Dear Friend:
If you're at all interested in learning how to banish fat from your body... in loving your body so much you can't get enough of yourself in the mirror... or in skyrocketing your energy levels... then you're in for some great news.
You see, I accidentally stumbled upon a way to easily and effortlessly melt fat from anyone's body.
It's a near-failproof method that works unbelievably well. When I used it, I dropped almost 10 pounds in my very first week (I was obese and had a lot to lose). From there, I quickly melted off another 20 pounds... then 50... and before I knew it, I was down 105 pounds.
I have every intention of sharing my plan with you, but before I do, I need to get one thing out in the open right now.
lunedì 20 dicembre 2010
Hair loss activity
Many people are scared to become bald, both male and female. Many of them worry when they see an amount of hair in their basin after shampooing. But as a matter of fact, our hair naturally loses about 50-100 hairs. The hairs removed often stays on our head. So when we take a shower we see a lot of hair in the basin, truth is this hair had been shed earlier.It is really hard to tell if your hair is starting to get thin.
Checking News
The original frailty adjuster was calibrated using 1994 to 1997 data from the MCBS for the community-residing, age 55 or over population enrolled in fee-for-service (FFS) Medicare (Kautter and Pope, 2004). The MCBS is a nationally representative sample of Medicare beneficiaries.
sabato 30 maggio 2009
Medicare risk adjustment for the frail elderly
Several analyses have shown that diagnosis-based risk adjusters do not fully predict the expenditures of the frail elderly, where frailty is generally defined in terms of functional impairments (Pope et al., 1998, 2000; Kautter and Pope, 2001, 2004; Kautter et al., 2007). Diagnosis-based models do predict the expenditures of the frail elderly substantially better than demographic models, but some residual expenditures statistically associated with functional impairment remain unexplained. CMS has thus had a continuing interest in exploring ways to incorporate frailty adjustment into the CMS-HCC risk adjustment methodology for Medicare Advantage and other Medicare private organizations (Pope et al., 2004). The goal of frailty adjustment is to account for the costs not explained by diagnosis-based risk adjustment.
Predicting expenditures accurately for subgroups of Medicare beneficiaries is desirable. Accurate prediction for the frail elderly is especially significant because they do not comprise a uniform proportion of the enrollment of all Medicare capitated organizations, and their expenditures are considerably higher than the average beneficiary. This is a particularly important issue for organizations whose models of care focus disproportionately on the frail elderly, for example PACE organizations. (1) A payment factor to account for potentially higher expenditures for the frail elderly is important in ensuring the viability of these organizations, and access for beneficiaries to the care they provide. Therefore, since 2004, CMS has applied a frailty adjustment to payments for enrollees in PACE organizations (Kautter and Pope, 2004-2005). (2) CMS adopted the approach taken by many researchers and clinicians of defining frailty as functional impairment, and using counts of difficulty in performing activities of daily living (ADLs) as the core measure of functional impairment. The original frailty adjuster model was estimated using ADL information in the Medicare Current Beneficiary Survey (MCBS). The frailty adjuster is prospective, meaning that Medicare expenditures in a given year are predicted by ADL information in the prior year.
As reported here, the frailty adjustment factors have recently been updated and refined. Effective 2008, CMS is applying these new frailty factors to PACE organization payments on a 5-year phase-in schedule (Centers for Medicare & Medicaid Services, 2007a,b; 2008). (3)
We present research results for Medicare risk adjustment of the frail elderly since the adoption of frailty adjustment for PACE organizations in 2004 (Kautter, Ingber, and Pope, 2007). In particular, we describe the development of a frailty adjuster estimated on the Medicare Fee-For-Service Consumer Assessment of Healthcare Providers and Systems (CAHPS[R]) Survey. Medicare is transitioning PACE organization payments to 100 percent of the revised frailty adjuster over the 5-year period 2008-2012.
ORIGINAL FRAILTY ADJUSTER
The original frailty adjuster was calibrated using 1994 to 1997 data from the MCBS for the community-residing, age 55 or over population enrolled in fee-for-service (FFS) Medicare (Kautter and Pope, 2004). The MCBS is a nationally representative sample of Medicare beneficiaries. (4) We found that frailty factors are quite different for community-residing versus long-term institutionalized (nursing home) beneficiaries, and concluded that the appropriate frailty adjuster for the long-term institutionalized should be a factor of zero. (5)
At the time the initial frailty model was created, the MCBS data was the only comprehensive data available that allowed linkage of individual-level functional impairment data (ADLs) to Medicare claims data. Information from the MCBS was used to predict expenditures related to frailty that were unexplained by the CMS-HCC risk adjustment model. The ADLs may not relate to the incremental expenditures causally, but are strongly correlated with additional expenditures. Actual frailty scores for health organizations are calculated at the contract level (rather than the plan benefit package level) (6) using these frailty factors and an estimate of the ADL limitations of enrollees reported in the Health Outcomes Survey (HOS) sent to a sample of enrollees in each organization. These frailty scores are added to the risk adjustment factors in payment. The original frailty factors calibrated on the 1994-1997 MCBS were 1.094, 0.340, 0.172, and -0.143 respectively, for, counts of ADL difficulty 5-6, 3-4, 1-2, and 0 (Kautter and Pope, 2004).
UPDATE AND REFINEMENT OF FRAILTY ADJUSTER
The source of data used to calibrate the frailty factors was changed so that the methods used to gather ADL-related data for both calibration and payment would be similar, avoiding measurement disparities that come from using different data collection methods. As previously noted, the original frailty factors were calibrated using ADL limitation information gathered from MCBS in-person surveys. CAHPS[R] data, which were used to update and refine the frailty factors, and HOS data, which are used to calculate frailty scores for payment, both collect ADL information via mail surveys with telephone followup.
Predicting expenditures accurately for subgroups of Medicare beneficiaries is desirable. Accurate prediction for the frail elderly is especially significant because they do not comprise a uniform proportion of the enrollment of all Medicare capitated organizations, and their expenditures are considerably higher than the average beneficiary. This is a particularly important issue for organizations whose models of care focus disproportionately on the frail elderly, for example PACE organizations. (1) A payment factor to account for potentially higher expenditures for the frail elderly is important in ensuring the viability of these organizations, and access for beneficiaries to the care they provide. Therefore, since 2004, CMS has applied a frailty adjustment to payments for enrollees in PACE organizations (Kautter and Pope, 2004-2005). (2) CMS adopted the approach taken by many researchers and clinicians of defining frailty as functional impairment, and using counts of difficulty in performing activities of daily living (ADLs) as the core measure of functional impairment. The original frailty adjuster model was estimated using ADL information in the Medicare Current Beneficiary Survey (MCBS). The frailty adjuster is prospective, meaning that Medicare expenditures in a given year are predicted by ADL information in the prior year.
As reported here, the frailty adjustment factors have recently been updated and refined. Effective 2008, CMS is applying these new frailty factors to PACE organization payments on a 5-year phase-in schedule (Centers for Medicare & Medicaid Services, 2007a,b; 2008). (3)
We present research results for Medicare risk adjustment of the frail elderly since the adoption of frailty adjustment for PACE organizations in 2004 (Kautter, Ingber, and Pope, 2007). In particular, we describe the development of a frailty adjuster estimated on the Medicare Fee-For-Service Consumer Assessment of Healthcare Providers and Systems (CAHPS[R]) Survey. Medicare is transitioning PACE organization payments to 100 percent of the revised frailty adjuster over the 5-year period 2008-2012.
ORIGINAL FRAILTY ADJUSTER
The original frailty adjuster was calibrated using 1994 to 1997 data from the MCBS for the community-residing, age 55 or over population enrolled in fee-for-service (FFS) Medicare (Kautter and Pope, 2004). The MCBS is a nationally representative sample of Medicare beneficiaries. (4) We found that frailty factors are quite different for community-residing versus long-term institutionalized (nursing home) beneficiaries, and concluded that the appropriate frailty adjuster for the long-term institutionalized should be a factor of zero. (5)
At the time the initial frailty model was created, the MCBS data was the only comprehensive data available that allowed linkage of individual-level functional impairment data (ADLs) to Medicare claims data. Information from the MCBS was used to predict expenditures related to frailty that were unexplained by the CMS-HCC risk adjustment model. The ADLs may not relate to the incremental expenditures causally, but are strongly correlated with additional expenditures. Actual frailty scores for health organizations are calculated at the contract level (rather than the plan benefit package level) (6) using these frailty factors and an estimate of the ADL limitations of enrollees reported in the Health Outcomes Survey (HOS) sent to a sample of enrollees in each organization. These frailty scores are added to the risk adjustment factors in payment. The original frailty factors calibrated on the 1994-1997 MCBS were 1.094, 0.340, 0.172, and -0.143 respectively, for, counts of ADL difficulty 5-6, 3-4, 1-2, and 0 (Kautter and Pope, 2004).
UPDATE AND REFINEMENT OF FRAILTY ADJUSTER
The source of data used to calibrate the frailty factors was changed so that the methods used to gather ADL-related data for both calibration and payment would be similar, avoiding measurement disparities that come from using different data collection methods. As previously noted, the original frailty factors were calibrated using ADL limitation information gathered from MCBS in-person surveys. CAHPS[R] data, which were used to update and refine the frailty factors, and HOS data, which are used to calculate frailty scores for payment, both collect ADL information via mail surveys with telephone followup.
How Can I Help My Overweight Child?
Be Supportive.
One of the most important things you can do to help overweight children is to let them know that they are okay whatever their weight. Children's feelings about themselves often are based on their parents' feelings about them. If you accept your children at any weight, they will be more likely to accept and feel good about themselves. It is also important to talk to your children about weight, allowing them to share their concerns with you. Your child probably knows better than anyone else that he or she has a weight problem. For this reason, overweight children need support, acceptance, and encouragement from their parents.
Focus on the family.
Parents should try not to set children apart because of their weight, but focus on gradually changing their family's physical activity and eating habits. Family involvement helps to teach everyone healthful habits and does not single out the overweight child.
Increase your family's physical activity.
Regular physical activity, combined with healthy eating habits, is the most efficient and healthful way to control your weight. It is also an important part of a healthy lifestyle. Some simple ways to increase your family's physical activity include the following:
Be a role model for your children. If your children see that you are physically active and have fun, they are more likely to be active and stay active for the rest of their lives.
Plan family activities that provide everyone with exercise and enjoyment, like walking, dancing, biking, or swimming. For example, schedule a walk with your family after dinner instead of watching TV. Make sure that you plan activities that can be done in a safe environment.
Be sensitive to your child's needs. Overweight children may feel uncomfortable about participating in certain activities. It is important to help your child find physical activities that they enjoy and that aren't embarrassing or too difficult.
Reduce the amount of time you and your family spend in sedentary activities, such as watching TV or playing video games.
Become more active throughout your day and encourage your family to do so as well. For example, walk up the stairs instead of taking the elevator, or do some activity during a work or school break-get up and stretch or walk around.
The point is not to make physical activity an unwelcome chore, but to make the most of the opportunities you and your family have to be active.
Teach your family healthy eating habits.
Teaching healthy eating practices early will help children approach eating with the right attitude-that food should be enjoyed and is necessary for growth, development, and for energy to keep the body running. The best way to begin is to learn more about children's nutritional needs by reading or talking with a health professional and then to offer them some healthy options, allowing your children to choose what and how much they eat. The pamphlet "Dietary Guidelines for Americans" is a good source of dietary advice for healthy Americans ages 2 years and older. This pamphlet is available from WIN.
One of the most important things you can do to help overweight children is to let them know that they are okay whatever their weight. Children's feelings about themselves often are based on their parents' feelings about them. If you accept your children at any weight, they will be more likely to accept and feel good about themselves. It is also important to talk to your children about weight, allowing them to share their concerns with you. Your child probably knows better than anyone else that he or she has a weight problem. For this reason, overweight children need support, acceptance, and encouragement from their parents.
Focus on the family.
Parents should try not to set children apart because of their weight, but focus on gradually changing their family's physical activity and eating habits. Family involvement helps to teach everyone healthful habits and does not single out the overweight child.
Increase your family's physical activity.
Regular physical activity, combined with healthy eating habits, is the most efficient and healthful way to control your weight. It is also an important part of a healthy lifestyle. Some simple ways to increase your family's physical activity include the following:
Be a role model for your children. If your children see that you are physically active and have fun, they are more likely to be active and stay active for the rest of their lives.
Plan family activities that provide everyone with exercise and enjoyment, like walking, dancing, biking, or swimming. For example, schedule a walk with your family after dinner instead of watching TV. Make sure that you plan activities that can be done in a safe environment.
Be sensitive to your child's needs. Overweight children may feel uncomfortable about participating in certain activities. It is important to help your child find physical activities that they enjoy and that aren't embarrassing or too difficult.
Reduce the amount of time you and your family spend in sedentary activities, such as watching TV or playing video games.
Become more active throughout your day and encourage your family to do so as well. For example, walk up the stairs instead of taking the elevator, or do some activity during a work or school break-get up and stretch or walk around.
The point is not to make physical activity an unwelcome chore, but to make the most of the opportunities you and your family have to be active.
Teach your family healthy eating habits.
Teaching healthy eating practices early will help children approach eating with the right attitude-that food should be enjoyed and is necessary for growth, development, and for energy to keep the body running. The best way to begin is to learn more about children's nutritional needs by reading or talking with a health professional and then to offer them some healthy options, allowing your children to choose what and how much they eat. The pamphlet "Dietary Guidelines for Americans" is a good source of dietary advice for healthy Americans ages 2 years and older. This pamphlet is available from WIN.
Is My Child Overweight?
If you think that your child is overweight, it is important to talk with your child's doctor. A doctor is the best person to determine whether your child has a weight problem. Physicians will measure your child's weight and height to determine if your child's weight is within a healthy range. A physician will also consider your child's age and growth patterns to determine whether your child is overweight. Assessing overweight in children is difficult because children grow in unpredictable spurts.
For example, it is normal for boys to have a growth spurt in weight and catch up in height later. It is best to let your child's doctor determine whether your child will "grow into" a normal weight. If your doctor finds that your child is overweight, he or she may ask you to make some changes in your family's eating and activity habits.
For example, it is normal for boys to have a growth spurt in weight and catch up in height later. It is best to let your child's doctor determine whether your child will "grow into" a normal weight. If your doctor finds that your child is overweight, he or she may ask you to make some changes in your family's eating and activity habits.
What Causes Children to Become Overweight?
Children become overweight for a variety of reasons. The most common causes are genetic factors, lack of physical activity, unhealthy eating patterns, or a combination of these factors. In rare cases, a medical problem, such as an endocrine disorder, may cause a child to become overweight. Your physician can perform a careful physical exam and some blood tests, if necessary, to rule out this type of problem.
Genetic Factors
Children whose parents or brothers or sisters are overweight may be at an increased risk of becoming overweight themselves. Although weight problems run in families, not all children with a family history of obesity will be overweight. Genetic factors play a role in increasing the likelihood that a child will be overweight, but shared family behaviors such as eating and activity habits also influence body weight.
Lifestyle
A child's total diet and his or her activity level both play an important role in determining a child's weight. The increasing popularity of television and computer and video games contributes to children's inactive lifestyles. The average American child spends approximately 24 hours each week watching television-time that could be spent in some sort of physical activity.
Genetic Factors
Children whose parents or brothers or sisters are overweight may be at an increased risk of becoming overweight themselves. Although weight problems run in families, not all children with a family history of obesity will be overweight. Genetic factors play a role in increasing the likelihood that a child will be overweight, but shared family behaviors such as eating and activity habits also influence body weight.
Lifestyle
A child's total diet and his or her activity level both play an important role in determining a child's weight. The increasing popularity of television and computer and video games contributes to children's inactive lifestyles. The average American child spends approximately 24 hours each week watching television-time that could be spent in some sort of physical activity.
Iscriviti a:
Post (Atom)
Specials
Post
