- What's the new hot thing all
the marketers and optimizers should focus on
for 2018, 2019, 2020, and beyond?
(intro music)
People often ask me,
"Hey, what are the trends for marketing"
"or conversion optimization for 2018 and beyond?"
And they expect all, you know,
AI machine learning, this type answer,
but I always say, "You know, it's complicated."
Because like there is an income gap,
like to top 1% own, like,
99% of the wealth in the world, and so on.
The same is true in marketing and optimization.
There's a knowledge divide,
so at the top 1% are extremely savvy.
They know everything.
They work with the best tools, the best minds,
they work on exciting stuff,
they're like way far ahead of everybody else.
The rest of the 99% was worried about
"What should my button copy say?"
"What should my headline say?"
Like this teeny, tiny, basic stuff.
Like they're light years behind of the top 1%.
So, if you want to join the top 1%
what can you do?
Yes, there is a resource component here.
Like if you're a small business,
you just can't afford the best tools.
If you're a small business
you don't have the type of volumes on your website,
like traffic volumes to use data in interesting ways.
And also, if you're a small business
you need to do a lot.
So in big businesses you can specialize
in a very small things, then build expertise.
So part of it is that.
But, you can still put in effort to learn.
Read 20 books on a subject, and you know more
than 90% of people about it.
Read tons of blog posts, but very careful
which blog posts you read,
because most of the content out there
is written by, bloggers.
Not experts.
And where are the bloggers getting their material?
From other bloggers.
And so it's like this self-fulfilling loop of bullshit.
And it's like never ending.
So, most people are getting bad advice,
and they're not actually getting better.
Always read stuff that is actually written
by practitioners, not ghost writers.
Forget the Neil Patel type of stuff.
Learn from real practitioners who do real things,
then you can maybe bridge the knowledge gap.
For more infomation >> Top Marketing and Optimization Trends for 2018? Here's My Take. - Duration: 2:33.-------------------------------------------
Liverpool player explains the moment he knew Jurgen Klopp was perfect for Anfield ● News Now ● #LFC - Duration: 2:15.
The Liverpool captain went to watch Borussia Dortmund in a Champions League thriller against
Real Madrid at the Bernabeu.
Liverpool captain Jordan Henderson has revealed the exact moment he realised Jurgen Klopp
would be a perfect fit for the Liverpool job.
According to the Mirror, Henderson said he flew out to Spain to watch a Champions League
match featuring Borussia Dortmund and Real Madrid,
and was so impressed with Dortmund's display that he knew Klopp was the right man for the
job.
The match took place five years ago during the semi-final stage of the illustrious competition,
with Dortmund making it through the tie 4-3 on aggregate to seal a spot in the final.
"I knew he was special before I even started working with him," Henderson told the Mirror.
"His team were outstanding that night in Madrid."
Henderson went on to discuss the final against Bayern Munich that year saying that, despite
being on the losing end,
Klopp's Dortmund displayed excellent organisation and teamwork which the Liverpool midfielder
believed was massively down to the German manager.
"A lot of people admired his work at Dortmund, and when he came to Liverpool I knew how special
he would be," Henderson added.
"I couldn't wait to start working with him in training and be part of something special
– and I still feel the team he is building at Anfield can be very special in the near
future."
There is no doubt Liverpool look to be progressing under Klopp, especially with the assembling
of a world-class attacking trio of Roberto Firmino, Mohamed Salah and Sadio Mane.
As the German goes about putting the final pieces together in defence, the Reds finally
look to be getting back to the dominant European force they once were.
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Billy Fury - We Were Meant For Each Other [ CC ] - Duration: 2:17.
We were meant for each other
Darling I know this is true
I can't share with another
The love that is only for you
Love can't wait any longer
Each tender kiss seems to say
We were meant for each other
So tell me you love me today
I'm yours forever more
Say you'll be mine
Until forever more
Until the end of time.....mmmm
If one day follows another
As rivers flow into the sea
We were meant for each other
There's no other lover for me
We were meant for each other
There's no other love for meeeeeeeeeee
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dogIDs Waterproof Soft Grip ScruffTag Collar for Small Dogs - Duration: 0:30.
My new dog IDs collar makes me feel like a princess.
It's soft grip material is chic and comfy all in one.
You won't find any stains on my wardrobe.
Wait! What was that? A smudge! Remove it! Phew, ok keep going.
My personal information is built into the collar and the engraving is even guaranteed to last!
Fetch yours today, but pink is my color.
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Using Credit Union "Backdoors" for Better Rates - Duration: 6:20.
Hey I'm Adam Jusko from ProudMoney.com and today I am talking about credit
unions and how to use credit unions to get the best rate -- even if you think you
don't qualify for a credit union. There are many ways to sort of get into credit
unions and get those rates that you may have heard about or that you might see
online. There are sort of some "backdoor" ways to do it with a lot of credit
unions, and so we're gonna talk a little bit about that so that you can sort of
add that into your mix when you're looking for the best rates on your
mortgages, your auto loans, credit cards -- all those sorts of things. Now, just real
quick, if you don't know what a credit union is, a credit union is... it's basically...
offers banking products but it is a organization, a nonprofit organization,
that sort of comes together out of, usually, a company or government entity,
and the people that are part of the credit union are members, so they're
people that have something in common. So if you are, you know, with a
certain employer, or you worked for the federal government or a local government,
a teachers union --- whatever it might be, a credit union may be formed to
offer financial products to the people that are part of that group,
whatever that group may be. Now many times the credit union will start off
being sort of a very specific group and over time it will really grow in terms
of who's allowed to be a member. So it might start as an employee credit
union and then it might be, you know, everyone that lives or works within an X
mile radius of wherever the corporation exists or whatever the
situation is. But, anyway, the sort of idea of the credit union is by having a
nonprofit organization that is just for members, it's not like a bank
that has a profit motive. And so, you know, it sort of it gives the credit union the
ability to give better rates because they're not just trying to get
their loans out there so they can make money,
they're really working in their members' best interests -- at least that is how
credit unions work in theory, and that is how oftentimes they do work -- although you
shouldn't just take it for granted that a credit union is, you know, across the
board better than a bank. So, that being said, a lot of people don't pay attention
to credit unions right now... they go sort of to the big banks or a local bank
because they don't think that they might qualify for a credit union. But these
days, especially with the larger credit unions, they are really trying to, you
know, accommodate new members as much as possible. And oftentimes it's good for
them if they can get bigger because they can actually offer more services as the
credit union grows. So there is sort of a, you know, what I call a "backdoor" to
membership in a lot of credit unions. They may have a list of all
these eligibility requirements but sort of in the fine print or sort of in the,
you know, the very bottom of the list they're going to tell you that there's a
way that you can sort of get around some of these requirements and still become a
member of that credit union. And the way that often happens is you will join sort
of a, you know, maybe a charitable organization or some organization that
is somehow related maybe to what the credit union's, you know, base membership
is about and that's how you will, you know, manage to get your way in. I'll
give you three examples of that, that I have pulled... PenFed, which is the
Pentagon Federal Credit Union, you'd normally think that as a
government employee/military that sort of thing, those are the people that have
eligibility. But if you want to be a PenFed member you can do so by getting a
membership in the Voices for America's Troops, which is an organization that has
a $17 membership -- you join that and then you can join PenFed.
Alliant Credit Union --- again, another organization: Foster Care to Success a
ten dollar membership or contribution to that organization then means that you
can get into Alliant Credit Union. Digital Credit Union, which actually is
interesting because it is a credit union that was developed as part of Digital
Equipment Corporation, which no longer even exists... but there is still a Digital
Credit Union. You can get into that credit union through an organization
called Reach Out for Schools. And so a lot of these... actually you don't even
have to, you know, sort of go off and join the other organization -- they
actually wrap it into the membership application when you want to
get in the credit union. So say you want to get in this particular credit
union, it might be part of the application -- "go off here online
and join that," and then come back to your application and finish it out or, you
know, however they work the mechanism. It still is... they're gonna do a lot of that
work for you in terms of trying to, you know, make you eligible. So if you are
online or in whatever way that you might find out they you can find
better rates on a car loan or a mortgage or credit cards or whatever financial
product it is, you should always look to see if there's a way for you to
join a certain credit union -- even if on the surface it seems like you can't.
Because not only do you have the "backdoors," there also often are ways to do
it if you are a relative of somebody that's in the credit union or you're a
relative of somebody that could be in the credit union -- you know, they try and
widen the eligibility as much as possible in a lot of these credit unions,
especially the larger ones. So that is it for this video. Please
visit ProudMoney.com for all kinds of financial "best of" lists and other
financial stories and good stuff too. Thanks for watching. Bye.
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Gucci Mane Tweets Offer to Pay for His 20-Year High School Reunion | Billboard News - Duration: 1:35.
It's been 20 years since Gucci Mane graduated from high school,
and now the platinum-selling MC wants to fund a reunion for the class of 1998.
In addition to the reunion, Gucci also invited his classmates
to a car and bike show in Atlanta, tweeting…
"I want to personally invite anybody who graduated from #McNair aka
McNasty aka #BouldercrestHigh to v103 car and bike show to go with me
and also I want [to] pay for our 20 year reunion myself!"
Gucci actually visited his old stomping grounds last year,
as seen here in a post from Hip Hop Facts this past March.
The positive message on Twitter is just part of a much larger lifestyle
of positivity and kindness to which Gucci has dedicated himself
since being released from prison nearly two years ago.
In the time since he has been out, Gucci has become a New York Times
best-selling author for his memoir 'The Autobiography of Gucci Mane,'
announced plans for a feature film based on the book and has
suggested launching his own production company 1017 films.
Gucci also is adamant about spreading uplifting messages across his social media, like…
"If I can change anybody can!"
"Push yourself to keep going to new levels!"
and "Be a blessing to somebody, not a burden!"
For more on Gucci Mane, head to billboard.com
and until next time, for Billboard News, I'm Kevan Kenney.
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I'm Sorry For My G2A Video - Duration: 5:35.
Youtubers, i've made a mistake
A few few, days, ago about a week, ago
what's up youtubers this is editing ah poster in
editing J-Sav
About right here i said i wasn't gonna put in the about a week ago meme i'm gonna do it anyway
an old about seven, days, ago i made
Five random uh steam keys on g2 am sure a lot of you, guys know. Gta and
I went with, my videos doing, uh
Crap, that's that's out that's out, that's how, it's doing
thank, god i'd done anything saw it
But it's just it's just a. Video just me going, buying the key for way too much money just
a load
Let's go just show, what the games i got were?
Explicitly games a little bit as what was and?
so i got when i click on it and
One of the next videos i'll play is why is gta killing the industry so i go i shouldn't know, why?
So you go over in i watch little video great video don't
Don't. Ask, why, i watch all this it's interesting, okay?
Yes so basically he sits there and he talks, about, why it's bad my favorite a really iterate all the points he makes
But basically it's a way for criminals to
launder money
take, dirty, money turn it into clean untraceable money i
Was thrown. Credit cards or stuff like that's very easy and it hurts game devs a lot, and
He has examples from where game devs actually put like, their game on pirates bay
Because they're so desperate because it costs it game devs money
Cuz, they, had to give the money back there's, also transaction, fee i guess
So when they have to the money back knowing they're, not making a sale and they're not making money
They're, losing money and to small indie developers that can really make or break you know. You're at
Your, bottom line and make companies go to business
so it's literally killing the industry and
Also, they're, using stolen credit cards a lot of times i'm actually looked it up a little bit more i don't have
Those sources up here for cuz, i didn't prepare that much for the video of course it didn't do a job on me cuz
That's well as, well i?
Got stuck, my hobby is making a lot of money
Buying stolen credit cards and then buying games off like humble bundle and then resell them for cheap cheap
and
Yes if we killed through las tres with their stolen credit card, you're hurting the game industry it's just
Just because you, want to deal and it's just you support, from like, humble, bundle that you know, gives the charity or not
But um i don't think people don't know. About this and that's, why, this video is actually really good news mean?
Pretty recently, bullet parry, hey
Made pretty recently and this is a good video i'm gonna, link it in the bottom of my old video
My, take, away the gta g - a link from, my old video and replace it with the video of home
His video here
I'm not sure if they should take, down the video or not i'll think
About that if i am dunking, put this video up, maybe i'll hide the video or something
but i
Feel, bad because i didn't i didn't know, that it was bad like this i just i don't know how i got the keys
But i still a parliament pope really but
Maybe some of the keys on gta are just bought in bulk
But i guess the ones that seem too good to be true are too good to be true and watch this guy's video he
Explained it way better than i did?
Only 21,000 views you shed a lot more i wish i could say i wish i get that many views
That buddy, views but damn
but um either way, this guy great quality video a lot of good points, welcome, well
and
just good to know i guess
i'm sorry
Let me know if i should, still, make the video of reviewing the games i bought because they, did spend the money on the games
I'm not gonna maybe i won't say they're from z to a or in the video they, don't support gta
And then i'll review, or something i'll think about it but i'm a. Little rambling video not really any special
But anyway mail of follow-ups on your heart, me start switch review. Number
To, dream believe in strength, now i'm the only
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Documentation Essentials for Pediatric SLPs - Duration: 42:10.
>> The American Speech-Language-Hearing Association is pleased to welcome you to this online education
program entitled "Documentation Essentials For Pediatric SLPs: Articulating the Need
for Skilled Services."
Here with us today is Gennith Johnson, Associate Director of health care services and speech-language
pathology.
Welcome, Gennith.
>> Hi, Jill, thank you.
I would first love to give a warm welcome to Shannon Butkus, our speaker of the hour.
Welcome, Shannon.
>> Thank you.
I'm really excited to be here.
>> Great.
Before we start, Shannon, let's talk a little bit about why we planned this webinar.
I know you have over 15 years of experience as a clinician and over 10 years of experience
as the owner of a private practice.
I also understand you have an in-depth knowledge of how to successfully advocate for patient
benefits and provider reimbursement rates at the state and national level.
Not to mention you also have lots of experience and involvement working with insurance companies
and Government agencies on the development of policies and implementation of Alternative
Payment Models.
So I was really excited to hear that you will be presenting on these topics at the upcoming
ASHA Private Practice Connect Conference in July in Baltimore, Maryland.
Why is this topic so important to you?
And what are today's participants going to walk away with to improve their practice?
>> Well, I'm really passionate about making sure children have coverage for speech therapy
services.
Over the past few years, I've had the opportunity to interact with insurers from across the
country.
Many of them have expressed concerns about the quality of documentation SLPs are submitting
when they request prior authorization.
That motivated me to really start thinking more about documentation and what we could
do as clinicians to make sure our kids got the coverage they needed and deserved.
So my hope today is that participants walk away with ideas that they can immediately
incorporate into their patient reports to not only strengthen their coverage quality
but include the likelihood that services will be approved for coverage.
>> Wonderful.
Well, let's go ahead and get started.
I can't wait to hear more.
And this sounds like a topic that our members will find really, really relevant for their
practice.
>> Perfect.
So today's title "Documentation Essentials for Pediatric SLPs: Articulating the Need
for Skilled Services," I want to briefly start with my disclosures.
I do have financial disclosures.
ASHA is providing me compensation to give this presentation today.
And then I'm also owner of a pediatric speech-language pathology practice as well as co-owner of
a health care consulting company.
Non-financial disclosures, as well.
I'm a member of ASHA's Health Care Economics Committee And I'm also ASHA's Texas State
Advocate for Reimbursement.
So the framework for today's presentation, we're really going to dive into four things.
We're going to do a brief introduction where I'll give you some practical tips.
And then we'll do a description of the disorder that necessitates intervention and an explanation
of how those disorders impact what I call a patient's functional communication in safety.
Then we're going to dive into goal writing and we'll end with discharge criteria.
So let's get started.
Introduction I'm seeing more and more that the trend for short, concise patient reports
is becoming a thing of the past.
As insurers scrutinize the costs they are spending on services, one of the ways they
do that is through a tool called utilization management.
And for us, that means we're going to see prior authorization become more and more common.
Because of that, what we write is very likely going to determine whether our patients' services
are deemed medically necessary.
If they are deemed medically necessary, our patients are going to qualify for services.
And if they are not, then even when our kids may have coverage, if our documentation doesn't
reflect the need for skilled services, an insurance company is likely to deny that.
So it's really important that we think about what we're writing, especially when we know
we have to submit it for prior authorization.
So using the strategies we discuss today, our hope is that we're going to strengthen
the quality of your patient report and improve the chances that your request for speech therapy
interventions are approved.
So I want to start with practical tips.
First and foremost, don't underestimate the importance of formating.
You want to use headings.
You want to organize your information in a logical sequence.
And a you definitely don't want to make your doctors or insurer hunt for your information.
On average, insurers reviewing our requests for speech therapy services may have between
five and seven minutes per case review.
That means they are going through them very quickly.
And they are expecting to see things flow.
If they can't find it quickly, it's really unlikely that they are going to hunt for it.
And this probably seems logical.
But we want to spell and grammar check reports.
I've previously done some co-presentations with insurers who have provided me sample
documentation.
And one of their concerns is, our reports are poorly written.
We're not spell checking them.
We're not doing a grammar check.
And in some instances, we're even using patient names that don't correspond to the patient
that we're actually talking about on any given day.
Other practical tips, we need to work efficiently.
If our patient reports are going to get longer than what we have done in the past and I suspect
they are going to, we have to work smart.
We have to use templates whenever we can.
But I want to stress the importance of not cutting and pasting clinical information.
If you begin to write the same thing for every patient every time, savvy insurers are going
to notice those patterns.
And they will start to deny your requests.
Not necessarily because your patient doesn't have a need for skilled services.
But because they don't feel it's been individualized to the unique needs of your patient.
Other ways to work efficiently.
It's helpful to develop standardized descriptions for each assessment you use.
Don't reinvent the wheel.
Those are things you can cut and paste in.
A description for a (inaudible) or a PLS 5 doesn't change from patient to patient report.
So grab those and cut those in.
And also, come up with a predesigned table that you can insert your standardized assessment
results into quickly.
Be sure to include your raw scores, your standard scores, your age equivalence, and your percentile
rates.
An insurer may want to see some combination of all of those things when making a determination
of medically necessary speech therapy services.
Then it's also important that we know the requirements of your payer scores.
Typically speaking, Medicare Part B guides documentation.
But every insurer can establish its own documentation requirements.
This is especially true for Medicaid managed care organizations.
Many of us listening today probably have Medicaid managed care organizations that we work with
Some of you may only have one or two that you have to work with.
Others of you may have 10 to 12 or even more.
And every single one of those insurers can come up with unique items that they want you
to discuss in your patient report.
So with that in mind, you need to make sure that your EMR or documentation template has
enough flexibility to meet the individual requirements of your payer.
So my suggestion is that you set up your EMR or your documentation template so that you
document to your most restrictive payer 100% of the time It's better to have extra information
in your patient report than forget to include something.
If you make it a habit of documenting to your most restrictive payer each and every time,
you'll reduce the number of times requests are sent back and forth between you and the
insurer as being incomplete.
Now, those are a few practical tips.
The next thing I want to do is really get into the meat of this, which is report writing,
and discuss what I consider to be three key elements of patient reports
The first is what I call Impact on Functional Communication and Safety And I ask myself
three things: Do my goals aim to improve the care and reduce costs through prevention?
Do my goals increase safety?
And does the intervention increase my client's independence?
If I can answer yes to any or all of those things, then I'm beginning to build a case
that my declined has a medically necessary reason for speech therapy services.
So beyond that, we're going to talk about goal writing.
And I'm going to focus on SMART goals.
Both for long-term goals as well as short-term And then we're going to end with discharge
planning, what's the end goal of treatment?
So let's dive right in.
First and foremost, Impact on Functional Communication and Safety.
The first question I ask is: Do my goals aim to improve care and reduce costs through prevention?
And here is an example: Would improved swallow function reduce the likelihood of hospitalization
or reduce a patient's reliance on a G-tube?
If you can answer yes to that question, then your client qualifies for medically necessary
for speech therapy services.
Your interventions will ultimately result in a cost savings to the insurer.
And your services are not only beneficial to the patient in that instance, but they
are also deemed beneficial to the insurer, because it lowers their overall costs.
Then we want to look at whether the goals increase safety.
For example, would a child have an increased ability to communicate safety information
in the event of an emergency situation?
If you're working with a patient that can't currently express their name, their family's
name, a phone number, or even what's wrong, then there's a need for skilled intervention.
Another thing I think about is whether my patients comprehend the words no and stop.
And if they don't comprehend the words no and stop, it places them at risk.
For example, if you're crossing a street and a patient -- you're holding your son or daughter's
hand and they get separated from you and you yell no and stop, if a child doesn't understand
that and they run into the street, there's a chance that they could be harmed.
And so we want to consider those things.
If they don't understand no and stop, then that's a reason that they may need skilled
intervention.
Another is whether the child's articulation and language delays place them at risk for
social isolation or bullying.
Unfortunately in this day and age, bullying is becoming an increasingly alarming problem.
And if a kid is at risk for bullying because they are being teased or ridiculed or excluded
as a result of their speech and language delay, then there's a skilled need for intervention.
So I think about all of those things when I'm writing my section titled: Functional
communication and safety.
Another thing I think about is independence.
Would my goals support a reduced reliance on a caregiver or other individual?
If what I'm doing during treatment increases their independence so that they can move through
their day with a reduction in support, my patients have a need for medically necessary
speech therapy services.
So let me show you what that looks like.
Here is one example of something we might write: Sam's language delays have a substantial
negative impact on her functional communication and safety.
She is not able to use words to express her wants and needs nor is she able to state the
site of pain or injury.
Additionally, she cannot state when she is not feeling well.
As a result, her family members and caregivers must infer all of her needs, making it difficult
for them to know exactly what is wrong with Sam and when her family should/shouldn't take
her to the doctor.
She is at high risk of injury due to her inability to follow simple commands such as stop, wait,
and don't touch.
Further, her communication delays prevent her from engaging in social and play activities
with same-age peers, causing periods of social isolation.
That brief paragraph, all of four to five sentences, is a clear reflection to the insurer
how the delays I have identified through my testing and evaluation process impact my client.
And when they see a statement like that, it hits home specific reasons why my client needs
speech therapy services.
Here is one more example: Based on the information collected during the assessment, Liam's delays
have a negative impact on his ability to functionally communicate across all environments.
At this time he is not using language to interact with other children his age.
And he prefers to isolate himself rather than play with other kids.
Additionally, reduced speech intelligibility, secondary to difficulty obtaining adequate
airflow to support sustained speech, limits his ability to relate information to others,
including his parents and preschool teachers.
Further, he is not participating in conversational exchanges as would be expected for a child
his age and he often wanders the room rather than engage with other children.
He is at risk of not advancing to his next classroom at a day care due to social communication
delays, which would result in him being placed in a different classroom than his twin sister.
Again, while that paragraph is a bit longer, it provides a clear explanation to the insurer
why I need to provide speech therapy services.
I see these summary paragraphs are very beneficial to an insurer when they are making a determination
either yes, they are going to pay for your speech therapy services, or no, they are not.
And framing it in terms of the impact on your patient's functional communication and safety
really makes it hit home for them.
Now, moving on to goal writing.
I want to really quickly cover the International Classification of Function, Disability and
Health, this is called the ICF.
The ICF is a classification of health and health-related conditions for children and
adults that was developed by the World Health Organization.
The ICF framework is intended to be used in an interprofessional collaborative practice.
And really in person-centered care.
The ICF is endorsed by ASHA as well as APTA and AOTA.
And insurers are actually looking to see if we're writing goals with the ICF in mind.
In this particular example, this is in Texas.
But the Texas Health and Human Services Commission actually released a document stating it was
their expectation that providers write short- and long-term goals using the ICF framework.
So what are the components of the ICF?
There's functioning and disability, which encompasses body functions and structures.
And then activity and participation.
There's also contextual factors.
These are environmental factors, which are factors that are not within the patient's
control, such as family, work, Government agencies, laws and cultural beliefs.
And then there are personal factors, which include things like race, gender, age, and
education level So what does the ICF mean for us?
Short- and long-term goals must focus on function.
Goals should be measurable, developed in conjunction with the patient and family, specific to the
patient's needs.
We can't rely on a preset group of goals that we use for all of our patients.
Again, that's a pattern that our insurers will detect over time.
Our goals have to be specific to the setting where the services are provided.
This is particularly relevant for services in the home and community setting.
More and more in pediatrics when we submit requests for prior authorization I'm seeing
insurers say, if you want to provide services outside of the clinic, then you need to justify
why.
So if you're going to do services in the home or in the community, say a preschool, make
sure you clearly relate your goals back to those settings.
So how do we do this?
We write SMART goals.
SMART goals are specific, they are measurable, they are attainable, they are realistic, and
they are timely.
Another thing insurers look at, if prior authorization is required for continued services, reviewers
will look to see if your patients mastered their goals.
You want to make sure that you set goals that your patients can reasonably accomplish.
If you set lofty goals and your patients come up short of those goals, even though they
may have made wonderful progress, you could see an insurer say to you, well, the patient
failed to master their goals.
It doesn't actually look like the speech therapy services are beneficial So we're not going
to approve the request for continued services.
So make sure that you keep that in mind.
What can your patients reasonably accomplish in the timeframe that you select?
So what are functional goals?
Functional goals represent a series of behaviors or skills that allow a patient to achieve
an outcome relevant to their safety and independence, there are those goals again, safety and independence,
within the context of an everyday environment.
So SMART goals must be specific.
They have to be objectively measured.
And within a given timeframe.
Are you setting goals that you intend to measure within an eight-week period, within a three-month
period, within a six-month period?
That's often going to be determined by your payer source.
So you may have to adjust those from payer source to payer source.
You'll also want to look at what -- how attainable your goals are in relation to your client's
progress and/or developmental delay.
So you really have to think about kids in the absence of a developmental delay may be
able to make progress at a faster pace than our kids who do present with developmental
delays, autism, Down syndrome, cerebral palsy.
So make sure to keep that in mind when you're setting your goals.
And then relevant to the client and family.
Although I don't cover it in this workshop, one of the things that we do include in our
patient report is a statement of the family goals.
And then as we develop our own goals, we make sure that those goals tie directly back to
the client and family's goals Chances are if you write goals without input from the
client and the family, and they don't happen to be important to them, you're not going
to have a lot of family support.
And in the absence of family support, your patient's rate of progress may slow.
And if their rate of progress may slow, then it may be harder over time to get continued
services, even if your patient needs those services.
And then your goals also have to be based on medical need.
Again, think what is the impact on their functional communication and safety.
Again, more and more insurers are paying attention to goals that are medical in nature versus
goals that are academic in nature.
And if you write goals that are academic in nature, while your kids may have a need for
speech therapy services, an insurer could look at those goals and say, those appear
to be goals that could be accomplished in an academic setting and they might deny them.
Now, thinking to recertification requests, you're always going to want to include your
previous authorization period's goals and provide an update on progress.
And I'm going to cover an example of that here in a few slides.
But let's talk now about long-term goals.
Long-term goals should reflect the highest level of desired function anticipated upon
discharge.
I always suggest to individuals that they think hierarchically.
What's the most complex skill you're trying to achieve within your designated timeframe?
Identify this and then designate that as your long-term goal.
Here is an example of what we shouldn't write when we're thinking about long-term goals.
Patients will develop age-appropriate articulation skills.
Or patients will develop age-appropriate receptive and express language skills.
That's a very generic goal that doesn't really tell the insurer why the speech therapy services
are important.
So instead of that goal, we might want to write something that's more specific.
Within 6 months, the patient will demonstrate the ability to participate in conversational
exchanges for up to 8 volleys in order to maintain conversations with peers and relate
critical medical and safety information to adults.
That goal is time bound, within 6 months.
It's specific.
It's measurable.
And I also state why the goal is important, which is a key for insurers.
In terms of short-term goals, we want to state why we're working on the particular skill.
I think of these as the building blocks required to master a long-term goal.
I always have my therapists write short-term goals framed around these key statements.
The patient will XYZ in order to.
Or the patient will blank so that.
And then to reduce.
To prevent.
To increase.
To decrease.
When you add the second component of these statements, you automatically tie your goal
to a function.
And you provide the reason.
And that's what our insurers are looking to see.
So if you can write your short-term goals in this type of pattern, you'll increase the
likelihood that a reviewer will look at these and say, these are medically necessary goals.
So here is an example of what we should not write.
Sam will increase her knowledge of object-functions from 35 objects to greater than 50 objects.
It's not necessarily a bad goal.
But it's not time bound.
And it doesn't state why the goal is important.
Instead, we could reframe that goal so that it said, within 3 months, Sam will increase
her knowledge of object-functions from 35 objects to greater than 50 objects in order
to carry out at least 10 activities of daily living in her home environment.
Now that I've couched that goal in this manner, same goal, but I've made it time bound.
And I've stated the reason why the goal is needed.
In this particular instance, this patient needs to increase their ability to complete
activities of daily living.
An insurer is going to look at that and say, this goal makes sense to me.
I understand why there's a need to work on it.
Here is another example, within 6 months, Sam will follow 1-step directions to increase
-- there is one of my key phrases -- her independence during the completion of at least 5 home routines
And here is my example, it's time to brush your teeth.
Go get your toothbrush.
Writing the goal in this manner makes it very relatable to the insurer.
Now, some practical tips.
Make sure that you select goals that are consistent with the information provided in your patient
report.
Does the information about the Impact on Functional Communication and Safety relate to the goals
you've written?
And is the information regarding the impact on the patient's functional communication
and safety consistent with the areas of weakness you identified?
You want to make sure that all of those things cohesively work together.
If you comment on impact and functional communication and safety related to a child's feeding and
swallowing but then turn around and write a goal for a pragmatic, an insurer is probably
going to touch that and say, where did this come from?
It doesn't make sense to me.
So make sure all of that information cohesively works together.
Now, other practical tips.
If you're going to continue a goal from one plan of care to the next, which does happen
from time to time, be sure that you don't write the goal verbatim.
You want to update the goal to reflect what the patient has achieved so far.
And where you hope to get them during the next certification period.
And here is an example.
If the original goal was that the patient will produce the phoneme /s/ in all positions
of words with greater than 80% accuracy and they have achieved 40% proficiency you can
write a subsequent goal that says, the patient will increase their ability to produce the
phoneme /s/ in all positions of words from 40% accuracy to greater than 80% accuracy
in order to -- and then you could continue on with that to tie it back to the specific
reason you're working on the goal.
Another practical tip.
As silly as this might seem, make sure that you report progress so that it matches how
the goal is written.
If you write a goal that your criteria is for 80% mastery be sure to report progress
as 7 out of 10 trials.
I think we're all thinking here that that ought to be easy enough for an insurer to
understand, don't assume that they will make that conversion for you.
Just instead of 7 out of 10 trials, write the 70% of trials.
I have actually heard of some instances where reports were sent back for additional information
because there was a mismatch in how the progress was reported.
Another practical tip.
Some of your insurers will require that you report the baseline level of performance,
especially in instances where your patient hasn't mastered the goal.
So if you have a goal within 3 months, the patient will label a minimum of 25 objects
in order to communicate their wants and needs to primary caregivers, you could document
as follows: The patient's ability to label objects and make requests increased from 3
objects to 15 objects.
The patient is consistently using 10 words to make requests.
Alternatively, you could do it as follows: The patient is labeling 15 objects and is
consistently using 10 words to make requests.
And then you'll see I clearly designate baseline, the patient demonstrated the ability to label
3 objects at the start of this plan of care.
You can report that in either way.
Just be sure to report it.
Again, I know of instances where insurers will send requests back if clinicians have
failed to include the baseline level of performance.
Now, manufacturing on to the last area, discharge planning.
And this might seem to some of you like a silly one to include.
Why is my discharge planning that important?
Again, as prior authorization becomes a more common strategy and insurers are thinking
more and more about the cost of care, they want to understand that you have a discharge
plan.
And that you don't intend to keep your patient on services indefinitely.
You know, in the model of the past, it has not necessarily been uncommon that we bring
a kiddo on for speech therapy services at the age of 2 or 3 and that they are continued
on with services at the age of 5, 6, 8, 10 years of age And we're moving beyond that
model.
And insurers want to understand and see that you're thinking about that.
So this means we have to think about what the beginning, the middle, and the end of
treatment is from the day we bring that child onto services.
Treatment in this instance then becomes something that is not lifelong.
We need to be identifying what family community resources may be available to support the
patient.
And we need to think about how we can transition our clients from our setting to those settings
as soon as it's feasible.
But I will add, without compromising the quality of care our patients are receiving.
So when we identify discharge criteria, we need to use the information generated when
discussing that Impact on Functional Communication and Safety And again, I've taken what I consider
that key section.
And I'm tying it now to my discharge plan.
I want to talk about a document quickly that was developed by ASHA.
It's called the Admission/Discharge Criteria in Speech-Language Pathology Ad Hoc Committee
on Admission and Discharge.
It was created by members of ASHA that were speech-language pathologists.
This document becomes important not only because it gives us suggestions on when we should
consider discharge for our patients, but also because insurers, during the audit process,
are using it to determine whether we have discharged our patients at an appropriate
time.
And I have seen some instances in reports produced by the Office of Inspector General
where they have found that speech-language pathologists potentially didn't discharge
their patients when it was appropriate.
And so per this document, patient and client discharge from treatment ideally occurs when
the individual family or designated guardian, as well as the speech-language pathologist,
conclude that the communication or feeding and swallowing disorder a remediated or when
compensatory strategies are successfully established.
And then they give multiple suggestions.
And I'm not going to read them all to you.
Because you'll have this as a reference But one is that the speech, language, communication,
or feeding and swallowing disorder is now defined within normal limits or is consistent
with the individual's pre-morbid status.
That's probably one of the ones we're most familiar with.
Another is that the goals of treatment have been met and the patient can functionally
communicate.
Another includes that the individual's speech and language communication or swallowing skills
no longer adversely affect their individual's educational, social, emotional, or vocational
performance.
So here we're not necessarily saying that their scores are all within the average range.
But we are saying the patient can functionally communicate to navigate through their environment.
And that's what an insurer is looking to see Now, there may be other instances where discharge
is warranted prior to mastery of treatment goals.
That could include an instance where you have an unwilling patient, where treatment attendance
has been inconsistent or poor, and where you've taken efforts to address those items.
But you don't have family support in return.
You may have a family that requests to be discharged to move to another service provider
or you could have a family that is not in your service area.
And in that instance, if that occurs, then we really have a responsibility to help that
family try to locate a provider within their new home territory.
There may be an additional reason for discharge that's appropriate, including if your treatment
no longer results in measurable benefit.
So here we're not saying that the patient has mastered their goals.
But we are saying the patient's progress has plateaued.
And if you have reached a point where your patient's progress has plateaued, even if
they haven't met all of their goals, it's time to consider whether discharge is appropriate.
And if discharge would be appropriate, then we need to discharge the patient, even if
we're in the middle of an authorization period.
And referencing back to the Office of Inspector General, this is where they cited concern.
They were reviewing treatment notes.
They saw clinicians were documenting essentially the same level of performance and progress
from treatment session to treatment session, from week to week to week to week.
And rather than discontinuing those services, say after a four- to six-week period, or having
a conversation with the family if there was an adjustment that needed to be made in their
plan of care, they stayed the course to the end of the authorization period and didn't
discharge the client.
And that was concerning to the auditor.
Another reason it might be appropriate to discharge is because the patient has a serious
medical, psychological, or other condition, or if you experience behaviors with your client
that are interfering with their improvement in participation.
And in those instances, it may be need to take a break from services, help them case
manage their needs with other service providers, and then readmit them to your practice at
the point in time in which they are stable to continue and make progress towards goals.
Thinking these things through will really help you be successful in writing your patient
reports.
So a few practical tips with respect to discharge planning.
You want to avoid these statements, don't write something that says, when maximum potential
is met.
Or when functional potential is met Those statements will probably be flagged by your
insurer and sent back to you for more information because they are really not specific.
They don't demonstrate to the insurer anything about the beginning, the middle, and the end
of treatment So here is an example, discharge is not expected
within the next 6 months due to the severity of Sam's delays and the complexity of the
goals established.
Discharge will be considered when Sam can successfully: Follow directions to assist
in the completion of activities of daily living.
Use words/approximations to state her wants and needs to her primary caregivers.
And when Sam can state the site of injury or illness to assist in her medical care.
I based my discharge criteria on the things I wrote in my section titled Impact on Functional
Communication and Safety.
So I've essentially written that section I've now written goals that are consistent with
that section.
And here my discharge planning is consistent with my goals and consistent with my section
titled Impact on Functional Communication and Safety.
When I have information that's that seamless, it shows to the insurer I have a plan.
And again, that plan increases the likelihood of coverage.
Here is a second example.
Discharge is not expected over the next 6 months as Sam has a number of skills he needs
to acquire before achieving the ability to functionally communicate.
Long term, the SLP anticipates discharge when Sam can complete the following tasks: Transition
through his day with a minimal number of protest behaviors.
Initiate and maintain social relationships with peers.
Use short sentences to comment on activities and express his wants and needs.
And ask and answer questions in a conversation at format to provide critical personal and
safety information.
Again, I'm telling that seamless story.
And I'm showing to the insurer from Day 1 I'm thinking about discharge.
Therefore, I'm increasing the likelihood of coverage
So a few concluding thoughts.
When we're documenting medical necessity, your client's coverage and your ability to
seek reimbursement through an insurer is dependent on the quality of your documentation.
Unfortunately, as insurance requirements increase, the length of our reports are likely to increase.
So you want to make sure that you plan accordingly and make sure you give yourself and your staff
adequate time to write your patient reports.
In my practice, we used to be able to write a patient report in an hour to an hour and
a half.
I live in a state where we have seen some pretty significant increases in expectations
relating to our documentation and evaluation reports.
Because of that, I now have to a lot two to two and a half hours for my SLPs to write
patient reports.
But because we're willing to spend the time upfront and make sure we get the patient report
right and correct, we have better than a 98% approval rating.
And we have really almost eliminated the time we have to spend during the appeals process
in fighting for coverage.
And for us, that extra time upfront makes it more than worth it.
So make a goal.
Now that we're at the end of this workshop, let's think about one thing you can implement
from this course in the next week or month.
One item, if you don't already have it, might be to build in that section titled Impact
on Functional Communication and Safety.
And really spend the next month integrating those into your patient reports.
You would want to set a calendar reminder to check your progress.
And when you do, share your experience on social media so we all know how it's working.
Thanks so much for joining us today.
It's been a pleasure to give this workshop.
>> Thank you so much, Shannon, for sharing so much helpful information.
I'm really looking forward to hearing more at the upcoming ASHA Private Practice Connect
Conference in Baltimore this July.
Thank you, again, to all of our participants.
And we hope to see you at another webinar soon.
Goodbye for now from the ASHA National Office.
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The ultimate for the basic body are you you when you touched to mouthmath - Duration: 5:17.
For more infomation >> The ultimate for the basic body are you you when you touched to mouthmath - Duration: 5:17. -------------------------------------------
Upward Spiral: A Comprehensive Campaign for Our Neighbors in Need - Duration: 4:35.
We treat each other with dignity,
that's a true reflection of St. Vincent de Paul.
There's so much going on...
they don't know where to turn.
It's in giving that we receive
that's especially true with St. Vincent de Paul.
There are so many people going hungry,
there's a lot of people homeless.
We've been homeless for seven months months.
We've been living in our truck.
We said we are gonna be the first ones there
so we can get the birth certificate.
No matter what it takes.
We started out at four o'clock and we were here at five.
That line can be a bit challenging.
There's a lot of people
in the dark.
I haven't had power since Halloween,
October 31st, 2007.
This is my experience
this is my first time down here.
St. Vincent de Paul is that safety net
for those individuals in our community
just that piece to get them through.
That bridge. That gap.
The Upward Spiral is meeting our neighbors at that crossroad
and helping them move forward in their life.
We're obviously limited by the resources that we have
both financially and physically.
Individuals have to come back multiple days and so if you need
to have your eyes examined on one day, you've got to come back the next day
to the pharmacy, and then if you need help with food, that's another day.
You wonder how they're doing over the night,
or are they gonna come back the next day
and a lot of people don't even come back.
They get discouraged.
We pray for each and every person that walks into St. Vincent de Paul
for those who we've helped and
those who we haven't been able to reach.
How many times can someone come down here it's a struggle?
And gas, and a lot of people don't have automobiles
they've got to either take the bus or walk.
It's a lot of work and moms and dads and they're not able to come.
The new facility truly is for our neighbors.
It is a service facility dedicated
to the services that we provide.
We feel people maintaining their dignity
is the number one thing we can do for them.
I think it would be great if
we could have this pantry expanded
to be open more than just three days a week.
They come down one time and get everything at once
then they don't have to worry about coming back and coming back again.
We are bursting at the seams here.
(laughs)
The building is small but when
you walk in the lobby I mean you see volunteers hauling big carts of food
and you might see a woman in a wheelchair trying to get through that same hall.
A room that we use for clients
we also use for storage, so when we
interview a patient, we're essentially doing it in the phone booth.
We are a vital link across the continuum of care
and without this service, these patients will suffer.
If it wasn't for the pharmacy,
I wouldn't be able to take all the medications.
We all need to do our part
no matter how small or great it is
but to gift so that we may continue to do this work,
but to do it in a new way.
Equally important is the second piece of our campaign
which is to assist our Conferences.
We have 56 parish based Conferences throughout Hamilton County
and approximately 25 of those Conferences on a monthly basis don't
have enough resources at the local level to meet the needs of their neighbors.
Our Conferences are out in the field, you're out in the neighborhoods.
East side, west side, north side.
We have been responding to these needs every day to the best of our ability
and these needs continue to grow.
The invitation that we have as
Catholics is to use the gifts that God's given us
for the service of others.
If you have it you, have to give it back.
Even if you don't have, it you should be giving it back.
This organization has been a strong steward of its money.
Not overspending, being very careful, and being very judicious about growing.
It's a living organization. It's comprised of people.
We're part of the body of Christ and to the extent that someone is hurting,
someone has a need, because it's a blessing for us to have a chance to see
if there's a way that we can we can help that person.
My own personal spiritual journey, you know, has only been enriched by hanging around this place over the
years and getting to meet some of the incredible clients.
You often think that you're helping them, but you find out
when it's all said and done that they actually help you more.
I thank God for St. Vincent de Paul.
-------------------------------------------
Girling: "The time has come for me to part company with the ECR" - Duration: 1:40.
Since I joined the European Parliament
I've been a member of the European Conservatives and Reformists.
We had a very strong reformist agenda in the last Parliament.
In this Parliament, that reform agenda seems to have dissipated.
Brexit has obviously had an effect.
The dominance in the group of the Polish government party, the PIS, has had an effect.
And then we have a number of disparate small parties,
most of whom I have not a great deal in common with politically
on an individual basis.
So the time has come for me to part company with the ECR.
I'm still a member of the Conservative party as I speak now.
I hope that will continue.
It's the Conservative party postion to be in the ECR,
so in that sense I don't suppose they'll be terribly pleased with me.
But I'd like to make the point that it's not an issue
about my membership of the Conservative party.
It really is an issue about how we operate here in the European Union.
On the Brexit side, Britain needs friends in Europe.
The EPP is the biggest party.
It represents a consensual, centre-right, pragmatic position.
It's the place where I think British Conservatives naturally belong.
We do not belong in a far-right, populist, nationalist party.
I think we belong in the EPP.
A lot of the decisions will be made by people who come from that EPP family.
So it seems to me that from a Brexit point of view,
it is a much better place for me, as a British MEP, to be.
-------------------------------------------
Hosting for Amazon Affiliate Niche and Authority Sites & WHEN to UPGRADE - Duration: 8:48.
let's talk about the hosting specifically hosting for Amazon
affiliate sites I had a question come in a couple weeks ago someone was just
getting started they hadn't even purchased a hosting package yet and they
wanted to know how they could plan for the future and they were willing to make
an investment that we're willing to pay a little bit more for hosting to sort of
like plan for the future and plan for future growth I like that kind of
thinking it's kind of the way I think - I'd rather you know make an investment
early on and just be set for a little while this is where it may surprise you
a little bit I'm gonna recommend that you don't have to do that yes my name is
Doug Covington I talk about Amazon affiliate marketing and project
management so this is about hosting you know I will say up front I'm gonna put a
couple links below they are affiliate links it will cost you anymore but if
you buy the hosting that I mention here I'll get a commission so I just want to
let you know links are below if you want to check it out feel free to just go
directly to the sites the awesome part about starting a niche site or an Amazon
affiliate site is you can basically start a business for about $200 that
would be for you know hosting maybe a premium theme a couple of tools here and
there stuff like that Hosting is probably the biggest expenditure up
front the host thing I started with was shared hosting and that's what I
recommend you start with - it is gonna be the cheaper hosting for basically any
hosting company and just like it sounds it's shared so you're on a server with a
bunch of other websites and typically it's gonna be like multiple hundreds
right you're gonna be on a server with hundreds of other people don't worry
about it the thing is when you're first getting started you're probably not
gonna get that much traffic and it's ok if you're on a server that runs a little
bit slower because there's so many other people on it now I started on Bluehost
and I used the Bluehost shared package and it was great in fact I still have an
account over there Bluehost and it was fine they have good customer service
I have heard like people like the customer service and then other times
people don't like the customer servus keep that in mind customer
service is probably one of the number one things to look out for but typically
even on a shared hosting package you can you know hop on the chat you could send
an email depending on the company you may be able to call about and talk to
you know customer service person or even like a system administrator when do you
move like when is it time to upgrade your hosting a quick reference point
these prices could change but I'll give you a range so for shared hosting it's
probably gonna be about three or four dollars a month to maybe eight or nine
dollars a month the trick is most of the companies will
have like a promo deal so when you first sign up the first year it may be you
know three dollars a month but then the second year when you were new it may
jump up to nine dollars a month a lot of times I don't mind paying a little extra
if the service is there right I actually upgraded hosting to a different hosting
company right so I heard good things about SiteGround
so I have one of my bigger sites over on site ground and your customer service is
even better than Bluehost I think the cool thing with site crown is when I had
an issue when I had a question I could chat with not just a customer service
person but it was actually a tech person it was an administrator so they could
check my server they could reset things and they could answer technical
questions because that makes a big difference depending on what you need
but keep that in mind so the point is when you first sign up shared hosting
any hosting will probably have a promo rate when you first sign up for hosting
q then second year may jump up so keep that in mind always keep that in mind
when do you upgrade I think whenever you get to about 300 to 500 visitors a day
that's probably a time you want to get out of the shared hosting account and
upgrade typically you can stay at the same hosting company and just upgrade
your account for more resources there are many different flavors of the
specifics depending on what a hosting company calls upgraded account so those
are things like semi dedicated hosting cloud hosting maybe WordPress optimized
hosting in all the cases you end up with more resources dedicated to your
specific domain you're probably still on a shared server but instead of having
like 800 other websites on that server you'll have like eight it's much smaller
and the result is you have a faster server response time which is one of the
main factors it's actually like speed up or slow down your site if you have fast
server response time that's a very good thing now what about cost so we're
looking at once you hit about 300 visitors a day you'll want to upgrade
you could say at the same host you can move to another host if you want to the
cost varies right so just like before there's a range but for this you know
upgrading hosting I'm aiming for about $25 a month you know give or take 10 or
15 dollars so maybe it's $18 a month or maybe it's $45 a month depending on you
know what hosting company you want to work with so again little recap you
shared hosting in the beginning up to about 300 visitors a day once you get to
about 300 you want to probably upgrade that'll be good
most likely until you hit like a thousand visitors a day or so maybe even
1200 or 1500 a day this actually happened to me I was getting about a
thousand visitors a day and then I added more keyword golden ratio content over
time it slowly moved up so after a few months I was actually getting about
1,500 to 1,800 visitors a day my site started loading pretty slow it started
crashing the server actually so the server was crashing I wouldn't be able
to log in I just had many issues and it was very slow because the growth was
very slow eventually I realized that I needed to upgrade my hosting
unfortunately the hosting company that I was with they didn't know that right
away I kept asking if I needed to upgrade but they just said no just make
sure it's optimized for speed I already did all that stuff that they told me to
do so eventually I upgraded to a cloud package over at site ground it was
fantastic it solved all my problems this upgrade right so at that point the
site's making good money so I could afford to invest in the infrastructure
you know frankly that overhead solo and an Amazon affiliate site it's fine to
pay her for the hosting right so I upgraded the hosting to more processors
very few other domains on my server it was semi dedicated cloud hosting and
essentially it like sped up my site so dramatically I was able to handle up to
you know four to five thousand visitors a day I didn't hit the cap I never had
any issues the site loads fast once I moved over it's fantastic I have the
ability to add more resources without changing my hosting account so I could
just log into my account and add more memory add more CPUs pay a few extra
dollars so maybe around the holidays when I know I'm gonna get more traffic I
can upgrade the service package and just do it for a few months and then scale it
back down with the times right how much am I paying for that it's a hundred and
twenty-five dollars a month yeah this is significant investment right a hundred
and twenty-five dollars a month but it's a business where it's making far more
than that it's a no-brainer to actually like invest in good hosting if you could
pay for it right so you wouldn't want to you know pay $125 when you're just
getting your site started it doesn't make any sense to do that question of
the day what do you think about when you should upgrade hosting what kind of
hosting do you have let me know in the comments below don't forget check out
some of the links to my hosting company so I mentioned blue house I mentioned
site gram but I also use it a smaller company called MDD they're just a
smaller company again they have great customer service where you can you know
hop on a chat open a support ticket on their site and you get to a technician
right away you get to a person who could actually like log on to the server
see what's going on versus some other companies the bigger company is a lot of
times you do end up working with a service representative who just has a
script and they don't actually have access to your server which is a big
deal you have questions you need someone who
could go in and check things the answer your questions fast
Doug Huntington if you want to learn more about Amazon affiliate marketing
take a look at the channel and please subscribe thanks
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Stones Gambling Hall Raising Money For WEAVE - Duration: 1:37.
For more infomation >> Stones Gambling Hall Raising Money For WEAVE - Duration: 1:37. -------------------------------------------
Jeff Crittenden's Easter message for 2018 - Duration: 4:11.
Happy Easter! My name is Jeff Crittenden. I'm the chair of the Foundation. I just
want to wish you a Happy Easter across the country and well beyond our borders.
What an incredible celebration for all of us. Well, I'm here to talk again about
the Foundation – and when I think about Easter and I think about the Foundation,
I can't help but go to the Gospel of Mark, where the women who make their way
to the tomb that morning get there only to find a young man who has been
waiting for them. This young man says, "He's not here: He's gone ahead of you.
"He's risen. He is in the Galilee – Go, go to the Galilee and there you'll see Him."
What exciting news to hear. And so we begin – we begin our adventure going off
to the Galilee. And as we're traveling, it isn't long before the stories begin to
pile up. We encounter a story about Thomas, who has an incredible amount of
questions for Jesus: what does this all mean? Or maybe it's Emmaus, as those are
walking away from Jerusalem and a stranger comes into their midst, and
says that the scriptures burn within their hearts, and the revelation
and the breaking of bread. Or maybe – just maybe – it's that tender story of Saint
Peter, as there he is on the beach talking with Jesus:
Feed my sheep, Peter. Tend my lambs, Peter. Feed my sheep." – "You know that I love
You, Lord," Peter replies all three times. Now anyone
who's been around The United Church for a while, when you hear those words it
takes you right back to Wolfville, the General Council there, when our moderator
Marion Pardy was speaking this scripture to our next to be moderator, Peter Short.
She looked into his eyes, and she said with a twinkle, "Peter, do you love me?" No
one will ever forget that moment, as the whole place erupted in laughter! It was
so beautiful. I've sometimes wondered, "Why the Galilee?" But even there, when you just
give it a minute, it begins to dawn upon you that we'll see Him, that He's there
in the Galilee waiting for us, why? Because that's where all of His ministry
took place. There in the Galilee He taught us everything about healing, about
welcoming people, about community. He taught us everything about who we are
together. That's what I think about when I think of the Foundation: about us being
together, a community that makes a difference in the neighbourhood. Whether
it's in Vegreville United Church, where there's a seniors' friendship lunch, or
maybe it's in Montreal at the Montreal City Mission with the women's Weaving a
Dream program, or maybe it's up in Kamloops as the Pride Choir sings with
all their hearts; or maybe it's the outreach that happens at
St. George Church, and all throughout Newfoundland. The Galilee, it
doesn't take us very long to realize, is right here in our very midst. As you
walk out the door you see it in the neighbours that you meet, both strangers
and friends. So the Foundation would love for you to come in to talk with us about
the ministry you'd like to do in your neighbourhood. The Foundation is just
waiting for you to give us a call and say, "This is what we have some energy for,
"this is what we're excited about, this is going to make a difference." My friends,
please, please contact us and let us know what it is that you are interested in
doing. We're waiting to hear from you. Happy Easter, and may blessings come from
us here at the Foundation to your neighborhood.
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Synonym and antonym for Bank, BCS and admission test - Duration: 8:29.
Learning synonym and antonym
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