In his most recent blog post, Nick Valeriani, Chief Executive of West Health, describes three steps you can take to become a smarter health care consumer: exercise more, protect your healthcare data, and demand transparency in pricing and quality. I have a relevant example from my own life on the importance of transparent pricing. I had a surgical procedure done at a surgery center jointly owned by the surgeons who practice there and their hospital employer. The center told me what my co-payment would be and asked that I pay this amount up front, which I did. A few weeks after the surgery, the center sent me another bill for twice the amount I had already paid. The center had underestimated the number of procedures that I would undergo, and unlike the hospital that employed the surgeon, the center did not accept the rate my insurer was willing to pay for the procedures that were performed, which increased my co-payment. I objected to the bill and made the point that I could have elected to have the surgery done at a facility wholly owned by the hospital, which would have reduced my bill considerably. The center’s billing company agreed to reduce my bill to ten percent of the billed amount.The surgery center had not been transparent, but I was able to leverage my expectation of transparency to reduce my total bill.
I was admitted as an attorney in Iowa on December 20. Before that date, I could not hold myself out as an attorney authorized to practice law in Iowa. After December 20, I can claim that distinction.
Iowa requires that every attorney admitted to practice law be sworn in by a Justice of the Iowa Supreme Court, which is equivalent to the Court of Appeals in New York State. This means that 30 seconds after being admitted as an attorney in Iowa, I was shaking hands with a Justice from its highest court. Cool.
The three of us who were sworn in on December 20 had the honor and privilege of having Justice Brent R. Appel administer the oath. He took the time to explain why he thought the tradition of having Supreme Court Justices administer the oath had merit, and why it should continue. He stressed the importance of civility, public service and professionalism. Eric and Katelin bore witness to the ceremony and were duly impressed by his humility and sense of honor.
Below is the oath I swore to uphold.
I swear or affirm:
As an officer of the Court serving in the administration of justice, I will:
- Support the Constitution of the United States and of the State of Iowa
- Perform to the utmost of my abilities and education
- Maintain the respect due to the Courts and my colleagues
- Faithfully and ethically discharge the duties required of Iowa lawyers
As a zealous advocate and counselor for my clients, I will:
- Strive to be worthy of trust and respect
- Counsel clients to maintain only those disputes supported by law and the legal process
- Use only those means that are consistent with justice
- Maintain the confidences of my clients as required by law
- Support the cause of the defenseless or oppressed, pro bono publico
As a member of the legal community, I will:
- Strive to represent the legal profession as one of justice, honor, civility and service.
I hope I can live up to these high words.
According to my Kindle, I bought 17 new books this year, twelve of which were published in 2011. Here are my favorites that were published over the past year.
Pulphead: Essays by John Jeremiah Sullivan. Mr. Sullivan is a Southern Chuck Klosterman. He writes about music, culture and American life from the perspective of someone who grew up going to church every Sunday and quoting the Bible. Mr. Sullivan writes about oddballs and eccentrics, the staples of every good Southern story. Mr. Klosterman writes about ordinary people who find themselves in odd and weird situations.
A Killing in Iowa: A Daughter’s Story of Love and Murder by Rachel Corbett. Ms. Corbett takes artistic license with the title of this Kindle single. She was not related to the murderer in the story. He was her mother’s boyfriend for a short period of time. I believe her though when she says his death had an impact on her. Particularly when she found out he killed another woman before he took his own life within 12 hours of sleeping on her mother’s couch. She also does a good job of putting his life and death in context. What is it about Southeastern Iowa that gets to people?
State of Wonder by Ann Patchett. This is a woman’s story. Both the protagonist and antagonist are women. It is also a Midwesterner’s story. The protagonist grew up in Minnesota, the daughter of an East Indian father and Minnesotan mother. She had one foot in both cultures, but felt most at home in the place where she did not look like she belonged. “Being the child of a white mother and foreign graduate-student father who took his doctoral degree back to his country of origin after he was finished had become the stuff of presidential history, but when Marina was growing up there was no example that could easily explain her situation.”
Before I Go To Sleep: A Novel by S. J. Watson. What would your life be like if you woke up each day with no memory of what happened the day before? This is an engrossing detective story. You may figure out whodunit long before the book ends but you will want to read on to find out whether our heroine safely navigates her way to freedom.
Bossypants by Tina Fey. Tina (I don’t think of her as Ms. Fey) is writing from the perspective of every woman who has been in a position of authority and been less than comfortable wielding her power. I hear you girl! She is witty, self-effacing, and endearing. She tells a good story and makes us like her even more.
The Paris Wife: A Novel by Paula McLain. This is the story of how Ernest Hemmingway met and married his first wife, Hadley Richardson. She is eight years older than he when they meet and then marry. He is ambitious and devoted to his craft. She is his best reader and critic. They did not live well but did live fully. If you touch brilliance once, are you tainted forever or can you move on and accept an ordinary but constant life? This book was not published in 2011 but I got so much out of it I have to share it.
Justice: What’s the Right Thing to Do by Michael J. Sandel. I bought this book because Tom Friedman recommended it. I was intrigued by his description of the political philosopher who speaks to standing-room-only crowds in China. Mr. Sandel is a professor at Harvard Law School. His goal is to give students a framework for answering some of the tough questions confronting every citizen. He doesn’t provide answers, just questions and a roadmap for developing your own answers. Is the role of government to produce the greatest happiness for its citizens, ensure free markets, or promote virtue? Professor Sandel explains the political philosophy and historical context for each answer. His own view — promote virtue — may be surprising, but perhaps is one that we should (re)consider.
Note: This post also appears on Indie Moines’ New York-based sister site, Indie Albany.
Eric and I recently sold our house in New York and bought a new house in Iowa.
We have some prior experience with this process. We have bought four houses and sold three during our twenty-four year relationship. We bought our first house in Northern Virginia in 1989, just before we got married. The interest rate was 10.5%. According to the flyer that we received from the selling agent, who was also our agent, we paid more than anyone else in the neighborhood had previously paid for a house there, ever. Yeah us!
When Eric got transferred to Idaho in 1991, we tried to sell it but the housing market had fallen and we were under water. We eventually sold it at a loss, after renting it for less than we were paying on the mortgage for about five years.
We did a little better on our next house, but not much. We bought it in 1992 and sold it in 1993 for the same price. Luckily, Eric’s employer paid the realtor fees so we didn’t lose too much money.
Having learned our lesson — you need to be in a house for awhile if you want your investment to pay off — it took us some time to get back into the market in New York. We moved there in 1993, but did not buy a house until 1999. Luckily, its value nearly doubled during the twelve years we owned it. When we refinanced in 2002, we also put more money down at a time when many homeowners were taking equity out of their properties. We would have paid for the house completely in less than four more years had we stayed.
With that much equity in the property, we were able to put down a very sizable up-front payment on our Iowa house once we sold the New York one. So that’s how it’s supposed to work! Here are some other things I have (re-)learned about buying and selling an existing home:
- Work with an experienced realtor. They are professionals and they know what they are doing. The realtor will keep your expectations in check. They do most of the work and make everything easier. They know the market and what is out there. They are also a buffer between you and the people who are touring your house and making snap judgments about your decorating choices and budget priorities. Being judged is bad for the soul. Also, if you are buying a house, make sure you have your own agent, someone who represents your interests and not those of the seller. Eric and I strongly recommend the realtors we worked with: Mary Anne Hess at Coldwell Banker Prime Properties and Sue Mears at Mid-America Group Realtors. You may get lucky using a for-sale-by-owner approach, but it puts an undue burden on you, the buyer, and the buyer’s agent if you do so, since there’s no way you’re going to know all the ins and outs of the legal, contractual and civic requirements associated with major property transactions in your market. You get what you pay for, especially in this situation.
- Buyers want the latest updates. A friend told me recently that she and her husband were updating their kitchen because they planned to sell it in a few years and move to Florida. This sounded crazy to me. Why spend all that money to put in features that you will not have a chance to enjoy? So it will sell faster, of course.
- You should fix the stuff you know is a problem before you put your house on the market. Every house has issues. You know better than anyone what the issues are with your house. Don’t wait for the home inspector to tell you what you already know. Just fix it.
- Don’t waste too much time looking at houses that have been on the market for months, unless you want to buy a fixer-upper. Houses that have been on the market aren’t selling because there are too many things wrong with them. At least in the markets we have been looking at, a house that has been on the market more than 90 days isn’t selling for a reason. We stopped looking at them to save time.
- If you are not sure what you are doing, ask for help. We should have asked our parents and older colleagues for advice when we bought our first house. I am not sure why we didn’t, probably because we thought we were smart enough to figure it out on our own.
- A house is an investment, until you live in it awhile, and then it becomes a home. Don’t fall in love with a house until you own it. Don’t pay more than market price for a home because you think it is your dream home. If a house is priced right, it should sell for about 95% of the asking price, so you need to start there or below there if you don’t want to pay too much. While it is true that your monthly payment won’t go up by much if you overbid $5,000 for a home, you will notice that $5,000 when it comes time to sell the house.
- Don’t buy more house than you need. Buying a house is a big investment. There are many other investments that you need to make in your life. You need to save for your kids’ college and save for your retirement. You also need to enjoy life along the way, because there are no promises that you will ever make it to retirement. If you buy more house than you need, you are putting too many eggs in one basket and short-changing those other investments (unless you are among The One Percenters).
- It’s the interest rates, stupid! We thought we did well when we refinanced our house in New York at 4.6%. The rate on our house in Iowa is 3.2%. That is a lot of Cheetos (which is what Eric and I call things we impulse buy). If you are sitting on the sidelines wondering whether it is a good time to get into the market, you should act now and buy that house. Interest rates are already starting to go up.
I don’t plan on selling another home soon, and hopefully never will again. I hope Katelin likes this house because we are seriously thinking about handing her the keys, if and when we decide to move on.
“Oh, sweetheart, you don’t need law school. Law school is for people who are boring and ugly and serious. And you, button, are none of those things.” Legally Blonde (2001)
Our lovely daughter Katelin is studying cultural anthropology and business at SUNY Geneseo. Her friends are all nice, interesting people, and we have enjoyed spending time with them. It’s fun to see things from their perspective. During a recent visit, one of her friends surprised me with the title question: “So, how is the law?” I wasn’t sure how to respond. The law has been good to me. I am less sure it is a good career for twenty-somethings. I am not encouraging Katelin to go to Law School and did not want to encourage her friends to attend either. Here are some sobering statistics:
- In 2009, the median salary for new Law School graduates was $72,000. In 2010, it was $63,000. The national mean salary for attorneys was $93,454 in 2009, and $84,111 in 2010.
- The average debt for Law School graduates is $75,500. That’s a lot of Cheetos.
- The number of applicants to Law Schools was 83,400 in 2008 and 87,900 in 2010.
If you are considering Law School after graduation, please keep the following points in mind:
- Law School can prepare you to do many things. You don’t necessarily need to practice law after you graduate. We live in a society governed by the rule of law. Knowing what the rules are, or more importantly knowing how to figure out what the rules are, is a valuable skill in many areas.
- If you go to Law School, you will want to spend at least some part of your career in the private practice of law. Three-fourths of Law School graduates are in private practice. It is where the jobs are and where the money is. Fortunately, it is also the best way to learn what it means to be a lawyer who zealously represents her clients. If you spend your entire career in government service or with a corporation as your client, you will miss out on this important perspective.
- Avoid taking on too much debt. Apply to a number of Law Schools and pick the one that is the best deal. If you spend $40,000 per year to make $60,000, it will take longer for the investment to pay off. If your third choice school is offering you a scholarship, it may pay off financially to accept it. Student loans are easy money, until it is time to pay them back. You want to minimize your debt burden to give yourself flexibility after you graduate.
- Don’t mess around once you start Law School. You need to graduate near the top of your class to get a great job in such a competitive market. I am 15 years out of Law School but still have my GPA and Law School ranking on my resume. You will carry those statistics around with you for the rest of your career.
- Go to Law School near where you want to live. I went to Albany Law School. It is the best place to go if you want to practice law in Albany. There are some Law Schools that have a national reputation. You can go anywhere with a Harvard or Yale Law School degree. A regional Law School is perfectly fine, though, if you know were you want to live.
Golf season is in full swing. Eric and I are playing most weekend days. I also play in a Tuesday night league. I am happy to report that I am regularly breaking 100. If I could chip and putt more consistently, I would be scoring in the low 90’s instead of the high 90’s.
Now I know why most experienced golfers spend so much time on the practice green. What used to look boring and mind-numbing is now an essential part of improving my score. If I have time before a round, you will find me on the practice green chipping and putting.
Did you know only 51.9% of golfers break 100? This statistic assumes that golfers accurately report their scores, and honestly count every errant shot. I played with a couple of guys early in the season that I didn’t know. One of them took a mulligan off the tee on every other hole, which should, per USGA rules, count as two strokes per hole (the swing and the penalty) and not zero. On the 18th tee, he announced that he needed to par the hole to break 100. I chose not to emasculate him.
You can’t get away with this type of scoring in the league. If you are not accurately counting your strokes, you can count on your opponent to do it for you. My league handicap is currently 15, which means my average score has been 51 for 9 holes. I expect it will drop a point or two in the next recalculation as I have scored under 50 the last two weeks.
I attribute my improved scores to one thing: keeping my head down. As in life, you need to stay focused on what you are doing and not look up to score well on the golf course. Don’t worry about what others are doing. Stay focused on the task at hand and you will succeed.
One of my fellow league golfers lost her husband this year. It happened on the golf course during our first round of the year. She returned to the league and the place where it happened after a few weeks. She is scoring better than ever. Her secret: her husband is there with her at every hole telling her to keep her head down. May he rest in eternal peace.
CMS announced on June 17 that it will deploy predictive modeling technology to pre-screen claims. The goal is to identify fraudulent claims before they are paid.
Medicare has typically paid whatever claims a participating provider submits, and then sought to recover erroneous claims through retrospective review. This “pay and chase” approach is good for providers and keeps the cost of participating in Medicare at reasonable levels. It can be bad for taxpayers though because fraudulent claims will be paid just as quickly as valid claims.
Predictive modeling technology is widely used in private industry. It is used by credit card companies to detect fraud, insurers to evaluate risk, and financial analysts to evaluate business scenarios, among other things.
CMS has contracted with Northrop Grumman to develop the technology:
Northrop Grumman will deploy algorithms and an analytical process that looks at CMS claims – by beneficiary, provider, service origin or other patterns — to identify potential problems and assign an “alert” and assign “risk scores” for those claims. These problem alerts will be further reviewed to allow CMS to both prioritize claims for additional review and assess the need for investigative or other enforcement actions.
Northrup Gruman has a number of software development contracts with CMS, including the contract to develop and maintain the National Level Repository for use in assessing whether a provider has met the meaningful use standard.
If the new technology works, it could be good for providers and taxpayers by detecting truly fraudulent claims and eliminating criminal abusers. If it does not work and yields too many false positives, providers could become bogged down in justifying valid claims that should be paid without any question.