Make Sure Your Prepared For Everything. Yes! Anything Can Happen to YOU

Only 40% of American companies have any type of travel risk-management program in place to help employees deal with medical emergencies, kidnapping and extortion threats or any of the other problems that can occur when traveling abroad, said Craig Banikowski, chairman of the global risk-management committee for the National Business Travel Association. The numbers are even more dismal when it comes to small business or the sole proprietor who travels. “People are under the impression that nothing bad can happen to them,” Mr. Banikowski said. “And if something does, they believe the embassy is going to step in and make everything right.” Truth is… “embassies can only do so much,” said Randy Spivey, executive director of the Safe Travel Institute, which provides survival training and travel risk-reduction training to companies like Wal-Mart and Boeing. “Business travelers have to take some responsibility to help themselves.” Small businesses and entrepreneurs do not have the resources of large corporations, but they can still mitigate risks. For example, experts suggest that you check out State Department warnings and advisories at travel.state.gov. The site also provides comprehensive information on other travel-related matters, including the role that United States embassies play when a traveler gets into trouble. They advise registering your trip with the State Department at http://travelregistration.state.gov/. Save those two sites for future travel.

• Make copies of all important documents, like a passport, credit cards, driver’s license and medical information and leaving a copy with a colleague or family member. Consider scanning and e-mailing these documents to yourself.
• Before going abroad for business/pleasure, find out if your medical policy covers sickness and injuries overseas. Even if policies do promise reimbursement, travelers probably will have to pay any costs upfront for medical care. Most insurance policies do not cover medical evacuation, which can easily run into the six figures.
• Purchase international health insurance. Some, for example, could range from a 10-day program for $80, which includes access to its 28 global alarm centers, medical assistance and evacuation, etc., to $4 to $6 a day for medical evacuation and cashless access to its worldwide network of 4,000 English-speaking doctors and 750 hospitals.

It’s Not The End of the World

An increasing number of adults, 11 million in all, are taking care of an older person in their home. And that number will likely rise sharply over the next few decades as the population ages. Certainly the emotional and financial advantages of opening your home to a parent can be great. You won’t have to stress about whether they are taking proper care of themselves - you’ll be able to see for yourself and help as needed. And if your mom or dad becomes frail or chronically ill, neither one of you will have to pay the $30,000 or so a year that the average assisted-living facility costs. But if you do nothing more to get ready for your parental roomie than put clean sheets on the bed in the guest room, you run the risk of jeopardizing your parents’ physical safety. The prep steps range from minor remodeling projects (such as installing handrails or brighter lighting) to major renovations (like building a separate apartment), with costs from a few hundred dollars to much more than a hundred thousand.

• The Layout Of Your Home An unused basement or attic space is the traditional place to add an extra bed and bathroom. But before taking that route, check whether you can expand your square footage with a first-floor addition. Either way, plan for extra storage space. Older people don’t like to leave familiar things behind. This is often where a lot of tension comes in.
• Your Parents’ Health  Right now Mom and Dad may prefer a separate apartment. But in a few years their health could change dramatically, and cooking or climbing stairs might become impossible. That’s why adding a bedroom and bath on the first floor of your home is usually the best way to go for a long-term arrangement.
• Budgeting  Adding a bed and bath will cost at least $60,000 to $150,000 in most suburban communities. A very basic basement or attic renovation may set you back as little as $50,000, although you’ll likely spend six figures on an extensive project. Installing an elevator can cost from $40,000 to $75,000 or more, but you can add solid banisters for a few hundred dollars or a stair lift for a few thousand.
• When To Buy The Premium  Falls are the No. 1 cause of injury among the elderly, and most of them occur in the bathroom. The best solution is to spend $50 to $300 to install grab bars in the bath and shower. Check that the label says they meet the Americans with Disabilities Act guidelines for safety. Use adhesive safety strips on the bottom of the tub or shower floor instead of plastic mats, which can slide easily, and use nylon mats with nonskid backing on the floors.
• Eliminate entryway barriers.  At the very least, you’ll need to get rid of steps and curbs that can be especially troublesome in winter weather. You’ll pay $1,500 each to make doorways wide enough to fit a wheelchair or walker. Look into installing doors with swing-clear hinges, which cost about $75 and can add an extra inch or two of space.

“It shows how unfair our system is. These people were not getting care, and they were at least as in need of it as the people who were insured.”

When uninsured adults with common chronic illnesses became eligible for Medicare, they saw doctors and were hospitalized more often and reported greater medical expenses than people who had had insurance. And their increased use of medical services continued at least until at least age 72, researchers are reporting today. Their study, published in The New England Journal of Medicine, is one of the first to follow a large group of people through that crucial time of transition from being ineligible for Medicare to receiving Medicare benefits. Participants were interviewed and surveyed about their health and medical care every two years until 2004. That allowed the Harvard researchers to ask what happened when people who had not had insurance suddenly could have their health care paid for by the federal government.The effect that emerged — a surge in the use of health care by those who were previously uninsured — was concentrated in people with cardiovascular disease or diabetes. Those are conditions, the investigators noted, in which treatment can prevent serious consequences that can require extra doctor visits, hospitalizations and expense. When such previously uninsured people became eligible for Medicare, they had 13% more doctor visits, 20% more hospitalizations, and reported 51% greater medical expenditures than those with the same diseases who had had insurance all along.

The study also shows that it may be less expensive than expected to provide universal health insurance. Medicare is bearing the brunt when uninsured people put off seeing doctors or seeking medical care until they turn 65. The uninsured were very different from the insured people in the study. They had much less education, their incomes were lower, they were more likely to smoke and to be depressed.

Spending a Little Extra To Tell You When To Stop

In just three years, sales of 100-calorie packs of crackers, chips, cookies and candy have passed the $20-million-a-year mark, making them a breakout hit on par with the SnackWells low-fat fad of the 1990’s. But food companies are cramming store shelves with even more offerings, and new ones are on the way. What’s To Come? Frito-Lay has started selling 100-calorie servings of beef jerky. Pepperidge Farm said it was developing several more 100-calorie variations of Goldfish and cookies, after rolling out three new ones a couple of weeks ago. Frito-Lay, a unit of Pepsico, now makes Doritos and Cheetos that are slightly smaller than the ones sold in regular-size bags. Hershey, for example, now sells 60-calorie chocolate bars. Jell-O sells 60-calorie pudding packs. 

The growing popularity of these snack packs — sales grew nearly 30% last year — may also be another sign that some consumers have had their fill of supersize food. As a business concept, the idea is simple. Take an existing product, portion smaller amounts of it into single-serving bags, and sell several of the bags for about the same or more as a regular-size package. Consumers do not seem to mind paying more even though they are getting fewer Goldfish. “The irony,” said David Adelman, who follows the food industry for Morgan Stanley, “is if you take Wheat Thins or Goldfish, buy a large-size box, count out the items and put them in a Ziploc bag, you’d have essentially the same product.” Mr. Adelman estimates that snack packs are about 20% more profitable than larger packages.

Don’t Be Fooled! People like to think, ‘Oh, this is healthy, it’s only 100 calories. A single portion of junk food is better than a large portion of junk food, but it’s not better than an apple, a peach or a vegetable.
 

What exactly is 100 CALORIES?·
About four Hershey’s Hugs
· One tablespoon of peanut butter
· One medium orange
· One Trader Joe’s plain mini bagel
· Four-pack of Ben-Bud baby carrots (lots!)
· One 1/2 -ounce wedge of Maybud farmer’s semi-soft cheese
· One Edy’s Smoothie fruit and yogurt bar (2.75 ounces)
· .77 ounces Stacy’s Simply Naked baked pita chips
· 8-ounce can of Sprite
· 15 to 20 jelly beans or plain M&Ms

Other States Watching Closely

There is a lot of talk about overhauling health care in the United States, but Massachusetts is actually trying to do it — again. Today, the home of some of the nation’s most prestigious hospitals and medical schools becomes the first state to require its residents to have health insurance or face financial penalties. Making insurance mandatory — and more affordable — for Massachusetts’s 6.5 million residents is the centerpiece of a law approved by the legislature last year that civic and business leaders hope will dramatically reduce the ranks of the state’s 400,000 uninsured and the number of people who seek costly “uncompensated” care in hospital emergency rooms.

Nearly 20 years ago, then-Gov. Michael S. Dukakis signed universal health-care legislation that was supposed to bring coverage to everyone by 1992. But the law’s requirement that employers provide coverage to workers or pay a tax proved unpopular.

July 1 marks the beginning of the “individual mandate” (the legal obligation to obtain health insurance), but the real deadline is Dec. 31. The state’s 175,000 employers have to pitch in, too. Businesses with 11 or more full-time employees that do not offer health insurance must pay an annual “fair share” assessment of $295 per employee. Costs are still too high for some. Already, state officials expect to exempt 60,000 residents from the new mandate because they cannot afford the insurance at the going rates, even though they earn too much to qualify for subsidies. That is a big reason that Massachusetts is destined to fall short of universal coverage under the new law, officials say, although proponents say covering 99% of residents is possible.

Psychiatrists who took the most money from makers of antipsychotic drugs tended to prescribe the drugs to children the most often.

As states begin to require that drug companies disclose their payments to doctors for lectures and other services, a pattern has emerged: psychiatrists earn more money from drug makers than doctors in any other specialty. How this money may be influencing psychiatrists and other doctors has become one of the most contentious issues in health care. For instance, the more psychiatrists have earned from drug makers, the more they have prescribed a new class of powerful medicines known as atypical antipsychotics to children, for whom the drugs are especially risky and mostly unapproved.Vermont officials disclosed Tuesday that drug company payments to psychiatrists in the state more than doubled last year, to an average of $45,692 each from $20,835 in 2005. Antipsychotic medicines are among the largest expenses for the state’s Medicaid program. According to their income statements, drug makers generally spend twice as much to market drugs as they do to research them.

Endocrinologists received the second largest amount, according to the Vermont analysis, earning an average of $33,730. As in Vermont, psychiatrists earned on aggregate the most in Minnesota, with payments ranging from $51 to $689,000. The NY Times found that psychiatrists who took the most money from makers of antipsychotic drugs tended to prescribe the drugs to children the most often. These and other stories have helped to fuel a growing interest among state and federal officials to document and restrict payments to doctors from drug makers. At a gathering last month at Columbia Law School in New York, state attorneys general from across the country discussed ways to get similar data for their states. The Senate Special Committee on Aging held the first of a series of hearings on the issue on June 26, which could lead to legislative proposals to restrict and require disclosure of payments and gifts to doctors from drug companies nationwide. Amen to that! Efforts to require disclosure of payments to doctors began almost by happenstance in 1993, when The Minnesota Legislature passed a law that restricts drug companies from giving doctors gifts valued at more than $100 in any given year.

180 Plants Shut Down, 23,000 Food Safety Violations, A Death Penalty and More To Come

After weeks of insisting that food here is largely safe, regulators in China said Tuesday that they had recently closed 180 food plants and that inspectors had uncovered more than 23,000 food safety violations. The nationwide crackdown, which the government said began last December, also found that many small food makers were using industrial chemicals, banned dyes and other illegal ingredients in things like candy and seafood. The government has moved aggressively in recent months to enforce food safety regulations and to weed out fake or contaminated food products. Regulators said an investigation involving 33,000 law enforcement officials found illegal food-production and meat-processing operations, fake soy sauce and the use of banned food additives. Experts here say that the country’s food regulations are not being enforced and that small-business men are willing to go to extraordinary lengths to increase profit.Corruption and bribery are also part of the food and drug industry here. The former head of the food and drug watchdog agency was recently sentenced to death for accepting bribes and approving the licensing of substandard drugs. And now, a Ministry of Agriculture official is on trial in Beijing for accepting bribes in exchange for endorsing food products.

A. T. Kearney, an international management consulting firm, issued a report this week saying that one cause of food safety problems in China was inadequate logistics systems and a lack of cold storage. The firm said China needed to invest about $100 billion over the next 10 years to upgrade its logistics and refrigeration abilities and to put new standards into effect. In China, the study said, there are only about 30,000 refrigerated trucks for transporting food; the United States has about 280,000. Yikes!

As a single person, you’re the one in charge of saving for your retirement

If you’re like most Americans, you’ll spend more of your life single than married. And like many, you may experience those single years while you’re preparing for retirement and in retirement. Whether you’re part of a couple or not, you still should save as much as you can for retirement. The difference between being part of a couple and being on your own is not only a matter of accumulating enough funds, but also of assembling adequate financial safeguards to protect yourself from unemployment and disabling illness.

What’s the difference between couples and singles retirement planning? There are certain costs, like utilities, property taxes and housing expenses, that are not much less if you are single than if you are in a couple. On the savings side, the difference is likely to be substantial — the single person doesn’t have the benefit of someone else working and saving in a 401(k) plan. If you haven’t saved enough for retirement, join the club. The Employee Benefit Research Institute reports that roughly half of all workers have saved less than $25,000. Because of advances in health care, financial advisers are recommending that Americans save enough to provide for themselves through age 100 or even 110. $25,000 will probably cover a little over one year into a luxurious retirement.Single people usually wait longer than married people to take retirement saving seriously, says Bob Enright, a certified financial planner with the Burton/Enright Group in San Francisco. “Traditional financial planning is all about making sure that you, your spouse and kids are taken care of,” he says. “When you are single, the focus is drastically different. Single people tend to feel more invincible because they haven’t had as much responsibility thrown their way so they don’t start saving until their 40s or even their 50s.”

If you’re not sure how much you should be saving, try this simple formula: whatever percentage represents half of your current age. “If you are 50, you should be saving 25% of your income,” he says. “A lower percentage — like 10% — isn’t enough. And with this formula, the percentage increases as you get older, so you’ll be saving more.”

The obvious first destination for your retirement savings dollars is an employer-sponsored retirement plan — a 401(k) , 403(b) or 457 plan. If your employer matches any portion of your savings, those funds are equivalent to free money. If you max out your 401(k) or don’t have one, consider either a traditional or Roth IRA. If you are under certain income limits, you can make a before-tax contribution to an IRA of $4,000 in 2007, along with a $1,000 catch-up contribution if you are 50 or over. Experts are divided on the advisability of setting up a Roth if you’re single. “The biggest benefit of a Roth — the ability to pass on money to your heirs — isn’t as big of a deal for someone who is single and has no kids,” Enright says.

When considering a retirement date, money isn’t the only issue. Obviously, it’s important to have enough savings to live comfortably, but it is also important to have an idea of what to do with your time when you retire. Think about what interests you and what interests that you weren’t able to pursue when you were busy with your career. A key issue in a fulfilling retirement is finding some type of affinity group to get involved with. Besides retirement, drafting and updating wills, financial and health care power of attorneys and other estate planning documents is a must-do, especially for single people who don’t have a spouse to back them up.

“When you start thinking of oncology as a business, then all these decisions make sense.”

When Medicare cracked down two years ago on profits that doctors made on drugs they administered to patients in their offices, it ended a windfall worth hundreds of thousands of dollars a year for each physician. The change, which mainly affected drugs to treat cancer and its side effects, had an immediate effect. In all, cancer doctors billed about $4.4 billion for chemotherapy and anemia medications in 2005, down from $5.6 billion in 2004, with Medicare covering 80% of the bills in each year. The difference mostly represented profit that doctors had made on the drugs.

Cancer doctors say the change did nothing to reduce a larger problem in cancer treatment. Some physicians say that cancer doctors responded to Medicare’s change by performing additional treatments that got them the best reimbursements, whether or not the treatments benefited patients. Those doctors also say that Medicare’s reimbursement policies are responsible. Cancer patients and their families play a role in rising costs, too, because they understandably want doctors to exhaust every possible treatment, even if the doctors might serve their patients better simply by talking and listening to them.In general, oncologists make money by providing chemotherapy, even when it has little chance of success. With the new limits on cancer drug profits, some cancer doctors are searching for new income — like performing chemotherapy more often or installing multimillion-dollar imaging machines where they profit when their patients receive diagnostic scans. They are also putting new pressure on cancer patients to make out-of-pocket drug co-payments, which can amount to hundreds of dollars a month. In some cases, they are requiring patients to get injections of certain drugs at the hospital instead of in their offices. Instead of writing prescriptions that patients filled at pharmacies, cancer doctors bought drugs themselves, then administered them to patients and billed Medicare or private insurers for reimbursement.

Today, the drugs range from relatively inexpensive treatments like Taxol, a breast cancer drug that costs about $150 a dose, to a new wave of biotechnology therapies like Avastin, a drug for colon and lung cancer that can cost as much as $8,800 a dose. Before 2005, Medicare paid a markup of 20% to 100% on many drugs, and private insurers paid even more. Doctors pocketed the difference, after certain expenses, as profit. Because the profits on different drugs varied enormously, doctors had an incentive to prescribe medications with the highest margins. The increase in spending, and concerns about the perverse incentives created by the system, caused Congress to change the reimbursement system to more closely tie Medicare payments to what doctors actually pay for the drugs. Now, drug reimbursement is supposed to amount to only 6% more than the average price of the drug paid by all doctors.  As a result of the Medicare cutbacks, some doctors say they have been forced to refer patients to hospitals for chemotherapy treatment. Because of the complexities of Medicare rules, hospitals can make money providing chemotherapy for patients even in cases when doctors cannot. But it can be a serious inconvenience for people who are very ill and may have a few months to live.

“People go where the money is, and you’d like to believe it’s different in medicine, but it’s really no different in medicine,” says Dr. Robert Geller, who worked as an oncologist in private practice from 1996 to 2005 before leaving to become senior medical director at Alexion. “When you start thinking of oncology as a business, then all these decisions make sense.” Not sure when you should switch doctors? 10 Signs You Need A New Doctor.

Why America’s Healthcare is F*#!ed

Professor Regina Herzlinger has been studying the U.S. health care system for decades, advocating for consumer-driven reform as the best remedy. But the slow pace of change, which she attributes to a fat-cat network of insurers, policymakers, hospitals, and even employers, has her fed up. Her new book, Who Killed Health Care? adopts the emotional language of a manifesto in demanding change to make health care more responsive to customers, affordable to those in need, and a hotbed of innovation and entrepreneurship. Key concepts include:

• Today’s American health care system is set up structurally to reward the major players—hospitals, health insurers, and lawmakers—while short-changing patients and taxpayers. Hospitals want to control the health care delivery system, and they’ve become oligopolists or monopolists in many markets, thus obviating price and quality competition, and they’ve become vertically integrated by hiring physicians and using them. Initially the hospital was a place almost like a hotel or an office while the doctors were the stars. Increasingly, the hospitals have won the power struggle, and the physicians are more or less the blue-collar workers. Whether Democrat or Republican, power is seductive, and politicians are actually practicing medicine … by micromanaging the payment system.
• Health care is not the hotbed of innovation and entrepreneurial activity one might expect from a $2 trillion industry. Risk takers are often beaten down by established interests.
• 300,000 people die every 3 years in hospitals. How? Through uncaring bureaucracies, over-stressed care providers, and poor management. In a hospital, the scope of work is so broad that the possibility of cross-infection is monumental. If you go into a general hospital, there’s no way they can keep those walls and floors clean and free from all bacteria. Another reason is “failure to rescue.” If something happened to you, your respiration got compromised, you couldn’t breathe, and they didn’t get to you in time.

A failure to address the obesity epidemic would “explode the federal budget”

Wary of tackling Social Security or Medicare reform, members of Congress are pitching a new prescription for the nation’s coming fiscal woes: fresh fruit and exercise.  Healthy diets won’t pay the trillions of dollars in unaffordable health benefits promises. Politicians and policy advocates are arguing that heavier Americans — not just older Americans — pose an urgent fiscal threat. A doubling of obesity rates among the Medicare population has been a big force behind the program’s spiraling cost, concluded a 2006 study by Emory University health economists. Emory’s Kenneth Thorpe and David Howard found that spending on obese patients accounted for 25% of total Medicare spending in 2002, up from 9.4% in 1987.

Growing waistlines also hold implications for Social Security. While there is speculation that obesity might slow or stop longevity gains, experts are much more sure of its link to disability. Higher disability rates are a double negative, driving up Social Security costs while shrinking the potential payroll-tax base.

What Are The Chances of That One Passing

The United Nations health agency yesterday issued its strongest policy recommendations yet for controlling tobacco use, urging all countries to ban smoking at indoor workplaces and in public buildings. Tobacco use is the world’s leading cause of preventable death, accounting for 10% of adult fatalities, according to the World Health Organization. It is responsible for 5.4 million deaths each year, a figure that is expected to rise to 8.3 million by 2030, the agency says. In its 50-page report, the WHO said governments of both rich and poor countries should declare all public indoor places smoke-free, by passing laws and actively enforcing measures to ensure that “everyone has a right to breathe clean air, free from tobacco smoke.” So far, Ireland and Uruguay as governments that have successfully tackled smoking by creating and enforcing smoke-free environments. Imagine How Las Vegas Casinos Would Smell Then.

For Drug Makers, a Downside to Full Disclosure

When GlaxoSmithKline settled a lawsuit three years ago with the State of New York over the antidepressant medication Paxil, the company agreed to take an unusual step: publicly disclosing the results of its clinical trials for Paxil and other drugs. The company, which was criticized at the time for failing to publicize all pediatric trials of Paxil, not just the positive ones, made good on its promise. The first posting on a new Web site was about 65 studies involving its popular diabetes drug, Avandia.

The New England Journal of Medicine released its finding that Avandia posed a heightened cardiac risk. Many companies besides GlaxoSmithKline already post results from some studies or trials on their Web sites. Studies have found that the vast majority of drug and medical device studies are never published in medical journals. Some experts also believe that releasing the results of hundreds of studies involving drugs or medical devices might create confusion and anxiety for patients who are typically not well prepared to understand the studies or to put them in context. That’s just great! Other experts have argued that the relative efficacy or cost of competing drugs can be compared only when all study results, rather simply those that a company chooses to publicize, are available.

“I would be very concerned about wholesale posting of thousands of clinical trials leading to mass confusion,” said Dr. Steven Galson, the director for the Center for Drug Evaluation and Research at the F.D.A. But even before the recent Avandia episode, advocates were pushing lawmakers to take the next step by requiring that producers of drugs and makers of devices not only register trials but also publicly disclose study findings. Recently, a report issued by the Institute of Medicine, a part of the National Academy of Sciences, recommended that the F.D.A. release all summaries of study data it had collected in the process of approving new drugs as well as all post-marketing studies of those products. Then, there is also the question of who the audience for such information should be — scientists, consumers or both?

Hospitals Aren’t What They Used To Be

Most hospitals in San Diego County and across the country are now using some sort of electronic medical records system – a technological leap proven to reduce medical errors and one that many think is key to slowing runaway health care costs. For nearly two decades, physicians, health experts and even U.S. presidents have declared the nation within reach of the holy grail of medical information technology: a vast computerized network linking hospitals, doctors’ offices, pharmacies, laboratories, clinics and insurers that would allow a patient’s comprehensive medical record to accompany him around the nation’s fractured health care system.Creating this system has proven much more difficult and costly than anyone predicted:

• The health care and software industries have been slow to adopt technical standards that are needed to allow different computer systems to talk to each other.
• Some health care providers, particularly doctors, have been reluctant to invest heavily in new technology without assurances that they will reap the financial savings created by the investment.
• And the legal mandate to protect patients’ privacy remains a vexing challenge for those creating systems designed to share information.

Kaiser Permanente is in the midst of rolling out the nation’s biggest electronic medical records system. Once fully deployed in 2010, KP HealthConnect will cover Kaiser’s 8.4 million members, 32 hospitals and 431 medical offices in California and six other states. The project, estimated to cost more than $3.2 billion, has encountered numerous problems that included a four-year delay. Physicians are moving from an intuitive way of practicing medicine, in which they treat a patient based on their own knowledge and experience, to so-called evidence-based medicine guided largely by mountains of data analyzed for patterns and trends.

A Great Way To Avoid Costly Mistakes

Geisinger Health System is trying to learn in an experiment that some experts say is a radically new way to encourage hospitals and doctors to provide high-quality care that can avoid costly mistakes. After taking a cue from the makers of television sets, washing machines and consumer products, Geisinger essentially guarantees its workmanship, charging a flat fee that includes 90 days of follow-up treatment. Even if a patient suffers complications or has to come back to the hospital, Geisinger promises not to send the insurer another bill.

Geisinger stands out as a group that has transformed the way it delivers care, said Dr. Donald M. Berwick, the chief executive of Institute for Healthcare Improvement, a national nonprofit organization whose goal is better patient care.  In almost no other field would consumers tolerate the frequency of error that is common in medicine, Dr. Berwick said, and Geisinger has managed to reduce the rate significantly. “Getting everything right is really, really hard,” he said. Researchers estimate that roughly half of American patients never get the most basic recommended treatments — like an aspirin after a heart attack, for example, or antibiotics before hip surgery.Reviewing the existing professional guidelines and medical literature, Geisinger’s cardiac surgeons came up with their list of 40 action items viewed as best practices — including giving a patient antibiotics within a specified time before surgery, and then giving beta blocker drugs afterward to reduce the chances of an irregular heartbeat. Doctors can choose not to follow a particular measure, based on the needs of an individual patient. But they rarely do so. And they also know that any of the steps can be altered if new medical evidence emerges.