Eight Important Features That a Good Call Center Software Must Have

The proliferation of call centers and their growing popularity has led to a huge demand for call center software and such software is essential for every call center who wants to increase and maintain their proficiency and productivity.

They allow one to manage interactions, reduce hold time, route calls immediately to ideal agents, provide detailed call reports and assist in customer communication. However, not all call center software is up to the mark. Here are some features which are a must in any outbound or inbound call center software.

1) Easy to understand navigable lay-out: Keeping in mind the requirements of call centers, various General User Interface (GUI) based software units are being developed to provide a unique platform for the user to carry on interactions with their callers without any interference. Moreover, GUI can also be used for the task of gathering and producing information.

Remember, whichever GUI software you prefer for your call center it must be clear and easy to read. It must help the users to easily understand its functionality. The GUI software should be such that a user must be able to navigate his way through the numerous processes without getting lost.

2) Callback function to keep the caller happy With call center software it is important to have call back function as it allows the caller, whose call is not processed at the time of call, to instruct the system to establish the connection whenever the line is available. This is done by the system by retaining both the called and calling numbers, redialing the called number periodically and alerting the caller when the connection has been made. This way, the caller will not be disappointed.

3) Built in real time statistics In any contact centers, there are numerous data that need to be kept track off and the most challenging part is to use the data effectively. Call center software has built-in real time statistics that make it easy to establish communication with agents and executives instantly. Real time statistics built right into the software, helps the users to see and process the displayed data and make the correct decisions in real time.

4) Manage time with built-in IVR

A built-in Interactive Voice Response (IVR) system greets caller and prompts them to enter enquiries over their telephone keypad. It helps in providing the caller with a lot of information without burdening the call center agent and by reducing the time spent by the agent providing repetitive and standard details. It therefore helps by increasing the efficiency call agents. IVR is a must have software for any call center as it helps a call center agent to spend their time in a more productive way.

5) Improve communication with pop-up screens For incoming call software, a pop-up window is an essential. With a pop-up window, the call center agent will be able to see the caller’s name, address, time of call, and other pertinent information on his/her screen. This feature helps in maintaining a database with various details about the caller and so it becomes easy to establish a good call agent and caller relationship.

6) Handling computer calls With various call center software, there are call routing solutions to help call agents handle calls more effectively. In the longer term, efficiently routing and handling customer phone calls, chats, e-mail, and other media boosts the call center’s productivity. With call routing software, one gets valuable information related to a caller, like the time of call, duration of call, geographical location etc. This information helps to direct the caller to the agent who can help the caller best.

7) Quality monitoring capability As quality assurance is important for the success of any call center software, it is important for the call center software to be equipped with the capacity for real time monitoring. It will allow the supervisor to keep track of past records of the interactions between the call center agents and the callers to check on the performance quality of the agents.

8) Customisable elements The best way to judge the quality of any call center software is to review its customisable, flexible and scalable features. The more flexible is the software, the more it will suit the changing requirements of the call center company. With a feature enriched and easy-to-use call center software solution; there will be an increasing number of callers being handled which will ultimately improve the productivity of a call center.



Source by Kath Dawson

How to Find an Email Address

1. Finding an email address is now possible online through the use of very simple tools anyone can access. If you want to trace an email address, you just need to know where to start you search.

2. The web is suffused with websites such as Yahoo, Switchboard, Worldemaildirectory or Bigfoot that will help you do a free reverse email search. However, most of these sites, that have been at the apex of their market for almost 20 years, are not as competitive as they used to be.

3. Now, how to find an email address? Internet users do not want to be found anymore and are desperate for privacy. They do not automatically register to an email directory as they do not want to be publicly accessible.

4. Tracking an email address is more difficult as users seek more privacy on line. In order to perform an accurate reverse email search, you need to find the IP address of the user.

5. An IP address is a unique series of numbers that can be presented as the identity card of the computer. A computer can be identified through its IP address. However, that is only the first step as the matching between user’s name and IP is confidential.

6. Users need to be equipped with high-quality products used by professionals that will uncover the techniques used to disguise IP address. You may not have a name but you will have a location. This is one step further in you reverse email search.

7. Think like a professional and act as one: if you want to be serious about you email address search you may want to contemplate the idea of investing in high-standard tools that detectives use to access private data. These services might greatly improve your results.

8. The last point you need to remember is to keep a reasonable degree of expectations: If a person does not want to be found then they will not be found, unless you use more sophisticated tools available on the market now.



Source by Sophia Munoz

Getting the Best Out of Landscaping Services

Most people know only about landscaping as a way to maintain their gardens like pruning some plants or taking out the weeds. But landscaping services can do so much more for a garden whether it’s big or small.

Landscaping is changing the appearance of a lawn or backyard. It can involve trimming the grass or pruning some branches of a tree but it can also entail building or adding on some structures to give a lawn or backyard more appeal. Landscapers can even add or remove some of the soil just to alter the feature of the whole layout of the land.

There are so many ways for landscaping to improve the appearance of your backyard. Your backyard doesn’t even have to be enormous for it to have potential. Some people equate landscaping with mansions or large fields but even the most modest lawns can turn out to be wondrous landscapes if the design is right. With the right amount of budget and a little creativity you could have a beautiful lawn or backyard in no time.

Before you start looking for an expert in landscaping, try visualizing first how you want your backyard to look like. Better yet, look at photos of beautiful landscapes online or in   magazines  so that you could have a more concrete idea on the appearance of your lawn.

When you’re ready to meet with a landscaper, there are a few details you should know first so that you’ll be able to choose the right person for the job. First, pick a landscaper that has experience. Landscaping can be quite expensive so be careful in choosing a landscaper so that you won’t end up remodelling your lawn a number of times. A landscaper with experience has clients that could vouch for his or her professionalism. Ask around about the landscapers you are canvassing and you might be able to discern which one is the most efficient.

Picking the most affordable landscaper is just as important as picking the most efficient. If you want to pick a landscaper that you can afford, try asking your roster of landscaping firms to place a bid. This way you could see which landscaping firm can do the job at the most decent price.

After you’ve chosen a landscaper to your liking, the next thing to do is to discuss the details on your lawn. You and your landscaper must be on the same page with everything otherwise you’ll have problems in the near future. No detail is trivial and you should discuss everything with your landscaper. From the kind of grass you want to use up to the kind of water feature you want installed, every detail should be discussed with your landscaper.

When you’re working the designs with your landscaper try your best to hear their opinions even if it means getting rid of some of your designs. Landscaping services providers are experts in figuring out what water feature or backyard structure works best with the lawn so let them help you with your lawn.



Source by Daniel Cargille

What Is Cushing Syndrome in Dogs?

Cushing syndrome is one of the most common endocrine diseases that dogs can suffer. The common thing is that it appears in animals older than six years and among small dog breeds (such as Yorkshire, Maltese or Schnauzer bichon). It is a chronic disease that can not be prevented, but with the right treatment, your pet can enjoy a good quality of life. Below we tell you what it consists of and what are its possible treatments.

Origin of Cushing syndrome in dogs

This condition causes alterations in the metabolic system and occurs when the body begins to produce large amounts of the hormone cortisol (which is responsible for responding to stress). Excess of this hormone can cause health problems to your pet, such as damage to your vital organs or reduction of energy and strength.

These are the main causes of Cushing syndrome:

• Pituitary-dependent tumors

These tumors are located in the pituitary gland of the brain. It causes increased production of adrenocortical hormone-trope (ACTH) and over-stimulation. This leads to increased production of cortisol in the adrenal glands.

• Adrenal Tumors

These are tumors located in the adrenal glands. This abnormality affects the cortex of one or both glands (located in the upper extremities of the kidneys).

• Glucocorticoids

They are medicines used to combat or control allergy problems and immunosuppressive diseases. Their overuse can fill the body with cortisol while slowing the activity of the adrenal glands and reducing them in size.

• Racial predisposition

There are several breeds of dogs that tend to have pituitary tumors (poodle, tackle, Boston terrier, bobtail, German shepherd, dwarf poodle… ). On the other hand, the glucocorticoid’s effect especially races like the shepherds of the Pyrenees, the farmers, the boxers and the poodles, making them more susceptible to get this syndrome.

This disease can not be predicted or predicted, and you can not avoid it (except to control the doses of glucocorticoid’s), but detect it in time itself. The following are the most common symptoms for detection. If you detect any of them in your pet, we advise that you go to the veterinarian to diagnose it and, if necessary, start treating it as soon as possible

• Lack of hair on the body, especially on the sides and tail.

• Polyura increased urine.

• Polydipsia increased thirst.

• Increased appetite.

• Fatigue and continuous gasping.

• Abdominal swelling.

• Muscular atrophy.

• Dark pigmentation on the skin.

• Delayed healing.

How to Treat Cushing Syndrome in Dogs

The fundamental thing about this disease is that the endocrine system ceases to exceed the production of the hormone cortisol. But this is quite complicated since you have to find the exact proportion of hormone-regulating drugs. The good thing is that once this ratio is found your dog will be able to have a normal life again.

In addition to pharmacological treatment (which would be for life), there is also the possibility of surgery if the syndrome is caused by adrenal and pituitary-dependent tumors. The operation is to remove the tumor, but it is more risky and complex than the pharmacological treatment.

If you want to make sure that your dog receives the appropriate treatment, it is best that you go to your veterinarian and consult your doubts. He will know what is best for your dog and what is the right solution for him.

Do you but have or have you had Cushing syndrome? Did you detect any of the symptoms mentioned? Did you opt for a treatment or for the operation? Tell us your experience, sure that readers who suffer for their pets will be quieter.



Source by Raja Abdul Rehman

10 Abdominal Exercise Substitutions

Today, you’re going to discover the six-pack abs approved abdominal exercise substitution list AND 1 exercise you should never do.

Please print this exercise substitution list out and email it to your friends. Heck, you could even post it at your gym.

HERE WE GO – starting with the 1 exercise NEVER to do…

Now yesterday I told you about how I saw a trainer put his client through a BACK-DESTROYING exercise, and here’s what it was:

The exercise was weighted Stability Ball Crunches – but there were not normal crunches on the ball that you see people do. No way.

You see, not only did the client do a full-on sit-up motion, but she kept going – violently – into a total body flexion movement that ended with her almost putting her head between her knees.

But doing any type of spinal flexion can be harmful to your low back because this will compress the disks in your spine.

In fact, Dr. Stuart McGill, the world’s expert on low-back injuries and abdominal training, said in a recent New York Times article, “…no sit-ups, they place devastating loads on the disks.”

The disks in your spine are the same disks that get herniated in low back injury. And moves like sit-ups essentially CRUSH the disks between the bones in your spine, causing terrible pain and nerve damage.

So STOP doing crunches and sit-ups!

Fortunately, you can still get six-pack abs and a flat, sexy stomach by using back-friendly ab exercises instead.

So let’s review a huge list of abdominal exercise substitutions:

1) Replace crunches with:

Planks, mountain climbers, and stability ball jackknives

2) Replace cross-crunches (i.e. twisting or oblique crunches) with:

Side planks and cross-body mountain climbers

3) Replace sit-ups with:

Stability ball jackknives, stability ball planks, stability ball pikes, stability ball rollouts, and hanging knee raises

Now let’s take a look at how we can make some of these back-friendly ab exercises even harder for your abs:

1) How to increase the difficulty of the Plank

First of all, before you move on from the plank, you have to master it.

Dr. McGill says that we should all be able to do a plank for 2 minutes straight.

Now I’ll be honest, I let myself go on this exercise last summer, and not surprisingly, it was probably one of the reasons I had back pain.

At one point, I was only able to do a strict plank for 75 seconds, but I’ve worked my way back up over 135 seconds, and now my back pain is gone.

You can also do pushup-planks, as those will help prepare you for pushups if you are a beginner.

Eventually you will graduate to the Stability Ball Plank, which is 30% harder for your abs than regular planks.

2) Harder versions of the Side Plank

Advanced versions include the Side Plank with Leg Raise and Side Plank with DB Lateral Raise (allowing you to train your shoulders at the same time). Dr. McGill adds that we should be able to do aside plank for 90 seconds straight.

3) Mountain Climbers substitutions

You can use the Spiderman Climb exercise as a replacement, and this is excellent for lower-body and hip mobility.

A harder version of mountain climbers is the Cross-Body Mountain Climber, and you can also do mountain climbers with your hands on the ball or with your hands on the floor and feet on the ball.

One of my favorite advanced versions is the “Hands on the Floor, Feet on the Ball Cross-body Mountain Climber” or even the “EXTREME X-Body Mountain Climber”.

Stability Ball NOTE

If you don’t have a ball, you need to get one. They are cheap, and I’m not asking you to do any dangerous circus tricks on them!

But if you don’t have a ball, you can replace the Stability Ball Plank with the Mountain Climber exercise, but it will not be as difficult.

4) How to increase the difficulty of the Stability Ball Jackknife

Eventually you’ll progress to the Stability Ball Pike. And another way to do this exercise is using the TRX straps. That is one of the exercises that gets improved by the TRX. Very effective movement. But even with the ball you can step up your training by using this exercise.

5) The Stability Ball Pike

This is another exercise improved by using the TRX, as well as a cool toy I bought called the Power Wheel. The key to the exercise is raising your hips up as high as possible, and again, using the Power Wheel or TRX allows you to do that better.

6) Alternatives for the Stability Ball Rollout

If you are new to this exercise, you can use a modified Roll-out that is easier.

Plus, you can substitute an ab wheel in place of the ball or you can even use the TRX in a similar type of movement. It works because you are fighting the extension of your torso.

Stretch your abs on the way out, and contract your abs to return to the starting position. This movement will leave your abs quite sore if it is a new exercise for you!

7) Additional Advanced Abs Exercises

Once you’ve dominated all of these Stability Ball exercises, you can move to traditional advanced ab exercises of of Hanging Knee Ups and Hanging Leg Raises.

However, you should only do these exercises if you can fully ELIMINATE momentum from the exercise. Do NOT swing your hips or rock back and forth.

8) Pushups That Workout Your Abs

You should also understand that a LOT of traditional exercises work your abs and slight variations of traditional moves can work your abs very hard.

For example, some of the best pushups for abs include:

* Elevated Pushups

* T-Pushup

* Spiderman Pushups

* Decline Spiderman Pushups

You’ll get all of these in six pack abs home workouts, of course.

9) Pulling Exercises that work your abs

Back in the day, I trained a fit woman who had never been asked to do a chin-up by her previous trainers. So I had her do 2-3 sets of 3-5 repetitions.

She came back the next session and couldn’t believe how sore her abs were from this exercise. So again, you will get a lot of ab work from traditional movements. In addition to the chin-up, here are my favorite “total body pulling muscle ab exercises”.

* DB Renegade Row

* Pullups

* Chinups/Pullups with kneeups

* Spiderman Pullups

Use those to make your workouts more efficient.

10) Shoulder/Arm Exercises

YES, you can use shoulder and arm exercises to work your abs. Any time you do a standing exercise, you’ll need to brace your abs HARD in order to maintain a stiff torso. That works your abs as hard as planks and side planks.

Plus, in the triceps extension exercise, you are stretching your abs as you lower the weight and contracting your abs as you contract your triceps to return the dumbbells or bar to the start position. I’ve had super-sore abs just from doing triceps!

So here are my favorite upper body exercises for abs:

* 1-Arm Press

* 1-Arm Curl

* DB Triceps Extension

Hope you enjoyed that massive list of ab exercise substitutions!

Just say NO to crunches!



Source by Craig Ballantyne

Finding your Dream Car

Thinking about buying a used car? How do you know which car is right for you? It’s all in asking the right questions.

First, ask yourself what you really need in a car. Who will be driving it most of the time? Where will you be driving in? Over what sort of terrain? Do you need a lot of storage space and lots of seating? Are you going to be traveling back and forth over long distances?

What features are an absolute must? Air conditioning, adjustable controls, cruise control?

What safety features you are looking for? Anti-lock brake systems, head injury protection, or child protection equipment?

How much are you willing to spend?

What kind of down payment can you make?

Realistically, what can you afford to pay monthly?

It’s important to know this amount before you even start looking. Then do your research. Check websites, dealerships, and Consumer Reports   magazine . Look for reliability and repair ratings as well as safety advice. The website http://www.edmunds.com offers pricing information and advice on buying a used car.

Go exploring for that perfect car. Gather as much info as you can on the different makes and models. Check out the retail value, available options, performance, and track record for repairs.

No matter where you buy your used car, be prepared to stand firm. There are a bazillion other cars you could fall in love with. Be willing to walk away from the car if the deal doesn’t meet the criteria you laid out earlier. Your ability to negotiate a great deal will increase by leaps and bounds.

Always know the market value of any car you’re considering and make your first offer lower. You want a little room to negotiate.

Ask for a detailed vehicle history report and service records from the seller. This report can identify major problems including past accidents, flood damage, and odometer discrepancies. When you decide to buy a car, make sure you get it checked out by a trusted mechanic before you hand over any money. That’s absolutely crucial.

Buying a used car can be one of the most exciting purchases you ever make. Following a few guidelines will ensure that it’s also one of the wisest!

Go to http://www.Automotive.com/used-cars/ for a great selection of used and pre-owned vehicles.



Source by Adam M

Case Study Theories for Content Marketing Success – Why It Is Needed?

Content marketing is one of the newest forms of marketing, bettered as effective marketing. It’s proving to be one of the most intelligent forms of psychedelic business driving marketing. The Global Survey in the area of the Digital marketing confirms that 72% of marketers offer a better ROI than magazine advertising, while 69% feel that it’s more effective than direct mail and PR. The realization to the success factor can be realized from the varied case studies theories that are necessary to keep one with the trends and the market variations.

Case Studies needs in marketing

The Innovative and creative marketing strategies are imperative to the success of a brand and the workforce. The best lessons that can be learned through experiences and practical solutions for a wide variety of companies, industries, and agencies. Within these case studies, you will find ideas and inspiration for everything from social media plans, lead generation, direct marketing, research, branding, sales force, and more.

Success factors matter- How much?

The success of the content marketing in the ongoing years has increased to a huge level with the broadening of the help in the different areas mostly the companies and agencies in the digital marketing.

In the today’s digitize the world it is observed that marketers searching Google and other search engines for inspiration to create an epic content marketing plan. It’s not that much of easiness to get stumped with all of the information available or you might simply need a few examples of different successful endeavors from some epic companies. The one thing that matters for the success in the content marketing is the popularity and the reach of the audience by the marking of the words.

Content marketing at the small or large extent matters with the basic inspiration that one will be able to take with you to your next content marketing meeting with the certain speculations in designing the best of the content needs for the advertising and the marketing campaigns.

What can be done to prepare the successful case studies with the content driving?

• Play your part with the video content in the form of the live streaming and podcasts.

• The mission should go with the put forward the center players as the target audience and drive the content needs that is ease with the language and digestible.

• The pre-requirements with the content need in the form of multiple content formats as because it can be well-understood by the people it differently formats.

• Media and the news print part also play a major role in the different content needs to drive the requirements with media house states they are not the only ones responsible for coming up with these stellar content ideas.

• Marketing is all about the getting the best headline and the slogan to create the most appealed part of the driven the lead generation. As the marketer with the content option should look for a memorable slogan that helps people remember your company quickly and easily!

Ready, Set, and Go with the content marketing

For the success of the content marketing in drawing the case studies, it is better to be in the limelight of extreme, yet engaging content marketing and copy writing. Content marketing has helped the company reposition itself. It still faces challenges as industry revenue continues to falter, but the company has weathered the storm better than content needs and the success measures with the preparation of the successful case studies.



Source by Sahil Prajapati

Statutes in U.S. Healthcare System

The healthcare field is the subject of a host of federal statutes, regulations, guidelines, interpretive information, and model guidance. There are a considerable number of statutes and regulations that have an impact on the delivery of healthcare services. A statute is legislative enactment that has been signed into law. A statute either directs someone to take action, grants authority to act in certain situations, or to refrain from doing so. Statutes are not self-enforcing. Someone must be authorized to do so to take action. A statute may authorize the Department of Health and Human Services to take action, and it is up to the department to implement the law. Regulations, or rules, are made by administrative personnel to whom legislatures have delegated such responsibilities. It is a tool for developing policies, procedures, and practice routines that track the expectations of regulatory agencies and departments. The statutory and regulatory requirements are subject to judicial interpretation.

A very important element of healthcare management is to understand the key regulatory environment. One government statute that effects patient healthcare is the Anti-Kickback Statute. The Medicare and Medicaid Patient Protection Act of 1987 (the “Anti-Kickback Statute”), has been enacted to prevent healthcare providers from inappropriately profiting from referrals. The government regards any type of incentive for a referral as a potential violation of this law because the opportunity to reap financial benefits may tempt providers to make referrals that are not medically necessary, thereby driving up healthcare costs and potentially putting patient’s health at risk. The Anti-Kickback statute is a criminal statute. Originally enacted almost 30 years ago, the statute prohibits any knowing or willful solicitation or acceptance of any type of remuneration to induce referrals for health services that are reimbursable by the Federal government. For example, a provider may not routinely waive a patient’s co-payment or deductible. The government would view this as an inducement for the patient to choose the provider for reasons other than medical benefit. While these prohibitions originally were limited to services reimbursed by the Medicare or Medicaid programs, recent legislation expanded the statute’s reach to any Federal healthcare program. Because the Anti-Kickback statute is a criminal statute, violations of it are considered felonies, with criminal penalties of up to $25,000 in fines and five years in prison. Routinely waiving copayments and deductibles violates the statute and ordinarily results in a sanction. However, a safe harbor has been created wherein a provider granting such a waiver based on a patient’s financial need would not be sanctioned. The enactment of the 1996 Health Insurance Portability and Accountability Act (HIPAA) added another level of complexity to the Anti-Kickback statute and its accompanying safe harbors. HIPAA mandated that the OIG (Office of Inspector General) furnish advisory opinions to requesting providers that are either in an arrangement or contemplating an arrangement that may not fit squarely within the law. For a fee, the OIG would analyze the arrangement and determine whether it could violate the law and whether the OIG would impose sanctions on the arrangement. In many of its advisory opinions published over the past few years, the OIG has stated that it would not impose sanctions, even though it found that the arrangement in question could violate the statute. A common reason the OIG has given for not imposing sanctions has been that the arrangement provides an overall benefit to the community. Healthcare finance professionals need to ensure that all business transactions comply with the Anti-Kickback statute.

The Anti-Kickback statute effects the patient. The main aim of this statute is to improve patient safety, provide satisfaction and avoid risk. The result of the acquisition of a physician’s practice would serve to interfere with the physician’s subsequent judgment of what is the most appropriate care for a patient. It would also interfere with a beneficiary’s freedom of choice of providers.

Physicians have direct patient care responsibilities. Any incentive payments to such physicians that are either tied to overall costs of patient treatment or based on a patient’s length of stay could reduce patient services. Also, the profits generated by cost savings may induce investor-physicians to reduce services to patients. Health care programs operate on the good faith and honesty of health care providers. It is important to ensure that quality services are provided at the hospital. The Anti-Kickback statute helps the government not to tolerate misuse of the reimbursement systems for financial gain and hold the responsible parties accountable for their conduct. Such conducts can also prompt patient complaints. The hospitals and physicians who are interested in structuring gainsharing arrangements might adversely affect patient care.

The Anti-Kickback statute creates a protective umbrella, a zone in which patients are protected so that the best health care is provided. This statute helps to improve efficiency, improve quality of care, and provide better information for patients and physicians. The Anti-Kickback statute is not only a criminal prohibition against payments made purposefully to induce or reward the referral or generation of Federal health care business, it also addresses the offer or payment of anything of value in return for purchasing, leasing, ordering of any item or service reimbursable in whole or part by a Federal health care program. It helps to promote quality and efficient delivery of health care transparency regarding health care quality and price.

There are millions of uninsured patients who are unable to pay their hospital bills. Giving a discount on hospital charges to an uninsured patient does not implicate the Federal Anti-Kickback statute. Most need-based discounting policies are aimed at making health care more affordable for the millions of uninsured citizens who are not referral sources for the hospital. For discounts offered to these uninsured patients, the Anti-Kickback statute simply does not apply. It is fully supported that a patient’s financial need is not a barrier to health care. Furthermore, OIG legal authorities permit hospitals and others to offer bonafide discounts to uninsured patients and to Medicare or Medicaid beneficiaries who cannot afford their health care bills. The Anti-Kickback statute is concerned about improper financial incentives that often lead to abuses, such as overutilization, increased program costs, corruption of medical-decision making, and unfair competition.

There are risk management implications of this statute. There are risks associated with the Anti-Kickback statute and its good to prevent them. Rather than be an imposing and daunting challenge to understand, the outcome can be development of risk management systems to guide the delivery of health care. This fact is recognized that such statutes are an important attribute of the risk management professional. For example there are potential risks under the Anti-Kickback statute arising from hospital relationships. In case of joint ventures there has been a long-standing concern about arrangements between those in a position to refer or generate Federal health care program business and those providing items or services reimbursable by Federal health care programs. In the context of joint ventures, the chief concern is that remuneration from a joint venture might be a disguised payment for past or future referrals to the venture or to one or more of its participants. The risk management should be done by having a knowledge of the manner in which joint venture participants are selected and retained, the manner in which the joint venture is structured and the manner in which the investments are financed and profits are distributed. Another area of risk is the hospital’s compensation arrangements with physicians. Although many compensation arrangements are legitimate business arrangements, but may violate the Anti-Kickback statute if one purpose of the arrangement is to compensate physicians for past or future referrals. Risk management is to follow the general rule of thumb that any remuneration flowing between hospitals and physicians should be at fair market value for actual and necessary items furnished or services.

Risk management is also needed in entities such as in cases where a hospital is the referral source for other providers or suppliers. It would be prudent for the hospital to scrutinize carefully any remuneration flowing to the hospital from the provider or supplier to ensure compliance with the Anti-Kickback statute. Also, many hospitals provide incentives to recruit a physician or other health care professional to join the hospital’s medical staff and provide medical services to the surrounding community. When used to bring needed physicians to an underserved community, these arrangements can benefit patients. However, recruitment arrangements pose substantial fraud and abuse risk. This can be prevented by having knowledge of the size and value of the recruitment benefit, the duration of payout of the recruitment benefit, the practice of the existing physician and the need for the recruitment. Another area where risk management is to be applied is when the discounts are given. The Anti-Kickback statute contains an exception for discounts offered to customers that submit claims to the Federal health care programs. The discounts should be properly disclosed and accurately reported. The regulation provides that the discount must be given at the time of sale or, in certain cases, it should be set at the time of sale. This will help in risk management. It is also needed in medical staff credentialing and malpractice insurance subsidies.

The key areas of potential risk under the Federal Anti-Kickback statute also arise from pharmaceutical manufacturer relationships with 3 groups: purchasers, physicians or other health care professionals, and sales agents. Activities that pose potential risk include discounts and other terms of sale offered to purchasers, product conversion, consulting and advisory payments. The pharmaceutical manufacturers and their employees and agents should be aware of the constraints the Anti-Kickback statute places on the marketing and promoting of products paid for by federal and state health care programs. To that end, the draft guidance recommends pharmaceutical manufacturers ensure that such activities fit squarely within one of the safe harbors under the Anti-Kickback statute. The Department of Health and Human Services has promulgated safe harbor regulations that protect certain specified arrangements from prosecution under the Anti-Kickback Statute.

Healthcare being one the most regulated of all sectors of commerce, it is important that all facts and circumstances with respect to the statutes and regulations are evaluated.



Source by Meenu Arora Kapur

Boston Terriers and Aggression

The Boston Terrier is descended from tough, ferocious dogs. Bulldogs were developed to work with butchers to engage and control steers and cattle-animals that were many times their own size and that could cause fatal injury if the dog was not quick or tough enough. The terriers that contributed their genes to the Boston’s family pool were pit fighting dogs, fearless fighters of their own kind but completely harmless to humans. How these ferocious breeds were used to create the friendly, happy companion we know today is difficult to explain or understand. But throughout the generations, the dogs were selected as much for their easygoing, nonaggressive nature as for their type and structure.

Boston Terriers can be aggressive toward other dogs, particularly when they are behind a fence or on a leash. This may be something the dog has learned, or it may be a genetic tendency. Regardless of its origins, this behavior is not typical of Boston Terriers and is not to be considered acceptable. In many cases, this behavior can be changed by teaching the dog to focus on his owner and by rewarding the dog with praise and treats for ignoring the other dog or dogs. Under no circumstances should a dog be punished or corrected for this aggressive behavior by yanking on the leash, yelling at the dog or hitting the dog. The aggressive behavior is usually caused by fear, and punishment can increase the fear and thereby increase the aggression that the punishment was intended to stop.

If your Boston Terrier does display aggressive behavior toward you, other humans or other dogs, you should seek the services of a competent dog trainer or behavior specialist who will work with you to change the dog’s behavior without resorting to punishment or correction of any sort. Before the training begins, the trainer or specialist will probably recommend a thorough vet exam to rule out physical causes for the aggressive behavior. Sometimes pain or illness can cause a dog that has always been peaceful to suddenly behave aggressively. Certain chemical imbalances in the body, such as low thyroid hormone levels or abnormalities of the liver, can trigger aggressive behavior in dogs. I have seen a few cases of Boston Terriers who would suddenly and unaccountably “turn on” their owners and bite them severely, and every case of that type was attributed to a brain disorder causing seizures or seizure-type problems.

Aggressive behavior is not normal for Boston Terriers. A Boston that does develop aggression should be checked thoroughly by a vet and put on a program of positive, reward-based behavior modification under the supervision of an experienced dog trainer, behavior specialist or Certified Veterinary Behaviorist.

Ask your dog-owning friends for recommendations on dog trainers. Call trainers to ask whether you may observe their classes (if they say no, look elsewhere). Look for a trainer who is very positive, one who emphasizes praise and rewards for the dog’s good behavior and avoids punishment or corrections for bad behavior.



Source by Rick Alan Thomas

Premature Ejaculation, Solving the Problem – Part 1

Premature ejaculation is not life-threatening and does not prevent conception. It therefore receives little attention in the public and medical literature. It is however widely accepted to be the most common form of male sexual dysfunction. This is the first in a series of articles on ‘coming too quickly.”

What options do men have when they suffer with premature ejaculation?

Option 1. They can explore the internet, magazines or sex shops for an answer. Sadly men have been taken advantage of by rip-off “cures” which are sold at outrageous prices. These men who simply want to improve their sexual experience and provide more satisfying experiences for their partners have been preyed upon by unscrupulous ‘entrepreneurs’ with no credentials. They have been exploited by unfulfilled promises that sprays, lotions, creams, vitamins, herbs, dietary supplements and useless techniques will solve their problem. When these gimmicks fail to do so the men are left feeling frustrated, angry and worst of all, hopeless about finding a solution. Which is even worse than taking their money.

Option 2. They can resort to medications that may slow ejaculation. Antidepressants are most commonly used. While approximately 1/3 of men do respond, they must continue to take the drug indefinitely and there are many potential side-effects, some extremely dangerous. Aggression and suicide are the most serious, and these occur most commonly in young people, the very group that is most likely to have this problem. Unfortunately more doctors are prescribing these drugs largely because they do not have time in their busy practices to address the problem otherwise.

Today, a new threat lies on the horizon.

A new drug is in clinical trials in the USA and Canada. The manufacturer plans to market it specifically for premature ejaculation. They claim that its shorter half-life will eliminate side-effects but that has not been proven. If doctors begin to prescribe this drug in response to demands from patients, the impact will be dramatic, since estimates of the occurrence of premature ejaculation. in young men range up to 70%.

When the pharmaceutical company starts to pour millions of dollars into advertising, as has been done with erectile dysfunction, countless young men will start using this drug. Many will never stop. The number of men suffering with premature ejaculation is five times larger than the number with erectile dysfunction. One can only imagine the resources that will be committed to advertising to an audience of this size.

The ultimate tragedy in following either of the two options mentioned above is that the solution to premature ejaculation lies with neither of them. Premature ejaculation can not be cured by medication, nor can it be resolved by any of the expensive gimmicks offered online.

I am writing this article because of the growing number of websites peddling trash plus the growing threat of widespread antidepressant use. Men should not be seduced into buying useless products or using potentially harmful drugs that do not address the root of the problem. This could lead to a generation of men who are dependent on a drug that has been created for the sole purpose of establishing a very profitable market for the pharmaceutical company. If that comes to pass it would be a monumental tragedy because it is absolutely unnecessary.

In Part 2 of this series we will look at the third option, the one that is recognized by experts to be the right approach to solving the problem of premature ejaculation.



Source by Dr Sy Silverberg M.D