Journeys of Don, Angie & Cookie

FEB 1, 2012 - MAJORING ON THE MINOR

donself@donself.com (Don Self) — Thu, 02 Feb 2012 05:20:30 GMT

The patient was brought in on a stretcher, in critical condition and the on-call surgeon was paged to the ICU. The EMTs and nurses updated the physician that the patient had been hit and drug by a truck along the highway for at least 30 feet. The patient's left lung had collapsed, the patient was unresponsive and the head trauma looked severe. The physician spent a few minutes looking over the patient and then proceeded to pull shards of glass and bits of rock out of the patient's superficial wounds on his legs until the patient expires.

Sounds ridiculous doesn't it? It's a great thing for the patients that most physicians are so much better at medicine than they are business because if most physicians practiced medicine the way they run their business, we as patients would be in real trouble. What I am talking about is the massive urgency that so many physicians are concentrating on to achieve Meaningful Use. The main objective by almost every one of them is to qualify to get the $44,000 bonus (if they achieve it for five full years), so let's look at that for a minute or two.

$44,000 / 5 years = $8,800 a year
$8,800 / 12 months = $733.33 a month
$733.33 / 4.3 weeks = $170.54 a week
$170.54 / 5 days = $ 34.10 a day

It seems like it would be alot easier to adopt even one of the things I've been telling folks about to get 25 times the $34.10 a day and there would be no doubt you would get it.

Yep - you folks are going to alot of trouble for $34.10 a day (that's what it will average out to over 5 years, by the way)

So let's look at the maximum you can get from MU per year:

So - if you started last year, the maximum you can get in MU is $44K - but that means you get $18,000 this year, $12K next year, $8K in 2014, $4K in 2015 and your check in 2016 from meeting it in 2015 will be $2,000.

If you start this year, you can max out at $44K - just putting the checks one year later

if you don't start till 2013 - you'll max out at $39K and if you wait until 2014, then you'll only max out at $24K.

So - $18,000 this year. That sounds better. Let's look at this year.

$18,000 / 12 = $ 1500 per month
$ 1,500 / 4.3 = $ 348.83 per week
$ 348.83 / 5 = $ 69.76 a day

And if you get the Hydrostat I sell and do just one Hydrostat on a patient with GERD or abdominal pain or flatulence a day, you make a net of $73.10 per day and that takes about 4 minutes of a staff's time. If you do one Annual Wellness Visit on a Medicare patient per day and you use my test to determine cognitive level, you make $211 per day for your nurse spending about 25 minutes with a patient.

OK - My innerds are not getting real tickled about Meaningful Use yet. Forgive me.

And, if you're going after the Medicaid MU instead, you should know that the Medicaid incentives will be paid by the States, but the timing will vary according to State - and if you're in a state that has given away all of their money, like California - do you really expect them to have any money to pay MU?

Folks - don't get me wrong. You need to do it as it is money that the Congress put our grandchildren into further debt for and it's already borrowed money that we have to pay interest on, whether you take it or not (if you don't take it - they'll spend it on something else) - so you should get it because you deserve it.

JAN 30, 2012 - ARE YOU GETTING THE 1% E-RX CUT?

donself@donself.com (Don Self) — Tue, 31 Jan 2012 06:04:45 GMT

Many physicians did not listen last year when we pointed out that they needed to do at least 10 electronic prescriptions or they would get a 1% reduction in Medicare allowed on their payments in 2012. Now - they are getting the 1% reduction and calling me to find out how to fix it. You can't. You had a deadline last year and you have one this year too.

There is a change in the reporting requirements for 2012 and 2013 with regards to avoiding penalties for 2013 and 2014. You don't want to lose 2% in 2013, so you need to pay attention. During the first six months of 2012, you simply have to report G8553, the code that indicates you did an eRx during a visit ten times. So any time you do an eRx (for a Medicare Part B patient) during the 1st six months, you should report the G8553 code, and by doing that 10 times you will avoid the payment reduction the following year. That 2% in 2013 can add up as the 1% in 2012 already is, so you should look into doing at least 10.

GOP PRIMARY ELECTION

donself@donself.com (Don Self) — Mon, 30 Jan 2012 14:37:24 GMT

It seems there are still 4 men trying to get elected to be the GOP candidate to face Obama. Of those 4, it really boils down to 2 (Romney and Gingrich), as Santorum is not as well known throughout the country and Paul is a little too libertarian for most Republicans (myself included).

Don't get me wrong, as I do think Paul has SOME good ideas on fiscal issues - and some social issues, but his views on foreign policy, legalization of drugs, abortion and other things are just too out there for me. I also like Santorum but I do not think he has what it takes to beat Obama and that should be the first consideration of anyone voting in the GOP primary, in my opinion.

Seriously, why vote for someone if you do not think he/she has a chance on beating Obama and getting elected in November? Why waste your vote. Alot of Americans did that very thing in 92 and voted for Perot, even though he had the same chance on getting elected as Paul. So - if I'm looking at which of the two (Romney or Gingrich) do I think has a chance on beating Obama, then I need to look at the major issues: Economy, Foreign Policy, Obamacare - and Honesty.

What will happen when the GOP candidate is facing Obama in the debates or on the news bites when it comes to these 3 policies. Economy is going to be a top issue due to the number of people unemployed, the number of businesses sending jobs overseas, the amount of inflation we have (and we have alot of inflation right now folks!), the tax proposals that the president will embrace, interest rates, rate of printing money, etc... If we look at Romney's history as governor, we see (in my opinion) too many tax increases while he was there and we look at his own history of investing overseas in businesses himself (again in my opinion). Yes - he knows HOW to make money as a business - but I don't see that he is a conservative leader in that regard - as the way he does it is by investing in alot of overseas companies. If we look at Gingrich, it appears that his voting record - and especially as the speaker of the house was to reduce taxes that resulted in increased spending in the economy as well as increased number of jobs. I like that approach. It worked for Reagan and if both of the Bush's had stayed the course with it - we would not have had Clinton and we would have had a much better 2008 & 2009. While Obama's record is dismal when it comes to the economy and his spend spend spend approach & the unsurmountable debt it causes will have to be faced by my 3 grandchildren (ages 9 months, 3 years and 7 years), I have to think that Gingrich has a better chance on beating Obama than Romney on this issue.

With foreign policy, I think Romney lacks the experience in this regard that Gingrich has and since we're facing North Korea, Iran, Somalia, China and a resurge in Russian power in the middle east, I definitely lean towards Gingrich in this area.

Obamacare is one that is constantly on my mind as that one has impacted every one of my clients, my business and my own income more than foreign policy, unemployment, interest rates, etc... Santorum brought up an excellent point in last Friday's debate that I had not thought about previously. Obama touted the Mass. Healthcare System when he promoted Obamacare back in 2009. Obama used Romney's advisors to develop the plan. Romney touted the idea that federalizing his state's system would benefit the country. This means that when it comes to the debates prior to November, all Obama has to do is point at Romney and say "you were behind it, you helped develop it, your people helped me draft it - so now the only reason you say you don't like it is so that you can be elected". I think Romney is terrible on this issue - so again I have to go with Gingrich who has been very vocally fighting Obamacare since the beginning.

Honesty: If we look at the advertisements that are endorsed by each of the two men - we see some dishonesty. Romney is running ads saying that Gingrich was fined by the Ethics committee - yet when you look back at the reports - he wasn't. Romney ads say that the ethics charges against Romney forced him to resign in disgrace, yet the timing of when Gingrich left Congress doesn't jive with that as Gingrich had already been cleared of any wrongdoing by the Ethics board and said the charges brought against Gingrich was not supported in any way and the judge said the same thing. It appears that Romney is saying that someone being accused of something is tantamount to them being guilty and I don't like him lying to me as a voter.

I would, I think, prefer Jan Brewer or Sarah Palin or even Chris Christie as my first choice as the GOP candidate and I'm glad Rick dropped out (but I wish he would do his job on our border instead of waiting on the feds or Obama to do it), but I think I'm in favor of Gingrich for the GOP candidate this year.

If you agree, disagree or have an opinion - feel free to post it in the comments.

JAN 26 - DON'T WAIT TILL IT'S TOO LATE

donself@donself.com (Don Self) — Fri, 27 Jan 2012 17:03:46 GMT

As a medical provider, you would much rather the patient come to see you and follow your advice BEFORE they get to the point where it's too late to help them. It has to be so frustrating to have a patent with COPD not decide to put cigarettes down and quit smoking until the doctor gives them 3 months to live. By then - it's too late to add any days to their lives. It's almost the same way with me and physicians. In the past 5 years, the number of physicians that have waited until they have destroyed their practice, their income, their credit rating before they either come to me for help or they decide to start listening to me. It's equally frustrating when I know that I could have helped them had they not been so darn stubborn, set in their ways and unwilling to listen until their pride finally allowed sense to sink in.

Doctor, how do YOU feel if you have penicillin (that you have used hundreds of times to help patients with strep throat) and the patient refuses to let you give them an injection of it because they don't believe it will work or they didn't read anything about it in the latest issue of the Wall Street Journal? You know you have a 95% chance on helping them if they will just listen and follow your advice and YOU are the expert in this field - yet they don't. How frustrating!

Here is an email posted by a Family Physician who listened to me for 15 years before he finally started doing what I was recommending. He posted this today on the free email forum that I run that has 820 physicians, coders, billers and consultants on, when an office manager said her doctor was complaining of reduced income and sad because he couldn't give raises to his staff for another year.

"We are preparing our annual reviews and I plan to give raises to my staff and have given raises the past 4 years because 4 years ago I finally listened to Don and took his advice and implemented his recommendations. As suchI have been blessed, all of our vendors are paid, we have not missed a payroll and later this year several of the equipment leases will mature and I expect to give myself a pay raise as well. Praise the Lord!

What's the definition of insanity? Doing the same thing the same way but expecting a different outcome. You all need to encourage your docs to visit with Don and implement his recommendations. Pull out the ansar, pft, abi, VAT and labs cpt codes get the average reimbursements for these from him and let him perform an analysis of your practice and you will be shocked at the potential revenues walking out of your offices. Don can confirm this. I am simply telling you as a FP in Texas that I did this 4 years ago and it works!" Michael Benavides, D.O. - DALLAS

Money Magazine, CNN, Wall Street Journal and others have been reporting that physicians have been taking out loans to keep their businesses afloat and keep from laying off employees. Most are not giving raises and some are not taking paychecks home. Yet they refuse to take the penicillin or even let me explain how penicillin may help them!

Don't be like Dr. B was and wait 15 years before letting me help. Call me before you destroy your credit record with late pays. Sometimes just a little investment, as small as $4K in your practice can result in $6K a month increase in net income - and more importantly - you'll be able to help patient conditions that you're not helping now.

JAN 25, 2012 - MEDICARE ADVANTAGE VS MEDICARE TRADITIONAL

donself@donself.com (Don Self) — Thu, 26 Jan 2012 21:31:36 GMT

Many of your patients have switched their Medicare coverage from the original Medicare to the Medicare Advantage plans - often to the patient's detriment (in my opinion). Medicare Advantage plans do not always cover everything that traditional Medicare covers and sometimes there are more hoops for the physician's office to jump through to get paid. For that reason, more and more physician offices, clinics and others have chosen to NOT accept patients with the Medicare Advantage plans. The problem is that patients sometimes do not realize they are SWITCHING over to the dark side. They believe they are taking out a supplement or Medigap plan instead of completely getting rid of their original Medicare. When they show up at your office, and you ask them if they still have Medicare Part B, they believe they do. They pull out the cards to show you and one is for Part B and the other is for Part C (Advantage). Now you know that they replaced their B with C. If they don't pull out the cards, you may not know until you get denied from Part B and then you're out of luck because you may not be enrolled with their Advantage plan.

I spent alot of time today talking with someone that sells Part C to seniors. The senior is required to sign a paper acknowledging that they are not getting a supplement, but that they are enrolling in Part C. That is required, so they are signing it. The problem is that some patients are too ignorant of what Part C is as no one has either taught them or they are unable to understand it. The problem is also that some Part C salespeople may not be explaining it thoroughly, explaining it enough or even explaining it at all. Salespeople make money by enrolling people - and there will be some amount of larceny involved at times - but not all the time. If your office waits until the patient presents before explaining that you cannot see them today because you do not take their Part C Medicare, you're waiting too long and you may deserve losing the patients. Too many offices have a reactive approach to educating patients instead of a proactive approach. Those are the ones who wait until the patient has already switched before they tell them that they made a mistake or they cannot be seen. That is foolish, in my opinion. Physician offices and clinics, if smart, will take a PROACTIVE approach and educate the patients BEFORE the patient enrolls in Part C. Now - you really should become familiar with Part C as there are some advantages (especially on the Part A side), but if you do not take Part C - perhaps you should do something to minimize your OWN loss - and that is to educate your patients PROACTIVELY.

Here is something you can copy/paste into a note that tells folks when they can WITHDRAW from Part C. Most have no idea when they can withdraw, even though they are very well versed on when they can enroll.

Now’s the time to switch from a Medicare Advantage plan to Original Medicare if you’re dissatisfied.
If you’re unhappy with your private Medicare Advantage health plan, an annual “dis-enrollment” period allows you to return to the traditional fee-for-service Medicare program between Jan. 1 and Feb. 14. You can also select a drug plan to go with your new coverage. You should also know that the Medicare Premium dropped to $99.90 and the deductible for Part B dropped this year to $140.00.

A word of caution here: There are two things you can’t do during the six-week dis-enrollment period. You can’t sign up for a Medicare Advantage plan for the first time. And you can’t switch from one Advantage plan to another. If you have any questions, please ask our manager.

JAN 20, 2012 - 2 NEW SEMINARS FOR FEBRUARY

donself@donself.com (Don Self) — Mon, 23 Jan 2012 18:35:13 GMT

From the questions that I receive via email and on the Med-Mgrs listserv, we've noticed that alot of people have questions about the enrollment process with Medicare, PECOS, how to get credentialed with PPOs and other payers and how to negotiate contracts. In fact, it's absolutely AMAZING how many physicians have NO IDEA that they can negotiate contracts. They believe they are totally powerless - which is ridiculous! Physicians have alot more power and strength to deal with PPOs and insurance companies once they are educated on it. To sign whatever contract the payer presents is like paying list price at a car dealership.

We also see alot of questions on how to collect at the time of service, what patient statements should say, when you are allowed to collect, what the laws say about collecting or past due statements and who should collect. On many occasions, I have witnessed front desk or check out personnel not even asking for the co-pay or Medicare co-insurance when the patient did NOT have co-insurance, Medigap or Secondary policies.

For this reason, we scheduled TWO online seminars (webinars) in February. You can register for either or both at my store at DON'S WEB SHOP.

Thurs, January 19, 2012 - Annual Wellness Visits

donself@donself.com (Don Self) — Sat, 21 Jan 2012 04:54:03 GMT

Today's subject is the Annual Wellness Visits with Medicare patients. There is still quite a bit of confusion about them. There is confusion with the patients, with the medical staff, with the physicians and with the billing staff.

Let's start with the patients. Your patients believe that when they arrive, they will get to spend an hour or more with your physician discussing how many times they pee every night, what their grandchildren are or are not doing, the latest episode on Nick At Night of Andy Griffith or whatever. They NEED to be told on the phone when they make the appointment that they will NOT be seeing the doctor during this visit. They need to be told who they will be seeing and when they arrive, they SHOULD be told to sign a form acknowledging what the AWV is and what it isn't. The AWV does not require a co-pay, a co-insurance or a deductible, so the patients need to hear that if they demand to see the doctor with a problem during the visit, the patient WILL be required to pay a co-insurance or deductible.

The AWV is not the IPPE! While I have not started recommending clients offer the IPPE (welcome to Medicare physical) as I still do not believe it compensates the physicians enough for the time they spend (30 to 45 minutes), I do recommend everyone offer the Annual Wellness Visits (AWV) with codes G0438 and G0439. There are basically six points that the practice needs to make sure they do - plus the HRA (Health Risk Assessment) form that the patient can complete themselves. I added the HRA form to my site in the past couple of weeks, so feel free to download the questions. It's also apparent that Medicare pays for the AWV even when it is performed by the clinic nurse and does not necessitate the physician see the patient during the visit. This isn't a bad idea as it helps the doctor do a better job on the patient as the physician is more informed on the patient's conditions.

Even though the reimbursement only went up about 8 cents from last year to this year for the AWV as a result of the clinic having to get an HRA completed, it is still profitable. You can download additional help on the AWV on the FREE DOCUMENTS page on my website or read more in my book on this subject.

Thank you for reading the blog! if you like it, please let me know by leaving a comment. I wonder sometimes if people really take the time to read this.

Don

Jan 18 - Global Fee Periods

donself@donself.com (Don Self) — Thu, 19 Jan 2012 16:50:00 GMT

Today, we can talk about the Global Fee Periods published by Medicare and followed by alot of different insurance carriers. Unfortunately, there is a lot of confusion in the minds of folks regarding global fee periods as many think they are for surgeons only - which is not true. They apply to all doctors and most services. There are basically 4 different Medicare fee periods:

1 day global: These are shown on Medicare reports (and those you can download on my Free Documents page) as 000. Medicare says the day of the procedure, plus ZERO additional days are paid for as part of the procedure. This is their way of saying "one day".
10 day global. The day of procedure plus 10 days, anything done related to the surgery is bundled into it - per Medicare. It's interesting to note that cpt and private insurance only bundle "routine" follow up services, but Medicare bundles anything related. There is a big difference in those two - so pay attention.
90 day global means the day prior to the day of surgery, the day of surgery plus 90 days following the day of surgery are bundled into the surgery.
The last one are those shown by XXX. This means the global fee concept doesn't apply. Many people mistake 000 for meaning that - which is a huge mistake. Y

You can read more about this subject in my book. Don

JAN 12, 2012 - MEDICARE ABN'S

donself@donself.com (Don Self) — Fri, 13 Jan 2012 23:53:42 GMT

Hopefully you are not only using the Medicare ABN (Advanced Beneficiary Notice) the correct way in your medical practice, but that you are using the correct version. As of January 1st of this year, CMS says the only valid one is the one from March 2011. You can download the one approved by CMS on my FREE DOCUMENTS page on the left menu to make sure you are using the right one and there are also instructions you can download with it. Every once in awhile I talk to a medical office that either has no idea what an ABN is or they are not using it correctly. <br> <br> Some offices have the patients sign it before they get any lab tests and Medicare, CMS and the Office of Inspector General (OIG) feels that is a 'general' notice - so it's invalid. You must have a specific reason to believe that the service will be denied when you give it to a Medicare patient, per CMS. Some have the patients sign one during the first visit in case they ever need it. That's not valid either and will get you into trouble with Medicare and CMS. That is similar to you giving your wife an expensive gift when you first meet and tell her "that is my apology gift eventually when I screw up - which i will do". No way. You didn't make it to the 8 second count on that ride, cowboy. (watch rodeo to see what I mean). You also cannot have the patient sign the ABN after you render the service. That makes it invalid as well. <br> <br>Make sure you're using the correct version and using it when you should as the RACs will be looking for that as well. Hey - if you like these blogs, let me know. The really creative and brilliant ones I save for my monthly 8 page newsletter that goes out to thousands of subscribers each month.

Jan 11, 2011 - Holding Medicare Claims

donself@donself.com (Don Self) — Thu, 12 Jan 2012 22:21:00 GMT

From the www.donself.com website on January 11, 2012. If you want to find the current day's post, visit the new and revised www.donself.com and see the NEWs section on that same page.

Today was the 11th and today was the date that CMS said the carriers have to be using the revised 2012 Medicare Allowed amounts. Hopefully, you have held your Medicare claims for the first couple of weeks of this year so that you won't have the same problems that we had in 2010 and 2011 with delayed adjustments as that was a royal pain. If you've been on my site in the past week, you also know that the 2012 Medicare allowed amounts are downloadable on the link on the left in Excel for every locality. You also can go to my new Documents Page and download the 2012 Global fee periods, 2012 lab allowed amounts, HCPCs listings and more. Also - I have 2 new testimonials about how recommendations we made have helped GREATLY improve patient care, so please take the time to read those as that is what the true benefit of my advice is going to achieve. It's not about the money - it's about improving patient care and the money WILL follow! I hope you like the new format and I hope to give you updates on this page daily or every other day - so check back often.

Don

January 9, 2012 update - 2012 is HERE

donself@donself.com (Don Self) — Mon, 09 Jan 2012 23:41:44 GMT

Wow - where do I begin? 2011 was a phenomenal year and alot has happened since I last blogged. yes - that term "blogged" does sound weird and like it is something that should be outlawed in several states - but it is a term like "my bad" that people seem to use today - so why not?

Let's begin with current issues. Doctors were afraid of the threatened SGR reduction and as I've been saying for a year - it didn't happen as at the last minute, the 536 idiots in DC (435 idiots in the House, 100 idiots in the Senate and Mrs. Obama's husband at 1600 Pennsylvania) did a 2 month extension to give them more time to posture. Posturing is exactly what I am talking about as they can fix this - if they want to - but by prolonging it into the election year - they can use terms like obstructionist towards the other guys to blame the other party. I am most disgusted with the Democrats in this particular case as they could have put it off an entire year when they did the payroll cut extension - thereby giving the small businesses some kind of security so they would hire more employees than the 2 month extension to keep people afraid. The Medicare SGR delay was in the same bill with the payroll tax extension.

So - in February, we'll see them dance again - but there is NO WAY they will allow the reduction to go into effect. In fact, the new 2012 Medicare numbers (that are now on my website) show an increase in most areas (between 5% and 13% on the 3 diagnostics I sell the most of) and 1.4% as an average on others.

So - 2012 will be a great year, in my opinion. More and more doctors are starting to realize that what I've been telling them about doing better medical care and getting better medical outcomes on their patients increases their practice income - and more are trusting me. I'm getting better referrals and more of them - so business is exciting.

The family is fantastic and Angie and I are living alone again. In 2011, we moved her parents out of our house into their own and they are happy there. About 2 weeks ago, Nick and his family moved out and into their own place. So - for this has been the 3rd week out of the past 23 years, that Angie and I have lived alone in our home and we are very happy. I could run around my house nekid if I wanted to - but I'm afraid I might shock Cookie (our 13 year old dog) if I did, so I don't.

My involvement in the Royal Family Kid's Camp and Club has grown so I am now mentoring a 7 year old and really getting to have fun showing him how much fun being around a dad/grandpa is. We have alot of things planned this year. If you are not familiar with RFKC, check out their association. There are thousands of abused foster children who need someone to show them that Christ's love is not conditional and that they are worthwhile, loved, valuable and their future is not negative. Just spend 4 hours a month with one of those children and you will see how much of a difference you can make in their life. RFKC has camps (we have 3 of them a year here in Tyler) and it's amazing to see the change you can make in their lives with just a little bit of effort. Royal Family KIDS | Home and they have it for teens also called TEEN REACH. Yep - definitely worth looking into. You will be blessed even more than the children are.

So - everyone is healthy. All 3 of my grandchildren are within 2 miles of me (one is across the street) and all 3 of my sons and 2 daughters-in-law are within 6 miles of me. Angie's parents are a mile away and my dad is 1/2 mile away. In the past month, I've had the joy of seeing my sister, her husband and all 12 of their children (11 by birth and one is a son-in-law) and God is blessing me more than ever.

OK - let's talk about that for a minute. If you've read my blog in years past, you know that Obamacare scared alot of doctors and it caused me more than a bit of financial woes as that scare had physicians afraid to do anything positive in their business. For awhile, the majority were drawing in like turtles and even today - there are thousands that are borrowing money to keep their practice open - only because they either do not know about what I can do or they are too stubborn to listen and learn. But business suffered quite a bit. Now for a confession. Angie and I were out of church for a long time and we had gotten out of the habit of tithing. Sure - we did offerings when there was a special need and we gave to all kinds of charities to help others and still do - but I'm talking about tithing. Tithing is returning 10% to God through his church - which is showing obedience. It's not "giving". It's obeying. There is a reason that God wants us to tithe and it's not because HE needs our money. He owns everything and what does the God that created the entire universe need with my money? He needs my obedience. Last February, Angie and I talked about it and while we couldn't afford to - we decided to obey. Yes - you heard me right. We were not able to pay our bills, but we decided to write the check for 10% of the money we made the week before and dropped it in the plate. Hey - I knew about tithing from many years ago when we attended a different church - but I had lost the conviction that I needed to obey. So - we did in February and immediately - we started getting calls from medical offices that we had not heard of or those that had been putting us off for months and even years. There was no coincidence. I started getting people that I had never contacted calling me and asking me to speak or consult for them. Hey - that's what obeying God does. He uses your obedience to teach you. So - as a result - 2011 turned out to be a very good year financially - but more importantly - my walk with Jesus and God and the Holy Spirit has improved greatly. No - I'm still not the man I want to be and I may never get there - but I'm walking closer to God than ever before. That has transferred over to the relationship I have with my wife and my family. If this helps - just remember that He doesn't need our money or our time - he needs our obedience because through that obedience, He can give you more blessings than you are even looking for.

OK - more later.

Don

A frank discussion about Medical Offices, Medicare & Current Affairs

donself@donself.com (Don Self) — Wed, 21 Jul 2010 21:57:00 GMT

Ok - when I say "current affairs", this has nothing to do with Tiger Woods. It has everything to do with the current state our economy is, the problems we are facing with healthcare, the idiotic decisions by physicians, and the problems being faced by Medicare patients and those that will be faced by those that are 63 and 64 years old today.

First - let me say that we're all in good health and we had a very fun family reunion on Angie's side of the family.   Current news includes the fact that we have our house for sale (special pricing at shop.donself.com ) for anyone wanting to spend $225,000 on a beautiful home within walking distance to 4 schools with a great pool, guest house and more... Ok - a little shameless sales plug doesn't hurt.   Angie's parents (Jim and Ann) are looking to buy a place close to us (they have their home for sale in Early, Texas) and last - but not least is that we have a contract on 20 acres about 20 miles southwest of where we are now - literally on top of a mountain. Ok - the mountain is only 200 feet high but it is the close to the highest elevation in Cherokee County and if we get the property - we'll build a house facing the southwest with a panoramic view of at least 12 miles in about 3 directions - so it's the closest thing that I'll ever get to living on a mountain. The town is called Mount Selman - so it's legal for me to say it's a mountain. <grin>

Ok - business is slow and part of that is due to the absolute moronic decisions being made by Congress (I'm ready to get rid of 534 members today if I could - but I do want to keep Louie Gohmert as he is the ONLY one there that I trust - and that includes Kay Bailey and Cornyn!). It's also due to the ignorance of physicians and their staff that are hurting them by telling them to get rid of Medicare patients. Ok - Perhaps "get rid of" is not the right term to use. Many office managers, billers and even short sighted administrators of national and state medical and osteopathic physician associations are hurting the physicians with their bad advice.    I'll give you a little background first.

Prior to 1987, Medicare would follow whatever the private insurance carriers were doing, but that changed in 1987. That was when Medicare took advantage of the STUPIDITY of the AMA and instituted for the first time in this country - a limit on how much a physician could charge. The government doesn't limit what any other private business in this country can charge - but they effectively set the stage with physicians and the AMA let them do it because it didn't hurt them one bit. I am of the belief that the AMA looks out for the AMA and doesn't give a dang about the physicians or the members or the patients in this country. If it puts more money in their own pocket - halleluja and screw everyone else.    So - in 1985 the AMA asked for a "voluntary" fee freeze by all physicians and the physicians complied and then in 1987, Medicare came out with limits on how much physicians could legally charge - based on the previous 18 months history of fees charged by each physician.   Tadaaa!   So - the private carriers saw the government do it and then they started in 1989 sending out letters to their policyholders saying their doctor had "overcharged" or charged more than the Usual, customary and reasonable amount for the services they did" It did not matter that the patient had no idea that there was no such thing as a uniform UCR - as every carrier made up their own. They just heard "your doctor is screwing you" so they got upset. As a result in 1991, those same patients voted in someone who was going to "reform" healthcare and make the doctors accountable and honest. So - that unscrupulous jerk put his wife in charge of revamping healthcare and making it into socialized medicine.   Fortunately - the way he did that caused people to wake up and stop her - so she didn't accomplish anything.   So - then we had a couple of terms of Clinton that really didn't hurt our country too much - other than businesses paying more in taxes and our military that was stripped - but the healthcare arena stayed the same during his term with carriers slowly convincing physicians to sign contracts that anyone with a business degree would have torn up.   What many did not see happen in 1996 was the fact that Clinton - along with a republican led Congress passed a law that required a "sustained growth rate" of Medicare payments - which in fact - actually meant a budget neutral growth rate. Congress knew that in 2011, we would start having the baby boomers (those born after our soldiers and sailors returned home from World War II) hit Medicare and that would be a huge influx into the Medicare program.   So - they designed something to slowly reduce the amount Medicare was spending and that would begin in the future president's term. That took place in 2003, and Bush and the Congress felt the pressure - so they 'forestalled" the reduction of the 1.3% that year. Then in 2004 - they again did not want to upset the doctors and hospitals, so they did it again.   Each year - the reduction was not eliminated - but delayed - so it started accruing.   So - the first year, the Medicare allowed conversion factor was supposed to reduce by less than 2% and then next year when they delayed it - that meant that when it took effect it would be over 2% and over 3% the following year, etc... By this year - by federal law, the Medicare allowed (how much the physicians are paid) was supposed to reduce over 21%.   Congress was terrified that if they allowed this to happen that at least half of the physicians in the country would no longer see Medicare patients. But - since they couldn't get their heads out of their butts while they were pointing fingers at the BP people for spilling oil in the gulf (never let a good catastrophe go to waste when it comes to press time), they couldn't come up with a solution that made everyone look good.

So - last December - they delayed the reduction for five months - giving them five months to fix it.   Of course, they did NOTHING for the first 4 months on it at ALL! Then by May - when they started thinking about it - they had a great catastrophe to get in the way.   So - the government department over Medicare decided to help by holding all Medicare checks for the first 2 weeks in June to give Congress time to act. But - those Congressional members had to take some extra time off for this or that and then they couldn't come up with a solution in time. Once again, CMS (Centers for Medicare and Medicaid services) tried to help (help who???) by announcing they would hold Medicare checks for one more week. then, towards the last part of June - both chambers of Congress finally finished their tug of war between Pelosi and Reid trying to prove who had the most power and passed something - delaying it another 18 months.    That would take time for the Medicare payers to get their computers right so they had until July 1st to start issuing checks to the doctors.    Think about this.

No doctors got any checks in June for any Medicare services done in June. This doesn't mean a big deal to the Pediatrician doctors - as very few of their patients have Medicare.   But - what does it mean for the family doctor or internal medicine doctor or the geriatrician or the doctors visiting nursing homes?   What if you owned a business with alot of employees and alot of expensive supplies (drugs, equipment, lab tests, etc) that you had to buy and your income stopped - but you had to keep paying everyone?    Now - you get a feel for what your doctors have been going through.     Did you hear about this on CNN or FoxNews or in your paper? heck no!

Now - while we've seen all of this coming, I've been a voice in the wilderness telling physicians to see MORE Medicare patients and trying to convince them that Medicare patients are the most profitable they have.   While I've been telling them this - they've been listening to their office managers and billers and associations tell them to get rid of Medicare patients as they believe Medicare is one of the lowest paying (Medicaid is definitely by far the lowest paying).    The doctors listen to their office manager explain that Don must be wrong or smoking something he shouldn't and they'll give them an example of a Medicare payment.    They will show the doctor that the doctor is paid $52 for a level 3 established Medicare patient visit and they are paid $67 for a Blue Cross patient for the same service. The doctor looks at the $52 in one hand the $67 in the other hand and then doesn't take the time to let me explain why that is deceiving.

Since 2001, Medicare has been trying to get physicians to change how they practice to achieve better medical outcomes.   To accomplish this, they have moved massive amounts of money from the areas of office visits and procedures into evidenced based medicine, such as clinical lab testing and diagnostic testing.   Unfortunately - they did not tell the physicians about this move.   They just put alot more money into select areas and expected the physicians and their managers to figure it out - but they didn't.   Physicians kept seeing reduced payments for office visits (when compared to the national inflation rates) and reduced payments for procedures and did not realize that Medicare was MOVING money instead of reducing it. In fact, from 1996 to 2009, the federal government increased PHYSICIAN expenditures by more than $14 Billion per year. it almost DOUBLED IN THOSE 14 YEARS.   Yet during the first 10 years of this century, physicians kept feeling the pinch and had to draw money out of savings, reduce their own salaries, cut back on employees, offer less benefits to employees, reduce hours, etc... trying to survive.    My partner Keith and I have, for more than 3 years, been showing the physicians that would listen to us how they could easily increase their income by $ Hundreds of thousands per year while improving patient outcomes by following Medicare's new guidelines - but the vast majority were not listening to us.   So - those that have listened would benefit.    Sometimes they would come back and admit that they waited too long before listening, such as Dr. Mike Benavides in Dallas, Texas. Mike and his wife Cindy had been struggling for the first part of this decade like many other physicians and had to take out loans to cover payroll, lay off essential staff, reduce hours and sometimes go months without taking a personal paycheck.   After he listened to us, he increased his income by more than $150,000 per year by following Medicare's guidelines and he said "I wish I had acted on what you were telling me years ago instead of ignoring it".   Today - he's in great shape because he listened.

Last week I had a physician who I've known for about 20 years say "I had been reading what you've been saying for many years now Don, but when you said you could help me, I though you meant by $1,000 to $2,000 per month and did not realize you meant by $25,000 to $30,000 per month in increased profits. Now it's too late for me since I can never work again due to this disability but i wish I had acted back then".   That is Dean Gafford, DO in DeSoto, Texas. Dean had called me because he wanted someone to take over his practice since he can't practice anymore.   Another consultant and I put together a package for the doctor about to buy Dean's practice and in a 4 way conference call, Dean saw what we could actually do and he was surprised.

Keith and I have helped one doctor after another increase their income by $100,000 to $400,000 per year - so easily - just by following the new guidelines when they listen to us.   From Dr's Gastorf in Durant OK, to Tasha Wallace in Lehigh Acres Florida to Hector Lopez in El Paso to Jeff Lindenbaum in Pennsylvania to Dr. Lomas in Florida to David Braunreiter near Houston, Texas to so many others. I have dozens of letters from physicians showing what we did for them and every one of them point out that their patients are getting so much better care today than they did before.   Many of them reference patients who are ALIVE today thanks to what we taught the doctors - and while we could do so much more good - we run into the know-it-all office managers who are driving their physicians into bankruptcy. We run into the physicians who want to save 5 cents so they totally ignore the $10 they would get.

As an example, in May, I did a diagnostic analysis with a doctor and I showed the doctor the guidelines that Medicare and other carriers have and how often they want the doctor to do specific tests. Medicare and carriers have realized that it makes financial sense to pay $115 today to a physician to do an 8 minute test to detect peripheral arterial disease early enough so that the patient doesn't have to have an amputation of a toe or foot. When you consider that 33% of patients over 50 years old with diabetes have P.A.D. and that less than 10% of them are being diagnosed (per the National Institute of Health numbers), it makes sense to save the $7,000 they would pay for an amputation by paying $115.   So - I did with this doctor the same thing I've been doing for years with every one of the doctors I mentioned earlier and then asked the doctor "If you were doing this in your office, how many a day would you do and be conservative". He gave me very conservative numbers. Then, we looked at other diagnostics and some lab tests and he said that he needed to be doing these.   He agreed that it would be good for his patients and that these did meet the current guidelines (I showed them to him on the Medicare website).    As he gave me numbers, I would sometimes reduce them to be super ultra conservative.   When we finished, he agreed that after ALL expenses, by following the current guidelines, he would increase his net (net is after all expenses) monthly income by $17,312 per month.   He was excited about it and gave me his tax id and social so I could run it by the leasing agent and he could check with his CPA to make sure of the tax breaks and he wanted to start helping his patients. I also gave him 7 letters from other physicians similar to his practice that had done the same thing and increased their income by more than $200,000 per year and saved lives.   I called him a week later.   He didn't return my call. I called a week after that and sent an email. No return call.   A week later, his office manager said he was comparing prices and thought he could get the pulmonary function test equipment for $2,000 less and he would check back with me.   Last week he said he was waiting on his bank to see if they could get a better interest rate than the leasing company and I know for a fact that the leasing company we went to has rates almost equal to any bank in the country.   Ok - do the math. He has spent 2 months trying to save $2,000 and maybe save another $400 in the interest.   In that 2 months, using his conservative numbers he would have made another $34,624 but he hasn't because he's been busy trying to compare interest rates. He'll probably wait another month and by then it will be more than $50,000 he lost due to ignorance. yes - ignorance!   Forget the money for a minute. He pointed out that he was NOT running ABIs on his patients and I wonder how many of his patients have P.A.D. that are undiagnosed and by the time he acts - will need amputations of toes?    He was not running PFTs - yet 20% of Americans suffer from pulmonary dysfunction and COPD is the 4th leading cause of death. He is not performing heart rate variability tests and we KNOW that 30% of CHF patients are over beta blocked and 14% of Americans have orthostasis and between 11% and 14% of seniors with diabeteos suffer from silent ischemia.   I could go on and on but you get the idea. It's doctors like that which drive me mad.

One of the letters that I received from a physician in Malvern, Arkansas points how much he has changed how he practices by following the national guidelines that I showed him. He doesn't center on the fact that we've increased his net profits by $Hundreds of thousands per year over the past 2 years but he points out what his patients experienced as a result of it.    i give out these letters with the physician's phone numbers - yet so few of my prospects call them. They would rather spend their time trying to save $100 on the price of the equipment or listen to their office manager tell them I'm wrong instead of calling physicians who have proved that I'm right.

So - this is me spouting off.    I'll keep fighting to get these doctors to listen and some will and their patients will do better and the arrogant fools who do not listen will continue to pull money out of their savings trying to stay afloat and the battle will continue.

have a great day!

Immigration Problem - or is it more than that?

donself@donself.com (Don Self) — Sun, 16 May 2010 21:27:00 GMT

Charlene Burgett sent me an email today that came from an editorial that gave a pretty good synopsis of the problem we're having with the illegal aliens from Mexico coming in at such a high rate. It said:

"some people are protesting that the US might protect it's own borders and make it harder to sneak into this country, and once here, to stay indefinitely.   Let's see if we understand the people protesting, but bringing to a level even they can understand...

Let's say that I break into your house and when you discover I'm there - you insist I leave.

But I say, "No! I like it here and it's better than my house. I've made the beds and washed the dishes and did the laundry (the things you don't like doing) and I'm hard working and honest (except for breaking into your house) and if you object, then I'll get people around the country to protest. The protesters will say:

You're required to let me stay in your house
You're required to feed me
You're required to add me to your family's insurance plan and you pay the increased premiums
You're required to educate my kids
You're required to give me money so that I can buy candy, soda and other things
You're also required to let my husband stay also since he'll do yard work that your husband does but doesn't enjoy'
You're required to let my brother come in as well - even though he won't work - but you still have to support him too

It's only fair because you have a nicer house than I do and I'm just trying to better myself.   There is nothing you can do about me living in your house without you being called selfish, prejudiced, racist and a bigot.   Oh yeah - I demand that YOU learn MY language too so that we can communicate because I shouldn't have to learn yours as that would be unfair.

Would YOU object? let's get the addresses of the do-gooder protesters and see if they would object.

Ok - the real reason why the immigration problems scares the crap out of me is simple.   We have FBI, TSA, CIA, NSA, Homeland Security, Interpol, Treasury, Secret Service and every other law enforcement agency watching the airport and they won't let anyone come into the country with a pocketknife on an airplane through our airports.

But - we have thousands of people a day coming across the border, some with 1,000 pounds of drugs, some with cases of drugs and we have no idea who they are.   How many of them are from Iran or Pakistan or Saudi Arabia or some other country instead of poor, hardworking, honest (other than breaking in) Mexicans? How many of them could have a suitcase nuke or C4 or some other weapon of mass destruction? How many have already come over and how many will we get in this country before they get the word to not be a sleeper any longer?

We have an administration in DC of "not-my-faulters" who want to blame everyone else (It was Bush that did this or Cheney who did that and I am not at fault) instead of stepping up to the plate.   We have a governor here in Texas who is NOT using our state troops along the border now - but even if he did - would Arnie in California? Oh wait - Arnie has given everything away to the illegal aliens so they don't have any money any longer to pay troops or law enforcement.   Arizona is doing what they can, but how about New Mexico? Oh - that won't work either as they have Bill One-World-UN-Government Richardson as governor, so he is probably building a super highway for illegals to use.    So, even if we do succeed at stopping the illegal flow in Texas and Arizona - the bad guys will still get across in Arnie or Bill's land - which is why we need the federal government (uh - isn't that THEIR JOB????? to protect our borders?) to step in and do something.

Let's not forget the pandering that the liberals are doing to the President of Mexico. You remember TWO FACE Calderon (it's ok for us to have a tough immigration policy - but it's unfair and racist for the gringos in the USA to do it).

I haven't been a big proponent of Texas secession - although it is legal per US law if Texas decides to do it. But - if things continue the way they are, then perhaps it's something that should be considered after all. Interestingly, alot more people in Texas have started talking about it as well.

I guess we'll have to wait until we have a big bang (this is my big bang theory, by the way) and thousands or tens of thousands of Americans care killed by a radical islamist who came over through Mexico with a weapon of mass destruction before the morons in DC and specific governors get called on the carpet.   That could be the powderkeg that actually causes some changes to be made. I don't want it to happen - but I am convinced it WILL happen.   There is no doubt in my mind that the camel jockys are not dumb enough to have thought about this over the past couple of years. They see how wide open our borders are and they want to strike us. It's risky to come in through airports - but they have a better than 90% chance on getting across undetected from Mexico. Is anyone reading this dumb enough to think that they haven't thought of it too?

Keep this blog or copy and paste it to someone else and you remember this day when it happens. It may not be this year or it may be a year from September on the 10th anniversary. Symbolism means alot to those radical Islamists, so that date may be significant to them.   Obama, Perry, Richardson & Arnie were warned.   Everyone was and it looks like Arizona is the only one really taking a positive step. We really need to replace Perry with Greg Abbot here in Texas and I'm really sorry that he didn't run instead of Kay Bailey - but we really needed him where he is to tango with Obama about the healthcare issue. Maybe in 4 years?

A LITTLE HUMOR

donself@donself.com (Don Self) — Mon, 11 Jan 2010 14:10:00 GMT

I have decided to write a book, and in preparation, I"ve reviewed my monthly newsletters that I've written (Just those in the last 7 years) to make notes on things I want to make sure I cover. While doing this, I came across a few jokes that I've had in those newsletters and decided to share those with the readers of my blog. I hope you enjoy them as much as I did.

SOMEONE MIGHT MISUNDERSTAND…
We were dressed and ready to go out for the New Years Eve Party. We turned on a night light, turned the answering machine on, covered our pet parakeet and put the cat in the backyard.

We phoned the local cab company and requested a taxi, since we might choose to have a few drinks. The taxi arrived and we opened the front door to leave the house.   The cat we put out in the yard, scoots back into the house. We didn't want the cat shut in the house, because she always tries to eat the bird.

My wife goes out to the taxi, while I went inside to get the cat. The cat runs upstairs, with me in hot pursuit.     Waiting in the cab, my wife doesn't want the driver to know that the house will be empty for the night. So, she explains to the taxi driver that I will be out soon, 'He's just going upstairs to say Good-bye to my mother.'

“A few minutes later, I get into the cab, not knowing what my wife had told the driver. “Sorry I took so long,” I said, as we drove away.   “She was hiding under the bed. I had to poke her with a coat hanger to get her to come out!   She tried to make it to the closet, so I grabbed her by the neck. Then, I had to wrap her in a blanket to keep her from scratching me. But it worked! I hauled her downstairs and threw her out into the back yard!'

The cab driver hit a parked car

GETTING OLDER MEANS…
•    You don't care where your spouse goes, just as long as you don't have to go along.
•    Getting lucky means you find your car in the parking lot.
•    An all-nighter means not getting up to urinate!

Two gentlemen were talking, and one said, "Last night we went out to a new restaurant and it was really great. I would recommend it very highly."

The other man said, "What is the name of the restaurant?"

The first man thought and thought and finally said, "What is the name of that flower you give to someone you love? You know... that's red and has thorns."

"Do you mean a rose?"

"Yes, that's the one," replied the man. He then turned towards the kitchen and yelled, "Rose, what's the name of that restaurant we went to last night?"

Employment application blanks always ask 'who is to be notified in case of an emergency.' I think you should write, "A Good Doctor!"

“We had a patient call in yesterday morning, obviously still half asleep, to tell us that he was going to be late. The reason? He had left a message with our answering service that we were to call him in the morning and wake him for his appointment, so it was OUR FAULT!”

A woman brought her baby to see a doctor, and he determined right away that the baby had an earache. He wrote a prescription for ear drops. In the directions he wrote, "Put two drops in right ear every four hours" and he abbreviated "right" as an R with a circle around it. Several days passed, and the woman returned with her baby, complaining that the baby still had an earache, and his little bottom was getting really greasy with all those drops of oil. The doctor looked at the bottle of ear drops and sure enough, the pharmacist had typed the following instructions on the label: "Put two drops in R ear every four hours."

NEWSPAPER HEADLINES
   Include Your Children when Baking Cookies
   Something Went Wrong in Jet Crash, Expert Says
   Prostitutes Appeal to Pope
   British Left Waffles on Falkland Islands
   Lung Cancer in Women Mushrooms
   Miners Refuse to Work after Death
   Eye Drops Off Shelf
   Teachers Strike Idle Kids
   Local High School Dropouts Cut in Half
   Hospitals are Sued by 7 Foot Doctors
   New Study of Obesity Looks for Larger Test Group

A midget fortuneteller who escapes from prison is a small medium at large.

Recently, I was diagnosed with AAADD: Age Activated Attention Deficit
Disorder. This is how it manifests: I decided to wash my car. As I started
toward the garage, I spot the mail on the hall table. I should, go through
the mail before I wash the car. I lay the keys on the table, put the junk
mail in the trash can by the table, and notice that the trash can is full.
So, I put the bills back on the table and decide to take out the trash
first.

Since I'm going to be near the mailbox, when I take out the trash, I might
as well pay the bills first.
I see my checkbook on the table, but there is only one check left. My extra
checks are in my desk in the study, so I go to my desk, where I find the
bottle of juice that I had been drinking. I'm going to look for my checks,
but first I need to push the juice aside so that I don't accidentally knock
it over. But the juice is getting warm, and should be, put in the
refrigerator to keep it cold.

Heading toward the kitchen with the juice, a vase of flowers on the counter
catches my eye. They need to be watered. I set the juice on the counter, and
find my glasses, for which I've been searching all morning. I had better
put them back on my desk, but first I'm going to water the flowers.

I set the glasses back down on the counter, fill a container with water, and
suddenly spot the TV remote. Someone left it on the kitchen table. Tonight
when we sit down to watch TV, we will be looking for the remote, but nobody
will remember that it's on the kitchen table. I should put it back in the
den where it belongs, but first I'll water the flowers. I splash some water
on the flowers, but most of it spills on the floor. So, I put the remote
back down on the table, and get some towels to wipe up the spill.

Then I head down the hall trying to remember what I was planning to do. At
the end of the day: the car isn't washed, the bills aren't paid, there is a
warm bottle of juice sitting on the counter, the flowers aren't watered,
there is still only one check in my checkbook, I can't find the remote, I
can't find my glasses, and I don't remember what I did with the car keys.
I'm trying to figure out, why nothing got done today. It's baffling because
I know I was busy all day, and I'm really tired.

CHURCH BULLETINS & ANNOUNCEMENTS

1. Bertha Belch, a missionary from Africa, will be speaking tonight at Calvary Methodist. Come hear Bertha Belch all the way from Africa.

2. Announcement in a church bulletin for a national PRAYER &FASTING Conference: "The cost for attending the Fasting and Prayer conference includes meals."

3. The sermon this morning: "Jesus Walks on the Water." The sermon tonight: "Searching for Jesus."

4. Our youth basketball team is back in action Wednesday at 8 PM in the recreation hall. Come out and watch us kill Christ the King.

5. "Ladies, don't forget the rummage sale. It's a chance to get rid of those things not worth keeping around the house. Don't forget your husbands."

6. The peacemaking meeting scheduled for today has been canceled due to a conflict.

7. Remember in prayer the many who are sick of our community. Smile at someone who is hard to love. Say "hell" to someone who doesn't care much about you.

8. Miss Charlene Mason sang "I will not pass this way again," giving obvious pleasure to the congregation.

9. For those of you who have children and don't know it, we have a nursery downstairs.

10. Next Thursday there will be tryouts for the choir. They need all the help they can get.
Barbara remains in the hospital and needs blood donors for more transfusions. She is also having trouble sleeping and requests tapes of Pastor Jack's sermons.

11. During the absence of our Pastor, we enjoyed the rare privilege of hearing a good sermon when J.F. Stubbs supplied our pulpit.

12. The Rector will preach his farewell message after which the choir will sing "Break Forth into Joy." Irving Benson and Jessie Carter were married on October 24 in the church. So ends a friendship that began in their school days.

13. A bean supper will be held on Tuesday evening in the church hall. Music will follow. At the evening service tonight, the sermon topic will be "What is Hell? Come early and listen to our choir practice.

14. Eight new choir robes are currently needed, due to the addition of several new members and to the deterioration of some older ones.

15. Scouts are saving aluminum cans, bottles, and other items to be recycled. Proceeds will be used to cripple children.

16. Place your donation in the envelope along with the deceased person you want remembered. Attend and you will hear an excellent speaker and heave a healthy lunch.

17. The church will host an evening of fine dining, superb entertainment, and gracious hostility.

18. Potluck supper Sunday at 5:00 P.M. - prayer and medication to follow.

19. The ladies of the Church have cast off clothing of every kind. They may be seen in the basement .

20. This evening at 7 P.M. there will be a hymn sing in the park across from the Church. Bring a blanket and come prepared to sin.

21. Ladies Bible Study will be held Thursday morning at 10. All ladies are invited to lunch in the Fellowship Hall after the B.S.. is done.

22. The pastor would appreciate it if the ladies of the congregation would lend him their electric girdles for the pancake breakfast next Sunday.

23. Low Self Esteem Support Group will meet Thursday at 7 PM. Please use back door.

24. The eighth-graders will be presenting Shakespeare's Hamlet in the Church basement Friday at 7 PM. The Congregation is invited to attend this tragedy.

25. Weight Watchers will meet at 7 PM at the First Presbyterian Church. Please use large double door at the side entrance.

26. The Associate Minister unveiled the church's new tithing campaign slogan last Sunday "I Upped My Pledge - Up Yours."

27. Our next song is "Angels We Have Heard Get High"

CHRISTMAS GREETINGS

donself@donself.com (Don Self) — Wed, 23 Dec 2009 14:40:00 GMT

With only 2 days before Christmas

and not all of the shopping is finished

You've probably spent more than you should

with the true reason for Christmas diminished

It's not about the gifts and presents,

or the amount of drinks you'll intake

at the party with the employees in the office

Or the cookies and goodies you'll bake.

The season is about what happened

More than two thousand years ago

that has changed the entire planet

and given hope to those in the know

It wasn't the elf named Santa

that came to take away

the burden of all humans

and caused them to bow and pray

Nor was it about determining

Of who's naughty or trying to be nice

Because we could never meet the measure

or afford to pay the price

So God sent all humans a gift

In a small bundle of joy

to a couple named Mary and Joseph

in the form of a beautiful boy

He wasn't born in a hospital

It wasn't even an inn

He was probably born in a cave

That happened alot back then

There was no doctor or nurse

or even a midwife there to aid

the birth of this holy infant

who's birth would not be delayed

A crib was not available

and his parents both agreed

to lay the precious baby

in a tray for animal feed

That night was very special

and in fields not far away

shepherds were watching their flock

when an angel appeared to say

Fear not my appearing to you

I bring you news of joy

Christ the Lord is among you

He was born a baby boy

So, the shepherds went to visit

the child in a manger lay

and told all they came upon

what the angels had come to say

So God had sent his son

to earth for a purpose that night

to offer us salvation

which we can't be earned through might

We can try to be perfect and holy

but we'll fail because we sin

so Jesus is our only chance

if heaven we want to get in

So time is constantly moving

and the clock will not be slowed

So you need to make a decision

or you'll get what you are owed

You cannot earn salvation

it's a gift that can't be earned

therefore it cannot be taken away

nor can it be returned

To receive the gift is simple,

accept Jesus as savior and Lord

and you'll have eternity in heaven

His blood has provided the reward

So if you have any questions

or you wish for us to pray,

Just dial 903 372-7529

and you can have those blessings....today.

czars of USA

donself@donself.com (Don Self) — Thu, 29 Oct 2009 03:44:00 GMT

This article from Thomas Sowell appeared this week:

Dismantling America (Thomas Sowell)
Townhall.com ^ | October 27, 2009 | Thomas Sowell

Posted on Monday, October 26, 2009 11:00:52 PM by jazusamo

Just one year ago, would you have believed that an unelected government official, not even a Cabinet member confirmed by the Senate but simply one of the many "czars" appointed by the President, could arbitrarily cut the pay of executives in private businesses by 50 percent or 90 percent?

Did you think that another "czar" would be talking about restricting talk radio? That there would be plans afloat to subsidize newspapers-- that is, to create a situation where some newspapers' survival would depend on the government liking what they publish?

Did you imagine that anyone would even be talking about having a panel of so-called "experts" deciding who could and could not get life-saving medical treatments?

Scary as that is from a medical standpoint, it is also chilling from the standpoint of freedom. If you have a mother who needs a heart operation or a child with some dire medical condition, how free would you feel to speak out against an administration that has the power to make life and death decisions about your loved ones?

Does any of this sound like America?

How about a federal agency giving school children material to enlist them on the side of the president? Merely being assigned to sing his praises in class is apparently not enough.

How much of America would be left if the federal government continued on this path? President Obama has already floated the idea of a national police force, something we have done without for more than two centuries.

We already have local police forces all across the country and military forces for national defense, as well as the FBI for federal crimes and the National Guard for local emergencies. What would be the role of a national police force created by Barack Obama, with all its leaders appointed by him? It would seem more like the brown shirts of dictators than like anything American.

How far the President will go depends of course on how much resistance he meets. But the direction in which he is trying to go tells us more than all his rhetoric or media spin.

Barack Obama has not only said that he is out to "change the United States of America," the people he has been associated with for years have expressed in words and deeds their hostility to the values, the principles and the people of this country.

Jeremiah Wright said it with words: "God damn America!" Bill Ayers said it with bombs that he planted. Community activist goons have said it with their contempt for the rights of other people.

Among the people appointed as czars by President Obama have been people who have praised enemy dictators like Mao, who have seen the public schools as places to promote sexual practices contrary to the values of most Americans, to a captive audience of children.

Those who say that the Obama administration should have investigated those people more thoroughly before appointing them are missing the point completely. Why should we assume that Barack Obama didn't know what such people were like, when he has been associating with precisely these kinds of people for decades before he reached the White House?

Nothing is more consistent with his lifelong patterns than putting such people in government-- people who reject American values, resent Americans in general and successful Americans in particular, as well as resenting America's influence in the world.

Any miscalculation on his part would be in not thinking that others would discover what these stealth appointees were like. Had it not been for the Fox News Channel, these stealth appointees might have remained unexposed for what they are. Fox News is now high on the administration's enemies list.

Nothing so epitomizes President Obama's own contempt for American values and traditions like trying to ram two bills through Congress in his first year-- each bill more than a thousand pages long-- too fast for either of them to be read, much less discussed. That he succeeded only the first time says that some people are starting to wake up. Whether enough people will wake up in time to keep America from being dismantled, piece by piece, is another question-- and the biggest question for this generation.

THE JOYS OF SMALL TOWN TEXAS

donself@donself.com (Don Self) — Thu, 22 Oct 2009 14:19:00 GMT

Many people, especially those raised and living in Detroit, NYC, Chicago, San Francisco, Miami, etc... have no idea of the freedom of living in a small town in Texas.    We may have one murder every few years (I can't remember when the last one we had here was), and you don't always remember to lock the doors on your truck or even your house when you go to bed - and that doesn't bother you much.

If you have never experienced small town Texas, you may want to check out a video called TUNA TEXAS as it's a play with only 2 characters playing all of the people in a small fictitious town in west Texas.   Now - we live in East Texas that is different in geography, but the way people are here in Texas is pretty much the same in the small towns.

For instance, this morning on the Ranch (that's a local radio station), they were talking about the Hog Festival coming up this weekend in Ben Wheeler, Texas (about 30 miles from me) and the big parade they'll be having this weekend.

No - Not THAT kind of hog.

This kind of Hog!

They described all of the preparations being made at the Morris Feed Store for Saturday when they crown Miss Hog 2009, which is a local beauty contest. Now - can you imagine looking at someone's resume where they proudly listed themselves as winning the Miss Hog 2009 pagent? They talked about the greased pig run they'll have this weekend (Saturday afternoon) and the Corn on the Cob eating contest as well. More than likely, the mayor of Ben Wheeler will get up and make his usual announcements and on Saturday night, there will be the street dance where you see some of the best Two-Stepping that you've ever seen.

I know that you city slickers up in NYC would rather go spend $300 to see a Broadway Play of a bunch of people you don't even know by name get up and perform, while you sit there drinking fancy drinks - but until you've been to a real live Hog Festival or a Bluegrass Festival in Texas - you haven't REALLY lived. I'll tell you something else. At just about any Hog Festival or Bluegrass festival, a woman can get up and go the ladies room and not worry about anyone touching her purse sitting in her seat while she's gone. Can you say that about some of the shows you go to in those big cities? I doubt it. Of course, we know that same woman in Texas probably has a 38 in a holster under her shirt too - and that could be the difference.

if you haven't ever seen Tuna Texas - check out the DVD or video and I promise you that if you even HAVE any relatives living in a small town in Texas - you will recognize some of them in the way these 2 men play those characters. on top of that - if you haven't ever visited a Hog festival or Bluegrass Festival - you get up off your butt and come on down to East Texas this weekend. Oh yeah - on Saturday night, I won't be at the Hog Festival as my dad, 2 of my sons and my grandson will be with me at the Lone Star Dirt Track watching the last stock car races this year at our track. That beats any ole Broadway play any day of the week!

H1N1 PREVENTION - GARGLE WITH LISTERINE

donself@donself.com (Don Self) — Sun, 11 Oct 2009 20:00:00 GMT

Like you, I've received the email about how to prevent H1N1 (at least a dozen times), and I've done some research on this doctor and the American and British journals to see if anyone can substantiate or refute the gargle and proliferation claims. I've also done a little research on the credibility of Dr. Goyal and it seems that he is what the email claims.

I cannot find anything that refutes it and it seems that everything I have found supports the idea that gargling with Listerine or warm salt water will reduce your chances of experiencing any symptoms if you are exposed to H1N1. I also found it it very interesting that Scope is not approved by the FDA to kill germs to the any degree, in the way Listerine is, so the type of mouthwash does make a difference. Here is the advice from Dr. Goyal.

Dr. Vinay Goyal is an MBBS,DRM,DNB (Intensivist and Thyroid specialist) having clinical experience of over 20 years. He has worked in institutions like Hinduja Hospital, Bombay Hospital, Saifee Hospital, Tata Memorial etc.

Presently, he is heading our Nuclear Medicine Department and Thyroid clinic at Riddhivinayak Cardiac and Critical Centre, Malad (W).

The following message given by him, I feel makes a lot of sense and is important for all of you to know

The only portals of entry are the nostrils and mouth/throat. In a global epidemic of this nature, it's almost impossible not coming into contact with H1N1 in spite of all precautions. Contact with H1N1 is not so much of a problem as proliferation is.

While you are still healthy and not showing any symptoms of H1N1 infection, in order to prevent proliferation, aggravation of symptoms and development of secondary infections, some very simple steps, not fully highlighted in most official communications, can be practiced (instead of focusing on how to stock N95 or Tamiflu):

1. Frequent hand-washing (well highlighted in all official communications).

2. "Hands-off-the-face" approach. Resist all temptations to touch any part of face (unless you want to eat, bathe or slap).

3. Gargle twice a day with warm salt water (use Listerine if you don't trust salt). H1N1 takes 2-3 days after initial infection in the throat/nasal cavity to proliferate and show characteristic symptoms. Simple gargling prevents proliferation. In a way, gargling with salt water has the same effect on a healthy individual that Tamiflu has on an infected one. Don't underestimate this simple, inexpensive and powerful preventative method.

4. Similar to 3 above, clean your nostrils at least once every day with warm salt water. Not everybody may be good at Jala Neti or Sutra Neti (very good Yoga asanas to clean nasal cavities), but blowing the nose hard once a day and swabbing both nostrils with cotton buds dipped in warm salt water is very effective in bringing down viral population.

5. Boost your natural immunity with foods that are rich in Vitamin C (Amla and other citrus fruits). If you have to supplement with Vitamin C tablets, make sure that it also has Zinc to boost absorption.

6. Drink as much of warm liquids as you can. Drinking warm liquids has the same effect as gargling, but in the reverse direction. They wash off proliferating viruses from the throat into the stomach where they cannot survive, proliferate or do any harm

So, I am recommending to my family that everyone adopts a prophylactic approach to the H1N1 by making it a point to gargle at least twice a day with Listerine. It's important that you not just use it as a mouthwash, but that you also GARGLE with it.

Don Oct 10, 2009

OBAMA LIED TO CONGRESS.... TO AMERICA..... MULTIPLE TIMES

donself@donself.com (Don Self) — Fri, 09 Oct 2009 23:24:00 GMT

On September 9th, President Obama spoke to a joint session of Congress as well as America. His words were "Illegal immigrants will not be covered under the plans being reformed".      In the same session, he said "30 Million Americans have no health care coverage". Later, in the same speech, he said "46 Million Americans have no health insurance".

These are quotes that you can look up on the whitehouse.gov website for his speech.

Obama said, immediately before Rep. Joe Wilson rudely cried out "You Lie" (which he shouldn't have done in that forum), that "Illegal immigrants will not be covered under the plans being reformed".      Yet, on September 10, the Congressional Budget Office released the following statement "H.R. 3200 does not contain any restrictions on noncitizens—whether legally or illegally present, or in the United States temporarily or permanently—participating."     This is the bill that will be voted on next week.

Friends of mine have said that we should wait until the bill is finalized before we voice our displeasure.   How many MINUTES do you think will lapse from the time that Reid or Pelosi makes their final changes before they FORCE a vote next week?    Not hours... Minutes.

Also - as I've shown you previously - per the New York Times, the number of Americans that are not presently covered turns out to be closer to 20 million instead of the 30 Million and 46 Million numbers that Obama was throwing around the podium in his address to Congress.

And yet - we are still supposed to believe him?   Do you remember when he said "Nobody is talking about cutting Medicare benefits.”   Yet, HR3200 states specifically in Section 1161 that $156.3 billion in Medicare Advantage will be cut. Obama lied!

Sorry people, but I'm getting really frustrated at stupidity. I can't fix stupidity. I can help educate to reduce ignorance, but if you choose to remain stupid, there is nothing I can do about that.

A Revelation

donself@donself.com (Don Self) — Fri, 09 Oct 2009 02:35:00 GMT

This has been an interesting week and one that has opened my eyes to some things, as well.   Yesterday, we buried my aunt Molly and I have to say it was the most unconventional funeral that I have ever attended - and strangely enough - that was what Molly had wanted. There was no preacher. There was no one officiating the funeral.   It was held at the funeral home on the grounds of the cemetery and it was basically one family member or friend giving a testament to my aunt, after another.   It was exactly as Molly would have wanted it.   The room was full.   Afterwards, we accompanied the casket to the gravesite and placed her body next to those of my grandparents, her son, who was killed back in '93, and a few other family members and it was very brief.

Afterward, many of us went to a Hyatt Hotel and had a celebration of her life. I had put together a powerpoint of about 150 photos from her life and it played on a loop on the screen and everyone visited for several hours and ate too much. Angie and I had some great visits with both of Molly's daughters, their families, a couple of my cousins (I really enjoyed getting to see Phillip and Andy), and everyone else at the funeral.

Since Molly passed away last week, I've had a real burden in my heart about my failure to talk to her about Jesus. I've had the opportunity to do so (something like 28 years since I truly accepted Him as my savior), but I didn't do it. It's honestly easier for me to get up in front of 900 physicians and teach a 4 hour seminar than it is for me to talk to my own family members about Him and I do not know why.    Well, maybe I do. I don't really care what a stranger thinks of me, but I do care about what my own family members think and that is really stupid, in so many ways. It's also shameful. Jesus was prepared to go through ridicule, physical torture and even death for me and I'm feeling hesitant to have someone think odd of me? Pathetic is the word that comes to mind. So, I took the first step, at the funeral reception. I had typed up a couple of pages about how Molly's death has affected me in making me see the realization that I had wasted opportunities to talk to her about Jesus. So, I wrote a couple of pages about my feelings and I handed those out to people at the reception as they were leaving and I asked them to read it when they were alone.    I also gave them my phone number and encouraged them to call me if they wanted me to pray with them or to answer any questions.   Yes - that may be the coward's way of handling it - but at least it is a step in the right direction.

I also learned some things at the funeral to confirm some suspicions about my mother's siblings and how they've died and/or are now dying.    I had previously thought my mother died from COPD, almost 3 years ago. I had thought that her older brother and older sister had also died from COPD.   Molly died from IPF, which is Idiopathic Pulmonary Fibrosis, which is a rare disease of the lungs.   She was given 3 to 5 years a little more than 5 years ago. in fact, she lived 5 years and 4 days.   Molly was 2 days past her 59th birthday.    My uncle Bill also has it.   He was given 3 to 5 years, about 3 years ago.   My uncle Jerry told me that he has COPD and he is on full oxygen.    Sybil (another of mom's older sisters) has COPD.    Of the 7 siblings - ALL of them either have COPD or IPF. When you research IPF, you find that this RARE disease is suspected of being hereditary.    SUSPECTED?    Oh yeah - my grandfather (their father) died from COPD.    The research at the NIH and CDC says that IPF can be misdiagnosed as COPD.    So, today, i spent about 45 minutes on the phone with a Pulmonary Geneticist at UTSWMC in Dallas and she says that this family's incidence of pulmonary problems is more rare than any other that she's heard of, so I'm talking to the family members about participating in their study to help find the cause and any possible treatments.   IPF has a 100% death rate, it seems like, from all of the literature I found today. More than half live less than 2.5 years from the time they are diagnosed.    Lung transplants help and add some time - but no cure.   My generation may or may not be ok as it supposedly may skip a generation - unless they smoke - and I did smoke for 21 years and quit 14 years ago, but I want them to find a cure before my sons get to their 50s. I want them to find the cause and cure before the children of my cousins get to their 50s. That is why I spent so long on the phone with the doctor heading up the study today and told her that I'm willing to do whatever I can do to convince my relatives on that side of the family to let them take a blood sample so they can study the DNA, from each.   They need the blood from the children of the Nolen's that have already passed, so they can study theirs as well.   So - I'm going to try to convince people in my family to let the doctor send someone to their home.

This brings me to the point of my story.    Molly was on the transplant list within 3 days - which is almost unheard of. They waited a couple of weeks and she had no fever up to that point and lungs became available. On that day, she obtained a fever and infection and that ruled out her getting a transplant.    I started thinking about the fact that I had updated my drivers license last year and didn't remember signing it, so I pulled it out and there was no place to sign it now.   I then did some research and found the following website:

http://www.organdonor.gov/donor/registry.shtm

I then went to the site and enrolled for not only organs, but also tissue.   I plan on having a closed casket when i die, so if there is nothing in that box other than my shoelaces, that will be fine with me. OK - just kidding as they do not have to disfigure the body in any way for viewing (but I'm serious about my being a closed casket anyway), but I want them to take everything they need to help others.

My plea to you is for you to go to this same site and enroll. Just having your driver's license signed may not be enough. If you're in an auto accident and your purse is destroyed, your wish needs to be on something other than a piece of plastic in your wallet.   Please consider this act of selflessness as you may very well save someone else's life and that is a blessing.

Oh yeah - I may someday ask you about your relationship to Jesus, so don't be surprised if I do.   It's much more important that you have the right answer when He asks than when I do.

Donald Jay (Don) Self