This document summarizes a leadership summit on healthcare for the elderly that discussed various programs and models for delivering long-term care services. Key topics included Medicare and Medicaid funding challenges, person-centered planning, home and community-based services, care transition programs, patient-centered medical homes, community health workers, accountable care organizations, behavioral health homes, aging resource centers, livable communities, PACE programs, and the need for collaboration between health systems, community organizations, foundations, and state government to address the growing long-term care needs with limited new resources.
Paying for Value in Medicaid: A Synthesis of Advanced Payment Models in Four ...
FINAL PRESENTATION_SPECTRUM GENERATIONS- In a Post ACA World
1. HCBS Leadership Summit – Starting the Conversation
Cohen Community Center - Hallowell, Maine
December 5, 2014
2. In a Post – ACA State of Mind;
A Collaboration in Care
A discussion with Brett C. Seekins, Senior Manager
Baker Newman Noyes
December 5, 2014
3. Let’s talk about…
What’s brought us here today – Commission on Long Term Care
The Medicare Funding
The Medicaid Funding
Person Centered Planning
Home and Community Based Services
Community Care Transition Programming
Patient Centered Medical Home & Community Care Team
Community Health Workers
PACO / EMH – Pioneer Accountable Care Communities
Behavioral Health Homes
Aging and Disability Resource Centers
Livable Communities
PACE – The Program of All Inclusive Care for the Elderly
Others - Paramedic Care, Chronic Care Management, Chronic Pain Self Management, Maine State OADS and
LTSS report
CBO Successful National Working Model (Samples)
Funding Pilots and Demonstrations in Maine – Foundations, Health Systems, State, Insurance Companies
4. Commission on Long Term Care – and, so we begin
Convened per Section 643 of the American Taxpayer Relief Act, 2012
September 2013 Report out to U.S. Congress
Commission recommendation...
“Preparing to meet the LTSS needs of the population and ensuring adequate financial
resources will take time. The process should begin now.”
“…the magnitude of its impact on American families now and in the future,…dictate the
need for a sustained national dialogue on the subject.”
“The need for designing, executing and financing LTSS is of major continuing
importance to the health and quality of life of millions of Americans today and tens of
millions of Americans in the future.”
Source: Commission on Long Term Care report to Congress, September 2013
This Conversation Must Continue In All Provider Settings
6. The Collaboration of Care Model
PATIENT
ACUTE
POST-
ACUTE
REHAB
SERVICES
SKILLED
CARE
NURSING
HOME
MEMORY
CARE
HOME
MAKER
SVCS
HOME
HEALTH
ASSISTED
LIVING
CIL
AAA
ADRC
CAPs
SENIOR
CARE
CENTER
P&W
PCMH
7. Medicare Funding
No Surprise - Payment Rates and Exceptions for all providers types continue to be a challenge as a result
of the PPACA and other funding policy
Active Audit Scrutiny - OIG, RACs, MACs, CMS and DOJ
Hospital payments always a challenge, dogged by Readmission Penalties (2013 highest ever),
Demonstration Program reconciliations / take-backs in addition to Quality Measure Penalties, Numerous
Demonstrations & Pilots, I/P and O/P Payments always a challenge and don’t forget about ICD-10
Skilled Nursing Care PPS – 20% $ reduction over the past five years, Continued RAC scrutiny, Plagued by
3 day Hospital stay / Observation stay dilemma, Unintended consequences of Acute Demos & Pilots as in
“Where did my admissions go?”
Home Health Agency – 14% $ reduction blended over 4 years, top HHRGs removed, Case Mix Weights
decreased, Face to Face issues
Hospice – plagued by fraud issues in some areas of country, CMS tightening up regulations and continue to
assess payments / overpayments, New Regs out
Physician Payments – always a challenge – Doc Fix ever present
Sequestration Adjustment through FY 2021 – Impacts all Medicare providers, 2% payment reduction
8. Medicaid Funding
States continue to struggle with funding, payment models, Health Care Exchanges participation, all in the midst
of a recovering economy
SUCCESSES - Maine State Innovation Models, Maine Council on Aging and developing a strategic plan for
Long Term Care Supports and Services, Maine DHHS Office of Aging Disability Services in process of
developing thoughtful report on LTSS, Maine Quality Counts crown jewel of the State
Maine Adult Day Services just received a payment increase – the first in over a decade.
Maine Home Health Services rates have been held flat since 1998
Maine Nursing Homes recent $9M funding increase helps lessen a $24 per person per day Medicaid Shortfall
– continuation of funding will need to survive Legislative Budget Process
High MaineCare Utilization Nursing Homes receive a payment increase subject to MaineCare volume – is it
enough to save Rural NH’s?
SNF Medicare Payments no longer cross-subsidizes NH Medicaid Shortfall (national averages)
Maine Private Non-Medical Institutes still working out programmatic solutions with CMS
Hospital and Physician Payments are well below cost
Bracing for Alzheimer’s & Dementia related disease at a time when at-home Caregivers are decreasing
9. Meeting the growing healthcare needs of the
community with zero new resources
What does zero increase (potentially a decrease) in allocated healthcare
dollars in Maine mean for both the short and long term future of our
population?
Current service delivery models but less clients receiving appropriate care
Fewer healthcare providers and therefore limited access for patients
Fewer community based organizations doing the socio-economic outreach needed in order
to keep persons healthy in the community
OR
The conscious repurposing of allocated funds toward innovative, efficient and
effective models of service delivery and intervention, with an emphasis on
prevention and wellness, that uses the best of traditional healthcare and
community based outreach to achieve a different result….a result centered on the
Triple Aim.
This convention will challenge traditional means of established health care delivery
models. Can we do it?
The many Options that exist today will not be here Tomorrow
10. Person Centered Planning
Once considered “radical” - Organizing the delivery and rendering of services around the patient needs first
Model of care that involves providers, families and the patient to identify the full range of needs to
recovery
Appropriate staff are assigned as the patient centered care plan is developed
Assists individual in achieving personally defined outcomes in the most integrated community setting
Ensures delivery of services that reflect personal preferences and choice
Person Centered Plans review every 12 months
Plan States: Services/Supports, Vendors, Self-Directing?, Cultural Distinctions
Plan Goals Include: Community Participation, Employment, Income/Savings, Health Care and Wellness,
Education
Plan is directed by individual, and their representative, receiving care – Offering INFORMED Choices!
Source: National Association or States United for Aging and Disabilities and www.patient-centercare.org
Can Patient Centered Planning Be Done Without A Socio-Economic Assessment?
Is CBO Outreach Operationalized In Your Organization?
11. Home and Community Based Services
New Federal Register – Expansive and Restrictive, Strongly supports ADA, Olmstead Act, No Wrong Door,
Money Follows the Person, Community First Choice, PACE options, State Program Compliance
Reconciliations Required / 5 Year Transition to Conformance
Regulations / Clarifications detail when and where HCBS services can be performed
Regulations / Clarification to use of States application for 1915 Waivers and State Plan Amendments
States currently reporting out to CMS all HCBS Programming “gapping” current compliance policy to new
Regs
National push and desire to provide services in the community rather than center-based environments
(less costly, too) – NF occupancy rates to fall?
Higher Acuity Long Term Supports and Services on the rise (As in today’s NH residents used to be
Hospital patients so yesterday’s NH residents are now in the community receiving services)
Funding NF vs. HCBS – in 2001 57% NF, in 2012 57% HCBS with a 19% per annum increase
BIP Grants – States receive Enhanced FMAP by moving center-based care into the community as HCBS –
Maine participating!
Source: www.cms.gov
At-Home Caregivers Are In Decline
Can CBO’s Help Fill This Void?
12. Community Care Transition Programming
PPACA demonstration program providing funding to test 5 models for improving care transitions for high risk
Medicare beneficiaries
Goals are to improve transitions of beneficiaries from I/P hospital stays to other settings, improve quality of
care and to reduce readmissions and post-hospital utilization for high risk beneficiaries through the use of:
Transition Coaches and / or Transitional Care Nurses
Hospital Discharge Toolkits and Person Centered Interventions
Enhanced Admission post-discharge assessments / Enhanced Teaching / Patient and Family – Centered handoff
communications
CCTP is part of Partnerships for Patients – a national patient safety initiative intended to reduce harm to patients
and improve care transitions
CBO’s will use care transition services to effectively manage transitions and report process and outcome
measure
Paid on a per eligible discharge basis for Medicare beneficiaries at high risk for readmission, including multi
chronic conditions, depression and cognitive impairments
Southern Maine Area Agency on Aging: With Volume > 3,750 Readmission rate across four hospitals down
16% to 9.5%
Source: www.Medicare.gov, SMAA
Lower Cost CBO’s Are Driving Success & Savings
13. Patient Centered Medical Home & Community Care Teams
Pilot led by Dirigo Health Agency’s Maine Quality Forum (MQF), Maine
Quality Counts, and the Maine Health Management Coalition
PCMH Practices include a diverse mix of adult and pediatric practices from around the
state to help identify / address socio-economic, personal and environmental safety
challenges patients face attempting to follow their plans of care
Practices are expected to implement a set of ten “Core Expectations” addressing key
practice changes, and participate in a PCMH Learning Collaborative.
The ultimate goal of this effort is to sustain and revitalize primary care both to
improve health outcomes for all Maine people and to reduce overall health care
costs
CBO’s are Organically Positioned To Serve As The Community Connector to PCMH
Is This Value Added Work?
14. Patient Centered Medical Home & Community Care Teams (cont’d)
Community Care Teams are multi-disciplinary, community-based, practice-integrated care
management teams that works closely with the PCMH Pilot practices to provide enhanced
services for the most complex, most high-needs patients in the practice.
Conduct Face to Face Interview with PAT, Family or Care Navigator
Identify PAT needs, current living conditions, finances and LTC needs
Review PAT enrolled ore eligible to be enrolled health insurance benefits
Discuss best living options, PAT ADL ability
Develop Social Services care plan
CCT is a resource to answer PAT/FAM questions, relay what services are available to them and how
they will be delivered, increase confidence level in obtaining services
Recent 1 year pilot with CCTs utilizing ADRC to assist in service delivery to older and disabled adults
had mixed results.
Both PCMH and CCT pilot recently extended for 2 additional years.
Source: Maine Quality Counts & Maine Association on Area Agencies on Aging
Should CCT’s Be Health System Centric?
Or A Mix Of Health System & CBO Collaboration?
15. Community Health Workers
Growing evidenced based support making contributions to Improving Health Outcomes, Appropriate
Utilization, Realization of Cost Savings (Chronic Disease, Asthma, Diabetes, HIV), Cancer Screenings,
High Utilizers, High Risk Individuals
Model Design: Community Resource Connector/Educator role which informs all parties about plan
of care responsibilities, focus on prevention, reduction of avoidable cost, remove barriers
Patient engagement is supported by the CHW who works / lives in the community with a team based
approach to a known plan of care
Community Connectivity proves to be cost effective, enhances communication, improves advocacy and
partnerships
CHW focus is a person-centered specific in this program - rather than one of multiple clinical roles that
an employee would serve as part of a health system
As part of State Innovation Model (SIM), four (4) Maine Center for Disease Control two year pilots
projects kicked off in September 2014. Projects are led by community based organizations and by
healthcare systems.
Source: Maine State Innovation Model / Healthcare System Transformation
Low Cost, High Gain Intervention
Who Is Most Appropriate To Deliver This Service?
16. Pioneer ACO’s / Eastern Maine Health
Designed for Health Care Organizations and Providers proficient in service delivery across
multiple settings
ACO vs. PACO - Assists to move more rapidly through Shared Savings Payment model to a
Population Based Payment Model
Path is consistent / parallel with ACO (Medicare Shared Saving model)
EMH/PACO Readmission rates dropped almost 10% over two years
EMH/PACO Acute Admits / 1,000 slid from 66 to 42 over same period
Since 2012 PCP visits up 24%, ER down almost 3%, Admits down 21% for PACO
membership
The Patient Experience scored well: MD 91% and Communication 92%
Source: CMS and Eastern Maine Health Systems, Michael Donahue, VP of Network Development and ACO Activities
Collaborations Of Care At Work Driving Success!
17. Behavioral Health Homes
Stage B of Maine’s Health Home Initiative
Partnership between a licensed Community Mental Health Provider (Behavioral Health
Home Organization) and one or more Health Home primary care practices
Goals: Manage Physical and Behavioral Health of individuals with significant care
needs
Supports Adults with serious mental illness and Children with serious emotional
disturbance
Members are enrolled through the BHHO with established treatment relationship and
assists in identifying partnering PCP
Designed to build upon existing care coordination and behavioral health expertise of
BHHO
Source: Maine State Department of Health and Human Services, Office of MaineCare Services
Can CBO’s Partner with BHHO’s To Serve As An Extension Of A PCMH Care Coordination Team?
18. Aging and Disability Resource Centers &
Center for Independent Living
Aging and Disability Resource Center (ADRC) and Center for Independent Living
(CIL)
All five of Maine’s AAA’s are designated as ADRC’s and Alpha One is designated as
CIL by the Maine DHHS Office of Aging and Disability Services
No Wrong Door (NWD), Single Point of Entry (SPE) - To be addressed by Maine DHHS
through the federal Balancing Incentive Program (BIP) grant
Improved health outcomes through community resource expertise
Data driven
Person centered solutions
Engaging people in their own care for enhanced individual experience
Comprehensive options counseling for informed decision making
Collaborative approach between ADRC and CIL
Marginal federal funding; zero state funding
Source: Maine State Area Agencies on Aging
18
Client
Access
Awareness
&
Information
Assistance
Helping People Stay In The Community,
Where They Want To Be & Where It Is Most Cost Advantageous
Is This A Concept Worth More Investment?
19. Livable Communities
Core services of any Livable Community Model
Quality Housing both affordable and adaptable
Mobility options i.e. transportation to medical appointments and grocery shopping
Easy access to information and resources
Emergency food preparation, odd jobs. and technology assistance, and home maintenance
Active Community Involvement
Social components: Lectures, movies, concerts, access to community meals to help members connect to the community
Respect and social inclusion
Positive community attitudes about people of all ages (i.e., recognizing the valuable societal roles that people play across their
lifespans).
Should be in the forefront of any municipality planning efforts: SEE Cape Elizabeth Senior Citizen
Advisory Commission, Brett Seekins, Chairman
http://www.capeelizabeth.com/news/2014/senior_citizen_advisory_commission_report.html
Living example in Maine
At Home Downeast / A Village model – member sponsored organization catering to the needs of the senior
community
Members pay an annual fee for a range of critical service provided by approved / responsible area vendor
Source: www.whcacap.org Washington Hancock Community Agency and n4a website: www.n4a.org
Perfect Point of Intersection For Collaboration Of Care
20. PACE – Program of All Inclusive Care for the Elderly
An inter-disciplinary team approach to care for the frail elderly:
Community Based
Comprehensive
Medicaid Funding Capitated
Coordinated
Membership: Nursing Home eligible, 55 years and older, Reside in PACE service area, Lives in community at time of
enrollment
Medicaid Eligible – No cost
Medicare Only Eligible – Pay Medicaid Portion
Medicaid / Medicare Eligible – No cost
Ineligible for Medicaid / Medicare – Pay monthly rate
Medicaid Payment Share - Known and Capitated
Medicare Payment Share – Sliding payment scale with frailty risk adjustment factor
Source: www.npaonline.org, The National PACE Association, Peter Fitzgerald, President
21. More PACE
Services Provided:
Nursing
Physical, Speech, Occupational and Recreational Therapy
Meals and Nutritional Counseling
Social, Mental Health, Behavioral Health, Psychiatric Services
Medical Care and Home Health Care
Social Work, Assisted Living, Nursing Home and Acute Care Services
Personal Care and assistance with IADL’s
Prescription Drugs
Audiology, Dentistry, Optometry, Podiatry
Respite Care
Transportation to PACE Center and PCP other Doctor visits
105 PACE Programs in 31 States – and growing
All Provider Types Working In Concert In A Heavily Person-Centered Case Managed System
To Drive Results & Enhance The Life Of The PACE Member
23. Community Paramedic Care in Maine
With the approval of LD 1837 a number of Community based Paramedic Pilot Programs were launched
Unmet local health care needs are assessed, Program works with primary care providers, coordinates
services with home health agencies and provides for a robust community education and quality improvement
plan
Intent is expand the sphere of Paramedicine but not change its scope
Patient Treatments include Post Discharge Visits for:
CHF and COPD
Diabetes
Flu Vaccinations
Blood draw / Specimen Collection
Home Safety & Wellness checks, Fall Prevention and Medication Reconciliation
Source: Maine EMS, Jay Bradshaw, President
Creative Pilot Programs Wanted – What’s your idea?
24. Chronic Care Management
CMS set to pay physicians separate fee for CCM for Seniors with multiple conditions
delivered outside of office visits
Payment rate ($40.30 PMPM) per qualified patient
CMS understands complicated cases require additional supports to coordinate a care
regimen between perhaps many specialists in hopes to reduce errors, complications,
readmission and ensure patient is on track to recovery
Not clear whether CBO’s and related service entities can assist the PCP with execution
and delivery of the management services – this would be / should be a natural order of
progression
Source: www.Medscape.com
Can CBO’s Serve As The Socio-Economic Resource Utilizing
Evidence Based Assessment Tools To Generate Informed Decisions?
25. Chronic Pain Self Management
Interactive evidenced based workshop educates and supports adults dealing with CP
Program designed to assist adults with CP as they battle Frustration, Fatigue, Sleep,
Isolation, Appropriate Exercise, Activity vs. Rest, Medication Management, New Treatments
Proven Benefits – Increased vitality /energy, Reduction in Pain level, More independent,
Improved Mental Health and Satisfaction, Enriched living
Source: Maine State Area Agencies on Aging
Minimal Investment needed to expand program exponentially
26. Maine State OADS and LTSS
Maine DHHS Office of Aging and Disability Services Director Jim Martin and team have been busy
developing a four year State Plan on Aging as required by the Older Americans Act of 1965
Highlights:
Development of Senior$afe training curriculum
Three year grant to assure systems of care capable of service dementia needs
Statewide integrated data management system for aging services
Surrogacy to all self-directed long term care programs
Goals:
Protect rights of aging & disabled adults and enhance the response to elder abuse, neglect and exploitation
Source: Maine DHHS, Office of Aging and Disabilities, James Martin, Director, September 2014
27. Maine State OADS and LTSS (cont’d)
Goals (continued)
Assist aging people & families in making informed decisions about access, their health care
needs and long term care options
Enable aging & disabled adults to remain safely in community with a high quality of life as
long as they can with HCBS and supports for family caregivers
Encourage aging & disabled people to stay active, health, connected to their communities
through employment, civic management, evidence based disease and disability prevention
programming
Increase programmatic consistency and appropriate transfer of information to OADS partners
and vendors
Continued education with Policy Makers and State Leaders and support reallocation of
resources to the changing demographic
29. Successful CBO Collaborations of Care
California: Partners in Care – Improving Population Health Using Integrated Care Network for
Medicare Care and Social Services
Source: California, Partners in Care Foundation
30. Smart911
Free service used by public safety officials throughout the country
Enhances communication and response time
Provides more resident specific information based upon pre-registration of service by
household through a Safety Profile
With this information first responders now know what to expect inside the home and
Emergency Management know who and what types of services to send to the house
Opt-in available for Emergency Notification Service to receive alerts via voice, text or
email
Source: Smart911 Community Outreach
31. Community First Choice
PPACA program to expand Medicaid coverage for person-centered HCB attendant
services and supports
States eligible for 6% Enhanced FMAP; must meet several specific requirements
Individuals eligible for NF or ICF individuals with intellectual disabilities will receive
supports and services at home; transition cost available from those settings to home
CFC states will provide HCB services with ADL and IADS supports in addition to
assistance with health care needs
Members have “Self-Directed” option
FY 2015 CMS to study program effectiveness, cost comparisons, member satisfaction with
regard to emotional and overall well being
Montana – Believes program is success with regard to patient satisfaction and cost savings
Source: National Council on Aging and www.cms.gov
32. SASH (Vermont) – Search And Services at Home
Housing, health care and community based organizations collaborate
Designed to Provide Personalized Coordinated Care
Each team serves a maximum of 100 clients
Helps adults participants stay safely at home REGARDLESS OF AGE OR
RESIDENTIAL SETTING
Helps Vermont’s most vulnerable citizens, seniors and individuals with special
needs, access the care and support they need to stay health while living
comfortably and safely at home
After 3 years, the Medicare expenditure growth per client was $1,756-$2,197
lower than non-SASH Medicare recipients.
33. In Other States…
Massachusetts – Child Psychiatry Access Project is an interdisciplinary healthcare initiative that assists primary care
providers who treat children and adolescents for psychiatric conditions (Through 2012 successes have improved as much
as 57%)
Colorado – Sustaining Healthcare Across Integrated Primary Care Efforts is a joint effort with Rocky Mountain
Health Plans, University of Colorado and the Collaborative Family Health Association. This initiative looks at the
impact of global payments on the integration of behavioral health, primary care to test real work applications to inform
policy (estimated savings $650M/1M patients). Members diagnosed with arthritis, asthma, diabetes or hypertension
along with a behavioral health condition
Colorado – Senior Reach - Senior Reach is an award winning, innovative collaboration between Jefferson Center for
Mental Health, Seniors’ Resource Center, and Mental Health Partners, and is having a profound impact in the community
and has proven highly successful in decreasing depression, anxiety, feelings of hopelessness and social isolation among
seniors. Our mission is to support the well-being, independence and dignity of older adults by educating the community,
providing care management and mental health services, and connecting older adults to community resources.
Source: www.pcpcc.org
34. More programs…
Tennessee – Cherokee Health Systems has offered an array of comprehensive primary care,
behavioral health and prevention programs and services. It has also developed a Behavioral Health
Integrated Care Training Academy
Washington – Improving Mood Providing Access to Collaborative Treatment is a team-based
approach that integrates depression treatment into primary care and other medical settings. This model
has proved to be twice as effective as traditional care plans improving physical / social functioning,
quality of life and a reduction in healthcare costs
Texas – One ACO in Amarillo using analytics and working with home health care agencies targeted
beneficiaries with extended episodes of care and moved them to less costlier settings. Other clinical and
claims data of almost 11,000 beneficiaries were tracked to “follow the money” and fill the service gap
with more appropriate plans of care, personnel and settings. Discharges received a PCP visit within a
week. Readmission DECREASED 23% and the ACO saved $5M and received HALF from the Medicare
Shared Savings Program, or ACO
Source: www.pcpcc.org
35. And, more…
Utah – Intermountain Healthcare integrated depression treatments and mental health care
services into primary care practices within clinics proving prolonged oversight of plans of
care. Patients with depression 54% reduction in ED visits. Program costs reduced by 27%
Pennsylvania – Doylestown Hospital has teamed up with a ShopRite to pilot a new community
outreach program called “Health Connections”. Health Connections is retail-based health
resource center located within the ShopRite in the Warminster Town Center shopping center. The
goal is to make health information accessible and personal for the prevention of illness, and to
help residents find the appropriate care when the need arises.
Source: www.pcpcc.org and http://www.drugstorenews.com/article/doylestown-shoprite-local-hospital-pilot-store-health-resource-center
36. Social Bonds are an option…
Making their way back into popularity as a way to promote “Pay for Success”
programming
UK, Australia, New York, Massachusetts, California, Utah, HUD, New South Wales,
Colorado, Connecticut, Illinois, North Carolina, Ohio, Oregon, South Carolina, New
Jersey, Michigan, Maryland, Canada
While not all health care related some programs are targeting: Prison Recidivism,
Substance Abuse, Prevention and Early Intervention Health Care, Home Visits, Social
Services, Chronic Homelessness, Home and Health For Good Program, Universal
Home Visiting Program for Infants
37. Possibilities…
New York – Rock on Café – Roughly one third of a child’s dietary intake occurs
during school hours. Since health and academic outcomes are related to nutrition,
school nutrition policies and programs have been identified as a key intervention area
Michigan – American Indians experience significant health disparities compared to
the general U.S. population. Steps to a Healthier Anishinaabe adopted a unique
framework to implement health promotion intervention activities in multiple American
Indian communities in MI by enabling each community to tailor interventions to their
specific culture and health priorities.
Source: www.cdc.gov
38. Possibilities
Missouri – Evaluating Mobilization Strategies with Neighborhood and Faith Based
Organization to Reduce Risk for Health Disparities aimed to engage neighborhoods and
faith based organizations in changing conditions to reduce risk for cardiovascular disease and
diabetes. Results indicated strategies worked by increasing implementation of community
changes by neighborhood and faith based organization
Arizona – A Pebble in The Pond: The Ripple Effect of an Obesity Prevention
Intervention Targeting the Child Care Environment worked with child care providers to
implement organizational best practices which promote positive nutrition and physical
activity in behaviors of your children. Child Care best practices have increased in addition to
broader state early childhood development systems
Source: www.cdc.gov
39. They said it…
• Always laugh when you can. It’s cheap medicine. (Lord Byron)
• I learned along time ago that minor surgery is when they do the operation on someone else, not you. (Bill Walton)
• A hospital bed is a parked taxi with the meter running. (Groucho Marx)
• By medicine, life may be prolonged, yet death will seize the doctor too. (William Shakespeare)
• I got the bill for my surgery. Now I know why doctors wear masks. (James H. Boren)
• A Short History of Medicine
2000 B.C. - "Here, eat this root."
1000 B.C. - "That root is heathen, say this prayer."
1850 A.D. - "That prayer is superstition, drink this potion."
1940 A.D. - "That potion is snake oil, swallow this pill."
1985 A.D. - "That pill is ineffective, take this antibiotic."
2000 A.D. - "That antibiotic is artificial. Here, eat this root."
(Author Unknown)
