"Back of the bus", in the US, is a reference to a method of racial discrimination in the US where blacks were forced to move to the farthest seats away from where fares were paid. This is different from the younger experience of wanting to be in the back of a school bus farther away from surveillance by authority (bus driver).
In Montgomery, the first four rows of bus seats were reserved for white people. Buses had "colored" sections for black people—who made up more than 75% of the bus system's riders—generally in the rear of the bus. These sections were not fixed in size but were determined by the placement of a movable sign. Black people could sit in the middle rows, until the white section was full. Then they had to move to seats in the rear, stand, or, if there was no room, leave the bus. Black people were not allowed to sit across the aisle from white people. The driver also could move the "colored" section sign, or remove it altogether. If white people were already sitting in the front, black people could board to pay the fare, but then had to disembark and reenter through the rear door. Sometimes, the bus departed before the black customers who had paid could make it to the back entrance.
In 1900, Montgomery had passed a city ordinance for the purpose of segregating passengers by race. Conductors were given the power to assign seats to accomplish that purpose; however, no passengers would be required to move or give up their seat and stand if the bus was crowded and no other seats were available. Over time and by custom, however, Montgomery bus drivers had adopted the practice of requiring black riders to move whenever there were no white only seats left.
S00–T98 Injury, poisoning and certain other consequences of external causes S90–S99 ankle and foot S92 Fracture of foot, except ankle S92.4 Fracture of great toe
For unusual cases, it'd be something like: S92.9 Fracture of foot, unspecified in which case a progress note would have to be sent to the insurer.
Statements like this make it clear that people don't understand the nature of the insurance industry.
No, health insurance is just like any other insurance, such as car insurance.
1) Insurers collect premiums. This is their revenue. 2) Insurers spend money on running their business. This is overhead. 3) Insurers pay out money for covered events. This is claims paid. 4) What's left over is profit.
Every transaction (claim) costs insurers money. Be it healthcare, auto, or life.
This poster does not understand the nature of any insurance industry, much less American health insurance. If they can deny a claim, then they can keep the money that they collected through premiums as profit.
I know it sounds counter intuitive but insurance companies make their money by skimming a percentage off of every transaction
It's counter-intuitive because it's not true.
Having been in healthcare for a while now, I have no idea what this poster is talking about.
Considering that insurance billing currently has nothing to do with injury coding, and this is merely the next iteration of it, I think your paranoia is misplaced.
WTF?
CMS1500 billing forms require you specify both an ICD-9 diagnosis code (that would be the "injury code" you're denying) and a CPT procedure code (that would be what you did for the injury you coded).
Neither the government (Medicaid, Medicare) nor private insurance companies currently base payment on injury codes, so I'm not sure why you think they will begin to now.
Because the current ICD-9 codes do not have detailed causation. Here's what a billing looks like:
Fracture of lower limb (820–829)
(820) Fracture of neck of femur
(821) Fracture of other and unspecified parts of femur
(822) Fracture of patella
(823) Fracture of tibia and fibula
(824) Fracture of ankle
(825) Fracture of one or more tarsal and metatarsal bones
(826) Fracture of one or more phalanges of foot
(827) Other, multiple, and ill-defined fractures of lower limb
(828) Multiple fractures involving both lower limbs, lower with upper limb, and lower limb(s) with rib(s) and sternum
(829) Fracture of unspecified bones
The injury is indicated. The cause is not.
But if you give insurance companies more information about the circumstances of injury, as you do in ICD-10, then you allow insurance companies the information to more finely deny coverage. So your insurance policies now state they will cover injuries except for those that occur on a list of dangerous activities.
And in case you think they wouldn't micromanage like that, a friend of mine was able to get insurance coverage but ANY injury to his left knee, which had an ACL repair done 20 years ago, would not be covered.
In an era where both public and private insurance is trying to save money, more reasons to deny coverage is sure to come out of this.
The 25 or so other countries who use these codes already have not yet imploded.
When doctors are salaried and are paid for the extra time they spend pushing papers, as they are in other western countries, then it's no big deal. The government-paid doctors just see fewer patients and make the same amount of money.
In the US, however, this is an unfunded mandate. Doctors spend an extra few minutes looking up more detailed codes per patient, times the number of doctors, and you can see the economic impact.
You know what's BAD for a car engine? -30C
You know what's BAD for plastic? -30C
You know what's BAD for plants and animals? -30C
Sure its not good but it should still work.
Plants and animals generally don't "still work" at -30C. Only very specialized plants and animals do.
If you purchase a pack of alligators to pull your Iditarod sled across Alaska, not only are you operating them outside their design specs, the clerk has every right to deny you a warranty replacement when yours dies.
You should use specialized, extra-insulated alligators. But they aren't mass produced, so they cost more.
Coercion - the use of express or implied threats of violence or reprisal (as discharge from employment) or other intimidating behavior that puts a person in immediate fear of the consequences in order to compel that person to act against his or her will
What? Doctors have to be convinced to follow evidence-based medicine? What were they practicing before? And why are they against it?
You know, there's never been a randomized control trial of the effectiveness of parachutes versus placebo when jumping out of planes at high altitude. Would you care to volunteer?
Some things are just obvious or can be deduced from retrospective analysis or theoretical modeling. And some times it would be unethical or impractical to conduct a randomized control trial of a treatment (e.g., testing an AIDS drug versus placebo).
I'm saying people should use evidence-based medicine and you're saying that sometimes you can't collect evidence. You're missing the point.
Evidence-based medicine: where there's evidence of effective treatment, you should use it in the practice of medicine.
Whatever you're talking about is off point. And also wrong. The trials of the FIRST AIDS drug was versus a placebo because it was not obviously safe or effective. The phase 2 trials for most truly novel drugs are randomized, controlled for safety. There are instances when a study is cut short because of overwhelming efficacy (cut short because it would be unethical to keep an obviously effective treatment from the control group). But it's rare. And people do die while in the control group.
After an existing drug become the standard of care, then it's less likely for new drugs to be compared against placebo, but rather compared to standard care.
But I, like you, digress.
The idea that doctors are ALLOWED to prescribe drugs for off-label use horrifies me (it's off-label because there's no proof it works for the off-label condition).
No, there is often tons of proof. Off-label just means that the manufacturer hasn't gone through the (expensive, time-consuming) process of proving its effectiveness to the FDA. If the patent has expired there's often no financial incentive to go through the trouble.
That's begging the question. There's rarely any proof. And by proof, I mean scientific (randomized, controlled) proof. That's because it's easier and cheaper to NOT do the studies and just say it's obviously/intuitively correct. Or do a 8 person "study" and call it proof.
One thing particularly bad about medical research is that everyone's a doctor. And they believe it. Any "doctor" can do research or just sign onto a ghost written study.
In academia, doctor generally means a PhD with a modicum of research training and in-depth knowledge of an area of research.
Medical Physicians are more artisans/mechanics than researcher, even down to the apprenticeship/internship. They are not trained to be researchers in medical school.
With everyone who has an MD believing they can do research, high quality research is drowned out by the tons of mediocre, bad, or downright misleading research.
What got me started thinking about this is a movement I heard about a few years ago: Evidence-Based Medicine.
What? Doctors have to be convinced to follow evidence-based medicine? What were they practicing before? And why are they against it?
The idea that doctors are ALLOWED to prescribe drugs for off-label use horrifies me (it's off-label because there's no proof it works for the off-label condition).
I personally would rather not have my hard drive erasing my data without my express approval, but I'm not the average Joe.
Actually, you're probably the average Joe. What you're not is the target market. There are plenty of use cases where large, inexpensive, volatile memory is desirable.
So basically this is in violation of our right to peaceably assemble.
No. The government can always put reasonable restrictions on your right to assemble for various reasons. e.g. sorry, can't assemble in the Oval Office tomorrow.
This law doesn't stop you from assembling, you just need to register if your group is being subversive.
The Far Side is a bunch of one-liners and it's like listening to Steven Wright for an hour. Initially funny, but then you get used to the rhythm and they're mostly just chuckles until one hits you.
C&H has much more story telling so should be considered a different medium. The humor builds up.
So I do appreciate both, but can't really say one is better. In Slashdot speak, they solve different problems.
I find this odd too, since it's usually a government law that allows the suit and the government that adjudicates the result and the government that enforces the punishment.
Dissenting opinions were written by Justice *Scalia* and Justice *Ginsburg* both contending that the Constitution was not implicated here, raising principles of federalism.
It's not often you see Scalia and Ginsburg together in the minority.
In the US, these kinds of laws are enacted at the state level, not federal. So some states have them and some states don't and the ones that do all differ.
There are 2 parts to these laws: 1) Duty to Rescue/Report - You must try to assist or report 2) Good Samaritan - You are protected from charges if something goes wrong as a result of your trying to assist
Every state has a random combination of the two types of laws.
So good luck figuring out whether you're "damned if you do" and/or "damned if you don't."
No statute offers blanket protection from prosecution or civil suit. There are degrees of protection based on the circumstances.
And depending on your occupation/training, your requirements may differ. So for instance, doctors and teachers may be more or less required to assist/report (confidentiality vs severity of crime), and more or less responsible for the outcome.
I've spoken with a couple of doctors who helped people in medical emergencies, and when the paramedics came, they told the doctors to quietly and quickly go away.
I've noticed this too. I try to be objective about Chinese and American relations. We're definitely frienemies, but lately I've noticed subtle push-back from the pro-China folks.
Like my comment in a previous post got modded to +4 insightful but then ended back down to +2:
Google should also check where all their laptops were manufactured. And make sure each BIOS is clean.
So you have access to these firewalls but you don't know how to go about diagnosing the problem aside from an Ask Slashdot? Am I the only one who's a little baffled by this?
I would ask, so you have access to government firewall information and you don't have an NDA? That baffles me.
Slashdot Mirror
"Back of the bus", in the US, is a reference to a method of racial discrimination in the US where blacks were forced to move to the farthest seats away from where fares were paid. This is different from the younger experience of wanting to be in the back of a school bus farther away from surveillance by authority (bus driver).
From Wiki re Rosa Parks: http://en.wikipedia.org/wiki/Rosa_Parks
In Montgomery, the first four rows of bus seats were reserved for white people. Buses had "colored" sections for black people—who made up more than 75% of the bus system's riders—generally in the rear of the bus. These sections were not fixed in size but were determined by the placement of a movable sign. Black people could sit in the middle rows, until the white section was full. Then they had to move to seats in the rear, stand, or, if there was no room, leave the bus. Black people were not allowed to sit across the aisle from white people. The driver also could move the "colored" section sign, or remove it altogether. If white people were already sitting in the front, black people could board to pay the fare, but then had to disembark and reenter through the rear door. Sometimes, the bus departed before the black customers who had paid could make it to the back entrance.
In 1900, Montgomery had passed a city ordinance for the purpose of segregating passengers by race. Conductors were given the power to assign seats to accomplish that purpose; however, no passengers would be required to move or give up their seat and stand if the bus was crowded and no other seats were available. Over time and by custom, however, Montgomery bus drivers had adopted the practice of requiring black riders to move whenever there were no white only seats left.
This is sort of how it works.
S00–T98 Injury, poisoning and certain other consequences of external causes
S90–S99 ankle and foot
S92 Fracture of foot, except ankle
S92.4 Fracture of great toe
For unusual cases, it'd be something like: S92.9 Fracture of foot, unspecified
in which case a progress note would have to be sent to the insurer.
Statements like this make it clear that people don't understand the nature of the insurance industry.
No, health insurance is just like any other insurance, such as car insurance.
1) Insurers collect premiums. This is their revenue.
2) Insurers spend money on running their business. This is overhead.
3) Insurers pay out money for covered events. This is claims paid.
4) What's left over is profit.
Every transaction (claim) costs insurers money. Be it healthcare, auto, or life.
This poster does not understand the nature of any insurance industry, much less American health insurance.
If they can deny a claim, then they can keep the money that they collected through premiums as profit.
I know it sounds counter intuitive but insurance companies make their money by skimming a percentage off of every transaction
It's counter-intuitive because it's not true.
Having been in healthcare for a while now, I have no idea what this poster is talking about.
Woah mods. Mod him up. This guy is absolutely right. GP doesn't know what he's talking about.
Considering that insurance billing currently has nothing to do with injury coding, and this is merely the next iteration of it, I think your paranoia is misplaced.
WTF?
CMS1500 billing forms require you specify both an ICD-9 diagnosis code (that would be the "injury code" you're denying) and a CPT procedure code (that would be what you did for the injury you coded).
So you're obviously pulling s* out of your a*
Neither the government (Medicaid, Medicare) nor private insurance companies currently base payment on injury codes, so I'm not sure why you think they will begin to now.
Because the current ICD-9 codes do not have detailed causation. Here's what a billing looks like:
Fracture of lower limb (820–829)
(820) Fracture of neck of femur
(821) Fracture of other and unspecified parts of femur
(822) Fracture of patella
(823) Fracture of tibia and fibula
(824) Fracture of ankle
(825) Fracture of one or more tarsal and metatarsal bones
(826) Fracture of one or more phalanges of foot
(827) Other, multiple, and ill-defined fractures of lower limb
(828) Multiple fractures involving both lower limbs, lower with upper limb, and lower limb(s) with rib(s) and sternum
(829) Fracture of unspecified bones
The injury is indicated. The cause is not.
But if you give insurance companies more information about the circumstances of injury, as you do in ICD-10, then you allow insurance companies the information to more finely deny coverage. So your insurance policies now state they will cover injuries except for those that occur on a list of dangerous activities.
And in case you think they wouldn't micromanage like that, a friend of mine was able to get insurance coverage but ANY injury to his left knee, which had an ACL repair done 20 years ago, would not be covered.
In an era where both public and private insurance is trying to save money, more reasons to deny coverage is sure to come out of this.
The 25 or so other countries who use these codes already have not yet imploded.
When doctors are salaried and are paid for the extra time they spend pushing papers, as they are in other western countries, then it's no big deal. The government-paid doctors just see fewer patients and make the same amount of money.
In the US, however, this is an unfunded mandate. Doctors spend an extra few minutes looking up more detailed codes per patient, times the number of doctors, and you can see the economic impact.
You know what's BAD for a car engine? -30C
You know what's BAD for plastic? -30C
You know what's BAD for plants and animals? -30C
Sure its not good but it should still work.
Plants and animals generally don't "still work" at -30C. Only very specialized plants and animals do.
If you purchase a pack of alligators to pull your Iditarod sled across Alaska, not only are you operating them outside their design specs, the clerk has every right to deny you a warranty replacement when yours dies.
You should use specialized, extra-insulated alligators. But they aren't mass produced, so they cost more.
Coercion - the use of express or implied threats of violence or reprisal (as discharge from employment) or other intimidating behavior that puts a person in immediate fear of the consequences in order to compel that person to act against his or her will
What? Doctors have to be convinced to follow evidence-based medicine? What were they practicing before? And why are they against it?
You know, there's never been a randomized control trial of the effectiveness of parachutes versus placebo when jumping out of planes at high altitude. Would you care to volunteer?
Some things are just obvious or can be deduced from retrospective analysis or theoretical modeling. And some times it would be unethical or impractical to conduct a randomized control trial of a treatment (e.g., testing an AIDS drug versus placebo).
I'm saying people should use evidence-based medicine and you're saying that sometimes you can't collect evidence. You're missing the point.
Evidence-based medicine: where there's evidence of effective treatment, you should use it in the practice of medicine.
Whatever you're talking about is off point. And also wrong. The trials of the FIRST AIDS drug was versus a placebo because it was not obviously safe or effective. The phase 2 trials for most truly novel drugs are randomized, controlled for safety. There are instances when a study is cut short because of overwhelming efficacy (cut short because it would be unethical to keep an obviously effective treatment from the control group). But it's rare. And people do die while in the control group.
After an existing drug become the standard of care, then it's less likely for new drugs to be compared against placebo, but rather compared to standard care.
But I, like you, digress.
The idea that doctors are ALLOWED to prescribe drugs for off-label use horrifies me (it's off-label because there's no proof it works for the off-label condition).
No, there is often tons of proof. Off-label just means that the manufacturer hasn't gone through the (expensive, time-consuming) process of proving its effectiveness to the FDA. If the patent has expired there's often no financial incentive to go through the trouble.
That's begging the question. There's rarely any proof. And by proof, I mean scientific (randomized, controlled) proof. That's because it's easier and cheaper to NOT do the studies and just say it's obviously/intuitively correct. Or do a 8 person "study" and call it proof.
The FDA frowns on off-label marketing: Pfizer, based in New York, struck the largest off-label promotion settlement to date in September 2009, agreeing to pay $2.3 billion for unauthorized marketing of its recalled painkiller Bextra and three other drugs
And there's evidence that there's often lots of financial incentive to go through the trouble:
Botox approved to treat migraines
The bigger issue is how to fix them.
The people are the problem.
One thing particularly bad about medical research is that everyone's a doctor. And they believe it. Any "doctor" can do research or just sign onto a ghost written study.
In academia, doctor generally means a PhD with a modicum of research training and in-depth knowledge of an area of research.
Medical Physicians are more artisans/mechanics than researcher, even down to the apprenticeship/internship. They are not trained to be researchers in medical school.
With everyone who has an MD believing they can do research, high quality research is drowned out by the tons of mediocre, bad, or downright misleading research.
What got me started thinking about this is a movement I heard about a few years ago:
Evidence-Based Medicine.
What? Doctors have to be convinced to follow evidence-based medicine? What were they practicing before? And why are they against it?
The idea that doctors are ALLOWED to prescribe drugs for off-label use horrifies me (it's off-label because there's no proof it works for the off-label condition).
So yeah, it's the people.
I personally would rather not have my hard drive erasing my data without my express approval, but I'm not the average Joe.
Actually, you're probably the average Joe. What you're not is the target market. There are plenty of use cases where large, inexpensive, volatile memory is desirable.
See previous posts.
Cults involve not being able to leave the cabal. You need a different term for groups where you can't join.
That would be "Cliques", just for the alliteration.
Have we entered a new era where plagiarism is not just tolerated, but seen as normal?
It was the best of times, it was the worst of times;
It was a dark and stormy night.
In a World....
So basically this is in violation of our right to peaceably assemble.
No. The government can always put reasonable restrictions on your right to assemble for various reasons. e.g. sorry, can't assemble in the Oval Office tomorrow.
This law doesn't stop you from assembling, you just need to register if your group is being subversive.
That's insightful? That's what's called a false dichotomy.
It's not mutually exclusive: The Chinese Government is likely to spy BOTH on US citizens AND their own citizens, just for different purposes.
The US Government does both as well, but US abuses of US citizens are more likely to have discovery and recourse than China's abuse of Chinese.
Just a bad argument all around.
I'd fall into the 'hard to compare' category.
The Far Side is a bunch of one-liners and it's like listening to Steven Wright for an hour. Initially funny, but then you get used to the rhythm and they're mostly just chuckles until one hits you.
C&H has much more story telling so should be considered a different medium. The humor builds up.
So I do appreciate both, but can't really say one is better. In Slashdot speak, they solve different problems.
True, ignorance is no defense for breaking the law, UNLESS the law says it is.
Many laws require "willful" misconduct for prosecution.
A simple example is that it's illegal to lie under oath, but it's not illegal to be wrong.
I find this odd too, since it's usually a government law that allows the suit and the government that adjudicates the result and the government that enforces the punishment.
Does anyone have a good explanation for that?
From the wiki article above:
Dissenting opinions were written by Justice *Scalia* and Justice *Ginsburg* both contending that the Constitution was not implicated here, raising principles of federalism.
It's not often you see Scalia and Ginsburg together in the minority.
In the US, these kinds of laws are enacted at the state level, not federal. So some states have them and some states don't and the ones that do all differ.
There are 2 parts to these laws:
1) Duty to Rescue/Report - You must try to assist or report
2) Good Samaritan - You are protected from charges if something goes wrong as a result of your trying to assist
Every state has a random combination of the two types of laws.
So good luck figuring out whether you're "damned if you do" and/or "damned if you don't."
No statute offers blanket protection from prosecution or civil suit. There are degrees of protection based on the circumstances.
And depending on your occupation/training, your requirements may differ. So for instance, doctors and teachers may be more or less required to assist/report (confidentiality vs severity of crime), and more or less responsible for the outcome.
I've spoken with a couple of doctors who helped people in medical emergencies, and when the paramedics came, they told the doctors to quietly and quickly go away.
Each sales meeting could be a contract negotiation with legal implications as well as a demo or whatever.
This would be awesome for the techs who have to deliver the goods.
The sales guys can't just make false promises any more. They'd be on the hook too.
Management would be scared of over-promising in presentations and reign in the sales team.
Now that would change company dynamics.
Ahhhh, if only.
Why all the pro-China posts lately on Slashdot?
I've noticed this too. I try to be objective about Chinese and American relations. We're definitely frienemies, but lately I've noticed subtle push-back from the pro-China folks.
Like my comment in a previous post got modded to +4 insightful but then ended back down to +2:
Google should also check where all their laptops were manufactured. And make sure each BIOS is clean.
There's a battle going on on /.
So you have access to these firewalls but you don't know how to go about diagnosing the problem aside from an Ask Slashdot? Am I the only one who's a little baffled by this?
I would ask, so you have access to government firewall information and you don't have an NDA? That baffles me.
Having worked in the industry, I agree with all the above.
But I think you give Managers and Coders too much credit.
The reason this kind of abuse happens routinely is Managers can get away with it and Coders let them.
This is just the Stanford Prisoners' Experiment played out in real life.
If you don't like the situation, stop playing your roles. And I promise you, the Managers love their roles.