BC HEALTH
Saved by @Alex1Powell

THREAD - Doctors want to fix “surprise bills” more accurately called unpaid insurer bills but today’s “agreement” is NOT the right fix for patients

It’s just a big boost to insurer profits & will shutter independent physician practices & rural hospitals!

1/x

 The Independent Dispute Resolution (IDR) in this compromise directs arbiter to consider “in network median rates” when settling disputes which is a sham arbitration & tantamount to benchmarking aka rate setting

Who dictates in network rates?

Insurers!

2/x
This bill prohibits use of charge data (aka usual & customary) which is another way of saying doctors must accept whatever poor contract terms or low balled payment offers insurers are jamming down their throats

This is just giving more power to profitable insurers

3/x
The reason why arbitration works in states like NY, TX is that it levels playing field, directs arbiters to consider independent price database like @FAIRHealth that can’t be manipulated by either side

Insurers have total control over “median in network” rates w their monopolies
When insurers have control over terms of arbitration, they will do everything in their power to do what any respectable publicly traded corporation will do: tilt the terms in their favor to increase profits

5/x

https://t.co/NfgMrWNoq5
In CA, insurers started terminating contracts with physician groups overnight to drive down in network median rates

Independent practices had to shutter their doors or join large health systems to survive. Consolidation drives up costs! Rural areas were hit hardest.

6/x
When out of network payments are tied to in network rates, there is literally no option for providers to fight back against unfair take it or leave it contracts that insurers design to ⬆️ profits

Tying arbitration to “median in network” rates gives insurers ALL the leverage

7/
We need to model federal bill like NYS where IDR is fair & based on charges

“From 2015-2018, the Out of Network Law saved NY more than $400 mil in emergency services, reduced out-of-network billing by 34%, lowered in-network ED physician payments by 9%”

https://t.co/HhqkTkB4Fe
NYS surprise bill law has not caused any physician shortages as opposed to huge shortage exacerbated in CA

NY’s surprise bill saved consumers $400 mil per @NYGovCuomo @NYDFS

In CA consumer complaints re access to care skyrocketed after benchmarking implemented

9/x
Insurers even love the NY law. They even personally endorsed the law!

10/x
Remember Congress has a bill modeled after successful NY law that has a fair IDR

HR3502 by @DrPhilRoe @Dr_RaulRuiz already has 110 cosponsors but House and Senate leadership continues to ignore!

11/x

https://t.co/c7t6qnsuXJ
In conclusion, doctors want an end to unpaid insurer bills aka ‘surprise’ bills ASAP

This agreement though is unacceptable - benefits insurers only & will crush independent practices & rural hospitals. Will drive consolidation, ⬆️ cost, exacerbate access to care problems

12/x
We need to fix “surprise medical bills” the right way with a fresh start in January

@SenSchumer @SpeakerPelosi @senatemajldr @RepKevinBrady @RepRichardNeal

/end
👆🚨 @EdLaborCmte
@EdLaborGOP
@BobbyScott
@GOPHELP
@SenateHELP
@SenateFinance
@SenFinance
@SenateApprops
@WaysMeansCmte
@EnergyCommerce
@WaysAndMeansGOP
@HouseCommerce
@AppropsDems
@HouseAppropsGOP
@HouseBudgetDems
@HouseBudgetGOP
@HouseGOP
@HouseDemocrats
@WhipClyburn
👆🚨 @LeaderHoyer
@GOPLeader
@senatemajldr
@SenJohnThune
@SenJohnBarrasso
@SpeakerPelosi
@SenSchumer
@LeaderHoyer
@WhipClyburn
@SenatorDurbin
@PattyMurray
@SenStabenow
@amyklobuchar
@VP
@realDonaldTrump
@ChuckGrassley
@RepJeffries

More from Health

Starks\u262a\ufe0f\U0001f1f9\U0001f1e9
Starks☪️🇹🇩...
@MegaIntelIect
Thread on how atheism leads to mental retardation (backed with medical citations🧵💉)

To start with, atheism is an unnatural self-contradicting doctrine.

Medical terminology proves that human beings are naturally pre-disposed to believe in God. Oxford scientists assert that people are "born believers".

https://t.co/kE0Fi588yn
https://t.co/OqyXcGIMJn


It should be known that atheism could never produce an intelligently-functioning society and neither ever will.

Contrastingly, Islam produced several intellectuals & polymaths, was on the forefront of scientific development, boasting 100% literacy


It is also scientifically proven that atheism led to lesser scientific curiosity and scientific frauds, which is also why atheists incline to pseudo-science.

Whereas, religion in general and Islam in particular boosted education.

https://t.co/19Onc84u3g


Atheists are also likely to affected by pervasive mental and developmental disorders like high-functioning autism.

Cognitive Scientists and renowned Neurologists found that more atheism is leads to greater autism.

https://t.co/zRjEyFoX3P
HEALTH
Buku Renal
Buku Renal
@BukuRenal
“Should I give them more fluid?”

Extremely common question during AKI referrals from junior docs.

⛔️ Fluid management is tricky, often misunderstood, & can cause huge iatrogenic harm ⛔️

We try to convey important principles in THREAD 👇

#tipsfornewdocs #medtwitter #tweetorial

Currently too often patients with high creatinine are given too much IV fluid, driven by an AKI ➡️ fluid reflex

We’ve seen 7 litres be given in one shift.

Medics & surgeons, juniors & seniors, it seems everyone loves to reach for extra IV fluid (especially if urine output poor)

Why does huge volume IV fluid ‘resuscitation’ consistently occur?

Lots of reasons, including FALSE beliefs:
🛑 IV fluid always “treats AKI”
🛑 Hypotension = hypovolaemia
🛑 Lactate >2 means fluid deficiency
🛑 Septic patients are very hypovolaemic

The rule with IV fluids and AKI is to remember this 5 word phrase:

💥 💥 Aim for euvolaemia, then stop💥 💥

Fluid status is like Goldilocks - hypovolaemia is bad for the kidneys BUT excess volume is also harmful for renal function and will cause other complications too.

It is easy to say “target euvolaemia” - but we agree it is more difficult to do!

Fluid status assessment is certainly made harder by a belief that we must only rely on a snapshot assessment of examination features which are NOT specific / sensitive / reliable to elicit like.…
HEALTH
Advertisement
(Cyriac) Abby Philips
(Cyriac) Abby Philips
@drabbyphilips
1/
Remember woman who tuk multiple @SriSriTattva products 4 range of problems frm diabetes 2 gas 2 liver disease & developed liver failure, listed for liver transplant?
Here is original thread:
https://t.co/PXxI1Slyv2
23 samples, Analysis results
#MedTwitter #livertwitter


2/
Before I go into results, I must say this was overwhelming. There was SO MUCH the lab identified, impossible to put everything here. So I made a summary. At the end of this thread, I have linked a full analysis described in Excel format. Some results were VERY concerning

3/
How did we analyse?
Here R links 2 methods
They R high end, done under strict protocols
Frm Ministry of Forest, Environment, Climate / NABL approvd Lab
ICP-OES https://t.co/O1CLhqVQAu
GC MSMS https://t.co/zRJoXyWQIr
FTIR https://t.co/goAembQ08p
Here is list V analysed 👇


4/
Sample names written on top (each column).
First 5 samples: C what we identified in #Ayurveda #medicines
Antibiotics
Steroids (anabolic/synthetic)
#NARCOTICS - LSD, Morphine
Blood thinners (possible reason Y bleeding tests were off the roof in the patient)
Heavy metals!


5/
Next 5 samples (total 10 now)
Mercury is clear winner. Almost all samples
See controlled substances - Butyrolactones https://t.co/CPz0FwPEOm, methylamine https://t.co/OZnXY7U9UQ
Alcohols, industrial solvents
Rare metals - cobalt, lithium
Again lots of blood thinners
#Ayush
HEALTH
Hypertroph | Fitness Coach
Hypertroph | Fitness C...
@CoachHypertroph
I transformed my body in 6 months.

People charge INR 25,000+ for this information. It should be free.

Just follow these simple fat loss rules:


Exercise:
• 3-4x per week
• Weights > Cardio
• Compound movements first
• Cardio after weights

Don't focus on burning calories focus on getting stronger

Video

Nutrition:
• 20-25% calorie deficit
• 1.6-1.8 g/Kg Protein
• 2x fruits & veggies daily
• Limit eating out

Food quantity determines weight loss. Food quality determines health.

Video

Sleep:
• Fix wake up time
• Sleep 8 hrs
• No caffeine after 2 pm
• Dinner 2-3 hours before bed

Have a routine, and be consistent. Routines save your time and maximise your energy.

Video

Simple is beautiful.

Don't bookmark and forget.

• Commit to the end goal
• Disappear for 6 months
• Build yourself in private

Before you go, I would love to give you 10 bonus tips to make you unstoppable-

(with step-by-step video tutorials)
ALL , HEALTH
David Fisman
David Fisman
@DFisman
I do want to talk a bit about connections, conflicts and information during a pandemic. Since @fordnation insinuated I have COI which I don't, let's take a look at a single instance where @fordnation and Hospital for Sick Children are both making interesting decisions.

Both share a powerful supporter in Peter Gilgan, who has been a great supporter of Sickkids

But his company, Mattamy Homes, has also substantially bankrolled Ontario Proud, which I have reason to believe pushed the Postmedia hit on my reputation.


Sickkids and Mattamy have very close ties. Here is Mary Federau, a longtime Sickkids exec who has moved to Mattamy but remains involved with the Sickkids foundation:


Mary's bio is too modest. It looks as though it has been scrubbed a bit over the last 72 hours. Here's the google cache from Jan 25:
HEALTH

You May Also Like

Arif Hasan\U0001f1ee\U0001f1f3
Arif Hasan🇮🇳...
@arifhasan18
5 star RSI Strategy by @VishalMalkan

Unconventional approach of 60-40 RSI and range shift concept.

According to him,
whenever the market is bearish,
it won’t be able to cross 60,
and whenever in a bullish trend,
it won’t be able to cross 40.

Like & Retweet for Maximum Reach.

So, instead of the 70-30 Relative Strength Index,
we will use the 60-40 range for the RSI indicator for this strategy.

When the
Monthly and Weekly RSI>60,
& when the RSI takes support at 40 in the daily chart,
it may bounce back and most probably it will not go below 40.

If a bullish candle is formed at the 40 RSI level,
the prices may bounce back, and one can enter the stock.

The stoploss can be placed at the low of that bullish candlestick,
and the target can be the 60 RSI level.

When the
Monthly and Weekly RSI<40,
& when the RSI takes resistance at 60 in the daily chart,
it may bounce back and most probably it will not go above 60

If a bearish candle is formed at the 60 RSI level,
the prices may bounce back from there, & 1 can enter the stock 4 shorting

The stoploss can be placed at the high of that bearish candlestick, and the target can be the 40 RSI levels.

#banknifty

This range shift concept can be applied in any timeframe,
whether intraday, daily,weekly, etc.
ALL
sriram \U0001f1ee\U0001f1f3
sriram 🇮🇳...
@SriramKannan77
Saptapadi

The most essential rite (Sanskrit: rītī) of a Hindu marriage ceremony is Saptapadi (English: seven steps, saptapadī). Saptapadi is a Sanskrit term that means "seven steps." The wedded couple walks seven steps after tying the Mangalsutra, which is known as Saptapadi.


The couple legally becomes husband and wife after the seventh step.
Hindu wedding rituals: During Saath Phere, the bride and groom exchange their marital vows while circumambulating (walking around) the sacred fire seven times.


This is because the bride and groom exchange marriage vows and hope for a happy married life together.

1. The first marriage vow, out of seven, is a petition to the Lord for nutrition and nourishment for the Hindu bride and groom.


2. Hindu Bride and Groom: The second marriage promise is for strength in sickness, health, good times, and terrible times.

3. For the Hindu Bride and Groom - The third marriage promise is for the Hindu bride and groom's prosperity.

4. For Hindu Bride and Groom - The fourth pledge is to stand by their families in good times and bad.
ALL
Advertisement
Anastasis
Anastasis
@OrdersofM
https://t.co/6cRR2B3jBE
Viruses and other pathogens are often studied as stand-alone entities, despite that, in nature, they mostly live in multispecies associations called biofilms—both externally and within the host.

https://t.co/FBfXhUrH5d


Microorganisms in biofilms are enclosed by an extracellular matrix that confers protection and improves survival. Previous studies have shown that viruses can secondarily colonize preexisting biofilms, and viral biofilms have also been described.


...we raise the perspective that CoVs can persistently infect bats due to their association with biofilm structures. This phenomenon potentially provides an optimal environment for nonpathogenic & well-adapted viruses to interact with the host, as well as for viral recombination.


Biofilms can also enhance virion viability in extracellular environments, such as on fomites and in aquatic sediments, allowing viral persistence and dissemination.
ALL
k\u0101rthik \u0b95\u0bbe\u0bb0\u0bcd\u0ba4\u0bcd\u0ba4\u0bbf\u0b95\u0bcd \u0915\u093e\u0930\u094d\u0924\u093f\u0915 \U0001f1ee\U0001f1f3\U0001f1ee\U0001f1f3\U0001f1ee\U0001f1f3 | Sanatani
kārthik கார்த்திக் कार...
@almightykarthik
Hello Dear Tweeples!

It’s Siddhars time of the week! Last week I shared story of Guru (Machamuni or Yogi Matsyendranath), this week I bring you information on his Shishya.

#Thread on Gorakanathar Siddhar.

@LostTemple7


His origin story is interesting, though I couldn’t verify it’s authenticity, so not sharing the story here. He’s shishya of Machamuni Siddhar and also learnt from Agasthiya Siddhar.

@HelloNNewman @RajiIndustani @Kishoreciyer1

Unlike other Siddhars, he is depicted as either with a Tiger or seated & wearing Tiger skin. While I couldn’t find any explanation for this. My interpretation is as follows:

Tiger is a predator that lurks around and attacks unexpectedly.


Our 5 indriyas and 5 vikitis also similar to Tiger, they lurk around and attacks our thoughts when we’re least expecting. Gorakkar is said to have mastered these aspects, thus to denote this, he shown with Tiger.

@Itishree001 @VarierSangitha @jananisampath

Gorakanathar or Gorakshnath (as he’s known in the Nath Sampraday) is celebrated Guru in both Northern and Southern part of India. He’s one of the NavNath in Nath Sampraday and also 18 Siddhars of Tamil tradition. During his life, he’s travelled Indian subcontinent extensively +
RELIGION , ALL
SK
SK
@sk_diary1
Sri Sanjeevi Rayar Temple located in Ayyangar Kulam,near Kanchipuram,TN

#Thread

Ancient but beautiful temple dedicated to Hanuman. This temple is a legendary one. According to the Sthala Puranam of Sanjeevi Rayar temple,it is associated with an episode from Ramayana.


Legend story -Hanuman was flying from Himalayas to Lanka bearing Sanjeevi hill to revive Lakshmana during battle between Rama& Ravana, a piece of the Sanjeevi Parvat fell at this place.Many believe this legendary story & even today that no one here dies of any kind of poisoning.

From historical background of the temple it is known that temple was originally built by a great scholar &administrator Kotikanyadanam Lakshmikumara Tatacharya. Temple itself&village were named following name of great scholar Tatacharya, who was then popularly known as Ayyangar.

He was the royal preceptor of Vijayanagara emperor Venkata Raya who had his capital at Chandragiri in AP.Upon returning from a pilgrimage,robbers tried to attack Tatacharya at this place. Being a great devotee of Hanuman,he instantly composed a poem in Sanskrit praising Hanuman.


The bandits immediately ran away &Tatacharya decided to build a temple dedicated to Anjaneya at that very place.This Sanskrit poem is called Hanumad Vimshati, has been inscribed in Grantha script inside this temple.The huge temple tank called Tatasamudram, in honor of Tatacharya.
ALL