레이블이 Promotional Medical Items인 게시물을 표시합니다. 모든 게시물 표시
레이블이 Promotional Medical Items인 게시물을 표시합니다. 모든 게시물 표시

2013년 11월 28일 목요일

About 'medical items'|...unsure about an item, keep it out of reach. If your pet should happen to get into any item, seek medical attention immediately.







About 'medical items'|...unsure about an item, keep it out of reach. If your pet should happen to get into any item, seek medical attention immediately.








Focus               and               Framing               Overview               
               
               Community               Health               Systems,               Inc.

is               a               nonprofit               healthcare               organization               that               is               committed               to               providing               comprehensive               primary               health               care               to               citizens               of               southern               West               Virginia.

The               organization               was               established               in               1967               as               a               demonstration               health               care               project.

The               organization               first               was               established               in               leased               space               from               a               local               nonprofit               hospital               in               Beckley,               West               Virginia.

The               organization               then               moved               its               corporate               office               in               1977               to               252               Rural               Acres               Drive               in               Beckley,               West               Virginia               and               operates               from               that               location               today.

The               company               has               grown               over               the               years               and               has               9               locations,               33               providers,               and               over               150               employees               Of               the               9               locations,               the               majority               are               in               the               Beckley               area               and               the               others               are               in               close               proximity.

The               following               clinics               are               located               in               Beckley,               West               Virginia:               Rural               Acres               Clinic,               Carriage               Drive               Clinic,               Access               Health               Stanford,               CHS               Associates,               and               CHS               Professional               Medical               Ultrasonic's.

The               remaining               locations               are               Glade               Crest               Clinic               in               Daniels,               WV,               Clear               Fork               Clinic               in               Colcord,               WV,               Marsh               Fork               Clinic               in               Arnett,               WV,               and               Glen               Rogers/Ravencliff               Clinic               in               Ravencliff,               WV.

The               organization               offers               primary               health               care               services               including:
               1.

Family               Practice
               2.

Pediatrics
               3.

Internal               Medicine
               4.

OB/GYN
               5.

Ultrasonic's
               6.

Laboratory
               7.

Pharmacy
               8.

Billing
               9.

Administrative
               The               pharmacy               is               a               340(b)               provider               of               prescription               drugs.

This               means               that               the               pharmacy               provides               customers               the               lowest               possible               price               on               prescription               drugs               at               the               same               rate               the               federal               government               is               allowed               to               purchase               the               products.

According               to               Charles               Hunt               CEO               of               the               organization,               in               2005,               Community               Health               Systems,               Inc               rendered               services               to               34,998               users               accounting               for               112,467               patient               encounters               (C.

Hunt,               personal               communication,               May               28,               2006).

Community               Health               Systems,               Inc.

insurance               and               programs               offered               to               customers               are               Medicaid,               Family               Planning,               Cancer               Control,               Children's               Health               Insurance               Program,               Medicare,               United               Mine               Workers               Association,               Sliding               Fee               Scale,               Patient               in               Need,               and               Discounted               Pharmaceuticals.
               Issues               
               
               The               idea               for               this               project               was               introduced               by               the               Pharmacy               Director               in               a               management               team               meeting.

Because               of               the               potential               revenue,               the               Chief               Executive               Officer               asked               the               facilitator               to               explore               the               potential               of               carrying               durable               medical               products.

The               facilitator               was               responsible               for               gathering               information               on               durable               medical               equipment               and               determining               financial               projections               so               the               management               team               could               decide               the               direction               they               want               to               take               on               the               issue.

Durable               medical               equipment               is               described               as               wheelchairs,               crutches,               wrist               splints,               gauze,               needles,               and               other               types               of               supplies.
               Context               and               Stakeholders               
               
               First,               the               organization               is               established               as               a               Federally               Qualified               Health               Center               that               receives               a               grant               from               the               Department               of               Health               and               Human               Resources               in               the               amount               of               $1.6               million               dollars               every               April               1st.

The               grant               allows               the               organization               to               provide               healthcare               services               to               low               income               people               based               on               a               sliding               scale               fee               in               relation               to               their               monthly               income.

Second,               the               providers               that               are               employed               by               the               organization               are               not               responsible               for               medical               malpractice               insurance               because               they               are               covered               by               the               Federal               Tort               Coverage               Act.

The               government               covers               all               lawsuits               in               relation               to               receiving               medical               care               at               any               of               the               nine               locations               that               Community               Health               Systems,               Inc.

operates.
               One               of               the               stakeholders               of               the               organization               is               the               government.

It               provides               grant               money               to               offer               healthcare               to               the               underserved               population.

Second,               citizens               that               need               healthcare               are               stakeholders               because               of               the               many               different               payment               plans               that               are               available               based               on               household               income.

Third,               employees               of               the               organization               may               benefit               from               this               research               because               they               help               the               organization               carry               out               the               mission               and               the               vision.

The               last               stakeholder               of               the               organization               is               the               community               in               which               the               company               operates               because               it               brings               low-cost               healthcare               and               jobs.
               Affecting               Issues               
               
               Organizations               that               are               affected               by               the               issues               are               other               local               durable               medical               equipment               businesses               within               the               location               that               Community               Health               Systems,               Inc               operates.

Patient               services               are               also               affected               by               the               issues               because               their               care               is               controlled               within               the               Community               Health               Systems,               Inc.

frame               of               business               and               their               providers               are               writing               prescriptions               to               an               entity               of               this               organization               if               the               management               team               decides               to               move               forward               with               pursuing               the               durable               medical               equipment               market.

The               organization's               strategic               plan               is               affected               because               this               is               a               market               that               has               never               been               in               discussion               as               a               future               service               of               the               organization.
               Purpose               
               
               The               purpose               of               this               research               is               to               determine               the               feasibility               of               expanding               services               into               the               durable               equipment               market.
               Significance               
               
               The               information               gave               the               management               team               of               Community               Health               Systems,               Inc.

a               broad               overview               of               the               potential               or               exclusion               of               such               a               project.

The               researcher               investigated               all               possible               revenue               streams               related               to               the               durable               equipment               market.

This               allowed               the               Community               Health               Systems               team               to               see               how               other               organizations               operate               within               this               market.

The               organizational               impact               of               the               project               had               been               creating               an               additional               revenue               stream               for               the               organization               and               creating               more               jobs               within               the               local               community.
               Content               
               
               The               researcher               constructed               the               following               sections               of               the               research;               focus               and               framing,               literature               review,               methodology,               constructing               accounts,               and               plan               of               action.

The               focus/framing               section               gave               a               brief               overview               of               what               Community               Health               Systems,               Inc.

is               made               up               of               in               structure.

The               literature               explored               what               others               are               saying               about               the               durable               equipment               market,               reimbursement               rates,               forms,               and               other               policies               that               are               compromised               of               this               particular               venture.

The               methodology               section               provided               a               detailed               plan               in               how               the               research               project               had               been               carried               out.

The               constructing               accounts               section               told               the               stories               of               the               stakeholders               and               their               viewpoints               in               relation               to               the               study.

The               plan               of               action               section               demonstrates               the               steps               the               researcher               took               in               the               project               based               on               recommendations               from               the               management               team               of               Community               Health               Systems,               Inc.

In               the               financial               section               of               this               project               the               researcher               constructed               data               based               on               information               gathered               from               various               sources               and               showed               what               the               potential               profit               is               based               on               what               the               insurance               carriers               pay.
               Leadership               Model               
               
               The               researcher               used               the               change               theory               method               of               leadership               in               showing               others               the               possibilities               of               offering               durable               medical               equipment               within               their               established               scope               of               business.

Change               theory               is               about               motivating               others               to               help               the               organization               with               its               mission               and               vision.

Servant               leadership               was               a               key               part               of               the               model               because               the               researcher               worked               with               others               and               encouraged               everyone               to               be               participative               and               to               give               feedback.

The               researcher               acted               as               the               project               manager               and               moved               the               whole               research               from               the               start               to               the               finish.
               Literature               Review
               What               others               say               is               happening
               The               Durable               Medical               Equipment               (DME)               market               has               seen               dramatic               changes               year               after               year               and               regulations               from               insurance               providers               will               continue               to               add               new               laws               to               curb               abuse               and               waste.

According               to               Senator               Chuck               Grassley,               "Fraud,               waste,               and               abuse               are               enemies               of               the               health               care               system"               (Kozeny,               1997,               para.

6).

Healthcare               costs               are               always               rising               and               it               doesn't               help               when               the               insurance               carriers               have               to               keep               strict               guidelines               for               reimbursement               because               of               abuse               and               fraud.

The               negative               side               of               the               business               has               pushed               Medicare               and               Medicaid               to               tighten               controls               on               what               equipment               they               paid               for               as               a               result               of               fraudulent               claims               by               durable               medical               businesses.

Citizens               Against               Government               Waste               (1997)               gives               the               following               fraud               examples               as               cases               against               DME               providers:
               As               part               of               a               plea               bargain               agreement,               a               Texas               DME               company               paid               restitution               of               $450,000               and               was               sentenced               to               one               year               probation               for               supplying               wheel               chair               pads               to               nursing               home               patients               and               then               fraudulently               billing               Medicare               for               a               more               expensive               lumbar               sacral               support               system.
               A               Pennsylvania               DME               company               agreed               to               pay               $110,000               to               settle               criminal               and               civil               liabilities               for               submitting               false               claims               to               Medicare               for               marketing               and               distributing               lower-quality               body               jackets               to               long-term               care               facilities               than               those               actually               delivered.

The               company               and               its               president               were               barred               for               life               from               participation               in               any               HHS               programs.
               A               physician               fled               to               the               Dominican               Republic               and               his               cohort               in               crime               fled               to               Sierra               Leone               for               preparing               and               signing               fraudulent               certificates               of               medical               necessity               for               DME.

A               New               York               judge               sentenced               the               Dominican               refugee               in               absentia               to               78               months               in               prison               and               ordered               him               to               pay               $3.5               million.

His               partner               waived               extradition               to               return               to               the               United               States.
               A               New               York               DME               company               used               a               sham               subsidiary               to               submit               claims               in               Pennsylvania               for               equipment               sold               in               Western               New               York.

In               addition               to               a               criminal               fine               of               $300,000,               the               subsidiary               also               pled               guilty               and               agreed               to               make               full               restitution               of               $1.1               million               and               to               pay               a               civil               penalty               of               $2.5               million.
               These               fraudulent               schemes               of               durable               medical               equipment               businesses               have               contributed               to               the               strict               guidelines               for               reimbursement.

Insurance               companies               also               play               into               the               political               side               of               the               business               in               delaying               claims               for               payment               because               additional               information               may               be               needed.

These               examples               show               that               employees               will               be               required               to               keep               everything               documented               and               organized               in               case               of               an               audit               by               an               insurance               carrier.
               Insurance               fraud               is               a               continuous               battle               with               durable               medical               equipment               businesses.

For               example,               Senator               William               Cohen               of               Maine               explained               how               Medicare               beneficiaries               are               recipients               of               fraud.

He               said               that               a               supplier               paid               $28.57               for               a               mattress               that               was               supposed               to               prevent               sores               and               billed               Medicare               for               $1,132.

Medicare               paid               $943               of               the               price               and               the               rest               was               left               for               the               customer               to               pay               (The               Intelligencer,               1991,               p.

c-15).
               According               to               Center               for               Medicare               &               Medicaid               (1998)               they               have               implemented               new               guidelines               for               businesses               that               operate               as               a               durable               medical               equipment               supplier               that               states               the               following               requirements:
               Under               the               regulation               published               today,               suppliers               of               DME               (including               wheelchairs,               canes,               and               other               medical               supplies)               would               be               required               to               obtain               surety               bonds               of               at               least               $50,000.

In               addition,               the               proposed               regulation               would               ban               DME               supplier               telemarketing;               require               suppliers               to               have               a               physical               office               and               listed               phone               number;               codify               a               requirement               that               suppliers               reenroll               in               Medicare               every               three               years;               prohibit               suppliers               from               reassigning               a               supplier               number;               and               apply               criminal               and               civil               sanctions               for               misrepresentations               on               billing               number               applications               (para.

2).
               One               new               major               reform               of               the               durable               medical               equipment               is               that               Medicare               is               proposing               a               competitive               bidding               program               for               suppliers.

Senior               Journal.Com               (2006)               states               the               following               proposal:
               The               new               competitive               acquisition               program,               which               is               required               by               the               Medicare               Modernization               Act               of               2003               (MMA),               would               replace               the               current               DMEPOS               fee               schedule               payment               amounts               for               selected               items               in               select               areas.

CMS               has               discretion               under               the               law               to               first               phase               in               DMEPOS               items               for               bidding               based               on               high               cost               and               volume               or               largest               savings               potential.

Suppliers               in               a               competitive               bidding               area               would               submit               bids               for               selected               items,               and               CMS               would               use               these               bids               to               establish               Medicare               payment               amounts               for               these               items.

Under               the               proposed               rule,               the               Medicare               payment               amounts               would               be               the               median               of               the               winning               suppliers'               bids               for               selected               items               (para.

5-6).
               Payment               policies               for               most               insurance               providers               are               based               on               what               the               Federal               Government               reimburses               businesses               for               services               and               supplies.

According               to               Medicare.gov               (n.d.)               the               payment               method               that               is               established               is               called               assignment               which               is               an               agreement               between               Medicare               and               doctors,               other               health               care               providers,               and               suppliers               of               health               care               equipment               and               supplies               (wheelchairs,               oxygen,               braces,               and               ostomy               supplies).

Doctors,               providers,               and               suppliers               who               agree               to               accept               assignment               accept               the               Medicare-approved               amount               as               full               payment.

The               patient               pays               the               coinsurance               (usually               20               percent               of               the               approved               amount)               and               deductible               amounts.
               West               Virginia               has               several               requirements               on               top               of               what               Medicare               has               established               as               policies               of               opening               a               Durable               Medical               Equipment               (DME)               business.

The               State               requires               businesses               to               have               a               valid               business               license;               a               physical               store               location,               within               a               30-mile               radius               of               WV               borders;               be               handicapped               accessible               and               be               able               to               show               detailed               records               of               all               customers               serviced               by               the               organization.

West               Virginia's               government               does               random               audits               of               billing               from               DME               companies.

The               Medicaid               program               of               WV               has               the               same               guidelines               as               Medicare               in               requiring               providers               to               write               a               prescription               for               medical               necessity               for               durable               medical               equipment               (State               of               West               Virginia               Department               of               Health               and               Human               Resource,               2002).
               Future
               The               future               of               the               durable               medical               equipment               market               is               going               to               grow               as               the               baby               boomers               start               to               age.

Baby               boomers               are               those               citizens               that               were               born               between               1946               and               1964               in               the               United               States.

The               Great               American               Group               (2004)               states               "As               our               nation's               baby               boom               generation               moves               further               into               retirement               age,               and               as               life               expectancies               continue               to               expand,               the               need               for               medical               equipment               will               grow               exponentially"               (para.

1).

D.R.

Clark               (2006)               gives               the               following               outlook:
               Investors               in               biotech               and               many               other               healthcare               concerns               are               often               relegated               to               distant               investment               time               horizons,               requiring               the               biblical               patience               of               Job.

But               healthcare's               conservative               kissin'               cousin,               durable               medical               equipment               (DME),               shouldn't               be               overlooked               with               the               massive               throng               of               baby               boomers               in               need               of               'replacement               parts.'               DME,               which               generally               lacks               the               FDA               hurdles               associated               with               biotech,               may               indeed               hold               greater               immediate               promise               for               investors               Excite               Money               and               Investments               (2006).
               Consistent               with               this               claim,               there               seems               to               be               room               for               growth               in               Beckley,               West               Virginia.

Robert               Butcher,               the               Pharmacy               Director               of               Access               Health               Pharmacy,               stated               that               Eppy's               Drug               store               located               in               Beckley,               WV               does               most               of               their               business               by               selling               durable               medical               equipment.

He               said               most               of               the               sales               of               this               type               of               business               is               a               cash               business               and               provides               extra               revenue               for               the               company.

He               mentioned               that               the               service               could               be               easily               implemented               within               the               current               pharmacy               services               that               are               provided               by               Community               Health               Systems.

In               regard               to               Eppy's               Drugs,               he               mentioned               that               he               felt               like               most               of               their               income               was               from               the               home               health               side               of               the               business               and               less               from               filling               prescriptions.

(Personal               interview,               June               3,               2006).
               The               future               of               healthcare               is               only               going               to               keep               getting               more               expensive.

Federally               qualified               health               centers               have               the               chance               now               to               make               a               dramatic               change               to               healthcare               within               the               United               States.

These               organizations               are               allowed               to               offer               discounted               medical               care               to               the               underserved               population.

The               President               of               the               United               States               stated               "I               support               increasing               the               number               of               community               health               centers               across               America.

Community               health               centers               are               community-owned,               locally               administered               medical               clinics               where               people               can               receive               preventive               care,               free               vaccine               clinics,               health               alerts,               disease               screening,               and               counseling.

They               have               become               America's               health               care               safety               net.

Under               my               plan,               we               would               provide               $3.6               billion               in               federal               money               over               a               five-year               period               to               create               1,200               new               centers               from               coast               to               coast"               (USA               Today,               2000).
               Apropo               Benefits               Management               states               that               "Looking               ahead,               as               the               aging               of               baby               boomers               affect               the               utilization               of               DME               benefits,               it's               estimated               that               the               current               $6               billion               spent               on               this               population               alone               for               DME               services               will               nearly               double               over               the               next               three               decades"               (Apropo               Benefits               Management,               n.d.,               para.4).

This               leads               to               the               fact               that               baby               boomers               are               going               to               need               these               items               to               function               in               daily               living.

Companies               that               capitalize               on               this               market               will               people               function               as               normal               as               possible               with               the               use               of               advanced               technology               in               the               durable               equipment               market.
               According               to               Joe               Flower               (1996),               the               future               of               healthcare               around               the               world               will               be               based               on               the               following               four               changes.

First,               healthcare               communications               will               drive               future               healthcare               with               the               wide               array               of               advances               such               as               satellites,               online               forums,               and               medical               imaging               equipment.

Second,               outcomes               management               will               drive               healthcare.

Doctors               and               individuals               will               be               scanning               millions               of               past               occurrences               to               determine               what               therapies               have               worked               in               the               past.

The               other               part               of               this               system               in               called               "expert               systems"               which               will               help               doctors               diagnose               and               treat               patients               more               effectively.

The               third               change               in               health               care               will               focus               on               the               care               of               patients.

Patients               will               be               moved               out               of               hospitals               and               back               to               clinics,               doctors'               offices,               patient               homes,               and               schools.

Finally,               the               focus               on               population               health               will               change               health               care.

Citizens               will               be               able               to               prevent               a               lot               of               medical               problems               by               curbing               environmental               issues,               drinking,               smoking               and               other               things               that               cause               health               related               issues.
               In               addition,               there               are               two               major               trends               in               the               United               States               that               are               changing               the               healthcare               system:               restructuring               and               reform.

Restructuring               is               where               hospitals               will               be               closing               as               patient               care               moves               to               clinics               and               other               doctors.

The               reform               trend               is               where               government               will               step               in               to               help               control               healthcare               costs.

At               the               present               time,               the               reform               movement               is               on               the               local               and               state               level               where               research               is               being               conducted               to               determine               if               they               can               reduce               healthcare               cost               and               help               the               patients               maintain               a               healthy               lifestyle               (Flower,               1996).
               What               has               been               done               in               similar               situations?
               A               company               located               in               Ohio               called               Progressive               Medical,               Inc.

started               out               in               1986               offering               electromedical               equipment               and               medical               supplies.

In               1990               they               saw               the               need               to               expand               services               and               started               offering               durable               medical               equipment.

In               1996               they               expanded               again               by               opening               a               pharmacy               that               offered               home               delivery               service               to               its               patient               base.

The               company               is               considered               a               managed               care               cost               containment               company               where               they               provide               services               to               the               community               in               which               they               live               (Progressive               Medical,               2006).
               According               to               Pharmacy               Times               (2005),               pharmacy               services               and               home               health               care               work               well               together.

Pharmacists               know               their               patients               better               than               most               other               healthcare               providers               and               can               help               decide               what               equipment               they               might               need.

This               service               offers               the               patient               the               convenience               of               simple               billing,               one-stop               shopping,               and               a               friendly               face.

Pharmacy               Times               states               that               "DME               sales               will               grow               between               18-21               billion               by               2008"               (Wertheimer,               Chaney,               Santella,               Popomaronis,               &               Mick,               2005).
               The               trend               of               combining               pharmacy               services               with               home               health               care               products               is               growing.

Companies               are               seeing               that               people               are               getting               older               and               that               they               need               products               that               help               them               function               throughout               the               day.

Implementing               durable               medical               equipment               as               an               add-on               service               offers               companies               an               opportunity               to               create               additional               revenue               sources               with               out               much               overhead               by               combining               these               services.

Durable               medical               equipment               is               going               to               become               a               big               business               as               more               and               more               technology               advances               occur               to               help               people               function               better               in               their               daily               lives.
               Walgreens               Pharmacy               is               seeing               the               future               of               home               health               care               products               and               has               expanded               its               services               to               offer               respiratory               services,               home               infusion               services,               and               home               medical               equipment.

By               providing               these               services               it               allows               the               pharmacist               to               offer               better               patient               monitoring               and               education               about               the               products               that               the               company               provides               to               customers.

The               overall               goal               of               Walgreens               is               to               offer               cost-containment               solutions,               benefit               coordination,               and               account               management               for               their               customers               (Walgreens               Pharmacy,               2006).
               According               to               Mickey               Plunkett,               a               sales               representative               for               Physician               Sales               &               Service               that               sells               medical               supplies               and               equipment,               more               and               more               clinics               are               implementing               the               selling               of               durable               medical               equipment               and               supplies               as               an               extra               revenue               source               that               requires               little               overhead.

He               mentioned               that               he               can               wholesale               all               the               types               of               supplies               required               for               this               business.

By               adding               durable               medical               equipment               the               company's               providers               can               write               the               prescription               for               the               patient               to               receive               the               product               and               they               can               obtain               it               immediately               within               the               clinic's               location.

By               already               operating               a               free               standing               clinic               the               paperwork               to               get               started               for               this               business               is               minimal               and               can               be               implemented               within               a               matter               of               days               (Personal               interview,               June               10,               2006).
               The               trend               seems               to               be               that               more               and               more               major               retailers               are               combining               the               add-on               service               of               Durable               Medical               Equipment               (DME).

According               to               Smith,               "by               providing               DME               to               patients,               hospital               pharmacies               can               realize               substantial               net               income               while               improving               continuity               of               patient               care"               (Smith               and               Popilarski,               n.d.,               para.

1).

This               reduces               overhead               and               is               easily               implemented               with               services               already               being               offered               to               patients.
               Clearly,               the               research               shows               that               combining               durable               medical               equipment               with               existing               services               is               very               beneficial               for               the               company               and               patients.

Patients'               care               can               be               better               managed               by               their               healthcare               provider               if               everything               can               be               controlled               within               one               location.

The               major               drawback               of               implementing               this               service               is               the               strict               guidelines               that               most               insurance               carriers               require.

However,               the               overall               benefits               outweigh               the               negatives               and               help               the               patient               live               a               comfortable               life.
               Organizational               Buy-In
               The               management               team               of               Community               Health               Systems,               Inc.

wants               to               see               the               financial               projections               of               the               revenue               potential               of               this               type               of               business.

Given               the               financial               impact               of               such               an               expansion,               they               are               committed               to               the               research.

Employees               of               the               organization               are               committed               to               providing               quality               healthcare               to               the               patients               of               southern               West               Virginia.

The               board               of               directors               of               Community               Health               Systems,               Inc.

is               very               interested               in               offering               this               type               of               service               because               they               know               that               the               majority               of               patients               are               elderly               and               need               durable               medical               equipment               to               function.

The               community               as               a               stakeholder               would               benefit               because               the               company               helps               lower               healthcare               costs               and               provides               services               that               are               needed               within               the               area.
               Making               this               type               of               business               a               success               requires               leadership               that               has               a               vision               of               where               they               want               to               go               and               a               mission               to               create               customer               value.

Strategic               Leadership               is               essential               because               it               allows               people               to               demonstrate               the               potential               of               something               and               create               a               learning               environment.

This               would               be               a               great               opportunity               for               the               organization               to               allow               people               within               the               organization               to               step               up               and               take               a               leadership               role               in               operating               a               business               such               as               the               durable               medical               equipment.

If               the               organization               decides               to               operate               this               type               of               business               they               need               to               make               sure               it               balances               with               the               goals               of               the               organization.

Businesses               are               designed               for               one               thing               and               that               is               to               impact               the               bottom               line               and               operating               without               a               clear               focus               will               end               in               failure.
               Methodology
               Methodological               Assumptions
               Based               upon               the               researcher's               experience,               a               number               of               assumptions               made               in               regard               to               this               project.

First,               the               researcher               assumed               that               a               lot               of               policies               would               have               to               be               reviewed               to               make               sure               the               key               components               of               opening               this               type               of               business               were               examined.

Second,               the               researcher               assumed               that               the               durable               medical               equipment               field               is               heavily               saturated.

However,               the               researcher               believed               that               this               type               of               business               could               be               a               success               for               the               organization               as               long               as               the               management               team               has               committed               to               providing               the               necessary               funds               to               implement               this               business               model.

Finally,               the               researcher               understood               that               researching               this               type               of               business               field               would               be               cumbersome.

A               number               of               challenges               were               met               in               preparing               a               document               that               is               comprehensive               and               beneficial               to               the               management               team               of               Community               Health               System,               Inc.
               The               action               research               process               of               this               project               was               identifying               the               problem               which               consisted               of               determining               the               feasibility               of               adding               a               durable               medical               equipment               business               to               existing               services.

The               second               step               was               taking               a               course               of               action               that               consists               of               researching               what               others               have               done               and               the               potential               benefits               of               such               a               business.

The               third               step               of               action               was               taking               action               on               the               purpose               which               was               determining               the               feasibility               of               the               durable               medical               equipment               market.

This               step               determines               how               to               start               the               business               and               what               is               needed               to               get               the               business               opened.

The               fourth               step               of               action               was               evaluating               the               steps               of               action               the               researcher               implemented               previously               to               determine               if               he/she               is               on               the               right               path.

Finally,               the               last               steps               of               action               was               identifying               the               findings               and               reflecting               on               each               section               of               the               project               to               learn               and               determine               if               something               could               be               done               a               different               way.
               The               facilitator               chose               action               research               to               use               because               it               involves               participatory               hands-on               learning.

According               to               R.

O'Brien               (1998),               "Action               research               is               used               in               real               situations,               rather               than               in               contrived,               experimental               studies,               since               its               primary               focus               is               on               solving               real               problems               (para.

14).

This               method               of               research               provided               the               researcher               with               valuable               information               by               working               with               the               management               team,               employees,               customers,               and               state               agencies               in               finding               information               about               the               durable               medical               equipment               market.

Coghlan               and               Brannick               (2005)               states               that               "Action               research               has               been               traditionally               defined               as               an               approach               to               research               which               is               based               on               a               collaborative               problem-solving               relationship               between               researcher               and               client               which               aims               at               both               solving               a               problem               and               generating               new               knowledge"               (p.

9).
               This               method               worked               well               for               the               facilitator               in               working               with               the               management               team               in               learning               about               the               subject               of               this               project.

Literature               information               was               reviewed               and               analyzed,               so               that               it               could               be               interpreted               into               actual               facts               and               presented               within               this               report.

Action               research               allowed               the               facilitator               to               put               the               findings               into               action               and               learn               from               each               step               within               the               action               research               model.
               Research               Processes
               The               first               step               of               action               was               gathering               information               from               the               meeting               with               the               management               team               to               determine               what               products               they               wanted               the               facilitator               to               explore.

Second,               after               gathering               the               information,               the               researcher               prepared               the               surveys.

One               survey               was               designed               for               the               patients               and               the               other               was               designed               for               the               providers               of               Community               Health               System,               Inc.

The               patient               survey               was               distributed               among               the               nine               locations               that               the               organization               operates.

The               receptionists               at               these               locations               had               instructed               the               patients               to               fill               out               the               brief               survey.

The               survey               was               given               to               all               patients               for               a               one               week               period.

The               researcher               hand               delivered               the               provider               surveys               and               asked               them               to               fill               it               out               and               send               it               to               the               administrative               offices               after               completion               to               keep               them               separate               from               the               patient               survey.
               When               this               information               was               gathered               the               researcher               prepared               a               graph               of               the               findings               and               presented               the               findings               to               the               management               team               of               the               organization.

At               this               point,               the               researcher               asked               the               company               to               purchase               CPT               and               ICD-9               coding               books,               so               that               the               researcher               could               find               the               billing               codes               for               durable               medical               equipment               to               move               the               project               ahead.

CPT               stands               for               current               procedural               terminology               and               each               service               has               a               five               digit               billing               code               used               by               insurance               companies               to               determine               what               the               patient               had               performed               by               the               physician               and               what               services               the               insurance               is               being               billed.

This               list               of               numbers               is               maintained               by               the               American               Medical               Association               and               is               used               for               billing               codes               for               services               rendered               (http://en.wikipedia.org/wiki/Current_Procedural_Terminology).

The               ICD-9               coding               book               stands               for               International               Statistical               Classification               of               Diseases               and               Related               Health               Problems.

It               is               published               by               the               World               Health               Organization               and               is               used               world-wide               for               morbidity               and               mortality               statistics,               reimbursement               systems,               and               automated               decision               support               in               medicine               (http://en.wikipedia.org/wiki/ICD-9).

These               two               books               gave               the               researcher               the               information               to               start               looking               for               payment               rates               established               by               the               health               care               insurances               to               determine               their               rate               of               payment               for               services               related               to               the               durable               medical               equipment               market.

The               researcher               had               built               the               financial               section               of               the               project               using               the               most               common               durable               medical               equipment               used.

Those               items               were               calculated               to               determine               the               potential               profit.

The               researcher               used               the               following               insurances               as               guidelines               when               calculating               potential               revenue               from               durable               medical               equipment:               Medicare,               Medicaid,               Blue               Cross/BlueShield,               Benefit               Plan               Administrators,               Accordia,               and               Aetna.

These               insurances               make               up               most               of               Community               Health               Systems               patient               base.

For               patients               that               don't               have               insurance,               the               researcher               established               pricing               schedules               based               on               the               sliding               scale               fee               established               by               Community               Health               Systems,               Inc.

The               rate               is               broken               down               into               the               following               five               categories               20%,               40%,               60%,               80%,               and               100%               based               on               household               income.

If               the               price               required               is               less               than               what               the               organization               pays               for               the               product,               then               a               markup               of               10%               was               added               to               the               item               and               was               considered               a               cash               only               sale               for               the               product.

The               next               step               in               the               research               involved               contacting               vendors               and               gathering               information               on               the               wholesale               price               of               the               equipment               and               supplies               that               make               up               the               durable               equipment               business.

Based               on               this               information               the               researcher               prepared               financial               data               that               was               relevant               to               the               purpose               of               the               project.

Microsoft               Excel               sheets               were               used               for               formulating               the               financial               projections.
               Rigor
               The               researcher               was               presented               with               a               number               of               challenges.

First,               it               was               difficult               to               find               accurate               payment               rates               from               insurances               in               relation               to               the               durable               equipment               market.

The               researcher               was               interacting               with               employees               and               patients               to               find               information               that               was               useful               for               the               management               team               and               the               research               project               of               durable               medical               equipment.

Second,               gathering               the               surveys               from               the               receptionist               at               all               nine               locations               was               challenging.

It               was               important               for               the               receptionist               to               understand               that               each               patient               checking               in               must               be               given               a               survey               and               that               the               surveys               must               be               returned               once               they               left.

The               patient               survey               captured               only               a               weeks               worth               of               patients               and               did               not               reach               the               entire               patient               base               of               the               organization.

Putting               all               the               findings               into               a               report               that               is               useful               and               beneficial               was               challenging               and               required               the               researcher               to               spend               a               lot               of               time               researching,               writing,               and               constructing               each               section               of               the               project.

Presenting               the               findings               to               the               management               team               required               a               lot               of               leadership               in               conveying               the               evidence               of               the               project.
               Ethical               Issues
               The               first               ethical               issue               that               the               researcher               was               faced               with               was               keeping               all               information               confidential               until               time               to               release               the               financial               projections               to               the               management               team.

The               second               ethical               issue               was               assuring               all               participants               that               their               names               will               not               be               included               in               the               research               and               that               their               confidentiality               was               protected.

The               third               issue               was               preparing               financial               projections               that               were               accurate               and               presenting               them               to               the               management               team.

Finally,               the               researcher               was               prepared               to               take               criticism               on               the               findings               and               was               prepared               to               back               up               findings               with               data.
               Constructing               Accounts
               Setting               the               Scene
               Community               Health               Systems,               Inc               was               looking               for               revenue               projections               and               the               feasibility               of               the               Durable               Medical               Equipment               market.

The               facilitator               provided               financial               analysis               and               it               showed               the               potential               reimbursement               rate               of               the               business               opportunity.

The               facilitator               guided               members               of               the               organization               in               formulating               a               plan               of               action               that               is               consistent               with               the               business               scope               of               the               organization.
               Constructing               Accounts
               The               facilitator               provide               two               surveys,               one               for               the               patients               and               one               to               the               providers               of               Community               Health               Systems,               Inc.

The               patient's               surveys               shown               that               they               would               like               to               purchase               Durable               Medical               Equipment               as               they               see               their               provider               for               an               office               visit.

This               eliminates               the               worry               for               them               about               having               to               deal               with               paperwork               and               more               than               one               provider.

The               providers               expressed               interest               in               how               much               time               would               be               saved               by               offering               Durable               Medical               Equipment               with               current               services.

The               provider's               survey               showed               that               they               average               about               five               patients               a               week               for               referral               services               to               other               Durable               Medical               Equipment               businesses.

The               facilitator               translates               that               information               into               fifty-five               patients               a               week               getting               referred               to               other               organizations               that               provide               this               type               of               service.

The               surveys               showed               that               the               time               required               for               paperwork               referrals               would               be               decreased               and               allow               the               nursing               and               provider               staff               more               time               to               see               other               patients.

The               patient               buy-in               was               exceptional               from               the               sixty-three               surveys               returned               because               they               want               to               purchase               low-cost               products.

Community               Health               Systems,               Inc.

can               offer               the               items               at               a               low-cost               because               of               the               purchasing               contracts               that               in               place               with               the               federal               government.

The               sliding               scale               financials               for               people               that               do               not               have               insurance               showed               that               the               company               can               still               make               a               profit               by               providing               these               types               of               products.
               The               facilitator               gathered               statistics               on               the               state               of               West               Virginia               and               it               showed               that               West               Virginia               is               an               older               generation               of               citizens.

According               to               West               Virginia               Health               Statistics               Center               (2003),               "The               Graying               of               America               has               begun               in               West               Virginia.

Compared               to               343,156               people               aged               45-64               in               1950,               there               were               455,282               in               2000.

The               population               of               residents               aged               65-74               increased               from               94,833               to               148,463.

However,               the               number               of               people               aged               75               and               older               has               nearly               tripled,               from               42,896               to               128,432"               (para.

4).

This               is               strategic               opportunity               for               the               organization               to               capitalize               on               and               provide               products               to               the               patients.
               In               the               survey               process,               the               facilitator               used               the               servant               leadership               style               model               of               leadership               to               allow               others               to               voice               their               ideas               and               suggestions               in               relation               to               the               durable               medical               equipment               market.

The               facilitator               provided               guidance               and               worked               as               a               team               member               with               other               employees               in               determining               the               scope               of               the               durable               medical               equipment               market.

This               was               how               the               facilitator               built               relationships               with               the               participants,               so               that               the               strategic               plans               of               the               organization               can               be               achieved               by               having               energized               leaders               to               carry               out               the               potential               of               an               idea               or               suggestion.
               The               personal               interviews               related               to               the               project               provided               a               great               deal               of               information               about               the               durable               medical               equipment               market.

Charles               Hunt,               CEO               of               Community               Health               Systems,               Inc               provided               the               guidance               in               what               the               organization               was               wanting               out               of               the               research               in               previous               communications.

The               facilitator               then               contacted               patients               and               providers               using               a               survey.

From               the               information               received               the               facilitator               recognized               that               there               was               organizational               buy-in.
               The               main               portion               of               the               project               was               establishing               Microsoft               Excel               spreadsheets               of               the               potential               profit               of               each               item.

The               first               projection               was               established               for               people               that               had               insurance               coverage.

It               showed               the               potential               reimbursement               rate               that               the               insurance               carriers               would               reimburse               an               organization               for               in               regard               to               a               certain               product.

The               second               set               of               financial               projections               was               established               for               people               that               had               no               insurance               coverage,               but               based               on               the               sliding               scale               fee               structure.

This               was               the               key               part               that               the               management               team               of               Community               Health               Systems,               Inc.

was               looking               for               to               see               what               type               of               products               offered               the               biggest               return               on               investment.
               Epiphanies
               The               facilitator               special               moment               in               the               project               came               at               the               beginning               of               the               research               process.

The               facilitator               was               researching               and               finding               nothing               about               durable               medical               equipment               except               policies.

The               facilitator               then               shifted               the               frame               and               focus               and               looked               for               trends               related               to               durable               medical               equipment.

The               trends               showed               how               the               baby               boomer               generation               was               growing               and               the               needs               that               were               going               to               be               needed               in               relation               to               the               healthcare               field.

The               statistics               for               this               generation               show               that               the               needs               for               durable               medical               equipment               products               are               going               to               be               at               an               all-time               high               in               the               future.

The               evidence               clearly               show               that               people               are               going               to               live               longer               lives,               but               will               need               products               to               help               them               function               as               normal               as               possible.
               Constructing               General               Accounts
               The               researcher               discovered               trends               that               point               to               the               future               of               the               durable               medical               equipment               market.

The               most               notable               trend               in               relation               to               the               overall               healthcare               market               is               the               aging               of               baby               boomers.

The               older               generation               of               adults               is               going               to               need               products               and               supplies               that               allow               them               to               function               in               society.

The               research               show               that               most               older               citizens               are               going               to               need               mobility               products               that               allow               them               to               use               their               head,               arms,               body,               and               legs               to               function               as               best               as               possible.
               The               management               team               was               looking               at               profit               potential               of               products               and               the               facilitator               provided               financial               projections               that               show               what               the               potential               is               for               each               item.

The               research               shows               that               start-up               costs               are               minimal               since               the               services               can               be               added               on               with               current               pharmacy               services.

The               main               cost               to               the               organization               is               initial               inventory               costs               and               this               was               discussed               with               providers               in               what               products               receive               the               most               referrals.
               Contextualizing
               Summary               of               Outcomes
               The               facilitator's               experience               was               a               learning               opportunity               that               required               interaction               with               the               employees               and               patients.

The               providers               were               excited               that               the               management               team               wanted               their               input               on               the               potential               of               offering               durable               medical               equipment.

The               employees               were               excited               because               they               felt               like               they               were               owners               within               the               organization.

Patients               were               very               excited               since               they               would               be               able               to               purchase               items               at               a               low               cost               and               not               have               to               worry               about               all               the               paperwork               requirements.

Just               by               doing               the               surveys               the               facilitator               notes               that               a               lot               of               time               would               be               saved               and               could               be               used               on               more               productive               activities               by               not               filling               out               referral               paperwork.

This               would               provide               more               time               with               the               providers               to               spend               with               their               patients.

Nursing               staff               would               not               have               to               get               everything               together               to               send               with               the               referral               paperwork.
               The               evidence               shows               that               the               market               potential               for               durable               medical               equipment               market               is               there.

The               organization               is               in               a               position               to               offer               the               service               without               much               up-front               overhead.

The               statistics               on               West               Virginia               shows               that               the               population               is               consisted               up               mostly               of               older               people.
               The               stakeholders               viewpoints               is               that               there               is               a               market               for               durable               medical               equipment               within               the               business               scope               of               Community               Health               Systems,               Inc.

The               research               shows               the               majority               age               group               of               West               Virginias               is               old               and               need               this               type               of               service               at               a               low               cost.

The               personal               communication               that               the               facilitator               had               with               the               Pharmacy               Director,               showed               that               he               was               right               in               stating               that               adding               the               service               with               existing               pharmacy               services               would               not               cost               a               lot               and               could               provide               an               additional               revenue               stream               for               the               organization.

The               organizations               major               stakeholder               the               United               States               Government               would               benefit               the               most               since               this               is               a               big               part               of               the               Presidents               plan               to               give               more               grant               money               to               community               health               centers.

The               governments               plan               is               to               shift               more               money               and               resources               to               these               types               of               businesses               to               help               people               save               on               money               for               doctor's               visits               and               prescription               drugs.
               The               implications               of               the               study               on               the               policies               within               the               organization               would               require               a               step-by-step               procedure               to               be               written               to               show               the               providers               how               to               refer               the               patients               to               the               pharmacy               to               receive               their               products.

The               services               that               would               be               affected               would               be               the               pharmacy               because               they               would               need               to               be               training               on               what               requires               a               prescription               and               what               does               not               require               a               prescription.

The               management               team               would               have               to               update               their               strategic               plan               to               include               durable               medical               equipment               into               the               company's               range               of               services.

The               facilitator               notes               that               there               are               no               major               implications               by               the               outcomes               of               this               research.
               Plan               of               Action
               The               facilitator               would               recommend               the               organization               to               expand               into               the               durable               medical               equipment               market               because               of               the               potential               and               low-cost               investment.

The               organization               can               test               the               market               to               see               if               the               potential               is               really               there               as               the               research               had               shows.

The               facilitator               would               then               recommend               an               advertising               campaign               in               all               clinics               associated               with               the               organization               to               inform               patients               of               the               new               expansion               of               service.

The               management               team               should               select               a               person               that               can               lead               this               project.

This               step               is               important               because               he/she               will               build               a               team               that               has               a               common               goal.

This               person               would               be               the               contact               for               employees               and               patients               in               determining               the               needs               of               each               group.

This               person               would               then               work               with               the               pharmacy               staff               to               determine               the               area               in               the               pharmacy               where               the               products               would               be               carried.

This               team               of               employees               then               would               determine               inventory               levels               to               establish               before               offering               this               service               to               the               patients.
               The               facilitator's               evaluation               of               the               plan               would               be               by               monitoring               products               sold               and               analyzing               financial               statements               monthly.

The               management               team               would               meet               with               the               leader               that               they               selected               to               make               sure               that               patients               are               informed               of               the               services               and               that               the               providers               are               referring               them               to               the               pharmacy               for               services               related               to               durable               medical               equipment.

By               doing               this               method               of               evaluation               the               management               team               would               be               able               to               determine               to               continue               the               business               or               eliminate               it               from               its               current               operations.
               The               plan               of               action               from               this               research               would               have               to               have               detailed               goals.

The               management               team               would               have               to               establish               these               to               the               business               leader               that               is               leading               the               project.

Brainstorming               sessions               could               be               used               to               formulate               advertising               plans               to               inform               the               community               about               the               services               that               the               organization               is               offering.

The               information               from               this               project               should               have               shown               management               to               let               the               employees               be               creative               in               their               jobs               and               allow               employees               to               make               suggestions               on               services               and               how               they               can               be               done               more               efficiently.

The               business               is               simple               and               easily               implemented               because               of               the               low               overhead               costs.

The               management               team               should               not               micromanage               the               opportunity,               but               give               the               project               leader               the               responsibility               to               make               it               a               success.
               The               conclusion               of               the               research               is               that               the               information               found               from               all               sources               shows               that               potential               of               durable               medical               equipment               is               established               in               the               trends               that               were               discovered               in               the               research.

The               patient               base               of               the               organization               is               older               people               that               need               these               types               of               products               now.

The               implementation               is               rather               simple               since               it               would               be               added               onto               existing               services.

The               providers               would               play               a               key               role               in               informing               their               patients               that               the               organization               offers               these               products               and               at               a               reduced               rate               than               their               competitors.

After               the               implementation               of               the               project               the               management               team               should               look               at               more               opportunities               for               expansion               that               require               little               overhead               because               it               adds               to               the               bottom               line               of               the               organization.
               Evaluation               of               Results
               The               evaluation               of               opening               this               business               would               be               to               monitor               the               financial               statements               monthly.

Talk               with               providers               and               discuss               new               products               that               need               to               be               kept               into               inventory.

The               leader               of               the               business               should               send               out               more               surveys               in               about               six               months               and               ask               how               they               are               doing               and               what               could               be               improved               to               meet               their               needs.

The               management               team               should               look               at               the               business               volume               on               a               monthly               basis               and               look               for               areas               of               improvement.
               Leadership               Elements
               The               four               key               leadership               elements               that               the               facilitator               used               were               learn,               direct,               analyze,               and               reflect.

The               facilitator               kept               an               open               ear               and               listened               to               what               the               participants               had               to               say.

The               facilitator               was               creative               in               designing               the               project               and               enjoyed               the               relationship               building               that               the               projected               allowed               to               form.

Selling               the               idea               and               research               conclusion               was               the               most               interesting               part               because               it               taught               the               facilitator               the               key               to               leadership.

You               have               to               sell               yourself               and               take               the               stage               and               perform               what               you're               required               to               do.
               References
               Apropo               Benefits               Management.

().

Durable               Medical               Equipment:               a               tough               challenge.

Retrieved               June               15,               2006,               from               http://apropobenefits.com/DMEperspective.html
               (Centerfor               Medicare               Medicaid               20               NEW               HHS               REGULATION               FIGHTS               MEDICARE               FRAUD               AND               ABUSE               AMONG               DURABLE               MEDICAL               EQUIPMENT               SUPPLIERS)Centers               for               Medicare               &               Medicaid.

(20).

New               HHS               Regulation               Fights               Medicare               Fraud               and               Abuse               among               Durable               Medical               Equipment               Suppliers.

Retrieved               June               17,               2006,               from               Centers               for               Medicare               and               Medicaid               Services               Web               Site:               http://www.cms.hhs.gov/apps/media/press/release.asp?Counter=42
               (Citizens               Against               Government               Waste               Wright               E               L               1997               Medicare               Fraud:               the               Symptoms               and               the               Cure)Citizens               Against               Government               Waste,               &               Wright,               E.

L.

(1997).

Medicare               Fraud:               the               Symptoms               and               the               Cure.

Retrieved               June               16,               2006,               from               Citizens               Against               Government               Waste               Web               Site:               http://www.cagw.org/site/PageServer?pagename=reports_medicare
               (Coghlan               D               Brannick               T               2005               Doing               Action               Research               in               your               own               Organization)Coghlan,               D.,               &               Brannick,               T.

(2005).

Doing               Action               Research               in               your               own               Organization               (2nd               ed.).

Thousand               Oaks,               CA:               Sage               Publications.
               (Excite               Money               And               Investments               28               SmallCap               Sentinel:               Could               Durable               Medical               Equipment               be               Therapeutic               for               Your               Portfolio?)Excite               Money               And               Investments.

(28).

SmallCap               Sentinel:               Could               Durable               Medical               Equipment               be               Therapeutic               for               Your               Portfolio?

Retrieved               June               15,               2006,               from               http://money.excite.com/jsp/nw/nwdt_ge.jsp?news_id=pzn-96293&feed=pzn&date=20060328
               (Flower               J               1996               Future               of               Healthcare)Flower,               J.

(1996).

The               Future               of               Healthcare.

Retrieved               June               30,               2006,               from               http://www.well.com/~bbear/healthcare_future.html
               (Great               American               Group               2004               Industry               outlook               on               Hospital               and               Medical               Equipment)Great               American               Group.

(2004).

Industry               outlook               on               Hospital               and               Medical               Equipment.

Retrieved               June               15,               2006,               from               http://www.greatamerican.com/PDF/Hospital%20&%20Medical.pdf
               (Kozeny               Jill               26               Grassley               Legislation               to               Mandate               Specific               Billing               for               Durable               Medical               Equipment)Kozeny,               Jill.

(26).

Grassley               Legislation               to               Mandate               Specific               Billing               for               Durable               Medical               Equipment.

Retrieved               June               17,               2006,               from               http://www.senate.gov/~grassley/releases/1997/pr6-26.htm
               (Medicare               bilked               into               paying               millions               for               junked               goods               10               )Medicare               bilked               into               paying               millions               for               junked               goods.

(10).

The               Intelligencer,               pp.

C-15.
               (MedicareGov               Medicare               Coverage               of               Durable               Medical               Equipment)Medicare.Gov.

().

Medicare               Coverage               of               Durable               Medical               Equipment.

Retrieved               June               29,               2006,               from               Medicare               Web               Site:               http://www.medicare.gov/Publications/Pubs/pdf/11045.pdf
               (O'Brien               R               1998               An               Overview               of               the               Methodological               Approach               of               Action               Research)O'Brien,               R.

(1998).

An               Overview               of               the               Methodological               Approach               of               Action               Research.

Retrieved               July               19,               2006,               from               University               of               Toronto               Web               Site:               http://www.web.ca/~robrien/papers/arfinal.html#_Toc26184655
               (Progressive               Medical               Inc               2006               Progressive               Medical,               Inc.)Progressive               Medical,               Inc.

(2006).

Progressive               Medical,               Inc.

Retrieved               June               30,               2006,               from               http://www.progressive-medical.com/12050.cfm
               (Senior               JournalCom               26               New               Medicare               Competitive               Bidding               Rule               Can               Save               Taxpayers               Billions)Senior               Journal.Com.

(26).

New               Medicare               Competitive               Bidding               Rule               Can               Save               Taxpayers               Billions.

Retrieved               June               17,               2006,               from               http://www.seniorjournal.com/NEWS/Medicare/6-04-24-NewMedicareCompetitive.htm
               (Smith               J               E               Popielarski               E               Hospital               Outpatient               Pharmacies               and               Durable               Medical               Equipment)Smith,               J.

E.,               &               Popielarski,               E.

().

Hospital               Outpatient               Pharmacies               and               Durable               Medical               Equipment.

Retrieved               June               14,               2006,               from               http://www.ajhp.org/cgi/content/abstract/43/4/928
               (State               Of               West               Virginia               Dhhr               1               Medicaid               Program               Instructions)State               Of               West               Virginia               Department               of               Health               and               Human               Resources               (1).

Medicaid               Program               Instructions.

Retrieved               June               16,               2006,               from               Bureau               for               Medical               Services               Web               Site:               http://www.wvdhhr.org/bms/sprog_instr/pima_files/bms_pima0228.pdf
               (Usa               Today               13               George               W.

Bush               on               Health               Care)USA               Today.

(13).

George               W.

Bush               on               Health               Care.

Retrieved               June               28,               2006,               from               George               W.

Bush               on               Health               Care               Web               Site:               http://www.issues2000.org/George_W__Bush_Health_Care.htm
               (Walgreens               Pharmacy               2006               Products               and               Services)Walgreens               Pharmacy.

(2006).

Products               and               Services.

Retrieved               June               30,               2006,               from               http://www.walgreenshealth.com/whc//////////////common/jsp/aboutus_prod_services.jsp?_requestid=234835#hcare
               (Wertheimer               A               I               Chaney               N               M               Santella               T               M               Popomaronis               W               T               Mick               L               200510               Increasing               Profits               with               Home               Health               Care               Products)Wertheimer,               A.

I.,               Chaney,               N.

M.,               Santella,               T.

M.,               Popomaronis,               W.

T.,               &               Mick,               L.

(2005,               October).

Increasing               Profits               with               Home               Health               Care               Products.

Retrieved               June               30,               2006,               from               Pharmacy               Times               Web               Site:               http://www.pharmacytimes.com/Article.cfm?Menu=1&ID=2664
               (West               Virginia               Health               Statistics               Center               200310               HSC               Statistical               Brief               Number               10)West               Virginia               Health               Statistics               Center.

(2003,               October).

HSC               Statistical               Brief               Number               10.

Retrieved               July               18,               2006,               from               http://www.wvdhhr.org/bph/oehp/hsc/briefs/ten/default.htm
               (Wikipedia               11               Current               Procedural               Terminology)Wikipedia.

(11).

Current               Procedural               Terminology.

Retrieved               June               14,               2006,               from               http://en.wikipedia.org/wiki/Current_Procedural_Terminology
               (Wikipedia               9               ICD)Wikipedia.

(9).

ICD.

Retrieved               June               14,               '2006,               from               http://en.wikipedia.org/wiki/ICD-9
               Butcher,               Robert.

Personal               Interview,               June               3,               2006.
               Hunt,               Charles.

Personal               Interview,               May               28,               2006.
               Plunkett,               Mickey.

Personal               Interview.

June               10,               2006.






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      March 11, 2008 · 3:44 pm ↓ Jump to Comments Item of the Day: Parkinson’s Medical Admonitions (1803) Full Title: Medical Admonitions to Families...
    4. refreshingnews9.blogspot.com/   05/04/2009
      ... the insides of normal items such as stuffed toys and model...this elephant toy using a GE 4-slice medical research scanner and then processed it...
    5. diseasemanagementcareblog.blogspot.com/   09/25/2011
      ...luxury items. When it comes to items like household cleaners, shampoo and...economically "afford" a relatively small fee for a medical service doesn't mean they'll perceive that they...
    6. turkishdelight.blogspot.com/   05/30/2010
      ... with the rest of the groceries. But we still try to hide the items by adding in other things to cover it up. I once knew someone...
    7. leasesleasing.blogspot.com/   03/11/2008
      ...tool to acquire the items you need. You can lease... medical equipment, furniture...tool to acquire the items you need. You can lease... medical equipment, furniture...
    8. 50plusandcounting.blogspot.com/   10/22/2006
      ...". Simply, it will refer to some item I found on line, or some other ...too damn many times. The are a medical parts and service company. A few ...
    9. sarahbethphotography.blogspot.com/   11/02/2008
      ... tons of great silent auction items and raffle prizes, and it all ..., spay/neuter programs, medical needs, and generally being ...
    10. mpetrelis.blogspot.com/   05/28/2008
      ... Cancel SF Gay Dance Party This item, which appeared in today's Leah Garchik... need to be on stand-by and their medical services needed because ...
    11. Medical Items - Blog Homepage Results

      Hard to get MEDICAL books reference?Lets buy online now! Its... and reliable! All brand new books & item. Ready stock. Feel free to comment or review about the...
      Wordpress Blog of Egan Medical, provider of quality home medical equipment, medical supplies and supplements.
      Arcane items of medical obscurity are the neurologist's lifeblood. We can figure stuff out. This blogger ...



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