Did You Know?

There are numerous benefits to applying blood conservation principles in patient care, most often referred to as Patient Blood Management. For example:







Have We Lost the Art of Medicine?

Experienced Caregiver Shares 3 Tips for Injecting Humanity into an Often Cold & Arbitrary Heath-Care System

As a well-traveled, well-educated couple who spent most of their lives in New York City, Philip and Ruth Barash had witnessed and experienced much as they approached their golden years. A savvy New York couple, they’d learned to anticipate challenges.

Philip was a U.S. Army veteran who’d served in the Korean War and later became an attorney; Ruth’s education and experience includes philosophy, art, real estate, public relations and executive-level civic work. But one problem they didn’t foresee was navigating their own country’s health-care system. In the most prominent city of the wealthiest nation on the planet, how bad could it be?

“Philip’s health problems began in 1988 and steadily continued until his death in 2012,” says Barash, who shares her health-care experiences in a new book, “For Better or Worse: Lurching from Crisis to Crisis in America’s Medical Morass,” (http://forbetterorworsebook.com/).

“We were in and out of doctors’ offices, hospitals and emergency rooms a lot, and I was shocked by the lack of compassion we frequently encountered, as well as the number of health-care professionals who simply are not good diagnosticians.”

Barash’s cautionary tale traces her husband’s long death through a medical journey fraught with mismanagement and excess, useless interventions and a sometimes complete disregard for pain – even when there was no hope of healing.

“The art of intuitive, compassionate health care is dying as doctors rely more on technology and are guided through an arbitrary template established by insurance company policies,” she says.

Barash discusses some of the lessons she has learned while navigating overcrowded and dingy emergency room lobbies, callous staff and tech-absorbed doctors.

• Have an advocate! Through the years of Philip’s health problems, we encountered extreme kindness, thoughtfulness and high intelligence; we were also confronted with arrogance, indifference and self-serving staff during some of the worst moments. As hard as it was for both of us, we always knew we had each other. If and when you find yourself requiring medical assistance, avoid going it alone; it will be exponentially more difficult, and your chance for survival will exponentially decrease.

• Ask what benefits a proposed treatment will have. We all like to think we have good doctors, and that if we’re hospitalized, we’ll be competently cared for. We also like to think Santa will bring us nice presents if we’ve been good children. Realize that invasive and expensive tests are often not necessary; in fact, they often make things worse. Be as skeptical about a procedure proposed by a doctor as you would by any salesman.

• Don’t get sick! While this may seem like a facetious bit of advice, since we all succumb to illness at some point – it’s actually a sincere sentiment. Do not take your health for granted; do not think “they” will invent a quick fix between now and the time you find yourself in need of serious medical attention. Unnecessary health risks such as smoking; illegal drug use; excessive alcohol intake; and a diet filled with sugar, salt and fat will take you sooner rather than later to the hellish journey known as the U.S. health-care system.

About Ruth Fenner Barash

Ruth Fenner Barash studied philosophy at City College of New York and did graduate work at the University of Chicago. In 1958, she met and married Philip Barash, a private practice attorney. She went on to work in public relations and real estate, served education and civic organizations at the executive level, and taught art in various media. Her long marriage was a “harmonious adventure” despite the couple’s treacherous journey through the health-care system. Her husband died in 2012.

NAMSS and AHLA Approve Partnership

The NAMSS Board of Directors and the Executive Committee of the AHLA, American Health Lawyers Association, have approved an exciting joint initiative allowing NAMSS members access to a network of 11,000 health lawyers.

NAMSS members can now join the AHLA organization and their Medical Staff, Credentialing and Peer Review Practice Group (MS/CPR) at the discounted rate of $110 for annual membership.

Established to help bridge the relationship gap between MSPs and the legal staff who represent their facilities, this partnership will provide a platform for NAMSS members to have open dialogue with legal staff and exchange information about the regulatory issues affecting hospitals and credentialing departments across the country.

New Patient Blood Management Certification Program Proposed by Joint Commission

The Joint Commission is developing a Patient Blood Management certification program for Joint Commission-accredited hospitals. Patient blood management incorporates a patient-centered approach into the blood utilization activities and blood conservation strategies that occur within the hospital. Blood conservation strategies minimize the need for blood transfusions.

Patient blood management applies to all patient populations from pediatrics to geriatrics. It also spans the entire continuum of patient medical care, including the management of anemia, minimization of blood loss, and optimization of coagulation, in addition to evidence-based transfusion.

Living Forever Online May Not Be a Good Thing

Guest Post.  In these days of social media and automatic bill pay, Hillel L. Presser, Esq. offers some worthwhile tips for all of us.

Asset Protection Lawyer Offers 3 Steps to Take Now

Now, you really can live forever, but that’s not necessarily a good thing.

Many of your online accounts – from automatic bill payments to eBay – may remain active after you pass away, unless you take steps to ensure they don’t, says attorney Hillel Presser, author of “Financial Self-Defense (Revised Edition), ”www.assetprotectionattorneys.com.

Automatic bill pay, for example, can theoretically keep tapping your bank account long after you’re gone or, at least, until your money is.

“It’s important to make sure your online bank and shopping accounts, even your social media, can be closed out, or that your loved ones are authorized to access them,” Presser says. “You may ask, ‘Why would I care if I’m gone?’ I can tell you from experience: because it can create real headaches, and more heartache, for your family.”

Bank and shopping accounts will be vulnerable to identity theft, which would affect your estate if someone opens credit cards in your name. You might have valuable intellectual property, like domain names. They may need access to your health records, particularly if you died under questionable circumstances, he says.

There’s the sentimental stuff – photos and emails — that your family may want as a remembrance of you, and the libraries of music and ebooks, which may represent a considerable investment on your part.

“The problem is, even if you provide a family member with all of your accounts, log-ins and passwords, they may not be legally allowed to access them,” Presser says. “In many cases, they may be violating the accounts’ terms of service or violatingfederal privacy and computer fraud laws. Some states have laws governing online materials, but they’re different and which of your accounts are covered depends on where the provider is located.”

What can you do to ensure your family isn’t left with a virtual nightmare after your passing? Presser offers these tips:

• Create a list of all of your accounts, including log-innames, passwords, and answers to any security questions. Obviously, your list will need to be securely stored. Since you’ll need to update it regularly as you add accounts or change passwords,  it will be easiest if you keep the list on your computer in a password-protected folder. Some versions of Windows allow you to create protected folders, but you may need to get third-party software to do this, such as freeAxCrypt. Remember to create a backup of your list, whether it’s on a jump drive or printed out on paper. Store the backup in a secure place such as a safe deposit box. Do not put password information in your will, which is a public document.

• If you have a Google account, set up the new inactive account manager. In May 2013, Google became the first site to give users an option for choosing what becomes of their content if they should become debilitated or die. Under the profile button, click “Account,” scroll down to “Account Management,” and you’ll find instructions for “Control what happens to your account when you stop using Google.” You can select how long the account should be inactive before your plans are set into motion; choose to whom you want to offer content, such as YouTube videos, Gmail, Google+ posts, Blogger and Picasa web albums, or whether it should simply be deleted.

• Appoint a digital executor. Perhaps the simplest way to ensure your online life is taken care of is to appoint a digital executor – a tech-savvy person who will be willing and able to carry out your wishes. Authorize the person to access your inventory of log-in information and spell out what you want done with each account, whether it’s providing access to loved ones or business partners, or deleting it.

The digital world has grown and transformed so rapidly, the law hasn’t kept up, which makes managing your digital afterlife challenging, Presser says.

“Until there are more consistent laws and procedures governing this area, it’s best to plan ahead, leave clear instructions and be sure you have a list of accounts where your estate lawyer or a loved one can find it and access it,” he says. “It will make a world of difference to your survivors.”

About Hillel L. Presser, Esq., MBA

Hillel L. Presser’s firm, The Presser Law Firm, P.A., represents individuals and businesses in establishing comprehensive asset protection plans. He is a graduate of Syracuse University’s School of Management and Nova Southeastern University’s law school, and serves on Nova’s President’s Advisory Council. He is a former adjunct faculty member for law at Lynn University. Complimentary copies of “Financial Self-Defense” are available through www.assetprotectionattorneys.com.

Questions to Ask About Blood Transfusion and Heart Surgery

Conventional wisdom may lead you to believe you’ll fare better (during surgery) if you get a transfusion, but that’s not always the case, said Colleen Koch, MD, vice chair for research and education in cardiothoracic anesthesiology at the Cleveland Clinic in Ohio. In fact, heart surgery patients who receive blood transfusions tend not to do as well as those who don’t receive them, Dr. Koch noted.

During a coronary artery bypass graft (CABG) surgery, for example, a patient at one hospital might be given two units of blood, while doctors at another center may decide not to give a similar patient a blood transfusion.

Before you head to the operating room, it’s smart to ask your medical team about the likelihood of needing a blood transfusion and whether it can be avoided.

Read the rest of Questions to Ask About Blood Transfusion and Heart Surgery to see questions to ask prior to surgery.

Physician Suicide – A Tragedy for Us All

“Physicians have the highest suicide rate of any profession.  In the United States we lose over 400 physicians per year to suicide. That’s the equivalent of an entire medical school. Even that’s an underestimate because many physician suicides are incorrectly identified as accidents.”

So states Pamela Wible, M.D. in her article, What I’ve learned from saving physicians from suicide.

In the article she quotes a Canadian doctor who shares her frustration with the practice of medicine.  “My head is exploding from banging it against the system.”

If you suspect a physician you know is suffering, reach out; there is help available.

CMS Provider Charge Comparison Data

Working your way through the large CMS Provider Charge Data file will take a bit of time and effort, but it’s certainly a gold-mine of comparitive costs.  Charges for the top 100 DRGs with and without major complications / comorbid conditions, is searchable across locations and organizations.  Downloadable as an Excel or comma delimited file.


Reporter Finally Gets to Wear Shirt & Tie Louwana Berry Gave Him

Since I worked nearby at the Cleveland Clinic during the time these young girls went missing, this is a story that touches my heart.

19 Action News Reporter Bill Safos has covered Amanda Berry’s disappearance since the beginning. He grew very close with the Berry family, and Amanda’s mother, Louwana. In fact, Bill’s shirt and tie were a gift from Louwana. Before she passed away, she bought the clothes for Bill and made him promise that he wear them on “the day Mandy comes home.”

It was a promise Bill was more than honored to keep today.

Bloodless Medicine Lessons Learned: Benefiting All

surgeryBloodless medicine programs have been formed in hundreds of leading hospitals around the globe in the last 20 years.  Initially established to meet the needs of patients who decline transfused blood for religious or personal reasons, as healthcare consumers become more educated a growing number of patients are now requesting care without the use of donated blood whenever possible. 

What lessons in blood management have we learned during the past two decades?

Transfusion triggers have been lowered. 

In 1998 the “10/30 rule” (i.e., RBC transfusion indicated below a hemoglobin concentration of 10 g/dL or a hematocrit of 30%) was standard in most hospitals.  “There is now increasing evidence that RBC transfusions are associated with adverse outcomes and should be avoided whenever possible.” 1  

Most hospitals now use a transfusion trigger of around 8 g/dL hemoglobin.

The value of treating pre-operative anemia is more recognized

Studies have indicated that nearly 50% of patients entering an OR may be anemic at the time of incision. 

An article in The British Medical Journal stated “Previously undiagnosed anaemia is common in elective orthopaedic surgical patients and is associated with increased likelihood of blood transfusion and increased perioperative morbidity and mortality.  Anaemia should be viewed as a serious and treatable medical condition, rather than simply an abnormal laboratory value.” 2

It is important to know your hemoglobin level, just like you know your cholesterol and blood pressure numbers.   

Many hospitals are moving toward patient blood management

An advisory committee of the US Department of Health and Human Services issued a letter in 2011 that stated, in part, “Blood transfusion carries significant risk that may outweigh its benefits in some settings and add unnecessary costs.  Improvements in rational use of blood have lagged behind improvements in the quality and safety of the products.”  3

Organization-wide patient blood management incorporates lessons learned in managing the care of bloodless medicine patients into improved care for all patients.


  1. Anemia and perioperative red blood cell transfusion: a matter of tolerance.  Crit Care Med 2006 May;34    (5 Suppl):S102-8. PMID:16617252
  2. Detection, evaluation, and management of preoperative anaemia in the elective orthopaedic surgical patient: NATA guidelines  Br. J. Anaesth. (2011) 106 (1): 13-22. doi: 10.1093/bja/aeq361
  3. US Department of Health and Human Services Advisory Committee on Blood Safety and Availability www.hhs.gov/ash/bloodsafety/advisorycommittee/recommendations/reommendations_201106.pdf