Bank of America Health Care Conference 2024 Presentation
Exact Sciences' Mission is to help eradicate cancer by preventing it, detecting it earlier and guiding treatment. In the early innings of how genomics will transform cancer prevention, diagnosis and treatment
Exact Sciences' Cologuard and Oncotype DX are two of the top brands ever in cancer diagnostics. They are helping to build a platform company through which other innovative cancer diagnostics will help patients.
Guided to 15% growth (CAGR) through 2027. Projecting over 20% adjusted ebitda margins by 2027.
Near-term growth drivers - Cologuard and Oncotype DX globally. Future drivers - pipeline.
Reiterated 2024 Revenue and EBITDA guide.
60 million Americans not up to date with colon cancer screening - huge unscreened population
Q4 2023 - highest dollar growth in screening in history. Sequential decrease in Cologuard screening revenue due to normal Q1 seasonal weakness. Despite sequential screening revenue decline, screening revenue still increased 7% YOY, and management confident in achieving 2nd Quarter and 2nd Half Guide revenue guides.
Cologuard will have steady predictable growth based upon # of sales calls to primary care physicians and increasing Health System Orders.
New Cologuard business opportunity starting last year - screening in Medicare Advantage population and gap closure programs in large health systems.
CEO Kevin Conroy: "We are confident in our ability to meet our 2nd quarter and 2nd half sales guidance."
Q1 2024 was in-line with expectations. Q1 of 2023 was an anomaly.
Sales and Marketing Spend - Spent about $800 million in sales and marketing in 2023 (sales force a relatively small component of this, sales force being brought back to levels of 2022) - High ROI from investment in additional sales people.
Last 5 quarters added 50,000 new primary care providers - docs, pa’s and nurses
As docs order more, amount of orders increases. As sales calls increase in frequency, pcp’s order more.
Calling on a doc once per quarter will result on average in six orders. Calling on a doc six times per quarter will result on average in 24 order. Sales reps provide pcp's tools, education, motivation to increase colon cancer screening numbers.
Priorities for CFO - Maintain Growth Engine not only of CG and Oncotype, but also new product pipeline - Flywheel of innovation needs to keep spinning. Will expand over 300 basis points of leverage in 2024. Increasing leverage in G&A going forward. Clear and credible pathway to adjusted ebitda margins of 20% in 2027
CFO Aaron Bloomer: Exact Sciences will show FCF growth and positive FCF delivery for each of the next three quarters in 2024.
17% CG growth embedded in 15% CAGR through 2027. (Compound Annual Growth Rate)
Impressive CAGR over the past few years. Seeing increasing opportunities to enhance the use of Cologuard as a frontline screening tool.
Over a billion dollars invested in EXACT NEXUS - Electronic Ordering, Result Delivery, Prior Authorization, Reimbursement embedded into physician's EPIC electronic record. Huge amount of customer satisfaction - makes using Cologuard easy.
Long arduous process of including Cologuard into the Quality Measures (2-3 years from being included in USPSTF guidelines), which can help health systems and plans increase their star rating in order to get quality bonuses, which is a key to their success.
130,000 new cases/year, 50,000 deaths/year from Colon Cancer, with 60 million people in U.S. not current with CRC screening guidelines.
Colonoscopy capacity in US is 12,000,000. Half screening, half diagnostic. Cologuard is helping health system and GI’s getting more people screened.
Re-screening now mid 20's as a % of revenue - aiming for 50%
Because of Covid, for two years in a row, only 1.2 million people have been eligible for re-screens. This year 1.6 million eligible for re-screen, and that number will increase annually. Also, 20 million new prospective customers in the 45-49 age group - want them to be happy customers for next 30 years. The 45-49 age group rescreens are starting to kick off this year (USPSTF guideline to include that age group updated in 2021).
Cologuard Plus - 10 Years of R&D and Clinical Trials - Improved False Positive Rate, Cancer Detection, Advanced Adenoma Detection. Improvement on all levels, and Cologuard 3.0 already in development.
Looking for a modest price increase for Cologuard Plus rolling in over a couple years period of time. Because false positives are lower - 30% fewer false positives - more people will stay in Cologuard Testing Family
Cologuard Plus also benefits from 5-7% Lower COGs = margin expansion.
20th Anniversary for Oncotype in US. 1 billion cumulative investment in Oncotype infrastructure. Quality of Science and Clinical Evidence behind it is unmatched. Company is deeply rooted in being patient and customer-centric.
Question to Brian Baranick, General Manager of Precision Oncology - How are you gonna catch up in MRD?
With respect to MRD, have never seen such a fast developing market - real clinical unmet need - enthusiasm among patients and physicians - excited to be apart of this market. Exact Sciences will catch up in MRD due to the following:
1) World class commercial capabilities - precision oncology reps are experienced, know physicians/territories, how to sell and how to get access to leverage these relationships to launch CRC MRD next year.
2) Exact Sciences' Nexus Platform - IT infrastructure to help providers save time obtaining prior use authorizations. This billion dollar company investment will allow providers to obtain prior use authorizations and order MRD tests more quickly and easily.
3) Better Performing Product - Partnering with West German Study Group and NSABP (National Surgical Adjuvant Breast and Bower Project) To build out evidence around MRD tests - Goal is for Exact Sciences' MRD tests to have best in Class Evidence. Exact Sciences' MRD tests measure more mutations in blood than some of the first mover companies in space, and will have best in class evidence. Investors will hear more about performance of MRD assays and evidence in the back half of this year.
Blood-based screening assets - crowded marketplace - Use case for Cologuard Blood will be limited.
Great idea in concept - Bert Vogelstein is a pre-eminent researcher in the field and wrote a 2005 paper on the subject of CRC screening blood test. He concluded that detecting circulating tumor dna from precancerous lesions/polyps is impossible - you can’t find what’s not there. According to Kevin Conroy, if you’re not finding pre-cancer, you don’t have a true screening test.
The real power of colon cancer screening is finding and removing pre-cancerous polyps which may result in Stage 1 disease - that is the goal. As a result, it is highly unlikely that blood tests to screen for CRC will end up in the USPSTF guidelines and quality measures b/c they are unable to detect precancer. CRC screening blood test will end up being more of a niche market. Commercial payers will not be too excited to pay for something which is not in the quality measures. Probably won’t find out if blood CRC screening will be in the quality measures until 2028-29 (After likely USPSTF in 2027). Howver, fee for service medicare advantage has agreed to pay for blood based crc. USPSTF meets every 5-8 years on CRC screening (August, 2014 - May, 2021). Predict next Meeting in 2027. This cycle think 6 years until USPSTF and then quality measures 2-3 years later
Management expects two or three blood tests to be approved by the FDA, including Cologuard Blood. Don't believe blood tests will ultimately be a big overhand for investors as Cologuard will still grow market share even with other FDA approved CRC blood tests as it is the most effective CRC screening test. GI societies recently weighed in - not recommending blood tests for frontline CRC screening. The growth of Cologuard over the coming years will be what excites investors, not CRC blood test.
Question to CFO Aaron Bloomer: What is most underappreciated or misunderstood about the company?
CFO is excited about pipeline. The company has spent many years developing these pipeline products, a number or which are slated to launch over the next few years. Don’t think investors appreciate the impact these pipeline products will have on patients, on revenue and the Company's growth profile, as well as on margins.
Excited about mid-teens growth in Cologuard and along with MRD and other new products coming online in the next few years which will provide both the Company with both leverage and diversification.

*If there is a better thread to post this under, please let me know :).
My mom had a fall few weeks ago, which resulted in her losing a couple of her front teeth and some fractures to her mandible and teeth. After she was discharged from the hospital, we went to her PCP, who referred her to an oral surgeon within her health plan network. My mom has Medicare (including a Medicare Advantage Plan) and Medicaid. We proceeded with the consultation since we had an authorization from the health insurance, but the oral surgery office had let us know that the oral surgeon is not in the dental plan network and therefore will be an out-of-network provider. The recommended oral surgery would include teeth extraction (D7210), bone grafting (D7953) and general anesthesia (D9222) for three teeth and will cost approximately 7k.
I was originally under the impression that because the oral surgery is needed due to trauma/injury/fall and not for cosmetic/teeth health reasons, the procedures will be billed to medical insurance, but after calling a different oral surgery office to ask, they told me that different offices bill differently, but it seems both offices would bill to dental insurance instead of medical insurance. The dental coverage under my mom's Medicare Advantage Plan has a quarterly allowance of a few hundred dollars, so we would still be responsible for at least 6k for the surgery. My mom's dental coverage through Medicaid is still processing so I'm unable to confirm if it will provide some coverage at the moment.
So I guess my questions are:

1. Does Original Medicare (Parts A & B) provide coverage for oral surgeries due to trauma/injury? If so, does it matter whether the surgeon bills to dental or medical? Assuming the surgeon bills to dental and only gets the allowance from the Medicare Advantage Plan (Part C) or we pay upfront and get reimbursed the allowance amount, can I submit a claim of the remaining amount to Medicare to see if they're able to reimburse?
   
2. My mom's dental insurance for Medicaid and Medicare Advantage Plan are with the same company (and therefore have the same in-network dentists/providers). Does anyone know what the Medicaid coverage is like for the procedures (with codes) above? If Medicaid can at least cover the teeth extractions or whatnot, that will help alleviate some of the out-of-pocket costs.
   

I understand that each patient/plan is different and coverage isn't the same for everyone, but some general insight would be helpful to just give me an idea of our backup plans.

This is a complicated mess, and I’m going to try to be as clear as I can, and provide as much detail as possible without doxing myself or anyone else involved in the situation. My questions are about a therapy practice in Maryland.

• all therapists who work at this place, are classified as 1099 contractors.
• the therapists are required to use the company’s branding; their biller; their supervisors; their letterhead & documentation; etc. The therapists are required to pay the practice owner for all of these things.
• the therapists are required to pay for their own psychology today profile, but report on that site that they work for this particular practice. The practice website advertises all of the therapists as employees & required that they all utilize a specific photographer for headshots, and each therapist was required to pay for it.
• the therapists are required to use a specific EHR, at the highest/most expensive tier of that platform, and must pay for it themselves. They are required to give the biller and the practice owner access to the accounts.
• any therapist who is not clinically/independently licensed, are required to attend supervision with a supervisor picked by the practice owner. The therapist is required to pay for this supervision. Weekly individual and group supervision are put on their schedules, regardless of their own ability to meet during those scheduled times, and they are required to pay for every session, even if they don’t attend.
• for each session that is held, the therapists bill under the practice’s group PNI 2. The whole reimbursement rate is supposed to go to the therapist who held the session, but they are charged $15 per session for some of the fees listed above (biller, use of branding, etc). This means that they are paying self-employment taxes on that whole amount, but then they are paying a significant amount back to the practice so it’s not true income.
• therapist’s payments from insurances (which get first paid to the practice/business, and is then supposed to come to them), are being withheld if the business owner feels that the therapist owes her money for all of the fees listed above.
• other therapists have been sent letters from the practice owner and/or her admin, indicating that they will send invoices to collections if not paid by the therapists
• there have been increases/changes in fees, changes in practice policies, etc., which have been sent to therapists via newsletter. They are told that these changes are effective immediately. No therapists are given a new contract to sign when these changes are introduced.

Ok, I think those are the big things. There are other issues related to professional ethics, which have been reported to the practice owner’s licensing board. My questions about everything listed above is the following:

• where can the therapists seek help?
• is this a DoL issue? I haven’t been able to find good info on the state DoL website on where/how to file complaints about misclassified employment outside of landscaping & seasonal workers
• should any of this be reported to insurance panels? Would the therapists put themselves at risk if they blew the whistle on filing claims under the group NPI 2 while they were classified as contractors? (Some mental health licensure in the state has regulations about provisionally licensed therapists working for themselves & some insurance panels won’t accept provisionally licensed therapists to take their coverage unless that therapist is part of a group practice)
• some provisionally licensed therapists were accepting Medicare; should this be reported to Medicare? Again, will this bring risk to the therapists?
• many of these therapists feel extremely stuck, as they are worried about retaliation and/or they can’t afford to leave or think they owe the practice owner a lot of money. How can they get access to good, competent legal advise for a very limited fee? Legal aid has indicated that this is out of their scope.
• how can these therapists successfully get paid & does anyone have tips on how to address the “collections” threats and withholding of payments?

Thanks, everyone, for whatever you can offer

Uber on Wednesday announced several new product updates at the company’s annual Go-Get showcase in New York City that aim to help its customers save money on rides and food.
The product updates reflect Uber’s continued push to drive growth and demand across its mobility and delivery business segments. The new features could help the company attract more riders and users to its app.
Here are the key new offerings the company announced:
Uber Shuttle
Riders looking for a more affordable way to get to the airport, work and live events, such as sports games and concerts, can reserve seats on an Uber Shuttle.
Uber has partnered with local shuttle services that will pick up riders and bring them to their destination. Uber said the shuttle services employ commercially licensed drivers, and users can tip and rate them directly within the Uber app.
The shuttles will have between 14 and 55 seats. Users can reserve up to five seats as early as seven days in advance, and they’ll receive a QR code ticket. Riders can track their shuttle’s location within 25 minutes of departure time.
The company said the shuttle will be a “fraction of the price” of a ride with UberX. The trip won’t be impacted by surge pricing.
Uber will start to roll out the feature at Miami’s Hard Rock Stadium and at select concert venues in Chicago, Pittsburgh and Charlotte, N.C., this summer. Uber said it will expand the offering in the future.
Uber Caregiver
Caregivers can add loved ones, such as elderly family members, directly to their profiles starting this summer. This will allow caregivers to book rides for people they care for and order medical supplies and groceries on their behalf.
The feature will also allow for three-way chats between drivers, riders and caregivers.
Uber said the user’s insurance benefits can be applied when applicable to help minimize out-of-pocket costs. Uber Caregiver will initially support Medicaid recipients, customers who are 65 and older with Medicare Advantage, and customers with commercial insurance from their employers.
Caregivers can sign up to be notified when other insurance providers are added.
Costco on Uber Eats
Uber said Costco will be available as an on-demand option within Uber Eats in select locations across the U.S. starting Wednesday.
Users can order products from Costco even if they are not members, but Uber said members will save between 15% and 20% compared with nonmembers.
Costco members can enter their member numbers in the Uber Eats app and are eligible for 20% off of Uber One, the company’s subscription membership.
Schedule UberX Share
Uber said it is launching a new feature on Wednesday that lets users schedule a shared ride in advance. The feature will save users around 25% on average compared with a typical ride on UberX, the company said.
Scheduled UberX Share rides are initially launching in cities with some of the highest return-to-office rates. This includes New York, San Francisco, Los Angeles, Chicago, Atlanta and San Diego. Uber said more locations will follow.
Uber One for Students
Uber will offer its Uber One membership program at a discount for college students. The program normally costs $9.99 per month, but it will be available to students at $4.99 a month.
The company said students will also get access to free items and special deals, such as daily discounts on their orders from Taco Bell, Domino’s and Starbucks.
The Uber One Student Plan is launching in the U.S. in May. It will roll out in Canada, New Zealand and Australia in July, as well as in Japan and France in September.
Uber Eats Lists
Uber is introducing a new feature called “Lists” to Uber Eats that allows users to curate and share lists of restaurants and go-to spots. The company shared examples like “date night desserts” and “toddler-approved dinners.”
Source: https://www.cnbc.com/2024/05/15/uber-go-get-uber-announces-uber-shuttle-uber-caregiver-costco-perks.html

Hello all,
I’m currently contemplating a job offer for an orthopedic office. It would be sports med with a new surgeon. He’s not super busy yet, but it is a practice with a few extremely established surgeons so it stands to reason he will get pretty busy eventually. The salary is reasonable but the bonus structure is only 1% of total billing. I’ve heard of other PAs in the area getting something like 20-30% of total billing, once you cover your salary and benefits (roughly 1.5x your salary), and for a busy practice, that seems like a much better structure. I don’t want to seem greedy, but my previous practice worked us extremely hard, with no bonus or salary increase, so I just want to be sure I’m being compensated fairly for my work.
Any advice would be appreciated.
In addition, does anyone have any resources to see reimbursement rates for various CPT codes? I’ve tried googling but seems to get a pretty wide range.

I am a recent retiree from the Army. I have been interviewed for one position I did not get, and I am looking for pointers on improving my resume. I also use the USA.jobs resume creator when required. I have 15+ years of operations experience up to the Sergeant Major level but also just graduated with an accounting degree with honors. I am trying to leverage my education and experience, but also applying to the fields separately. I keep getting conflicting advice on my resume, so any help is appreciated.
Citizenship: Yes - United States Citizen Security Clearance: Active Secret Clearance Availability: Full-Time/ Permanent
PROFILE SUMMARY
Accomplished leader with over 15 years of experience in operations, strategic planning, and team leadership. Dedicated to driving organizational excellence through dynamic strategies aligned with institutional objectives. Proven track record of adept leadership, fostering cohesive teams, and ensuring timely project delivery. Skilled in problem-solving and communication, adept at identifying and resolving operational challenges. Proficient in fiscal management and cost optimization, resulting in budget-friendly solutions and improved profitability. Experienced in organizational development, enhancing work culture, and boosting employee engagement and retention.
PROFESSIONAL EXPERIENCE
[U.S. Department of the Army](): Senior Operations Manage Operations Sergeant Major 1-314^th Infantry Battalion - Joint Base McGuire-Dix-Lakehurst, NJ April 2022 to Retirement (40 Hours per Week)
~Duties & Related Skills:~

• Trained and supervised staff on financial databases and digital systems crucial for accurate financial record-keeping and daily operations
• Received formal recognition for administrative expertise, driving successful financial operations, and influencing process improvements
• Collaborated with operational partners to facilitate two Army-level training exercises and coordinate financial aspects of all training activities
• Conducted specialized correspondence training for financial and operational staff, enhancing financial reporting accuracy and efficiency
• Identified, remedied, and approved Defense Travel System travel claims, resulting in substantial cost savings and heightened quality assurance in financial processes

U.S. Department of the Army: Senior Operations Manage Future Operations and Planning Lead & First Sergeant Fort Drum Garrison Headquarters & 10^th Mountain Division Headquarters - Fort Drum, NY September 2019 to March 2022 (40 Hours per Week)
~Duties & Related Skills:~

• Provided direct administrative and technical support to senior executives and a team of 15,000 personnel
• Revamped and optimized the future operations staff section, fostering a professional environment focused on organizational enhancement and superior customer service
• Handpicked to lead a planning and future operations cell, surpassing fifteen highly qualified candidates based on proven expertise and exceptional results
• Conceptualized, developed, and implemented standard operating procedures for expeditionary logistics nodes, resulting in considerable time savings for outload and mission command establishment
• Demonstrated mastery in overseeing six digital automation networks and executing senior operational actions for five international training exercises, ensuring seamless mission command
• Successfully planned and executed training exercises involving over 3,000 personnel across a dispersed area spanning 250 miles, achieving a 100% success rate

U.S. Department of the Army: Senior Operations Manage Current Operations Lead & First Sergeant 1-504^th Parachute Infantry Regiment & 82^nd Airborne Division Headquarters - Fort Liberty, NC December 2015 to August 2019 (40 Hours per Week)
~Duties & Related Skills:~

• Supervised division current operations section, enabling rapid worldwide deployment of contingency forces within 18 hours
• Demonstrated effective communication, interpersonal, multitasking, and leadership skills, driving results in dynamic environments
• Maintained precision and diligence in performing duties, consistently delivering accurate results
• Excelled in planning and organizing tasks under adverse conditions with minimal supervision, achieving exceptional outcomes
• Conducted data analysis, program evaluation, and risk management for eleven joint-level exercises, earning formal recognition from executive leadership
• Coordinated real-world deployments, humanitarian missions, international exercises, orders production, emergency responses, casualty affairs operations, and daily correspondence with upper echelons
• Projected an expert proficiency with Microsoft Suite tools, PowerBI, and Tableau.
• Managed a $15 million renovation and transformation of a joint task force operations center, overseeing assets worth over $2.5 million

CIVILIAN EDUCATION
Institute: Southern New Hampshire University Degree: Bachelor of Science – 2024 Major: Accounting Honors: Summa Cum Laude (3.9 GPA)
MILITARY EDUCATION
Basic, Advanced, and Senior Leadership Course U.S. Advanced Airborne School Air and Unit Movement Officer U.S. Air Force Air-load Planner Combat Lifesaver Emergency Medical Technician
CERTIFICATIONS
· U.S. Defense Counterintelligence & Security Agency – DOD Mandatory Controlled Unclassified Information, Awareness & Reporting · U.S. Department of the Army – Information Security Program, Army OPSEC Level 1 · U.S. Department of Defense – Certified OPSEC for EOP Operators/ OPSEC Awareness for Military Members, DoD Employees & Contracto Combating Trafficking in Person for Investigative Professionals/ Combating Trafficking in Person General Awareness/ Combating Trafficking in Persons for Acquisition & Contracting Professionals/ Level 1 Antiterrorism Awareness, Military Occupational Code, Managing your Transition, Financial Planning for Transition, Employment Fundamentals of Career Transition, Identifying & Safeguarding Personally Identifiable Information PII, Introduction to Privacy Act 1, 2, & 3
SPECIALIZED KNOWLEDGE, SKILLS & ABILITIES (KSA)
· Demonstrates comprehensive understanding and proficiency in deployment and mobility operations, including wartime contingency plans and adherence to relevant instructions, regulations, directives, and local operating procedures.
· Proficient in handling classified and/or protected documents, with adeptness in utilizing various automated data management systems.
· Proficient in budget analysis and administration, encompassing knowledge of budgetary methods, practices, policies, procedures, regulations, and precedents, as well as the accounting system for budgetary information.
· Skilled in implementing security methods, rules, regulations, and principles, supporting security administration, resolving security-related issues, and performing diverse security assignments.
· Proficient in providing authoritative consultation and conducting complex training administration, with the ability to assess program needs, evaluate status, and recommend/implement improvement solutions.
· Proficient in applying tact and diplomacy in advising individuals and high-level officials on complex and sensitive issues, related to planning, organizing, and directing functions of small organizations.
· Demonstrates entry-level proficiency in applying basic principles, concepts, and practices of the occupation.
· Effective communication skills in conveying factual and procedural information clearly, both orally and in writing.
· Proficient in assessing and measuring organizational trends, concerns, and needs, identifying gaps in services, and providing recommendations for effective plans and tools.
· Ability to analyze problems, identify significant factors, gather pertinent data, and utilize critical thinking skills to recognize solutions.
· Skilled in conducting one-on-one training, group presentations, and training sessions through oral communication.
· Demonstrates ability to plan, organize work, follow instructions, and manage multiple ongoing projects effectively, with proficiency in locating, assembling, and composing information for reports, inquiries, and limited technical correspondence.
· Proficient in identifying training needs, instructing personnel, and communicating effectively both orally and in writing.
ADDITIONAL DUTIES
Budget Analyst 2022 [– ]()2024 Knowledge Management Officer 2016 – 2018 Digital Master Gunner 2016 – 2018 Army Instructor 2011 – 2013 DTS Authorizing, Certifying, and Reviewing Official 2008 – 2024
AWARDS
Eagle Scout Bronze Star Medal Meritorious Service Medal (4) Army Commendation Medal (6) Army Achievement Medal (5) Army Good Conduct Medal (7) Drill Sergeant Identification Badge Combat Infantryman Badge Expert Infantryman Badge Command Cyber Readiness Award First Army Commanding General Award Friends of Lynn Woods Cyrus M. Tracy Award
ORGANIZATIONAL PARTICIPATION
National Eagle Scout Association Veterans of Foreign Wars National Infantry Association 82^nd Airborne Division Association
VOLUNTEER ACTIVITY
Habitat for Humanity 2022 - Present Salem Hospital 1992 - 1996
EDUCATIONAL FOCUS AREAS
Organizational Leadership, Leadership Communication, Operations Management, Principles of Management, Human Relations in Administration, Principles of Finance, Financial Accounting, Managerial Accounting, Intermediate Accounting I II & III, Advanced Accounting, Cost Accounting, Auditing Principles, Auditing and Forensic Accounting, Financial Statement Analysis, Business Valuation, Federal Taxation, Microeconomics, Macroeconomics, Business Law I & II, Global Business Dimensions, Driving Business Opportunities, Critical Business Skills for Success, Applied Marketing Strategies, Data Analytics for Financial Professionals, Statistics, and Technology in Society.

Sorry this took so long, kinda got caught up.
Don't have too much to say, other than Maple Whiskey is rapidly becoming one of my favorite drinks, and I'm sorry this took so long to come out. Real life kinda got in the way for a bit (I have one of those?), and I had to put stuff on the backburner. Sorry.
That about covers it.
Previous/Main/Discord/Next
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Fries limped his way down the ship’s hallways, using the wall to his right to support himself. Twisted metal and debris littered the hallways, but it had clearly not come from this sector. He was in the center of the ship, far enough away that nothing was dangerously damaged yet, but they were obviously putting stuff in the wide, CEVA-rated hallways for the time being. He gritted his teeth from the pain and was forced to take short, shallow breaths as he walked. He clutched his side as he shuffled along, almost wishing that he was in one of the suits to help support him.
“Fuck me.” He muttered, pausing for a moment outside of his room to breathe. He was about to type in his code to unlock the door when he realized that it was already unlocked. Not sure why and fearing the worst, he drew his personal pistol from the back of his suit’s waistband, keeping it close in to himself to make sure that it couldn’t get pulled away from him. Exhaling sharply as he brought his arm away from his chest to hit the button that opened the door.
It quickly slid open with a sharp hiss and allowed him into the room. The lights were on, and the room didn’t seem to be different, but he distinctly remembered having locked the room prior. He slowly walked in, trying to clear as much as possible while coming in. He took note of the new bag in the room, but couldn’t see anything else new in the room.
His attention was rapidly divided by a shipwide alert that the admiral had left the vessel, causing him to turn around suddenly.
“You alright?” a voice behind him asked, causing him to rapidly turn around to aim the gun, but wound up hurting him more and causing him to drop to one knee.
“What in the fuck are you doing in my room?” the ODST whispered, barely able to speak from pain.
“Got moved down here for safety, you can ask Donahue.” she stated, helping him up and taking the gun from him.
“Got it… he just left the ship?” he asked, immediately attempting to lay himself down on the bed.
“Yeah, he’s heading to see the Tikaqick.” Firdaus stated with a slight bit of disdain in her voice.
“You got a problem with them?” the ODST muttered, barely looking at her.
“Not as many as with my own people, but certainly a fair number of problems with them.” she hissed, helping the man move towards the bathroom.
“You’re going to need to explain, but in a bit. I have like six different bandages to switch.” Fries grunted, closing the door behind him.
_____
“Sir?” the lieutenant Marine beside him asked, racking a round into her rifle’s chamber, “You alright?”
“Hmm?” The man asked, his head quickly snapping up to look at her, “Oh, yes. I’m fine.”
“You’re sure?” she asked again, watching as the man sealed on his helmet.
“Yes.” He nodded, shooting a glance back at the ship they left from, “Yes… it’s not my first time doing this…”
The crew continued on in relative silence. The Marines and ODSTs were a mix of the two crews, one of each being from the old crew and one of each being the replacement crew. The Marine Lieutenant was one of the new crew, along with the ODST Sergeant. The Marine Sergeant and ODST Captain, however, were both well experienced in combat.
“We’re approaching the landing bay.” The pilot called out over radio, “Thirty seconds.”
“Copy that.” Donahue nodded, standing up and bracing himself against the roof to avoid floating around, “Well… Guess it’s that time again.”
“There’s no CIA on board and the ship isn’t a USS.” The Marine sergeant stated, unbuckling himself but not standing up, “It’ll be different this time.”
“Let’s hope not. Flu’ron’s still on board.” James Orwell, the xenobiologist muttered, attempting to raise his reflective visor, to little avail.
The Marine floated over and helped the man with his visor before floating towards the pilots’ cabin door and letting himself in, floating between the two so he could see out the front window.
“Siddown, Sergeant.” One of the pilots muttered, not looking back as he did minute adjustments to the ship’s trajectory as they approached.
“This whole damn thing could be made of gold…” The Marine muttered, magnetically locking himself to the floor and kneeling down as they approached.
“Crossing threshold, standby for turbulence.” One of the pilots radioed out, a hydraulic whine reverberating through the ship’s hull as they lowered the landing gear.
“Back and seal the hatch, Sergeant.” The other pilot snapped, barely looking back at the Marine, instead focusing on the windows and displays ahead of them.
“Copy that.” The Marine nodded, taking the time to check the two pilots’ weapons stowed behind their chairs before floating himself back into the crew compartment and sealing the hatch behind him.
“Ten seconds to landing. Artificial Gravity is off in the bay, disarming OMS.” A pilot called out, still keeping a smooth voice about him, “Threshold crossed, stand by.”
The ship seemed to do nothing for a moment before a very light shudder echoed through the hull, followed by a sharp, metallic ‘thud’.
“We have contact, maglocks engaged.” The first pilot informed.
“Gravity systems and harmonics coming online. Disengaging RCS.” the second pilot called out, likely talking to his partner over the crew in the back. After a few seconds of silence, the ship seemed to spool down and orange lights came on in the back of the crew compartment, showing up just over the CEVA-sized, round airlock doors at the sides of the craft and above the regularly-sized hexagonal door at the back of the craft. After a moment, a female robotic voice called out ‘Pressure stable’ and the lights switched to green.
“We’re down. Thank you for flying Air Peregrine, please take your bags from the overhead compartments and leave in an orderly fashion.” one of the pilots called out, putting on an extremely good and smooth ‘airline’ voice.
“You are aware that you’re talking to an Admiral, right.?” the Marine Lieutenant asked, seemingly disappointed at the pilot.
“Oh, I imagine he does.” Donahue smiled, motioning for the ODSTs to head out the door first.
The two armored figures were already moving towards the door, letting the ladder come out first before checking pressure one last time and opening the rear door. To their shock and horror, the void of space lay just outside the door, though nothing was losing pressure.
“Plasma barrier?” a Marine asked, his voice faltering slightly when he saw the smoking form of the Dracula in the distance.
“Something like that…” James muttered, waiting for the Admiral to head down the ladder after the ODSTs before following him down.
There were no aliens directly off their ship, which surprised them slightly, but gave the crew time to prepare themselves. They were supposed to form a ‘triangle’ with Donahue at the front, the two ODSTs behind him, and the two Marines on either side of James, behind the ODSTs. However, they had more than enough time to prepare, to the point of it becoming awkward. The team moved to the left side of the Ranger, and sat in waiting. The Marine Sergeant began to get skeptical and checked the chamber of his rifle while his reflective visor dropped into place, subtly preparing for a conflict.
However, before their thoughts could fester any further, a door off the left-side nose of the Ranger opened to reveal the creatures that owned the ship. They were around the same height as a Human, albeit seeming a little taller on average. They were obviously Avian-esque, with short, stubby, owl-like faces, in opposition to the long beaks of Afi’end. They had two large eyes just behind their beak, with what appeared to be two sets of closed eyelids underneath them. Their feathers were gray and black, with a small amount of crow-like iridescence in them. They had long wings which wrapped around their bodies, making a ‘cloak’ around them. Their legs were similar to that of an Afi’end’s, but seemed slightly thinner.
They wore thick, heavily stylized armor. It had gold plating with ivory and blue-diamond accents, glassy pauldrons, and other, seemingly glowing, lines and accents in it.
The rest of the ship looked similar; with gold, ivory, and blue-diamond glass seeming to come from all parts of the ship. The ship looked incredibly clean, with no smudging seeming to come from anything except the Humans. The flight deck they were on was made of some kind of ivory-esque compound as well, with the only scuffs on it being from the RCS thrusters the Ranger had used earlier. Against the gold, whites, and blues of the alien vessel, the greens, grays, and oranges of the Human suits contrasted hard;
Donahue’s suit was nothing special, nor was it too dirty, but it was not perfectly hermetic, like the rest of the ship seemed to be. James’ suit did seem to fit their criteria of cleanliness everywhere except his boots, where it was obvious that he hadn’t put hours of work into cleaning the dirt out of the fabric on the last surface mission he had done. The Marines’s suits were the most well-loved; boasting patches of stained mud, foliage, and other assorted junk all over the suit. The ODSTs were clearly battle-damaged, however: Cuts and scrapes into the plating could be seen around the arms and chest, with plasma burns etched into the metal of the helmet on the more experienced man.
Donahue almost wished he had been able to wash his suit now, but he hoped they would understand.
“Hey, we’re not the only ones to bring armed guards.” The ODST to his right stated.
“Oh thank Christ.” Donahue muttered, shifting his reflective faceplate up, “I would have felt awful if they trusted us that much.”
“Feel better, they don’t.” The ODST muttered back, standing up straighter as the aliens approached.
“Admiral Donahue?” the creature at the front of the group asked, looking at the admiral in the front of his own group.
“Captain Kinlykc?” Donahue asked, stepping towards the aliens. The creature seemed mildly amused at the Admiral’s suit, but went back to looking him in the eyes shortly after.
There was an awkward silence for a moment before the alien decided that it was likely in everyone’s best interests if something was said.
“Apologies for my awkwardness in this situation; it has been a long time since I’ve had the pleasure of doing a proper first-contact scenario.” it stated, clearly motioning for his own guards behind him to be less on-guard. The Humans were taken aback a bit, as the creature didn’t move his mouth to speak, but more seemed to emanate the words from itself.
Donahue nodded, but didn’t have to motion to his own men, as they had already come to stand down themselves.
“Entertainingly enough, I was still captaining that ship out there for our true first contact.” Donahue nodded, making sure that both his hands were visible in front of him.
“Really?” the avian asked, motioning for the admiral to follow him deeper into the ship, “Is your ship the only one in your fleet?”
Donahue paused for a moment before following the alien Captain, motioning for his team to follow shortly behind him.
“Negative, we’re just lucky.” The Admiral smiled, attempting to hide his trepidation through humor. The ODSTs were just as slow to follow behind, but eventually caught back up, seemingly worried about leaving the pilots alone. They were brought into a wide hallway. It had the same stylings as the docking bay had, but seemed to have ‘tiling’ instead of the solid piece that the other room had. James slowly pushed his way through the column of armored personnel and wound up beside the Admiral.
“Umm, excuse me, Captain Kinlykc?” He asked, fiddling with his suit to attempt to make sure the external speakers were working.
“Yes?” the avian asked, looking back at the scientist.
“How… are you talking?” He asked, not sure whether the question was to be considered rude or not, “As in, your mouth isn’t moving, how are you talking to us?”
After the scientist clarified himself, the avian seemed to understand the question.
“We do not breathe through our mouth, I’m assuming like you do then.” It nodded, tapping on its beak and unfolding its wings. It raised its arms and pointed at a set of openings under the creature’s armpits, “We breathe and vocalize through these.”
James was speechless for a moment, but the Admiral was relatively sure that was because he was deciding whether or not it was entirely wrong to lean in closer for a better look.
“If you do not mind me asking a question of my own, what are the clothes you’re wearing?” The avian asked, motioning to everybody except the ODSTs, “Are they your uniforms?”
“These?” James repeated, pulling at his suit, “These are pressure suits. To keep our own atmosphere in.”
“But why?” The bird asked, continuing down the path, “We scanned your vessel as the door opened to analyze what your atmosphere was to accommodate, and they were almost identical.”
"We pressurized our vessel to the bay’s atmosphere.” Donahue stated, nodding at the two, “Our atmospheres are similar, and very breathable, but not the same.”
“Why the pressurized suits then? We can breathe the same atmosphere, no?”
“Our people are not nearly as advanced as some others, who can do bacterial scans of atmospheres before they even land to make sure that neither side will infect the other. We cannot do that, so we hermetically seal off from everybody else to avoid infecting them.” James stated, finishing Donahue’s explanation.
That was an answer that seemed to sit well with the avian, who nodded at them and continued down the hallways.
_____
Kinsey practically dive-rolled out of her vessel’s docking port and into the Dracula’s gravity field, her helmetless RHEV suit’s bulk causing her to roll erratically to the side. She quickly got back up and started jogging her way to the other side of the ship, her quickly-moving, armored figure moving everybody out of her way. She wasn’t in any actual hurry, but the message did have to be delivered relatively quickly.
She quickly dog-legged down a side hallway and towards flight bay 3, near the primary medical bay. As soon as she was at the area, she started heading back towards the outer hull of the ship again, turning only when she was directly on a course with the med bay. After a few moments of running, she turned into the medbay, where Flu’ron was inspecting a rifle another Marine had given him.
“Feathers!” she called out, skidding to a halt outside the door.
“Oh Hells.” Flu’ron muttered as he looked up at her. He handed the rifle back to the Marine and walked towards her, “What do you need, Doctor?”
“Only us Marines can call him ‘Feathers’.” the Marine muttered, putting on a fake pout for her.
“Look!” She exclaimed, ignoring the Marine’s protest and shoving a datapad into the avian’s face.
After pulling back a bit, he took the pad from her and started reading the text on it. After a moment, during which the Marine came over to see what the commotion was, Flu’ron looked up from the pad and nodded at her.
“Well… Goddamn!” He smiled, handing the pad back and pulling out his own tablet, “One-hundred. Going your way.”
“Woah, hold on, I think I missed something. What’s going on?” the Marine asked, confused as to why the Afi’end was sending the scientist money.
“Her brother, who was listed KIA a month and a half ago, is not dead.” Flu’ron explained calmly, watching as the scientist practically bounced off the walls with excitement. He wasn’t sure whether it was because of the money or that Frost was still alive.
“And the fucker made it onto Xalantun before me!” Kinsey stated, calming down enough to get the words out.
“You saw the ‘sent’ date, right?” Flu’ron stated, making sure she knew how recently she had received it.
“Three hours, forty-five minutes ago!” she stated, nodding enthusiastically.
“If the round-trip time isn’t that long, why’d it take him nearly a month to respond?” Flu’ron asked, just sitting down to enjoy the show.
“I’ve got two theories; either he’s been too busy to respond, or this is the first time he’s gotten a data dump in months.” She stated, “Where’s Firdaus, she owes me money!”
Flu’ron shrugged, but the Marine perked up, “To my knowledge, she’s down in Deck 5, section 6, subsection 3, room 156. She’s keeping hidden from the alien ships around us.”
Kinsey perked up at that knowledge, suddenly looking concerned, “Hold on, what?”
“Yeah, she’s residing in an ODST’s room, to my knowledge. Not sure why she’s hiding though. I’m not saying anything to anybody who isn’t a crewmember on board this ship though, aside from you, doc; she wants to stay hidden, we’ll keep her that way.”
“In an ODST’s room?” Kinsey asked, looking immediately at Flu’ron.
“He’s got four broken ribs, you need to go stop her.” the avian stated, rolling his eyes, “I’ll prep the machines, just in case.”
“Ok, I gotta check on two things with her then.” Kinsey stated, nodding at the two before running out of the room and yelling “Carry on!” at the pair.
_____
“Peregrine, we’re going deeper into the vessel, think you can handle yourselves?” The Marine Sergeant asked, slinging his rifle onto his back.
“Hey! Keep that thing out!” the Lieutenant snapped, motioning to his gun again.
The man rolled his eyes, but unlimbered his rifle again.
“Copy that, Praetor. We’re good for the time being.”
“Understood. Keep us apprised, yeah?” the Marine radioed back, shifting his suit around to relieve a pinch he had created in his armpit.
“Copy that, Praetor. Out.” one of the pilots responded back, killing the communications network afterwards. The Marines and ODSTs walked alongside the Admiral and xenobiologist in silence, taking intrigued glances down hallways as they passed them, and receiving intrigued glances back from aliens as they passed them in the hallways. They weren’t entirely privy to the conversation that was happening ahead of them, but they weren’t looking to be part of it either. The two veterans were far more interested in getting a good look at the ship than having to talk to anybody, and the two newer members were still too paranoid to pay attention to anything other than their duties.
They were brought into an unoccupied room with a large window that looked out into the deep space just beyond, though the Dracula and other alien vessel blocked the view. The guards from both species gave a quick visual sweep of the room as they came in. Upon watching the Tikaqick guards sit down or generally relax, the veteran ODST and Marine slung their weapons and moved towards the back of the room, motioning for the other two to do so as well. Despite obvious hesitation to do so, they eventually moved to the back with the other two soldiers.
“So what, if you are able to tell me, are your people doing out here?” Captain Kinlykc asked, glancing back at the soldiers momentarily before returning his gaze to the Human ship.
“Sadly, I am not able to give you our reasoning for being out here. That’s not exactly something I can give away freely.” Donahue sighed, not even sure why he’d actually have to explain that, “What I can tell you is that we weren’t planning to be out this far.”
“Really?” the avian asked, looking at the man with surprise, “Scans have indicated that your vessel is prepared for long-range assignments, based on compartmentalization and areas theorized to be for food.”
Donahue raised an eyebrow at the statement, realizing that they likely had a near-perfect model of the interior of the ship if they could theorize about the ship’s rooms, even if they couldn’t entirely see the contents of the rooms. He was relatively concerned at the revelation, but didn’t let it show.
“Well, that ship is a modification of our first attempt at a long-range exploration ship, but the project was canceled five years before first contact.” Donahue explained, watching as a few suited figures climbed around the hull of his vessel, “There were only ever three of the ships created, all of which got converted to combat duty."
“Really? I know they got converted, but what became of the other vessels?” the avian asked, seemingly entranced by the same men on the hull.
“Well, the Armstrong-Class exploration vessels, named the AC-00 J.T.K., AC-01 J. Harker, and AC-02 M. Reynolds, were all brought back to our home planet as soon as possible, be that from assignment or construction, for retrofit.” Donahue explained, turning away from the window so he could better look at the avian, who saw the gesture and did the same, “The J.T.K. was a prototype, and was axed shortly thereafter. The Reynolds was renamed to Serenity and moved to be part of the United States Space Force, but was destroyed on assignment after the newly-fitted reactors went on runaway and melted half the ship off.”
“And the J. Harker?” it asked, indicating towards the window, clearly already knowing the answer.
Donahue nodded and motioned out the window, “Refused the new reactors, renamed to Dracula, joined the USSF, made first contact, made first contact negotiations, made first Human-to-alien combat, limped back to our space, received the first official ship-systems AI, became the first ship in the UNITF a year later, and still remains in combat as the oldest space combat ship in our service. As a species.”
The bird looked at the vessel with a new form of respect in its eyes, though whether for the crew or the vessel was unknown. It gave a shallow nod to the vessel before turning back to the man in front of him, “How old is it?”
Donahue had to pause to think for a moment, trying to remember everything he could about his ship.
“Well… the program to make them started nearly seventy years ago, and she was the first ‘production’ model. After decades of systems upgrades and additions, she’s the embodiment of Theseus’s ship, but her original christening would have been… forty-eight years ago.” He muttered, ignoring the confused look on the alien’s head when he mentioned Theseus, “I remember her first launch. I would have been around seven at the time.”
“How… Do you keep something like that running for that long? Especially if it’s a combat device.”
“Same way we keep the grandfather clock and jukebox in the primary lounge running; good care from a good crew.” Donahue nodded, watching as the blue sparks from a plasma cutter lit up a section of hull that was surrounded by CEVAs.
_____
“Watch it! Merde!” The Marine snapped out as Kinsey sprinted past him, intent on quickly making it to the room.
“Sorry! A life is at stake!” she called back, hearing another string of words in French that she didn’t care to translate yelled back at her.
The scientist slid to a halt in front of room 156, trying the door, then knocking on it rapidly. When nobody came to the door, she looked up and down the halls, locking eyes with the Marine, who was still watching her.
While still looking at him, she grabbed a tool out of her belt and started to plug it into a receptacle below the keypad.
“Code is two-five-four-eight.” The Marine called out, shaking his head and just walking away.
“Oh.” was all she could manage, pausing for a second to put the tool away before waving back at the Marine, “Thanks, Frenchie.”
“Je m'appelle Mauvieux…” he mumbled from down the hall, turning down another hall, seemingly to get away from her and the scene of the crime.
She ignored him entirely as she punched in the code and hit the button to open the door. The door had barely slid open entirely before she slipped inside and looked around for the snake.
“Firdaus, don’t! His ribs are-” She started, pausing when she realized that the snake was not doing anything other than sitting curled up in a corner of the room, a book in her hands. She looked surprised when she saw the suited Kinsey enter the room.
A door slid open to the scientist’s right, revealing the ODST she was looking for. Unfortunately, he was covered only by a towel around his waist, was clutching at his floating ribs with one arm, and had a pistol in his other hand, pointed directly at her head. As soon he recognized who he was looking at, he lowered the sidearm and leaned against the doorframe.
“Jesus Christ, Ev. What th’ fuck yeh doin’ in here?” He hissed, letting her take the gun from his hand and put it on a nearby desk, “And who th’ fuck gave you the emergency code to my door?”
“Someone who I forgot the name of.” Kinsey shrugged, stopping the man from bending over to pick up his clothes, which had been unceremoniously dumped onto the floor. She handed them to the ODST, who nodded at her and headed back into the bathroom, leaving the door open and hoping, or simply not caring, that the two women didn’t look into the room while he was dressing.
“Ok then, better question; and one I already asked you: Why the fuck are ya barging in here?” he wheezed out from the bathroom, obviously struggling a bit as he tried to dress himself.
“Making sure the thirty-odd foot long constrictor isn’t doing anything to the poor man with the four broken ribs.” She shrugged, shooting a shit-eating grin back at the snake, who flipped off the woman as she smiled back.
“Hey, don’t worry, I drew a gun on her as well.” Fries chuckled, grunting immediately afterwards. After a moment, he came out of the bathroom far more clothed than previous. He immediately went towards the scientist and gave her a quick, one-armed hug that leaned a fair deal of his weight on her, something that took her off-guard.
“Hey… you alright?” She asked, clearly realizing that something was wrong. She knew how the ODST usually acted, and he wasn’t generally the kind to hug without a stiff drink or three in him, let alone put weight on somebody else.
“Yeah, just… didn’t like what happened out there.” He sighed, pulling his weight off of her and going to lean against a wall.
“Didn’t hear what happened. You mind filling me in?” She muttered, moving to sit in a nearby chair. It creaked in protest to the woman’s suited 6’2” frame sitting down, but didn’t break.
“Thought I was going to die stranded out in the middle of fuck-off=nowhere space.” Fries wheezed, knocking his head on the wall behind him, “Kinda… put into perspective what I was told from day one was still a possibility.”
“Well, now I’m more interested in who told you what from the start.” She chuckled, clearly attempting to lighten the mood.
“Me mum always told me that I’d die alone in space, a billion and a half miles away from home.” He muttered somberly. He thought for a moment before his face twisted into a sad grin, “First time she’d shown concern for me in years.”
“Jesus, man. I’m sorry.” the woman muttered, feeling bad about her previous attempt at humor.
“Seriously; my condolences.” Firdaus piped up, simply sitting in her coils and watching the ODST sadly.
“Ehh… Whatever. That cunt never wanted to have me to begin with.” the man shrugged, grunting slightly as he sat down, “I did her a favor when I joined the forces.”
“That’s… not how you should look at that…” Kinsey muttered, standing up slightly when the man sat down, but sat back down when he waved her down.
“Ehh. Don’t care anymore. She’s six feet under an’ can’t bitch at me anymore.” He stated callously, rolling his eyes.
Kinsey quickly snapped to look at him, an expression of horror and sadness on her face. Firdaus seemed to share the same reaction as her, but was far less expressive in her movements.
“What the hell, dude?! Your mother died?! When! How?!” she exclaimed, getting out of her chair and motioning her arms out.
“Three years ago, MDMA overdose.” he muttered, clearly wanting the subject to change.
“Fuck…” the scientist muttered, picking up on the man’s clear reluctance to continue the conversation, “You could have said something.”
Fries paused for a moment, before simply shaking his head, “Nope.”
Kinsey paused for a heartbeat before nodding and stepping back towards the door, “Well, I’m sorry that there’s no better place to leave this at, but I’m going to head out.”
“Alright. Have a good time doc.” the ODST muttered, looking down at the floor for a moment before looking back up at her and nodding again, “Check in again sometime soon, yeah?”
“Yeah. Can do.” She nodded, opening his door and stepping out.

Hello Fellow Apes,
This is the only time that I have to write so I'm going to make anymore post regarding vertical consolidation since UNH is being sue like a catholic priest over its current monopoly of healthcare.
https://news.bloomberglaw.com/health-law-and-business/unitedhealth-faces-justice-department-antitrust-probe-wsj-says
With that said, let's get this show on the road. Vertical consolidation, often referred to as vertical integration, is a strategy used by companies to gain control over their entire supply chain. This approach involves a company expanding its business operations into different stages of production or distribution that are normally operated by separate businesses. We're going to use UNH as an example here, but on the surface, UNH is pitching their vertical integration in a positive light.
UnitedHealth Group, through its Optum division, is actively engaging in vertical consolidation within the healthcare sector. This strategy involves integrating various healthcare services under one corporate umbrella, which has been a significant trend in the industry. Optum encompasses a wide range of health services, including pharmacy benefits management, healthcare providers, clinics, and data analytics platforms. By consolidating these services, UnitedHealth aims to create a more integrated healthcare delivery system that can provide more coordinated and efficient care. We'll go more into this later.
This type of vertical integration allows UnitedHealth to manage both the provision of healthcare services and the insurance coverage aspects, leading to "potentially" lower healthcare costs and improved health outcomes. However, this consolidation also raises concerns about market competition, as it could limit choices for consumers and control more of the healthcare process within a single company's ecosystem.
This consolidation trend is not unique to UnitedHealth. It reflects a broader movement within the healthcare industry where large entities are increasingly integrating providers such as hospitals and physician groups to create comprehensive healthcare networks. This trend is expected to continue and possibly accelerate, influencing how healthcare services are delivered and accessed in the United States.
Health insurance companies have increasingly engaged in vertical consolidation as a strategy to streamline operations, reduce costs, and expand their market influence. There are several ways in which these companies are using vertical consolidation to funnel consumers into their health services business segments:

1. Many insurers are buying or partnering with hospitals, specialist clinics, and primary care practices. By owning these providers, insurers can direct their policyholders to use these in-network services, which are often cheaper for the insurance company due to controlled pricing and streamlined services.
2. Insurers are acquiring or creating their own Pharmacy Benefits Managers (PBMs). These entities manage prescription drug benefits on behalf of health plans. By controlling the PBMs, insurers can influence prescriptions and direct consumers to specific pharmacies or mail-order drug services, often owned by the insurer itself.
3. Some insurers are integrating vertically by acquiring companies that provide specialty medical services, such as dialysis centers, mental health services, and rehabilitation facilities. This allows them to keep these often expensive and frequently used services within their network, potentially lowering costs and increasing the use of these services among their insured population.
4. Insurance companies are also developing or acquiring digital health platforms that offer telemedicine services, health apps, and other digital health tools. These platforms often direct users to preferred providers or services that are part of the insurer’s network, promoting an integrated approach to healthcare that keeps all aspects of patient care within one system.
5. Through vertical consolidation, insurers are pushing more into value-based care agreements where providers are paid based on patient outcomes rather than services rendered. By owning healthcare providers, insurers can better implement these programs, which aim to reduce unnecessary services and focus on preventive care.

Vertical consolidation can also give health insurance companies a form of crowding power in the marketplace. Crowding power typically refers to the ability of a company to dominate certain areas of the market, which can edge out competition and influence both pricing and availability of services. By owning multiple layers of the healthcare delivery system—from insurance to providers to pharmacies—insurers can gain substantial control over the entire healthcare experience of their consumers. This integration allows them to dictate terms and conditions to both consumers and other healthcare providers who are outside of their network. Controlling more steps in the healthcare value chain allows insurers to potentially set or influence pricing at multiple points—from the cost of medical procedures to the price of pharmaceuticals. This can make it difficult for smaller, independent providers or new entrants to compete effectively. Furthermore, With their own networks of providers and services, integrated health insurers can direct patients to use these in-network services, thereby increasing the volume for their owned services while potentially limiting the volume going to competing providers. This can crowd out independent providers and smaller competitors who cannot offer the same range of services or prices.
Vertical consolidation can also provide insurers with extensive data on consumer behavior, health outcomes, and cost efficiency. This information can be used to optimize their own services and pricing models further, strengthening their market position and making it harder for others to compete on the same level of efficiency or personalization. Large, vertically integrated companies often have greater resources to influence healthcare policy and regulations. This can lead to a regulatory environment that favors large, integrated entities over smaller competitors or new entrants. While crowding power can lead to increased efficiency and potentially lower costs for consumers, it also raises significant concerns about competition, consumer choice, and the overall health of the market. Regulators often scrutinize such consolidations closely to ensure they don't harm consumer interests, and this is why UnitedHealth is being sued by DOJ.
For Medicare Advantage (MA) plans, which are private plans offering Medicare-covered benefits, vertical consolidation can play a significant role in managing financial risks and costs, particularly in the face of changing policies from the Centers for Medicare and Medicaid Services (CMS). One of the primary ways vertical consolidation helps is through more direct control over costs. For Medicare Advantage plans, controlling healthcare costs is crucial since they receive a fixed payment per enrollee from CMS. By owning providers, MA plans can directly influence the cost of care, reducing overall expenses and potentially offsetting losses due to policy changes that might reduce reimbursement rates or impose new cost-sharing requirements. Vertical integration allows MA plans to streamline care delivery. For example, they can implement more effective care coordination and management practices across their owned networks, which can lead to better health outcomes and reduced hospitalizations—a significant cost factor. This efficiency can help balance out negative impacts from policy changes by keeping patients healthier and reducing expensive medical interventions. Owning a broader swath of the healthcare delivery system gives MA plans access to comprehensive data across the care continuum. This data can be used to identify cost-saving opportunities, manage chronic conditions more effectively, and tailor preventive measures. Such data-driven strategies can help MA plans stay financially viable even when CMS policies become less favorable. However, with the recent earnings, we are seeing many companies failing on their cost modeling.
The twist behind all of this is the whole process might not be all rainbow and butterflies. In a somewhat new findings in the JAMA health forum, vertical consolidation might actually drive higher utilization and spending. In the words of Moocao, "Integration of health systems allows PCP to refer to higher-level specialists if they can't solve something. Before integration, they have to think really hard before referral"
https://www.fiercehealthcare.com/providers/newly-integrated-pcps-steer-patients-toward-systems-higher-utilization-spending-study
Despite previous studies, vertical integration isn't beneficial for healthcare access or coordination. This is why the Biden administration and other lawmakers are scrutinizing mergers that lead to greater vertical integration and provider consolidation. This scrutiny includes proposed updates by the Federal Trade Commission and the Department of Justice to antitrust guidelines, specifically considering the impacts of vertical integration. There is ongoing debate, with some stakeholders arguing that consolidation can help providers survive economically challenging times, while others believe these mergers cause significant market harm without benefiting patients.
Anyway, I hope this helps explain to you why you are seeing so much consolidation, but the cost saving isn't showing up, and why these giant healthcare companies are being sued.

Hey everybody,
I'm trying to compile a List of all the German physical releases for the vita. I mostly used PSO Archives Region 2 List and just checked each one on german eBay and Amazon. If any of you have any additions, please let me know. I am trying to get a full list, including Limited Editions!
Titles I've found German Releases for (if there's no title in the "German title" column, it's the same as in english):

Game	German Title or [Notes]
99 Vidas	[Limited Run]
99 Vidas [Collector's Edition]	[Limited Run]
Aegis of Earth: Protonovus Assault
Akiba's Beat
Akiba's Trip: Undead & Undressed
Angry Birds: Star Wars
Arcana Heart 3: LOVE MAX!!!!!
Army Corps of Hell
Asphalt Injection
Assassin's Creed Chronicles
Assassin's Creed III: Liberation
Atelier Shallie Plus: ~Alchemists of the Dusk Sea~
Batman: Arkham Origins: Blackgate
Best of Arcade Games
BlazBlue: Chrono Phantasma Extend
BlazBlue: Continuum Shift Extend
Borderlands 2
Bunny Must Die!	[Limited Run]
Bunny Must Die! [Soundtrack Bundle]	[Limited Run]
Call of Duty: Black Ops: Declassified
Chaos;Child
Child of Light: Complete Edition
Criminal Girls: Invite Only
Danganronpa 2: Goodbye Despair
Danganronpa Another Episode: Ultra Despair Girls
Danganronpa V3: Killing Harmony
Danganronpa: Trigger Happy Havoc
Dead or Alive 5+
Deception IV: Blood Ties
Demon Gaze
Demon Gaze II
Disgaea 3: Absence of Detention
Disgaea 4: A Promise Revisited
Disney Epic Mickey 2: The Power of Two	Disney Micky Epic 2: Die Macht der Zwei
Disney Infinity 2.0: Marvel Super Heroes
Dragon Ball Z: Battle of Z
Dragon's Crown
Dungeon Hunter Alliance
Dungeon Travelers 2
Dynasty Warriors 8: Xtreme Legends
Dynasty Warriors: Next
Earth Defense Force 2: Invaders From Planet Space
Everybody's Golf
Farming Simulator 14	Landwirtschafts-Simulator 14
Farming Simulator 16	Landwirtschafts-Simulator 16
Farming Simulator 18	Landwirtschafts-Simulator 18
Fate/EXTELLA: The Umbral Star
FIFA 13
FIFA 14: Legacy Edition
FIFA 15: Legacy Edition
FIFA Football
Final Fantasy X/X-2 HD Remaster†	[X-2 HD Remaster Digital only]
Formula 1: 2011
Freedom Wars
Gal*Gun: Double Peace
God Eater 2: Rage Burst/God Eater: Resurrection†	[God Eater: Resurrection Digital only]
God of War Collection
God Wars: Future Past
Grand Kingdom
Gravity Rush
Gundemoniums	[Limited Run]
Gundemoniums [Soundtrack Bundle]	[Limited Run]
Hakuoki: Edo Blossoms
Hakuoki: Kyoto Winds
Handball 16
Hatsune Miku: Project Diva F 2nd
Helldivers Super-Earth Ultimate Edition
History: Legends of War
Hyperdevotion Noire: Goddess Black Heart
Hyperdimension Neptunia Re;Birth2
Hyperdimension Neptunia Re;Birth3
Hyperdimension Neptunia U: Action Unleashed
Hyperdimension Neptunia: Producing Perfection
Injustice: Gods Among Us: Ultimate Edition
inviZimals: The Alliance	InviZimals - Das Bündnis
inviZimals: The Resistance	Invizimals - Der Widerstand
J-Stars Victory VS +
Killzone: Mercenary
LEGO Batman 2 - DC Super Heroes
LEGO Batman 3 - Beyond Gotham	LEGO Batman 3 - Jenseits von Gotham
LEGO Harry Potter - Years 5 - 7	LEGO Harry Potter - Die Jahre 5 - 7
LEGO Jurassic World
LEGO Legends of Chima - Laval's Journey
LEGO Marvel Avengers
LEGO Marvel Super Heroes: Universe in Peril	LEGO Marvel Super Heroes - Universum in Gefahr
LEGO Ninjago - Nindroids
LEGO Ninjago - Shadow of Ronin	LEGO Ninjago - Schatten des Ronin
LEGO Star Wars - The Force Awakens	LEGO Star Wars - Das Erwachen der Macht
LEGO The Hobbit	LEGO Der Hobbit
LEGO The Lego Movie Videogame
LEGO The Lord of the Rings	LEGO Der Herr der Ringe
Little Big Planet: Marvel Super Hero Edition
Little Big Planet: PS Vita
Little Deviants
Looney Tunes: Galactic Sports	Looney Tunes - Die galaktischen Spiele
Lost Dimension
Lumines: Electronic Symphony
Lumo
Mary Skelter: Nightmares
MegaTagmension Blanc + Neptune VS Zombies
MeiQ: Labyrinth of Death
Metal Gear Solid: HD Collection
Michael Jackson: The Experience HD
Minecraft: PlayStation Vita Edition
ModNation Racers: Road Trip
Moto GP 13
Moto GP 14
MUD: FIM Motorcross World Championship
MXGP The Official Motocross Videogame	MX GP - Die offizielle Motocross-Simulation
NAtURAL DOCtRINE
Necrosphere Deluxe	[Limited Run]
Necrosphere Deluxe [Soundtrack Bundle]	[Limited Run]
Need for Speed: Most Wanted
New Little King's Story
Ninja Gaiden: Sigma Plus
Odin Sphere: Leifthrasir
One Piece: Burning Blood
One Piece: Pirate Warriors 3
One Piece: Unlimited World Red
Operation Abyss: New Tokyo Legacy
Operation Babel: New Tokyo Legacy
Persona 4: Dancing All Night
Persona 4: Golden
Phineas & Ferb: Day of Doofensmirtz	Phineas & Ferb - Doofenshmirtz' große Stunde
PlayStation All-Stars Battle Royale
PlayStation Vita Pets
Psycho-Pass: Mandatory Happiness
Putty Squad
Rayman Legends
Rayman Legends/Rayman Origins
Rayman Origins
Reality Fighters
Resistance: Burning Skies
Ridge Racer
Root Letter
Sayonara UmiharaKawase++	[Limited Run]
Sayonara UmiharaKawase++ [Collector's Edition]	[Limited Run]
Senran Kagura: Estival Versus
Shinobido 2: Revenge of Zen
Silent Hill: Book of Memories
Sly Cooper: Thieves in Time	Sly Cooper: Jagd durch die Zeit
Smart as...
Sonic & All Star Racing Transformed
Sonic & All Star Racing Transformed Limited Edition
Sorcery Saga: Curse of the Great Curry God
Soul Sacrifice
Space Hulk
Spy Hunter
Steins;Gate
Steins;Gate 0
Stranger of Sword City
Street Fighter X Tekken
Super Monkey Ball: Banana Splitz
SuperDimension Neptune vs Sega Hard Girls
Sword Art Online: Hollow Realization
Sword Art Online: Lost Song
Tales of Hearts R
Tearaway
Teslagrad
Tetris Ultimate
The Amazing Spider-Man
The Jak and Daxter Trilogy
The Legend of Heroes: Trails of Cold Steel
The Legend of Heroes: Trails of Cold Steel II
The Muppets Movie Adventures	Die Muppets Filmabenteuer
The Ratchet and Clank Trilogy
The Sly Trilogy†	[Sly 3 Digital only]
Tokyo Twilight Ghost Hunters
Touch My Katamari
Toukiden 2
Toukiden: Kiwami
Toukiden: The Age of Demons
Trillion: God of Destruction
Ultimate Marvel vs. Capcom 3
Uncharted: Golden Abyss
Unit 13
Vasara Collection	[Limited Run]
Vasara Collection [Collector's Edition]	[Limited Run]
Velocity 2X: Critical Mass Edition
Virtua Tennis 4: World Tour Edition
Wipeout 2048
World of Final Fantasy
WRC 5
WRC: FIA World Rally Championships 3
WRC: FIA World Rally Championships 4
Yomawari: Night Alone
Ys VIII: Lacrimosa of DANA
Ys: Memories of Celceta
Zero Escape: Volume 2: Virtue's Last Reward

Region 2 Titles Without German releases:

Game	Notes
7’s Carlet
A Rose in the Twilight
Axiom Verge
Bad Apple Wars
Ben 10: Galactic Racing
Bit Dungeon +	Limited Run
Code: Realize ~Future Blessings~
Code: Realize ~Wintertide Miracles~
Collar x Malice
Corpse Party: Blood Drive
Criminal Girls 2: Party Favors	Banned in Germany
Darkest Dungeon
Death Mark
Demetrios: The Big Cynical Adventure
Drive Girls
Football Manager Classic 2014
Ice Cream Surfer	Limited Run
Jonah Lomu Rugby Challenge
Mortal Kombat	Banned in Germany, only UK Version found
Muv-Luv
Muv-Luv Alternative
Ninja Gaiden: Sigma 2+
Period: Cube ~Shackles of Amadeus~
Psychedelica of the Ashen Hawk
Psychedelica of the Black Butterfly
Punch Line
Riddled Corpses EX	Limited Run
Rugby 15
Rugby World Cup 2015
Slain: Back from Hell
Slain: Back from Hell - Signature Edition
Spongebob Hero Pants
Superbeat: XONiC
Tadeo Jones
Tadeo Jones: Y El Manuscrito Perdido
Terraria
The Bard's Tale: Remastered and Resnarkled	Limited Run
The Count Lucanor
The Deer God	Limited Run
The Long Reach
The Longest 5 Minutes
Tokyo Tattoo Girls
Tokyo Xanadu
Top Trumps Turbo
Valkyrie Drive: Bhikkhuni	Banned in Germany
Vegas Party
XBlaze Code: Embryo
Yomawari: Midnight Shadows

Question about Zero Escape: Volume 1 & 2: The Nonary Games, according to the PSO Archive list this game has a physical region 2 release. But I haven't found any info or pictures of it. Can anyone confirm if this game even has a Region 2 release (easily identified by the PEGI rating on the cover).

In the digital age, having a robust online presence is essential for businesses of all sizes. Whether you're a small startup or a large corporation, effective marketing tools can make or break your success. ClickFunnels and Builderall are two prominent platforms that offer comprehensive marketing solutions, each with its own set of features and benefits. In this comprehensive comparison, we'll delve into the strengths and weaknesses of ClickFunnels and Builderall to help you make an informed decision for your business needs.
Join Builderall Now

Section 1: Understanding ClickFunnels

ClickFunnels is a popular marketing platform founded by Russell Brunson in 2014. It is renowned for its user-friendly interface and its focus on creating high-converting sales funnels. Here are some key features of ClickFunnels:

1. Intuitive Funnel Builder: ClickFunnels provides a drag-and-drop funnel builder that allows users to create sales funnels without any coding knowledge. With its wide range of templates, you can easily customize your funnels to suit your specific marketing goals.
2. Seamless Integration: ClickFunnels integrates with a variety of third-party tools, including email marketing platforms, payment gateways, and webinar services. This ensures smooth workflow automation and enhanced functionality.
3. A/B Testing: ClickFunnels offers built-in A/B testing functionality, allowing users to compare different versions of their funnels to determine which one performs better. This helps in optimizing conversion rates and maximizing ROI.
4. Membership Sites: ClickFunnels enables you to create membership sites where you can deliver exclusive content to your subscribers. This is ideal for businesses looking to monetize their expertise and build a loyal customer base.

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Section 2: Exploring Builderall

Builderall is an all-in-one digital marketing platform that offers a wide range of tools and features for online entrepreneurs. Founded in 2011 by Erick Salgado, Builderall aims to provide a comprehensive solution for building and growing an online business. Here are some key features of Builderall:

1. Versatile Website Builder: Builderall provides a powerful drag-and-drop website builder that allows users to create responsive websites, blogs, and e-commerce stores with ease. It offers a variety of templates and customization options to suit different business needs.
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Section 3: ClickFunnels vs. Builderall: A Comparative Analysis

Now that we've explored the key features of ClickFunnels and Builderall, let's compare the two platforms based on various factors:

1. Ease of Use: ClickFunnels is known for its user-friendly interface and intuitive funnel builder, making it ideal for beginners. Builderall, on the other hand, offers a more comprehensive set of tools, which can be overwhelming for some users.
2. Pricing: ClickFunnels offers tiered pricing plans starting from $97 per month, while Builderall's plans start from $19.90 per month. However, Builderall's lower-priced plans come with limitations on features and functionality, whereas ClickFunnels offers more advanced features even in its basic plan.
3. Funnel Building Capabilities: ClickFunnels specializes in creating high-converting sales funnels and offers a wide range of templates and customization options. Builderall also provides funnel building tools but lacks the depth and sophistication of ClickFunnels in this aspect.
4. Integration Options: Both ClickFunnels and Builderall offer integration with third-party tools and services. However, ClickFunnels has a larger ecosystem of integrations, including popular platforms like Shopify, WordPress, and Salesforce, making it more versatile for businesses with diverse needs.

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Conclusion:
In conclusion, ClickFunnels and Builderall are both powerful marketing platforms that cater to different needs and preferences. ClickFunnels excels in creating high-converting sales funnels and offers a user-friendly interface, making it ideal for beginners and small businesses. On the other hand, Builderall provides a comprehensive suite of tools for building and growing an online business, including website building, email marketing, and e-learning capabilities.
Ultimately, the choice between ClickFunnels and Builderall depends on your specific requirements, budget, and long-term business goals. If you're primarily focused on sales funnel optimization and simplicity, ClickFunnels may be the better option. However, if you need a more extensive set of tools and are willing to invest the time to learn them, Builderall could be the right choice for you. Whichever platform you choose, both ClickFunnels and Builderall have the potential to help you succeed in your online marketing efforts.
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I was wondering if anyone had experience dealing with SECO compliance or there expectations? Currently our firm is working on a state-funded commercial building under the 2018 IECC code in Texas; however, on there website it says that it also requires submission of ASHRAE 90.1-2016 form. The non-residential form says to do IECC or ASHRAE 90.1-2016, but the statement in the other image sounds like we're required to also these ASHRAE 90.1-2016 forms.
https://preview.redd.it/6zl3wdt1tozc1.png?width=993&format=png&auto=webp&s=90ccacbf692c6de937369ada521a6cbf434a94de
Doing both IECC and ASHRAE 90.1-2016 theoretically is going to cause some discrepancies based on the differences between the two. Has anyone delt with this recently and can clarify if SECO need these ASHRAE forms filled out in addition to the IECC documentation we provided? I know in the IECC you have an option to use ASHRAE 90.1-2016 to show compliance wit IECC, but I've been told to do only the IECC prescriptive compliance path. I tried calling and emailing the contact they have on their website, but since they're government regulated I don't think I will get a response any time soon lol. Honestly I would like to hear anyone's opinion if they have one.
https://preview.redd.it/vwmus1muqozc1.png?width=878&format=png&auto=webp&s=1a4a016aacc1adec835052674f4140eab99e0b03

Can anyone help me understand why couples sessions (90847) are reimbursed at a lower rate and given less time than individual sessions (90837)? It makes absolutely no sense to me that an individual session is at least 53 minutes, whereas a couples session is 45. Why would the rule be less time and lower payment for seeing 2 people instead of one? It's more work! Of course I always end up spending the entire hour with a couple, but then if I don't want to be committing insurance fraud I have to use a code that only gives me credit/payment for 45 minutes.
This probably doesn't deserve its own post, but it's been boggling my mind for years. I chose the "rant" flair, because that's definitely what this is, but I'm also receptive to advice.

I asked for an estimate from my dental clinic prior to my crown appointment. Here's what they sent:

• 27200: 1167$
• 99111: 308$

I contacted my insurance provider, and they informed me that procedure code 27200 (Crowns) has a provincial guideline maximum rate of 1167$, which is normally inclusive of service charges (code 99111). The agent said "your clinic may be charging you more"... Is this what is happening here? Are crowns/27200 normally billed as an unique code?
Back story, I was reimbursed by this dental clinic in the past as they charged me out of pocket and billed my insurance for the same, so they double dipped and thought I just wouldn't check my EOB.
Let me know if I am just being suspicious now, or if this is sketchy.

Full article here:
https://sharylattkisson.com/2016/11/what-the-news-isnt-saying-about-vaccine-autism-studies/
A Small Sampling
Many of the studies have common themes regarding a subset of susceptible children with immunity issues who, when faced with various vaccine challenges, end up with brain damage described as autism.
“Permanent brain damage” is an acknowledged, rare side effect of vaccines; there’s no dispute in that arena. The question is whether the specific form of autism brain injury after vaccination is in any way related to vaccination.
So what are a few of these published studies supporting a possible link between vaccines and autism?
As far back as 1998, a serology study by the College of Pharmacy at University of Michigan supported the hypothesis that an autoimmune response from the live measles virus in MMR vaccine “may play a causal role in autism.” (Nothing to see here, say the critics, that study is old.)
In 2002, a Utah State University study found that “an inappropriate antibody response to MMR [vaccine], specifically the measles component thereof, might be related to pathogenesis of autism.” (“Flawed and non-replicable,” insist the propagandists.)
Also in 2002, the Autism Research Institute in San Diego looked at a combination of vaccine factors. Scientists found the mercury preservative thimerosal used in some vaccines (such as flu shots) could depress a baby’s immunity. That could make him susceptible to chronic measles infection of the gut when he gets MMR vaccine, which contains live measles virus. (The bloggers say it’s an old study, and that other studies contradict it.)
In 2006, a team of microbiologists in Cairo, Egypt concluded, “deficient immune response to measles, mumps and rubella vaccine antigens might be associated with autism, as a leading cause or a resulting event.”
A 2007 study found statistically significant evidence suggesting that boys who got the triple series Hepatitis B vaccine when it contained thimerosal were “more susceptible to developmental disability” than unvaccinated boys.
Similarly, a 5-year study of 79,000 children by the same institution found boys given Hepatitis B vaccine at birth had a three times increased risk for autism than boys vaccinated later or not at all. Nonwhite boys were at greatest risk. (“Weak study,” say the critics.)
A 2009 study in The Journal of Child Neurology found a major flaw in a widely-cited study that claimed no link between thimerosal in vaccines and autism. Their analysis found that “the original p value was in error and that a significant relation does exist between the blood levels of mercury and diagnosis of an autism spectrum disorder.”
[quote]The researchers noted, “Like the link between aspirin and heart attack, even a small effect can have major health implications. If there is any link between autism and mercury, it is absolutely crucial that the first reports of the question are not falsely stating that no link occurs.”[/quote] (Critics: the study is not to be believed.)
A 2010 rat study by the Polish Academy of Sciences suggested “likely involvement” of thimerosal in vaccines (such as flu shots) “in neurodevelopmental disorders such as autism.” (The critics dismiss rat studies.)
In 2010, a pilot study in Acta Neurobiologiae Experimentalis found that infant monkeys given the 1990’s recommended pediatric vaccine regimen showed important brain changes warranting “additional research into the potential impact of an interaction between the MMR and thimerosal-containing vaccines on brain structure and function.”
A study from Japan’s Kinki University in 2010 supported “the possible biological plausibility for how low-dose exposure to mercury from thimerosal-containing vaccines may be associated with autism.”
A 2011 study from Australia’s Swinburne University supported the hypothesis that sensitivity to mercury, such as thimerosal in flu shots, may be a genetic risk factor for autism. (Critics call the study “strange” with “logical hurdles.”)
A Journal of Immunotoxicology review in 2011 by a former pharmaceutical company senior scientist concluded autism could result from more than one cause including encephalitis (brain damage) following vaccination. (Critics say she reviewed “debunked and fringe” science.)
In 2011, City University of New York correlated autism prevalence with increased childhood vaccine uptake. “Although mercury has been removed from many vaccines, other culprits may link vaccines to autism,” said the study’s lead author. (To critics, it’s “junk science.”)
A University of British Columbia study in 2011 that found “the correlation between Aluminum [an adjuvant] in vaccines and [autism] may be causal.” (More “junk science,” say the propagandists.)
A 2011 rat study out of Warsaw, Poland found thimerosal in vaccines given at a young age could contribute to neurodevelopmental disorders. (Proves nothing, say critics.)
A Chinese study in 2012 suggested that febrile seizures (an acknowledged side effect of some vaccines) and family history of neuropsychiatric disorders correlate with autistic regression.
A 2012 study from the Neurochemistry Research Marie Curie Chairs Program in Poland found that newborn exposure to vaccines with thimerosal (such as flu shots) might cause glutamate-related brain injuries.
In 2013, neurosurgeons at the Methodist Neurological Institute found that children with mild mitochondrial defect may be highly susceptible to toxins like the vaccine preservative thimerosal found in vaccines such as flu shots. (“Too small” of a study, say the critics.)
In 2016, Frontiers published a survey of vaccinated vs. unvaccinated children. The vaccinated had a higher rate of allergies and NDD (neurodevelopmental disorders, including autism) than the unvaccinated. Vaccination, but not preterm birth, remained significantly associated with NDD after controlling for other factors. However, preterm birth combined with vaccination was associated with an apparent synergistic increase in the odds of NDD.
Then, there’s a 2004 Columbia University study presented at the Institute of Medicine. It found that mice predisposed for genetic autoimmune disorder developed autistic-like behavior after receiving mercury-containing vaccines. (Critics say that’s not proof, and the work was not replicable.)
There’s Dr. William Thompson, the current CDC senior scientist who has come forward with an extraordinary statement to say that he and his agency have engaged in long term efforts to obscure a study’s significant link between vaccines and autism, heightened in African Americans boys. (The CDC says the data changes made were for legitimate reasons.)
There’s the current CDC immunization safety director who acknowledged to me that it’s possible vaccines may rarely trigger autism in children who are biologically or genetically susceptible to vaccine injury.
There’s the case of Hannah Poling, in which the government secretly admitted multiple vaccines given in one day triggered her brain injuries, including autism, then paid a multi-million dollar settlement, and had the case sealed from the prying public eyes under a confidentiality order.
There was the former head of the National Institutes of Health, Dr. Bernadine Healy, who stoked her peers’ ire by publicly stating that the vaccine-autism link was not a “myth” as so many tried to claim. She disclosed that her colleagues at the Institute of Medicine did not wish to investigate the possible link because they feared the impact it would have on the vaccination program.
There’s former CDC researcher Poul Thorsen, whose studies dispelled a vaccine autism link. He’s now a “most wanted fugitive” after being charged with 13 counts of wire fraud and nine counts of money laundering for allegedly using CDC grants of tax dollars to buy a house and cars for himself.
And there are the former scientists from Merck, maker of the MMR vaccine in question, who have turned into whistleblowers and accuse their company of committing vaccine fraud.

Full article here:
https://sharylattkisson.com/2016/11/what-the-news-isnt-saying-about-vaccine-autism-studies/
A Small Sampling
Many of the studies have common themes regarding a subset of susceptible children with immunity issues who, when faced with various vaccine challenges, end up with brain damage described as autism.
“Permanent brain damage” is an acknowledged, rare side effect of vaccines; there’s no dispute in that arena. The question is whether the specific form of autism brain injury after vaccination is in any way related to vaccination.
So what are a few of these published studies supporting a possible link between vaccines and autism?
As far back as 1998, a serology study by the College of Pharmacy at University of Michigan supported the hypothesis that an autoimmune response from the live measles virus in MMR vaccine “may play a causal role in autism.” (Nothing to see here, say the critics, that study is old.)
In 2002, a Utah State University study found that “an inappropriate antibody response to MMR [vaccine], specifically the measles component thereof, might be related to pathogenesis of autism.” (“Flawed and non-replicable,” insist the propagandists.)
Also in 2002, the Autism Research Institute in San Diego looked at a combination of vaccine factors. Scientists found the mercury preservative thimerosal used in some vaccines (such as flu shots) could depress a baby’s immunity. That could make him susceptible to chronic measles infection of the gut when he gets MMR vaccine, which contains live measles virus. (The bloggers say it’s an old study, and that other studies contradict it.)
In 2006, a team of microbiologists in Cairo, Egypt concluded, “deficient immune response to measles, mumps and rubella vaccine antigens might be associated with autism, as a leading cause or a resulting event.”
A 2007 study found statistically significant evidence suggesting that boys who got the triple series Hepatitis B vaccine when it contained thimerosal were “more susceptible to developmental disability” than unvaccinated boys.
Similarly, a 5-year study of 79,000 children by the same institution found boys given Hepatitis B vaccine at birth had a three times increased risk for autism than boys vaccinated later or not at all. Nonwhite boys were at greatest risk. (“Weak study,” say the critics.)
A 2009 study in The Journal of Child Neurology found a major flaw in a widely-cited study that claimed no link between thimerosal in vaccines and autism. Their analysis found that “the original p value was in error and that a significant relation does exist between the blood levels of mercury and diagnosis of an autism spectrum disorder.”
[quote]The researchers noted, “Like the link between aspirin and heart attack, even a small effect can have major health implications. If there is any link between autism and mercury, it is absolutely crucial that the first reports of the question are not falsely stating that no link occurs.”[/quote] (Critics: the study is not to be believed.)
A 2010 rat study by the Polish Academy of Sciences suggested “likely involvement” of thimerosal in vaccines (such as flu shots) “in neurodevelopmental disorders such as autism.” (The critics dismiss rat studies.)
In 2010, a pilot study in Acta Neurobiologiae Experimentalis found that infant monkeys given the 1990’s recommended pediatric vaccine regimen showed important brain changes warranting “additional research into the potential impact of an interaction between the MMR and thimerosal-containing vaccines on brain structure and function.”
A study from Japan’s Kinki University in 2010 supported “the possible biological plausibility for how low-dose exposure to mercury from thimerosal-containing vaccines may be associated with autism.”
A 2011 study from Australia’s Swinburne University supported the hypothesis that sensitivity to mercury, such as thimerosal in flu shots, may be a genetic risk factor for autism. (Critics call the study “strange” with “logical hurdles.”)
A Journal of Immunotoxicology review in 2011 by a former pharmaceutical company senior scientist concluded autism could result from more than one cause including encephalitis (brain damage) following vaccination. (Critics say she reviewed “debunked and fringe” science.)
In 2011, City University of New York correlated autism prevalence with increased childhood vaccine uptake. “Although mercury has been removed from many vaccines, other culprits may link vaccines to autism,” said the study’s lead author. (To critics, it’s “junk science.”)
A University of British Columbia study in 2011 that found “the correlation between Aluminum [an adjuvant] in vaccines and [autism] may be causal.” (More “junk science,” say the propagandists.)
A 2011 rat study out of Warsaw, Poland found thimerosal in vaccines given at a young age could contribute to neurodevelopmental disorders. (Proves nothing, say critics.)
A Chinese study in 2012 suggested that febrile seizures (an acknowledged side effect of some vaccines) and family history of neuropsychiatric disorders correlate with autistic regression.
A 2012 study from the Neurochemistry Research Marie Curie Chairs Program in Poland found that newborn exposure to vaccines with thimerosal (such as flu shots) might cause glutamate-related brain injuries.
In 2013, neurosurgeons at the Methodist Neurological Institute found that children with mild mitochondrial defect may be highly susceptible to toxins like the vaccine preservative thimerosal found in vaccines such as flu shots. (“Too small” of a study, say the critics.)
In 2016, Frontiers published a survey of vaccinated vs. unvaccinated children. The vaccinated had a higher rate of allergies and NDD (neurodevelopmental disorders, including autism) than the unvaccinated. Vaccination, but not preterm birth, remained significantly associated with NDD after controlling for other factors. However, preterm birth combined with vaccination was associated with an apparent synergistic increase in the odds of NDD.
Then, there’s a 2004 Columbia University study presented at the Institute of Medicine. It found that mice predisposed for genetic autoimmune disorder developed autistic-like behavior after receiving mercury-containing vaccines. (Critics say that’s not proof, and the work was not replicable.)
There’s Dr. William Thompson, the current CDC senior scientist who has come forward with an extraordinary statement to say that he and his agency have engaged in long term efforts to obscure a study’s significant link between vaccines and autism, heightened in African Americans boys. (The CDC says the data changes made were for legitimate reasons.)
There’s the current CDC immunization safety director who acknowledged to me that it’s possible vaccines may rarely trigger autism in children who are biologically or genetically susceptible to vaccine injury.
There’s the case of Hannah Poling, in which the government secretly admitted multiple vaccines given in one day triggered her brain injuries, including autism, then paid a multi-million dollar settlement, and had the case sealed from the prying public eyes under a confidentiality order.
There was the former head of the National Institutes of Health, Dr. Bernadine Healy, who stoked her peers’ ire by publicly stating that the vaccine-autism link was not a “myth” as so many tried to claim. She disclosed that her colleagues at the Institute of Medicine did not wish to investigate the possible link because they feared the impact it would have on the vaccination program.
There’s former CDC researcher Poul Thorsen, whose studies dispelled a vaccine autism link. He’s now a “most wanted fugitive” after being charged with 13 counts of wire fraud and nine counts of money laundering for allegedly using CDC grants of tax dollars to buy a house and cars for himself.
And there are the former scientists from Merck, maker of the MMR vaccine in question, who have turned into whistleblowers and accuse their company of committing vaccine fraud.

Full article here:
https://sharylattkisson.com/2016/11/what-the-news-isnt-saying-about-vaccine-autism-studies/
A Small Sampling
Many of the studies have common themes regarding a subset of susceptible children with immunity issues who, when faced with various vaccine challenges, end up with brain damage described as autism.
“Permanent brain damage” is an acknowledged, rare side effect of vaccines; there’s no dispute in that arena. The question is whether the specific form of autism brain injury after vaccination is in any way related to vaccination.
So what are a few of these published studies supporting a possible link between vaccines and autism?
As far back as 1998, a serology study by the College of Pharmacy at University of Michigan supported the hypothesis that an autoimmune response from the live measles virus in MMR vaccine “may play a causal role in autism.” (Nothing to see here, say the critics, that study is old.)
In 2002, a Utah State University study found that “an inappropriate antibody response to MMR [vaccine], specifically the measles component thereof, might be related to pathogenesis of autism.” (“Flawed and non-replicable,” insist the propagandists.)
Also in 2002, the Autism Research Institute in San Diego looked at a combination of vaccine factors. Scientists found the mercury preservative thimerosal used in some vaccines (such as flu shots) could depress a baby’s immunity. That could make him susceptible to chronic measles infection of the gut when he gets MMR vaccine, which contains live measles virus. (The bloggers say it’s an old study, and that other studies contradict it.)
In 2006, a team of microbiologists in Cairo, Egypt concluded, “deficient immune response to measles, mumps and rubella vaccine antigens might be associated with autism, as a leading cause or a resulting event.”
A 2007 study found statistically significant evidence suggesting that boys who got the triple series Hepatitis B vaccine when it contained thimerosal were “more susceptible to developmental disability” than unvaccinated boys.
Similarly, a 5-year study of 79,000 children by the same institution found boys given Hepatitis B vaccine at birth had a three times increased risk for autism than boys vaccinated later or not at all. Nonwhite boys were at greatest risk. (“Weak study,” say the critics.)
A 2009 study in The Journal of Child Neurology found a major flaw in a widely-cited study that claimed no link between thimerosal in vaccines and autism. Their analysis found that “the original p value was in error and that a significant relation does exist between the blood levels of mercury and diagnosis of an autism spectrum disorder.”
[quote]The researchers noted, “Like the link between aspirin and heart attack, even a small effect can have major health implications. If there is any link between autism and mercury, it is absolutely crucial that the first reports of the question are not falsely stating that no link occurs.”[/quote] (Critics: the study is not to be believed.)
A 2010 rat study by the Polish Academy of Sciences suggested “likely involvement” of thimerosal in vaccines (such as flu shots) “in neurodevelopmental disorders such as autism.” (The critics dismiss rat studies.)
In 2010, a pilot study in Acta Neurobiologiae Experimentalis found that infant monkeys given the 1990’s recommended pediatric vaccine regimen showed important brain changes warranting “additional research into the potential impact of an interaction between the MMR and thimerosal-containing vaccines on brain structure and function.”
A study from Japan’s Kinki University in 2010 supported “the possible biological plausibility for how low-dose exposure to mercury from thimerosal-containing vaccines may be associated with autism.”
A 2011 study from Australia’s Swinburne University supported the hypothesis that sensitivity to mercury, such as thimerosal in flu shots, may be a genetic risk factor for autism. (Critics call the study “strange” with “logical hurdles.”)
A Journal of Immunotoxicology review in 2011 by a former pharmaceutical company senior scientist concluded autism could result from more than one cause including encephalitis (brain damage) following vaccination. (Critics say she reviewed “debunked and fringe” science.)
In 2011, City University of New York correlated autism prevalence with increased childhood vaccine uptake. “Although mercury has been removed from many vaccines, other culprits may link vaccines to autism,” said the study’s lead author. (To critics, it’s “junk science.”)
A University of British Columbia study in 2011 that found “the correlation between Aluminum [an adjuvant] in vaccines and [autism] may be causal.” (More “junk science,” say the propagandists.)
A 2011 rat study out of Warsaw, Poland found thimerosal in vaccines given at a young age could contribute to neurodevelopmental disorders. (Proves nothing, say critics.)
A Chinese study in 2012 suggested that febrile seizures (an acknowledged side effect of some vaccines) and family history of neuropsychiatric disorders correlate with autistic regression.
A 2012 study from the Neurochemistry Research Marie Curie Chairs Program in Poland found that newborn exposure to vaccines with thimerosal (such as flu shots) might cause glutamate-related brain injuries.
In 2013, neurosurgeons at the Methodist Neurological Institute found that children with mild mitochondrial defect may be highly susceptible to toxins like the vaccine preservative thimerosal found in vaccines such as flu shots. (“Too small” of a study, say the critics.)
In 2016, Frontiers published a survey of vaccinated vs. unvaccinated children. The vaccinated had a higher rate of allergies and NDD (neurodevelopmental disorders, including autism) than the unvaccinated. Vaccination, but not preterm birth, remained significantly associated with NDD after controlling for other factors. However, preterm birth combined with vaccination was associated with an apparent synergistic increase in the odds of NDD.
Then, there’s a 2004 Columbia University study presented at the Institute of Medicine. It found that mice predisposed for genetic autoimmune disorder developed autistic-like behavior after receiving mercury-containing vaccines. (Critics say that’s not proof, and the work was not replicable.)
There’s Dr. William Thompson, the current CDC senior scientist who has come forward with an extraordinary statement to say that he and his agency have engaged in long term efforts to obscure a study’s significant link between vaccines and autism, heightened in African Americans boys. (The CDC says the data changes made were for legitimate reasons.)
There’s the current CDC immunization safety director who acknowledged to me that it’s possible vaccines may rarely trigger autism in children who are biologically or genetically susceptible to vaccine injury.
There’s the case of Hannah Poling, in which the government secretly admitted multiple vaccines given in one day triggered her brain injuries, including autism, then paid a multi-million dollar settlement, and had the case sealed from the prying public eyes under a confidentiality order.
There was the former head of the National Institutes of Health, Dr. Bernadine Healy, who stoked her peers’ ire by publicly stating that the vaccine-autism link was not a “myth” as so many tried to claim. She disclosed that her colleagues at the Institute of Medicine did not wish to investigate the possible link because they feared the impact it would have on the vaccination program.
There’s former CDC researcher Poul Thorsen, whose studies dispelled a vaccine autism link. He’s now a “most wanted fugitive” after being charged with 13 counts of wire fraud and nine counts of money laundering for allegedly using CDC grants of tax dollars to buy a house and cars for himself.
And there are the former scientists from Merck, maker of the MMR vaccine in question, who have turned into whistleblowers and accuse their company of committing vaccine fraud.

DAY: MAY 8 2024
​

• 5-8-2024A 30-YEAR US STUDY LINKS ULTRA-PROCESSED FOOD TO HIGHER RISK OF EARLY DEATH Higher consumption of most ultra-processed foods is linked to a slightly higher risk of death, with ready-to-eat meat, poultry, and seafood based products, sugary drinks, dairy based desserts, and highly processed breakfast foods showing the strongest associations
• 5-8-2024ABOUT 90% OF US ADULTS ARE ON THE WAY TO HEART DISEASE, STUDY SUGGESTS Nine of 10 American adults are in the early, middle or late stages of a syndrome that leads to heart disease, a new report finds, and almost 10% have the disease already. “Poor cardiovascular, kidney, and metabolic health is widespread among the U.S. population,”
• 5-8-2024RESEARCH PROVIDES TIPS TO REDUCE CHILDREN’S LYING Getting children to speak the truth can be a struggle at times. While a lie, when discovered, is often followed by a punishment, there’s a more effective way to prevent future fibbing
• 5-8-2024MANAGING MIGRAINE EFFECTIVELY Migraine is a neurologic disorder. The severe pain of migraine typically is on one side of the head but may be on both sides. Symptoms also may include nausea, vomiting, sensitivity to light and sound, difficulty speaking, or visual disturbances known as aura with flashes of light or blind spots.
• 5-8-2024DRIVE TO BE ‘PERFECT’ PARENT ISN’T HEALTHY, SURVEY FINDS Parents striving to be “perfect” will never attain that goal, and the aim isn’t even healthy for their families, a new study says. The risks of striving for perfection are such that researchers have now created a scale to help parents track their burnout and, if necessary, counter it. The first-of-its-kind,
• 5-8-2024HOW INFECTIONS INFLUENCE OUR SOCIAL EMPATHY When people are ill, they feel less empathy for others than when they are healthy. The researchers investigated “sickness behavior,” a process in which the body reorganizes its biological priorities in the context of an acute infection
• 5-8-2024HYPERTENSIVE DISORDERS OF PREGNANCY MAY INCREASE WOMEN’S RISK FOR BLOOD CLOTS LATER IN LIFE South Carolina received a poor report card from the March of Dimes in 2023 because more of its mothers die due to pregnancy-related complications or childbirth than the national average.
• 5-8-2024ALMOST 30% OF CHILDREN AND ADOLESCENTS EXPERIENCE PAIN IN MUSCLES, BONES OR LIGAMENTS, STUDY SHOWSSome 27% of Brazilian children and adolescents suffer from musculoskeletal pain of unspecified cause The problem is frequently underestimated by parents and health professionals
• 5-8-2024TALKING WITH A FRIEND CAN EASE THE STING OF BEING LEFT OUT Small, simple forms of social connection—such as a conversation with a friend, or even just looking forward to one—can lessen the negative feelings and thoughts that come with being socially excluded
• 5-8-2024INCONCLUSIVE EVIDENCE SUGGESTS ZINC MAY SLIGHTLY SHORTEN COMMON COLD taking zinc may help to reduce the duration of common cold symptoms by about two days, but the evidence is not conclusive and potential benefits must be balanced against side effects.
• 5-8-2024HOW OUR KNOWLEDGE OF ARTISTS INFLUENCES OUR PERCEPTION OF THEIR WORKS A neurocognitive study shows that negative knowledge about an artist influences the perception of the artwork, regardless of the artist’s level of fame. Can we separate art from the artist? History is littered with examples of famous artists who have fallen into disrepute due to controversial statements, beliefs or actions. 5-8-2024STUDY SUGGESTS DAILY CONSUMPTION OF OLIVE OIL REDUCES CHANCES OF DEVELOPING DEMENTIA daily consumption of olive oil may reduce the chances of developing dementia. In the study , the group analyzed data for thousands of people included in two separate health databases and found that those people who consumed at least 7 g of olive oil daily were less likely to die from dementia-related ailments.
• 5-8-2024YES, ADULTS CAN DEVELOP FOOD ALLERGIES—HERE ARE FOUR TYPES YOU NEED TO KNOW ABOUT If you didn’t have food allergies as a child, is it possible to develop them as an adult? The short answer is yes. But the reasons why are much more complicated. Preschoolers are about four times more likely to have a food allergy than adults and are more likely to grow out of it as they get older.
• 5-8-2024STUDY SHOWS DAMAGING IMPACT OF HEAT WAVES ON VITAL ORGANS Periodic heat waves-induced neuronal etiology in the elderly is mediated by gut-liver-brain axis: a transcriptome profiling approach. Researchers have found evidence of the molecular causes of the damaging impact heat stress causes on the gut, liver and brain in the elderly.
• 5-8-2024STUDY REVEALS ROLE OF IRON IN ALLERGIC ASTHMA AND POINTS TO POTENTIAL NEW THERAPIES New USC research shows that iron serves as a gas pedal driving certain immune cells that cause inflammation in the lungs during an allergic asthma attack—and blocking or limiting iron may reduce the severity of symptoms.
• 5-8-2024HELPING YOUR CHILD MAKE FRIENDS WITH A CHILD WITH AUTISM Kids are very likely to make the acquaintance of a child diagnosed with autism spectrum disorder at some point, whether they know it or not. An estimated 95% of children with disabilities enroll in regular schools
• 5-8-2024GENE LINKED TO LEARNING DIFFICULTIES FOUND TO HAVE DIRECT IMPACT ON LEARNING AND MEMORY A gene previously linked to intellectual disability has been found to regulate learning and memory in mice. The gene, called KDM5B has previously been linked to some intellectual disability disorders and autism.
• 5-8-2024DIABETES IN YOUTH MAY INCREASE RISK FOR NEURODEGENERATIVE DISEASE, LIKE ALZHEIMER’S DISEASE, LATER IN LIFE Young people with diabetes may have a significantly higher risk of developing Alzheimer’s disease later in life Read More
• 5-8-2024NEW TOOL LINKS ALZHEIMER’S DISEASE TYPES TO RATE OF COGNITIVE DECLINE researchers have discovered a series of brain changes characterized by unique clinical features and immune cell behaviors using a new corticolimbic index tool for Alzheimer’s disease, a leading cause of dementia.
• 5-8-2024BARIATRIC SURGERY MAY REDUCE CANCER RISK When you think about obesity, you may not connect it to cancer. However, researchers long have suspected a link between certain cancers and weight. Among those are endometrial, ovarian, colon, liver, pancreatic and postmenopausal breast cancers, which together contribute to 15 to 20% of all cancer deaths in the U.S.
• 5-8-2024MOST SOCIALLY VULNERABLE COUNTIES LESS LIKELY TO HAVE CANCER TRIALS, ANALYSIS FINDS according to a research, the association between county-level social determinants of health (SDOH) and cancer clinical trial availability in the United States. Cross-sectional and longitudinal analyses of county-level trial availability and SDOH were performed.
• 5-8-2024SLEEP PROBLEMS AS A CHILD MAY BE ASSOCIATED WITH PSYCHOSIS IN YOUNG ADULTS Children who experience chronic lack of sleep from infancy may be at increased risk of developing psychosis in early adulthood, new research shows. children who persistently slept fewer hours, throughout this time period, were more than twice as likely to develop a psychotic disorder in early adulthood, and nearly four times as likely to have a psychotic episode.
• 5-8-2024LUNG CANCER IS THE DEADLIEST OF ALL CANCERS, AND SCREENING COULD SAVE MANY LIVES—IF MORE PEOPLE COULD ACCESS IT Many medical organizations have been recommending lung cancer screening for decades for those at high risk of developing the disease. But in 2022, less than 6% of people in the U.S. eligible for screening actually got screened. Compared with other common cancer screenings, lung cancer screening rates fall terribly behind.
• 5-8-2024WHAT YOU NEED TO KNOW ABOUT COVID VARIANTSThe virus behind COVID has mutated again, this time producing variants nicknamed FLiRT, the U.S. Centers for Disease Control and Prevention (CDC) has reported. The variants are appearing in wastewater sampling
• 5-8-2024TRIFAROTENE PLUS SKIN CARE BENEFICIAL FOR ACNE VULGARIS Trifarotene plus skin care is beneficial for patients with moderate acne vulgaris (AV) and acne-induced hyperpigmentation (AIH)
• 5-8-2024HEALTH RISKS OF USING CANNABIS ARE HIGHER IN ADOLESCENTS THAN IN ADULTS, STUDY FINDS Using cannabis on a regular basis may be significantly more dangerous for adolescents than adults, with adolescents showing higher levels of cannabis use disorder and reporting greater negative impacts on daily functioning than adults
• 5-8-2024ADVANCES IN MINIMALLY INVASIVE KIDNEY STONE SURGERY Most small kidney stones can pass on their own. However, kidney stones that are too large to pass on their own or cause bleeding, kidney damage or ongoing urinary tract infections may require surgical treatment.
• 5-8-2024CANDY COMPANY RECALLS PRODUCTS DUE TO SALMONELLA RISK A Midwestern candy company has issued a massive recall due to the risk of salmonella tainting some of its products. Palmer Candy Company of Sioux City, Iowa, is recalling “white coated confectionary items” because they could be contaminated with salmonella
• 5-8-2024WE KNOW LATE-NIGHT SCREENS ARE BAD FOR SLEEP. HOW DO YOU STOP DOOMSCROLLING IN BED? Sleep scientists long ago established that insufficient sleep is linked with poor health outcomes, anxiety, obesity and several other negative effects. The research is equally conclusive that smartphones are particularly disruptive to the circadian clock that regulates sleep and other hormones.
• 5-8-2024STUDY DEBUNKS CONCERNS ABOUT BABY FEEDING METHODS What, and how, a baby is fed can weigh on a caregiver’s mind. A study has found two popular, but somewhat controversial, methods appear to have little significant impact on infants’ appetite and weight. The study analyzed the diets of 625 7 to 10-month-old babies, evaluating appetite-related outcomes of baby food pouch use and baby-led weaning.
  
• 5-8-2024DO DYING PEOPLE HAVE A ‘RIGHT TO TRY’ MAGIC MUSHROOMS? 9TH CIRCUIT WEIGHS CASE
  
• 5-8-2024ADVOCATES FEAR IT WON’T PAY OFF
  
• 5-8-2024EXPERT EXPLAINS PINK EYE
  
• 5-8-2024RESEARCHERS DEVELOP FIRST MODEL OF THE BRAIN’S INFORMATION HIGHWAYS
  
• 5-8-2024COVID-19 STUDY EXAMINES LINK BETWEEN INSURANCE, RACE AND VACCINATION TRENDS
  
• 5-8-2024‘WRAPAROUND’ IMPLANTS REPRESENT NEW APPROACH TO TREATING SPINAL CORD INJURIES
  
• 5-8-2024STUDY FINDS THAT NEUROPATHY IS VERY COMMON BUT UNDERDIAGNOSED
  
• 5-8-2024STUDY SHOWS FREQUENT SALTING OF FOOD IS LINKED WITH INCREASED RISK OF STOMACH CANCER
  
• 5-8-2024SIMULATED HIGH-ALTITUDE EXPOSURE FOR 24 HOURS IS WELL TOLERATED DESPITE SINGLE-VENTRICLE PHYSIOLOGY
  
• 5-8-2024A COMPARISON OF SELF-REPORTED DATA AND PRIMARY CARE RECORDS IN UK BIOBANK
  
• 5-8-2024STUDY FINDS PARTICULATE SILOXANE AND CIGARETTE SMOKE ORGANIC AEROSOL IN A GYM ENVIRONMENT
  
• 5-8-2024STUDY FINDS THC LINGERS IN BREASTMILK WITH NO CLEAR PEAK POINT
  
• 5-8-2024NEW STUDY OFFERS INSIGHT INTO GENESIS OF SPINA BIFIDA
  
• 5-8-2024SEROTONERGIC NEURON FINDINGS SUGGEST POSSIBLE TREATMENT FOR DEPRESSION-RELATED INFERTILITY
  
• 5-8-2024SYSTEMIC ANTIBIOTICS IN FIRST YEAR OF LIFE TIED TO HIGHER ATOPIC DERMATITIS RISK
  
• 5-8-2024MRE-LIVER STIFFNESS MEASURE BETTER FOR VARICES IN NAFLD CIRRHOSIS
  
• 5-8-2024STRENGTHENING CAR-T THERAPY TO WORK AGAINST SOLID TUMORS
  
• 5-8-2024EXERCISE, NEW DRUG CLASS RECOMMENDED FOR MANAGEMENT OF HYPERTROPHIC CARDIOMYOPATHY
  
• 5-8-2024HOW DID THE EARLY COVID-19 PANDEMIC IMPACT BIRTH OUTCOMES IN AUSTRALIA?
  
• 5-8-2024A NEW FRONTIER IN NEUROSCIENTIFIC FUSION
  
• 5-8-2024INDIVIDUALS OF ALL AGES WITH POSITIVE SKIN OR BLOOD TEST SHOULD RECEIVE PREVENTIVE TREATMENT FOR TB, NEW STUDY SAYS
  
• 5-8-2024NEW RESEARCH REPORTS ON FINANCIAL ENTANGLEMENTS BETWEEN FDA CHIEFS AND THE DRUG INDUSTRY
  
• 5-8-2024SUSPENDED UK CLIMATE ACTIVIST PHYSICIAN WILL NOT STOP PROTESTING
  
• 5-8-2024A THIRD COVID VACCINE DOSE IMPROVES DEFENSE FOR SOME CLINICALLY EXTREMELY VULNERABLE PATIENTS
  
• 5-8-2024BIRD FLU HAS SPREAD TO COWS IN COLORADO. IS AVIAN INFLUENZA A THREAT?
  
• 5-8-2024POWER IMBALANCES AND HIERARCHY PREVENT DOCTORS FROM WORKING EFFECTIVELY IN TEAMS, RESEARCH SHOWS
  
• 5-8-2024EARLY ONSET BOWEL CANCER CASES INCREASING IN NEW ZEALAND
  
• 5-8-2024TEAM SYSTEMATICALLY MODIFIES GLYCERALDEHYDE DERIVATIVE JX22 FOR IMPROVED ANTI-HEART FAILURE EFFICACY AND SAFETY
  
• 5-8-2024RESEARCH TEAM IDENTIFIES FOUR NEW GENETIC RISK FACTORS FOR MULTIPLE SYSTEM ATROPHY
  
• 5-8-2024RESEARCHERS SAY FUTURE IS BRIGHT FOR TREATING SUBSTANCE ABUSE THROUGH MOBILE HEALTH TECHNOLOGIES
  
• 5-8-2024EATING DISORDER SYMPTOMS ARE SURPRISINGLY COMMON IN PEOPLE WITH INSULIN-DEPENDENT DIABETES
  
• 5-8-2024TEENS WHO VIEW THEIR HOMES AS MORE CHAOTIC THAN THEIR SIBLINGS DO HAVE POORER MENTAL HEALTH IN ADULTHOOD
  
• 5-8-2024RESEARCHERS DEVELOP FALLS PREDICTION MODEL USING HEALTH RECORDS TO PREDICT PATIENTS’ RISK OF FALLING IN THE UK
  
• 5-8-2024RESEARCHERS IDENTIFY WHAT DRIVES PARP INHIBITOR RESISTANCE IN ADVANCED BREAST CANCER
  
• 5-8-2024DISCOVERY OF KEY TARGET FOR PRECISION PHARMACOLOGY MAKES IDEAL CANDIDATE TO TREAT HEART FAILURE
  
• 5-8-2024STUDY SHOWS HOW SEPSIS CAN AFFECT VASCULAR SMOOTH MUSCLE CELLS ON AN ACUTE AND LONG-TERM BASIS
  
• 5-8-2024NEW GUIDELINES FOR DEPRESSION CARE EMPHASIZE PATIENT-CENTERED APPROACH IN CANADA
  
• 5-8-2024ASTRAZENECA WITHDRAWS COVID VACCINE AS DEMAND DIVES
  
• 5-8-2024RESEARCHERS OUTLINE HOW CELLS ACTIVATE TO CAUSE FIBROSIS AND ORGAN SCARRING
  
• 5-8-2024POTENTIAL LINK BETWEEN PTSD AND AUTISM FOUND IN MICE
  
• 5-8-2024RESEARCHERS FIND THAT A NEW MOTHER’S IMMUNE STATUS VARIES WITH HER FEEDING STRATEGY
  
• 5-8-2024REVISED CLINICAL GUIDELINES ON MANDATORY REPORTING OF SUBSTANCE-EXPOSED NEWBORNS SHOW PROMISE
  
• 5-8-2024COVID-19 PANDEMIC CHANGED ATTITUDES TOWARD WEARABLE HEALTH DEVICES, STUDY FINDS
  
• 5-8-2024CHILDHOOD MALTREATMENT RESPONSIBLE FOR UP TO 40% OF MENTAL HEALTH CONDITIONS AMONG AUSTRALIANS, FINDS RESEARCH
  
• 5-8-2024MORE THAN 321,000 US CHILDREN LOST A PARENT TO DRUG OVERDOSE FROM 2011 TO 2021: STUDY
  
• 5-8-2024RESEARCHERS DISCOVER NEW TARGET FOR POTENTIAL LEUKEMIA THERAPY
  
• 5-8-2024TRIAL SHOWS A FASTER APPROACH FOR STARTING EXTENDED-RELEASE NALTREXONE TO TREAT OPIOID USE DISORDER IS EFFECTIVE
  
• 5-8-2024FACTORS ID’D FOR CLEAN INTERMITTENT CATHETERIZATION COMPLIANCE IN YOUTH WITH NEUROGENIC BLADDER
  
• 5-8-2024PERSONALIZED NUTRITION MORE EFFECTIVE THAN GENERAL DIET ADVICE, STUDY FINDS
  
• 5-8-2024SCIENTISTS UNRAVEL HOW PSYCHEDELIC DRUGS INTERACT WITH SEROTONIN RECEPTORS TO POTENTIALLY PRODUCE THERAPEUTIC BENEFITS
  
• 5-8-2024‘MATHEMATICAL MICROSCOPE’ REVEALS NOVEL, ENERGY-EFFICIENT MECHANISM OF WORKING MEMORY THAT WORKS EVEN DURING SLEEP
  
• 5-8-2024RESEARCHERS MAY HAVE FOUND AN ACHILLES HEEL FOR HEPATITIS B
  
• 5-8-2024NEUROAFFIRMING CARE VALUES THE STRENGTHS AND DIFFERENCES OF AUTISTIC PEOPLE, THOSE WITH ADHD OR OTHER PROFILES
  
• 5-8-2024FUTURE PANDEMICS WILL HAVE SAME HUMAN CAUSES AS ANCIENT OUTBREAKS—LESSONS FROM ANTHROPOLOGY CAN PREVENT THEM
  
• 5-8-2024MANY PEOPLE ARE FEELING ECOLOGICAL GRIEF. HOW CAN WE HELP THOSE WHOSE WORK PUTS THEM AT RISK?
  
• 5-8-2024TAILORED VACCINE COULD ONE DAY TREAT ECZEMA IN CHILDREN
  
• 5-8-2024POTENTIAL CAUSAL EFFECT OF LONG-TERM PM? EXPOSURE ON HYPERTENSION HOSPITALIZATION
  
• 5-8-2024SLEEP APNEA PATIENTS CAN BREATHE EASY ABOUT CPAP THERAPY, COMPUTER SIMULATIONS SUGGEST
  
• 5-8-2024INTERVENTION IN NAVAJO NATION BOOSTS UPTAKE FOR HEART FAILURE DRUGS BY 53%
  
• 5-8-2024STUDY IDENTIFIES DISPARITIES IN END-OF-LIFE CARE FOR LUNG CANCER PATIENTS
  
• 5-8-2024INFLAMMATORY PROTEIN RESEARCH OFFERS TREATMENT STRATEGIES FOR A RARE, POTENTIALLY FATAL LUNG DISEASE
  
• 5-8-2024TEAM DEVELOPS COMPUTATIONAL APPROACH TO REDESIGN ANTIBODIES FOR BROADER EFFECTIVENESS AGAINST VIRAL PANDEMICS
  
• 5-8-2024A SMART NECKBAND FOR TRACKING DIETARY INTAKE
  
• 5-8-2024NEW DEVICE THAT EMITS MAGNETIC FIELD MAY OFFER HOPE FOR TREATING DEPRESSION
  
• 5-8-2024CHINESE HERB ASPIDOPTERYS OBCORDATA SHOWS POTENTIAL IN TREATING KIDNEY STONES
  
• 5-8-2024VOWEL INTELLIGIBILITY TESTING MAY HELP MONITOR PROGRESSION FOR PEOPLE WITH ALS
  
• 5-8-2024ROAD OF RECOVERY IN GASTROINTESTINAL SURGERY: FROM ERAS TO FRAS
  
• 5-8-2024LIFE-CHANGING UK HEALTH PROGRAM COULD REACH MORE F
  

AVAH reported a revenue increase to $490.7 million in Q1 2024, up 5.2% year-over-year, with a net loss of $11.2 million, slightly worse than analyst expectations.

Key Metrics

Revenue	$490.7M	5.2%
Gross Profit	$145.9M
	Net Income	$-11.2M
Earnings Per Share	$-0.06
Cash and Cash Equivalents	$42.6M

Segment Performance

• Private Duty Services (PDS) (revenue - $395.009M, growth - 5.9%) - Revenue increased by $22.1 million, driven by higher demand for home health services.
• Home Health & Hospice (HHH) (revenue - $54.613M, growth - -2.7%) - Revenue decreased by $1.5 million, primarily due to lower Medicare reimbursement rates.
• Medical Solutions (MS) (revenue - $41.031M, growth - 9.9%) - Revenue increased by $3.7 million, driven by growth in the company's respiratory therapy business.

Business Highlights

• Increased Adjusted EBITDA by 22.5% to $34.9 million, driven by cost reductions and improved operating efficiency.
• Raised full-year 2024 revenue guidance to greater than $1,970 million and Adjusted EBITDA guidance to greater than $150 million.

Guidance: Increased

• Revenue (full year): $greater than $1,970 millionM

Future Business Drivers: - Continued focus on cost reductions and operational efficiency. - Expansion into new markets and services. - Strategic acquisitions to enhance capabilities and market reach.
Expectations: AVAH's reported revenue of $490.7 million slightly exceeded the average analyst estimate of $483.98 million for Q1 2024. However, the EPS of -$0.06 was below the average estimate of -$0.05. The company's revenue growth and raised full-year guidance are positive, but the net loss poses concerns.

Clinical Nurse Specialist References: This looks like the acute care pharmacist role in ICU and ER.
You Tube Nursing Uncharted. The Role of a Clinical Nurse Specialist (CNS) Ep. 06 Highlight Nursing Uncharted
https://www.youtube.com/watch?v=L1_QwTuS3Hc
You Tube Nurse.org. How to Become a Clinical Nurse Specialist (CNS)How to Become a Clinical Nurse Specialist (CNS)
Nurse.org
https://www.youtube.com/watch?v=n8RXYQC0uIo
Nurse.org
How to Become a Clinical Nurse Specialist
https://nurse.org/resources/clinical-nurse-specialist/

What Does a Clinical Nurse Specialist Do?

A clinical nurse specialist's job varies depending on the type of facility they work at and their chosen specialty. However, their primary goal is always to improve outcomes. Therefore, they constantly ask questions like:

• How can I help the nurses at the bedside?
• How can I help these patients on the unit?
• What changes would improve processes throughout the hospital system?

Clinical Nurse Specialist Duties and Responsibilities

According to CNS Andrea Paddock, CNS responsibilities may change daily:
“My day-to-day can transition from being in my office planning for a project. So I'm doing a lot of reading, researching, writing, things like that. Other days, I'm out on the unit helping the nurses, running to codes, running simulations, teaching classes, running meetings, etc. No one day is ever the same.”
In fact, according to the 2020 NACNS survey, CNSs said they spent 26.6 percent of their day providing direct patient care, 22.1 percent consulting with nurses and other staff, 26.5 percent teaching nurses and staff, and 19.7 percent leading evidence-based practice projects. The majority of their time is spent precepting students (32.5%).
Clinical nurse specialists will also perform the following activities according to the survey:

• Assist with evidence-based practice projects
• Assist other nurses/staff with direct patient care (aka act as a resource)
• Assist with research
• Teach patients and families
• Conduct research as the primary investigator
• Teach in the community
• Provide transitional care

In other words, CNSs wear several hats and are valued members of healthcare teams.
What Does a Clinical Nurse Specialist Do? A clinical nurse specialist's job varies depending on the type of facility they work at and their chosen specialty. However, their primary goal is always to improve outcomes. Therefore, they constantly ask questions like: How can I help the nurses at the bedside? How can I help these patients on the unit? What changes would improve processes throughout the hospital system?
Clinical Nurse Specialist Duties and Responsibilities According to CNS Andrea Paddock, CNS responsibilities may change daily: “My day-to-day can transition from being in my office planning for a project. So I'm doing a lot of reading, researching, writing, things like that. Other days, I'm out on the unit helping the nurses, running to codes, running simulations, teaching classes, running meetings, etc. No one day is ever the same.”
In fact, according to the 2020 NACNS survey, CNSs said they spent 26.6 percent of their day providing direct patient care, 22.1 percent consulting with nurses and other staff, 26.5 percent teaching nurses and staff, and 19.7 percent leading evidence-based practice projects. The majority of their time is spent precepting students (32.5%).
Clinical nurse specialists will also perform the following activities according to the survey: Assist with evidence-based practice projects Assist other nurses/staff with direct patient care (aka act as a resource) Assist with research Teach patients and families Conduct research as the primary investigator Teach in the community Provide transitional care In other words, CNSs wear several hats and are valued members of healthcare teams.

CNS Certifications & Specialties

CNS certifications don't cover all specialty areas of nursing like other degrees. Currently, clinical nurse specialists can earn certifications in the following specialties:

• Adult
• Pediatric
• Neonatal
• Geriatric
• Oncology
• Critical Care (Adult, Pediatric & Neonatal)
• Orthopedic
• Perioperative
• Psychiatric-Mental Health (Adult, Adolescent/Child) CNS Certifications & Specialties CNS certifications don't cover all specialty areas of nursing like other degrees. Currently, clinical nurse specialists can earn certifications in the following specialties: Adult Pediatric Neonatal Geriatric Oncology Critical Care (Adult, Pediatric & Neonatal) Orthopedic Perioperative Psychiatric-Mental Health (Adult, Adolescent/Child)

CNS can bill for services and have provider status in many states. Pharmacist do not seem to have this.
NP, CNS, and CNM Services:7 Medicare makes payment for NP, CNS, and CNM services based on the MPFS.
The MPFS is a fee schedule with an individual payment amount for as many as 8,000 different procedure
codes. Section 1833(a)(1)(O) of the Act requires NPs and CNSs to be paid 85% of what Medicare would pay a
physician for the same service or 85% of the MPFS payment amount. Until January 1, 2011, CNMs were paid
65% of the MPFS payment amount. Beginning January 1, 2011, Medicare allows CNMs to be paid 100% of
the MPFS amount. The final section of this paper will posit arguments for changing the statute so that all
APRNs are paid at 100% of the MPFS.
Reference ANA: Medicare Payment for Registered Nurse Services and Care Coordination
https://www.nursingworld.org/~498582/globalassets/practiceandpolicy/health-policy/final_carecoordination.pdf

CNS Independent Practice MapCNS Independent Practice Map

https://www.ncsbn.org/nursing-regulation/practice/aprn/aprn-consensus-implementation-status/cns-independent-practice-map.page
All Nursing Schools:

What You’ll Do as a Clinical Nurse Specialist (CNS Job Description)

https://www.allnursingschools.com/clinical-nurse-specialist/job-description/
https://preview.redd.it/jlk3in7crczc1.png?width=798&format=png&auto=webp&s=f6d55786d31c2eb16c766654faf8c9e0f0a83466
International Council of Nurses. Guidelines for Advance Practice Nursing 2020:
https://www.icn.ch/resources/publications-and-reports/guidelines-advanced-practice-nursing-2020
https://www.icn.ch/sites/default/files/2023-04/ICN_APN%20Report_EN.pdf
https://preview.redd.it/wh0da0a2sczc1.png?width=749&format=png&auto=webp&s=3244c41cae29378b5b16cea0c81450ed7b4014d7
https://preview.redd.it/hljay7v6sczc1.png?width=781&format=png&auto=webp&s=a31841593469f6cbb913a6ab27b064f020a555c1
https://preview.redd.it/4abhhsn9sczc1.png?width=768&format=png&auto=webp&s=cf2d63e1b9b50de0142b2997e1bb42dbf829b598
The role of the nurse is also expanding in Ambulatory care. This looks like the AMCare RPH References:

RN Role Reimagined: How Empowering Registered Nurses Can Improve Primary Care

https://www.chcf.org/publication/rn-role-reimagined-how-empowering-registered-nurses-can-improve-primary-care/
https://improvingprimarycare.org/sites/default/files/topics/RN-Intro1-RN%20Role%20Reimagined-CHCF-Aug2015.pdf
With growing demands on primary care and a shortage of primary care clinicians, safety-net clinics are asking, What is the role of the registered nurse (RN) in primary care?
This report describes how 11 community health centers and county health systems in California, as well as two health centers outside California, are using the following strategies to expand the RN role in primary care:

• Provide RNs with additional training in primary care skills, so they can make more clinical decisions
• Empower RNs to make more clinical decisions, using standardized procedures
• Reduce the triage burden on RNs to free up time for other responsibilities
• Include RNs on care teams, allowing them to focus on their team’s patients
• Implement RN-led new-patient visits to increase patient access to care
• Offer patients co-visits in which RNs conduct most of the visit, with providers joining in at the end
• Deploy RNs as “tactical nurses”
• Provide patients with RN-led chronic care management visits
• Employ RNs’ skills to care-manage patients with complex health care needs
• Train some RNs to take responsibility for specialized functions
• Schedule RNs to perform different roles on different days
• Preserve the traditional RN role and focus on training medical assistants (MAs) and licensed vocational nurses (LVNs) to take on new responsibilities

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American Nurse:

Preparing RNs for emerging roles in primary care

https://www.myamericannurse.com/preparing-rns-for-emerging-roles-in-primary-care/

Registered Nurses: Partners in Transforming Primary Care

https://macyfoundation.org/publications/registered-nurses-partners-in-transforming-primary-care
https://macyfoundation.org/assets/reports/publications/macy_monograph_nurses_2016_webpdf.pdf
Registered nurses, the largest health profession in the nation with over 3.5 million
members, are ideally suited to provide the bulk of care for people with chronic
illnesses. In primary care, RNs may assume at least four responsibilities: 1) Engaging
patients with chronic conditions in behavior change and adjusting medications
according to practitioner-written protocols; 2) Leading teams to improve the care
and reduce the costs of high-need, high-cost patients; 3) Coordinating the care
of chronically ill patients between the primary care home and the surrounding
healthcare neighborhood; and 4) Promoting population health, including working
with communities to create healthier spaces for people to live, work, learn, and play.

The Vital Role of Nurses in Delivering Transformative Primary Care

https://www.chenmed.com/blog/vital-role-nurses-delivering-transformative-primary-care
Depending on their level of education and experience, the BMC Health Service Research Article observes, nurses can independently "provide a broad range of patient services, including preventative screening, health education and promotion, chronic disease management, acute episodic care, and a wide variety of therapeutic interventions."
The activation of nurses—under the guidance of MDs, physician assistants, and nurse practitioners—was a hallmark of 30 "high-performing, innovative primary care practices" highlighted in a 2017 study published by the Journal of Ambulatory Care Management. These organizations had "practice-wide standing orders" that directed nurses to "independently conduct preventative visits, manage minor acute illnesses, and provide significant chronic illness care and management" to the patient panels.

Value-Based Care Elevates the Role of the Registered Nurse in Primary Care

https://www.hfma.org/payment-reimbursement-and-managed-care/value-based-payment/54348/
For example, a patient may need to see only the nurse and nurse assistant for one scheduled visit but on another visit needs to be examined by the physician and provided training by the nurse.
Additionally, the patient pathway from appointment preparation to next appointment rescheduling was streamlined to shorten wait time by starting intake procedures from the moment the patient enters the office. Further, the critical handoff between the physician and the nurse is expedited by the needs-based stratification of patients, each associated with evidenced-based care protocol. This expands the role of nurse, allowing them to assume greater responsibility for patient care.
To be successful in such value-based initiatives, healthcare organizations must ensure nurses are working at the top of their license. Progressive providers have increased patient access by conducting new nurse-only patient visits during which registered nurses document patient histories, order lab and other diagnostic tests, and determine patient acuity.
By implementing newly defined standardized procedures, clinics are increasing the registered nurse’s scope of clinical decision making including medication refills and anticoagulant and chronic care management. Nurses also are conducting physical examinations, providing triage, and subsequently presenting patient cases to practitioners—activities that significantly improve overall workflow and efficiency. Moreover, evidence shows nurse-led chronic, complex, and transitional care management results in decreased hospital days and emergency department (ED) admissions.
The Ohio State School of Nursing

Redesigning nursing education to support patients in primary care

https://nursing.osu.edu/news/2020/12/16/redesigning-nursing-education-support-patients-primary-care
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Implementing Nurse-Run Hypertension Clinics
https://www.careinnovations.org/resources/nurse-run-hypertension-care/
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These tread seems to be international as all countries seem to move toward Value Based Care.

Tension as practice pharmacists ‘encroach’ on nurse duties

https://www.nursingtimes.net/news/primary-care/tension-as-practice-pharmacists-encroach-on-nurse-duties-12-03-2019/

Hospital hires newly qualified pharmacists for wards amid nurse shortage

https://pharmaceutical-journal.com/article/news/hospital-hires-newly-qualified-pharmacists-for-wards-amid-nurse-shortage

The global revenue cycle management (RCM) market is projected to witness a notable Compound Annual Growth Rate (CAGR) exceeding 11%, reaching approximately USD 600 billion by 2027. Key drivers for this growth include the escalating adoption of RCM tools by healthcare providers worldwide and the rapid advancements in technology within the sector. Additionally, the increasing emphasis on optimizing organizational workflows, coupled with ongoing innovations in integrated management software and systems aimed at error reduction, is expected to further propel market expansion throughout the forecast period.
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Market Trends:
· Transition to Value-Based Care: There is a shift towards value-based care models, where healthcare providers are reimbursed based on patient outcomes rather than the volume of services provided. This transition is driving the adoption of RCM solutions that can accurately capture and track patient data, facilitate quality reporting, and ensure compliance with value-based payment requirements.
· Integration of Artificial Intelligence (AI) and Automation: Healthcare organizations are increasingly leveraging AI and automation technologies within their RCM systems to streamline administrative processes, improve billing accuracy, reduce claim denials, and enhance revenue cycle efficiency. AI-powered analytics also enable predictive modeling and revenue forecasting, helping organizations make data-driven decisions to optimize financial performance.
· Focus on Patient Engagement and Experience: There is a growing emphasis on patient engagement and satisfaction throughout the revenue cycle. RCM solutions that incorporate patient-friendly billing and payment options, transparent cost estimates, and personalized communication strategies are becoming increasingly important for enhancing patient experience and fostering patient loyalty.
· Interoperability and Data Exchange: Interoperability and seamless data exchange between different healthcare systems and stakeholders are critical for efficient revenue cycle management. As healthcare organizations adopt electronic health records (EHRs) and other digital health technologies, interoperable RCM solutions that can integrate with various systems and facilitate data sharing are in high demand.
· Regulatory Compliance and Coding Changes: Healthcare regulations and coding requirements are constantly evolving, necessitating ongoing updates to RCM systems to ensure compliance and accurate reimbursement. RCM vendors are focused on providing solutions that can adapt to regulatory changes, automate coding processes, and minimize compliance risks for healthcare organizations.
Market Opportunities:
The revenue cycle management (RCM) market presents numerous opportunities for growth and innovation. One significant opportunity lies in addressing the evolving needs of healthcare providers as they navigate the transition to value-based care models and the increasing complexity of healthcare regulations. RCM vendors can capitalize on this by developing solutions that facilitate accurate and timely reimbursement, support quality reporting, and enable organizations to demonstrate value-based care outcomes. Additionally, the integration of artificial intelligence (AI) and automation technologies presents opportunities to streamline administrative processes, reduce costs, and enhance revenue cycle efficiency.
According to the recent report published by RC Market Analytics, the Global Revenue Cycle Management Market is expected to provide sustainable growth opportunities during the forecast period from 2024 to 2030. This latest industry research study analyzes the revenue cycle management market by various product segments, applications, regions and countries while assessing regional performances of numerous leading market participants. The report offers a holistic view of the revenue cycle management industry encompassing numerous stakeholders including raw material suppliers, providers, distributors, consumers and government agencies, among others. Furthermore, the report includes detailed quantitative and qualitative analysis of the global market considering market history, product development, regional dynamics, competitive landscape, and key success factors (KSFs) in the industry.
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Geographically, the revenue cycle management market report comprises dedicated sections centering on the regional market revenue and trends. The revenue cycle management market has been segmented on the basis of geographic regions into North America, Europe, Asia Pacific, Latin America, and the Middle East & Africa. Revenue cycle management market estimates have also been provided for the historical years 2020 to 2023 along with forecast for the period from 2024 - 2030.The report includes a deep-dive analysis of key countries including the U.S., Canada, the U.K., Germany, France, Italy, China, Japan, India, Australia, Mexico, Brazil and South Africa, among others. Thereby, the report identifies unique growth opportunities across the world based on trends occurring in various developed and developing economies.
The Revenue Cycle Management Market Segmentation:
By Product:

• Software
• Services

By Type:

• Integrated
• Standalone

By Delivery Mode:

• On-premise
• Web-based
• Cloud-based

By End-User:

• Physician Offices
• Hospitals
• Diagnostic Laboratories
• Others

By Region:

• North America
• Europe
• Asia Pacific
• Latin America
• Middle East & Africa

Major participants in the global revenue cycle management market include The SSI Group, Inc., AllScripts Healthcare, LLC, Experian Health, R1 RCM Inc., McKesson Corporation, and athenahealth, Inc. These companies are pursuing market growth through strategies such as expansion, new investments, the introduction of innovative services, and collaborative ventures. Additionally, they are leveraging expansion and acquisition strategies to explore new geographical markets, aiming to harness joint synergies for a competitive edge in the industry.
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Key Questions Answered by Revenue Cycle Management Market Report:

• Product popularity and adoption based on various country-level dynamics
• Regional presence and product development for leading market participants
• Market forecasts and trend analysis based on ongoing investments and economic growth in key countries
• Competitive landscape based on revenue, product offerings, years of presence, number of employees and market concentration, among others
• Various industry models such as SWOT analysis, Pestle Analysis, Porter’s Five Force model, Value Chain Analysis pertaining to Revenue Cycle Management market
• Analysis of the key factors driving and restraining the growth of the global, regional and country-level markets from 2020-2030

About Us:RC Market Analytics is a global market research firm. Our insightful analysis is focused on developed and emerging markets. We identify trends and forecast markets with a view to aid businesses identify market opportunities to optimize strategies. Our expert’s team of analysts’ provides enterprises with strategic insights. RC Market Analytics works to help enterprises grow through strategic insights and actionable solutions. Feel free to contact us for any report customization at sales@researchcorridor.com.
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LPC moving to Utah later this summer from Colorado and wondering if anyone can share the reimbursement rates for the 90837 CPT code. I am already credentialed with the United, Cigna, Aetna in CO. Any help is appreciated!!