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Dobson | DaVanzo's evaluation of Medicare Shared Savings Program Accountable Care Organizations (ACOs) found greater savings than the Centers for Medicare and Medicaid Services (CMS) benchmark savings estimate.
Dobson | DaVanzo was recently commissioned by the American Association for Homecare (AAHomecare) to conduct a survey amongst stakeholders experiencing consequences of the recent expansion of competitive bidding for durable medical equipment (DME).
Dobson | DaVanzo, as a subcontractor to LMI, has been awarded a task order as part of a contract to support the Measure and Instrument Development and Support (MIDS) under the Centers for Medicare and Medicaid (CMS) Center for Clinical Standards and Quality (CCSQ). The MIDS contract has an overall value of $1.6 billion over 10 years. We look forward to working alongside LMI to improve the quality of the Medicare program.
HME News reported that Pacific Research Institute (PRI) referenced a 2016 survey conducted by Dobson | DaVanzo in a new study titled "Reforming CMS' Competitive Bidding Process to Improve Quality and Sustainability."
In a recently released report, Dobson | DaVanzo discusses the role generic medicines play in decreasing the rate of increase in drug expenditures. Apart from unique and innovative introductions to the drug market, a conversion to generics has consistently reduced inflationary pressures in the U.S. drug marketplace.
In a study for the Federation of American Hospitals and the American Hospital Association, Al Dobson, Joan DaVanzo, Randy Haught and Phap-Hoa Luu estimated that the cumulative federal payment to hospitals between 2010 and 2028 would exceed $218 billion.
MedPAC recently released their June 2018 Report to Congress in which they have acknowledged Al Dobson as a contributor. The Commission publishes two annual reports advising Congress on issues affecting the Medicare program. The latest report can be found here.
In the January 2018 issue of Value in Health, Joan DaVanzo and Randy Haught coauthored an article that presents findings from the first comprehensive study of Medicare spending on wound care. The study found that close to 15% of Medicare beneficiaries had at least one type of wound or infection and estimated the cost of wound care for Medicare beneficiaries to be nearly $32 billion. This study has broad implications given that Medicare expenditures related to wound care are much higher than previously thought, and lays the foundation for future research and the development of more appropriate quality measures and reimbursement models. The article can be accessed here, and the Alliance of Wound Care Stakeholders' press release about the study can be found here.
Sarmistha Pal (lead author) and Joan DaVanzo co-authored a December 2017 article in Surgery Technology International on the impact of Neuromuscular Electrical Stimulation (NMES) on episode costs and post-acute care utilization in total knee replacement patients with disuse atrophy. NMES is a complement to conventional forms of physical therapy. NMES involves the application of low-level electrical currents to targeted muscles which helps to strengthen the quadriceps muscle, thereby improving surgical outcomes and decreasing complications. The authors found that patients who used NMES had lower costs and a lower probability of readmission. The article can be accessed here.
In a study for The Commonwealth Fund, Al Dobson, Joan DaVanzo, Randy Haught and Phap-Hoa Luu examined how the Affordable Care Act's Medicaid expansion affected the financial status of safety-net hospitals. Using Medicare Hospital Cost Report data for federal fiscal years 2012 and 2015, the authors analyzed changes in Medicaid inpatient days as a percentage of total inpatient days, Medicaid revenues as a percentage of total net patient revenues, uncompensated care costs as a percentage of total operating costs, and hospital operating margins. The authors found that the operating margins of safety-net hospitals in expansion states improved (in large part due to increased Medicaid revenues and reduced uncompensated care costs) while the operating margins of safety-net hospitals in non-expansion states declined. The study can be accessed here.
A Dobson | DaVanzo report entitled, "Access to Home Medical Equipment: Survey of Beneficiary, Case Manager, and Supplier Experiences", was released on October 12, 2017.
The analysis was based on a social media survey of beneficiaries, case managers/discharge planners, and suppliers. Over 1,000 responses were gathered in a 6-week time frame, indicating the power of social media to gather relatively large amounts of information in a short period of time. The report found that the Medicare Competitive Bidding (CB) process may require mid-course corrections in order to improve the beneficiary experience under CB. The report is available here.
Al Dobson presented at the American Orthopedic and Prosthetic Association's Centennial Celebration and World Congress on Saturday, September 9. Al's presentation, "The Economic Value of Orthotics and Prosthetics Care to the Medicare Program: 2011 – 2014 Update" summarized Dobson | DaVanzo's recent research on the financial benefit to government and private payers when a person with spinal injury or lower limb loss or impairment attains restored mobility through receipt of orthotic and prosthetic services. This research, which confirmed the findings of an initial study that used earlier years of data, suggested that the receipt of orthotic and prosthetic services leads to a reduction in health care utilization that equals or exceeds the cost of the services, thus increasing quality of life for the patient and reducing the cost to Medicare. To view the presentation, click here.
Al Dobson, Kennan Murray and Joan DaVanzo recently co-authored a report for 340B Health summarizing an analysis that assessed the financial impact of 340B discounts on drug manufacturers and evaluated the plausibility of claims that the 340B Program is a cause of pharmaceutical price increases, cost shifting, and reductions in private sector research and medical discovery. The analysis found that the 340B Program cannot plausibly be a major driver of U.S. drug spending or a major cause of cost shifting by drug manufacturers to make up for 340B discounts. The results of this analysis were published on the 340B Health website to view click here.
Al Dobson, Kennan Murray and Joan DaVanzo recently co-authored a report for 340B Health which evaluated the financial challenges faced by disproportionate share hospitals participating in the 340B drug discount program due to their characteristics as safety net hospitals and their unique patient populations. The study analyzed whether 340B DSH hospitals incur higher drug spending than non-340B hospitals because they treat high levels of low-income patients and operate as safety net facilities. The analysis found that 340B DSH hospitals incur higher drug spending than non-340B hospitals due to the low-income patients they treat and the nature of the safety net facilities they operate. Read the report here.
Dobson | DaVanzo's study of the MedPAC site-neutral post-acute care payment system prototype was published in a letter from the American Hospital Association (AHA). The letter, "Recommendations on the Development of a Post-Acute Care Prospective Payment System", discusses AHA's concerns with the MedPAC prototype, and makes several recommendations. The concerns and recommendations follow from the Dobson | DaVanzo's report, which examined the prototype payment system data sources, econometric approach, and policy implications. To view the letter which includes the report click here.
Dobson | DaVanzo co-authors "Addressing the Risk of Bacterial Contamination in Platelets: A Hospital Economic Perspective," an article published in the Transfusion Journal which is currently posted on Wiley OnlineOpen. The article, commissioned by Verax Biomedical, Incorporated, discussed the comparative study on the economic value of Platelet PGD test and that of pathogen reduction technology (PRT). In comparison to platelets treated by PRT, platelets tested by the PGD test have extended shelf-life, accrue significantly lower cost, and thus generate savings for hospitals. To read the article click here.
Dobson | DaVanzo's AAHomecare Study was mentioned in an article featured on HME Business. The article, "AAHomecare Prioritizes Payer Relations" discusses how Laura Willard, Vice President of Payer Relations, enhances relations with various payers beyond Medicare, using resources such as Dobson | DaVanzo's study, which analyzed the full operational costs plus cost of goods against the current Medicare reimbursement environment. To read the article click here.
In a June 2017 study for The Commonwealth Fund, Al Dobson, Randy Haught and Joan DaVanzo estimated the financial impact of the Medicaid provisions in the American Health Care Act (AHCA) on safety-net hospitals. Using the Dobson|DaVanzo Hospital Finance Simulation Model, Medicare Hospital Cost Report data, and assumptions on how states would respond to the AHCA Medicaid provisions, the authors found that beginning in 2020, the financial status of safety-net hospitals could deteriorate as Medicaid coverage is reduced and the per-capita spending limits proposed in the AHCA grow. In addition, the authors found that small rural safety-net hospitals and safety net hospitals treating large proportions of low-income patients could be hurt the most. Ultimately, the study shows the strain that would be placed on safety net hospitals due to Medicaid provisions in the AHCA, and indicates that unintended consequences such as hospital closures, cost shifts to Medicare and private insurers and reduced provider payments may be a byproduct of the proposed legislation. The study can be accessed here.
Al Dobson, Randy Haught, and Joan DaVanzo co-authored "How the American Health Care Act's Changes to Medicaid Will Affect Hospital Finances in Every State", a report which was recently released by The Commonwealth Fund. The report provides a state-by-state look at the impact of the AHCA Medicaid provisions on hospitals. Specifically, changes in uncompensated care, Medicaid payments, and hospital financial margins over the next ten years. To read the report click here.
On May 18th, Luis Arzaluz participated as a moderator for a Capitol Hill briefing titled "Looking Ahead: The Affordable Care Act's (ACA) Individual Health Insurance Market, What's in it for Latinos?" The panel was part of the Congressional Hispanic Caucus Institute's annual Policy Briefing Series held at the Dirksen Senate Office Building. Luis presented findings from his research on the ACA exchanges' individual insurance market performance and its policy implications on Latinos' access to health insurance coverage. The briefing was attended by Congressional staffers and public policy experts. Organizations represented on the panel included the Kaiser Family Foundation, Families USA, and the Center for Budget and Policy Priorities. To view the white paper that the briefing was was based off of click here.
Alex Hartzman and Sarmistha Pal co-author blog "ACO Performance and Quality" with the National Association of ACOs published on Public Health Post. The blog discusses the Medicare Shared Savings Program (MSSP) and ACO performance to date as well as directions for future research. To read the blog click here.
On Tuesday, June 20, Al Dobson and Randy Haught presented findings from the report, "The Financial Impact of AHCA Medicaid Provisions on Safety-Net Hospitals" during an educational teleconference sponsored by The Commonwealth Fund. To read the report click here.
Al Dobson presented at the Federation of American Hospitals' 2017 Policy Conference on Wednesday, June 14. Al's presentation, "Alternative Payment Models: A Field Report" summarized Dobson | DaVanzo's recent research on Alternative Payment Models (APMs) including bundled payments and Medicare Shared Savings Program (MSSP) ACOs. Al spoke about the provider- and market- level changes his firm is observing through its work with a diverse range of clients, and shared considerations for hospitals given the continuing trend away from fee-for-service and toward value-based payment. To view the presentation, click here.
On Thursday, April 20th Al Dobson presented at the National Association of Long Term Hospitals (NALTH) 2017 Spring Clinical Education and Annual Meeting. Al's presentation discussed the current political landscape, the growth of alternative payment models (APMs), and the role of the long-term care hospital (LTCH). To read more about Al's presentation click here, and make sure to flip to page 13.
On Monday, May 15th, Dobson DaVanzo & Associates, LLC celebrated its ten-year anniversary at The Mayflower Hotel in Washington, DC. Many colleagues and friends came to share our success. Ten years ago, Dobson | DaVanzo started with a staff of three, working at the kitchen table at the owners' house, and has since grown from three people to twenty. The firm performs health economics and policy studies for government and commercial clients, influencing public decisions, and appearing in legislation and regulation. Our client list is extensive, representing a broad spectrum of influential health care system stakeholders. We are thankful to all of our clients and friends who have supported us over the past ten years, and who will continue to support us over the next ten!
Alex Hartzman and Kimberly Rhodes Author "Accountable Care Organizations and Disparities," a letter to the editor published in the May 2017 issue of Health Affairs. The letter discusses ACOs and their potential to reduce disparities in care quality for minority populations. To read the article click here.
Steven Heath authors a blog for The Public Health Post titled "The Importance of Medicaid DSH Payments". To read Steven's blog click here.
The Alliance for Home Health Quality and Innovation released the data analysis study from Dobson | DaVanzo, entitled, " Data Analysis Underscores Value of Home Health in the Medicare Comprehensive Care for Joint Replacement Payment Model." The data was released in an online article on Morning Consult entitled "When Seeking Value, Look to Home Health Care." To read this article and access the data click here.
Dobson | DaVanzo's report to American Hospital Association (AHA) and the Federation of American Hospitals (FAH), "Estimating the Impact of Repealing the Affordable Care Act on Hospitals", was featured on a PBS news segment Monday, December 12. To view this broadcast click here.
Al Dobson and Joan DaVanzo co-authored an article published in "Health Affairs" magazine that discussed their findings from 2011 in regards to disproportionate-share hospitals. To read the abstract from this article click here
The Federation of American Hospitals (FAH), and the American Hospital Association (AHA), together have released Dobson | DaVanzo report, entitled, "Estimating the Impact of Repealing the Affordable Care Act on Hospitals", which can be viewed here.
Al Dobson gave the presentation at the Omni Shoreham in Washington, DC for the 2016 annual NALTH conference. The presentation titled, "ACOs and Bundling Part 2: Thriving and Surviving Under Payment and Delivery System Change" can be accessed here.
Dobson | DaVanzo conducted an annual membership survey for the National Association of Psychiatric Health Systems (NAPHS), which compiled data on types of services provided, bed categories, utilization and payer mix. Data was analyzed and presented in snapshot form for the year under study, and in trend from using data from previous years. Results were recently published in The 2016 NAPHS Annual Survey.
While providing technical assistance to CMS, Dobson | DaVanzo conducted analyses on the impact of Medicare DSH payments on eligible IPPS hospitals in FY 2017 based on methodology put forth in the FY 2017 IPPS/LTCH PPS Final Rule. Dobson | DaVanzo analyzed the Medicare Cost Reports to determine the change in estimated DSH payments for eligible hospitals by select hospital characteristics from FY 2016 to FY 2017. Dobson | DaVanzo also analyzed and prepared responses to public comments related to Medicare DSH payments under Section 3133 of the Patient Protection and Affordable Care Act.
In a recently published Milbank Quarterly study, Dobson | DaVanzo developed a financial simulation for determining the savings to Medicare that could accrue if frail elderly and disabled people could receive care in MediCaring communities. This model of care was developed by lead author Joanne Lynn, of Altarum Institute. The study showed that communities could implement the MediCaring model within current Medicare and Medicaid spending levels. To read the study, please click here.
Al Dobson recently gave a presentation to the Home Care Association of New York State, entitled, "The Federal Value-Based Purchasing Landscape: The Priority of Value-Based Purchasing Initiatives and How Home Care Can Best Participate". To read this presentation, please click here.
Al Dobson gave a webinar presentation to NAACOS membership, which provided ACOs the ability to evaluate their performance relative to "peer groups", in areas such as demographic spending, utilization, and quality measures.
Al Dobson gave a presentation at AdvaMed's Payment Policy Conference, on the topic: Managing Healthcare Spending and Cost: From Fee-for-Service to ACOs & Beyond. To read his presentation, entitled, "Post-Acute Care Provider Dynamics in an Alternative Payment Model World", please click here.
The Benevis Foundation released a report prepared by Dobson | DaVanzo that compares the dental utilization and monthly Medicaid expenditures for patients who received care by a Kool Smiles provider – a national children's dental provider – to non-Kool Smiles providers. Using government-provided data for seven states, the report compares the utilization and Medicaid expenditure trends for diagnosis, restorative, and extractions services for both types of providers who operate within the same geographic area. The study found that within and across states over time, Kool Smiles is a low-cost and conservative provider of dental service for Medicaid patients.
To access the Full Report, please click here. For Executive Summary, please click here. To access the Presentation, please click here.
Al Dobson recently gave a presentation on benchmarking comparison and performance analysis project results at the 2016 NAACOS Spring Conference, in Baltimore, Maryland. To read his presentation, entitled, "Data Warehouse and Analytic Activities", please click here.
MACPAC has just released their Report to Congress on Medicaid and CHIP, in which Dobson | DaVanzo has provided technical data.
To read full report, please click here.
Al Dobson gave a webinar presentation for the Kentucky Hospital Association Post Acute Care Leaders Forum. The presentation, entitled, "KHA Post-Acute Care Leaders Forum: Post Acute Care Challenges in an Alternative Payment Model Environment", can be viewed here.
Al Dobson presented at CHA's Center for Post-Acute Care Conference, in Redondo Beach, California. The topic discussion, "How New Payment Models are Driving Post-Acute Care Delivery", addressed how the delivery of care across the continuum is being transformed by new payment models. Dr. Dobson's presentation, entitled, "Post-Acute Care Provider Dynamics in an Alternative Payment Model World", explains how bundled payments, value-based purchasing, and site-neutral models are changing how post-acute care services will be delivered in the future. Please click here to read this presentation.
Research conducted by Dobson | DaVanzo was published in a recent special issue of Military Medicine. The goal of the study was to determine the extent to which Medicare patients who received selected prosthetic services had less health care utilization, lower Medicare payments, and/or fewer negative outcomes compared to matched patients not receiving these services. A retrospective cohort analysis using Medicare claims data (2007–2010) and propensity score matching techniques to found that patients who received lower extremity prostheses had comparable Medicare episode payments ($6,099 per-member-per-month for study group, $6,015 per-member-per-month for comparison group) and better outcomes than patients who did not receive prostheses. The article entitled, "Economic Value of Prosthetic Services Among Medicare Beneficiaries: A Claims-Based Retrospective Cohort Study" can be accessed here.
Al Dobson presented at the American Orthotic & Prosthetic Association (AOPA) O&P Leadership Conference in Palm Beach, Florida. The discussion topic was "CMS' Goal of Converting 50% of Medicare Payments to Value-Based vs. Fee-for-Service". Dr. Dobson's presentation was entitled "Hospital Challenges in an Alternative Payment Model Environment". Please click here to read presentation.
Al Dobson participated in a panel at the AMSUS WARfighters Receiving Innovative Orthopedic Rehabilitation (WARRIOR) Symposium in San Antonio, Texas. The symposium is the only one of its kind to bring military healthcare professionals together as well as International Delegates, to address the need for rehabilitation of service members and civilians following amputations or severe extremity trauma. To read Dr. Dobson's presentation, entitled "The Economic Value of Orthotics and Prosthetics Care to the Medicare Program", please click here.
On October 13, Al Dobson gave a presentation to the Federation of American Hospitals Board of Governors, entitled, "Hospital Challenges in an Alternative Payment Model Environment".
To read this presentation, please click here.
On October 10, Audrey El-Gamil gave a presentation to the AOPA National Assembly in San Antonio, Texas, entitled, "Projecting the Adequacy of Workforce Supply to Meet Patient Demand".
To read the final report, please click here.
Al Dobson presented to the NAACOS Fall 2015 Conference in Washington, D.C. The presentation was entitled, "Data Warehouse and Preliminary Analytic Activities".
To read this presentation, please click here.
In early October, Al Dobson gave a presentation to the AHA Post-Acute Care Steering Committee, entitled "Pressures on LTCH and IRF Utilization under Value-Based Purchasing".
Please click here to read presentation.
Randall Haught and Al Dobson presented an alternative post-acute care payment model to MedPAC staff on October 5, 2015.
In September, Al Dobson gave a presentation entitled "Value-Based Purchasing: A More Efficient Health Care System Through 'Creative Destruction'", to the Allied Hospital Associations at the A2HA 2015 Fall Meeting in Baltimore.
Please click here to read presentation.
In September, Greg Berger, along with co-author David Introcaso, wrote a HealthAffairs Blog entitled "MSSP Year Two: Medicare ACOs Show Muted Success".
Click here to read the blog.
On September 15, Joan DaVanzo presented to AAMC CMMI CORE Steering Committee on Health Care Innovation Challenge Award Year 1 progress on payment model development for eConsult. Her presentation was entitled, "Developing the Sustainable Payment Model & Engaging Commercial Payers".
To see this presentation, please click here.
While providing technical assistance to CMS, Dobson | DaVanzo conducted analyses on the impact of Medicare DSH payments for FY 2016 Final Rule by hospital characteristic. Dobson | DaVanzo analyzed the Medicare Cost Report to determine the change in estimated DSH payments for eligible hospitals by hospital characteristic from FY 2015 to FY 2016. Dobson | DaVanzo also analyzed and prepared responses to public comments related to Medicare DSH payments under Section 3133.
Dobson | DaVanzo conducted a RUC-like survey to determine the appropriate work and practice expense inputs for providing superficial radiation therapy (SRT). The analyses and model spreadsheets that re-engineered the Medicare payment with alternate input assumptions were shared with CMS and were used to inform CMS' proposed payment rates included in the FY 2016 Medicare Physician Fee Schedule NPRM. Consistent with Dobson | DaVanzo's analysis, CMS proposed to adjust the equipment inputs and is seeking further stakeholder comment on increasing physician work and other practice expense inputs.
In concert with Dixon Hughes Goodman Healthcare, produced "Bundled Payment Analytic Tools, BPCI Monthly Manager", powered by Dobson | DaVanzo, which was released early this summer.
Dobson DaVanzo & Associates was commissioned by 340B Health to determine the extent to which disproportionate share (DSH) hospitals enrolled in the 340B drug pricing program focus their services on vulnerable patient populations. Under the 340B program, safety-net hospitals and other health care providers that serve the poor in large numbers can buy prescription drugs for less. Congress intended for them to use the savings to stretch scarce resources and provide more services to more patients. We found that:
• As a percentage of total patient care costs, 340B DSH hospitals provide nearly twice as much care as non-340B hospitals – 41.9 percent versus 22.8 percent – to Medicaid beneficiaries and low-income Medicare patients.
• 340B hospitals provide nearly 30 percent more uncompensated care than non-340B hospitals – $24.6 billion to $17.5 billion. Although 340B hospitals accounted for only 35 percent of all hospitals included in the analysis, 340B hospitals provided 58 percent of all uncompensated care. In addition, when taking hospital size into account and looking at uncompensated care as a percent of total patient care costs, 340B hospitals across all hospital sizes provided consistently high levels of uncompensated care.
• A higher percentage of 340B DSH hospitals provide public health and specialized services – many of which are unprofitable but essential to their communities – than non-340B hospitals.
"Three metrics have been used in the literature to describe safety-net hospitals: 1) provision of services to vulnerable populations, 2) a disproportionate amount of uncompensated care, and 3) type of care provided," said author Joan DaVanzo. "Our analyses found that DSH hospitals participating in the 340B program surpass non-340B hospitals on all three criteria, regardless of size."
Click here to read the report.
To learn more, please visit 340B Health at http://www.340bhealth.org/
Al Dobson and Joan DaVanzo attended the PHI 2015 Conference, "Bridging The Continuum of Care: Hospital & Post-Acute Care Integration", at the Mayflower Hotel in Washington, DC. Dr. Dobson also chaired a session entitled, "New Approaches for Discharging Hospital Patients to Post-Acute Care".
Al Dobson gave a presentation , "Evaluating Shared Savings Payment Policies and Promoting Data-Driven Decision-Making in the Medicare MSSP ACO Program", at the National Association of Accountable Care Organizations (NAACOS) Spring Conference, in Baltimore on April 2, 2015.
To view the presentation, please click here.
Today Dobson | DaVanzo released a study that estimates the potential Medicare savings for deferring provider payments for RAC appeals until after Administrative Law Judge (ALJ) hearing determination (Level 3). Due to significant delays in the ALJ process, requests for hearings often take around 30 months until review and determination is received, resulting in significant interest payments for CMS when reimbursing providers for successful appeals. The study analyzed data from the Office of Medicare Hearing and Appeals (OMHA) and testimony from a Chief ALJ Judge to estimate the Medicare savings for avoided interest payments under this policy. This study focuses on the savings for RAC audits for O&P services, as well as all Medicare Part B services associated with RAC Level 3 audits.
Click here to read the report.
National Association of Psychiatric Health Systems (NAPHS) commissioned Dobson | DaVanzo to define the substance use disorder population and to appraise existing policies regarding the coverage, funding, and delivery of addiction treatment. The report, "Addiction Treatment Today and Tomorrow: Implications and Policy Recommendations" notes that transformative policies (namely, the federal Mental Health Parity and Addiction Equity Act (MHPAEA) and the Affordable Care Act (ACA) have sought to improve patient access to treatment by reforming prior insurance coverage restrictions. Yet significant coverage gaps persist. The full report, along with the Dobson | DaVanzo two-page Executive Summary, is available at www.naphs.org.
On March 4, 2015, Al Dobson gave a presentation at the Select Medical CEO and Medical Director Conference in Coral Gables, Florida. His presenatation, "Market Place Considerations for Inpatient Rehabilitation Facilities Under Medicare Bundled Payment for Care Improvement (BPCI)", can be viewed by clicking here.
Al Dobson and Joan DaVanzo gave a presentation today at the Health Dimension Group (HDG) National Summit: The Pursuit of Value, in Orlando, Florida. The presentation, entitled, "Market Place Considerations For Post Acute Care Providers Under Medicare Bundled Payment for Care Improvement (BPCI) Initiative" can be viewed by clicking here.
Dr. Dobson presented to the Illinois Association of Defense Trial Counsel/Illinois Insurance Association in Chicago at their 50th annual meeting in March. Dr. Dobson's presentation was entitled "The Role of Charges in Hospital Finance: What is "Reasonable Value"?"
Dr. Dobson presented to the Kentucky chapter of Healthcare Financial Management Association (HFMA) at the Winter Institute held in Louisville, Kentucky. Dr. Dobson presented findings from the American Hospital Association (AHA) and the Association of American Medical Colleges (AAMC) commissioned study to conduct quantitative analyses of a set of episode-based payment bundles. The purpose of this study was to highlight considerations for policymakers and providers using descriptive statistics and multivariate regression analyses. Dr. Dobson also discussed key issues for bundling in practice and showed supporting Medicare claims data illustrating how to appropriately define, price, and manage the bundle.
Dr. Al Dobson delivered a presentation entitled "Improvements to Medicare Disproportionate Share Hospital (DSH) Payments: National Provider Call" during a CMS National Provider Call. The purpose of the Call was to solicit public comment to inform the implementation of Section 3133 of the Affordable Care Act (ACA) as it relates to definitions and measures of the uninsured and uncompensated care. Approximately 1,300 stakeholders joined the call.
To view the presentation, click here.
The Missouri Hospital Association and Missouri Foundation for Health released a report on November 28th entitled The Enrollment and Economic Impacts of Medicaid Expansion on Missouri.
Dobson | DaVanzo was commissioned, along with the Department of Health Management and Informatics (HMI) at the University of Missouri School of Medicine, to determine the potential economic impacts if the state participates in Medicaid expansion under the Affordable Care Act. Two simulation models were developed based on the Impact Analysis for Planning (IMPLAN) model building software to estimate: (1) increased enrollment in and direct federal and state expenditures on Medicaid, and (2) the value-added economic and tax impact on the states economy, as well as private employer health insurance premiums.
To view the full report, click here. To view the executive summary, click here.
At the 1st National Dual Eligibles Summit, Dr. Al Dobson delivered a presentation entitled Can Medicare Acute and Post-Acute Care Payment Bundles Improve Care for Dual Eligibles? In the presentation, Dr. Dobson argued that Medicare acute and post-acute care payment bundling is a sensible, near-term policy approach to payment reform for dual eligibles. Payment bundling could address misaligned provider incentives under siloed prospective payment systems and the lack of care coordination faced by the vast majority of dual eligibles in fee-for-service. The presentation was based on a research study funded by The Commonwealth Fund.For more information about the National Dual Eligibles Summit, click here.
The American Hospital Association (AHA) and the Association of American Medical Colleges (AAMC) released a report written by Dobson | DaVanzo analyzing a series of episode-based payment bundles. Using beneficiary-level Medicare claims files for a five percent sample of beneficiaries over a three-year span, Dobson | DaVanzo identified a number of important considerations for hospitals for bundled payment policy based on descriptive statistics and multivariate regression analyses.
The report concluded that in order to promote Medicare payment bundling as a nationwide, population-based model, policymakers will need to design a complete framework that carefully considers the options for defining and pricing bundles, with adequate safeguards to protect the quality of patient care and the financial stability of providers. It will likely be necessary to determine the cost to providers of delivering care within an episode, rather than use the current Medicare payment levels to predict payment.To view the issue brief and full report, click here.
Dr. Dobson addressed the Maine Primary Care Association on October 25th at the Annual Conference entitled Health Reform Ready: Community Health Centers as Assets, Allies & Innovators. Dr. Dobson presented on The Potential Role of Health Centers in CMS Payment Bundling Systems of the Future.
Dr. Dobson remarked that community health centers could have an impact on bundle expenditures if they can improve the continuity of care and become part of the deal flow. He emphasized the need to work with hospitals and physicians to ensure care is minimized for high risk patient populations during a bundle time frame.
To view the full presentation, click here.
Dobson | DaVanzo released its final report for the Clinically Appropriate and Cost Effective Placement (CACEP) Project: Improving Health Care Quality and Efficiency on behalf of the Alliance for Home Health Quality and Innovation (AHHQI). The CACEP Project examines how the Medicare post-acute care benefit currently serves seniors. The final report presents models for the use of clinically appropriate and cost effective post-acute care and potential Medicare savings achieved under delivery system change scenarios. The final report has received coverage in numerous publications, including BNA, Healthcare Finance News, Inside Health Policy, MedPage Today, Modern Healthcare and PhysBizTech.
To view the full final report and Working Papers #1 to #4, refer to the AHHQI website. To view the study highlights, click here.
Audrey El-Gamil addressed the Home Care & Hospice Alliance of Maine in Freeport, Maine on September 13th. Ms. El-Gamil presented on Clinically Appropriate and Cost-Effective Placement (CACEP) Project findings in a presentation entitled Use of Home Health Care Services to Transform Health Care Delivery.
President Al Dobson will be featured in a panel discussion moderated by The Honorable Billy Tauzin, Former Chairman of the Energy and Commerce Committee, at the National Press Club on October 10 from 9:00 to 10:30 a.m. To register, click here.
Dobson | DaVanzo staff have briefed numerous Congressional staffers and government stakeholders in preparation for the release of its final report of the Clinically Appropriate and Cost Effective Placement (CACEP) Project: Improving Health Care Quality and Efficiency. The CACEP Project examines how the Medicare post-acute care benefit currently serves seniors. The final report presents models for the use of clinically appropriate and cost effective post-acute care and potential Medicare savings achieved under delivery system change scenarios.
Steven Heath, Research and Data Analytics Manager at Dobson|DaVanzo, was invited to address the Florida Association of Community Health Centers in July. He reported on the results of a study done for Washington State entitled, The Economic and Clinical Impact of Community Health Centers: Contributions to Public Health and Economic Implications and Benefits for the State and Counties.
Al Dobson addressed the 12th Annual Gulf Coast Home Care Conference in Point Clear, Alabama, on August 2nd. He presented the Closing Session based on a 4-paper home health series entitled, Post Acute Bundling: Clinically Appropriate and Cost Effective Placement. Following his presentation, Dr. Dobson also facilitated a discussion over lunch with board members from the Alabama, Louisiana and Mississippi home care associations.
Audrey El-Gamil, Senior Associate at Dobson | DaVanzo, presented findings from the CACEP Working Paper Series at the AcademyHealth 2012 Annual Research Meeting in Orlando, Florida.
The Alliance for Home Health Quality and Innovation (AHHQI) commissioned Dobson|DaVanzo & Associates to study how the Medicare home health benefit can better meet beneficiary needs and improve the quality and efficiency of care provided within the U.S. health care system. The first two Working Papers of the Clinically Appropriate and Cost-Effective Placement Project (CACEP), based on this research, reveal that when home health care is used as the first clinically appropriate setting for post-acute care, Medicare spends less per patient on average.
For highlights of this study, click here. For a full report, click this link.
Home Health Community to Release Dobson | DaVanzo Landmark Study of Medicare Costs and Opportunities for Improved Efficiencies. To see the 2/27/12 Press Release, click here.
Dr. Al Dobson was invited to be a discussant, along with Philip Cooper (AHRQ) and John Graves (Harvard University), at the Health Economics Research Organization panel held during the American Economics Association annual meeting in Chicago on January 7th. Dr. Dobson provided in-depth discussion on a paper presented by three University of Minnesota researchers, Pinar Karaca Mandic, Roger Feldman, and Peter Graven, The Role of Agents and Brokers in the Market for Health Insurance.
September 20, 2011: Las Vegas.
Dr. Allen Dobson addressed the National Association of Support for Long Term Care (NASL) in Las Vegas on Tuesday, September 20, 2011.Dr. Dobsons presentation was entitled, Bundled Payments; Baffling Implications. The NASL meeting was held in conjunction with the AHCA/NCAL 62nd Annual Conference. For more information about payment bundling, contact Dr. Dobson at: email@example.com.
We are pleased to announce that Anne E. Pick joined Dobson DaVanzo as a Research Analyst. Ms. Pick, who recently graduated with her MPH in Health Policy from the George Washington University, comes to the firm with expertise in health policy, public health, stakeholder outreach, and media relations. Her prior experience includes work with Senator Chuck Grassley and with the Senate Finance Committee on health reform.
For more information about Ms. Pick, visit our staff page.
Dobson | DaVanzo was invited to examine the Institute of Medicines report entitled, Geographic Adjustment in Medicare Payment: Phase 1: Improving Accuracy (released June 1st). To view our analysis, entitled: An Examination of the Data, Materials, and Assumptions Used in the Institute of Medicine Report: Geographic Adjustment in Medicare Payment: Phase 1: Improving Accuracy, click here.
The study was commissioned by the National Association of Psychiatric Health Systems (NAPHS)
The methodology involved conducting a series of confidential interviews with health policy leaders to determine if and how PAF information can be used by organizations in various sectors of the health care industry.
Dobson DaVanzo & Associates, LLC has been selected for the 2009
Best of Business Award in the Business services at non-commercial site
category by the Small Business Commerce Association (SBCA)
Read the press release
The study uses California hospital data to examine how a public plan
could impact hospital finances and private sector health insurance
Al Dobson participated in an advisory board conference on July 1 in Bridgewater, New Jersey to discuss the potential fair market value and reimbursement structure for drug eluting stents.
The study explored how the nation's recent economic down turn is affecting the financial stability of the nursing home industry.
Read the article
Al Dobson delivered a presentation entitled, Assessing Potential Medicare Savings from Implementing a Change in Payment for Selected Clinical Laboratory Services at the Centers for Medicare & Medicaid Services (CMS) Laboratory Public Meeting: Payment for New Clinical Laboratory Tests for 2010. He presented a study conducted by Dobson | DaVanzo that investigated the correlation between the rapid growth in utilization of a less reliable laboratory test and its higher reimbursement rate using publically available Medicare data. Dobson | DaVanzo found that Medicare savings would be substantial, and test accuracy would improve if payment policy were changed to incentivize the more reliable test. CMS implemented a version of this proposal.
The poster presented findings from a study completed in April that examined the impact on the nursing home industry in Pennsylvania of providing public financing for assisted living in addition to home and community based services.
Al Dobson delivered a presentation entitled "How Should Bundled Payments be Structured: Bundling from the Perspective of an Administrative Price Setter" at a conference on bundling post-acute care at Georgetown University on June 24.
A study conducted by Dobson | DaVanzo was highlighted in the June 2009 issue of Long Term Living Magazine. The study explored how the nation's recent economic downturn is affecting the financial stability of the nursing home industry.
To view the article, click here.
The article compares hospitals' cost of care with their quality of service and attempts to find a correlation between the two. The authors found that hospitals with low risk adjusted costs were more likely to be for-profit, treat more Medicare patients, and employ fewer nurses.
To view the article, click here.
Investment in Future Care Capacity Deferred, Seniors' Imminent Post-Acute and Long-Term Care Needs Placed in Jeopardy.
View the report in pdf format


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was that Beyonces and Jay-Z son at the Grammys
By JonnyMLOT
@JonnyMLOT (65)
February 1, 2010 4:04pm CST
Whos kid is that is he the next jay z
2 responses
@psphacker (1055)
• United States
1 Feb 10
No that was not Beyonces and jay-z son at the grammys.
@BinaryKat (738)
• United States
1 Feb 10
No actually from what I read on another site, that is actually suppose to be Solange's little boy. As far as I know Beyonce and Jay-Z do not have children together yet.


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Neighborhood swimming pools, a fire station and tree trimmers are on the chopping block in Modesto Mayor Jim Ridenour's proposal to balance the city budget by cutting $10 million in spending.
Ridenour on Monday unveiled his plan for the 2008-09 budget year, which begins July 1. In addition to the cuts, it calls for an additional $3 million in revenue through a mix of fees, including a monthly 75 cent charge that could show up on cable TV bills.
A sharp decline in tax revenue is driving the reductions, although Ridenour says he fears the picture could worsen depending on how the state balances its budget. His proposal calls for $120 million in spending from the city's general fund, which pays for such basics as public safety.
"We've had to ask the hard questions about programs and services and have come to the realization that we cannot be all things to all people," Ridenour said.
Some of the most prominent proposed cuts include:
Residents can weigh in on the mayor's proposal at four hearings next week. The budget is expected to go the council for a vote May 27.
Council can choose other cuts
Some council members have said they wanted to protect police funding for the next budget year.
"As a government agency, keeping the public safe is our ultimate priority, because that is something people can't do in and of themselves," Councilwoman Kristin Olsen said.
Ridenour said he would be open to filling all the positions if council members find other cuts they would prefer.
In addition to the suggested cuts, he's offering $5.8 million in other reductions council members could choose. Those options tend to be more drastic, but they could become necessary if the city's financial outlook continues to worsen.
Councilman Brad Hawn said the choices would be difficult.
"If you look at one thing on its own, you may make a pretty good case that it shouldn't be cut," he said. "But it takes a different importance when you look at them all together."
Ridenour had more sway over the budget than in previous years because of Measure M, the government-reform ballot measure voters approved in February. It gave him more influence over the budget, obliging the city manager to work with the mayor in writing the budget plan.
"We are managing to our revenues, and our revenues are in decline, so our expenses must follow suit," acting City Manager Jim Niskanen said.
The city's overall $650 million budget is not entirely bleak. Modesto's sewer and water funds do not rely on general tax revenue, instead drawing their revenues from user fees. Both are in the black as the city prepares for hundreds of millions of dollars in improvements to the two systems.
Bee staff writer Adam Ashton can be reached at firstname.lastname@example.com or 578-2366.


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Peer reviewed
Direct link
Direct link
ERIC Number: EJ786089
Record Type: Journal
Publication Date: 2008-Mar
Pages: 15
Abstractor: Author
Reference Count: 0
Developing Multicultural Competence Using the Structured Peer Group Supervision Model
Lassiter, Pamela S.; Napolitano, Louise; Culbreth, John R.; Ng, Kok-Mun
Counselor Education and Supervision, v47 n3 p164-178 Mar 2008
Interest in the role of supervision in counselor training has increased concurrent with the interest in effective strategies for developing multicultural counseling competency. L. D. Borders (1991) proposed a model of group supervision appropriate for use with supervisees of differing skill levels; however, the model does not overtly provide for supervisees' development of multicultural awareness and skills. This article presents a format of peer group multicultural supervision in which supervisees work to increase their multicultural competencies while engaging in helper roles important for working with culturally diverse clients.
Descriptors: Supervision, Counselor Training, Peer Groups, Cultural Awareness, Cultural Pluralism
American Counseling Association. 5999 Stevenson Avenue, Alexandria, VA 22304. Tel: 800-422-2648; Tel: 800-347-6647; Fax: 800-473-2329; Web site: http://www.counseling.org
Publication Type: Journal Articles; Reports - Descriptive
Education Level: N/A
Audience: N/A
Language: English
Sponsor: N/A
Authoring Institution: N/A


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New York Times best-sellers for the week of Jan. 29
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10. In the Garden of Beasts: By Erik Larson. (Crown, $26.) This portrait of Berlin during the rise of the Nazis centers on the experiences of William E. Dodd, who became the U.S. ambassador to Germany in 1933, and his daughter, Martha.
New York Times News Service


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Retreat Announcement
We are excited to announce that the dates are now set for our 6-day, 2018 Big Bear Lake Summer Retreat. As most of you know, due to the mudslides in Montecito we are unable to use La Casa de Maria for this summer's Retreat as had been planned. We have had to make a change in location and feel lucky to have found a camp on the lake in Big Bear Lake that can accommodate our group this summer. Unfortunately, we were unable to secure the same dates that we announced prior to the mudslides, but hope that these new dates will work for everyone.
Sunday, June 10, 2018 through Friday, June 15, 2018
We hope you will join us and in Big Bear for this unique opportunity for therapy in a beautiful environment, with ample time, and a great community of people and support.
Patients from all stages of therapy are welcome and encouraged to attend. Please note that this Retreat is open only to those who are current or past patients of the Primal Institute. If you are interested in attending a Retreat and have not been through the program at the Primal Institute, please contact us to find out about 1-week, pre-retreat program that we offer twice yearly.
Accommodations are dormitory style, but the lodge we are staying at is quite large and we will limit the number of participants in order to provide semi-private, shared accommodations. There are no "private rooms" that can be reserved, all room selections will be on a first come basis. Please plan to bring linens, pillow, and towels for your stay as they are not provided at this lodge. You may consider bringing a sleeping bag for added comfort if needed. Meals are included and will be served daily in the dining hall. We will continue with "buddy matching" and introduce new exercises for you to participate in.
Please plan your arrival and check-in at the lodge at 3:00 PM on Sunday, June 10th, our first group meeting will be held at 7:30 PM that evening. The Retreat will conclude on Friday, June 15th at around 1:00 PM.
The cost for this 6-day Retreat is $1650.00, which will include your room, all meals and therapy. An $850.00 non-refundable deposit is required at the time of sign-up. You may pay by check, Visa, MasterCard, or cash (U.S. funds only please). The balance of $800.00 will be due in full, on or before Monday, May 14, 2018. Confirmation and full details will be sent to you upon your acceptance.
** Please Note: There will be No refunds given after May 14, 2018 for any cancellation.
Please visit us at our Primal Institute blog page where you will find monthly articles and live chat.


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Cooking a beef roast isn't as difficult as you might imagine, and it makes a beautiful presentation in the center of your table. In our meat department, find Certified Angus Beef roasts, known for superior marbling, firmness and tenderness.
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Beef Chuck Boneless Roast
This roast is available in large, flat-shaped pieces, typically cut 2 to 2 1/2 -inch thick. This robust, beefy roast requires moist heat cooking to soften and tenderize. It's a cut used to make pot roast. Braise it slowly on the stove, in the oven or in a slow cooker with onions, carrots, garlic, beef broth, fresh thyme and dry red wine.
Eye of Round Roast
An economical cut that can be slightly tough and dry, it becomes more tender and flavorful when cooked in the slow cooker or braised. Another roasting method calls for cooking the eye of round in a high-heat, 500-degree oven. Rub the meat with your spices of choice, plus olive oil and salt and pepper to taste. Roast for five minutes per pound and then turn off the oven, but leave the meat inside for another 2-2 1/2 hours until tender!
Bottom Round Roast
This economical and flavorful cut is great for autumn and winter comfort food dishes in the slow cooker or braised in the oven. Try it with barbecue sauce, and add onions, carrots, potatoes and fresh herbs. Or make a sauce with balsamic vinegar, soy sauce (use tamari for gluten free!) and honey.
Semiboneless Rib Roast
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Sirloin Strip Roast
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Our meat associates are ready to help you select the beef roast that's right for your dinner or party!


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of the Clinthill, the horseman who now arrived at the little
Tower of Glendearg, was one of the hopeful company of whom the poet
complains, as was indicated by his "splent on spauld," (iron-plates on
his shoulder,) his rusted spurs, and his long lance. An iron
skull-cap, none of the brightest, bore for distinction a sprig of the
holly, which was Avenel's badge. A long two-edged straight sword,
having a handle made of polished oak, hung down by his side. The
meagre condition of his horse, and the wild and emaciated look of the
rider, showed their occupation could not be accounted an easy or a
thriving one. He saluted Dame Glendinning with little courtesy, and
the monk with less; for the growing, disrespect to the religious
orders had not failed to extend itself among a class of men of such
disorderly habits, although it may be supposed they were tolerably
indifferent alike to the new or the ancient doctrines.
"So, our lady is dead, Dame Glendinning?" said the jack-man; "my
master has sent you even now a fat bullock for her mart--it may serve
for her funeral. I have left him in the upper cleugh, as he is
somewhat kenspeckle, [Footnote: _Kenspeckle>/I>--that which is
easily recognized by the eye.] and is marked both with cut and
birn--the sooner the skin is off, and he is in saultfat, the less like
you are to have trouble--you understand me? Let me have a peck of corn
for my horse, and beef and beer for myself, for I must go on to the
Monastery--though I think this monk hero might do mine errand."
"Thine errand, rude man!" said the Sub-Prior, knitting his brows--
"For God's sake" cried poor Dame Glendinning, terrified at the idea of
a quarrel between them,--"O Christie!---it is the Sub-Prior--O
reverend sir, it is Christie of the Clinthill, the laird's chief
jack-man; ye know that little havings can be expected from the like o'
"Are you a retainer of the Laird of Avenel?" said the monk, addressing
himself to the horseman, "and do you speak thus rudely to a Brother of
Saint Mary's, to whom thy master is so much beholden?"
"He means to be yet more beholden to your house, Sir Monk," answered
the fellow; "for hearing his sister-in-law, the widow of Walter of
Avenel, was on her death-bed, he sent me to say to the Father Abbot
and the brethren, that he will hold the funeral-feast at their
convent, and invites himself thereto, with a score of horse and some
friends, and to abide there for three days and three nights,--having
horse-meat and men's-meat at the charge of the community; of which his
intention he sends due notice, that fitting preparation may be
timeously made."
"Friend," said the Sub-Prior, "believe not that I will do to the
Father Abbot the indignity of delivering such an errand.--Think'st
thou the goods of the church were bestowed upon her by holy princes
and pious nobles, now dead and gone, to be consumed in revelry by
every profligate layman who numbers in his train more followers than
he can support by honest means, or by his own incomings? Tell thy
master, from the Sub-Prior of Saint Mary's, that the Primate hath
issued his commands to us that we submit no longer to this compulsory
exaction of hospitality on slight or false pretences. Our lands and
goods were given to relieve pilgrims and pious persons, not to feast
bands of rude soldiers."
"This to me!" said the angry spearman, "this to me and to my master
--Look to yourself then, Sir Priest, and try if _Ave_ and
_Credo_ will keep bullocks from wandering, and hay-stacks from
"Dost thou menace the Holy Church's patrimony with waste and
fire-raising," said the Sub-Prior, "and that in the face of the sun? I
call on all who hear me to bear witness to the words this ruffian has
spoken. Remember how the Lord James drowned such as you by scores in
the black pool at Jeddart.-To him and to the Primate will I complain."
The soldier shifted the position of his lance, and brought it down to
a level with the monk's body.
Dame Glendinning began to shriek for assistance. "Tibb Tacket! Martin!
where be ye all?--Christie, for the love of God, consider he is a man
of Holy Kirk!"
"I care not for his spear," said the Sub-Prior; "if I am slain in
defending the rights and privileges of my community, the Primate will
know how to take vengeance."
"Let him look to himself," said Christie, but at the same time
depositing his lance against the wall of the tower; "if the Fife men
spoke true who came hither with the Governor in the last raid, Norman
Leslie has him at feud, and is like to set him hard. We know Norman a
true bloodhound, who will never quit the slot. But I had no design to
offend the holy father," he added, thinking perhaps he had gone a
little too far; "I am a rude man, bred to lance and stirrup, and not
used to deal with book-learned men and priests; and I am willing to
ask his forgiveness--and his blessing, if I have said aught amiss."
"For God's sake! your reverence," said the widow of Glendearg apart to
the Sub-Prior, "bestow on him your forgiveness--how shall we poor folk
sleep in security in the dark nights, if the convent is at feud with
such men as he is?"
"You are right, dame," said the Sub-Prior, "your safety should, and
must be, in the first instance consulted.--Soldier, I forgive thee,
and may God bless thee and send thee honesty."
Christie of the Clinthill made an unwilling inclination with his head,
and muttered apart, "that is as much as to say, God send thee
starvation, But now to my master's demand, Sir Priest? What answer am
I to return?"
"That the body of the widow of Walter of Avenel," answered the Father,
"shall be interred as becomes her rank, and in the tomb of her valiant
husband. For your master's proffered visit of three days, with such a
company and retinue, I have no authority to reply to it; you must
intimate your Chief's purpose to the Reverend Lord Abbot."
"That will cost me a farther ride," said the man, "but it is all in
the day's work.--How now, my lad," said he to Halbert, who was
handling the long lance which he had laid aside; "how do you like such
a plaything?--will you go with me and be a moss-trooper?"
"The Saints in their mercy forbid!" said the poor mother; and then,
afraid of having displeased Christie by the vivacity of her
exclamation, she followed it up by explaining, that since Simon's
death she could not look on a spear or a bow, or any implement of
destruction without trembling.
"Pshaw!" answered Christie, "thou shouldst take another husband, dame,
and drive such follies out of thy thoughts--what sayst thou to such a
strapping lad as I? Why, this old tower of thine is fensible enough,
and there is no want of clenchs, and crags, and bogs, and thickets, if
one was set hard; a man might bide here and keep his half-score of
lads, and as many geldings, and live on what he could lay his hand on,
and be kind to thee, old wench."
"Alas! Master Christie," said the matron, "that you should talk to a
lone woman in such a fashion, and death in the house besides!"
"Lone woman!--why, that is the very reason thou shouldst take a mate.
Thy old friend is dead, why, good--choose thou another of somewhat
tougher frame, and that will not die of the pip like a young chicken.--
Better still--Come, dame, let me have something to eat, and we will talk
more of this."
Dame Elspeth, though she well knew the character of the man, whom in
fact she both disliked and feared, could not help simpering at the
personal address which he thought proper to make to her. She whispered
to the Sub-Prior, "ony thing just to keep him quiet," and went into
the tower to set before the soldier the food he desired, trusting
betwixt good cheer and the power of her own charms, to keep Christie
of the Clinthill so well amused, that the altercation betwixt him and
the holy father should not be renewed.
The Sub-Prior was equally unwilling to hazard any unnecessary rupture
between the community and such a person as Julian of Avenel. He was
sensible that moderation, as well as firmness, was necessary to
support the tottering cause of the Church of Rome; and that, contrary
to former times, the quarrels betwixt the clergy and laity had, in the
present, usually terminated to the advantage of the latter. He
resolved, therefore, to avoid farther strife by withdrawing, but
failed not, in the first place, to possess himself of the volume which
the Sacristan carried off the evening before, and which had been
returned to the glen in such a marvellous manner.
Edward, the younger of Dame Elspeth's boys, made great objections to
the book's being removed, in which Mary would probably have joined,
but that she was now in her little sleeping-chamber with Tibb, who was
exerting her simple skill to console the young lady for her mother's
death. But the younger Glendinning stood up in defence of her
property, and, with a positiveness which had hitherto made no part of
his character, declared, that now the kind lady was dead, the book was
Mary's, and no one but Mary should have it.
"But if it is not a fit book for Mary to read, my dear boy," said the
father, gently, "you would not wish it to remain with her?"
"The lady read it," answered the young champion of property; "and so
it could not be wrong--it shall not be taken away.--I wonder where
Halbert is?--listening to the bravading tales of gay Christie, I
reckon,--he is always wishing for fighting, and now he is out of the
"Why, Edward, you would not fight with me, who am both a priest and
old man?"
"If you were as good a priest as the Pope," said the boy, "and as old
as the hills to boot, you shall not carry away Mary's book without her
leave. I will do battle for it."
"But see you, my love," said the monk, amused with the resolute
friendship manifested by the boy, "I do not take it; I only borrow it;
and I leave in its place my own gay missal, as a pledge I will bring
it again."
Edward opened the missal with eager curiosity, and glanced at the
pictures with which it was illustrated. "Saint George and the dragon--
Halbert will like that; and Saint Michael brandishing his sword over
the head of the Wicked One--and that will do for Halbert too. And see
the Saint John leading his lamb in the wilderness, with his little
cross made of reeds, and his scrip and staff--that shall be my
favourite; and where shall we find one for poor Mary?--here is a
beautiful woman weeping and lamenting herself."
"This is Saint Mary Magdalen repenting of her sins, my dear boy," said
the father.
"That will not suit _our_ Mary; for she commits no faults, and is
never angry with us, but when we do something wrong."
"Then," said the father, "I will show you a Mary, who will protect her
and you, and all good children. See how fairly she is represented,
with her gown covered with golden stars."
The boy was lost in wonder at the portrait of the Virgin, which the
Sub-Prior turned up to him.
"This," he said, "is really like our sweet Mary; and I think I will
let you take away the black book, that has no such goodly shows in it,
and leave this for Mary instead. But you must promise to bring back
the book, good father--for now I think upon it, Mary may like that
best which was her mother's."
"I will certainly return," said the monk, evading his answer, "and
perhaps I may teach you to write and read such beautiful letters as
you see there written, and to paint them blue, green, and yellow, and
to blazon them with gold."
"Ay, and to make such figures as these blessed Saints, and especially
these two Marys?" said the boy.
"With their blessing," said the Sub-Prior, "I can teach you that art
too, so far as I am myself capable of showing, and you of learning
it." "Then," said Edward, "will I paint Mary's picture--and remember
you are to bring back the black book; that you must promise me."
The Sub-Prior, anxious to get rid of the boy's pertinacity, and to set
forward on his return to the convent, without having any further
interview with Christie the galloper, answered by giving the promise
Edward required, mounted his mule, and set forth on his return
The November day was well spent ere the Sub-Prior resumed his journey;
for the difficulty of the road, and the various delays which he had
met with at the tower, had detained him longer than he proposed. A
chill easterly wind was sighing among the withered leaves, and
stripping them from the hold they had yet retained on the parent
"Even so," said the monk, "our prospects in this vale of time grow
more disconsolate as the stream of years passes on. Little have I gained
by my journey, saving the certainty that heresy is busy among us with
more than his usual activity, and that the spirit of insulting religious
orders, and plundering the Church's property, so general in the eastern
districts of Scotland, has now come nearer home."
The tread of a horse which came up behind him, interrupted his reverie,
and he soon saw he was mounted by the same wild rider whom he had left
at the tower.
"Good even, my son, and benedicite," said the Sub-Prior as he passed;
but the rude soldier scarce acknowledged the greeting, by bending his
head; and dashing the spurs into his horse, went on at a pace which
soon left the monk and his mule far behind. And there, thought the
Sub-Prior, goes another plague of the times--a fellow whose birth
designed him to cultivate the earth, but who is perverted by the
unhallowed and unchristian divisions of the country, into a daring and
dissolute robber. The barons of Scotland are now turned masterful
thieves and ruffians, oppressing the poor by violence, and wasting the
Church, by extorting free-quarters from abbeys and priories, without
either shame or reason. I fear me I shall be too late to counsel the
Abbot to make a stand against these daring _sorners_ [Footnote:
To _sorne_, in Scotland, is to exact free quarters against the
will of the landlord. It is declared equivalent to theft, by a statute
passed in the year 1445. The great chieftains oppressed the
monasteries very much by exactions of this nature. The community of
Aberbrothwick complained of an Earl of Angus, I think, who was in the
regular habit of visiting them once a year, with a train of a thousand
horse, and abiding till the whole winter provisions of the convent
were exhausted.]--I must make haste." He struck his mule with his
riding wand accordingly; but, instead of mending her pace, the animal
suddenly started from the path, and the rider's utmost efforts could
not force her forward.
"Art thou, too, infected with the spirit of the times?" said the
Sub-Prior; "thou wert wont to be ready and serviceable, and art now as
restive as any wild jack-man or stubborn heretic of them


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The Time Traveler's Guide examines the writing of time travel stories and historical fiction. Books always transport us to other places, especially stories involving time travel or those set in different historical eras.
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Ancient egyptian medicine the medicine of the ancient egyptians is some of the oldest documented from the beginnings of the civilization in the c 33rd century bc until the persian invasion of 525 bc, egyptian medical practice went largely unchanged and was highly advanced for its time, including simple non-invasive surgery, setting of bones. Medicine of the pharaohs egyptian medicine influenced the medicine of neighbouring cultures, ancient egyptian chemists equally excelled in preparing and. Ancient egyptian medicine was arguably the most advanced of its time natural and supernatural remedies were used together by practitioners/priests in order to cure injury, illness, and disease.
The ancient egyptians had a vast collection of medical knowledge that influenced neighboring cultures and future nations this paper aims to answer the question: how did ancient egyptian medicine influence other ancient kingdoms' medical knowledge and treatment. Best answer: ancient egyptian medicine refers to the practices of healing this medicine was highly advanced for the time, and included simple, non-invasive surgery. Herbal medicine in ancient egypt not all of egyptian medicine was based on wishful thinking, much was the result of experimentation and. Transcript of how did the ancient egyptians influence modern day life how did the ancient egyptians influence modern day couk/ancient_egyptian_medicinehtm.
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