675 1809 Nevada 641 786 1636 1770 1891 New York 891 973 1725 1923 2095 Ohio 579 602 1235 1392 1524 Oklahoma 712 805 2182 2476 2717 Oregon 1007 1072 1697 1855 1989 Pennsylvania 560 626 1427 1614 1772 Rhode Island 1026 1113 2014 2226 2417 South Carolina 654 717 1572 1741 1859 South Dakota 431 467 1309 1550 1766 Tennessee 656 717 1625 1810 1949 Texas 783 818 1983 2182 2317 Utah 629 685 1359 1485 1610 Virginia 536 600 1275 1418 1541 Vermont 487 541 1315 1470 1591 Washington 671 713 1516 1651 1773 Wisconsin 578 653 1649 1874 2123 West Virginia 669 773 1633 1886 2072 Wyoming 410 429 1345 1587 1792 Methodology The table shows the average annual rate for a 2015 Honda Accord LX culled from 10 ZIP codes in the state from the following carriers in no particular order Progressive Allstate State Farm Nationwide GEICO and Farmers Data was provided for Insurancecom by Quadrant Information Services New Hampshire doesnt require drivers to have car insurance but most drivers do and weve listed what is mandated if you choose to carry coverage When should I drop full coverage Our data show that 40 percent of drivers who own 10yearold model cars are buying comprehensive and collision coverage Many consider dropping these optional coverages on a car nearing the end of its life If you can manage such a loss that is replace a stolen or totaled car without a payout from insurance do the math on the potential savings For example a 25yearold woman with a clean driving record living in Stirling NJ would pay about 1302 a year for full coverage 5010050 liability uninsured motorist personal injury protection and comprehensive and collision coverage with a 500 deductible on a 10yearold Ford Focus ZX4 Dropping comprehensive and collision she would pay about 806 a year a savings of 496 a year Lets say her car is worth 4450 as the actual cash value an insurance company would pay If her car were totaled tomorrow and she still carried full coverage she would get a check for 3950 the actual cash value of the car minus her 500 deductible In other words she is paying 496 a year to protect herself against a 3950 loss Of course the value of the car drops with each passing year and so do the insurance premiums At a certain point most drivers would choose to accept the risk and bank the collision and comprehensive premiums because they would be unlikely to find a reliable replacement with the insurance payout

O O O B I B I O O O B I B I O O O O O O O O O O O O O O O O O O O O O O O O O O O B I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I O O O O O O O O O O O O O O O O O O O O O O O B I O O B I O O B I O O O O O B I O O O B I O O O O O B I O O B I O O O B I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I O O O O O O O O O O O O O O O O O O O O O O O O O B I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I O O O O B I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I O O O O O O O B I O O O O O O O O O O O O O O O O O O O O O O B I O O O O O B I O B I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I O O B I O O B I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I O O O O O O O O O O O O O O O O O O O O B I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O


Our Team At Insurity we are one single team of insurance and technology experts who is dedicated to meeting the needs of our clients in an everchanging market Leadership Team Meet the team that leads Insuritys people and products to deliver success Chris Giglio Chief Executive Officer Michele Shepard Chief Revenue Officer Bob Larew Chief Operating Officer Mitchell Wasserman Chief Product Officer Chris Lafond Chief Financial Officer Doreen Tyburski Chief Human Resource Officer Mark Adessky General Counsel Jonathan Victor Chief Information Officer Kirstin Marr President Valen Analytics Board of Directors Harry Taylor Managing Director TA Associates Ken Schiciano Managing Director TA Associates Alex Goor Board Member Paul Stamas Managing Director General Atlantic Raph Osnoss Vice President General Atlantic Preston McKenzie Special Advisor General Atlantic Ryan Clark President Managing Director Genstar Capital Dennis Chookaszian Strategic Advisor Genstar Capital David Wroe Strategic Advisor Insurity Chris Giglio CEO Insurity Chris Lafond Chief Financial Officer Insurity Ready for your next career challenge

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Frequently Asked Questions about Enhanced Intel SpeedStep Technology for Intel Mobile Processors Documentation Content Type Product Information Documentation Article ID 000005723 Last Reviewed 08152018 Click or the topic for details Where can I find processor speed processor number cache size chipset compatibility pricing and product order code information Find Intel Processor information by searching the If you can not find the Intel Processor you are looking for What are Nettops Nettops are a simplified version of your everyday desktop designed with a small form factor to be affordable and energy efficient The lowcost platform solution built around the with the is a simplified PC at subentry system price points This category of devices is aimed at content consumption rather than content creationbrowsing websites watching online video and streaming videos For more information see the What are mobile internet devices MIDs represent a new category of small mobile devices that allow you to communicate with others enjoy your favorite entertainment and access information on the go Consumer electronics and PC companies are using Intel Atom Processor technology to deliver exciting new products for consumers and business users The latest generation of small powerful highly portable Internet connected devices combines many great capabilities with the convenience of a pocket sized solution for your life on the go What are entrylevel desktop PCs What are home servers Home servers do more than traditional external hard drives Powered by Intel technology home server systems blend your digital life into a seamless experience the whole family can enjoy What is the Intel Atom Processorbased storage platform The delivers energyefficient performance for innovative home server and network attached storage NAS system designs Can I replace my aging laptop with a netbook A netbook doesnt have the processing power and functionality needed to run many of the applications your current laptop supports even if its a few years old A laptop powered by the is a good option How do I know if Im looking at a netbook If the computer in question is powered by an it is a netbook Laptops on the other hand may use one of a variety of Intel Processors Appearances can be misleading since many fullfeatured laptops have ultrathin and light designs Which operating systems are supported The driver for the Intel Atom Processor technology supports the following operating systems Which chipsets may be used with the Intel Atom Processors D410 and D510 The Intel Atom Processor D410 or the Intel Atom Processor D510 may be paired with the in an entrylevel desktop How can I encourage my kids interests in computers without unleashing them on my work PC Computers offer great opportunities for kids to learn and play Consider the value and easeofuse of a netbook which lets kids explore the Internet without interfering with your work Where can I find information about Intel Atom Processors If you can not find information on the Intel Atom Processor installed in your netbook or nettop system or your mobile internet device MID contact the system manufacturer or check the system manufacturers website Information specific to processor installed in your system is often only available through the netbook nettop or MID manufacturer The information below can help resolve issues with laptops or notebooks and Enhanced Intel SpeedStep Technology For the latest information contact your computer or mobile motherboard manufacturer About What is Enhanced Intel Speedstep Technology Enhanced Intel SpeedStep Technology is an advanced means of enabling very high performance while also meeting the powerconservation needs of mobile systems Requirements and compatibility Which Intel Processors support Enhanced Intel Speedstep Technology See the tool What are the system requirements to support Enhanced Intel Speedstep Technology Is Enhanced Intel Speedstep Technology compatible with Intel HyperThreading Technology Yes The operating system sees two virtual processors Requests to change the power state are prioritized between each virtual processor by the BIOS and the operating system The power state defaults to the virtual processor requesting the highest state Use and performance How do I use Enhanced Intel Speedstep Technology Follow the standard integration procedures for installing the various system hardware components If you are using Microsoft Windows XP install the Windows XP SP2 Make sure you have met all Once all hardware and software have been installed use following steps How do I determine if Enhanced Intel SpeedStep Technology is working with Microsoft Windows XP Why does the operating speed not change on my laptop when I go from AC to DC power or DC to AC power Why does my keyboard not work when I switch performance modes You need to update your keyboard BIOS Updates are typically available on the laptop manufacturers website Contact the manufacturer for more information For laptops running operating systems older than Microsoft Windows XP Why did the applet icon disappear from the task bar after I changed the power management settings In BIOS under the Power menu make sure that your Power Savings are set to or You can also access the applet through the Control Panel Why did the settings remain unchanged after I changed the power management settings in the applet This may be a BIOS issue Contact your laptop manufacturer and request a system BIOS upgrade Laptop manufacturers generally provide downloadable updated drivers Why does the applet icon not appear in the task bar This may be a BIOS issue Contact your laptop manufacturer and request a system BIOS update Laptop manufacturers generally provide downloadable updated drivers Once I remove the Enhanced Intel SpeedStep Technology applet icon from the taskbar how do I access the applet or bring back the icon You can always access the applet through the Control Panel To reenable the Enhanced Intel SpeedStep Technology taskbar icon

O B I O B I I O O O B I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I I O O O O O O O O O O O O O O O B I I O B I I O O O O O O O O O O O O O O O O O O O O O O O O O O B I I O O O O O O O O O O O B I I O O B I I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I I O O O

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perception clips for you to practice before your exam Start Driving Exam Free Extra Resources DVSA Questions for you to practice before you can do your car theory test exam Other Fees To Consider Book A Theory Test DVSA Practical Test Or Other Resources Theory Test Booking 23 DVSA THEORY TEST FEE DVSA Practical Test 62 DVSA PRACTICAL TEST FEE WEEKDAY PRICE Driving Resources From 499 THE MOST COMPREHENSIVE GUIDE TO PASS YOUR THEORY TEST All payments are made at the time of booking the course payments are to be made or by calling 0800 056 9418 only no other method of payment is accepted Whatever driving courses or driving lessons you need we are the driving school for you Your instructor is selfemployed and independent Where Intensivecoursescouk Ltd Driving School Agency makes bookings with or supplies any information or documentation to you or processes any payments for your lessons they act as the agent for your instructor Intensive Courses Price List When you do our intensive driving lessons you can be sure you are in the best hands We are the leading intensive course specialists in the UK We offer great value for money using the best intensive driving instructors We work around your diary and we come to you most postcodes are covered we will organise your theory and practical tests for you and your practical test will be booked for the last day of your driving course if you have not passed the theory test then the practical test will be booked once the theory test has been passed Generally you can start your driving lessons within two weeks in most postcodes that we cover once payment has been received We can help you to find a practical test for the date you want When booking your course just state when you would like your course to start and we will endeavour to find you a practical test for the end of your course some test centres have a longer waiting period than others All you need to do is concentrate on studying with our comprehensive theory test questions bank as it has over 960 questions and we also have the hazard perception clips to help you on your way to passing first time Our courses are flexible and we will work around you as much as possible we do lessons from a minimum of 25 hours per day you will only pay for lessons used any unused lessons are refunded back to you at the end of the course It couldnt be simpler to book one of our intensive driving courses all you need to do is check out the most suitable driving course for you below or if you are unsure which intensive driving course is best for you call the office on 0207 205 2251 who will talk you through the best options for you All prices and descriptions below include the day of your test the hours include from the first lesson to the drop off home after your practical test and are for our Intensive and SemiIntensive driving courses The descriptions below should only be used as a guide For Automatic Driving Lessons For more information about Intensive Driving Courses Generally you can start your driving lessons within two weeks in most postcodes that we cover once payment has been received We can help you to find a practical test for the date you want this will also depend on what dates are available on the DVSAs Governments website at the time of booking

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Back to Blog Major Changes to EM Coding and Documentation Under 2019 Medicare Physician Fee Schedule Proposed Rule by Bill Finerfrock on July 24 2018 at 107 PM On July 12 th the Centers for Medicare and Medicaid Services CMS released the 2019 Medicare Physician Fee Schedule PFS proposed rule This annual update to the regulation makes changes to Medicare Part B reimbursements for services covered under this and other outpatient payment models Under the proposed 2019 PFS CMS is making some major changes to Evaluation and Management EM coding and documentation requirements In this post the first of a three part series on the 2019 PFS proposed rule well cover new EM standards set under the proposed rule and how they might impact you as a provider The first of the proposed changes is to allow providers to base EM coding determinations on medical decisionmaking or time in addition to the current EM coding guidelines from 1995 and 1997 that are primarily based on providers work and cognitive labor This change is a result of criticism for the current guidelines of which rely on relatively subjective determinates that have caused a wide variance in EM level selection practices between hospitals at times resulting in compliance risks Another major change to EM billing being proposed by CMS in the 2019 PFS would be to pay a single rate for EM visit levels two through five CMS believes this will reduce the burden on providers by decreasing the amount of work and deliberation it takes to document the correct visit level and preventing the need for subsequent audits Additionally CMS believes such changes will eliminate the increasingly outdated distinction between the kinds of visits that are reflected in the current CPT code levels Since the 2019 conversion factor CF has not been finalized CMS modeled this proposed change based on the 2018 CF If the standardized EM reimbursement was in place in 2018 EM levels two through five would be paid at 135 for new patients and 93 for established patients The proposed 2019 CF update is only a slight change 006 from the finalized 2018 rate Therefore assuming the proposed 2019 CF is finalized the rates outlined in the 2018 model should be an accurate indication of what the actual rates will be under the proposed rule Further CMS is proposing to relax the requirement for teaching physicians to personally document their participation in an EM procedure in the medical record Currently providers under the supervision of teaching physicians can make notes in the medical record However the teaching provider is required to personally document their involvement In response to stakeholder feedback suggesting that this process is duplicative and burdensome CMS is proposing to change the requirements so that the medical record must only document that the teaching physician was present at the time the service was furnished Under the proposed rule the teaching physician does not CMS will be accepting comments on the proposed rule until September 10 2018 We will continue to keep you informed as updates become available

O O O O O O O O O O O O O B I I O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O

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major changes to e / m coding


Analytic Trigonometry 3 Double Angle Formulas 3 DoubleAngle Formulas by M Bourne The doubleangle formulas can be quite useful when we need to simplify complicated trigonometric expressions later With these formulas it is better to remember where they come from rather than trying to remember the actual formulas In this way you will understand it better and have less to clutter your memory with Sine of a Double Angle sin 2 α 2 sin α cos α Proof Recall from the last section the sine of the sum of two angles sin α β sin α cos β cos α sin β We will use this to obtain the sine of a double angle If we take the left hand side LHS sin α β and replace β with α we get sin α β sin α α sin 2 α Consider the RHS sin α cos β cos α sin β Since we replaced β in the LHS with α we need to do the same on the right side We do this and obtain sin α cos α cos α sin α 2 sin α cos α Putting our results for the LHS and RHS together we obtain the important result sin 2 α 2 sin α cos α This result is called the sine of a double angle It is useful for simplifying expressions later Continues below Cosine of a Double Angle Using a similar process we obtain the cosine of a double angle formula cos 2 α cos 2 α sin 2 α Proof This time we start with the cosine of the sum of two angles cos α β cos α cos β sin α sin β and once again replace β with α on both the LHS and RHS as follows LHS cos α α cos2 α RHS cos α cos α sin α sin α cos 2 α sin 2 α Different forms of the Cosine Double Angle Result By using the result sin 2 α cos 2 α 1 which we found in Trigonometric Identities we can write the RHS of the above formula as cos 2 α sin 2 α 1 sin 2 α sin 2 α 1 2sin 2 α Likewise we can substitute 1 cos 2 α for sin 2 α into our RHS and obtain cos 2 α sin 2 α cos 2 α 1 cos 2 α 2cos 2 α 1 Summary Cosine of a Double Angle The following have equivalent value and we can use whichever one we like depending on the situation cos 2α cos 2 α sin 2 α cos 2α 1 2 sin 2 α cos 2α 2 cos 2 α 1 Example 1 Find cos 60 by using the functions of 30 Answer Example 2 Find the exact value of cos 2x if sin x 1213 in Quadrant III Answer Exercises 1 Without finding x find the exact value of sin 2x if cos x 45 in Quadrant I Answer 2 Prove that 1tan2xsec2xcos2x Answer 3 Prove that 2 csc 2x tan x sec2x Answer 2 Sin cos tan of Sum of Two Angles 4 Half Angle Formulas

O O O O B I O O O O O O O O O O O O O O O O O O O B O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I


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