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24 July 2010

CF-18 Crash Alberta International Airshow

Pilot ejects moments prior to crash, narrowly escaping certain death from the impact and fiery wreckage.

Canadian Forces pilot Capt. Brian Bews ejects as his CF-18 fighter jet plummets to the ground during a practice flight on Friday, July 23, 2010. He was preparing for the weekend airshow.

CF18 accident
Witnesses hear odd engine sounds

Jet about to crash
Pilot parachuting safe and clear of nosediving fighter jet

CF-18 Aircraft escape system works according to intended design

Plane crashes
Flaming crash in Lethbridge County, Alberta

All photo images by Ian Martens, Lethbridge Herald via Associate Press

16 July 2010

Performance Improvement in Government Healthcare

I noticed a job listing the other day, as "Director, Performance Improvement". It would likely be an intellectually satisfying and ethically fulfilling employment opportunity. The job is a full-time, direct hire position with Health Services Advisory Group Inc. (which goes by the unfortunate acronym, HSAG and pronounced as ay-ch SAG), in Phoenix, Arizona.

My previous work in Public Health was with the Medicare-funded Office for Children with Special Health Care Needs (OCSHCN), where I was actually an employee of the State of Arizona. In addition to performance evaluation and utilization management, I enjoyed a diverse range of duties that included epidemiological studies, PHI (Protected Health Information) security, pharma utilization and provider payment (and beneficiary claim) fraud detection. However, the downside was that it was very difficult to work as a performance and quality assessor for OCSHCN' Childrens' Rehabilitative Services (CRS) while an employee of the program itself.

Well, CRS's 17,000 members are a very vulnerable sub-strata of the population: eligibility requirements are defined by Arizona Revised Statutes for enrollee diagnosis and age. The intent is to provide a healthcare system oriented specifically to the needs of youth and children under the age of 18 whose lives are significantly or entirely circumbscribed by the severity of their mostly congenital and often intractable medical conditions. It was awkward, even emotionally upsetting to present findings that resulted in changes about delivery of care to this member population.

Pharma and formulary

Due to the actuarial principle of adverse selection, it was particularly difficult to make decisions on level of care when resources were limited. Should treatment of a debilitating genetic disorder, PKU (Phenylketonuria), with a wonderful new drug be authorized, given the price: approximately $40,000 per year, depending on the child's weight (grams/cm by age), then doubling, once an adult? The drug does not cure PKU. The treatment regimen is lifelong.

Durable Medical Equipment

In addition to drug therapy, there were also cost and utilization issues pertaining to DME including prosthetics. Regarding DME, relevant questions were:
  • whether to allow electric motorized wheelchairs?
  • how often should wheelchairs be replaced? Different standards must be applied to children than adults, as handicapped children grow just like other children, even if not at the same rate.
  • discontinue coverage of cochlear implants in order that many other services may continue? A pair of cochlear implants costs approximately $50,000 all-inclusive. Those same funds could be used instead for a dozen or more cleft lip or cleft palate surgeries, with funds remaining for a few club foot corrective surgeries too. 
When resources are scarce, decisions are difficult. Fortunately in the cochlear implants issue, a compromise was reached, which allowed for a single cochlear implant while the child was under CRS program care, along with audio therapy and support, with the second cochlear implant covered by AHCCCS, the state provider of Medicaid services once the child were 18 years of age, depending on the patient's level of satisfaction and interest in receiving the second implant.

Arizona - Progressive Exemplar

Contrary to popular belief due to the furor regarding Arizona State Bill 1070, also known as the "AZ State Immigration Law" and mentioned in a prior post, the State of Arizona is remarkably progressive in certain areas. My former employer, CRS, is an instance of such. Arizona is one of only three states in the Union with a program dedicated to providing services to children with special health care needs. By assembling health care providers attuned specifically to this segment of the population, these children receive much better care than they would through many private managed care programs.

In fact, there are a significant number of additional CRS enrollees who are not Medicare-eligible. Approximately 2,000 children, in addition to the 17,000 count cited above, are covered by private insurance as payor for services. These children could be enrolled with any provider or managed-care program covered by their insurance, yet CRS is considered the best choice. Of course, CRS is an accredited provider for many major commercial insurance carriers, and cost for services is adjusted accordingly.

I miss my work, and would welcome the opportunity to analyze and monitor performance and quality of services from outside the program provider. Alternatively, it would be great to do similar work for enrollee pools with a more diverse disease prevalence profile than chronically ill children.

12 July 2010

Succor for Soles and Souls

For my Phoenix area reader segment, have a gander at this shoemaker review from New Times publisher's online Transplants To Phoenix Examiner columnist Susan Rienzo,"A Shoe Repair Shop That Restores Soles AND Souls".
In many of the traditional old neighborhoods that a lot of transplants escaped from, there was a shoe repair shop. In my former hometown, it was run by an Italian guy with a strong accent and a stronger attitude. He always took Wednesdays off. When my best friend and I were in high school, we used to joke that he did so in order to play golf with all the doctors. God, we were brats! Anyway, in this throw-away culture, shoe fixers in the Valley are few and far between. Someone who takes pride in their work and does things the old-fashioned way is even harder to find.

But when the strap on one of your cutest, most favorite sandals breaks (and you know it will), fear no more... Affluent Scottsdale Shoe and Luggage Repair at 10855 North Frank Lloyd Wright Boulevard (Suite 108), just north of Shea, provides quality work and so much more. The shoemaker, Rick, is a man who will practically rebuild a beloved purse, or pocketbook as they say in New Jersey, that another "fixed" in a slipshod way. (The only reason 'purse repair' isn't also in the shop's name is that it would be too long to fit on a sign.)
I had a recommendation of my own, which I'll reproduce here, from the comments section of the Examiner post:

So nice to read about a shoemaker and handbag repair store! Okay, I self-edited because I say "pocketbook" instead of handbag too!

I was raised in Arizona and New Mexico. After some years in California, I finally moved to New York City. I became accustomed to the convenience and savings from the shoemaker's shop two blocks from my tiny apartment in Gramercy Park.

Resoling shoes, restitching a fancy leather belt or pocketbook that was perfect otherwise, replacing raw hide laces, or adjusting woven leather sandals straps that would've cost $75 to repace, but merely $10 to repair like new): shoemakers do that and much more. I purchased rubber galoshes with ankle snaps to wear over my shoes for the winter, so that gray icy slush wouldn't pour over the tops of my work heels.

Overly tight shoes could be stretched and become comfortable again. Tiny holes in supple fur-lined leather gloves would be stitched while I waited. I even chose to have a cocoa brown suede skirt purchased from Saks Fith Avenue, and far too long for me, but with elaborate scalloped hemline, hemmed by my shoemaker! Most seamstresses were not eager to alter suede. Amazingly, my shoemaker, on the southwest corner of Third Avenue and East 23rd Street in Manhattan, even re-cut the scalloping in the hem!

In these days of "sustainabile technology", the shoemaker's services are what we need. Thank you so much for your article. And your readers comments too! I'm not the only one, there ARE others who remember!

For Central Phoenix residents far from Scottsdale, here's a suggestion: Try Colonnade Shoe Shop & Repair, on 1925 E. Camelback Rd, Ste D136 adjacent to Fry's Grocery on E. Highland and 20th St in Phoenix. I'm just getting to know them, but "so far so good"! Phone number is (602) 212-0784. A bonus feature which I appreciate is that they are open Sunday through Friday, 9:30am through 5:30pm, closed on Saturday. It is so very convenient to find a small business with hours on Sunday!

For additional corroboration, you may want to check out the recent reviews for Colonnade Shoe Shop posted on Yelp.

Post title courtesy of the Dept of Questionable Puns.

11 July 2010

Code for America in Binary

I've missed the boat for July 4th, but I felt like passing this around anyway.

The Gov 2.0 organization, Code for America has released a binary style image for eight American Patriots who were recognized for Independence Day 2010.

The images are available as Adobe Acrobat PDF files for download on the Rock the red, white, and blue -- In binary section of the Code for America site.

05 July 2010

The Personal World Clock

Need to know the time, exactly? The display on one's wireless telephone is usually sufficiently close to an atomic clock for most purposes. However, if you want a world clock with cities and/or times zones customized specifically for you, then it would be worth having a look at Time and Date dot com, the most frequently used time-and-date site on the internet, according to Alexa, the web analytics company.

The site has numerous offerings, two mainstays are Time and Date's configurable World Clock as well as a variety of traditional, clever modern and even historical calendars.

The company is privately-held and based in Norway. The site also offers links to something called Znake, "the Java game", with which I had no ability whatsoever!

The Personal World Clock is available in Java applet form and with a standard customization tool, as a free or fee-based service depending on usage requirements.

There are strict usage restrictions, which I adhered to in producing one version of their date and time clock. Have a look at the site and maybe you'll find something interesting for yourself.