2009 Small Business: Doctors going broke

By Parija Kavilanz | CNNMoney.com
Doctors in America are harboring an embarrassing secret: Many of them are going broke.
This quiet reality, which is spreading nationwide, is claiming a wide range of casualties, including family physicians, cardiologists and oncologists.
Industry watchers say the trend is worrisome. Half of all doctors in the nation operate a private practice. So if a cash crunch forces the death of an independent practice, it robs a community of a vital  “A lot of independent practices are starting to see serious financial issues,” said Marc Lion, CEO of Lion & Company CPAs, LLC, which advises independent doctor practices about their finances.
Doctors list shrinking insurance reimbursements, changing regulations, rising business and drug costs among the factors preventing them from keeping their practices afloat. But some experts counter that doctors’ lack of business acumen is also to blame.
Loans to make payroll: Dr. William Pentz, 47, a cardiologist with a Philadelphia private practice, and his partners had to tap into their personal assets to make payroll for employees last year. “And we still barely made payroll last paycheck,” he said. “Many of us are also skimping on our own pay.”
Pentz said recent steep 35% to 40% cuts in Medicare reimbursements for key cardiovascular services, such as stress tests and echocardiograms, have taken a substantial toll on revenue. “Our total revenue was down about 9% last year compared to 2010,” he said.
“These cuts have destabilized private cardiology practices,” he said. “A third of our patients are on Medicare. So these Medicare cuts are by far the biggest factor. Private insurers follow Medicare rates. So those reimbursements are going down as well.”
12 entrepreneurs reinventing health care Pentz is thinking about an out. “If this continues, I might seriously consider leaving medicine,” he said. “I can’t keep working this way.”
Also on his mind, the impending 27.4% Medicare pay cut for doctors. “If that goes through, it will put us under,” he said.
Federal law requires that Medicare reimbursement rates be adjusted annually based on a formula tied to the  Although Congress has blocked those cuts from happening 13 times over the past decade, most recently on Dec. 23 with a two-month temporary “patch,” this dilemma continues to haunt doctors every year.
Beau Donegan, senior executive with a hospital cancer center in Newport Beach, Calif., is well aware of physicians’ financial woes.
“Many are too proud to admit that they are on the verge of bankruptcy,” she said. “These physicians see no way out of the downward spiral of reimbursement, escalating costs of treating patients and insurance companies deciding when and how much they will pay them.”
Donegan knows an oncologist “with a stellar reputation in the community” who hasn’t taken a salary from his private practice in over a year. He owes drug companies $1.6 million, which he wasn’t reimbursed for.
Dr. Neil Barth is that oncologist. He has been in the top 10% of oncologists in his region, according to U.S. News Top Doctors’ ranking. Still, he is contemplating personal bankruptcy.
That move could shutter his 31-year-old clinical practice and force 6,000 cancer patients to look for a new doctor.
Changes in drug reimbursements have hurt him badly. Until the mid-2000′s, drugs sales were big profit generators for oncologists.
In oncology, doctors were allowed to profit from drug sales. So doctors would buy expensive cancer drugs at bulk prices from drugmakers and then sell them at much higher prices to their patients.
“I grew up in that system. I was spending $1.5 million a month on buying treatment drugs,” he said. In 2005, Medicare revised the reimbursement guidelines for cancer drugs, which effectively made reimbursements for many expensive cancer drugs fall to less than the actual cost of the drugs.
“Our reimbursements plummeted,” Barth said.
Still, Barth continued to push ahead with innovative research, treating patients with cutting-edge expensive therapies, accepting patients who were underinsured only to realize later that insurers would not pay him back for much of his care.
“I was $3.2 million in debt by mid 2010,” said Barth. “It was a sickening feeling. I could no longer care for patients with catastrophic illnesses without scrutinizing every penny first.”
He’s since halved his debt and taken on a second job as a consultant to hospitals. But he’s still struggling and considering closing his practice in the next six months.
“The economics of providing health care in this country need to change. It’s too expensive for doctors,” he said. “I love medicine. I will find a way to refinance my debt and not lose my home or my practice.”
If he does declare bankruptcy, he loses all of it and has to find a way to start over at 60. Until then, he’s turning away new patients whose care he can no longer subsidize.
“I recently got a call from a divorced woman with two kids who is unemployed, house in foreclosure with advanced breast cancer,” he said. “The moment has come to this that you now say, ‘sorry, we don’t have the capacity to care for you.’ ”
Small business 101: A private practice is like a small business. “The only thing different is that a third party, and not the customer, is paying for the service,” said Lion.
“Many times I shake my head,” he said. “Doctors are trained in medicine but not how to run a business.” His biggest challenge is getting doctors to realize where and how their profits are leaking.
“On average, there’s a 10% to 15% profit leak in a private practice,” he said. Much of that is tied to money owed to the practice by patients or insurers. “This is also why they are seeing a cash crunch.”
My biggest tax nightmare!
Dr. Mike Gorman, a family physician in Loganvale, Nev., recently took out an SBA loan to keep his practice running and pay his five employees.
“It is embarrassing,” he said. “Doctors don’t want to talk about being in debt.” But he’s planning a new strategy to deal with his rising business expenses and falling reimbursements.
“I will see more patients, but I won’t check all of their complaints at one time,” he explained. “If I do, insurance will bundle my reimbursement into one payment.” Patients will have to make repeat visits — an arrangement that he acknowledges is “inconvenient.”
“This system pits doctor against patient,” he said. “But it’s the only way to beat the system and get paid.”

Government-built malware running out of control, F-Secure claims

Government-built malware running out of control
“Governments writing viruses: today we sort of take that for granted but 10 years ago that would have been science fiction,” he told the public conference. “If someone had come to me ten years ago and told me that by 2014 it will be commonplace for democratic Western governments to write viruses and actively deploy them against other governments, even friendly governments, I would have thought it was a movie plot. But that’s exactly where we are today.”

Who Owns the Moon?

Who exactly owns the moon?
Bigelow: Moon property rights would help create a lunar industry
Lunar private property rights covered by Outer Space Treaty
Moon Mining Rush Ahead?
No one owns the moon says scientist
NASA: Earth’s Moon
Moon facts
You have probably wondered: who owns the moon? Technically, the ownership of the moon is governed by the 1967 Outer Space Treaty which requires nations to ensure that activities or experiments of their nation do not interfere with the peaceful exploration and use of outer space. Additionally, under current United Nations law, member states are “prohibited from appropriating the moon.” Recentlythis complex subject has been back in the news again as Robert Bigelow, founder and president of Bigelow Aerospace, has called for clarification from the Federal Aviation Administration’s Office of Commercial Space Transportation (AST) on whether launching a Moon habitat allows them to have a zone of operation that other persons are prevented from entering. It would seem that such a zone would essentially allow Bigelow (and others, potentially) to run a privately run lunar base engaged in mining operations. While this seem outlandish, it’s a very real concern. Commenting on the matter, Professor Ian Crawford ofBirkbeck College noted that he thought space tourism is more likely to take place before the moon is mined for its minerals. [KMG]
The first link will take interested parties to an article from NASASpaceflight.com about Bigelow’s recent renewed interest in the possibility of private moon exploration. The second link will take users to a news article from the Examiner about the world of lunar private property rights. Moving along, the third link will take interested visitors to a great piece from National Geographic’s Dan Vergano about Bigelow’s quest to clarify private property rights on the moon. Next, visitors will find an article from the Telegraph which talks about the ownership of the moon and
various international treaties governing this matter. A great site from NASA follows, which provides information about the moon, complete with photos, videos, and an interactive map of its surface. The final link leads to a fun set of basic facts about the moon, specially selected for children. The Scout Report


Seek ‘biosignature’ spying ability to ‘identify, locate specific individuals’

By Steven Peacock
Feb 15 2104
The federal government doesn’t just want the ability to track down your car; it wants to be able to track down your body as well.
Just as details are emerging about a controversial, nationwide vehicle-surveillance database, WND has learned the federal government is planning an even more invasive spy program using “physiological signatures” to track down individuals.
The goal of this research is to detect – as well as analyze and categorize – unique traits the government can exploit to “identify, locate and track specific individuals or groups of people.”
According to the program’s statement of objectives, “The scope of human-centered [intelligence, surveillance and reconnaissance, or ISR] research spans the complete range of human performance starting at the individual molecular, cellular, genomic level.”
Documents WND located through routine database research reveal the ability to follow people by detecting “certain characteristics of operational interest” is designed for U.S. military and intelligence-gathering superiority.
It remains unknown when such capabilities might transition to the realm of domestic counterterrorism or law enforcement operations; however, the feds – through the Air Force Research Lab, or AFRL – are recruiting private-sector assistance in order to make this “biosignature” spying a reality.
Existing ISR systems are “ideal for identifying and tracking entities such as aircraft and vehicles, but are less capable of identifying and tracking the human,” the lab says in a planning document known as a Broad Agency Announcement, or BAA.
The Human-Centered ISR Leveraged Science & Technology Program will seek to develop, with outside help, technologies that the government can use “to identify, locate and track humans of interest within the operational environment,” according to solicitation No. BAA-HPW-RHX-2014-0001.
Research specific to fusing and analyzing sensor data has undergone consistent growth, but such efforts have been “system-centric” and fail to “adequately address the human element.”
This new research scheme seeks to strengthen the ability of intelligence analysts by placing the human component at the forefront of their efforts.
AFRL’s research could have implications for a variety of domains, such as air, space and cyberspace, it says. The program’s outcome also will broadly apply to other U.S. Department of Defense organizations and the intelligence community.
A second component of the AFRL initiative is the Human Trust and Interaction Program, which will conduct research into human-to-human and human-to-machine interactions.
This program segment entails several sub-areas, including Trust and Suspicion, which will focus on “the recognition of suspicious activities in the cyberspace realm.”
This segment will examine open-source data such as social media. It also will continue to leverage “more traditional intelligence sources.”
AFRL says it anticipates awarding three or four initial contracts for the overall initiative, which has an estimated program value of about $50 million.
The goal of this and other AFLR programs typically start out as largely theoretical, similar to the approach taken by the more widely known Defense Advanced Research Projects Agency, or DARPA, which created ARPANET, the defense-system predecessor to the Internet.
The Department of Homeland Security, on the other hand, merely has to solicit bids from industry for a National License Plate Recognition, or NLPR, database system.
While DHS is soliciting this service specifically for Immigration and Customs Enforcement, or ICE, functions, the breadth of this NLPR service encompasses the gathering of transportation-movement data from major metropolitan areas nationwide.
This database, which would be fed with information gleaned from multiple sources, would “track vehicle license plate numbers that pass through cameras or are voluntarily entered into the system,” according to the program solicitation.
The vehicle tracking-data then would be “uploaded to share with law enforcement.”
The database will be compatible with smart phone technology, enabling law enforcement offices to download thousands of listings – as well as close-up photos – of vehicle license plates.
Once DHS secures this service, the contractor must retain and make available data from previous months, as well as update the system with “new and unique” data monthly.
DHS anticipates awarding a one-year contract with four one-year options by May 14. It did not disclose the estimated cost.

Financial Literacy The Vampire Squid Strikes Again: The Mega Banks' Most Devious Scam Yet

The Vampire Squid Strikes Again: The Mega Banks’ Most Devious Scam Yet
Banks are no longer just financing heavy industry. They are actually buying it up and inventing bigger, bolder and scarier scamsthan ever
By Matt Taibbi
Feb 12 2014
Call it the loophole that destroyed the world. It’s 1999, the tail end of the Clinton years. While the rest of America obsesses over Monica Lewinsky, Columbine and Mark McGwire’s biceps, Congress is feverishly crafting what could yet prove to be one of the most transformative laws in the history of our economy – a law that would make possible a broader concentration of financial and industrial power than we’ve seen in more than a century.
But the crazy thing is, nobody at the time quite knew it. Most observers on the Hill thought the Financial Services Modernization Act of 1999 – also known as the Gramm-Leach-Bliley Act – was just the latest and boldest in a long line of deregulatory handouts to Wall Street that had begun in the Reagan years.
Wall Street had spent much of that era arguing that America’s banks needed to become bigger and badder, in order to compete globally with the German and Japanese-style financial giants, which were supposedly about to swallow up all the world’s banking business. So through legislative lackeys like red-faced Republican deregulatory enthusiast Phil Gramm, bank lobbyists were pushing a new law designed to wipe out 60-plus years of bedrock financial regulation. The key was repealing – or “modifying,” as bill proponents put it – the famed Glass-Steagall Act separating bankers and brokers, which had been passed in 1933 to prevent conflicts of interest within the finance sector that had led to the Great Depression. Now, commercial banks would be allowed to merge with investment banks and insurance companies, creating financial megafirms potentially far more powerful than had ever existed in America.
All of this was big enough news in itself. But it would take half a generation – till now, basically – to understand the most explosive part of the bill, which additionally legalized new forms of monopoly, allowing banks to merge with heavy industry. A tiny provision in the bill also permitted commercial banks to delve into any activity that is “complementary to a financial activity and does not pose a substantial risk to the safety or soundness of depository institutions or the financial system generally.”
Complementary to a financial activity. What the hell did that mean?
The Feds vs. Goldman
“From the perspective of the banks,” says Saule Omarova, a law professor at the University of North Carolina, “pretty much everything is considered complementary to a financial activity.”
Fifteen years later, in fact, it now looks like Wall Street and its lawyers took the term to be a synonym for ruthless campaigns of world domination. “Nobody knew the reach it would have into the real economy,” says Ohio Sen. Sherrod Brown. Now a leading voice on the Hill against the hidden provisions, Brown actually voted for Gramm-Leach-Bliley as a congressman, along with all but 72 other House members. “I bet even some of the people who were the bill’s advocates had no idea.”
Today, banks like Morgan Stanley, JPMorgan Chase and Goldman Sachs own oil tankers, run airports and control huge quantities of coal, natural gas, heating oil, electric power and precious metals. They likewise can now be found exerting direct control over the supply of a whole galaxy of raw materials crucial to world industry and to society in general, including everything from food products to metals like zinc, copper, tin, nickel and, most infamously thanks to a recent high-profile scandal, aluminum. And they’re doing it not just here but abroad as well: In Denmark, thousands took to the streets in protest in recent weeks, vampire-squid banners in hand, when news came out that Goldman Sachs was about to buy a 19 percent stake in Dong Energy, a national electric provider. The furor inspired mass resignations of ministers from the government’s ruling coalition, as the Danish public wondered how an American investment bank could possibly hold so much influence over the state energy grid.
There are more eclectic interests, too. After 9/11, we found it worrisome when foreigners started to get into the business of running ports, but there’s been little controversy as banks have done the same, or even started dabbling in other activities with national-security implications – Goldman Sachs, for instance, is apparently now in the uranium business, a piece of news that attracted few headlines.
Wall Street’s War
But banks aren’t just buying stuff, they’re buying whole industrial processes. They’re buying oil that’s still in the ground, the tankers that move it across the sea, the refineries that turn it into fuel, and the pipelines that bring it to your home. Then, just for kicks, they’re also betting on the timing and efficiency of these same industrial processes in the financial markets – buying and selling oil stocks on the stock exchange, oil futures on the futures market, swaps on the swaps market, etc.
Allowing one company to control the supply of crucial physical commodities, and also trade in the financial products that might be related to those markets, is an open invitation to commit mass manipulation. It’s something akin to letting casino owners who take book on NFL games during the week also coach all the teams on Sundays.
The situation has opened a Pandora’s box of horrifying new corruption possibilities, but it’s been hard for the public to notice, since regulators have struggled to put even the slightest dent in Wall Street’s older, more familiar scams. In just the past few years we’ve seen an explosion of scandals – from the multitrillion-dollar Libor saga (major international banks gaming world interest rates), to the more recent foreign-currency-exchange fiasco (many of the same banks suspected of rigging prices in the $5.3-trillion-a-day currency markets), to lesser scandals involving manipulation of interest-rate swaps, and gold and silver prices.
But those are purely financial schemes. In these new, even scarier kinds of manipulations, banks that own whole chains of physical business interests have been caught rigging prices in those industries. For instance, in just the past two years, fines in excess of $400 million have been levied against both JPMorgan Chase and Barclays for allegedly manipulating the delivery of electricity in several states, including California. In the case of Barclays, which is contesting the fine, regulators claim prices were manipulated to help the bank win financial bets it had made on those same energy markets.
And last summer, The New York Times described how Goldman Sachs was caught systematically delaying the delivery of metals out of a network of warehouses it owned in order to jack up rents and artificially boost prices.
You might not have been surprised that Goldman got caught scamming the world again, but it was certainly news to a lot of people that an investment bank with no industrial expertise, just five years removed from a federal bailout, stores and controls enough of America’s aluminum supply to affect world prices.

Celebrate in February: Valentine Clip Art – Presidents Day – St. Brigid's Day

VALENTINE CLIPART— FREE TO USE! *Wonderful* Valentine clipart–free to use! It has hearts, cupids, backgrounds, and even animations.
IMBOLC February 1st St. Brigid’s Day!
The day of the gin-i-ker (tine caor) and jazz (teas).

OPT OUT of care.data programme automatically collecting patient health records

The Daily Telegraph article referenced by Tom Gray’s posting does indeed express concerns here in Europe about the impact that Snowden’s revelations might have on the collection of data from medical records.  However, if you read the comments that have been attached to the article you will see that in England at least there is considerable concern *about* the NHS’s “care.data” programme for automatically collecting patient health records from their doctor’s surgery. These concerns I believe are pre-Snowden in origin, and centre on the fact that the data will be collected for each patient *unless* he/she opts out, and that much of the data will be at best “pseudonomised”.
One of the leaders of the campaign against care.data is Dr Neil Bhatia (in British English a “General Practitioner” or GP, i.e a family doctor) – his website is
at: http://www.care-data.info
Quoting Dr Bhatia:  care.data is going to begin very soon, and it will affect every man, woman and child in England and their confidential medical records.  All households in England will shortly receive a junk mail leaflet through their letterbox about this programme, entitled  “Better information means better care” .  This leaflet is not about sharing your medical information with doctors, nurses and other health professionals outside of your GP surgery.  It’s not about the ways in which your GP shares information about you as part of providing essential medical care.
It’s not about ensuring that hospital specialists have the information that they need when you are referred to see them.
And it’s not about submitting information so that GP surgeries and hospitals are paid appropriately for the care that they provide.  This leaflet is about care.data .  Not that you’d know, since “care.data” is never mentioned in the leaflet.  The HSCIC and NHS England are not asking for your permission to extract and upload your data – they’re forcibly taking your information.  Your information is not going to “the NHS” – it’s going to a single organisation, the HSCIC.
They alone determine what happens to it next – not you.
There is no consent with care.data – the decision has been made for you, and your GP surgery, by the HSCIC.
All you have is the right to object and reverse the decision affecting your medical information.
You have to act if you wish to preserve your confidentiality. Unless you do, care.data will go ahead and involve your GP records by default. > > And you have to act fast, because once your data is uploaded you can never get it removed from the HSCIC databases.
This website aims to provide information to everyone about care.data so that you can make an informed decision about opting out or not.
If you do decide to opt-out, this site will tell you how to do so and the opt-out options that you have.
This website provides facts, not opinion. It’s for you to decide whether to opt-out or not. This site will tell you what will be happening to your medical information and what control you have over the data flows to and from the HSCIC databases.  . . . .
care.data is not anonymous
• Sensitive and identifiable information is going be extracted from your GP records and uploaded to Health and Social Care Information Centre (HSCIC) databases
• Sensitive and identifiable information has already been extracted, and will continue to be extracted from your hospital records and uploaded to HSCIC databases
• You will not be asked for your explicit permission or consent before these extractions take place
• The two sets of your information will be combined into one database and subsequently released, in various formats, to organisations within and outside of the NHS, for the purposes of administration, healthcare planning and research
• The HSCIC charges for releasing information to organisations, especially identifiable information
It sells data
• The information is not going to be available to doctors and nurses, and so will not be used to provide direct medical care
• The HSCIC will keep your uploaded information indefinitely – it will never be deleted, but continuously added to
• You cannot prevent the HSCIC from releasing information uploaded about you in anonymised or potentially identifiable formats
• You cannot control when, to whom, for what purposes, and what specific information the HSCIC releases about you from your care.data record <snip>
I and my family have managed to opt out.
Brian Randell