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brown water

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Everything posted by brown water

  1. Tucker runs a little slower than the others… FullSizeRender.mov FullSizeRender.mov
  2. We had to resort to photoshop to get a dignified picture of Gus. I believe Colonel Angus has been posted earlier but...
  3. They’re great dogs. Ours generally fall in the useless category though. In fact I damn near had the reverse situation when this dumbass fell in the pool last weekend.
  4. Chloe turned 10 yesterday. Some things never change…
  5. Doing the same thing with the family plus a small group my daughter’s high school friends before everyone heads in different directions for college. Would appreciate any recommendations you have about the stay. TIA.
  6. At least one is…
  7. KKKris KKKross Some of them try to crime but they can't crime like thisSome of them try to crime but they can't crime like thisSome of them try to crime but they can't crime like thisSome of them try to crime but they can't 'Cause I'm the Biggity Biggity Biggity Biggity Mac Daddy The Biggity Biggity Biggity Biggity Mac 'Cause I'm the Biggity Biggity Biggity Biggity Mac DaddyThe Biggity Biggity Biggity Biggity Mac
  8. SEC! SEC! SEC! This would be an easy swap on uniforms and t shirts
  9. To normal people... These are the ones who think wearing a mask or getting a vaccine is an unthinkable infringement on liberty. I hope there is a proportionate increase when it comes to prison time.
  10. Tonight’s 40 day dry aged ribeye. Dry brine starter Wednesday evening. Will post the final results.
  11. My Milkshake brings all the * Boys to the ** yard * Proud ** Prison
  12. And that’s fair. It shouldn’t be an offense either. But here we are.
  13. Found this. Not sure how credible the source but it’s consistent with the discussion I mentioned. https://www.kevinmd.com/blog/2014/08/oncologist-pay-chemotherapy-buy-bill-needs-stop.html Passage of new legislation: A step in the right direction? Congress attempted to fix the problem with passage of the Medicare Modernization Act (MMA) in 2003. The new law did not take away physician’s ability to buy chemotherapy drugs, administer them in-office or bill for them. However, it did alter the reimbursement structure. To bridge the gap between the price physicians pay for drugs and the pay they collect, the MMA developed a reimbursement model based on average sales price (ASP), plus a 6 percent markup and administrative fee. As part of this legislation, manufacturers are required to report a drug’s ASP to the Centers of Medicare and Medicaid Services (CMS) quarterly to substantiate reimbursements. This change did not address the problem. Oncologists maintained their income by altering their practice patterns. As the reimbursement for established medications decreased, oncologists have chosen to use progressively more expensive chemotherapy drugs with increased frequency of treatment. That’s because under the fee-for-service reimbursement model, each new treatment equals another payment. It’s difficult, if not impossible, to prove this shift is directly motivated by personal financial gain. But it’s also hard to deny the financial gain that resulted.
  14. I’ll try to run it down from an open source. I was a senior executive at US Oncology when it was acquired by McKesson (drug distributor) in 2010. The usage data relative to reimbursement model change was part of an internal public policy presentation.
  15. Much of the migration from clinics to hospitals happened for reasons similar to my prior post. Many hospitals qualified for even lower drug prices under a federal rule (340b) that was intended to subsidize hospitals that cared for underserved communities. Under 340b the significant drug discount created a windfall profit that was used to hire the oncologists out of private practice often for well more than they were currently earning. The point remains, the system puts in conflict patient outcomes, total cost to the system and economic incentives to financially rational actors.
  16. She’s not wrong about this. Medicare pays average sales price plus 6% for chemotherapy drugs. Large oncology practices with buying power negotiate lower than average prices from distributors while smaller practices typically pay more but everyone receives the same reimbursement. So, yes, oncologists do make money on chemotherapy and, frankly, it has been a obstacle (among others) to the uptake of personalized medicine where genomic testing may indicate a more effective treatment. In fact, in the early 2000s the Medicare reimbursement changed from average wholesale price plus 15% to average sales price plus 6% which significantly narrowed the margin made on drugs. As a result, the total amount of chemotherapy prescribed increased significantly. I wish it wasn’t true but like everywhere cost plus payment tends to yield more cost to generate more payments. In this case, the narrowing of margin produced more cost as physicians seemed to solve back for their otherwise lost income.
  17. Would Fullvarine be an acceptable compromise?
  18. Caption... Florida Georgia Whine embarks on the This Is How We Troll tour
  19. I’d find the place with the longest post arrival quarantine requirement. And then conveniently forget to mention the requirement.
  20. Chokkums Razor
Football ... Basketball ... Baseball ... Other Sports ... Futbol ... 🤫995🤫 ... Gambling ... Movies & TV ... Music ... Hobbies ... Lulz ... Food & Travel ... Daily Texan ... Business & Markets ... Cloak Room ... Help ... For Sale ... Board Discussion ... Advertise... Tailgate Donations

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