#medical-coding-2019-changes

[religion-is-a-mental-illness]

By: Josh Code

Published: Apr 22, 2025

Allan Josephson faced career destruction after criticizing gender-affirming care for minors. Years later, he sees a cultural tide turning—and legal vindication at last.

Child psychiatrist Allan Josephson will receive a $1.6 million settlement this week from the University of Louisville, which fired him in 2019 for criticizing the rush to use hormone therapy and gender reassignment surgery to treat gender dysphoria in children.

In an exclusive interview with The Free Press about the settlement, Josephson said when he heard the offer, he was stunned.

“I looked at my wife and I said, ‘This is amazing.’ ” Josephson told The Free Press. “We felt vindicated by the amount that we won.”

In 2019, Josephson was among the first doctors in the United States to lose his job for publicly criticizing the growing movement to quickly affirm and medically transition children with gender dysphoria. His ordeal began after he spoke out at a Heritage Foundation panel on the threat of activist clinicians. “Transgender ideology… is neglectful of the need for developing coping skills and problem-solving skills in children,” he said on the panel.

“The fact that even back then, that position was being held up as somehow being anti-trans is just absurd,” said Jamie Reed, who in 2023 blew the whistle to allege medical misconduct at the Washington University Transgender Center at St. Louis Children’s Hospital.

Since Josephson’s firing, a sea change has taken place regarding transgender medicine in America. President Donald Trump was elected after promising to greatly restrict gender-affirming care for minors. During the 2024 campaign season the GOP spent at least $215 million on trans-themed television ads, the most famous of which targeted Kamala Harris’s stance on transgender issues with the slogan “She’s for they/them, President Trump is for you.” On the day of his inauguration, Trump signed an executive order mandating that the federal government acknowledge “women are biologically female” and “men are biologically male.”

“I'm a doctor who pursues the truth for his patients, so when Trump says there are two sexes—male and female—I’m encouraged by that,” Josephson said.

But 2017 was a different time. By then, Josephson had served as the chair of the university’s Division of Child and Adolescent Psychiatry and Psychology for 14 years, received one of the American Psychiatric Association’s highest awards, and testified as an expert witness in several court cases on gender dysphoria. A few weeks before he spoke on the Heritage panel, Josephson visited the university’s gender clinic and met a patient with gender dysphoria. He worried clinicians were failing to treat patients’ underlying mental illness before capitulating to demands for hormones and surgery, he said.

“Of course you affirm the child and love the child, but you don't affirm a bad idea,” Josephson said on the panel.

Five days after the panel, Brian Buford, who at the time was executive director of the university’s LGBT Center, came across a blog post about the panel claiming Josephson’s comments were “anti-trans BS.” He expressed concerns about the comments in an email to Toni Ganzel, then the dean of the University's School of Medicine, who forwarded them to Josephson’s then-supervisor, Charles Woods, according to Josephson’s legal complaint. Six weeks later, Woods sent Josephson a letter telling him that “the majority of Division faculty disagrees with your approach to management of children and adolescents with gender dysphoria” and asked him to resign or be “unilaterally remove[d]” from his division chair position. Left with no choice, Josephson resigned. But it didn’t end there.

The university reduced Josephson’s “salary, retirement benefits, and academic travel funds,” according to the suit. The filing also says that after Josephson’s demotion, his colleagues began soliciting complaints about him, including scrutinizing his tax forms and noting the number of hours he was working. Three faculty members replaced Josephson after his demotion from division chair, and one expressed fear in an email to his co-chairs that the complaint campaign “makes it look like I am intentionally looking for things to target Allan [Josephson].”

As attacks on his character mounted, Josephson’s own faculty began to scour his notes on patients' clinical charts to find evidence of bad practice, he said. “That was the kind of intimidation and fear that I lived with,” Josephson said.

The University of Louisville declined to comment. Buford, Ganzel, and Woods, did not respond to Free Press requests for comment.

Finally, in 2019, the university chose not to renew Josephson’s contract, effectively terminating his position. So he partnered with the Alliance Defending Freedom, a conservative Christian legal defense fund, to sue officials at the University of Louisville, alleging that by firing him, his former employer violated his First and Fourteenth Amendment rights.

“I wanted it actually to go to court, because I thought that would be the final vindication,” Josephson said. “The personal cost was so enormous. I'm getting older, so this came at a good time, and there was a good settlement.”

Jamie Reed, the pediatric gender care whistleblower, said there’s still much to be done to protect children from life-altering surgeries they may later regret. Later this year, the Supreme Court is expected to rule on U.S. v. Skrmetti and determine whether states can ban gender-affirming surgeries for minors. For now, Josephson’s home state of Kentucky is one of 26 states with such bans.

“These kinds of one–off legal wins are hugely important, but I don't see that we're at a position yet where the United States has actually come to face the fact that damage is being done,” Reed said. “Half of our states are still doing this to children.”

==

We're officially in the "Find Out" phase of history's biggest medical scandal.

[mostlysignssomeportents]

The surveillance advertising to financial fraud pipeline

Monday (October 2), I'll be in Boise to host an event with VE Schwab. On October 7–8, I'm in Milan to keynote Wired Nextfest.

Being watched sucks. Of all the parenting mistakes I've made, none haunt me more than the times my daughter caught me watching her while she was learning to do something, discovered she was being observed in a vulnerable moment, and abandoned her attempt:

https://www.theguardian.com/technology/blog/2014/may/09/cybersecurity-begins-with-integrity-not-surveillance

It's hard to be your authentic self while you're under surveillance. For that reason alone, the rise and rise of the surveillance industry – an unholy public-private partnership between cops, spooks, and ad-tech scum – is a plague on humanity and a scourge on the Earth:

https://pluralistic.net/2023/08/16/the-second-best-time-is-now/#the-point-of-a-system-is-what-it-does

But beyond the psychic damage surveillance metes out, there are immediate, concrete ways in which surveillance brings us to harm. Ad-tech follows us into abortion clinics and then sells the info to the cops back home in the forced birth states run by Handmaid's Tale LARPers:

https://pluralistic.net/2022/06/29/no-i-in-uter-us/#egged-on

And even if you have the good fortune to live in a state whose motto isn't "There's no 'I" in uter-US," ad-tech also lets anti-abortion propagandists trick you into visiting fake "clinics" who defraud you into giving birth by running out the clock on terminating your pregnancy:

https://pluralistic.net/2023/06/15/paid-medical-disinformation/#crisis-pregnancy-centers

The commercial surveillance industry fuels SWATting, where sociopaths who don't like your internet opinions or are steamed because you beat them at Call of Duty trick the cops into thinking that there's an "active shooter" at your house, provoking the kind of American policing autoimmune reaction that can get you killed:

https://www.cnn.com/2019/09/14/us/swatting-sentence-casey-viner/index.html

There's just a lot of ways that compiling deep, nonconsensual, population-scale surveillance dossiers can bring safety and financial harm to the unwilling subjects of our experiment in digital spying. The wave of "business email compromises" (the infosec term for impersonating your boss to you and tricking you into cleaning out the company bank accounts)? They start with spear phishing, a phishing attack that uses personal information – bought from commercial sources or ganked from leaks – to craft a virtual Big Store con:

https://www.fbi.gov/how-we-can-help-you/safety-resources/scams-and-safety/common-scams-and-crimes/business-email-compromise

It's not just spear-phishers. There are plenty of financial predators who run petty grifts – stock swindles, identity theft, and other petty cons. These scams depend on commercial surveillance, both to target victims (e.g. buying Facebook ads targeting people struggling with medical debt and worried about losing their homes) and to run the con itself (by getting the information needed to pull of a successful identity theft).

In "Consumer Surveillance and Financial Fraud," a new National Bureau of Academic Research paper, a trio of business-school profs – Bo Bian (UBC), Michaela Pagel (WUSTL) and Huan Tang (Wharton) quantify the commercial surveillance industry's relationship to finance crimes:

https://www.nber.org/papers/w31692

The authors take advantage of a time-series of ZIP-code-accurate fraud complaint data from the Consumer Finance Protection Board, supplemented by complaints from the FTC, along with Apple's rollout of App Tracking Transparency, a change to app-based tracking on Apple mobile devices that turned of third-party commercial surveillance unless users explicitly opted into being spied on. More than 96% of Apple users blocked spying:

https://arstechnica.com/gadgets/2021/05/96-of-us-users-opt-out-of-app-tracking-in-ios-14-5-analytics-find/

In other words, they were able to see, neighborhood by neighborhood, what happened to financial fraud when users were able to block commercial surveillance.

What happened is, fraud plunged. Deprived of the raw material for committing fraud, criminals were substantially hampered in their ability to steal from internet users.

While this is something that security professionals have understood for years, this study puts some empirical spine into the large corpus of qualitative accounts of the surveillance-to-fraud pipeline.

As the authors note in their conclusion, this analysis is timely. Google has just rolled out a new surveillance system, the deceptively named "Privacy Sandbox," that every Chrome user is being opted in to unless they find and untick three separate preference tickboxes. You should find and untick these boxes:

https://www.eff.org/deeplinks/2023/09/how-turn-googles-privacy-sandbox-ad-tracking-and-why-you-should

Google has spun, lied and bullied Privacy Sandbox into existence; whenever this program draws enough fire, they rename it (it used to be called FLoC). But as the Apple example showed, no one wants to be spied on – that's why Google makes you find and untick three boxes to opt out of this new form of surveillance.

There is no consensual basis for mass commercial surveillance. The story that "people don't mind ads so long as they're relevant" is a lie. But even if it was true, it wouldn't be enough, because beyond the harms to being our authentic selves that come from the knowledge that we're being observed, surveillance data is a crucial ingredient for all kinds of crime, harassment, and deception.

We can't rely on companies to spy on us responsibly. Apple may have blocked third-party app spying, but they effect nonconsensual, continuous surveillance of every Apple mobile device user, and lie about it:

https://pluralistic.net/2022/11/14/luxury-surveillance/#liar-liar

That's why we should ban commercial surveillance. We should outlaw surveillance advertising. Period:

https://www.eff.org/deeplinks/2022/03/ban-online-behavioral-advertising

Contrary to the claims of surveillance profiteers, this wouldn't reduce the income to ad-supported news and other media – it would increase their revenues, by letting them place ads without relying on the surveillance troves assembled by the Google/Meta ad-tech duopoly, who take the majority of ad-revenue:

https://www.eff.org/deeplinks/2023/05/save-news-we-must-ban-surveillance-advertising

We're 30 years into the commercial surveillance pandemic and Congress still hasn't passed a federal privacy law with a private right of action. But other agencies aren't waiting for Congress. The FTC and DoJ Antitrust Divsision have proposed new merger guidelines that allow regulators to consider privacy harms when companies merge:

https://www.regulations.gov/comment/FTC-2023-0043-1569

Think here of how Google devoured Fitbit and claimed massive troves of extremely personal data, much of which was collected because employers required workers to wear biometric trackers to get the best deal on health care:

https://www.eff.org/deeplinks/2020/04/google-fitbit-merger-would-cement-googles-data-empire

Companies can't be trusted to collect, retain or use our personal data wisely. The right "balance" here is to simply ban that collection, without an explicit opt-in. The way this should work is that companies can't collect private data unless users hunt down and untick three "don't spy on me" boxes. After all, that's the standard that Google has set.

If you'd like an essay-formatted version of this post to read or share, here's a link to it on pluralistic.net, my surveillance-free, ad-free, tracker-free blog:

https://pluralistic.net/2023/09/29/ban-surveillance-ads/#sucker-funnel

Image: Cryteria (modified) https://commons.wikimedia.org/wiki/File:HAL9000.svg

CC BY 3.0 https://creativecommons.org/licenses/by/3.0/deed.en

[cal-daisies-and-briars]

🔼 Max please! :)

Yeah! 500 for throuple:

---

Shannon pulls out of the hug. She sniffs. “What do you mean, Eddie? He was struck by lightning.”

“He fell,” Eddie whispers. “He was up the ladder and he fell. He was just… He was hanging there. I couldn’t lift him.”

The image in Shannon’s head is entirely gruesome. Something out of a tragedy or a horror movie. 

“Eddie,” she whispers. “Not your fault.”

“He saved me,” Eddie reminds her.

She remembers walking into the men’s bathroom. Finding Buck covered in Eddie’s blood. 

“And he still thought he failed you,” she says. “He’s alive, right? He survived, so-”

“They’re keeping him alive,” Eddie says. “He might not… We can’t be sure.”

Okay, so much for either of them being strong. Shannon feels like she could crumple.

“What do we do?” She asks him.

Eddie wipes his eyes. He looks exhausted. 

“I don’t know,” he admits. “But we have to make decisions.”

“What decisions?” Shannon asks. 

“Maddie’s not his medical power of attorney anymore,” Eddie explains. “He changed it. We are.”

Shannon goes cold. Even colder. She didn’t think she could feel colder. 

They have to choose if and when to give up on him. 

🔼

“Buck, she’s dead.”

The words pierce something vital in Buck’s heart.

“No,” he shakes his head. “No, no. No way. I was just texting with her.”

Maddie frowns. “Uh, no. You weren’t, Evan. That’s not possible.”

“Where’s my phone?” Buck demands. “I’ll show you. I’ll call her!”

Maddie sighs. “Do you remember in 2019, right before your leg was crushed? She was hit by a car. Your team took the call.”

Buck shakes his head again. “No, no. Maddie. She survived. She hurt herself, but she survived.”

Maddie’s face twists. “She didn’t. I’m sorry.”

“No,” Buck insists. “No. Shannon is alive. She’s alive. I need to call her.”

“I didn’t… I didn’t realize you and her were close?” Maddie asks. 

“Close?” Buck asks. “I-I love her. We… She and Eddie and I…”

Maddie blinks, surprised. “Sorry, what?”

“What about Jane?” Buck demands. Like this is a code he’s cracked. Like there’s no logical way to explain that without admitting it’s all a joke, Shannon is alive. “If Shannon is dead, where is Jane?”

“Evan, who is Jane?” Maddie asks.

“Who… Who is Jane?” Buck parrots. 

Maddie nods. “Mhm. I don’t know a Jane either.”

“My… My daughter,” he whispers.

Not stepdaughter. He forgets the step. 

Maddie sucks in a sharp breath. “Oh… You don’t… You don’t have a daughter.” “No,” Buck insists. “She’s three. She… She looks just like Eddie. She… She’s the… Please, Maddie. Please.”

[labourcompliance]

Compliance for Labour Laws in India

Here’s an overview of the key labor laws in India:

1. Wages and Salary Compliance

Minimum Wages Act, 1948: Sets minimum wage standards for different types of employment. Employers must pay at least the minimum wage set by the government.

Payment of Wages Act, 1936: Ensures timely payment of wages without unauthorized deductions.

Equal Remuneration Act, 1976: Mandates equal pay for men and women performing the same work.

2. Social Security Compliance

Employees’ Provident Fund (EPF) Act, 1952: Provides a retirement savings scheme for employees in specified establishments. Employers are required to contribute to employees' PF accounts monthly.

Employees’ State Insurance (ESI) Act, 1948: Offers medical, cash, and maternity benefits to workers. Employers and employees contribute a portion of wages toward ESI funds.

Payment of Gratuity Act, 1972: Provides gratuity to employees after five years of continuous service upon retirement, resignation, or death.

3. Working Conditions and Safety

Factories Act, 1948: Regulates health, safety, and welfare conditions in factories. This includes proper lighting, ventilation, safety precautions, and working hour restrictions.

Contract Labour (Regulation and Abolition) Act, 1970: Regulates employment conditions for contract laborers and mandates basic welfare measures by contractors.

Building and Other Construction Workers (Regulation of Employment and Conditions of Service) Act, 1996: Ensures safety, health, and welfare for construction workers with provisions for safety equipment and accident compensation.

4. Industrial Relations Compliance

Industrial Disputes Act, 1947: Governs the resolution of industrial disputes through negotiation, arbitration, and conciliation. It provides mechanisms for lay-offs, retrenchment, and worker compensation during conflicts.

Trade Unions Act, 1926: Regulates the formation, registration, and rights of trade unions, ensuring workers can collectively bargain for better conditions.

5. Welfare and Benefits Compliance

Maternity Benefit Act, 1961: Ensures paid maternity leave and job security for women during pregnancy and post-delivery.

Child Labour (Prohibition and Regulation) Act, 1986: Prohibits the employment of children in certain hazardous occupations and regulates working conditions for children aged 14-18.

6. The Code on Wages, 2019

A consolidated law merging multiple wage-related acts, including the Minimum Wages Act, Payment of Wages Act, Equal Remuneration Act, and the Payment of Bonus Act.

Establishes a national minimum wage, simplifies wage-related compliance, and standardizes definitions across states.

These codes aim to streamline compliance, reduce complexity, and standardize labor laws across India. Once implemented, the new labor codes will replace 29 existing labor laws, making compliance easier and enhancing worker protections.

Importance of Labor Law Compliance

Labour law compliance helps businesses avoid penalties, protect their reputations, and ensure fair treatment of workers. Many companies engage third-party compliance service providers to stay updated on regulatory changes and ensure they meet all required standards.

[callsign-owl]

Easter Break - Part 2

This is a continuation of Easter Break - Part 1

Trigger Warning: alcohol, drugs

London, United Kingdom - April 2019

"Pack what you need. I’ll wait in the car," Percival said, already turning toward the door. He didn’t give Owl a chance to protest or change his mind—he never did. It was always Percy’s way or no way at all. Without another word, Percy turned and the flat, clearly expecting Owl to follow as soon as he was ready.

Owl watched him leave, feeling a knot of resentment tighten in his chest. Even when he agreed to something, Percy always found a way to make it feel like it wasn’t really his choice. With a heavy sigh, Owl grabbed the still packed backpack he had brought from Hereford. Then his eyes drifted toward the bookshelf once more. Percy might be under the impression that he had talked Owl down, but the temptation still lurked in the corners of his mind. Owl crossed the room in a few quick strides and pulled down one of the medical textbooks that concealed his hidden stash. His fingers found the small, familiar bundle tucked behind the books. With a quick glance toward the door to make sure Percy hadn’t come back, Owl shoved the pills into his bag.

He zipped the backpack closed, slung it over his shoulder and made his way to the door. Outside, Percy’s black car was already idling by the curb, the driver waiting patiently behind the wheel. Typical Percy—despite the traffic and the chaos of London, he insisted on being driven everywhere. Owl rolled his eyes at the unnecessary display of wealth. Percival sat in the backseat, the door already open, a silent invitation for Owl to join him. Without a word, Owl climbed in. The moment the door closed, he slipped on his noise-canceling headphones, hoping it would send a clear message: he didn’t want to talk. But, of course, Percy was not that easily deterred.

"Whether you like it or not, we’re going to talk," Percy said. He didn’t need to raise his voice; his words had a weight to them that was impossible to ignore. Owl clenched his jaw but didn’t take the headphones off. He kept the music on and his eyes closed, hoping Percy would take the hint and drop the subject. But no such luck.

"*redacted*," Percy continued, his tone growing more insistent. "I want to know what happened."

Owl sighed, cracking open one eye and glancing sideways at his brother. "What happen to the 'you're backing the hell off' part of our deal? Besides I assume you already read some sort of report. So what's the point of me telling you what you already know?"

Percy’s eyes narrowed, the cool detachment that always lingered behind his words now tinged with irritation. "Yes I've read the report. It's factual and up to code but still it is vague leaving room for interpretation. I want to hear the full story from you."

Owl sighed deeply, willing himself to stay calm. He could feel the frustration bubbling beneath the surface. “What did the report say?” he eventually asked and pulled the headphones down to rest around his neck. Owl wanted to know what information had made it into the paperwork and what hadn't, before he said anything to Percy.

Percy’s gaze flicked down to his phone as he pulled up the document. “It says that you participated in a parachute jump, your first one. That you completed it, albeit with some issues. Afterward, you apparently went into some state of shock and later injured your hand in an ‘accident.’” He paused, glancing over at Owl. “That’s all it says.”

Owl snorted softly and shrugged. "Sounds about right." Owl was a little surprised and certainly pleased about just how vague the report seemed to be.

Percival didn’t look convinced. He leaned forward slightly, his voice dropping. “*redacted*, what really happened? I know you well enough to know that there is more to that story than the report says.”

Owl rolled his eyes at Percy. He was very well aware of the fact that Percy wouldn‘t stop nagging him until he got at least some sort of answer. "Fine. You want the details?" Owl said bitterly, his voice low. "It’s exactly what you expect it would be. I screwed up. Had a bad day and it got in my head. End of story. That's really all you need to know."

"That’s not enough," Percy replied, his tone sharp. "It wasn’t just some minor little incident like that report makes it out to be —it was obviously serious enough that Captain Price thought sending you home early was neccessary. That doesn’t happen just because you were having a bad day."

Owl‘s frustration increased even more and he tightened his fingers around the strap of his backpack. The last thing he wanted was to be interrogated by Percy. "Just leave me alone Percy!", Owl snapped.

Percy leaned forward slightly, his gaze hard and unrelenting. "I am just trying to understand why you keep self-destructing every time something goes wrong."

"Self-destructing?" Owl let out a short, humorless laugh, shaking his head. "You make it sound like I’m some kind of ticking time bomb."

"Because that is exactly what you are," Percy shot back, his voice cold. "Every time things get difficult, you spiral and end up hurting yourself in one way or another. You think I don’t know what’s going on in that head of yours, but I do. And if you don’t start addressing it—really addressing it—it’s going to ruin you."

Owl‘s fists clenched in his lap. "I don’t need you to tell me how to handle my things," Owl muttered through gritted teeth. "I’m doing jusf fine."

"You’re not fine, *redacted*," Percy said, his voice softening slightly but still firm. "And pretending that you are isn’t going to help anyone. Least of all you."

Owl sighed. He was tired—tired of the constant prodding, the relentless concern that always felt like judgment. Percy never let up, never allowed Owl any space to breathe. His brother always had to know everything, to pick apart every mistake as if it were a problem he could solve.

“You said that you to back the hell off,” Owl snapped, his voice cutting through the tense silence that had settled over the car. “That was the deal, remember? You promised. So, stop fucking pushing.”

Percival's lips thinned into a line, but he didn’t respond right away. He watched his younger brother closely, weighing his next words carefully. "Backing off doesn’t mean I'm going to ignore what’s right in front of me, *redacted*."

Owl turned sharply to face him, his frustration boiling over. "No, backing off means backing off," he spat. "You don’t get to sit there and keep digging just because you think you know better. You promised me space, and right now, you’re doing the exact opposite. So either you back the fuck off right now or I am going to get out of the car this instance.”

Percival’s eyes narrowed at Owl‘s words. He knew his brother well enough to understand that Owl didn’t make empty threats, especially when he was backed into a corner like this. The London traffic wasn’t exactly fast, but he didn't want to risk Owl actually stepping out of a moving vehicle. His brother had always been impulsive, and when pushed too far, he wouldn’t hesitate to follow through on his words.

Percy let out a slow, controlled exhale, his gaze lingering on Owl for a moment longer before he finally leaned back against the leather seat, his posture stiff but resigned. “Fine,” he said, his voice clipped, the edge of frustration still evident. Percy always hated backing down. He was used to being the one in control, the one who always had the answers, but with Owl, things were never that simple. Owl‘s self-destructive tendencies weren’t something Percy could control or fix, no matter how hard he tried.

Owl remained silent and kept his eyes trained on the city streets as they moved past. He had seemingly won this small victory, but the lingering sense of unease in the pit of his stomach told him that it wasn’t over. Percy never let things go easily. The tension in the car was palpable. Neither of them spoke for the rest of the car ride.

Finally, after what felt like an eternity, the car rolled to a stop in front of the the family estate. Owl immediately pushed the door open and got out before Percy could say anything. Percival stepped out right behind him, his usual composed demeanor firmly back in place. He gave Owl a long, appraising look, but to his credit, he remained silent. Owl slung his backpack over his shoulder and started toward the door without looking back. He could feel Percy’s eyes on him and he knew that Percy would probably not keep his promise for long.

───── ⋆⋅☆⋅⋆ ─────

Owl stepped into the grand entrance of the estate, the familiar scent of polished wood and marble filling the air. The place hadn’t changed in the slightest. It was the same imposing, pristine monument to wealth and control that it had always been. Every detail seemed to scream perfection, from the immaculate marble floors to the towering ceilings that made Owl feel small and insignificant. This house had never felt like home to him; it had always been more of a prison, filled with expectations he could never meet.

Without thinking, Owl made his way to his old room. It was more out of habit than any real desire to be there, but where else was he going to go? The estate might be massive, but this was the only space he had ever called his own in this house. As he opened the door, he was struck by how familiar it all was. Everything looked almost exactly as it had the last time he’d been here, though it was clear someone had taken care to clean the place up. The furniture gleamed as if it had been recently polished, and the bed was freshly made.

Percival had planned everything, Owl thought with a scowl. It was obvious that his brother had prepared for his arrival, even if Owl hadn’t wanted to come here in the first place. The bed was perfectly made and it felt like just another one of Percy’s silent manipulations, his way of making sure Owl would feel comfortable—under the guise of concern, of course.

Owl dropped his backpack on the floor and sat down on the edge of the bed. His gaze wandered around the room, landing on the bookshelf in the corner. There were still some old books his father had insisted he read, mostly on finance, law, and politics. The collection was a testament to everything Owl had rejected, everything he had tried to run away from. He’d hated it then, and he still hated it now. Owl had not read a single one of those books. But they were still there, a silent reminder of his failures. He had never been the son his father wanted, and he had never cared to try.

The longer Owl stared at the books, the more the old resentment intensifed. It felt as if the weight of all those expectations—his father’s voice, Percy’s constant scrutiny—was pressing down on him, suffocating him. And in that moment, an idea sparked. Without a second thought, Owl stood up and headed over to the bookshelf. One by one, he grabbed the books. Each title was more pretentious than the last. Clutching the entire stack in his arms, Owl left his room and headed straight for the one place that symbolized everything his father had stood for—his old study. The door to the study was slightly ajar, and without knocking, Owl shoved it open and marched in.

The room was empty, but it was obvious Percy had claimed the space for himself. Papers were neatly stacked on the massive desk, and a laptop sat open, the screen saver glowing faintly. Owl moved straight toward the fireplace. The crackling embers from an earlier fire still glowed faintly, and it didn’t need much to be rekindled.

Owl felt a twisted sense of satisfaction as he tossed the first book into the flames. It hit the burning logs with a satisfying thud, the pages curling and blackening almost instantly. One by one, he fed the fire, tossing each hated volume into the flames. "Good riddance," Owl muttered under his breath as he watched the books burn. There was something satisfying about seeing the words, the ideas, the very essence of everything his father had wanted for him, reduced to ash. Owl didn’t move. He just stood there, watching the flames dance as the heat from the fire began to grow. He could feel the warmth against his skin, but more than that, he could feel the weight lifting from his shoulders, even if just for a moment.

Owl‘s eyes drifted to the liquor cabinet, its glass doors revealing shelves lined with expensive bottles of whisky. His father had been a connoisseur, always keeping the finest, most expensive spirits on hand for special occasions or business meetings. They were expensive, rare, and undoubtedly had beend some of his father’s most prized possessions. A wicked grin tugged at the corner of Owl‘s mouth as he strode over to the cabinet and pulled open the glass door. He scanned the bottles until he found the one he wanted—a particularly rare bottle of whisky his father had cherished. It was rpriceless.

Without hesitation, Owl grabbed the bottle, popped the cork and took a long, defiant swig not even bothering with a glass. The liquor burned as it went down. He drank again, slower this time, savoring the rich, smoky flavor. His father would have hated seeing him like this, disrespecting one of his "precious investments." And that thought made it all the more satisfying.

As Owl sat down on one of the leather armchairs, the bottle still in his uninjured hand, he let his gaze drift back to the fire. The room was filled with the crackling sound and the smell of burning paper as the books were slowly being reduced to nothing more than a few glowing embers and ash. Taking another long swig of the whisky, Owl leaned back in the chair. This wasn’t just about getting drunk or burning books. It was about making a statement. About giving the finger to his father and everything he had ever valued. And it felt so damn good.

───── ⋆⋅☆⋅⋆ ─────

Percival had been in the kitchen, standing at the counter, devouring a large tray of sweet pastries. It was a familiar routine —one that had become more and more frequent over the years as the stress of dealing with his father, his own responsibilities and also Owl mounted. His expensive tailored suit stretched tight over his growing midsection. As Percy stuffed another pastry into his mouth, the sharp scent of burning paper hit his nostrils, making him pause mid-bite. He frowned, chewing slowly as he sniffed the air. Something wasn’t right. The smell that was quickly growing stronger.

Percy quickly wiped his hands on his shirt, tried to adjust it as best be could and hurried out of the kitchen, his heavy footsteps echoing through the silent halls. His heart pounded in his chest, a mixture of the sudden exertion as well as the alarm and frustration, as he made his way toward the source of the smell. He had a sinking feeling he knew exactly what was happening or at least who was responsible for whatever was going in.

When Percy reached the study, he froze in the doorway. His eyes immediately fell on the fire crackling in the fireplacd, where the last remnants of some smoldering books were being reduced to ash. Then his gaze was drawn to the sight of Owl, lounging in one of the leather armchairs, a bottle of expensive whisky in hand, staring into the flames with a look of eerie calm and satisfaction.

Percy recognized the bottle instantly—the rare bottle their father had treasured, the one he had never allowed anyone to touch. And Owl was drinking from it like it was nothing more than a cheap bottle of beer from the corner shop.

For a long moment, Percy just stood there, his large frame filling the doorway, the shock and disbelief etched into his features.His breath came in slow, heavy puffs as he tried to process the scene before him.

“*redacted*,” Percy finally growled, his voice low and simmering with a dangerous mix of anger and frustration. He took a step into the room, his eyes narrowing as he took in the sight of his younger brother, drunk and clearly reveling in his act of destruction.

Owl didn’t look up immediately. He took another slow swig of the whisky, his eyes still locked on the fire. When he finally turned his head to look at Percy, there was a faint smirk tugging at the corner of his lips. “Well, look who finally showed up,” Owl said, his tone snarky. He raised the bottle in a mock toast, his hand unsteady as he swirled the remaining liquid around. “Care for a drink, Percy? It’s one of Father’s finest.”

Percy’s jaw tightened, his eyes flashing with barely contained rage. He struggled to keep his temper in check. “What the hell are you doing?” he demanded.

Owl shrugged, the smirk never leaving his face. “Burned some of my old books. Drank some good whisky.” He took another swig, not caring that he was already more than a little drunk. For the first time in a long while, Owl felt something that resembled relief—maybe even joy. The destruction, the chaos in the middle of his late father‘s study—it was all a cathartic release.

Percy, however, wasn’t having any of it. “You could’ve burned the whole bloody house down,” Percy almost yelled, his voice tense with anger and concern. His eyes flicked between the flames and Owl, the latter looking far too pleased with himself. “Do you ever think before you act?” Percy continued, his voice rising. “This is dangerous, and you know it!”

Owl waved him off. “Relax, Percy. It’s just a fire. The house is still standing, isn’t it?” His words were slurred, the alcohol clearly affecting him, but he didn’t care. In fact, he found Percy’s frustration rather amusing. “And besides,” Owl added, his smirk widening, “it’s the least Father deserves, don’t you think? A little send-off for all the shit he put me through.”

Percy’s frustration was growing being confronted with Owl‘s reckless attitude. But what really got under Percy’s skin weren‘t the burning books or the fire, it was the sight of his brother—drunk and spiraling out of control. “We both know this isn’t really about Father,” Percy said, his voice tight as he tried to keep his temper in check. “This is all about you!”

Owl rolled his eyes, leaning back in the chair with a lazy grin. “Oh, I’m perfectly fine. Better than I’ve been in quite a while, actually.” He laughed, the sound bitter and hollow. “It feels good, you know? Letting go of all this shit. Watching it burn. Maybe you should try it sometime.”

Percy’s expression darkened as he took a step closer, his voice low and firm. “This isn’t you letting go. This is you self-destructing.” He gestured toward the fire and the half empty whisky bottle in Ow‘s hand. “This—this isn’t going to fix anything. It’s just making things worse.” Percy stepped forward, grabbing the bottle from Owl‘s hand and setting it down on the table with a firm thud “That’s enough,” Percy said, his tone brooking no argument. “You’re done for tonight.”

Owl stared at the bottle on the table, his body tensing at Percy’s interference. His anger flared briefly, but then, just as quickly, it flickered out. Without a word, Owl pushed himself up from the chair, his movements slightly undsteady. His hand reached for the bottle again, he calmly lifted it to his lips, took one last long swig, and then set it back down with a mocking little smile.

"Goodnight, Percy," Owl said mockingly as he turned on his heel and headed for the door. Percy’s gaze burned into his back, but Owl didn’t look back, didn’t wait for a response. He pushed open the door, stepped into the hallway and made his way back to his room.

Once inside, Owl slammed the door shut behind him, locking it make sure Percy wouldn’t have an easy way of barging in. Ow leaned his back against the door for a moment. Then his mind drifted to the stash tucked away in his bag. Owl pulled the backpack onto the bed, unzipped the side pocket and fished out the small plastic bag. The pills glistened faintly in the dim light of the room, tiny promised of oblivion and bliss.

Without a second thought, Owl popped two pills into his mouth and slumped down on the bed. In combination with the alcohol it didn‘t take too long for the pills to take effect. Owl could feel, the slow, creeping numbness spreading through his body, dulling the sharp sting of reality. Owl closed his eyes, welcoming the sensation as it pulled him deeper into that familiar, comforting void—a place where nothing mattered, where he didn’t have to think or feel. He didn’t have to face Percy or the expectations that had suffocated him his entire life.

As the world around him faded into a haze, Owl sank deeper into the mattress and let the numbness spread through every fiber of his being. He didn’t care what happened next. Not tonight. Not anymore.

Continue reading here

[aditipurandare]

Diasporas Marking Identity: The Farewell (2019)

Lulu Wang’s film The Farewell follows Billi, a Chinese-American woman, who immigrated from her hometown of Changchun, China to New York city when she was 6. Her entire family discovers that her grandmother, still living in her hometown overseas, has been diagnosed with terminal lung cancer, and only has a few weeks left to live.  However, in a cultural practice common in China and many Asian countries, the family decides to keep the diagnosis a secret from her grandmother, Nai Nai, allowing her to remain blissfully unaware of her condition. To spend time with Nai Nai one last time without revealing the truth, the family orchestrates a fake wedding for Billi’s cousin as an excuse to gather in their hometown of Changchun in China. Billi’s parents, fearing that she will end up exposing the lie to her grandmother in line with Western ethics, tell her to remain in New York. She ends up scrambling for money and coming anyway. 

Throughout the trip, however, she clashes with the rest of the family over their deliberate dishonesty towards her grandmother. The decision to hide Nai Nai's terminal illness from her reflects a common practice in many Asian cultures, where the collective well-being of the family often takes precedence over individual autonomy. This contrasts sharply with the values typically upheld in Western societies, where honesty and individual rights are highly regarded. Billi, having grown up in the United States, embodies this Western perspective, leading to a profound internal struggle as she grapples with the family's decision to keep Nai Nai in the dark. At one point, Nai Nai goes to the hospital after a coughing attack. Once again, Billi brings up her moral dilemma with the doctor, and he also advises against telling her about her condition. He tells Nai Nai the cough is leftover from the pneumonia she'd had earlier in the year and it's a secondary infection. He agrees to change her medicine and orders an X-ray.

As Billi and her family navigate the moral and emotional complexities of maintaining this deception, they find themselves grappling with their love for Nai Nai and the ethical dilemma of concealing the truth. They believe that by withholding the truth, Nai Nai will be spared the emotional burden, allowing her to live out her final days in peace. Billi’s overarching struggles with the cultural differences between her Chinese heritage and her American upbringing highlight the clash between Eastern collectivism, where the family's well-being takes precedence, and Western individualism, where personal autonomy and honesty are highly valued. One night, her uncle Haibin describes to her that the lie allows the family to bear the emotional burden of the diagnosis, rather than Nai Nai herself.  

The movie’s culminating moments occur at the “wedding”, where Nai Nai gets her diagnosis from the doctor. Billi is the one to intercept the medical results first, and change them to display healthy results in order to maintain the lie. This moment becomes a poignant exploration of love, grief, and the complexities of cultural traditions. The film ultimately provides a nuanced and intimate portrayal of the immigrant experience, by not only highlighting innate cultural differences between the East and West, but also delving into the challenges faced by immigrants (in particular second generation immigrants) in reconciling their heritage with the culture of their adopted country. 

Discussion Questions:

What ethical questions does the family's decision to hide Nai Nai's diagnosis raise? Is there a universal code of ethics? 

How does nostalgia for the homeland simultaneously connect individuals to their roots and create a sense of displacement when living in a foreign country.

How could Billi changing the medical bill results show her reconciling her cultural conflicts?

[vague-humanoid]

NORWALK - The Norwalk La Mirada Unified School District board of education listened as Arthur Schaper, the California MassResistance field director, expressed unfounded claims about the John Glenn and Southeast Academy High School Wellbeing Center.

“These wellbeing centers, your staff, have been trained by Planned Parenthood,” Schaper said. “You have these counselors who teach kids they can change their sex like flipping a switch, it’s unacceptable.”

California MassResistance, an organization the Southern Poverty Law Center labeled a hate group, arrived at the Norwalk La - Mirada Unified School District board meeting on June 26 to oppose the Wellbeing Center and called for its removal.

The organization spread the unfounded claim on social media that Planned Parenthood trained the staff at the center. Schaper claimed, without evidence, that Planned Parenthood pushes an agenda of “sex mutilation” on students and influences them to become transgender.

The Torrance resident continued to call the LGBTQIA+ ideology a “cult and an illness,” as his California MassResistance supporters applauded. Schaper also accused the school board of hiding information on the center from parents and vowed to go door-to-door to spread his beliefs to the community.

NLMUSD superintendent, John Lopez, explained the district addressed most of MassResistance’s concerns of the Wellbeing Center with a fact sheet of frequently asked questions in February.

“The Wellbeing Center was approved by the board of education in 2019,” Lopez said. “They talked to the community members of John Glenn and got an intake of services they wanted.”

The services provided through the center are student-initiated, according to the FAQ. Students are reminded to include parents in their care, as expressed in the district’s memorandum of understanding with the LACDPH.

A minor may consent to medical care related to contraception, the prevention, or the treatment of pregnancy without parental consent, according to Cal. Family Code § 6925.

The superintendent emphasized that Planned Parenthood is not involved with the Wellbeing Center, after the board voted against the Planned Parenthood component in August 2022.

Wellbeing Center staff are trained by the Los Angeles County Department of public health.

Lopez was confused about how Schaper and MassResistance tied LGBTQIA+ into the Wellbeing Center.

“It’s disappointing that we have an opportunity to help our community by giving them resources they need and groups are putting a spin on things that aren’t happening,” Lopez said. “LGBTQIA+ wasn’t even addressed in any of our frequently asked questions because that never came up until now.”

The Wellbeing Center provides health education, information about substance abuse, mental health and stress reduction groups. Masters Level Health Educators from the LACDPH are present to support students, teach sexual health and provide sexually active young people with counseling, according to the FAQ.

A registered nurse is also available for on-site testing and treatment for sexually transmitted infections, condoms, over-the-counter emergency contraception, pregnancy tests and sexual health information for students.

The FAQ emphasizes that parents can also utilize the Wellbeing Center. Classes at the center teach parents about teen health, how to discuss alcohol and drugs with their child and how to effectively explain sexual decision-making.

[autonom-us-project]

Abortion Rights in New York 

In June 2022, the United States Supreme Court overturned the ruling of the landmark 1973 case Roe v. Wade, which had previously provided federal protections of the right to abortion.

With the responsibility of protecting the right to reproductive freedom left to the states, it can be difficult to keep track of all the constantly changing laws and regulations. To help, we’ve gathered the most important information on your state’s current laws, restrictions, and related details. Below is what you need to know about New York’s current abortion legislation.

*Please note, information on this website should not be used as legal advice or as a basis for medical decisions. Consult an attorney and/or a physician for your particular case.

Where does the law currently stand on abortion in the state of New York?

Abortion is currently legal and protected in the state of New York. 

When did New York’s current abortion legislation go into effect?

The state of New York recognized abortion access as a fundamental right in 2019, when comprehensive abortion rights legislation was enacted. In the years since, New York has continued to protect the right to abortion access legally, as well as put into place expanded protections for abortion access.

For more information on your state’s abortion legislation, see our breakdowns of various abortion bans, restrictions, and protections in the U.S.

Are there any legal restrictions to abortion access in the state of New York?

Currently, there are no restrictions to abortion access up until the point of viability, or the point at which a fetus is likely to survive outside of the uterus, typically occurring at 24 weeks. 

Past this point, an abortion is allowed only when necessary to preserve the life or health of the patient, as determined by a physician. 

What expanded protections are in place regarding abortion in the state of New York?

Provider Protections: New York state law authorizes certain healthcare practitioners to administer abortion services and includes protections for clinic access and safety as well as confidentiality measures for providers and volunteers. 

Medical Funding: The state of New York provides public funding for abortion and requires private insurances covering maternity services to cover abortion as well. 

Courtroom Protections: The state of New York allows anyone sued out of state for providing, accessing, or helping someone else access legal abortion services in-state to file their own legal counter-action for unlawful interference with a protected right, and collect compensation/punitive damages. 

The specifics can be read in the following New York Legal Codes: 2599-AA&BB,  240.70, SB S9384A, and SB S9039A

I am pregnant in the state of New York and wish to terminate my pregnancy. What now?

If you believe your pregnancy meets the requirements for a legal abortion in your state, schedule an appointment with a trusted physician as soon as possible. If not, you will need to arrange an appointment at a clinic providing abortion services out of state. Make sure the state you choose allows abortions at the gestational age your pregnancy will reach by the appointment date.

If you need financial assistance to do this, there are existing funds to help cover both the procedure and travel costs. 

Abortion funds can assist with the medical cost of the abortion itself. Practical Support Organizations, (PSOs), can assist with other costs incurred seeking an out-of-state abortion such as travel, lodging, childcare, provider referrals, emotional support, and judicial bypass for minors, among other needs. Here are a few resources available to those seeking support in New York:

New York Abortion Access Fund [Fund] – Provides support for those seeking an abortion from New York. Offers financial aid for abortion and lodging.  See their website for more information. 

New York City Abortion Access Hub [PSO] – Provides support for those seeking an abortion from New York City. Offers aid in the form of provider referrals, language services, and interpretation services. Provides Spanish language support. See their website for more information. 

Southern Tier Women's Health Services [Fund & PSO] – Provides support for those seeking an abortion from Central New York. Offers financial aid for abortion and transit. See their website for more information. 

National Abortion Hotline [Fund & PSO] – Provides support for those seeking an abortion Nationwide. Offers financial aid for abortion, transit, and provider referrals. Provides Spanish language support. See their website for more information. 

Women’s Reproductive Rights Assistance Project [Fund] – Provides funding for those seeking an abortion Nationwide. Offers financial aid for abortion and emergency contraception (the morning-after pill). See their website for more information. 

Abortion Freedom Fund [Fund] – Provides funding for those seeking an abortion Nationwide. Offers financial aid for abortion. See their website for more information. 

Indigenous Women Rising [Fund] – Provides funding for Indigenous individuals Nationwide seeking an abortion. Offers financial aid for abortion. See their website for more information. 

Reprocare [PSO] – Provides support for those seeking an abortion Nationwide. Offers aid in the form of provider referrals, emotional support, language services, and abortion doula services. Provides Spanish language support. See their website for more information. 

The Brigid Alliance [PSO] – Provides support for those seeking an abortion Nationwide. Offers aid in the form of provider referrals, emotional support, language services, and abortion doula services. Provides Spanish language support. See their website for more information. 

Regardless of the legislation your state currently has in place, remember that safe and legal options are always available. The most important tool you can arm yourself with in these difficult times is knowledge, so stay informed about changes in legislation and policy where you live, and know that there are always resources available to help you through this ♥️

[mariacallous]

Internal dissent within the mostly volunteer disease-news network known as ProMED—which alerted the world to the earliest cases of Covid, Middle East Respiratory Syndrome (MERS), and SARS—has broken out into the open and threatens to take down the internationally treasured network unless an external sponsor can be found.

The struggle for the future of the low-tech site, which also sends out each piece of content on a no-reply email list with 20,000 subscribers, has been captured in dueling posts to its front page. On July 14, a post by ProMED’s chief content officer, a veterinarian and infectious-disease expert named Jarod Hanson, announced that ProMED is running out of money. Because it is being undermined by data-scraping and reselling of its content, Hanson wrote, ProMED would turn off its RSS and Twitter feeds, limit access to its decades of archives to the previous 30 days, and introduce paid subscriptions.

Hanson is at the top of ProMED’s masthead, and the post was signed “the ProMED team,” which gave the announced changes the feeling of a united action. That turned out not to be the case. Very early on August 3, a post addressing “Dear friends and readers of ProMED” appeared on the site’s front page. The open letter was signed by 21 of its volunteer and minimally paid moderators and editors, all prominent physicians and researchers, and it makes clear that no unity existed.

“Although the [July post] was signed by ‘The ProMED Team,’ we the undersigned want to assure you that we had no prior knowledge,” the open letter stated. “With great sadness and regret … we, the undersigned, are hereby suspending our work for ProMED.”

The letter was taken off the site within a few hours, but the text had already been pushed to email subscribers. (WIRED’s copy is here.) On Friday, signers of the open letter said they had been locked out of the site’s internal dashboard. The site’s regular rate of posting slowed Friday and Saturday, but appeared to pick up again on Sunday.

Maybe this sounds like a small squabble in a legacy corner of the internet—but to public health and medical people, ProMED falling silent is deeply unnerving. For more than 20 years, it has been an unmissable daily read, ever since it received an emailed query in February 2003 about chat-room rumors of illnesses near Hong Kong. As is the site’s practice, that initial piece of intel was examined by several volunteer experts and cross-checked against a separate piece of news they found online. In its post, which is not currently accessible, ProMED reproduced both the email query and the corroborating information, along with a commentary. That post became the first news published outside China of the burgeoning epidemic of SARS viral pneumonia, which would go on to sweep the world that spring and summer—and which was acknowledged by the regional government less than 24 hours afterward.

Using the same system of tips and local news sources, combined with careful evaluation, ProMED published the first alerts of a number of other outbreaks, including two more caused by novel coronaviruses: MERS and Covid, which was detected via two online articles published by media in China on December 30, 2019. Such alerts also led the World Health Organization to reconsider what it will accept as a trustworthy notice of the emergence of epidemics. When the organization rewrote the International Health Regulations in the wake of SARS, committing member nations to a public health code of conduct, it included “epidemic intelligence from open sources” for the first time.

On the surface, the dispute between ProMED’s moderators and its leadership team—backed by the professional organization that hosts the project, the International Society for Infectious Diseases (ISID)—looks like another iteration of a discussion that has played out online for years: how to keep publishing news if no one wants to pay for it. But while that is an enduring problem, the question posed by the pause in ProMED’s operations is bigger than subscriptions. It looks more like this: How do you make a case for the value of human-curated intelligence in a world that prefers to pour billions into AI?

“ProMED might not always be the fastest, but it always provides important context that would not come through a news report,” says John Brownstein, an epidemiologist and chief innovation officer at Boston Children’s Hospital, who cofounded the automated online outbreaks database HealthMap and has collaborated with ProMED. “It’s the anti-social media, in a way. It’s a trusted voice.”

“ProMED possesses trained scientists that are able to discern what is really a problem and what is fake news,” says Scott J. N. McNabb, a research professor at Emory University’s Rollins School of Public Health and a former chief of public health surveillance at the US Centers for Disease Control and Prevention. “That's a tremendous advantage. So the reports are not coming from uninformed individuals, they're coming from professionals that have the medical expertise and public health expertise to really discern: ‘Is this genuine or not?’”

To understand why the fate of ProMED feels momentous, it helps to know a little bit about its history. The deliberately Web 1.0 site—it has no comment section and runs no graphics, so as not to stress the bandwidth in low-income nations—was created in 1994 and began being hosted by ISID in 1999. Its chief founder was the late John Payne Woodall, an entomologist and virologist who had a hand in most of the post-World War II build-up of global public health infrastructure, working for the Rockefeller Foundation, the WHO, and the CDC. (Cofounders were Stephen Morse, a professor of epidemiology at Columbia University’s Mailman School of Public Health, and Barbara Hatch Rosenberg, a biological weapons expert and former professor of microbiology at SUNY Purchase.)

Woodall believed that everyday people’s reports of events could constitute important early warnings of looming problems. The value of open source intelligence might seem obvious today, with every movement of the war in Ukraine, for instance, tracked on Twitter. But at the time, Woodall was challenging the accepted view that official public health surveillance data, gathered by governments and nongovernmental entities, was the key to understanding the havoc diseases can create. And he was leveraging early civilian access to the internet to do it. The site was established and scored its momentous early success exposing SARS all before Twitter launched and Facebook opened to the general public in 2006, and before the first iPhone went on sale in 2007.

The arrival of social media made it possible to instantly share information on all kinds of emergencies, from the Arab Spring to the Fukushima nuclear disaster to the Ebola epidemic in West Africa, and many accounts built audiences and monetization by conveying real-time alerts on arrays of subjects, often with no sourcing attached. The speed of Twitter (now known as X) could make ProMED’s careful verification look slow; though the organization pushed its content to its own Twitter account, those posts would often arrive after a breaking-news account got there first.

That left the site in a battle for funding. Its online host ISID lost revenue during the pandemic, as professionals stayed home from the conferences it had hosted. Internally, money began to dry up. One of the complaints aired in the open letter is that payments to the moderators, who receive a small stipend, are already in arrears and will be delayed for two more months.

“We are really up against a challenge of long-term, sustainable funding for operating ProMED,” says ISID’s CEO, Linda MacKinnon, who described the organization as sipping from project grants to keep core operations going on a budget of about $1 million a year. (MacKinnon spoke after the July 14 announcement but before the open letter was published.) “We have sort of grown organically over the years, from project to project that were all cobbled together, but not stepping back and putting together a business case of how to sustain, how to innovate. We have found ourselves partnering or collaborating with hospitals and academic institutions, but [not finding a] long-term home.”

Hanson, who published the post outlining the changes, told WIRED by email Friday evening: “Not a single entity has stepped forward with any type of funding to allow ProMED to continue to operate as it has for 28 years, which is to say open and free to the public. We have diligently pursued funding and messaged our plan for the past year and made our financial situation widely known.” He added, “Funders are primarily interested in the latest and greatest tools, so from their strategic perspective there's little value in ProMED—an aging but highly effective email surveillance system—to show to their leadership/benefactors.”

A deeper look at recent history shows that the battle over ProMED is not only about money, no matter how critical that might be. After Woodall, ProMED was led for years by Larry Madoff, an infectious disease physician and professor at the University of Massachusetts Medical School who built a wide network of collaborators. Madoff was abruptly dismissed by ISID two years ago, and both he and moderators who worked with him say they do not know why. MacKinnon will only say the action was “a board decision.” Madoff held the title of editor in chief; according to the site’s team listings, that title is not now in use.

Asked for comment, Madoff said this: “ProMED is a public good, and it ought to be freely available and remain so. It would be a shame if it lost large segments of its audience, many of whom are in low-resource settings, because of a failure of the parent organization to adequately provide resources.” He added: “Losing subscribers will hobble ProMED because it depends on its readers to send information. By not having that big subscriber base, by restricting your base through a paid model, you’re going to lose that.”

In 2020, Madoff told WIRED the site’s subscriber base was about 83,000 addresses (which cannot now be confirmed), whereas MacKinnon’s team set the current count at about 20,000. The open letter, among other demands, asks ISID to “ensure the administrative and editorial independence of ProMED's content and subscription policies. This could largely be accomplished by restoring a true Editor-in-Chief position with independent executive authority.”

WIRED reached out to all 21 signatories of the open letter to verify that it is authentic. As of Monday, six—Marjorie P. Pollack, Leo Liu, Maria Jacobs, Martin Hugh-Jones, Pablo M. Beldomenico, and Thomas Yuill—confirmed that it represents their views. “In the first six months of Covid, I averaged three hours of sleep a night,” says Pollack, an infectious disease physician who first joined the site in 1997, and wrote the December 30, 2019 post that first flagged the emergence of Covid. “We have been a collegial group of people, and we understood that ProMED represented a labor of love.”

Asked for comment on the open letter, MacKinnon emailed a statement Friday afternoon that was also posted to the ProMED site. ”We recognize that members of the ProMED community are concerned about the continuation of the platform,” it says in part. “We also know that we could have communicated changes more clearly to the community and apologize for any confusion and distress caused.” The statement went on to enumerate the site’s financial challenges and ended with a plea for “unrestricted operational funding and investment.”

The irony is that ProMED may have run out of runway just as past obstacles to its growth begin to evaporate. Unmeasured but apparently substantial portions of medical and public health users have departed Twitter following the shifts in its ownership and politics, and none of its replacements—Mastodon, Bluesky, Threads, or others—have accumulated the velocity or density to match. That could allow a revived ProMED to reestablish its utility as a trusted source that deserves broader support. But as even ProMED insiders acknowledge, that will need some kind of partner. Last week, supporters said they were hoping to lobby major public health graduate schools, or even the WHO’s new Hub for Pandemic and Epidemic Intelligence, based in Berlin, to lend ProMED financial support or a new institutional home.

“ProMED needs to be saved,” McNabb says. “We can move it into an academic setting, or into a broader context like a WHO collaborating center—wherever people feel comfortable and it can be funded appropriately. But we need to save it. It’s too important for public health.”

[hayleymedbil]

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Learn the basics⁤ of medical coding, coding ⁢systems, and the role of coders in healthcare.

Coding Systems

Explore ICD-10, CPT, and HCPCS ⁢coding systems essential for coding ‍medical⁣ diagnoses and procedures.

Health Insurance and Reimbursement

Understand the healthcare billing process, including claims submission and ⁤reimbursement methodologies.

Regulatory Compliance

Delve into laws and‍ regulations that govern healthcare coding and‌ billing practices.

ethics in Medical ‌Coding

Learn about ethical ​considerations and compliance in the field ‌of medical‍ coding.

Real-Life Success Stories

Hear from our past students ⁣who transformed their⁤ careers thru our online medical coding class:

“After completing the online medical coding class, I landed ​a job as‍ a junior⁢ coder in just ‌three months! The instructors were incredibly supportive, and the curriculum was complete.”

Sarah Johnson, Certified Medical Coder

“I was looking ​for a career change, and this course​ made transitioning to healthcare seamless. I now​ work‍ with a fantastic‌ team, and I couldn’t be happier!”

Michael Smith, Medical Billing Specialist

Practical Tips for ‌Success​ in Medical Coding

Stay⁢ Organized: Keep your notes, materials, and digital files organized for easy reference.

Practice Regularly: Coding requires practice. Engage ⁣in sample coding exercises to⁤ reinforce your knowledge.

Network⁣ with Professionals: ​ Join‌ online forums and social media groups to connect with certified coders and⁣ industry experts.

Stay Updated: The medical coding field evolves constantly. Subscribe to industry newsletters to stay informed of ⁣changes.

Frequently​ Asked Questions⁤ (FAQs)

1. How long does the online medical coding ⁣course take?

The course duration is typically 12 weeks, but you can work at your own ‍pace.

2. ⁤Do ⁣I need any prior experience⁤ to enroll?

No ‌prior ⁤experience ​is necessary! Our‌ course is designed for beginners and will guide you through the⁢ essentials of medical coding.

3. What certification⁢ will I be prepared for?

Upon completion,you will be prepared to take the‌ AAPC ⁤or AHIMA certification⁣ exam.

Conclusion

investing in your career through our ​online medical coding class is a stepping stone towards ‌a stable ⁣and rewarding profession in healthcare. ​With⁢ flexible learning options, ‌expert instruction, and a robust support‍ system, you have the tools to succeed. ‌Don’t wait any longer-enroll ‍today and unlock your ‍career ⁢potential! Join the ranks of trained⁢ medical coders ⁣and take the first step⁢ towards a brighter future!

https://medicalcodingandbillingclasses.net/open-your-career-potential-enroll-in-our-online-medical-coding-class-today/

[sahraeyll]

Open Your Career Potential: Dive into Online Medical Coding Training Today!

Unlock Your‌ Career Potential: Dive into Online Medical ‌Coding Training Today!

in today’s fast-paced healthcare industry, ther is an increasing‌ demand for qualified medical ⁤coders. If you’re seeking ‌a fulfilling career that offers job stability and competitive salaries, online medical coding ‍training may be your key ​too unlocking new opportunities.⁤ This ⁤article delves ⁢into the essentials of medical coding training, ​its benefits, real-life⁤ experiences, and practical⁢ tips for success in this rewarding field.

What​ is Medical Coding?

Medical coding is the process of‍ transforming healthcare diagnoses,⁢ procedures, medical​ services, and equipment into universal​ medical alphanumeric codes. These codes are then‌ used for‍ billing and insurance ‌purposes. Accurate coding ensures that healthcare‌ providers receive‍ proper reimbursement⁤ and contributes to efficient patient care.

Why Choose online Medical Coding Training?

With the rise​ of digital education,online medical coding training has become⁢ increasingly ‍accessible ⁤and convenient. Here are some compelling reasons ‌to ‍consider this route:

Versatility: ⁤Online courses offer the freedom to study at your‍ own pace and ⁣schedule,making it easier to ⁢balance ⁤your studies with work or ​personal commitments.

Affordability: Many online ⁤programs offer lower tuition fees compared to customary in-person classes, ⁢making education⁣ more ‍accessible.

Complete Curriculum: Most programs cover key areas such as ICD-10, CPT, and HCPCS Level II coding systems, medical terminology, and healthcare regulations.

Career Support: Many ⁣online training providers offer ⁢job placement assistance and resources to help you step into the healthcare workforce with confidence.

Benefits of Online Medical ⁤Coding Training

Embarking on online medical coding training ​comes ‌with various benefits that enhance your career potential:

1.Job ⁢Demand ⁣and Security

According to the‍ U.S. Bureau of Labor Statistics⁢ (BLS), the demand for medical coders is expected to grow by 8% from 2019 to 2029. This is much faster than the⁢ average for all occupations,indicating a robust job market ‍for certified professionals.

2. Competitive Salaries

medical⁤ coding professionals can earn competitive salaries. As‌ of May 2020, the median annual wage for medical records and health information technicians was $44,090 (BLS). With experience and certifications, ‌your earning potential can significantly increase.

3.⁤ Diverse Job⁤ Opportunities

Medical coders can‌ find employment in various settings, including‌ hospitals, ⁢outpatient clinics, insurance companies, and even​ remote positions. This diversity allows professionals to choose environments that best suit thier preferences.

4. Path to Advancement

Starting as a medical coder can open ⁣the door to advanced‌ roles such ⁢as compliance officer,coding⁢ auditor,or health⁤ information manager. Continued education and certifications can further enhance your career path.

Real-Life Experiences in Medical coding

Understanding⁤ the experiences of professionals​ who have undergone online medical coding training can be insightful. ⁤Here ⁤are two case studies:

Case Study 1: Sarah’s Journey

Sarah, a stay-at-home mom, decided to ​enter the workforce ‌after⁤ several years. She ⁢enrolled in an online medical coding ‍program,which allowed her to study during her children’s nap times. Within nine months, she obtained⁢ her​ certification ⁢and ⁤landed a ​remote coding job. Sarah⁣ reports a fulfilling career that gives her both financial independence and the flexibility​ to prioritize her family.

Case​ Study 2: James’s Transition

After working in retail for ⁢over⁣ a decade, James sought a career change. He‌ chose an ‍online medical coding course⁢ due to its reputation and positive⁣ reviews.Within a year, he achieved his ⁢certification and was ⁣hired by a local hospital.James appreciates the community aspect of his new profession and enjoys the continuous ⁤learning opportunities⁢ available in⁤ the field.

Getting Started with Online Medical Coding Training

If⁣ you’re ready to⁣ dive into online ‌medical coding training, here are some practical ​tips to help you start:

1. Choose the Right Program

Research various online medical coding programs based on your career goals, ‍budget, and learning‌ style.⁤ Look⁣ for accredited institutions that offer comprehensive ‍curricula and career ​support.

2.Prepare for the Course

Brush up on your⁤ medical terminology‍ and computer skills before beginning the coursework. Familiarize yourself with coding software ‍and tools commonly ⁤used in the industry.

3. ⁢Stay Organized

Create a study ​schedule to help manage your time effectively. ​Set aside specific hours each⁤ week dedicated to your coursework, and ⁢make note of⁣ important deadlines.

4. Participate in Study Groups

Engage ‍with fellow students through online forums,study groups,or social media. Building a network can provide valuable support and make your learning experience more enjoyable.

5.Pursue ‌Certification

After completing your training, consider taking certification exams, such⁣ as the Certified Professional Coder ​(CPC) or‌ the Certified‍ coding Specialist (CCS), ‌to enhance your job‌ prospects.

Conclusion: your Future ⁤awaits

Online medical coding training is an excellent opportunity to unlock your career potential in the fast-growing healthcare sector. By ‌investing⁣ in your education, you are positioning yourself for a stable job, competitive⁢ salary, and fulfilling career. Now is⁣ the perfect time to ​take the leap and dive into the world of medical coding. start your journey ⁣today,⁤ and who knows where it may lead you!

Table: Comparison of ⁢Medical coding Certifications

Certification

offered By

Focus‍ Area

Prerequisites

CPC

AAPC

Professional coding

None; recommended training

CCS

AHIMA

Hospital coding

Experience⁢ recommended

CCA

AHIMA

Entry-level⁤ coding

none; recommended training

CPMA

AAPC

Medical ​auditing

CPC/CCS required

https://medicalbillingcertificationprograms.org/open-your-career-potential-dive-into-online-medical-coding-training-today/

[brookemedbil]

Opening Profit Potential: How to Start Your Own Successful Medical Billing and Coding Business

Unlocking Profit Potential: How to‌ Start Your Own Accomplished Medical Billing and Coding Business

In today’s healthcare surroundings, medical billing‍ and coding offers budding entrepreneurs ⁤a fantastic chance to dive into a⁤ lucrative business. It requires minimal startup costs ​and has the potential for ample profits if done right.This article will take you ⁢through ‌the essential steps, benefits, practical tips, and firsthand experiences to empower you on your journey to start your very own medical billing and‍ coding business.

What is Medical Billing and Coding?

Medical billing and coding are vital ⁢processes in the healthcare industry,involving the conversion of healthcare services into universal medical alphanumeric codes. ‍These codes are utilized to⁤ submit claims to insurance companies and ensure that healthcare providers receive timely and accurate reimbursement for their services.

The Benefits ⁢of Starting ⁤a Medical Billing and Coding Business

1. Low Startup Costs

Starting a medical billing and coding business typically requires minimal investment in⁤ technology and resources:

Computer ‌and Software ​(e.g., billing software)

Office⁢ Supplies (e.g., printer, stationery)

Marketing Costs (website, business cards)

2. High Demand

As ‍healthcare providers expand their practices, the need for qualified medical billing professionals‌ continues to grow. The U.S. Bureau of Labor Statistics projects that jobs for medical records and health facts ⁤technicians ⁣will grow by 8% from 2019 to 2029.

3. Flexibility and Independence

One of the primary benefits is the flexibility it offers. Many​ medical billing and coding businesses can​ be run from home, offering you the freedom to set your own hours.

Steps to start Your Medical Billing and Coding Business

Step 1: Get Certified

While ‍certification is not mandatory, it substantially enhances ‌your credibility and helps you attract ⁢more clients. Consider obtaining certifications from recognized bodies such as:

The American Academy ⁣of Professional Coders (AAPC)

The American Health Information Management Association (AHIMA)

Step 2: Develop a Business Plan

Your business plan should detail your services, target market, pricing strategy, marketing plan,⁢ and financial projections. A well-thought-out plan paves the way for effective business execution.

Step 3: Legal ⁤Considerations

Choose a business structure (e.g., sole proprietorship, LLC) and register⁤ your business name. Additionally, consider obtaining liability insurance to protect your business⁢ from unforeseen issues.

Step 4: Invest in Technology

Invest in reliable‌ billing​ software and secure systems to protect sensitive patient data. Consider software solutions that offer the following features:

Claims Management

Patient Billing

Reporting and Analytics

Step 5: Marketing Your ⁢Services

To attract clients, create a professional website, engage with your local healthcare community, and consider networking at healthcare events. Leverage social‍ media ⁤and online advertising to reach a broader ‍audience.

Case Study: Success⁣ Story

Meet Jane Doe, a medical coder who transitioned from a 9-to-5 job ⁤to starting her own medical ⁣billing and ‍coding business. Within the first year of operation, ⁤she gained clients from several local healthcare providers, generating an annual revenue ​of over $100,000. Her secret? Networking and a strong online presence.

Practical⁢ Tips for Success

Stay Updated: Healthcare regulations and coding practices frequently enough change. Regular training‍ and continuing education are essential.

Professional Network: Connect with‍ other professionals in billing ⁢and coding. Networking can lead to⁤ referrals ⁢and business growth.

Client Relationship Management: Building strong relationships with clients can‍ lead to repeat business and referrals.

Financing Your Medical Billing and Coding Business

Understanding the financial aspect of your business is crucial. Below is a simple breakdown of potential initial investments (prices may vary):

Startup Expenses

Estimated Cost

Computer and Software

$1,500

Office Supplies

$200

Marketing Costs

$300

Insurance

$500

Conclusion

Starting your own medical billing and coding business‌ can unlock ‌your profit potential while ⁣offering valuable services to healthcare providers. With the right skills,planning,and commitment,you can create a rewarding career path. Given the increasing demand for billing and coding services, now is the perfect time to⁤ embark ‌on this journey. remember, every successful business begins with a single step—take yours today!

https://medicalbillingcodingcourses.net/opening-profit-potential-how-to-start-your-own-successful-medical-billing-and-coding-business/

[outsourcingmentalhealthbillin]

The Benefits of Partnering with an Indian SNF Billing Service Provider

Billing for Skilled Nursing Facilities (SNFs) can be a complex task. With intricate billing codes, numerous regulations, and an ever-changing healthcare landscape, SNFs often struggle to keep up. Outsourcing billing functions to experts can ease this burden, and partnering with an Indian SNF billing service provider offers numerous advantages that improve efficiency, reduce costs, and ensure compliance. This article explores why outsourcing SNF billing to India is a strategic decision.

What Are SNF Billing Services?

Skilled Nursing Facility (SNF) billing services involve managing the complex billing and claims processes for services provided to patients under Medicare, Medicaid, and private insurance. These services ensure that claims are accurately prepared, submitted, and followed up on according to the required regulations and guidelines. A significant shift in SNF billing occurred with the Patient Driven Payment Model (PDPM), finalized by the Centers for Medicare & Medicaid Services (CMS) in July 2018 and put into effect on October 1, 2019. PDPM replaced the previous Resource Utilization Group (RUG) system, shifting the focus from the volume of services provided to a more patient-centric model based on clinical characteristics. This significant shift in classification directly impacts how reimbursement rates are determined for SNF services, making it essential for billing providers to stay up-to-date with these changes.

The Challenges of In-House SNF Billing

Managing SNF billing in-house can be challenging. The primary obstacles include:

Regulatory Compliance:Constantly changing healthcare regulations require significant time and effort to stay updated.

Claim Denials and Rejections: Even minor mistakes can result in rejected claims, leading to financial strain.

Resource Allocation: Maintaining a well-trained billing team is resource-intensive, requiring ongoing investment.

Because of these challenges, many SNFs are turning to outsourcing for efficient, accurate, and compliant revenue cycle management.

Why Choose Indian SNF Billing Service Providers?

India has become a prime destination for outsourcing SNF billing services due to several key factors:

Cost Efficiency Outsourcing SNF billing to India offers substantial cost savings due to lower labor costs. This reduction in expenses allows SNFs to allocate more resources toward patient care, improving overall facility operations.

Expertise in Billing and Coding Indian service providers employ skilled professionals specializing in medical coding and billing. With extensive knowledge of U.S. billing codes, these specialists guarantee precise claim processing and full regulatory compliance.

Technology and Infrastructure Indian billing companies leverage advanced technologies, such as cloud-based platforms and AI-driven analytics, to streamline billing processes. These tools reduce errors, increase efficiency, and provide valuable insights into billing operations.

Time Zone Advantage India’s time zone allows billing companies to work on claims overnight. This benefit accelerates processing, enhancing turnaround times and resulting in quicker reimbursement cycles.

Core Benefits of Partnering with an Indian SNF Billing Provider

Outsourcing SNF billing to an Indian provider offers several operational and financial advantages:

Streamlined Billing Processes Indian providers optimize billing workflows to ensure claims are processed quickly and accurately. This reduces delays and minimizes errors, leading to smoother billing operations for SNFs.

Fewer Claim Denials With expertise in SNF-specific coding, Indian billing providers reduce the risk of claim denials. Their trained professionals ensure that claims are error-free, improving the revenue cycle and enhancing cash flow.

Reduced Operational Costs Outsourcing billing functions reduces the need for in-house billing staff and infrastructure, significantly cutting operational expenses. These savings can be reinvested into patient care, enhancing service quality.

Faster Reimbursement Indian billing professionals handle claims efficiently, accelerating the reimbursement cycle. Faster payments help maintain cash flow and reduce financial strain, ensuring that SNFs can focus on providing quality care.

Compliance and Regulatory Adherence Indian billing companies are familiar with U.S. healthcare laws and regulations. They ensure all claims comply with the latest standards, including adherence to HIPAA guidelines to protect patient data.

Info Hub Consultancy – Your Trusted Partner for SNF Billing in India

When choosing an Indian SNF billing provider, it’s essential to partner with a reliable, expert provider. Info Hub Consultancy Services (ICS) is a top provider of SNF billing solutions. ICS offers tailored solutions, ensuring billing accuracy, compliance, and timely reimbursements. Here’s why ICS is the right partner for SNF billing:

Tailored Billing Solutions: ICS works closely with clients to customize billing processes that align with their specific needs.

Highly Trained Professionals:ICS’s team of certified coders and billing experts specializes in SNF-specific billing codes and regulations.

Advanced Technology: ICS uses cutting-edge billing software and AI tools to streamline billing operations and reduce errors.

24/7 Support: ICS provides round-the-clock support for seamless billing operations and fast issue resolution.

Case Studies

Case Study 1: Improved Cash Flow for Oakwood Skilled Nursing Facility Oakwood Skilled Nursing Facility, located in the Midwest, faced challenges with outdated billing systems and frequent claim denials. After outsourcing to an Indian SNF billing provider, the facility saw a 20% reduction in claim denials, and the payment cycle was shortened from 60 days to 30 days. This streamlined approach allowed Oakwood to focus more on patient care while achieving better financial stability.

Case Study 2: Streamlined Billing for Maple Grove Nursing Home Maple Grove Nursing Home, a large facility on the East Coast, struggled with high operational costs and inconsistent billing practices. By partnering with an outsourcing medical billing services provider in India, Maple Grove reduced operational expenses by 15%, improved billing accuracy, and sped up reimbursements. This led to better financial management and enhanced patient care.

Conclusion

Partnering with an Indian SNF billing service provider offers significant benefits, including cost savings, expertise in billing codes, faster reimbursement, and regulatory compliance. By outsourcing billing to a reliable provider like Info Hub Consultancy Services (ICS), recognized as one of the Top Outsource SNF Billing and Coding Services Providers in India, SNFs can optimize their billing process, lower administrative costs, and improve financial results. As healthcare continues to evolve, outsourcing SNF billing remains a strategic solution to optimize revenue cycles and improve facility efficiency.

Need SNF billing support? Call Info Hub at +1 (888) 694-8634 or email inquiry@infohubconsultancy.com.

[myopinionisimportant]

I've been kinda-sorta keeping a diary. This has been a bit of a pattern for me throughout my life - in fact kinda-sorta is the way I've applied a lot of long-term habits, particularly before I was medicated for ADHD. Crazy that.

Anyway, in response to the inscrutable exhortations of my soul, I decided not only to start writing a few recent diary entries, but also to consolidate a few old ones into a single document. So I grabbed the actual paper journal I kept for about six months in 2012, the written record of my wedding day back in 2016 (which is three entries because it took me three sessions to sit down and write up), and a bunch of emails I sent myself in 2019.

And as you might figure from the dates there, the result is fairly sparse. Patchy, even. So I decided to also go back through my tumblr and grab any text posts that felt at all diary-esque, that illuminate anything about my life at the time, and chuck them into this Master Diary. Why? For what purpose? I dunno really. Inscrutable exhortations.

It has, however, made me reflect on a few things, which I suppose is the purpose of rereading one's diaries.

Number one (well, the real number one is that tumblr really doesn't love it when I go too many pages back in my own blog, but I've made that work so whatever) is that I really don't post that much about my real life. Even recently, I posted like one line about going to my first ever metal concert! It was a very cool experience, but all I wrote here was that I'd been, and then a couple of reblogs of the band or the lead singer. I don't think I've seen a single post about my birthday, or Valentines day, and maybe two about Christmas, and so far I'm back through all of 2021. It feels...impersonal. Most of my text posts are just about whatever game I'm playing, maybe a book I've read, or vague bitching about my job. Might be nice to change that, and post a little more about life in future. Treat this blog like a blog, y'know?

On the other hand, Reflection Number Two is that...the things that have made me go back to writing a personal diary tend to be the stuff that I wouldn't share publicly - long angry rants about my colleagues, or despairing about disappointments in my life which are, on the whole, minor. Just stuff that I wouldn't really want to put up online. So it's been nice to fill those gaps with stuff that's a bit more upbeat, you know? It makes a slightly more complete picture of what my life has been like in that time. It's good to see that I haven't just been overcome with doom and gloom for the last thirteen years, or however long.

And thing number three is, like...I have not changed much at all in the last five years. I keep seeing basically the same complaints about my job, the same posts about how I mean to learn more coding (but am not actually doing it), the same grandiose plans with nothing to back them up. At least running the podcast is a bit of a change from that, because that has actually come to something, that's something real that I can point to.

I don't know if I'll actually change how I post on here (or anything else about how I act in life). And I really don't know if I'll keep writing a diary (there's a part of it that feels like an unnecessary vulnerability, writing my secrets down. Secrets should be secret, no? Keeping them behind a single password doesn't feel all that secure). But it's been an interesting project, anyhow.

[nursingwriter]

Legal and Ethical Issues Related to Psychiatric Emergencies Psychiatric emergencies usually occur in children and adults due to mental problems such as change in mood and behavior. These emergencies can lead to involuntary holds of the individual by either the police or health institutions that deal with psychiatric disorders. These holds help ensure the safety of the patient. The emergencies arise from cases such as suicide attempts, agitation, etc. There are various state laws that allow patients to be held against their consent. The context in this case happens to be the state of New York. From a general perspective, the law allows an individual with mental illness to be held against their will if they pose a threat to others, if they pose a threat to their own life, or if they are disabled and unable to provide for themselves due to the mental illness. One of the persons that are allowed to hold a patient involuntary are the police. Police hold mentally ill individuals who have broken the law with the hope that by having him or her in their custody, they will be able to protect the society. Medical providers are also allowed to involuntary hold patients with mental illness so as to help them recover. Involuntary hold involves a maximum of 3-days or 72-hour period whereby the patient receives emergency medical care before further help is offered. According to the Welfare and Institutions Code (2014), if you were brought into a mental health facility against your will due to the psychiatric emergencies, you may be held for up to 72 hours for treatment and evaluation unless the person in charge can establish that you need an additional 14 days of mental health treatment. Medical practitioners and the police are the ones involved in releasing emergency holds depending on the condition of the patient or after a court ruling to release the patient. After the hold is over and the patient is released, the patients rights advocate picks up the patient. Emergency hospitalization for psychiatric hold involves the involuntary admission of patients with mental illness in a health facility or a law enforcement facility. In emergency hospitalization of inpatient commitment, a person voluntarily goes to a health facilities and talks to a health practitioner about their mental illness. The patient agrees on their own to be admitted in the hospital after meeting the available criteria for admission. In emergency hospitalization of outpatient commitment, the affected patient is assisted in the form of treatment used. Patients involved in outpatient commitment are those with no family members or are facing a severe form of mental illness. In the words of Namboodiri (2019), capacity in mental health includes analysis and diagnosis of a mental condition, treatment, care, and rehabilitation of a person with diagnosed or suspected mental illness. The capacity to treat or diagnose a patient with a mental illness is mainly dependent upon the psychiatrist or health professional involved in assessment. Competency in mental health context involves situations whereby health providers are supposed to assess patients with mental illness. It involves the capability to respect and listen to mentally ill patients since they are vulnerable and have less access to emergency care. EMTALA Emergency Medical Treatment and Labor Act EMTALA, is a legislation act that was established for emergency departments to help screen, stabilize and offer appropriate transfers to patients despite their insurance or their ability to pay. Financially needy patients were not properly stabilized and this act helped stop this practice. Many EMTALA cases involve patients with mental illnesses. EMTALA was mainly aimed at providing emergency care to all patients. Legal issues related to EMTALA Violating EMTALA laws is a serious offence and can lead to a hospital or medical provider being severely penalized. Maugham (2019) indicates that all individuals should have access to quality and affordable primary and emergency health care services. This is unfortunate to many because these benefits come at a cost. This law is clear, but it also requires the hospital to conduct screening and treatment according to its capabilities. The hospital decides for itself on the procedures to follow during the screening process. One ethical issue that might arise on the equitable treatment of all patients is in a situation whereby two patients requiring emergency attention are brought in the hospital. The two patients might be brought at a time when, for instance, the hospital has only one vacant bed. In such a scenario, it becomes difficult for the hospital to follow EMTALA laws. The hospital will then decide on which patient to accept in their facility. Due to the increased cases of suicide resulting from mental illnesses, methods of preventing suicide must be put in place. One of the method used is risk assessment. Suicide risk assessment involves presenting those at risk to clinical settings and monitoring them directly so as to ensure that the relevant interventions are offered. Brodsky et.al (2018) reveal how in the U.S., National Action Alliance for Suicide Prevention came up with a Zero Suicide Model. This model involves assessing, evaluating, and monitoring the patients in order to achieve zero suicide. Violence from mentally ill patients have become a great concern in the society. As Anderson & Jenson (2018) tell us, approximately 90% of physicians and nurses working in mental health areas have been subject to violence from patients. In order to end the violence, various screening tools on violence risk assessment must be used. Danger Assessment tool is one of the tool nurses and physicians use to assess risks associated with violence. This involves assessing a potential dangerous behavior in a patient by checking the patients history of assaults or threats. References Markiewicz, I., Heitzman, J. & Ziemba, G.E. (2016). Involuntary psychiatric holds-the structure of admissions on the example of Institute of Psychiatry and Neurology. Psychiatr Pol, 50(1), 7-18. Bender, D., Pande, N. & Ludwig, M. (2008). A Literature Review: Psychiatric Boarding. https://aspe.hhs.gov/reports/literature-review-psychiatric-boarding-0 Menninger, A.J. (n. d). Involuntary Treatment: Hospitalization and Medications. https://www.brown.edu/Courses/BI_278/Other/Clerkship/Didactics/Readings/INVOLUNTARYTREATMENT.pdf Torrey, E. F. & Zdanowicz, M. (2001). Outpatient commitment: what, why, and for whom. Psychiart Serv., 52(3), 337-41. Namboori, V. (2019). Capacity for mental healthcare decisions under the Mental Healthcare Act. Indian Journal of Psychiatry, 61(4), 676-679. Brodsky, B. S., Feiner, A. S. & Stanley, B. (2018). The Zero Suicide Model: Applying Evidence- Based Suicide Prevention Practices to Clinical Care. Frontiers in Psychiatry, 9(33). Read the full article

[outsource-medical-billing]

SNF Payment Rate Increase: What It Means for Your Facility's Reimbursement

Skilled Nursing Facilities (SNFs) play a crucial role in the post-acute patient treatment of elderly patients alongside individuals with complex medical conditions. The payment rates for Medicare, which funds SNF services, undergo regular changes to maintain coverage of increased costs resulting from inflation, labor costs, and healthcare spending components.

For fiscal year (FY) 2024, the Centers for Medicare & Medicaid Services (CMS) announced a 4.0% SNF Medicare Part A payment rate boost worth an estimated $1.4 billion as additional facility payments. The revenue increase acts as a valuable addition to SNFs, yet its benefits will differ based on patient populations along with current payment amounts and operational efficiency.

It is crucial for SNF administrators and healthcare providers to understand the implications of an increase in payment rate in order to maximize facility operations, improve patient care, and promote financial stability. Let us consider the effect of the SNF payment rate increase on your facility's reimbursement.

Impact of SNF Payment Rate Increase

Increased Revenue

An increased Medicare payment rate means SNFs directly access increased financial resources. Because SNFs are paid per diem per patient who is covered by Medicare, the increased payment rate will mean more money without a need to boost admissions of patients. This added income can cover increasing costs of healthcare services, wages of the staff, and facilities.

For instance, if an SNF were once reimbursed $600 per patient daily and saw a 4% rate increase, the new rate would be $624. Each day that 50 Medicare patients receive treatment corresponds to an annual sum of $438,000 based on a daily increase of $1,200.

Potential for Quality Improvement

SNF's financial growth allows facilities to make greater investments in healthcare services provided to patients. Through staff training investments, facilities can achieve higher patient care results and lower employee turnover rates. Updating electronic health records systems and patient monitoring equipment through improved efficiency leads to better patient care quality. Facilities enhancements in rehabilitation options alongside updated patient accommodation spaces improve patient care quality. Studies on more financially stable facilities have discovered reduced patient readmissions and higher patient satisfaction ratings, which emphasizes the need to invest in quality improvement.

Patient Mix Impact

The monetary gain from a rate increase payment relies on admitting the type of patients into an SNF. Medicare's Patient-Driven Payment Model (PDPM) groups patients based on their clinical requirements and not by the number of minutes of therapy given. The SNFs with admissions that involve more intensive patients, i.e., patients with ventilator or specialty nursing needs, would have a greater rise in payment.

Conversely, SNFs with more short-stay, lower-acuity patients may experience a reduced financial effect. Accurate patient assessment and coding are essential to achieving maximum reimbursements under PDPM.

Market Basket Adjustment

The payments that CMS makes to SNFs are adjusted based on the market basket index, which follows changes in operating facility costs, including medical supplies and labor expenses. The payment rate index for Medicare adjusts using three elements: medical supplies, employee costs, and operating costs, such as maintenance expenses and utility payments for facilities.

As the costs of labor increase, Medicare increases payment rates to enable facilities to sustain operations without compromising care quality. Nonetheless, SNFs must continue to be vigilant in managing costs to guarantee financial stability even during changing economic times.

Patient-Driven Payment Model (PDPM)

Released in 2019, PDPM superseded the earlier Resource Utilization Group (RUG-IV) system, moving from therapy-based reimbursement to patient care. In PDPM, Medicare takes into account five case-mix items: physical therapy (PT), occupational therapy (OT), speech-language pathology (SLP), nursing services, and non-therapy ancillary (NTA) services.

As PDPM payments are tied to patients' conditions, not therapy hours, SNFs should have precise coding and clinical documentation in place to reflect proper reimbursement levels. With the rise in SNF payment rates under PDPM comes the imperative of maximizing billing tactics.

How to Prepare for an SNF Payment Rate Increase?

In order to reap the full benefit of increased Medicare reimbursement rates, SNFs should follow these steps:

Reviewing the existing patient mix is also important in gauging the clinical acuity of the patient population.

Being able to identify opportunities for admitting higher acuity patients with specialized needs may enhance revenue.

Cost structures are reviewed to identify areas where cost-effectiveness could be enhanced, e.g., bargaining for improved supplier and vendor contracts or through technology-based solutions to maximize workforce allocation.

Reinvestment planning is necessary in order to reinvest extra revenue in staff incentives, facility renovations, and specialized care initiatives.

Also, learning from CMS updates through industry webinars, training programs, and consulting with third-party billing and compliance specialists keeps facilities up to speed on best practices.

Conclusion

The SNF payment rate increase requires proper financial planning and billing accuracy to maximize potential benefits despite its promise of better revenue and care quality. Using accurate coding and compliance with PDPM standards of documentation, 24/7 Medical Billing Services can help SNFs with complexity related to Medicare reimbursements. In fact, it will reduce the risk of denial and delays on claims with correct billing and management of claims and provide instant analytics for the best management of revenue cycles. Through the association with 24/7 Medical Billing Services, SNFs are able to focus on delivering exceptional patient care, thereby fostering financial stability and expansion. As a Top Outsourcing SNF Billing Services Provider Company, we ensure streamlined revenue cycle management and optimized reimbursements. Get in touch now to maximize the reimbursement performance with SNF billing solutions.

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