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Thursday’s Thoughts on Leadership: Leadership Lessons from the Cheshire Cat

InteroMojo - Thu, 07/31/2014 - 9:00am

“Would you tell me please, which way I ought to go from here?” asked Alice.
“That depends a good deal on where you want to get to,” said the Cat.
“I don’t much care,” said Alice.
“Then it doesn’t matter which way you go,” said the Cat.
– Alice’s Adventures in Wonderland by Lewis Carroll

Without question, indecision is one of the most destructive forces on your path to success. However obvious it seems, you won’t find success if you’re not sure where to look. The Cheshire Cat knew this well and it’s a lesson every leader must understand. Whether in a magical Wonderland or a real estate office, you should never lose sight of your destination and how you’re going to get there.

Fortunately, unlike Alice, you probably won’t have to content with mystical creatures or talking cats, but you will face unfamiliar challenges every day and must approach them with strength, determination and purpose. Draw confidence from the path you’ve chosen and know that you’ll get there no matter what comes your way.

So, how do you choose this path? Define your goals and then use them as milestones to guide you. Set objectives not only for yourself but also for your team. They’ll have something to strive for and in turn, know exactly what you expect them to achieve. But remember, it all starts with you, the leader, who must provide direction and clarity in order to move your team forward. Decide today where your path will take you and then commit to that destination with firm resolve.

As the Cat said, if you don’t care about where you’re going, it doesn’t matter which way you go.


Categories: Latest News

America COMPETES Reauthorization Act

WASHINGTON, D.C. – Senator John D. (Jay) Rockefeller, IV, Chairman of the Senate Committee on Commerce, Science, and Transportation, along with Senators Dick Durbin (D-IL), Bill Nelson (D-FL), Mark Pryor (D-AR), Chris Coons (D-DE), and Ed Markey (D-MA), today introduced the America COMPETES Reauthorization Act of 2014. 

The America COMPETES Reauthorization Act of 2014 builds on the goals and successes of the America COMPETES Act of 2007 and its reauthorization in 2010. The Senators’ billwould authorize stable and sustained increases in federal research and developme...

Rockefeller, Durbin, Nelson, Pryor, Coons, Markey Introduce America COMPETES Reauthorization Act of 2014

WASHINGTON, D.C. – Senator John D. (Jay) Rockefeller, IV, Chairman of the Senate Committee on Commerce, Science, and Transportation, along with Senators Dick Durbin (D-IL), Bill Nelson (D-FL), Mark Pryor (D-AR), Chris Coons (D-DE), and Ed Markey (D-MA), today introduced the America COMPETES Reauthorization Act of 2014. 

The America COMPETES Reauthorization Act of 2014 builds on the goals and successes of the America COMPETES Act of 2007 and its reauthorization in 2010. The Senators’ billwould authorize stable and sustained increases in federal research and developme...

POLITICO: Broadband: The other big obstacle to telemedicine

House Small Business Committee News - Thu, 07/31/2014 - 12:00am

POLITICO eHealth: Broadband: The other big obstacle to telemedicine
By David Pittman
July 31, 2014 

A lack of good Internet connections is nearly as big an obstacle to increasing telemedicine as the lack of Medicare funding for the services, witnesses told a congressional hearing Thursday.
Many hospitals and doctors’ offices across the country lack broadband or fiber-optic cabling with the necessary bandwidth to use certain forms of telemedicine, said Maggie Basgall of Lenora, Kan.’s Nex-Tech, a broadband-service provider for rural areas in the upper Midwest. Many patients lack wireless capabilities and are still reliant on dial-up Internet.
“Without that, they can’t do in-home telemedicine,” Basgall said following a House Small Business Health and Technology Subcommittee hearing.
Although there are 46 telemedicine-related bills pending before Congress, the hearing was just the second devoted to the issue this year. A bill is expected to be brought to the floor in 2015.
“What our purpose was today, and I think we’ve done it, was to start a discussion,” said Rep. Chris Collins, chairman of the subcommittee. “If we don’t start the discussion at some point, we’re seeing a hodge-podge of things move forward, state by state.”
Rep. Blaine Luetkemeyer (R-Mo.) said the lack of broadband was the biggest impediment to telemedicine after the lack of federal reimbursement.
“I live in a rural part of Missouri, and I’m barely in a broadband area myself,” Luetkemeyer said. “I know that there are a lot of areas within my own district that may not have broadband.”

Basgall singled out for blame the FCC’s quantile regression analysis, which changed the ways its $4.5 billion Universal Service Fund program doled out support to small telecommunications providers.

Rural broadband providers like Nex-Tech felt they could no longer reliably predict if they would be able to recover the costs of network upgrades and therefore stopped seeking loans to build faster networks, she said.
The FCC scrapped the changes earlier this year and is considering a replacement.

“I think [the FCC] realized it wasn’t predictable,” Basgall said. “People can’t build infrastructure when they’re trying to follow a model that doesn’t give them predictable support.”

Karen Rheuban, director of the University of Virginia’s Center for Telehealth, said the FCC’s Rural Health Care Program, which provides discounts to rural providers seeking broadband, has gone unfulfilled because of its “onerous, complex application process, and statutory exclusions to eligibility that do not always align with health disparities.”

Broadband wasn’t the only topic during Thursday’s hearing. Witnesses spoke about Medicare’s restrictive reimbursement policies, which are limited to live, face-to-face interactions delivered from health care facilities located outside of metropolitan areas. As a result, Medicare paid a mere $12 million for telemedicine services last year.

“Common sense says we need to move this forward,” Collins said. “If a doctor doesn’t get paid, they’re not going to participate.”

Rheuban also mentioned a cumbersome licensure model for providers who wish to treat patients in other states. Anti-kickback laws limit physicians from making referrals to places where they own an interest, such as telemedicine equipment they provided for another’s use.

Patient privacy laws and bureaucratic informed consent procedures are also barriers, Rheuban said.


Read the story here:

CQ: Growth of Telehealth May Hinge on Government Commitment

House Small Business Committee News - Thu, 07/31/2014 - 12:00am

CQ: Growth of Telehealth May Hinge on Government Commitment
By Kerry Young, CQ HealthBeat Associate Editor
July 31, 2014

Doctors, researchers and officials at companies such as Humana Inc. are tinkering with ideas for expanding the use of remote medical visits and services, but the true driver for expansion of telehealth likely will be the nation’s biggest purchaser of health care.

For now, the Centers for Medicare and Medicaid Services is taking a “rather cautious” approach in its payment policies for remote services and monitoring, Megan McHugh, a health researcher from Northwestern University, told a House panel Thursday.

That’s justified given that the evidence for benefits has not been conclusive, she said. Remote medical consultation and monitoring have been hailed by many advocates as potential game-changers that could cut costs and help people better manage chronic illnesses, such as diabetes.

Yet, studies so far have drawn opposing conclusions about the benefits, McHugh said. She cited a compilation of 20 reviews that found telemedicine effective, while 22 others found it to be of limited benefit or ineffective. Another 19 were less confident of the benefits, but did note its potential.

“The gradual expansion of telemedicine coverage under Medicare is a sensible course of action and one that will produce a slow but steady increase in the number of small practices that effectively and efficiently use telemedicine,” McHugh told the House Small Business Committee’s panel on health and technology.

Medicare’s decisions ripple beyond even the pool of roughly 50 million people covered by the program for the elderly and disabled. They are “magnified” because insurance companies often look to CMS decisions in setting their own policies, McHugh said. Through its rulemaking process, CMS has expanded somewhat the field of doctors and patients for which it will pay for telehealth, she said.

For 2014, CMS has somewhat widened the geographic limits that had been earlier written to restrict payments for the services to cases where people faced long trips to see a doctor. By allowing telemedicine payments for some parts of the metropolitan statistical areas, CMS has made services reimbursable for about 1 million more people enrolled in Medicare.

There’s clearly a drive among some lawmakers to get CMS to take a more expansive approach, even as small-scale experiments take place around the country that may make clear both the advantages and shortcomings of the technology.

Sen. Thad Cochran, R-Miss., this month introduced a bill (S 2662) that’s intended to waive certain Medicare restrictions on telehealth. It’s a companion measure to a bill (HR 3306) from Rep. Gregg Harper, R-Miss., which has about 20 cosponsors. The American Telehealth Association, which includes companies such as Humana and Dutch technology company Philips, supports the measure.

Smaller-scale efforts underway include a Humana program intended to help elderly people remain in their homes longer by protecting against falls and other health threats.

Humana in December said about 100 people in its Medicare Advantage programs had enrolled in the pilot program intended to use remote monitoring to help frail elderly people continue living in their own homes. The project involves in-home sensors and remote monitoring that will report changes in normal patterns of movement to Humana care managers. The sensors will check on daily activities such as sleeping and eating. Changes in patterns for these activities can be early warning signs of illness, and detecting them may allow Humana workers to step in earlier to offer aid, the company said.

In testimony for the Thursday hearing, McHugh said that dermatologists at Kaiser Permanente in San Diego were able to handle 50 percent more cases through a remote teleheath system, in which patients’ history and images of skin lesions were made available to them, than they would have been able to handle in face-to-face visits.

The question of licensing across states for telehealth services also arose at the hearing. Chris Collins, R-N.Y., the chairman of House Small Business’ health and technology panel, asked whether some exceptions to federal rules might be needed to allow doctors to get reimbursed for seeing their own patients via telehealth when they are far from home.

"I am from western New York and we have a lot of folks in our older population who go south for three months to Florida,” he said. “It’s not a New York doctor poaching in the Florida area for clients but an existing client relationship."


Find the article here: 

E&E News: In final House appearance, Perciasepe spars with Republicans over waters rule, trust issues

House Small Business Committee News - Thu, 07/31/2014 - 12:00am

 E&E News: In final House appearance, Perciasepe spars with Republicans over waters rule, trust issues
By Amanda Peterka, E&E Reporter
July 31, 2014 

The House Small Business Committee yesterday sent departing U.S. EPA Deputy Administrator Bob Perciasepe off with a contentious hearing over agency regulations.
Throughout the hearing, House lawmakers sparred over the agency's recent proposal to define which waters of the United States are included under the jurisdiction of the Clean Water Act. They jumped on comments by Perciasepe that the rule would not have a direct impact on small businesses or expand the scope of EPA's authority under the Clean Water Act.
It was Perciasepe's last time in the congressional hot seat before he leaves EPA in a couple of weeks to head a climate change group. Although Perciasepe did not give an inch in defending the waters rule, he expressed a desire for the agency to work more with Congress.
"I'm trying to explain what our intent is and trying to build a bridge," he said.
But Republican members of the committee said there were deep trust issues impeding cooperation.
"Nobody trusts the EPA," Rep. Chris Collins (R-N.Y.) said.
Perciasepe, who has been the agency's longest-serving deputy administrator, will take the helm of the Center for Climate and Energy Solutions on Aug. 11, succeeding Eileen Claussen. EPA announced his departure two weeks ago.
During his time as deputy administrator, Perciasepe has taken the brunt of congressional furor over agency rulemakings, appearing as the agency's representative at numerous hearings.
Though yesterday's hearing touched at times on EPA's long-awaited rules for reducing carbon dioxide emissions at power plants, talk of the waters rule dominated the hearing. The proposed rule released earlier this year seeks to clarify which streams and wetlands receive automatic protection under the Clean Water Act.
Farmers have lashed out at the proposal, calling it a federal power grab and raising concerns that they would be required to obtain permits for everyday farming activities.

Perciasepe sought to quell some of those concerns, saying that the rule that merely defines where other parts of the Clean Water Act will apply.

"If you have a permit now, you have to get a permit under this. But if you don't have to get a permit now, it's most likely you would not need a permit under this," he said.

But House Small Business Chairman Sam Graves (R-Mo.) said that before issuing the rule, the agency should have gone through the Regulatory Flexibility Act, a law that requires an agency to convene small-business review panels to determine potential impacts.

"I think a lot of these concerns may have been identified if the EPA had complied with the RFA," he said.

Perciasepe said EPA determined that the rule would not have direct impacts on small businesses.

"It doesn't directly impose any requirements on anybody if they're not discharging pollutants," he said. "So it doesn't directly impact large businesses or small businesses in any way."

But those comments drew some scorn and disbelief from Republican members of the committee. Not going through that review process is "either extremely naïve and incompetent, or it's arrogance to the highest degree," said Rep. Blaine Luetkemeyer (R-Mo.).

Even ranking member Nydia Velazquez (D-N.Y.) said she was concerned that EPA hadn't more fully examined the rule's impact on small businesses.

"I just do not understand how do you come to the conclusion that there is not direct impact on small entities, because you haven't provided us the process in which you arrived to that conclusion," she said.

But Velazquez distanced herself from statements made at the hearing that Congress -- both Republicans and Democrats -- do not trust the agency and believe it should completely start over with the waters rule.
Perciasepe also said he doesn't believe "that most people don't trust EPA" and dismissed the idea of withdrawing the rule. Congress, he said, has put the agency in a difficult position in light of Supreme Court directions that the agency clarify the scope of its authority over waters in the United States.

"I have a Supreme Court chief who's saying, 'Why don't the agencies do this?'" Perciasepe said. "There are three branches of government. I have one branch [the legislative] who wrote to me when I was acting administrator saying please do a rulemaking. Now I have that branch saying maybe we should withdraw it."

But those comments led one lawmaker, Rep. Richard Hanna (R-N.Y.), to accuse Perciasepe of falling back on the Supreme Court and not taking responsibility for EPA's actions. Perciasepe was "not going anywhere" with his testimony if the goal was increasing the trust between EPA and Congress, he said.

Members of the committee only briefly acknowledged Perciasepe's impending departure.

"I got to give you a lot of credit," Collins said. "I think you knew you were coming into the lion's den today, and here you are. It's hard to defend the indefensible, and that's what your agency has sent you to do."




Telemedicine Is Transforming How Small Medical Practices Provide Care, Reducing Costs

House Small Business Committee News - Thu, 07/31/2014 - 12:00am
The Small Business Subcommittee on Health and Technology, under the chairmanship of Rep. Chris Collins (R-NY), today conducted a hearing to examine how small medical practices are using telemedicine to expand their reach and grow their businesses.

Telemedicine usually refers to medical diagnoses and patient care when the provider and patient are separated by distance, but able to interact through technology. For example, a new mobile health small business launched a new product yesterday that allows people to see a doctor virtually via video conference on a smartphone. According to a recent study, the number of households using video consultations for medical care will grow from 900,000 in 2013 to 22.6 million in 2018.

“Over the past few years, there has been a lot of debate about reforming America’s health care system,” said Chairman Collins. “One of the best ways to reform health care and reduce costs is to allow the private sector to improve the industry through innovation and increased access. Telemedicine is the type of tool that does this, and we should fully embrace it. Some physicians and telemedicine advocates are concerned that regulatory barriers will keep this cost-saving and useful technology from reaching its full potential. Washington must work with the medical community to make sure technological advances, like telemedicine, are able to thrive so that they improve the quality and affordability of care.”

Materials from the hearing are available on the Committee’s website HERE.

Notable Quotes:

Dr. Karen Rheuban, Senior Associate Dean for CME and External Affairs Director at the University of Virginia Center for Telehealth in Charlottesville, VA said, “Telehealth is an essential tool to address the significant challenges of access to high quality care for both acute and chronic disease management, to mitigate workforce shortages, improve population health and lower cost of care. There are many opportunities for small practices to integrate telehealth models into every-day practice. However, even for large healthcare systems, managing and navigating the complex legal and regulatory environment which impacts the practice of healthcare using telehealth tools can be challenging. For small group practices and solo practitioners, telehealth holds great promise, but the administrative and regulatory challenges can be overwhelming. Thus it is imperative that we create and promulgate policies that foster certainty, transparency, high quality, secure and sustainable solutions that empower patients, providers and payers to adopt 21st Century models of care.”

Dr. Brenda Dintiman, FAAD at Fair Oaks Skin Care Center in Fairfax, VA said, “I have faced several barriers to most effectively providing care via telemedicine. While I face these barriers as a physician, it is ultimately the patients – often the most economically vulnerable – that are the most directly affected. The largest barrier as noted is reimbursement for telehealth services. Without assured reimbursement, providers and patients are unlikely to utilize telehealth. While Virginia law addresses coverage for telehealth services, this does not guarantee access with all private insurance and many states do not have similar policies.”

Ms. Maggie Basgall, Community Development Specialist for Nex-Tech in Lenora, KS said,“Telemedicine already offers health care providers numerous ways to better serve patients, and many more exciting innovations are on the horizon. The desire for advanced telemedicine already exists, but now we must supply – and then sustain – the robust broadband capability, funding, and education to spur increased adoption of the services across the country.”


Light Finally Shining on FDA’s Approval Delays of Next-Generation Sunscreen Products

WLF Legal Pulse - Wed, 07/30/2014 - 12:00pm
Guest Commentary by Samantha J. Malnar, a 2014 Judge K.K. Legett Fellow at the Washington Legal Foundation and a student at Texas Tech School of Law. A “call to action” this week from the Surgeon General of the United States reports that nearly 5 million people are treated with skin cancer in America each year. […]
Categories: Latest News

Rockefeller: Staff Report Finds Cramming on Wireless Phone Bills Was Widespread

WASHINGTON, D.C. – Senator John D. (Jay) Rockefeller, IV, Chairman of the Senate Committee on Commerce, Science, and Transportation, today released a majority staff report on the findings of the Committee’s investigation into wireless cramming – where consumers get charged on their phone bills for goods and services they never agreed to purchase.

The new report titled, “Cramming on Mobile Phone Bills: A Report on Wireless Billing Practices,” describes a billion dollar industry that has cost consumers hundreds of millions of dollars in u...

A Swing and a Miss by the Missouri Supreme Court

WLF Legal Pulse - Wed, 07/30/2014 - 9:05am
Have you ever been to a sporting event where the mascot and other cheerleaders shoot t-shirts and toss hot dogs into the crowd during lulls in the action? Fun for the whole family, right? Well thanks to a ruling from the Missouri Supreme Court, don’t be surprised if this tradition becomes a thing of the […]
Categories: Latest News


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