Last week, some of the biggest building societies posted profits, no mean feat in itself, but profits that were slashed by as much as 50 per cent thanks to Financial Services Compensation Scheme levies hiked up in the wake of the Icelandic bank crash and the Bradford & Bingley bailout.
These mutuals convinced 1.2 million people to take out new savings accounts in 2008, according to the BSA.
Some in the sector have fallen prey to the temptations of the boom years but others have kept up the long-standing traditions of prudent lending, sensible innovation and strong savings that have been sadly forgotten by many high-street banks.
The Government and the FSA should consider ways to ease the burden on the sector. They may need their help in years to come.
Park Row has confirmed that it is being investigated by the FSA as part of a review into its systems and controls.
Should the retail distribution review be delayed due to the economic turmoil?
Canada Life Group Insurance has made a number of enhancements to its online business portal.


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« SEEN & HEARD: Cannes You Believe It?
NEWS: Seyfi Teoman, 1977 – 2012 »
OPEN MIC: The Educated Eye
By The Global Film Initiative, on May 18th, 2012
Jim Canacci, Lecturer at Kent State University at Trumbull, on using Global Lens films to inform, expand and appreciate the world around us
"Every story reveals a world." -Global Lens Trailer
Jim Canacci, Lecturer at Kent State University at Trumbull
I truly believe that Global Lens changes "the way you see the world." I know this from personal experience and through sharing these films with the students and campus community at Kent State University at Trumbull.
My first year with Global Lens was in cooperation with my good friend, Dr. Ken Bindas, who is now the Chair of the History Department at Kent State University. He asked if I would partner with him to show the films on my campus in Warren, OH, as well as at the Lemon Grove in downtown Youngstown. He provided me with the materials, and asked if I could do "the rest." With the help of many generous people on my campus, we had a plan to show three of the films on campus during International Education Week. Jacob Roope, who organizes most of the events, helped choose which films fit best with the guest speakers and our potential audience members. Jacob Harver, who is co-owner of the Lemon Grove, was kind enough to show all the films the first year and did most of the organizing and marketing in Youngstown that first year.
I previewed Ordinary People by myself in our auditorium before showing it to students. I was completely blown away, and hooked on these films from that moment. I called Ken immediately after the screening. I could only think to say, "What just happened? What did I just see?" Ken just answered, "I told you." And, I think, that's what Global Lens offers. It gives us the stories we wouldn't hear, couldn't hear from the people in places we wouldn't know about were it not for the films. It makes us think about others differently, challenges our perceptions of the world, and reminds us how fortunate we truly are.
A scene from ORDINARY PEOPLE (dir. Vladimir Perisic, Serbia)
GFI Board Member Igor Kirman writes in "The Not-So-Ordinary Acts of ORDINARY PEOPLE", "Ordinary People gives us a couch-front opportunity to think about controversial topics. But the film is also a reminder that moral judgments are hard work." The characters Vladimir Perisic gives us in Ordinary People elicit sympathy despite the horror they engage in throughout the film. Strangely, it is the media as heard on the radio that plays a more disconcerting part in the story. Uprising violence is given as the reason for military action, but it is in direct contrast with what we as the audience have just seen. You have to read the subtitles and make the connection quickly as the troops move from one village to the next. The conversation about fishing with their fathers after they just killed a village of young men and boys is particularly eerie.
The response from the students to Ordinary People was overwhelmingly positive, and it garnered the largest audience at the Lemon Grove that year as well. After the screening, the audience asked when we were offering more films, and I told them I hoped my campus would support showing all the films in 2011. Contact information was exchanged and people looked to the holidays, but I really think every person who viewed the film, to a greater or lesser degree, realized how truly fortunate we all are to live where we do, to have all we have, and to have time to watch films we enjoy. I think this is the legacy of these films and this effort to share "stories from around the world."
This second year was a complete campus effort. Rob King planned an entire marketing strategy for the festival including articles to appear in our Quarterly magazine, information in the local newspapers of record, as well as live spots on the radio. I designed the posters for the campus and community, created the e-mail and Facebook reminders, and worked with Bobbi Bain, our resident web guru, on posting the film information on the campus homepage and the electronic sign in front of the campus. Jacob Roope had also planned all the events with International Education Week to cooperate with the films. All this and more were in store, but Ken called and said his innumerable duties as chair prevented him from participating. I feared we would be cancelled, but he put me in contact with Jeremy Quist, the Global Lens Series Manager at the Global Film Initiative. Jeremy and our generous Dean saved the films coming to our campus, and I will always be grateful for being included and trusted with this work.
A scene from BELVEDERE (dir. Ahmed Imamovic, Bosnia & Herzegovina)
The first film I previewed was Belvedere. I immediately saw the connections to the themes from the previous year. I didn't think it could be a coincidence since the two stories were so closely intertwined. Belvedere and Ordinary People work to make us understand two distinct stories centering around conflict—the victims and the cost of war. The films use violence and silence to put us into the minds of the protagonists. What act is more forgivable? A soldier following orders, or a mother seeking vengeance for her murdered family?
The students in my evening class who watched most of the films wrote an essay for class about how one of the films changed his/her worldview related to the issues addressed in the film. Each student picked a different film, but we discussed the themes in class. I think the lesson my students (as well as the campus community) learned most keenly was how lucky we are to live in a country free from domestic wars and crushing poverty.
My hope is that showing these films will change the way our students view others, appreciate diversity, and learn to appreciate fine films while enjoying the process of writing essays for class. It is much easier to write when you're invested in your subject and you feel you've actually learned something through the process. That's what Global Lens offers. That's what it means to me, at least.
Jim Canacci is a proud member of the English faculty at Kent State University at Trumbull. Jim lives in Boardman, Ohio with his wife, Kris, and his two talented daughters, Miranda and Gillian. Jim has coordinated Global Lens showings on his campus and at the Lemon Grove Cafe in Downtown Youngstown for the last two years and looks forward to many more.
College & University, Education, Features, Films, Global Lens, Midwest, North America, Partners, Partners, Topics, War & Conflict belvedere, International Education Week, jim canacci, kent state, ordinary people

redpajama_set_name: RedPajamaCommonCrawl


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Erdogan's crackdown on enemies just getting started after failed coup
In Turkey / Türkiye
Erdogan's crackdown on enemies just getting started after failed coup2016-07-252016-07-25https://newcoldwar.org/wp-content/uploads/2020/05/2020-NCW-Logo-New.pngNew Cold War: Know Betterhttps://newcoldwar.org/wp-content/uploads/2016/07/Turkish-President-Recep-Tayyip-Erdogan-attends-funeral-service-in-Istanbul-on-July-17-2016-for-victims-of-the-thwarted-coup-Alkis-Konstantinidis-Reuters.jpg200px200px
Al-Monitor's 'Week in Review', July 24, 2016
Turkish President Recep Tayyip Erdogan attends funeral service in Istanbul on July 17, 2016 for victims of the thwarted coup (Alkis Konstantinidis, Reuters)
On July 23, Turkish President Recep Tayyip Erdogan closed thousands of charities and private schools as he expanded his crackdown in the aftermath of the failed July 15 coup. A restructuring of the military is also in the cards. Kadri Gursel reports that 35 per cent (124 of 358) of the generals and admirals in Turkey's armed forces (TSK) have been arrested, and that the coup was "widespread" with "nationwide tentacles." He writes that, except for the Turkish navy, "it would not be an exaggeration to estimate that between one-third and one-half of forces on the ground had joined the uprising at various levels."
Erdogan has signaled that the coup aftermath will likely be a final reckoning for cleric Fetullah Gulen and his followers. The Gulen movement and the Justice and Development Party (AKP) had at one time been allies in advancing the AKP's Islamist agenda, including purges of alleged Kemalist elements in the TSK. During these years, Gulen followers expanded their influence among the judiciary, police and armed forces. This was fine with AKP rulers until 2013, when Gulen fell out with Erdogan, then prime minister, who subsequently began a widely publicized purge of Gulen loyalists in the judiciary and military.
Gursel writes, "Of the 124 generals and admirals detained, 83 are brigadier generals and rear admirals. As far as can be determined, about half of them were promoted to the rank of brigadier and rear admiral in 2013 and later. This indicates that most of the generals who today are accused of coup plotting were promoted to fill the ranks vacated by their colleagues who were purged in the Sledgehammer and Ergenekon cases. It can't be a coincidence that they constitute the majority of the plotters of this failed coup."
In addition to the Gulenists, those in the armed forces involved in the coup included "pragmatists who joined the plotters for career advancement and personal interests; soldiers who had to join under pressure or blackmail; and lower-ranking soldiers who couldn't defy orders because of the TSK's absolute-obedience culture," as Metin Gurcan reports.
Gurcan adds that the timing of the coup may have been related to a Supreme Military Council meeting scheduled for the first week in August to decide on senior military promotions and appointments. Gurcan wrote in August 2015 that then-newly appointed Chief of General Staff Gen. Hulusi Akar had been tasked to weed out Gulenists in the TSK as part of a broader purge authorized by the AKP.
An Al-Monitor correspondent who was an eyewitness to the failed coup and its aftermath writes, "The coup attempt was not the work of a small group of renegades, and the plan was not amateurish. The coup plotters had support from all segments of the armed forces and managed to seal all Turkey's borders. The coup was stillborn due to the efforts of the MIT [Turkish Intelligence Service], rather than simply failing on its own after being launched. … One unanswered question is why, despite knowledge of an imminent coup attempt, it was the police and members of the public — rather than the rest of the armed forces — who were on the streets trying to stop the F-16s and tanks. The coup was not an Erdogan plot, but if he succeeds in fully suppressing the takeover attempt, his hold over power will deepen. Mainstream media in Turkey have been instrumental in rallying support for Erdogan. Their unconditional support has prevented anyone from questioning the government's calls for the public to attend rallies for democracy."
Gursel concludes that the outcome is devastating for Turkey's institutions and regional standing: "This TSK, infested with Gulenists, was not the national army of Turkey. The [Gulenist] Congregation had become an army within an army. In addition, the TSK is a NATO army. Any crisis, any weakness in its command and performance would also be a NATO crisis. The TSK is in a historic crisis and decline."
Iran benefits from clear stance on coup
Erdogan is also keeping score with regard to the international response to the attempted coup and its aftermath. One possible outcome is an improvement in relations with Russia and Iran, as the Turkish government and media have been less than satisfied with the responses of the United States, the European Union and certain Arab countries, as Fehim Tastekin reports. Turkish officials and pro-government media have even alleged a possible U.S. role in the coup, and Erdogan will be sensitive to Western criticism of his crackdown.
On July 22, U.S. President Barack Obama condemned the coup attempt and rejected allegations that the United States had any advance knowledge of it. The U.S.-Turkish relationship may be put to the test if Turkey formally requests Gulen's extradition.
Iran seems to have benefited from its clear stance on the failed coup. Ali Hashem explains why Iranian leaders quickly and unequivocally opposed the coup and backed Erdogan as head of Turkey's democratically elected government. Iran's support came with a reminder, however, that Tehran hopes for a turnaround of Turkey's Syria policy. Hashem reports that Ali Akbar Velayati, foreign policy adviser to Iran's Supreme Leader Ayatollah Ali Khamenei and a former foreign minister, said while condemning the coup that he hopes "'the Turkish government will respect the views and votes of the Syrian people and allow them to decide their own government.'" Hashem adds, "It was a clear message from Iran to Turkey regarding Syria and the future of the struggle in the region. For five years now, Iranian officials have on repeated occasions stated that they have been trying to engage the Turks on a path to address the situation in Syria, and while unsuccessful, have never given up on this approach."
Turkish reports document Islamic State operations
Mahmut Bozarslan reports on Turkish state documents that reveal previously unknown details of Islamic State operations in Turkey. For example, "The IS emir in Turkey is Halis Bayancuk, also known as Abu Khazanla; at one point he was detained, but then released. His father, Haci Bayancuk, was a high-level official of Hezbollah in Turkey. Halis Bayancuk is the senior official of radical structures in Diyarbakir, which operate primarily in four locations: Madrasa/Masjid, Takwa Education and Reading Hall, Tavhid Bookstore and Dar-ul Erkam Reading Room. These locations focus on converting youths who are not deeply religious and then join the organization."
Bozarslan describes the operations of the IS transportation network:
Those who want to come to IS territory have to acquire a reference, known as "tazkiye," from an emir of the organization. That emir then sends the names of the people who will come to IS customs units to arrange the border crossing. The IS sponsor emir instructs potential recruits to go to Gaziantep by plane or by bus. The customs units convey the names of those coming to border emir Ilhami Bali.
This is when the transport network Bali has set up on the Gaziantep-Kilis-Raqqa axis gets into action. Jihadis contact Bali after reaching Gaziantep. They are told to take a taxi and go to a meeting point determined by the organization. At that point, the newcomers meet a liaison agent and are taken to IS guesthouses in Gaziantep and Kilis. Any personal belongings that may hinder their border crossing are taken from them and kept for safekeeping at a warehouse whose location hasn't been found yet. Then Bali sends one of nine taxi drivers working for him to bring jihadis and their families to the second meeting point at the town of Elbeyli.
Taxis are paid 40 Turkish liras per jihadi. These people are taken across the border by a smuggler named Huseyn Hano. Police determined that women among the newcomers are taken to a women's guesthouse under the control of Deniz Buyukcelebi, alias Abu Enes, while the men are taken to a camp at Tel Ahmar. Newcomers are allowed to bring a maximum of two suitcases per person. Belongings initially stored in Turkey are later sent to Tel Ahmar. … Ersen Celik, alias Abu Mousa, the IS official responsible for technological affairs, provided information previously unheard of after he was apprehended in Gaziantep.
Celik said IS is trying to build a hydrogen bomb and is planning to launch attacks using remote-controlled model planes in Turkey. Celik first came to Turkey in 2014 to buy model planes and left. He was arrested after his return to Turkey.
Is Erdogan seeing Gulenists or ghosts?, commentary by Simon A. Waldman, published in The Globe and Mail, July 25, 2016
Is Erdogan seeing Gulenists or ghosts?Turkey / Türkiye
Letter by 400 U.S. academics condemning repression in TurkeyTurkey / Türkiye


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5 October 2020 Company News, Sustainability
SMS transitions to international standard for Health & Safety at Work (ISO45001)
SMS is pleased to announce our successful transition to the new international standard for Health & Safety at Work, ISO45001.
Introduced as a new international standard, ISO45001 replaces the current standard (BS OHSAS 18001) and aligns with organisations who are serious about improving employee safety, reducing workplace risks and creating better, healthier working conditions.
The ISO45001 standard specifies requirements for an occupational health and safety (OH&S) management system. A great deal of work has taken place in the past 12 months to update our existing 18001 compliant management system to ensure it meets these new requirements, and that it is effective and subject to continual review and improvement.
Joint initiatives across internal teams – SHEQ, HR, Fleet, Procurement and Operations – has enhanced inter-departmental working and created greater standardisation throughout the Group with regards to occupational health and safety. Additionally, regional forums have been established and the introduction of a state-of-the-art Electronic Quality Management System (EQMS) enables enhanced reporting and corrective action tracking.
One of the key differences of the 45001 standard is a focus not just on safety, but on employee health and wellness. As an organisation, we have worked hard to improve our free resources and promotion of this area, including the provision of a dedicated online Wellbeing page and face-to-face support for our employees. These resources, which have been further developed to address COVID-19, include:
Mindfulness sessions via exclusive online workshops Exercise & stretching online classes
Bereavement support E-learning modules, including on Wellbeing, Resilience and Homeworking Home schooling resources (including virtual tours)
Provision of accredited mental health first aid training A dedicated Employee Assistance Programme, offering professional external support 24-7
Bronze Award accreditation for Healthy Working Lives
Employee wellbeing survey
In response to COVID-19 specifically, we are proud to have achieved the C-19 Business Pledge by vowing to help and support our employees, customers and communities to safely navigate the challenges of the pandemic. Our Safe & Healthy Return to Work measures and high levels of employee and customer engagement have been invaluable in this process.
Safety is a core value of SMS, and therefore safeguarding the wellbeing of all our stakeholders is the single biggest priority of our business. Transitioning to ISO45001 continues to demonstrate our commitment to a safe and healthy environment, as does how we live by all our core values in everything we do.
26 Jan 2023 Company News, Innovation, Metering, Net Zero, Press Release
SMS to innovate smart meter solution for generating tailored home heat efficiency insights
01 Dec 2022 Company News, Energy Management, Innovation, Net Zero, Sustainability
SMS wins 'Net Zero Leaders' Award at TELCA 2022
24 Nov 2022 Company News, Energy Infrastructure, Energy Management, Renewable Energy, Sustainability
SMS named as one of UK's nine climate tech "unicorns"


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Home » Integrate Your Revenue Cycle
Integrate Your Revenue Cycle
Payment and collection functions can no longer be confined to the financial silo. Clinical input is critical.
John Morrissey
The revenue cycle, that pivotal part of a hospital business concerned with documenting and generating claims for payment, began to reveal itself several years ago as much more than just the province of the finance department at Integris Health.
In preparing for whatever a Medicare recovery audit contractor might red flag in sleuthing for overpayments, financial managers at the 14-hospital, Oklahoma City-based system, kept digging into the clinical, coding and information-management areas to fully understand billing particulars. "It quickly became obvious that what happens on both the clinical side and financial side are so interrelated—including documentation—that they really couldn't be separated," says Gregory Meyers, system vice president for revenue integrity. Every clinical decision had a financial impact, he says.
In 2009, Integris pulled case management, health information coding and information management into the revenue-cycle function. "It became a natural evolution to us where we [viewed] the patient experience as two rails on the same railroad track," Meyers says. "We want our patients to have the same high-quality, patient-centric experience going down both rails of that track. And to do that, they can't operate in isolation. The clinical world and the financial world have to interact."
Experts in revenue-cycle management say it's time for hospitals to liberate claims payment and collection functions from the financial silo and incorporate within health care services one inclusive revenue cycle that starts before a patient shows up and ends when the account has been closed.
"Our belief is that the revenue cycle requires an integrated approach," says Deirdre Byrne, senior vice president of interim and consulting services with the B.E. Smith consulting firm. "Accountability certainly must reside with finance, but it is fundamentally impossible for the revenue cycle to be the success it must be as the engine for the organization if it doesn't have commitment from colleagues across the health system."
Specifically, some mainly financial areas could use more input from the clinical setting, especially in hammering out contracts that can succeed or fail based on how the terms mesh or clash with medical workflow and decision-making. By the same token, patient care areas need to better understand the financial impact of medical activities. That sometimes means first poking through cultural barriers.
"There has historically been a tension between the clinical folks and the financial folks in hospitals, in [that] there seemed to be sort of a bias on the [part of the] clinical staff that the financial staff really wasn't perhaps concerned about patient care and patient quality as much as the clinical staff was," Meyers says. "Like most large health systems, we've struggled with that—you'll occasionally hear a nurse saying, 'It's not my job to worry about finances; I'm here to take care of the patient.' "
But acute awareness of revenue-cycle issues during acute care protects not only hospital finances, but also those of patients. Inattention to those issues could make for an unhappy customer down the road and register a hit to a hospital's bottom line. A few examples of how the clinical side affects bills:
Treatment that isn't pre-certified. A patient goes to the radiology department for a series of imaging studies properly authorized by the insurer. Those results prompt the radiologist to order additional scans. The bill for those extra images is later denied because they weren't pre-certified. That doesn't mean the radiologist shouldn't have done it, says Jamie Townsend, vice president of consulting solutions for B.E. Smith. It just means when a plan of care changes, it has to be captured and communicated to the revenue-cycle side. Among other things, it should trigger a procedure to clear the move with an insurer.
Decisions to admit patients or keep them for observation. For instance, in the case of a Medicare beneficiary, a physician might prefer that he be in observation rather than be an inpatient. "And that sounds like a worthy effort," says Meyers. But if the patient met acute care criteria, "a hospital is leaving a lot of money on the table from a reimbursement standpoint, and, [financially], it's not the best thing for the [patient]." Medicare beneficiaries have one annual deductible as an inpatient, while observation, as an outpatient occurrence, carries extra copayments and additional costs, such as for drugs. "What looked like a really innocent decision on the front end from the clinical perspective has patient satisfaction impact [and] hospital revenue impact," he says.
Liability for uncovered services. Hospitals need a process of fair warning about out-of-pocket costs, says Anthony Spezia, president and chief executive officer of Covenant Health, Knoxville, Tenn. "For example, a patient no longer meets acute care criteria, and let's just say it's not convenient for the family [to pick the patient up that day]. Sorry, they need to be told if they stay another day, that will be their responsibility." If it's a physician who wants to keep the patient longer than the insurance will cover, he has to know and declare that the cost rests with the patient's family, Spezia adds.
Every Little Detail
The details that go into the business of health care—expenses incurred, necessary care authorized, supplies tracked and accounted for, reimbursement claims documented and explained—typically originate in managed care and purchasing contracts that first must be executed shrewdly and then communicated intelligently throughout the hospital, from patient intake to nursing unit to discharge, Byrne says. From pre-approvals to outlier dates, payment bundles to fixed fees, the terms need to be loaded into information systems and procedures that synchronize the clinical and revenue-cycle sides of the health care operation.
That sounds obvious, but it frequently fails in practice, says Townsend, who sees a lot of reacting rather than up-front planning when reimbursements are denied or come in less than expected. "A good revenue-cycle management approach focuses 80 percent of the brainpower, energy, reporting and time on pre-access functions"—the things to be done before a patient accesses care. "It's amazing that oftentimes a contract is negotiated without full knowledge of what the actual financial impact of that contract is going to be."
Full knowledge isn't possible, Townsend asserts, without involving clinical leadership in ascertaining what the health care setting can handle: for example, how a discount in service matches up against expenses; how a billing requirement plays out in the clinical setting; whether the workforce and infrastructure are sufficient to execute all agreed-upon terms profitably.
Item Master vs. Charge Master
Supply chain and pharmacy silos also have to be broken down and become a part of the revenue cycle, says Kelley Blair, vice president of professional services for Craneware, a vendor of revenue-cycle management software. "Supply and pharmacy costs are the second-biggest spend behind labor," she says, and "it can become very difficult to manage those costs and really identify what is being provided to a patient during the course of care because not all of it is billable, and that's one of the biggest ways that hospitals track what they're providing."
The supply chain function in a hospital likely is focused on such contracting matters as getting the best price and terms and may not be as aware of how the pricing information figures into the accounting of costs and allowable charges throughout the revenue cycle, Blair says.
All the information about purchased supplies—such as product name, vendor, cost, contract number with correct price—is loaded into what's known as an item master for materials management, while all the components of how charges are produced in the revenue cycle are contained in a charge master, says Karen Peterson, senior business solutions consultant at Craneware. Efforts by both departments to better link the two systems and reconcile product costs against their use in the emergency department, operating room and nursing units will pay off in more complete, clean bills, she says.
Two Root Causes of Denials
The act of sending patients to the hospital or receiving them in the ED triggers the need for a lot of financial information as well as clinical history, which if not obtained can doom the revenue cycle to unpaid bills. The Integris health system sustained $20 million in insurance denials last year, Meyers says, and in looking for the root causes found that a significant number came from two sources.
One was not having enough time to check insurance eligibility and verify the benefit level. "So we are really making a lot of effort to try to work with our medical staff and educate them on the importance of giving us as much advance notice as they can," Meyers says. "It helps us from a financial perspective, but it also allows us to begin to work with that patient from a clinical perspective and make sure their path through the system is as appropriate and as patient-centric as possible."
The other big cause of denials was a failure to get clinical documentation into the revenue cycle. "When it was all said and done, the services provided to the patient didn't match up with what we thought the services were going to be," Meyers says. "We'd call and get a particular radiology procedure pre-certified and authorized, and the physician does a second one—which may be a related procedure but we didn't have it pre-authorized. So when the bill gets to the insurance company, the feedback is, 'Well, sorry, you didn't get that approved, so we're denying that care.' "
The first step to solve that problem is integrating a good case manager into both the clinical and revenue-cycle worlds, says Byrne of B.E. Smith. Such managers are "setting the patient on a path, a plan of care…monitoring it to make sure that the patient is receiving the resources in the right time and place." The resources may be dictated in part by the terms under which the patient's insurance covers care.
That's part of an overall fail-safe process that has to operate alongside clinical activities without being intrusive, says Blair of Craneware. "It is unreasonable to expect that a clinician is going to know that now they've provided this new service, then a new pre-certification is going to be needed," she says. "There need to be systems in place that notify the right people to go and get that pre-certification and to understand that the care plan has changed."
One tactic is to build safeguards into the parallel information technology systems for clinical and business information, says Carol Conley, director of audit and compliance for CoxHealth, a three-hospital system in Springfield, Mo., with a critical-access hospital about 50 miles away. When a radiologist documents the results of imaging in the clinical IT system, they are sent over to the billing system. If, for some reason, the service isn't in the billing system to capture the charge, it's kicked out for manual review. Then a conversation ensues around whether one system had the service built in but not the other, Conley says.
Every department also gets a daily charge report listing patients and the charges that were billed the day before, she adds. That gives managers a chance to see if charges were missed and to make corrections.
Averting Angst
A final but crucial parallel pursuit revolves around the discharge process and beyond. With Medicare penalties for preventable readmissions as the wake-up call, health care organizations have begun institutionalizing the educational and psycho-social preparations needed for patients to understand their conditions, what they face after hospitalization and how to keep from relapsing. What they also need to provide is a plan for how patients will cope with their financial responsibility and a good idea of what that will be long before the bill arrives, experts say.
Feedback on the billing process in patient-satisfaction surveys seems to focus on the insecurity of patients and their families about the hit they face—"not knowing if it was going to be literally $500 or $50,000," says Byrne. "There was a time not that long ago when people would go into the hospital and have no concept of what they would come out with in terms of, 'Do we have enough room on our credit card?' or 'Can we refinance the house?' I've heard people have these conversations."
Integris uses business-intelligence systems at admission to resolve issues of Medicaid, charity care, ability to pay a balance in full or the need to work with a patient on other payment arrangements. "The moment we find out someone's coming here, it sets the whole process in motion on the revenue-cycle side to try to minimize the frustration and potential angst down the road on a patient for unnecessary financial reasons," Meyers says. "We pretty much know at the time of admission how that account is going to be resolved."
John Morrissey is a freelance writer in Chicago.
Leadership & StrategyCEOAffordable Care ActFinanceCFOOperationsPhysiciansTechnologyCOONew Care & Payment Methods
Accountability and the Revenue Cycle
Revenue cycle systems likely will undergo significant changes as providers respond to a vastly more complex reimbursement process.
Surviving a Revenue Cycle System Conversion
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Allegiance Health, Jackson, Mich., has found ways to add value financially through everything from getting bills out the door faster, to tightening up processes.
Resuscitate your cardiovascular supply chain: Efficiency through automation
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I love to share my beloved old movies with my kids and watch their reactions. This past weekend, I saw one of my favorite teen movies, Pretty in Pink, with my thirteen-year-old daughter.
Pretty in Pink came out when I was sixteen. In case you were not a sixteen-year-old girl in 1986, here's a synopsis: Molly Ringwald plays a girl from the wrong side of the tracks who goes to a school where the haves and the have-nots mix, but not too happily. The haves are mostly not very nice. Well, except adorable Andrew McCarthy, who buys a Lawrence Welk vinyl album from the Molly Ringwald at the record store where she works to show that he is smitten. (Asked if she had ever seen a vinyl album, my daughter replied, "Well, yeah, like in cartoons and stuff. I've never, you know, actually seen one in real life." I was embarrassed to tell her I still have a crate of them).
Did I mention this movie is 27 years old? Eek.
Anyway, if you haven't seen this flick since Reagan was president I think it's safe to spoil a few things for you. Andie (Molly Ringwald's character) has a best friend named Duckie, played by a very cute and very young Jon Cryer. He is like her – offbeat, an eclectic dresser and a true individual, also a have-not. (I just loved the courage to be themselves they both seemed to have). Also, he adores her. Goes to her house to pretend-study (but really just to gaze at her), rides his bike past her house obsessively. Heck, he even chills with her dad. He is Serious Boyfriend Material. She just doesn't know it.
Instead, Andie likes the Andrew McCarthy's character, Blaine. They hang out, kiss (Assessment from my daughter: "Eeew, people kissed so gross in the 80's. They're like eating each other's faces."). Blaine asks Andie to the prom.
Misunderstandings occur, Blaine bows to pressure from his snobby friends and "dis-invites" Andie. She goes anyway and meets up with Duckie by cinematic accident. But then Blaine swoops in and, with Duckie's blessing ("You came here alone. Go after him.") Andie chases after him to the parking lot where they engage in another "gross" 80's kiss.
Fade out to the fabulous OMD song, "If You Leave" and into a majorly significant cultural moment of my adolescence.
Except, here's the thing: somewhere in the middle of watching it as a 43-year-old woman, I realized… Andie should have ended up with Duckie. I don't know if you can fully appreciate the way this rocked my universe. I used to love that ending. It spoke to all my hopes and the things that dazzled me (I mean, come on, Blaine drove a BMW, people). Plus Blaine was clearly way cuter and a better dresser that Duckie. Andie was lucky to get him in the end.
Except, no, she wasn't. Duckie was constant and devoted and funny. Blaine was weak and a little mean (he just stopped calling at one point, with no explanation). What Blaine offers is superficial. Clearly the whole movie Duckie is being set up as the better guy that she finally sees for the first time when they run into each other at prom. In fact, a little Googling reveals that that's exactly the ending that was originally written and shot for the film. The test audience (no doubt vapid little sixteen-year-olds like me who also didn't understand what makes for a solid relationship) hated it, so they re-shot it with her getting the "better" guy.
And a significant moment of my adolescence becomes a significantly happy moment of my middle age when I realize that I have finally figured out what a good guy looks like. The other bonus? Unprompted, my daughter had a viscerally negative reaction to the ending. "This is horrible. Why doesn't she end up with Duckie? He's clearly a nicer guy." Let's hope she is spared 27 years of falling for the glitzy "bad boys." And, pat on the back for Mom for raising the kind of girl who knows that at thirteen.


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Q: Statistical Calculus In Big Data Set Wrong Values I am using the following code to make a small example of a function I intend to use on a big data set.
I calculate statistical features incrementally for each ID in which the unit is month.
df = pd.DataFrame([[58685991,'2020-06-01',2],
                   [58685991,'2020-06-01',1],
                   [58685991,'2020-06-01',0],
                   [58685991,'2020-12-05',7],
                   [57839709,'2020-12-01',5],
                   [57839709,'2021-01-08',3]],columns=['ID','DATE','QTD'])

def monthdelta(a,b):
    a1,a2,a3 = (int(k) for k in a.split('-'))
    b1,b2,b3 = (int(k) for k in b.split('-'))
    return (a1*12+a2) - (b1*12+b2)

startdate = {}
sums = {}
sumsqs = {}
num = {}
stdev = []
means = []
total = []
ind_max = []
ind_min = []
ind_maximum = 0
ind_minimum = 0

for row in df.T.iteritems():
    id = row[1]['ID']
    if id not in startdate:
        num[id] = 1
        startdate[id] = row[1]['DATE']
        sums[id] = row[1]['QTD']
        sumsqs[id] = row[1]['QTD'] * row[1]['QTD']
        means.append( row[1]['QTD'] )
        total.append( row[1]['QTD'] )
        stdev.append( 0 )
        ind_maximum = row[1]['QTD']
        ind_minimum = row[1]['QTD']
        ind_min.append( row[1]['QTD'] )
        ind_max.append( row[1]['QTD'] )
    else:
        num[id] += 1
        sums[id] += row[1]['QTD']
        sumsqs[id] += row[1]['QTD'] * row[1]['QTD']
        delta = monthdelta(row[1]['DATE'],startdate[id]) + 1
        means.append( sums[id] / delta )
        total.append( sums[id] )
        if delta == 1:
            stdev.append( 0 )
        else:
            stdev.append( np.sqrt((delta*sumsqs[id] - sums[id]*sums[id])/delta))
        if row[1]['QTD'] > ind_maximum:
            ind_max.append( row[1]['QTD'] )
            ind_maximum = row[1]['QTD']
        else:
            ind_max.append( ind_maximum )

        if row[1]['QTD'] < ind_minimum:
            ind_min.append( row[1]['QTD'] )
            ind_minimum = row[1]['QTD']
        else:
            ind_min.append( ind_minimum )

df['MEAN'] = pd.Series(means)
df['STDEV'] = pd.Series(stdev)
df['TOTAL'] = pd.Series(total)
df['MAX'] = pd.Series(ind_max)
df['MIN'] = pd.Series(ind_min)

The code works and I get the following output:
    ID          DATE       QTD  MEAN        STDEV     TOTAL MAX MIN
0   58685991    2020-06-01  2   2.000000    0.000000    2   2   2
1   58685991    2020-06-01  1   3.000000    0.000000    3   2   1
2   58685991    2020-06-01  0   3.000000    0.000000    3   2   0
3   58685991    2020-12-05  7   1.428571    6.301927    10  7   0
4   57839709    2020-12-01  5   5.000000    0.000000    5   5   5
5   57839709    2021-01-08  3   4.000000    1.414214    8   5   3

The problem I am encountering is when I apply it to a big data set, some ID's get wrong feature values I can't seem to understand why? Some only have one entry with one QTD but get a higher than 1.0 mean and the total is very high as well. This problem occurs with other features as well.
Not sure if it is because I use a series and then decide to make a column on the data frame.
Is there a way this could be done by manipulating the data frame itself wit .loc and .iloc? Would this be a saffer way to work with the data? I am not very confortable with them so if an example could be provided would be great.

A: Here's the same logic implemented in a vectorized form (which is generally more efficient on large datasets):
# convert DATE to datetime
df['DATE'] = pd.to_datetime(df['DATE'])

# calculate min, max, sum
df[['min', 'max', 'sum']] = (
    df
        .groupby('ID')['QTD']
        .expanding()
        .agg(['min', 'max', 'sum'])
        .reset_index('ID', drop=True))

# calculate delta
df['date_first'] = df.groupby('ID')['DATE'].transform('min')
df['delta'] = (
    (df['DATE'].dt.year - df['date_first'].dt.year) * 12 +
    (df['DATE'].dt.month - df['date_first'].dt.month) + 1)

# calculate sum of squares
df['qtd_sq'] = df['QTD']**2
df['sum_sq'] = df.groupby('ID')['qtd_sq'].cumsum()

# calculate standard deviation
df['stdev'] = np.where(
    df['delta']==1, 0,
    np.sqrt((df['delta']*df['sum_sq'] - df['sum']*df['sum']) / df['delta']))

# calculate means
df['means'] = df['sum'] / df['delta']

# drop temp columns
df = df.drop(columns=['delta', 'qtd_sq', 'sum_sq', 'date_first'])

df

Output:
         ID       DATE  QTD  min  max   sum     stdev     means
0  58685991 2020-06-01    2  2.0  2.0   2.0  0.000000  2.000000
1  58685991 2020-06-01    1  1.0  2.0   3.0  0.000000  3.000000
2  58685991 2020-06-01    0  0.0  2.0   3.0  0.000000  3.000000
3  58685991 2020-12-05    7  0.0  7.0  10.0  6.301927  1.428571
4  57839709 2020-12-01    5  5.0  5.0   5.0  0.000000  5.000000
5  57839709 2021-01-08    3  3.0  5.0   8.0  1.414214  4.000000

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