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1/ The “No Surprises Act” is deeply flawed. It should not advance in its current form. Work must continue to reach a meaningful remedy to “surprise medical bills” #SMB that keeps patients out of the middle and provides balance.

Here are several concerns w/ the current proposal:

 2/ The proposal should require that the initial “interim payment” made by the insurer for out-of-network services be considered the plan’s offer for IDR, to incentivize the insurer to pay a fair initial reimbursement.

But, the proposal does not.
3/ The proposal should allow the IDR process to consider UCR and an independent charge-based database. Lest it be a form of price-fixing by insurers since the qualifying payment is indexed to the insurer-set in-network median rate (w/CPIU adjustment).

But, the proposal does not.
4/ The proposal should avoid a complex administrative burden that threatens practice viability and leads to consolidation and higher healthcare costs for patients. Cost effective independent physician practice provides patients choice.

But, the proposal does not.
5/ The proposal should explicitly prohibit the IDR process from considering Medicare, Medicaid, and other public payer rates. These are well known to be below the cost of providing care and these programs are not implicated by the #SMB provisions.

But, the proposal does not.
6/ The proposal should require that ERISA plans must submit claim information to the APCD. The growth of ERISA plans makes this an imperative. Federal statute is necessary to stipulate.

But, the proposal does not.
7/ The proposal should clearly hold all health plans accountable, with enforcement and audit programs, as robust for ERISA plans as for other health plans.

But, the proposal does not.
8/ The proposal should clearly impose penalties on plans that fail to reimburse providers for out-of-network care or that provide false or inaccurate information on their median contracted rate.

But, the proposal does not.
9/ The proposal should omit revenue cycle timelines unreachable for physician practices - small businesses; omit penalties to physicians due to delayed responses from insurers; and limit insurers’ unwarranted opportunities to operate on the float.

But, the proposal does not.
10/ The proposal should explicitly hold out-of-network physicians harmless for erroneous information an insurer includes in its in-network physician directory, especially unbeknownst to the physician and without physician input.

But, the proposal does not.
11/ A flawed #SMB proposal will:

•Further narrow networks
•Limit access to care for patients
•Jeopardize health equity, and
•Put at risk healthcare jobs for employees

This has direct and indirect economic impacts.
12/ A flawed proposal fails to hold insurers accountable for their fundamental role driving #SMB thru:

•narrow networks
•high deductibles with disproportionate cost sharing
•take-it-or-leave-it contracts spurred by market dominance

It rewards insurers reaping record profits.
13/ A flawed #SMB proposal whose CBO score indicates 80% of “savings” comes from cuts to in-network providers while physicians risk our lives fighting a pandemic, sends the message that physician service is not valued.

Esp. now is not the time to rush a flawed SMB proposal.
14/ @PAMEDSociety urges Congress to go back to the drawing board on this: https://t.co/31WYbkbiWp
15/ @AmerMedicalAssn writes “...we oppose enactment of the bill in its current form...”

https://t.co/6vAd9I5VRs
16/ Please see👆 @CongBoyle @RepBrianFitz @CongressmanGT @RepMeuser @RepJohnJoyce @RepDwightEvans @RepDean @RepHoulahan @RepSusanWild @GReschenthaler @MikeKellyPA @RepConorLamb @mgs @USRepMikeDoyle @RepCartwright @RepFredKeller @RepScottPerry 
@RepSmucker @SenToomey @SenBobCasey
17/ Please see 👆 @SenateGOP @senatemajldr @SenateDems @SenSchumer @SpeakerPelosi @GOPLeader @HouseDemocrats @HouseGOP @HELPCmteDems @GOPHELP @HouseCommerce @EnergyCommerce @WaysMeansCmte @WaysandMeansGOP @EdLaborCmte @EdLaborGOP @WhiteHouse @Transition46 #medtwitter

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🔴[RIG FOR RED]
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Thread of decodes for the day. Make sure you check out the [SUB] threads too!
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@ImPranav_M @GunduHuDuGa That's a good qsn, if not a bit nuanced. Avataras are of many varieties and frankly, most of the classification is only for our understanding and not really binding on Paramatma Himself. We can take several approaches to understanding this. If you go by a Vedantic approach,+

@GunduHuDuGa Avatara means that which descends from an exalted state (Taara). Going by Upanishadic observaton of Purnam adham purnam idham, every manifestation of Bhagavan is indeed wholesome. In fact, Avataras usually happen when Iswara is propitiated with certain qualities already+

@GunduHuDuGa described in the Vedas by other Devatas. So, in order to please them, He assumes the form that best envisages the said Vaidika tatvam. For example, Varaha and Nrusimha avatars, though they have sthoola prayojanas, also exemplify the Tejovanna tatvam propounded by Upanishads.+

@GunduHuDuGa All these tatvams ultimately emanate from Him so whatever form He takes is indeed Purna. Now, one may ask then if that's the case, why such a distinction had to be made in the first place. That is because of upasana vidhis and understanding of how Bhagavad tatvam shines+

@GunduHuDuGa with each Leela being performed. Let's take Nrusimha avatar. The purpose of the avatar is neither to save Hiranyakasipu nor rescue Prahlada. For that He need not descend down as H's boons are applicable only for Brahman's creation and not Paramatma Himself.+
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@DefenseNigeria
The people can always be brought to the bidding...tell them they are being attacked, and denounce the naysayers for lack of patriotism and exposing the country to danger.

Hermann Goring

We've seen reports of Yoruba leaders asking President Buhari to stop the war and sack service chiefs immediately as a way of beginning restructuring.Our country is sitting on a keg of gunpowder they claim. Once again partisan hacks want to snatch victory from the jaws of defeat.

You see, when you are fighting small limited wars there is a natural inclination , on the part of politicians not directly impacted by the war to want to blow things out of proportion. There is a basic disconnection now in this country between the population and the war

....and i find it quite frankly. Frightening. Compared to what was obtainable 2015, the security situation in Nigeria has vastly improved yet the media ..and partisan hacks portray a much more pessimistic narrative.

Consider that in 2015 over 21 Local government areas and 2.6 million Nigerians were cut off from the rest of the country, under the administration of a caliphate in Nigeria for 16 months. A huge chunk of the northeast was no mans country.
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(PART 3) Angels - Izingelosi | Izithunywa of the 1st Sphere 🕯

[A Smallanyana Thread]

On Part 1 and 2, you will notice that we covered Angels that somehow also resemble human physical/ manifested features.

Part of the classic examples of how we as humans always depict these Celestial Beings through our works of art.

As we move up to the 1st Sphere of the Christian Angelology Hierarchy we get introduced to another breed of Izithunywa.

Let's Begin 📖

THRONES:

Also known as the Elders, they are a class of Celestial Beings mentioned by Paul the Apostle in Colossians 1:16, and they are also mentioned in the Book of Revelations as the 24 Elders.

They are the living symbols of God's justice and authority, symbolised as Thrones.

They are also associated with the Ophanim from the Jewish Angelic Hierarchy (Which we will still cover in detail within this series of Threads).

The Ophanim are referenced as Wheels seen in Ezekiel's vision of the Chariot in Ezekiel 1:15 - 21.

Also refer to Elijah's ascension.
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Small Cycle
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Environmental impact of carrier bags


• In this life cycle assessment of supermarket carrier bags we can conclude that the environmental impact of all types of carrier bag is dominated by resource use and production stages. It is because there is so much energy that is needed in the production stage.

Transport, secondary packaging, and end-of-life management generally have a minimal influence on their performance.

Whatever kind of bag is actually utilized, the essential towards decreasing the effects are actually towards recycle it as often times as feasible as well as where recycle for buying isn't practicable

The recycling of traditional HDPE as well as various other light-weight provider bags for buying as well as/or even as bin-liners is actually critical towards their ecological efficiency as well as recycle as container linings create higher advantages compared to reusing bags.
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Here is my Thread on 'Ketu (South Node) Through Nakshatras' The 27 Constellations 🙏❣.

Do check your “Past life Mastery” which KETU Represents🤞🏻.


1. Ketu in Ashwini Nakshatra:

Here native is Great at Financial Planning, Face reading, understanding other’s mind and intention, Driving Fast they don’t like but they are wayyy smooth over driving Fast. This is also great position which can make native Great Surgeon,

Neurologist, Psychologist.
These natives are Selfless and Sacrifice self for others. They gets Fame and Success but they just don’t care.

2. Ketu in Bharani Nakshatra:

They are good at Flirting, Attracting opposite sex, studing ancient subjects. They are also Great at Creativity and Artistic activities. The are lazy but they are really open minded who handles situations really well.

In Past life they have handles many things which is now helping them to make things easier in this life. They are great Leaders too.

They are really good at Hard work and Smart work both. And yes just as Ashwini they don’t much care about Fame and Success!
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Charlie Hebdo doesn’t come up as a cautionary tale now but rather 'why cant we be like that'?
Growing up, Hanuman was an adorable deity for us, who swallowed the sun, or who couldn’t figure out what was Sanjeevani booti so he picked up a whole mountain and came back with it. 2

Or he was loyal, admirable and when he cleaved his chest, you saw both Ram and Sita. Now we have a lot of “Angry Hanuman” stickers. Why is a cute childlike God angry? We don’t know. It's a convenient blank space where to paint all the angst of Hindu Khatre mein hain narrative. 3


The other strange thing that has started happening is pictures of Ram appearing sans Sita. “Jai Siya Ram” has become “Jai Shri Ram”. Some people disingenuously explain it as being the same thing - because Shri is a name of Lakshmi. Not really. Siya is an apbhransh of Sita. 4


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In Academia, people aren’t always supported when they need it. I want to share what @WesternU did when my husband died right after the pandemic shutdown. It should be shared with other uni’s as a model for empathy and proactive care when someone is in crisis.
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THE SCIENCE BEHIND YAJNA

Fire is, of course, one of the greatest discovery of mankind. Our control over the fire dramatically changed the entire human habits; earlier it was used to cook food, protection from animals and to stay warm.


Among the many applications of fire, one is Yajna (यज्ञ, yajña); also called as Havana (हवन) or Agnihotra (अग्निहोत्र).
Yajna is elaborately described in Yajurveda. In Yajurveda, Yajna is the greatest among all works (Karman). One can purify his /her soul by performing Yajna.

In Vedic culture, it is thought that the holy fire is the mediator between Gods and us; when the offerings are made to Yajna with chanting mantras, it directly reaches the Gods, who bless the people with rains, food, health, and good luck.

According to Apastamba Sutra, the definition of Yajna is Vedic sacrifice; an act by which we surrender something for gods e.g. grains (Anna), pulse, milk and milk product (ghee, butter, curd) fruits, plant juice (soma), etc.

As we said; Yajna is the contact medium for gods and

to seek their blessings.

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