47 days ago was my last blog entry and we've been busy since then.  Alot has been going on.  Most recently, I spent a big part of yesterday cutting up a limb that was about 25 feet long and about 10 inches in diameter - in 100 degree weather, yesterday.   It fell at dad's house, from a Sycamore tree, and missed the house by about 4 inches and also missed the air conditioning unit.  Had it hit either, we'd have some major damage.  



About 11 days ago, Angie, Crystal, Joe and I started a diet (Ultimate NY Diet) whereby we don't eat any lactose, sucrose or fructose, carbohydrates, milk, butter, potatoes, starch, etc...   So - we've been eating alot of fish, chicken and turkey, vegetables (other than carrots that have natural sugar in them) and egg whites.   We're getting alot of protein, green tea and limiting our coffee to 1 or 2 cups a day.  We've all had pretty good success.  I don't know how many pounds everyone has lost so far, but I've lost 11 and I can see my belt buckle again.   Angie still swims 20 laps every morning, so while she hasn't lost alot of weight (muscle weighs more than fat), she has definitely made progress as she is slimming down considerably in less than 2 weeks.  

About a month ago, Joe (our 2nd son) and (his wife) Crystal moved in with us and we're enjoying having them here.   Every couple of days, we get into a game of spades or some other game and we're having fun.  They're renting the house they own to someone else - so this gives them a chance to catch up, plus we enjoy having them here.   I'm not sure Cookie likes it as much because they have Jake and Jake is about 4 times her size and sometimes the younger Jake gets excited and steps on her, so she's always dodging. 

My voice is still pretty course and sometimes goes away because of the cyst/nodules on my vocal cord.   While we were in TN, I had an ENT doctor scope me and said it needed surgery.  When we got home, I scheduled the surgery with the office manager and the pre-visit with the ENT here and when he scoped it, he said that I have nodules and not a cyst, so he treated it with steroids, antibiotic and Nexium (He thinks it was caused by laryngeal reflux - even though I haven't had any kind of reflux that I've felt, for years).  That was about 3 weeks ago - and still no change and I have a follow-up visit with him scheduled in a couple of weeks.  We'll see then if he wants to do surgery or not.

For the past 3 Sundays, we've attended First Baptist (southern location) with Joe and Crystal.     Nick (our oldest), his wife Tiffany and our 2 grandchildren also attend this church.   We've enjoyed it - and visited 3 different Sunday School classes and I think we found one we really like.  Their pastor moved to Corpus a couple of months back, so they've had different preachers spend 2 weeks each while they're looking for an interim pastor.  The last 2 Sundays, they've had Chris Legg preaching and we REALLY like him.    It is absolutely amazing how much more you can get out of the Bible when you have someone teach you the context of what the Jews were going through and how they lived - and how that applies to the teachings in the Gospels.   It makes you realize different passages means something different than what you thought it had meant - when you realize what the situation was then.    Anyway - I think we'll be back to visit that church and SS again.   

A couple of weeks ago, I was visiting a client in Malvern, Arkansas and the night before my meetings with the doctor, I spent a couple of hours talking to a friend that told me a little bit about a book called THE SHACK.   I had never heard of it before, and he said it was about a guy my age that has a family crisis and then has a face-to-face meeting with God and how it changed his viewpoints on alot of things.   He really felt it had an impact on his life, so I told him that I'd find a bookstore and pick it up.   Unbeknownst to me, the next day while I was in meetings all day with the doctors and clinic staff, his wife went to the store and bought me the audio book of it on CD and I started listening to it on the 3 hour drive home.    WOW.    There were times when I thought I'd need to pull over because I was crying while listening to his crisis.  Yes - this is a book of fiction - but it was very well told.  There were other times when I was laughing and I have to tell you that this book has had a very good impact on me and my relationship with not only God, but also Jesus and the Holy Spirit.   No - it didn't result in me being "saved" in the traditional baptist sense - as I've accepted Jesus as my savior many many years ago and even though we went about 13 years without attending a church until very recently - I've never stopped talking to God and praying.   This just gave me pause to think about the separate kind of relationships I have with all 3 of the trinity - which I had never really thought much about.   I had always put my relationship to God in the same kind of way I've had my relationship with my father - in that He is my father.    In fact, thinking about it - I think my relationship with Jesus is probably close to my relationship with my dad than it is with me and God (yes - I know they are one and the same - but they are also different and this book helped me realize it even more...... even though it is fiction).   Hey - God can use anything to get His point across - if He wants to.    Anyway - regarding dad and Jesus - and the similarities are that I love both men and while I've always been comfortable with my dad doing things, playing games, fishing, skipping rocks, going to the stock car races or just talking - I'm rapidly getting that way with Jesus - while I'm still a little more reserved when talking to God.   OK - I won't tell you too much about the book other than I highly recommend it.  I'll warn you, though, that if you're close minded and the only way in the world that you can picture God in your mind is as a white guy with a long beard and robes and speaking English, you will be disappointed.   I'm rapidly learning to not put God in a box as my God is big enough that he can be anyone, do anything and appear any way that He wants to - and He may do exactly that - just to teach ME a lesson someday.

So - we've been home for about 5 weeks and we'll be home for a long time yet.  I still have to fly out to Orlando at the end of the month to speak to an Osteopathic Family Physicians convention - but we're having to watch our expenses for awhile.    Business has been slow - mainly because of the economy and the fact that physicians that have the intelligence to follow our advice are having trouble getting financing since the banking industry lowered the amount that banks and lending institutions can loan compared to their cash reserves, so I had to let Gayle go.   She's worked for me, on and off, for about 17 years and that was a very difficult decision - but over the past 3 months, her salary was twice of what mine and Angie's was combined.  In fact, I think this is the hardest we've been hit financially in about 19 years - but thankfully - we still have the business and alot of future.    I'm working on a fee, code, charge analysis of a large clinic in Oklahoma and we have 14 clinics in DFW that we're in the process of analyzing and that should be great.  

The 5th physician (in 22 years) that has decided to do everything we've recommended is in the process of getting a full lab in his practice and that too will help.   Yes - in 22 years, we've only had 5 physicians truly follow our advice.    The first was Dr. Mike in Dallas who 2 1/2 years ago - he came to me and said that his gross income was less than $30K and his employees, office overhead, etc... was eating it up and he needed help and even though he's been a retainer client for 16 years - he was ready to do whatever we recommended.  We started making changes immediately and his income started increasing and his medical outcomes improved and last month, his collections was over $100K, so he's added a mid level to his practice.  No - he hasn't worked harder - but he has learned to work smarter.    We have Dr. Tasha in south Florida who does everything we recommend and she has added a couple of providers and is spending more time with her 2 beautiful children and her husband and still making a very handsome living in her practice.   Then, we also have Dr. Joe in Southeast Texas who, while wanting to do everything we recommend and him buying everything in the right time frames - would have increased his income by $3,000,000 over the past two years - had his physicians working for him (MDs and not D.O.s) not gotten arrogant enough to think that THEY know more than the National Institute of Health, American Diabetes Association, American College of Cardiologists, American Association of Clinical Endocrinologists, PQRI, AHRQ, etc... and found excuses for not following the national guidelines.   Now - he's gotten rid of the 2 of the 6 providers and I spent 3 days there last week with them - RETRAINING the physicians and in the next 12 months - he will see an increase and more importantly - lives will be saved, improved and medical outcomes will improve drastically.   Of all of his current providers - I only think we'll have problems convincing one to follow the guidelines - but if she doesn't - then I'll ask him to replace her as his patients and their care is more important than an M.D. who thinks they know it all.     The 5th physician is in Malvern, Arkansas and this doctor puts patients first (the same way the other 4 that i talked about) and he's a real pleasure to deal with.   There is no doubt that we'll help him and the other 6 providers (4 physicians and 3 mid levels) increase that clinic's income by $5.4 million a year by the 2nd year.  Already - if his billing agency does their job right - their increase over the past 10 months should have been almost $1,000,000 - but it was not as much as it should be because someone in their billing department figured they knew more than we (and Medicare) did and didn't bill things the way they should have been.   I'm sorry - but I've just about had it with stupidity.  I can fix alot of things - but I can't fix STUPID and I'm way past the point in my life when I'll just "get along".  If a doctor has someone stupid working for them - then that person may not only be costing the doctor tens or hundreds of thousands a year - but they can also be endangering lives - and maybe I'm getting crotchity in my 53rd year - but I'm no longer going to pussy-foot around with these employees.  Either they do it right - or my advice to the doc is to add them to the 9% of the population that is unemployed.   With 9% unemployment out there - there HAS to be some good people with brains enough to do the job right and I'll do what i can to help the doc find them if need be.   Stupidity is no longer an answer or excuse that I'll accept and when I show someone what the CMS says they want or what physician arrogance is costing in lives - and they continue doing what they were doing before - then that is STUPIDITY and it's dangerous at the least.

It's like the office manager who hears me show their physician what they need to be doing in their office that they are not doing -  when the manager and the physician agree that doing it will increase their monthly net income by $8,000 a month (NET) - but not doing is  costing lives or costing patients to have amputations and then telling the doctor that maybe we should wait a year to do that.    THAT is stupidity and dangerous to the next patient that walks into that office with that condition - and that next patient may be the office manager's husband or parent......     How many patients will have to die, needlessly or how many will have to have a joint replaced, needlessly or how many will lose a toe or a foot, needlessly because of the stupidity and arrogance of the physician or the office manager?     That infuriates me!   I have letter after letter from clients that describe how many lives they have saved, how much their care has improved and how much they've restored a quality of life to their CHF or COPD patients because they followed the guidelines that we've shown them and then followed our advice and to hear someone using a small part of their brain tell me that they'll think about it and maybe do it next year????    

Ok - things will get better.   This Tuesday is our 30th wedding anniversary and David's (our youngest son) 23rd birthday.    Times are hard right now - so I don't expect any gifts - but it will be interesting to see which of our kids remembers either.  

So - in closing - go get that book and tell me what you think.  one of my daughers-in-law (Crystal) is reading it right now.