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Kiyan's Observations
Kiyan's Mailbag: Player selections, Marcelo's future, Guti's legacy, and more
February mailbag is here.
By Kiyan Sobhani@KiyanSo Feb 21, 2019, 8:40pm CET
Photo by Denis Doyle/Getty Images
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These observations — where I look at Real Madrid's history, its players on loan, Castilla, tactical tidbits, and other relevant thoughts -- are now a regular thing. All previous editions can be found here.
I do this monthly — they're so fun that I could do it daily. February's mailbag has me just north of 3, 000 words. I forced myself to stop. Let's dive in:
I'm not a huge fan of making definitive claims, or using words like "always". "Always" should be reserved for things like "The Dark Knight will always be good"; "Cutting open a fresh Mango on a hot day as it's just fallen from the tree will always hit the spot"; "Arjen Robben will always cut inside"; and "Marcos Llorente will always be immortal". Heck — we're not even sure that the universe we live in will always exist.
Nothing in football is static. Players will come in and out of the lineup. Things change constantly: tactical ideas, formations, player performance, managers, injuries (giving rise to fringe players), off-field relationships, managers. The questions we ask now are not the same as the ones we asked a month ago — furthering the case that we need to be more pragmatic and less reactionary with our takes in general (both as fans and journalists).
You can twist this a different way: If Gareth Bale and Lucas Vazquez are always working hard, always at the top of their games, always taking the game by the scruff of the neck, and always healthy, then who starts? Gareth Bale. He's the better game-changing player, has great defensive instincts, and creates goals out of nothing while outperforming his xG. His stats as a Real Madrid player, even if the fanbase looks at him as a disappointment given his transfer fee and expectations, are ridiculous. He remains a big game player.
(Random chart which may not be completely fair to any of those four players, but I'm posting it mostly just to illustrate Bale's stats in a vacuum.)
Bale is not always in that mode, though — so it's not impossible to understand that both Solari and Zidane have decided to bench him at certain points. (In various circumstances, Zidane opted to play a very in-form Isco; while Solari didn't look to rush Bale back from his injury with Lucas Vazquez playing as well as he has been.) And here's the thing: You know what you get from Vazquez every game. Ditto Vinicius who just annihilates wing-backs without fear like some some of alien predator. It's clock work. With Bale, it's a guessing game — and managers generally hate when they're not sure which version of a player they're going to get.
One of our Patrons on last week's loan-tracker podcast brought up the fact that Bale's goal against Atletico only registered .24 on the xG scale. That's what he brings you — goals from situations (in this particular context, a relatively acute angle) that average players wouldn't consistently score from. Is Alpha-Bale always available? If so, he starts. If he's a passenger that's going through the motions, you at least get other production from someone like Vazquez on that flank.
People aren't sleeping on that idea completely. Benzema and Vinicius's form can possibly be mutually exclusive (they likely play well regardless of each other), but they're also definitely correlated and feeding off of each other's play. Karim Benzema (and others) have said publicly how much they love playing with Vinicius, and it's tempting to get nostalgic — especially when you have Vinicius replacing Ronaldo in the famous front-line mafia of Champions League travelling pictures.
Feel free to keep your expectations in check — but Vinicius is an unselfish player (with raw kinks in his game that might make pundits who've only watched him a handful of times label him as a selfish winger), and he's been linking with Benzema really well.
Almost unknowable where a player ends up, so the only way to answer this is to go with my hunch. There's a good chance he doesn't retire at Real Madrid. And that has nothing to do with his current situation where he finds himself coming off the bench (which could be a temporary thing anyway) — but more to do with the fact that players don't always retire at the clubs they built their legacy in.
Zidane retiring at Real Madrid was a rare case. Players will either be sold off before their decline, or leave on their own initiative to either go back to their home-country or cash-in in Asia or the MLS. The club's two biggest legends since the turn of the century, Raul and Cristiano Ronaldo, didn't retire here. From the galatico era, Zidane stayed until the end. But Fernando Redondo, Roberto Carlos, OG Ronaldo, Luis Figo, David Beckham, Michel Salgado, Iker Casillas, Fernando Hierro, and Guti didn't. It's normal.
Ouf. Tough one. I've been going to one-to-two Real Madrid games per month as press for Managing Madrid — but all at the Bernabeu. So I've lost count how many times I've been there, but believe it or not, it wasn't until January that I attended my first non-Real Madrid match — a Rayo Vallecano - Real Sociedad (Raul de Tomas vs Theo Hernandez) showdown in Vallecas.
And that was... Phenomenal. The atmosphere was unbelievable. It was better than the Bernabeu. The Bernabeu is filled with tourists, families out for a show, high-ranking 'important' people, etc. So unless it's a big game — Clasico, Champions League knockout game (seriously, on those nights, it's magical, so don't get get me wrong. On the right night, the Bernabeu is unparalleled) — then it's not that loud. But Vallecas was bumping for a regular league game. Every single person in attendance is a fanatic. If you're in Madrid at the same time as Rayo home game, just go. It's absolutely worth it.
Top three on the current bucket list: Benito Villamarin (specifically for a Seville derby), Mendizorroza (ideally in a time machine to watch Marcos Llorente play in the 16/17 season), and Old Trafford. I've always thought going to a Manchester United home game would be a great experience. Maybe it's just that Real Madrid have so many good memories there, but I like the stadium-lighting and undeniable support the fans give.
Guti or Zidane?
— M.S. (@therealbozz) February 11, 2019
(Bozz is asking about them as players, not coaches, as clarified later.)
And Bozz isn't going to like the answer, because he believes it's Guti. He's wrong, but not wrong enough to think he's completely insane. Guti's Real Madrid legacy is huge, but his football legacy will never touch Zidane's, and he wasn't the better footballer over the course of his career.
Zinedine Zidane is, wait for it.. Overrated (if you're exposed to certain circles of Madridistas). There is some revisionist history with him, where fans see him, in hindsight, as a mythical figure who led the team to a dynasty. They claim him to be the best midfielder that ever lived. That's not true, though, nor does everyone claim it to be that way, and some fans overrated him enough that there was a surge of opposition from the other extreme — the fans who underrated him and claim Guti to be better.
The interesting thing about Zidane's legacy is that it fluctuates based on how Real Madrid are doing. The dark years ensuing the Galactico era — the fans kept reflecting on the good days when Zidane was around. When Real Madrid started winning again, they didn't need to think about him as much.
Guti is one of those players you appreciate more when he retires. When you talk about values of Madridismo — particularly the bit about fighting until the end — he fits perfectly. We loved him because not only was he a genius with a unique, aesthetically-breathtaking style of play, but he celebrated everything like it meant the world to him that Real Madrid scored a goal or won a game. Everything about him was sincere — watching him then is the same way we feel now when watching Marcelo celebrate a goal. He's all of us.
He had the dribbling elegance of Fernando Redondo, but with a certain dynamism and versatility. I don't need to mention his vision — you all know that it was unparalleled. But one thing that newer fans don't truly understand about Guti was his insane versatility. He could dictate things as a central midfielder, unlock a defense from anywhere on the pitch, string things as a '10', or play as a striker. One of my fondest memories of him, apart from his game-changing presence, absurd unpredictability with the ball (you'd scream at your TV when he didn't make an obvious pass, but then he slings something that no one in the stadium sees, and it generates a goal), famous passion, and slick dribbling, was the season where Real Madrid were thin at the striker position and Vicente Del Bosque had to play him up top. That season (2000 - 2001), he scored 18 goals.
This goal against Villarreal was from that campaign:
Guti is a legend. There's no shame in not having Zidane's legacy — and don't let the fact that he wasn't as good as the Frenchman downplay his greatness.
I included Guti in my all-time Fabrica XI on a recent Churros y Tácticas Podcast. He joined the club at the age of 10, and went on to make 387 appearances for the A-squad over the course of 15 years. That's incredible longevity.
That's a ton hype I just threw Guti's way.
But don't overrate him.
Zidane was the better player, and just more efficient. In just five seasons at Real Madrid (and 10, 000 less minutes), he came up just nine goals shy of Guti's record. Zidane may not have been as consistent as some fans remember him, but he was a big game player, had one of the greatest goals in Champions League final history, got to the UCL final thrice (twice with Juve), got to the World Cup final twice (Scoring two goals in the final and winning one of them; with the other ending up in a loss after he carried the French National Team at the age of 34), won a Balon D'or, and a FIFA POTY award. He was unplayable with Real Madrid on his day (and he had a lot of those days. If you weren't around for that era, I highly recommend you go on YouTube and search 'all in the touch, Zinedine Zidane' for a quick crash-course of his brilliant individual performances from various games).
Guti had zero international legacy. He should've been called up more than he was, but he never truly broke through as a starter for Spain or Real Madrid (though, later in his Real Madrid career, particularly when Capello arrived, Guti was a key cog). That stuff only puts him further behind Zizou.
Guti wasn't as good as any of the big names from that initial Galactico era (Raul, Zidane, Figo, Ronaldo), and again, that shouldn't be a stain on his legacy. He was regarded as an assist demon, but Luis Figo came in and trumped his assist stats in just five years.
Great player, though.
Your thoughts on RDT's fate for next season given Rodrygo's and Hazard's possible arrival?
— Blaze (@blaze_mathias) February 11, 2019
Raul de Tomas is one of the most underrated players in La Liga right now — he's the only offensive threat keeping his team 'afloat' (used incredibly loosely, given Rayo are currently the second-worst team in the league — but they have little talent, have lost a ton of close games, and without RDT as a reference point, their xG drops even further), and is a deadly finisher. He can generate his own shot at a high-rate from nothing (a big asset in Rayo, who don't create much for him apart from the odd Alex Moreno cross, or moment of magic from Imbula, Trejo, or Comesaña), score goals, dribble through multiple defenders, get on the end of crosses that seem out of reach, and he even drops deep to do defensive work at times while pressing and hounding defenders efficiently.
Photo by Gonzalo Arroyo Moreno/Getty Images
But his return isn't entirely (or arguably remotely) related to Rodrygo Goes or Eden Hazard. Raul de Tomas is a traditional striker, for one, so he's more likely to compete with Mariano. I'm not sure he competes with Karim Benzema or a sure-fire star striker, because I don't see him as an asset good enough to start for this club game-in, game-out. And I really believe in Mariano — he's a striker who can offer a lot of goals off the bench if given the time. De Tomas has been vocal about his hesitancy of wanting to come back to Real Madrid because he wants to play every game (get in line, Raul), so I'm not sure how much of a fit there realistically is.
He has a high floor and medium ceiling. I see him at a team like Sevilla at some point.
That's a really interesting player comp. I see similar attributes between Vinny and Jese — low center of gravity, quick, very combative and tenacious, neither pure strikers nor wingers but both feel comfortable going down the left flank and cutting inside. To some it might seem silly to compare the two in terms of upside, but people might forget how high we were on Jese in 2013 before his injury derailed his career.
But as reasonable of a comparison it is, Vinicius takes the cake easily. His mentality on and off the pitch, selflessness, and proven 'buy-in to whatever the manager asks of me defensively' team-play is what trumps it for me.
By the way, I wrote this article about Jese when Real Madrid sold him. Still feels fresh.
It's actually really unfair to include this question from Eric now, because it came in before Real Madrid's loss to Girona — so Eric had every right to be optimistic.
Here's an answer, after years of sample size and experience: No hay Liga. But don't worry Eric! This team will give you some more hope this season before they lose the league, just enough to rip your heart out. Barca will probably drop points here and there and Real Madrid will make another run. Heck, we may even cut it to six or four points before losing to Rayo in Vallecas in April.
We've seen this movie before.
A rare moment of Real Madrid winning La Liga in the 21st century
If you stretch it out to this calendar year, yeah — that's a safe bet. Still working diligently on it while simultaneously securing a book publisher, juggling four-to-five podcasts per week, writing for three websites (including this one, where I map out the schedule, make sure we're hitting our post mark, and post La Liga footage so that Javier Tebas can ban us on Facebook), watching virtually every La Liga, Chelsea, Dortmund, and Vitesse game, and spending hours with Luka and my wife. It's a lot. But I'm not complaining, I wouldn't live life any other way.
I'll be updating you sporadically throughout the process, and will be doing a bunch of giveaways and having Real Madrid bookmarks designed to go along with your book orders.
Not a question, but wanted to highlight that your passion for the sport and journalism comes out in your writings. Pls keep up the amazing work which you, @OmVArvind and @ElEzrah do on the podcast.
— Guitar_breaker (@Raul07_real) February 11, 2019
Thanks. And quick shoutout to the rest of the entire crew who've done amazing work this season: Lucas Navarette posting team news and lineups quicker than Solari knows about them; Emily Wilson's breakout year and diverse writing skills — the female Kiyan; Matt Wiltse loan-tracker and tactics extraordinaire — the only writer in the history of this website to get his article mentioned on live international television; Rob Husby never missing a notes & quotes or preview article; C-Trick's unparalleled tactical reviews; Sofi Serg's incredibly well-researched historical deep dives and beautiful artistic skills; Jess Houwen's always entertaining columns, and now rap-battle ghost-writing (can we get her in as an SNL script writer?), Sam Sharpe's fun-loving personality when it comes to everything except for Santiago Solari; and mrs.madridista (I'm not sure if I'm allowed to use her real name here) running the show in the comments alongside Prakash, Nirvik, and Shubham.
Here's some random 6lack and J Cole:
Absolute masterpiece.
Hey @KiyanSo , which team/club would you support or find near to heart if not @realmadrid.... #halamadrid
— Bob (@ruthwijreddy) February 12, 2019
The Toronto Raptors, wherever Marcos Llorente and Luka Sobhani play, wherever Raul and Fernando Redondo end up coaching, whichever team plays against Barcelona, and any team that plays against any of these players or future coaches: Jordi Alba, Xavi Hernandez, Raul Garcia, Dani Alves.
Is Solari's faith in Vinícius based in part with him seeing a version of himself during his playing days. A combining of physical agility and technical ability, going in crazy runs and dribbles taking on opponents with no fear https://t.co/yuSDUFGZ6m
— Anis Attia (@Sanheji) February 11, 2019
Thank you for sending this video — it didn't exist when I wrote my article about Solari (the player, not the coach) last season, but I wish it did. It was incredibly hard to find footage of him — on YouTube anyway — before he became head coach and started getting attention. I ended up going back and watching full matches to reminisce.
Such a fun player to have around. With him, Savio, Guti, and Pedro Munitis (not all at once, but during that time), Real Madrid had really great players off the bench during that era.
Does he love Vinicius because he was fearless like himself? Maybe — it's a valid question. Solari had a similar mentality in the sense that he could get dispossessed four times, and still take on defenders a fifth time with the same high level of confidence as before. It was hard to shake him.
I remember begging Del Bosque from my TV set to bring on Solari and burn down the left-wing in the second half of every match.
As a fan, are there is there any loss that you thought should make you angry but left you just giving up? The 5-1 this year this year was something like that for me.
— Mrinal (@Harshy_Syrup) February 11, 2019
Liverpool 4 - 0 Real Madrid; March 2009. It was a gutless performance. I wasn't angry, just lying in the fetal position while Gago and Lass looked like nine-year-old boys getting dunked on by prime Shawn Kemp.
We're going to start a live podcast tour. If you're in LA, Bay Area, Miami, or New York — stay tuned for announcements.
I've said this before, but I want you all to know my e-mails are open if you want to talk about anything: mental health, journalism / life advice, etc. Just click 'email' on my Instagram profile — or click directly on the Managing Madrid masthead.
I have a public Facebook page you can join here, and I'll soon be making a private group within it where you can interact with me and other Madridistas.
If you haven't seen me post on Facebook, it's because La Liga removed a bunch of Managing Madrid content from its page, and, I was the fall-guy for it — banned for three days. Back on tomorrow.


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Nonprofit introduces platform-neutral, problem-based 6-8 math curriculum
Written by Richard W. Walker
Aug 29, 2017 | EDSCOOP
Open Up Resources, a nonprofit provider of openly licensed curricula for K-12 schools, has released a problem-based mathematics core curriculum for middle-school students that develops math thinking skills through questioning, discussion and real-world contexts.
The Illustrative Mathematics 6-8 curriculum is available for free to school districts. It has been published as an open educational resource (OER) under a Creative Commons License, which enables the free distribution of an otherwise copyrighted work. The program is available in both digital and print formats at im.openupresources.org.
Illustrative Mathematics is a nonprofit community of educators dedicated to improving mathematics instruction in U.S. schools. It was founded in 2011 at the University of Arizona by mathematics professor William McCallum, one of the three lead authors of the Common Core math standards.
Larry Singer, chief executive officer of Open Up Resources, said a prominent technical benefit of Illustrative Mathematics 6-8 is that it is platform-neutral.
"The curriculum is being released as Common Cartridge, meaning you can load it on any [learning management system] you want, so we're not trying to impose a platform," he told EdScoop.
The focus in recent years in the education investment community has been in edtech, Singer said. "Almost all of that investment has been in platforms, such as learning management platforms," he explained. "The problem is that platforms without content are useless, so for us our major theory was [not] to impose a platform. We want this highest-level content to be available on whatever platform a district is ready for, so that the districts can choose the platform based on their operating model and still have the best content to use."
He added that the "holy grail for technology adoption in K-12 is when publishers begin publishing the same content in a platform-neutral way. Districts can evaluate platforms on their own merit with confidence that they can deploy the right content regardless of what they chose."
Illustrative Mathematics 6-8 was refined through a yearlong beta release with 175 teachers across six school districts during the 2016-17 school year. The curriculum authoring team used daily teacher feedback to refine the materials. All of the beta school districts have continued with the program, adopting it districtwide, according to Open Up Resources.
Officials at Evergreen Public Schools in Washington state decided to adopt the program districtwide because they saw a huge increase in student engagement with the materials, said Corrine Williams, a mathematics specialist with the district.
"Students were constantly talking about math, using precise language and constructing mathematically sound arguments," Williams said.
Singer said that making the curriculum available for free is a fiscal windfall for districts moving to a one-to-one digital learning program, in which students use devices as instructional resources instead of books.
Districts using the print version can focus on the transition to a digital environmental without paying a license fee for the curriculum while teachers learn the Illustrative Mathematics 6-8 pedagogy and instructional model.
"Now you can introduce a technology platform that is paid for with the savings and teachers can implement the curriculum," Singer said. "And the only transformation then is introducing the technology into the scene."
The work on the curriculum has been funded by the Bill & Melinda Gates Foundation, the William and Flora Hewlett Foundation and other philanthropies.
Common Core, Illustrative Mathematics, Larry Singer, Open Up Resources
Textbook publisher Pearson sues Chegg for copyright infringement
by Ryan Johnston • 4 months ago
Officials tell schools not to pay ransomware demands. Parents disagree, survey finds
by Benjamin Freed • 5 months ago
Senate approves bill for DHS review of K-12 cybersecurity

redpajama_set_name: RedPajamaCommonCrawl


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Home > Entertainment > Swifts new album could arrive this fall
Swift's new album could arrive this fall
Agencies12 May 2017 3:23 PM GMT
Singer Taylor Swift is reportedly gearing up to release her long-awaited sixth studio this fall. A source close to Swift told Us weekly that the Grammy-winning songstress will stay out of the limelight until she's ready to promote her forthcoming set.
"Taylor's been quietly recording new music for a couple of months. She's aiming to release an album this fall," the source said. According to the source, the diva is avoiding bigger recording studios in LA, New York, Nashville and London and once again capitalizing on her new pop sound."She's continuing down the pop route because '1989' was a huge success and fans really gravitated toward that album."


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Glass from a 3D printer
resuming
Transformation and upgrading of coal chemical industry in Xinjiang
Adding copper strengthens 3D-printed titanium
Home > News > Large-scale demonstrations across Myanmar will affect the price of roller contact bearing
Large-scale demonstrations across Myanmar will affect the price of roller contact bearing
For more than two weeks, thousands of people in villages and towns across Myanmar have come out to peacefully protest or participate in the non-violent civil disobedience movement against the military takeover, calling on the generals to transfer power and release the civilian leader Aung San Suu Kyi and other democratically elected leaders.
The military government tried to stop protests by banning gatherings of more than five people, curfews in certain areas and cutting off the Internet at night. They also sent troops to major cities, including members of elite counterinsurgency forces that allegedly engaged in human rights violations and violent campaigns against minorities.
In Yangon, demonstrators marched and waved slogans marked "Help Myanmar". In Myitkyina, the capital of Kachin State in northern Myanmar, protesters can be seen chanting and waving flags while riding a motorcycle.
In the capital Naypyidaw, a large crowd gathered to attend the funeral of a young woman. The woman died on Friday after being shot in the head during an anti-coup protest. Mya Thweh Thweh Khine was shot and killed just before her 20th birthday. This was the first well-known democracy protester.
Protesters gathered to protest the military coup in Yangon on February 22.
The video of her funeral shows a hearse with her picture in front and a group of cars driving out of the hospital. As the parade drove through the streets, people saw motorcycle riders and bystanders raising three fingers to salute from the Hunger Games movie used by the protesters.
Myanmar's Ministry of Foreign Affairs said in a statement on Sunday that the authorities "applied maximum restraint through the use of minimal force" when handling protests. It also stated that some foreign remarks and remarks are "equivalent to flagrant interference in Myanmar internal affairs."
In a Facebook post, the Ministry of Foreign Affairs called on diplomats to "respect the laws and regulations of the receiving country" and reiterated that "free and fair elections" will be held. Myanmar has entered a state of emergency for a year, but the military government has not yet given a timetable for holding elections.
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The price of roller contact bearing continues to be affected by factors such as market decline momentum, various opportunities and challenges. However, during the forecast period from 2022 to 2027, the global roller contact bearing sales market is expected to continue to be above average. The growth rate will continue to increase. It is expected that In the second half of this year, the price of roller contact bearing will increase to a certain extent.
Due to changes in consumer demand, import and export conditions, and various investigations on the development of roller contact bearing, the cost of roller contact bearing is constantly changing. Taking into account the current market macroeconomic parameters, value chain analysis, channel partners, demand and supply, the cost of roller contact bearing will also be affected to a certain extent. It is estimated that the cost of roller contact bearing will increase slightly from next year.
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This is an archived partial record of Stanly NCRSP activity in the 2016-2017 activity year.
During the 2016 Calendar Year members of the Stanly County Unit of NCRSP reported 10,117.5 hours of Community Service volunteer time. The individual top volunteer is Jane Barnhart with 1,568 hours.
11:00 a.m. and the business sessions at 11:30 a.m.
The Stanly County Unit NCRSP leadership team met in July to make plans for the coming year and prepare every member mailings announcing the new activity year.
New Stanly NCRSP President Cindy Misenheimer took charge at her first luncheon meeting.
Advanced preparation helps registration go smoothly. Members who have RSVP'd are listing and their nametags are at the ready.
The treasurer and secretary are prepared to collect dues from returning cash-pay members and to register our new members.
Members enjoy sharing updates with friends they may not have seen since our last meeting.
Bill Josey, new Superintendent of Stanly County Schools was the featured guest speaker.
Harriet Archer and Susan Calloway were all smiles in their duo selfie.
The first meeting of each year is traditionally devoted to back-to-school supplies from members for a local elementary school.
Every meeting has a raffle table of items donated by members. Proceeds from the activity fund our yearly $1000 scholarship to a high school senior planning on a career in education.
President Cindy Misenheimer welcomed members and guests to an opportunity to meet and question the candidates that are seeking to represent Stanly County in the North Carolina General Assembly.
Early arrivals were able to meet with the candidates one-on-one and face to face.
Dannie Montgomery is a working educator from Anson County and is seeking the NC Senate Seat in District 25.
Billy Mills is a recently retired educator and is seeking the NC House Seat in District 67.
Carson Snyder is a local businessman with an economics background and is seeking the NC House Seat in District 67.
The two incumbent members of the Senate and House were invited but were not in attendance.
The Dennis Vineyards venue is ideal for sharing before the business session and meal.
Our luncheon never disappoints and guests go the head of the line.
Cakes seem to be getting taller and taller and the strawberry cake was a big hit.
New member DeAnn Chandler shares this shot of her tablemates: l-r Carol Poplin, Claudine Burris, and Ann Lowder.
Due to renovations underway at Dennis Vineyards, we met at First Baptist Chuch in Albemarle. Our leaders and members were so impressed by the facility and the welcoming and cooperative attitude of the church's representatives. We will be here again for our March meeting.
President Cindy Misenheimer welcomed everyone and noted that Mary Adkins had an excused absence to visit with her new grandchild !!!!
Returning presenter Teresa Poplin from Carolinas HealthCare System - Stanly shared valuable information on a heart healthy life.
Stanly NCRSP member Charles Phillips is a successful "graduate" of Teresa's program offered through the YMCA.
Attentive members scored well on the quiz portion of the presentation,,,,,,but even when wrong, were rewarded with heart healthy correct answers.
Region 3 NCRSP's Associate Director and Membership Chair Ira LaVerne Reed addressed the group and noted that our turnout dwarfed the normal numbers for her local in Mecklenburg.
Region 3 NCRSP's Director Marilyn McClain invited members to the Region 3 upcoming general membership meetings.
Early arrivals help in preparing the space. Agendas, tableware, napkins, etc. must be placed at each table.
We may be retired from our school system jobs, but many members must keep in touch with their new business endeavors.
Registration begins at 11:00 a.m. for the 11:30 a.m. start time. Members pay for the luncheon, purchase extra take-home meals, buy raffle tickets, and more. Today the more included registration for the Region 3 end of year meeting and making a donation in anticipatation of Teacher/Staff Appreciation Week in May. With so many tasks to juggle, our registration folks do a great job.
Getting a seat early gives members time to share and catch up on life's happenings.
Shirley Summerlin (left) has a couple decades to go before she catches up with Charter Member Ree Phillips (right) who is enjoying her 33rd year as a member of Stanly County NCRSP.
President Cindy Misenheimer calls the members to order and shares the day's items of special interest. Members are encouraged to register to attend the Region 3 yearly meeting on April 24th in Charlotte. Teacher/Staff Appreciation Week activities are planned for the first week in May and members are asked to contribute cash toward the goodies and/or to volunteer to make the deliveries to each of the worksites in the Stanly County Schools system.
Today's special guest was Cissie Poplin, manager of hi-lites ladies clothing in Albemarle.
Click on the coupon pic and download/print your copy of the coupon if you missed today's meeting.
Before today's NCRSP meeting members visited hi-lites and picked an outfit to model in our own Fashion Show.
hi-lites manager Cissie Poplin and Stanly County's top model Harriet Archer enjoyed the day's events.
Member item donations to the Scholarship Fund Raffle is the primary funding source for our annaul $1000 scholarship award. A member's $1 raffle ticket presents an opportunity for a great return on the investment.
Talk about a BARGAIN !!!!! Cook Dwight Eudy's desserts and luncheon spread is surely the best deal in town for a member's $8 with additional takehome trays also available.
Someone gets to be the first lucky member to the dessert table. Today's smiling winner was Jane Davis.
At the last meeting of each activity year members are surveyed and their input has a large impact on the unit's scheduled activities during the coming year.
Stanly Early College senior Kimrey Lowder is this year's Stanly NCRSP Scholarship recipient. A $1,000 check will be forwarded to the University of North Carolina at Chapel Hill. Making the presentation is Stanly NCRSP Vice President and Scholarship Chair Rita Griffin.
The scholarship's main funding source is the raffle held at each meeting. Members bring items to donate and tickets are purchased for $1 at registration.
Stanly NCRSP volunteers reported over 10,000 hours of time serving the local community. These are the members whose hours exceeded 500 each for 2016.
Individual Stanly NCRSP members volunteered to be the primary support person for each of the schools in the Stanly County system. All members contributed to a fund to supplement the outlay of the principal volunteers.
Community volunteers Pam and Terry Morgan were staffing CentralElementary's office and received Pat Bramlett's delivery from the members of NCRSP.
Stanly Academy teachers and staff got goody bags delivered by member Sandra Huneycutt.
Aquadale Elementary staff enjoyed strawberry punch bowl cake with Cheerwine punch from NCRSP members Sarah Lee and Ann Lowder.
Mary Adkins accepted the two awards for the local at the Recognitions Banquet. Stanly received a sixth Gold Star award and was elevated to a Platinum Recognition local for multiple years of excellence.
***Our February and March meetings will be held at First Baptist Church in Albemarle. The Vineyard is being remodeled.
Harry was born February 25,1930 in Stanly County to the late Luke and Tommie Estelle Thompson Cook. He was a retiree of Charlotte-Mecklenburg Schools and Stanly County Schools. He was a member of First United Methodist Church. Harry proudly served his country as a Staff Sergeant in the US Air Force during the Korean War.
He was considered the "Mayor of Willow Oak Road".
One of The Greatest Generation and his wife of almost 70 years have both passed away within days of each other.
Nathan Owen Cranford, age 97, passed away on February 13, 2017, and Mattie B. Way Cranford, age 94, passed away on February 18, 2017. They were married on March 29, 1947.
Owen was born February 10, 1920, in Stanly County and lived here all of his life.
He was educated in the Albemarle City Schools and joined the Army Air Force during World War II, serving over 3 years in both London, England, and Kaufbeuren, Germany.
After the war, he worked in the Lillian Mills, making full-fashioned ladies' hosiery before he transitioned to building houses for professors at Pfeiffer College and working in the building supply business.
From 1965 to 1983 he worked as a Letter Carrier for the US Postal Service.
Owen was very talented with woodworking and made many fine pieces of furniture and clocks, eventually moving to woodcarving after his retirement, where he could take a block of wood and bring out some of the most intricate characters and animals. He won many awards for his talent.
Mattie B. was born February 9, 1923, in Elloree, SC, and came to Albemarle as a new bride.
She was educated in the Orangeburg, SC, school system, then attended Winthrop College for two years before transferring to and graduating from George Washington University in Washington, DC, with a Bachelor's degree in Secretarial Administration.
She worked at the US Treasury Department for six years prior to her marriage.
Mattie B. was a homemaker for 12 years before she began her 25 year teaching career as the first teacher in Stanly County for the Special Education students. She taught the Trainable Class for 23 years and the Profound and Severely Handicapped Class for 2 years.
She was active in the ARC (Association for Retarded Citizens) and honored as the ARC Teacher of the Year in Special Education in 1984. She was also active in the AARP, Stanly County Extension Homemakers, and the Stanly Memorial Hospital Volunteers. Recognized by the Albemarle Junior Woman's Club in 1960 with the coveted "Woman of the Year" Award, she was also a member of the NCAE and the Retired Teachers Association.
Both were very active in the community and in their church.
Owen joined Central United Methodist Church in Albemarle as a youth and Mattie B. joined after her marriage. Both have served the church faithfully over the years, with Owen for many years serving as the Chairman of the Board of Trustees and chairman of the property committee, taking care of the building and grounds.
He built children's furniture and created a large walnut cross which he made to honor his parents, NC and Delia Cranford.
Mattie B. taught Sunday School, participated in Circle groups, was President of the UMW (United Methodist Women), and supported many, many fund raising projects, always priding herself on being the high salesman of tickets to a given event. She was chairman of the bereavement committee for many years, only recently passing that torch.
Owen and Mattie B. also participated together in the Meals-on-Wheels Program, Friends of the Stanly County Senior Center, and the Community Concert Association. They were active in the ballroom dance events at the Senior Center and Owen provided the music for the weekly lessons as the DJ.
They participated in the Senior Games every year.
For almost 70 years, they were a team, working and playing together. Their lives were so intertwined that they entered eternal life together.
Nancy Isenhour Gamewell, 92 years of age, of Badin, passed away Friday, March 10, 2017 at Stanly Manor in Albemarle.


The color is white washed. These panels are made out of reclaimed teak wood with floral designs. Our wall panels are hand carved by highly skilled artisans in Thailand who spend countless hours meticulously carving these wonders of wood craftsmen. Most panels are made in sections for easy transport and to make hanging more manageable.
Because each piece is a unique creation, some variations may occur. Size is around 5'X5'Feet (60"x60"). These panels make beautiful bed headboards - both hanging or free standing - or as decorative panels. Then, he will assemble this product side by side. The total weight of this parcels is around 25 kilograms.
Great idea to be a nice gift. Please look at a category "Wall Hanging". You will see many "Teak Wooden Wall Art Panels" at the reasonable price.
Our packages are never lost. It should be arrived within 3-4 weeks except long holidays.
Please contact me with photos if you found a problem of a parcel such as wrong item or broken item within 7 days after you got a parcel. We will give you a solution case by case. If the item becomes defective more than 7 days after the date when you signed your signature, we will give you an advice to repair panels. Panels were fallen from the wall and broken.
However, we will give you an advice to repair it. The item "5ft Headboard Lotus Flower Wooden Craved Carving Teak Wood Art Panel Sculpture" is in sale since Wednesday, July 12, 2017. This item is in the category "Art\Art Sculptures". The seller is "bttp-art-antique-store" and is located in default, Bangkok. This item can be shipped worldwide.


Branch Success at the National AGM!
At the CAMRA AGM in April 1999, the Cambridge & District Branch received the Membership Recruitment Award 1998 for the large branches category, having recruited the most new members in past year amongst those branches.
At the latest count (the branch membership mailout in April) there were 375 members, up from around 300 a year before.
The membership fees greatly aid the national campaigning cause and the extra people are starting to make a difference to local activities (though more activitists are always welcome!). 3% of the branch membership are year-round activists, 4% including Beer Festival workers.
Nationally, membership is steadily increasing and is now over 54,000, up 4,000 in about two years: CAMRA Hits 50,000 Landmark.


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Home INDIA & BEYOND INDIA Trinamool sacks Mukul Roy as general secretary
Trinamool sacks Mukul Roy as general secretary
Kolkata, Feb 28:
The Trinamool Congress Saturday sacked Mukul Roy – once party supremo Mamata Banerjee's second-in-command – as its national general secretary.
(Pic courtesy: www. kalimpongnews.net)
Banerjee's close aide Subrata Bakshi, who was appointed national general secretary a few days back, will be the only one to hold the post.
"Subrata Bakshi has been appointed as the national general secretary," Trinamool secretary general Partha Chatterjee announced after the party's working committee meeting at Banerjee's residence here.
"There is only one general secretary – Subrata Bakshi," replied Chatterjee to media queries about Roy's fate.
Bakshi has also been entrusted with the responsibility of representing the party at the Election Commission.
"All matters relating to the EC will be handled by Bakshi. He will represent the party at the EC," senior party leader and state Panchayat Minister Subrata Mukherjee said.
Former railway minister Dinesh Trivedi and Sultan Ahmed have been made national vice presidents, while MPs Kakoli Ghosh Dastidar, Subhendu Adhikari, Rajya Sabha chief whip Derek O'Brien, and state Urban Development Minister Firhad Hakim have been made national joint secretaries.
The development comes a day after Roy – a former union minister – was replaced as the leader of Trinamool in the Rajya Sabha by Derek O'Brien. IANS
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text:
using System;
using System.Collections.Generic;

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redpajama_set_name: RedPajamaGithub


text:
George David Cummins
39 years old today
Clemence Sophia Larned Lozier
Hiram Paulding
George Washington Wright
Legal/Political
Elihu Washburne serves in the United States House of Representatives 03/04/1853 to 03/06/1869
Lyman Trumbull serves in the United States Senate 03/04/1855 to 03/03/1873
Moncure Conway serves as minister at Unitarian Church in Cincinnati, Ohio 10/26/1856 to 01/01/1862
Ozias Mather Hatch serves as Illinois Secretary of State 01/01/1857 to 01/31/1865
Andrew Gregg Curtin serves as Governor of Pennslyvania 01/15/1861 to 01/15/1867
Major Topics
Site Navagation
What is Anniversary Edition?
Journal Divided
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text:
Fringe review: 'The Breakfast Club: The Musical!'
By Ross Raihala | rraihala@pioneerpress.com | Pioneer Press
PUBLISHED: August 2, 2018 at 11:09 pm | UPDATED: August 4, 2018 at 11:18 am
Some of Broadway's biggest smashes are film adaptations and John Hughes' 1985 teen angst classic "The Breakfast Club" feels ripe for the transition. Unfortunately, FredPictures' attempt to do just that proves it's much harder than it looks. Writer/director Fred Cheng tried and failed to condense the 97-minute movie into a Fringe-length performance and those who aren't familiar with the source material are likely to be bewildered by what's on stage. The barely amplified music sounded piped in from an old boombox and the cast often struggled to get out all the lyrics, which veered toward the verbose and repetitive.
Presented by FredPictures at Southern Theater; 4 p.m. Aug. 5, 7 p.m. Aug. 6, 8:30 p.m. Aug. 8, 2:30 p.m. Aug. 11
Fringe Festival 2018
Ross Raihala
A Minnesota native, Ross Raihala joined the Pioneer Press as pop music critic in 2004, after stints at The Forum in Fargo, N.D., and The Olympian in Olympia, Wash. He covers local and national music as well as some theater and other arts and entertainment topics. His favorite part of his job is reviewing, and live tweeting, Twin Cities arena concerts. And, yes, he saw the same show you did.
Follow Ross Raihala	ross.raihala Follow Ross Raihala	@RossRaihala
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Review: History Theatre's 'Glensheen' is as funny and fascinating as ever
I was 5 years old and lived about 25 miles from Glensheen on June 27, 1977, the day Elisabeth Congdon and her nurse, Velma Pietila, were brutally murdered inside the 20,000-square-foot mansion in Duluth. My mother and sister were fascinated by the lurid tale that unspooled in the following years (and decades). After a trial that earned endless media coverage,...
Fringe focus: Family Fringe is back, previews start Monday
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Do I Need Proof of Citizenship to Open a Bank Account?
Last month, Bank of America reportedly froze access to a Kansas couple after they failed to provide proof of U.S. citizenship. Josh Collins and wife Jessica Salazar Collins disregarded a form the bank mailed them in June asking whether Collins (who was born in Wichita) was a citizen, assuming it was a scam.
The couple's access was restored after Collins provided a driver's license, but the incident left many people wondering why the bank was asking for proof of citizenship in the first place, and others wondering if you need to be a U.S. citizen to open a bank account.
Bank of America spokesperson Diane Wagner told The Kansas City Star the request was part of routine updates to customers' information. "If we don't hear from a customer in response to our outreach," she said, "as a last resort, we may restrict the account until we can confirm it is in compliance with regulatory requirements." In a statement last month, the bank asserted it is "required by law to maintain complete and accurate records for all of our customers and may periodically request information, such as country of citizenship and proof of U.S. residency."
However, federal law doesn't prohibit banks from opening accounts for non-U.S. citizens, and must only request and confirm their name, date of birth, residential address, and Social Security number. Some banks may request citizenship information as part of efforts to curb international money laundering. But there is no statute prohibiting banks from opening or giving access to accounts without proof of citizenship.
Many banks will ask for a valid photo ID and Social Security number when opening a checking or savings account. However, tourists, permanent residents, and even undocumented immigrants may still be able to open a bank account if they can provide a passport, individual taxpayer identification number (ITIN), alien identification card number, or any other government-issued document that proves your nationality or residence.
An ITIN is issued by the IRS to individuals who are required to have a U.S. taxpayer identification number but who don't have, and aren't eligible to obtain a Social Security number. ITINs are issued regardless of immigration status, and you can fill out a form W-7 to request one.
You may also have to provide proof of address, for which a utility bill, lease, current driver's license, municipal ID should suffice.
If you've been denied access to your account based on your citizenship, or are having trouble opening a bank account due to citizenship issues, contact and experienced banking attorney for help.


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Home|All News|Comments and Letters|Letter to Glenn Hackbarth Regarding MedPAC PFS Comments
Letter to Glenn Hackbarth Regarding MedPAC PFS Comments
September 24, 2013 Categories: Comments and Letters, Reimbursement and Coverage
Glenn M. Hackbarth, J.D., Chairman
Medicare Payment Advisory Commission
425 Eye Street, NW, Suite 701
Dear Chairman Hackbarth:
The American Clinical Laboratory Association is taking this opportunity to share our views on the recent comments submitted to the Centers for Medicare and Medicaid Services ("CMS") by the Medicare Payment Advisory Commission ("MedPAC" or "the Commission") with regard to the 2014 Medicare Physician Fee Schedule ("PFS") proposed rule ("the Proposed Rule").1 ACLA is an association representing clinical laboratories throughout the country, including local, regional and national laboratories. ACLA members would be affected directly by many of the policies that CMS included in the proposed rule. ACLA respectfully disagrees with some of MedPAC's comments. We would welcome the opportunity to discuss these issues further with you and the MedPAC staff.
In its comments, MedPAC discussed three issues of significance to laboratories: (1) using Outpatient Prospective Payment System ("OPPS") and Ambulatory Surgery Center ("ASC") rates in developing professional expense relative value units ("PE RVUs") under the PFS ("the OPPS Cap"); (2) the multiple procedure payment reduction ("MPPR") policy; and (3) revisions to the Clinical Lab Fee Schedule ("CLFS") to reflect technological changes. Our views on the Commission's comments are set out below.
I. Using OPPS and ASC Rates in Developing PE RVUs A. CMS's Proposal
In the Proposed Rule, CMS proposes to change the practice expense rate setting methodology beginning in 2014. CMS states it would compare the PFS payment rate for a service furnished in the non-facility setting to the total Medicare payment for the same service when furnished in a hospital outpatient setting. CMS proposes to limit the non-facility PE RVUs so that the total payment would not exceed the payment made in the facility setting. In performing this calculation, CMS applies the 2013 conversion factor to the unadjusted RVUs. CMS also proposed to exclude services for which five percent or less of the total number of services are furnished in the OPPS setting relative to the total number of PFS/OPPS allowed services.
B. MedPAC's Comments
In its comments on the OPPS Cap proposal, the Commission discusses its own review of the differences in payment between various patient settings, including recent reports in which it recommended that payment for evaluation and management ("E&M") hospital visits be reduced to the amount paid when the same visit is provided in a free-standing office, which it says is the lower cost setting. In its June 2013 report, MedPAC identified 66 groups of services provided in hospital outpatient departments and offices that met the Commission's principles for aligning payment rates across settings. It noted that aligning the payment rates across settings for most of these services reduced the OPPS payment rate to that which is paid in the non-facility setting. However, in some instances it also found the OPPS rate would increase where the total payment rate for a service was higher in the non-facility setting.2
In reviewing the OPPS Cap contained in the Proposed Rule, MedPAC concludes that where the payment for a service in the non-facility setting exceeds the total rate when it is furnished in the facility setting, then there may be reason to believe that the non-facility practice expense is overvalued. It proposes that CMS and the American Medical Association Relative Value Scale Update Commission ("the RUC") should expedite a review of practice expense RVUs to ensure they are valued appropriately. While this practice is ongoing, however, MedPAC recommends that CMS reduce the RVUs for those codes so that the non-facility rate equals the hospital outpatient rate. These new interim RVUs would be in effect while the RUC and CMS perform their review.
C. ACLA's Views
There are 38 Common Procedural Terminology ("CPT") codes for a variety of anatomic pathology services that would be affected by the OPPS Cap proposal. As shown in the chart included in our comments, a copy of which is attached hereto, the reduction resulting from the OPPS Cap would be anywhere from approximately 30 percent to over 80 percent for these codes. Many of the proposed rates are not even sufficient to cover the direct costs of providing the services. Put simply, most laboratories would find it extremely difficult to continue to provide the services to Medicare patients at these rates, and some laboratories almost certainly would stop offering the services entirely. Moreover, these reductions would have grave implications for patient care. Many of the services at issue, such as flow cytometry and in situ hybridization, are tests that are vital to the early diagnosis and treatment of cancer, including leukemia, lymphoma and breast cancer. It is unreasonable to expect that these services would continue to be available in the same manner as today if the reimbursement were to be cut in the draconian manner that CMS proposes.
First and most importantly, MedPAC does not offer any support for its statement that where the payment rate for a service in the non-facility setting exceeds the total rate when it is furnished in the outpatient department, it may indicate "that the practice expense RVUs for many of these codes are overvalued." Indeed, as explained below, there are a number of reasons this statement is inaccurate. It is wholly inappropriate simply to assume that the outpatient rates are the proper benchmark to use in establishing payments made under both the OPPS and the PFS methodologies.
Indeed, in its past analyses, MedPAC has taken the opposite view. In its June 2013 report in which it examined Medicare payment differences across ambulatory settings for certain specified services, MedPAC looked to the PFS rates as establishing the appropriate level of payment. Where payments for the same service were higher in the hospital outpatient department setting than in a freestanding physicians' office, it proposed reducing the hospital payments. However, where payments in the hospital were lower than in the office setting—the very situation being considered by CMS—MedPAC proposed raising the hospital rates. CMS now proposes to do the exact opposite. If the payment in the hospital is lower, CMS proposes to cut the PFS payment, rather than increase the hospital payment, as MedPAC suggested. (CMS is not as even handed as MedPAC was, as CMS does not propose to increase any PFS payments that are lower than the hospital rate.)
In its June 2013 Report, MedPAC took the position that payments for Ambulatory Payment Classification ("APC") 0344, which includes many of the anatomic pathology services that would be subject to the OPPS Cap, actually were too low. Because the services were paid more under PFS than under the OPPS, the Commission suggested that CMS should increase the OPPS payment.3 In that instance, MedPAC clearly did not believe the differential in payment was a sign that the PFS rate was too high; rather, it concluded just the opposite: that the payment under the OPPS rate was too low. In sum, MedPAC itself did not appear to believe that the differential in that case showed that the PFS codes were misvalued.4
Second, there are numerous reasons why the OPPS data should not be used to set payment levels for services delivered in non-facility settings. First, the PFS and OPPS are two entirely different payment systems. The payment levels are different because they were designed to be different. Just this year in the OPPS proposed rule, which was released on the very same day as the PFS Proposed Rule, CMS itself noted that OPPS is a prospective payment system and it is not intended to be a fee schedule in which separate payment is made for each coded line item. Further, OPPS payments represent the average payment for a bundle of services included in each APC. As a result, the payment may be low for some services in the bundle, but it will be high for others. From the hospital's standpoint, the payments average out because the hospital is supplying the whole mix of services in an APC. However, a laboratory (or other supplier) does not have the ability to offset the losses from inadequate payment on that service with the profits on others.
CMS also has noted that cost reports are to be used in determining the relative costs of various procedures furnished within the hospital so that Medicare payments for those services can be distributed appropriately among the various APCs. However, it also stated that:
In general, the median cost derived from this process may not represent the actual acquisition costs of the services being furnished, nor will they ever represent acquisition costs. They are estimated relative costs that are converted to relative weights, scaled for budget neutrality, and then multiplied by a conversion factor to result in payments that, as we have previously discussed, were designed in such a manner that they are not expected to pay the full costs of the services.5
Thus, it seems inappropriate now to claim that these APC payments provide a more accurate basis for payment, given that they are not designed to reflect the actual costs of providing the services.
Third, CMS's approach is based only on a comparison of the current payment amounts under the PFS and OPPS, as adjusted by CMS. CMS has based its proposal on a "snapshot in time" and would compare what the PFS rates otherwise would be in 2014 (using the 2013 conversion factor) to what the 2013 payment levels for the same service under the OPPS would be. It then would adjust the RVUs for the 2014 PFS to ensure that the PFS rate would not exceed the OPPS rate. However, this comparison skews results based on this year's data. Hospital rates and PFS rates change relative to each other each year as adjustments are made under both systems.
For example, APC 0343, one of the APCs that includes many of the pathology services at issue here, will increase from a payment of $38.10 in 2013 to $277.56 in 2014, an increase of over 600 percent. This far exceeds the 2013 PFS payment for this same service. If CMS waited just one year to undertake this exercise and compared the projected 2014 APC payment rates with the PFS payment levels, the hospital payments would far exceed the amounts paid under the PFS, eliminating the justification for imposing the OPPS Cap. In short, the fact that the PFS rate was higher than the hospital rate for one year appears to mean little if the rates change so dramatically from year to year. ACLA believes that this fluctuation in the relative rates undercuts the reasonableness of the OPPS Cap approach.
Finally, hospital cost reports do not accurately reflect the cost of providing anatomic pathology services. ACLA contracted with the Moran Company to conduct a review of the relevant inputs affecting CMS's proposal. The resulting report, entitled "The Effects of CMS's Proposed Cross Site Payment Caps on Reimbursement for Anatomic Pathology Services" ("the Moran Report"), is attached. As demonstrated in the Moran Report, there are significant concerns with the use of hospital cost reports as they apply to anatomic pathology services. The Moran Company conducted its own survey to determine how respondents' laboratory costs compare to those used by CMS under the OPPS system. That survey included some of the nation's largest laboratory companies, as well as numerous companies that specialize in anatomic pathology services. In virtually all cases, the average costs reported by the companies were significantly higher than those reflected in the OPPS rates. Moran concluded that it was likely that hospital cost accounting practices had underestimated the amount of direct and indirect costs associated with performing these procedures.
One reason why the OPPS data for anatomic pathology services may be inaccurate is that, until July 2012, many hospitals did not bill for anatomic pathology services. Under the "TC grandfather," independent laboratories were permitted to bill globally for the technical and professional components of anatomic pathology services if a hospital met certain requirements.6 It is our understanding that in most cases, hospitals referred out these services to independent laboratories, which then billed Medicare for the services. Thus, given the fact that the grandfather was eliminated just recently in July 2012, it may be that many hospitals were unfamiliar with the costs of providing these services and did not report their costs accurately. Moreover, based on CMS's own data, even today these services are not performed in hospitals routinely.
D. Summary
In sum, ACLA believes that there is no basis for MedPAC's suggestion that the OPPS rate should be used as an interim payment amount while CMS and the RUC review practice expense RVUs. Indeed, as suggested above, many labs would be unable to furnish the services at all during the review period, given the significant cut that the OPPS payments would represent. We agree that CMS should work with the RUC to determine appropriate practice expense RVUs for codes that may be misvalued, authority that CMS already has under the Affordable Care Act. However, we do not agree that the OPPS rate should be used during the interim period, especially given the fact that it could take several years for CMS and the RUC to complete their review. Therefore, ACLA urges MedPAC to revise its recommendations and to eliminate the proposal to use the OPPS rate while the RUC and CMS perform their review.
II. Multiple Procedure Payment Reduction Policy A. MedPAC's Proposal
As MedPAC notes, CMS has not proposed new MPPR policies for 2014; however, MedPAC encourages CMS to consider other opportunities to expand the MPPR. MedPAC states that some surgical pathology codes frequently are billed with more than one unit of service, which it suggests makes them candidates for possible application of the MPPR. MedPAC notes that claims for CPT 88305 (Level IV, surgical pathology) and CPT 88342 (immunohistochemistry) often include more than one unit of service. MedPAC also notes that a recent report by the Government Accountability Office ("GAO") found that Medicare's payment system provides a financial incentive to order a higher number of specimens per procedure.
B. ACLA's Views
ACLA believes that pathology codes are not appropriate candidates for MPPR adjustments. Each pathology specimen must be prepared separately, preserved, and made into a slide. Each slide then must be examined by a pathologist to make a diagnosis. Thus, there is little opportunity for the types of efficiencies that usually trigger the MPPR policy. Moreover, CPT 88305 was the subject of a significant cut last year—over 50 percent in the technical component and over 30 percent on the global payment. Therefore, additional cuts resulting from the implementation of an MPPR adjustment would have severe deleterious effects on the ability of laboratories to provide these services, especially if the other cuts outlined above resulting from the OPPS Cap also are imposed.
Further, while MedPAC is correct that the GAO found that there sometimes is a financial incentive to order a higher number of procedures, the GAO reached this conclusion in the context of a study on the impact of physician self-referral. Thus, that incentive exists only where the ordering physician also bills for the service, a circumstance that is made possible by the existence of the In Office Ancillary Services ("IOAS") exception to the physician self-referral law. An independent laboratory that is not owned by self-referring physicians has no ability to affect the way that services are ordered or billed. It seems far more reasonable to close the IOAS loophole to eliminate this financial incentive than to implement an unfounded MPPR policy.
III. Clinical Lab Fee Schedule Adjustments A. CMS's Proposal
In the Proposed Rule, CMS notes that the payment rates for many CLFS tests have not been adjusted to reflect technological changes. As a result, it proposes to develop a process to reconsider payment amounts to account for technology changes, including tools, machines, supplies, labor, skills, techniques and devices by which the tests are produced. Under its proposal, CMS will begin reviewing codes that have been on the CLFS the longest. Over time, CMS would review newer codes until it has reviewed all 1250 codes on the CLFS.
MedPAC states it supports the direction of CMS's proposal to determine whether technological changes have affected the appropriate price for tests paid for under the CLFS. MedPAC suggests two approaches that CMS could consider: (1) using Medicare Administrative Contractors ("MACs") to determine the impact of technology, or (2) examining rates paid by other payers such as the Federal Employees Health Benefits Program and the Veterans Administration. It also suggests that CMS should focus first on codes with the highest volume of claims, rather than on those codes that have been on the fee schedule the longest.
ACLA agrees that it is possible that technological changes may have affected the costs of performing some laboratory tests, both positively and negatively. We look forward to working with CMS as it reviews the impact of technology on laboratory services. However, ACLA also has urged CMS to ensure that the review process is carried out transparently, consistently, and with the opportunity for meaningful involvement by stakeholders. ACLA also urged CMS to begin with a pilot program in which it reviews a limited number of test codes in order to obtain greater experience with the process.
ACLA is troubled by MedPAC's suggestion that CMS should use the MACs to assist it in this exercise, as it did with the recent gapfilling process. ACLA does not believe it would be appropriate to utilize the MACs, as MACs have no particular expertise on or insight into the impact of technological changes on laboratory testing. ACLA's recent experience with gapfilling raised numerous concerns. We found that many contractors did not communicate with laboratories about their processes or inputs and that CMS was unwilling or unable to facilitate that communication. Moreover, as MedPAC itself notes, "CMS does not explain what data it would use to examine technological changes and adjust payment rates for specific codes." We would be especially concerned about using MACs to make these determinations in the absence of any clear direction from CMS about appropriate bases for determinations that technological changes had affected pricing. ACLA believes that whatever process is used to determine the impact of technological changes, it should be far more transparent and open than the gapfilling process was, and should involve laboratories and other stakeholders far more.
We also have concerns with MedPAC's proposal to examine rates paid by other payors. The statute gives CMS the authority to adjust the CLFS based on changes to the consumer price index and technological changes, although this will be the first time that CMS has used its authority for technological changes. The statute does not grant CMS the authority to adjust rates based on amounts paid by other payors, as MedPAC suggests doing here. Further, there may be numerous reasons, such as exclusivity provisions or reduced documentation requirements, why other payors may have lower rates that Medicare. There certainly is no basis for determining that the rates paid by other payors reflect technological changes not considered by Medicare. Therefore, we do not believe this approach is appropriate.
Finally, MedPAC also suggests the possibility of competitive bidding as a way of adjusting the lab fee schedule. However, as MedPAC notes, the agency would have to seek legislative authority for such a program. While Congress proposed a demonstration project for competitive bidding for lab services in 2003, a federal court subsequently blocked the project and then Congress eliminated the authorization for the program. There were numerous concerns about the model proposed for that competitive bidding demonstration. Many labs would have been unable to participate because they did not offer the full menu of laboratory services required. Other labs that worked primarily in nursing homes or in underserved areas probably would have gone out of business because they would have been unable to participate in the demonstration. As a result, Congress ultimately determined that the approach was not advisable. ACLA believes that Congress made the correct decision, and we do not believe competitive bidding is appropriate for the laboratory industry.8
In sum, we look forward to working with CMS on its review of technological changes that may have impacted prices on the CLFS, and we urge the agency to ensure the process is open and transparent. We do not, however, believe that the various options suggested by MedPAC are appropriate or likely to be productive.
We appreciate the opportunity to share our views on MedPAC's comments. We look forward to discussing these issues with you further.
Alan Mertz
President, American Clinical Laboratory Association
See Original PDF here.


text:
Home Education 5 Masks Some Women Hide Behind—But Shouldn't
5 Masks Some Women Hide Behind—But Shouldn't
Naomi Cahyani
I recently spent several days at a business conference and noticed that even women in leadership roles intentionally determined the "mask" they would wear for specific events. Sometimes the mask extends to wardrobe and accessory choices in addition to posture and facial expressions. Looking around at the men in the group, though, led me to believe that men do not feel pressured to make as much effort for their voice and positions on issues to be heard. Disappointing in many respects considering all of the history that has passed since the 1970s when women actively began the fight for equal rights – but then I realize that women's right to vote has not yet reached its 100th year anniversary.
Looking around at the women in the room, some of whom I've known for decades, I often found myself figuratively scratching my head and musing, "Who are you trying to be?"
Mask of Temperance
This is the mask that keeps our desires from being exposed. It is the woman who is hiding the parts of her nature that might give evidence that she enjoys life and all that it has to offer; it's like the alcoholic who must refuse any form of alcohol to avoid the risk of slipping down a dangerous slope. It's the woman who turns down the opportunity to speak her mind, for fear of hurting another's feelings – even when she knows she is firmly in the right. It's the woman who loves chocolate, but feels that she must reject dessert with an apologetic, "I'm on a diet," even when it is not true and is said only because it is what women are "supposed" to say. It's the woman who refuses to respond with passion or commitment to issues about which she has strong feelings, just because it's what she's been taught that women should do.
Mask of Modesty
This is the woman whose light shines brightly as a leader or a woman of talent or potential. Too many women are afraid to own their power for fear of offending some imaginary, critical body. When given praise or their gifts are acknowledged, they frequently turn their eyes to the floor and shake their heads in dissent. The mask of modesty has the effect of disempowering a woman from truly being the force that she could be. It's somehow been accepted that women were not created to either "rest on their laurels" or even accept having them acknowledged aloud. Modesty may keep many women from speaking up and speaking out, which contributes to the creation of a culture in which women's silence is accepted and still in some places, expected.
Mask of the Ostrich
This is the woman who refuses to speak up for or against an issue or concern, be it right or wrong. She has the ability to look away from events or social engagements that spur the majority of others to speak up or speak out. She deals with drama or conflict by averting her gaze; it's as if she goes beyond embodiment of the phrase, "see no evil, hear no evil, speak no evil," simply not to see, hear, or speak at all. She does not choose sides or address any issues directly; she merely hides behind a mask of unawareness and disinterest. It's not that she doesn't have strong opinions, good ideas, dark thoughts, or inspiring words that she might share, it is just that she intentionally disengages from the opportunities in which they could – and should – be shared.
Mask of the Crowned Queen
Most of us recognize the "queen" as we walk into a meeting room; she carries herself with regal posture and with no apologies for her strength and her expectations of being heard. The abilities to silence others with her gaze or communicate disdain and condescension with her eyes are skills that keep her in her place in the hierarchy as much as anything she might actually say aloud. She owns power and less powerful others are sometimes grateful for her willingness to take the lead. The queen typically enjoys her power and privilege and maintains it through dedicated efforts to keep other women from moving any further closer to the front than her own coattails. She is never apologetic for her opinion or her high self-regard. She commands and others deliver. It's a system that works for her and she is using her power to the max.
Mask of the Shrew
This is the mask that women who want to be heard — but do not have the regal privileges owned by "the queen" — might feel forced to wear when their opinion differs from the majority. Unable to feel confident or unlikely to be noticed if she were just to state her mind, a woman may feel the only recourse is to turn on the unappealing, but seldom unnoticed, behavior of the shrew who cuts through the air with a sharp word and cutting remark. While the shrew is hard to mistake, she is also able to gain the floor even when her tone repels others, but her attitude gains her access.
And When the Mask is Removed . . .
Who is the woman standing underneath the mask of the modest? Or the temperate? The ostrich or the queen? It could be any of the millions of women who have amazing, innovative ideas; street smarts; book smarts; common sense; and uncommon gifts. It could be any of the women who are still feeling silenced in this world – whether it is a result of their raising, their culture, their experiences, or their fears. It is a shame that even today, while men can show up "just as they are," and be confident that their words will find airspace, women often feel that they must put on airs or armor to gain a slice of airtime to share their own ideas.
The challenge today is to find a balance between overweening confidence and well-earned competence and speak from that centered place of deep knowledge or articulate questioning. Perhaps the surest way to support the transition to showing up as they are is for women to practice embracing and supporting the women who have the courage to do just that today. Make space for the women whose voices are obscured by masks of pretense or defense and perhaps the rest of the world will follow suit in time.
Who are you, when you take off your mask?
This article was found at:https://www.psychologytoday.com/blog/lifetime-connections/201703/5-masks-some-women-hide-behind-shouldnt
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