Western Section AUA Annual
Oct. 25-29, 2009, J.W. Marriott
October 25, 2009,
Las Vegas, Nevada
CUA Annual Meeting,
October 27, 2009, J.W. Marriott
Santa Ana, CA 92705
By: Gregg Marshall, CPMR, CSP
Do Away With Voice Mail
Carry Your Apps With
Clean Up Your Hard Drive for More
CALIFORNIA UROLOGICAL ASSOCIATION PRESIDENT'S REPORT
Joseph R. Kuntze, M.D.,
that, like it or not, change is in the air. The new administration
has articulated an intention to 'reform' the health care system. As
we all know, change can be good or detrimental. It is important for all of
us to be involved in the system. The emerging consensus is increased
funding for primary care (sound familiar?). As providers of primary care
services to men we need to access our congressional leaders and make them
aware of the value we bring to the system. Whether this is in the form of
psa screening, stone prevention, treatment of erectile dysfunction or
incontinence, referreral for colonoscopy or noting that high blood
pressure; we are the defacto primary providers for many of our patients.
When the buck stops, let's be sure some of them stop with us!
On another note, it seems like the insurance plans
continue to throw up road blocks to the delivery of efficient, cost
effective care. In the coming months I will ask our staff to contact the
major insurers in California and try to get the AUA best practice policies
authorization free for the areas in which they have been developed.
Hopefully this will decrease the hassle factor and allow us once again to
focus on patient care.
CUA 2008 Accomplishments
2009 HEALTH POLICY COMMITTEE REPORT
Jeffrey Kaufman, MD, FACS, Chair, Health Policy
Committee - WSAUA
The old Chinese curse "may you live in interesting
times" certainly applies to today's health care delivery system and
attempts to improve it. All of you are aware by now of President
Obama's plans for health care reform. But you may not appreciate how
significant the proposed changes will be to your day to day practice of
In order to achieve the goals Congress and the
administration have set, we are likely to see a move away from traditional
fee-for-service emphasizing instead pay-for-performance unlike anything
previously experienced. The new buzzword is Value
Based Purchasing, paying for quality of care, not quantity of care.
For many, this will present a new paradigm, focusing on wellness and
prevention rather than treating disease. Irrespective of how this is
implemented, the one thing we can count on is that change is coming.
the president has listed 8 principles he would like to see incorporated
into any new plan, at the time of writing this report legislation has not
yet been presented and the final details are still being decided.
Therefore, what follows is a broad outline of where we are today and what
we are likely to see introduced into Congress in the next couple of
months. Bear in mind that the timeline will be short in order to
have passage this year and there are strong political reasons why it must
be done before 2010 if it is to be done at all. In order to have a
bill passed before the August break, legislation must be ready to be
marked up by June. That means that staff is putting pen to paper
ironing out the details of their new plan as we speak. In response, the Western Section representatives, the
AUA and the AACU must be ready to respond as soon as those details are
known in order to protect our practices and our patients.
Certainly every other stake holder is actively involved and advocating for
their own narrow special interests-often at cross purposes to ours.
For the past several
years, our efforts inWashington D.C. have focused on
trying to convince lawmakers how badly the system is flawed. In that
respect, there is no disagreement today that health care delivery in
in crisis. In 2007, total health care expenditures constituted 16%
of the entire Gross Domestic Product. That figure increases by 2025
to 25%, an unsustainable amount that crowds out spending on other vital
services. The debate more recently has focused on how to fix the
system and how to pay for that reform. From March 14-17, 2009, the
AACU and AUA worked together to sponsor urology's fourth annual Joint
Advocacy Conference in Washington, D.C. As usual,
this year, with a record turnout of more than 135 urologists from all over
the country, the Western Section was heavily represented. As part of the meeting, we spent time visiting with
the Congress, Senate and their staffers (the ones who actually do the work
and write the bills) in a very successful attempt to have them understand
our concerns. Coming as it did just as the decisions
are being made on how to best craft legislation, our efforts were
particularly focused this year. Of course, what final appearance
reform will take depends on how it is funded and what political horse
trades are necessary to secure passage. What we can count is that
the bill will have something for every stakeholder to hate. No one
will love every part of the new system, but that is the compromise
necessary to move this plan forward.
different proposals are currently being discussed, they all have in common
3 basic goals: improving access to
care, improving the quality of
care delivered and controlling
costs. Our concern as
urologists is that we are included in the decision making of how
quality is defined and measured, that the quality measures do not become
new unfunded mandates, that oversight and regulation do not become so
burdensome that practices are strangled, that we continue to control those
elements of urologic practice necessary to insure proper outcomes
(especially with respect to participating in various ancillary services
that improve patient care such as imaging, ASCs and radiation therapy) and
that we are fairly compensated for our efforts.
Although we have been
reasonably successful so far at controlling the processes that define
quality care, major challenges remain:
barriers are being raised to participation in ancillary services, the
carrot and stick approach to encouraging performance promises to emphasize
the stick more than the carrot and the ongoing principle of "budget
neutrality" poses a major threat as Congress adjusts fee schedules to
value primary care services at the expense of all other care, shifting
major funding away from specialists toward various forms of bundled
payments that favor family doctors and some internists.
some feel that reform may not succeed unless sufficient funding is
secured, Obama's current budget proposal and recent legislation have
already begun the process. In addition to requesting $634 billion as
part of his new budget to be set aside as a down payment on reform, other
funds have already been approved. Twenty billion dollars have
already been committed to develop health information technology that will
become uniform, interoperable and universal across all elements of health
care. It is now taken as an article of faith
in Washington that
electronic health records are necessary for the salvation of the
system. The experts are convinced that using proper software
will cut costs, avoid duplicative efforts and testing, and improve
quality. Obviously, there are many challenges to this dream that
remain unsolved but those writing reform legislation have no doubt they
will be overcome.
As part of that effort, the carrot and stick model
promises bonuses that diminish over time to physicians who participate in
electronic records beginning in 2011 totaling $44,000 before transitioning
to increasing penalties up to 3% of total Medicare allowable charges or
more for failing to use HIT starting 2015. Already, bonuses of 2% of
Medicare allowable charges are available beginning this year for the use
of electronic prescribing. By 2012, failure
to use approved ERx will result in penalties up to 2%. At the
same time, the PQRI pay for performance process remains funded for at
least another year providing an opportunity for additional 2% of Medicare
allowable charges as bonus although it is unknown whether this too might
develop into a penalty for failure to participate in the future. In
a similar fashion, we can count on future bonuses and penalties to
encourage cooperation in other efforts to improve quality and cut costs.
At the same time, $1.1 billion has already been
funded for Comparative Effectiveness Research. While some would term
this "rationing", the intent is to critically analyze data in order to
determine what treatments provide the best outcomes at the best
price. The addition of the cost component to outcome measures raises
concerns among many groups that the new system will not be able to provide
everything to everyone, when they want it, all the time. If cost is
the product of price times quantity (C=PxQ) and cutting fees is a crude
undesirable tool, then the variable that remains to manipulate has to be
quantity. Indeed, those with the political courage to speak out
acknowledge that in order to control the burgeoning costs of healthcare,
some limits will be necessary. Panels have already been established
to oversee this research and funding for grants is already
available. Unfortunately, because of economic pressures, this
research is likely contribute to more aggressive turf battles as one
specialty or area of focus tries to dominate treatment of a particular
condition. Therefore, it is important
that urology retains the lead in this research, developing appropriate
evidence based guidelines and standards so that we-and no one else-retain
control of our areas of expertise.
Up until this year, one of our biggest demands of
Congress was that the failed Sustained Growth Rate formula used to update
Medicare fees be revised. Since most private payers in one way or
another base reimbursement on this figure, all payments are ultimately
controlled by a system that is based on incorrect data, includes costs for
part B drugs that are out of our control and artificially limits volume by
relating health care expenditures to the Gross Domestic Product.
Updates from this calculation have been negative for many years but
Congress, to avert steep cuts, has repeatedly and temporarily suspended
each cut back in favor of small increases that still have not kept up with
inflation (never mind accounting for substantial increases in
overhead). Because those updates were simply loans-never a
gift--which the SGR formula demanded be repaid, each delayed cut caused
the final adjustment to be steeper and steeper creating a debt Congress
was unable to resolve.
for us, since the current economic crisis has bloomed and figures are now
thrown around Washington in the
trillions of dollars without embarrassment, the amount of money necessary
to "re-base" the SGR seems small in comparison. Indeed, in Obama's
budget, he has called for $330 billion to resolve the previous deficit and
at the least, avoid an impending 40% cut in Medicare fees over the next
couple of years. Even if little else is done to correct the SGR
formula, this forgiveness of past loans will completely alter the
trajectory of future updates. Coupled with the recommendation that
part B drugs be removed from the formula (an adjustment worth $170
billion), we now project a modest increase over time. However, no
one is satisfied that the SGR as it's currently structured is
accomplishing what it was intended for-to control volume and costs in the
system overall. The logical response for any
given physician faced with diminishing fees is to increase his own volume
of work. This is exactly the opposite of what was intended and
as a consequence, the SGR will never succeed.
Revised plans are
targeting what are perceived as the biggest growth areas in medical care:
office based testing, minor procedures and high end imaging. Reform
will involve cutting and redistributing fees, re-aligning priorities,
removing incentives, bundling fees, withholding payment for bad outcomes
and rewarding value. Current proposals to
replace the SGR include substituting 6 different targets for the current
monolithic structure (separate limits for primary care E&M, all other
E&M, major surgeries, minor procedures, imaging and labs,
Although this new plan might bode well for some
urology practices depending on the nature of any given individual office,
the revised formula involves transferring funds to reward and support
primary care which is viewed as a specialty threatened with
extinction by an array of economic forces. As such, there is wide
spread sympathy in Washington that differentially greater reimbursement
must be given which, because of budget neutrality restrictions, will come
at the expense of specialists. Although we have argued that robbing
surgeon Peter to pay family doctor Paul will have unintended negative
consequences, Congress is set to implement this transfer in one way or
This asymmetric shift in funding may be done in
various ways: bundled payments may be given to a hospital-based groups
surrounding a major event such as cancer or open heart surgery (Events of
Care), to an outpatient group responsible for managing chronic medical
disease such as diabetes or CHF (Accountable Care Organizations) or
physicians may be allowed to participate in savings derived from efficient
cost effective treatments without violating kick back laws (gain
sharing). Each of these proposals to bundle payments threatens
specialists since it gives over authority on how to divide up payments to
someone with an inherent conflict of interest (do you really want your
local hospital deciding your fee schedule?). However, the most politically popular concept at
present is for the Medical Home.
Viewed as a team focusing on integrated health care
services emphasizing preventative care and chronic disease management, all
of which is necessary to control costs, the Medical Home looks like a
hybrid of the classic family medicine practice crossed with the gate
keeper, capitated managed care model. While few could argue that
better coordination of care will improve quality and cut costs, shifting
funds from specialty care to this structure will be detrimental to urology
practices and recalls memories of what impact using gate keepers had on
efficient specialty referral.
arguing that many urologists already serve as the "principle" (if not
"primary") health care provider for many of their patients, proposed
models for the Medical Home will not allow urology participation.
While we acknowledge the value of primary care and even support the
concept of a Medical Home, we have argued that any increase in financial
support should not invoke budget neutral offsets to other health care
providers. Congress intends to pay more to
family physicians for services beyond the classic face to face
episode, such as time spent on the phone coordinating care for their
patients. Who do they think is on the other end of that phone call
spending equal time integrating treatment? We are and we deserve
In another effort to realign priorities and remove
incentives for what is perceived as over-utilization, Congress seems
predisposed to closing out all participation in ancillary services.
As you know by now, an accommodation has been reached to allow most
lithotripsy partnerships to continue, even using "per click"
reimbursement. Restructuring ESWL treatments to provide a "service"
instead of renting equipment avoids Stark prohibitions.
Unfortunately, because of language in the law, this understanding does not
extend to other partnerships such as laser, microwave, and cryotherapy
units although a lawsuit has recently been filed in this regard.
prohibiting pathology and imaging partnerships have been modified to allow
some participation as long as the arrangement meets legal criteria.
Unfortunately, urologists' continued use of in office imaging equipment
continues to come under attack from organized radiology. It is imperative that we remain alert to
proposed legislation nationally and locally and make our case to
legislators that since no one knows our patients better, we should
retain control of any testing necessary for diagnosis and treatment.
This threat is especially important with respect to urology involvement
with radiation treatment partnerships. Radiation oncologists have
repeatedly attempted to nullify Stark safe harbors by changing the
definition of "ancillary services" (a legal term of art) in the AMA House
of Delegates as well as in the halls of Congress. We are hoping to
open dialogue with them to show that their efforts will have negative
results for their own members but much work remains in this respect.
Space prohibits discussing many more challenges in
detail. However, it is important for the Section to note the amount
of resources and energy now devoted by the AUA to health policy. In
addition to a much larger division with much more staff support and a
robust committee structure involving many urologists from around the
country, the AUA board of directors has made a clear and emphatic
statement that they will continue to fund and emphasize these
Out of the 2009 AUA budget of $39 million, although
health policy related revenues only comprise $1.26 million, the health
policy budget totals $5.935 million. Funding lobbyists, supporting
multiple committee activities, opening a new Washington D.C. office and expanding individual
urologists' involvement, we are well positioned to address whatever new
changes health care reform creates.
2009 COMMITTEE ON LEGISLATION
William Bonney, M.D.
On March 25th the California Medical
Association convened its Council on Legislation, to finalize CMA's
position on current issues in the California legislature.
Listed below are selected
legislative issues of possible interest to our CUA members. If theses or
other issues concern you, please use this website to identify your
California Senate and Assembly members. Call or send e-mail to the appropriate
Legislative Assistant in each office.
California Legislative Information
-- Home Page
-- Updates on specific Assembly or Senate bills
-- To contact legislative members from your own
(This was a
major issue discussed at the Council on Legislation)
A. The Process:
Mandated by JCAOH (Joint Commission for Accreditation
of Hospitals and Clinics), hospitals must retrieve patient records a) by
random sample, also b) for all cases with major complications.
These are reviewed by
hospital staff colleagues in each specialty, with the process and
conclusions reviewed by a locally appointed Hearing Officer. The physician
under review can negotiate for further review by an outside, independent
For physicians with repeated adverse outcomes, remedial
professional education is required, or hospital privileges may be
Review Process is systematic and fair in most hospitals, but there are
flaws in many situations. In 2007 CMA created a committee to
review this process.
The CMA committee's recommendations included:
a. A clear policy which condemns 'sham peer review'
for professional competitive reasons or administrative preferences. Peer review
is only to ensure patient safety and quality of care.
b. Hospital contracts may not exclude the Peer Review
and Report process. Medical staff must oversee Quality of
c. Hearing Officer must be an attorney, able
to streamline the Review/Hearing process.
Hearing Officer is mutually selected by all parties in the review
e. External Peer Review (by outside body)
must be provided if requested.
f. The judicial
review committee must include one physician with the same licensure and
another of the same specialty as the physician under review.
(In addition, any electronic
medical records under review must remain secure.)
law, Sections 805 and 805.1 of the Business and Professions Code, specify
certain peer review outcomes which require the hospital to submit an '805
report' to the Medical Board of California. About 150 of these '805
reports' are submitted each year, but many others are never sent
forward--often because the physician under review voluntary withdrew from
hospital privileges early in the review process. (Therefore,
these records are not representative outcomes data for assessment of the
Peer Review process.)
C. The Lumetra
Lumetra is the western region's Medicare
Quality Improvement Organization that won a bid from the Medical Board of
California in 2007 to perform a comprehensive study of California's peer review system (to
determine if functions well). This study was mandated by the
Legislature, and the final report was released in July 2008. It's
conclusions are critical of the Peer Review process.
The CMA has analyzed this
report and questions its validity. The number of '805 reports' submitted
each year is not a quality marker of Peer
Review. The 805 generally follows comprehensive
review of a physician after multiple complications. On the other
hand, most Peer Review is conducted early (to prevent complications) and therefore does not
generate an 805. Of the 366 hospitals under review,
Lumetra visited only 6. In Lumetra's direct physician survey,
most respondents declined to submit the documents needed to evaluate the
peer review process in each case.
D. Peer Review
1. Co-sponsored by CMA:
AB 120 (Hayashi) PEER REVIEW
Nearly all peer review done in California is done efficiently, timely,
and in a manner that protects patients from quality of care
However, the current peer review system can be strengthened. For example,
improper or biased review can be utilized to remove physicians for
non-quality of care concerns. In rare circumstances peer review can
be delayed to the point that patients are placed in danger by the
inability to promptly remove a physician that is providing substandard
120 improves an already robust system to make it even more effective in
ensuring high quality care in CA hospitals.
TITLE : An act to amend Sections 809, 809.2,
and 809.3 of, and to add Sections 809.04, 809.07, and 809.08 to,
the Business and Professions Code, relating to healing
TOPIC: Healing arts:
Committee on Business & Professions
of Interest" to CMA:
AB 834 (Solorio) PEER REVIEW
This is a spot
bill introduced at the request of the California Hospital
It is currently in "spot form" stating only legislative intent to
reform the peer review process
SB 58 (Aanestad)
This bill has
been amended to revise the peer review system in California. It mirrors
some of the provisions included in AB 120 but adds provisions not
supported by the CMA. It would demand external review for
certain medical outcomes and errors that are adequately addressed in
properly functioning peer review bodies. This bill is involved in ongoing
negotiations regarding the peer review reforms
Referred to Senate Judiciary Committee and Senate
Business & Professions Committee; 4/20/09
SB 700 (Negrete
McLeod) PEER REVIEW
revises the definition of peer review by stating the goal of peer review
is to determine qualifications for the practice of medicine. It would also
require peer review to be done in all medical settings including private
practice offices with one physician. CMA comment: Peer review is better done at
facilities where the majority of physicians have credentials. This bill is
also the subject of ongoing negotiations.
to Senate Business & Professions Committee; 4/20/09.
Health Care Reform--CMA Perspectives:
1. Tax credits and
direct subsidies to low-income families
. . then impose
individual mandates to obtain insurance
Outreach--enrollment of families already eligible for Medicaid and
3. Improve access:
reimbursement --> wider physician participation
4. Improve cost-efficiency (Health Care
plans devote 85% of revenue)
Please see Attachment to this message: CMA Perspectives on Health Reform
Take-home Message--Health Care Reform:
We as physicians must join this collaborative effort,
take the lead, and protect a) the doctor-patient relationship and b) a
healthcare system which allows independent, high quality practice with
adequate reimbursement. Problem: we have not
figured out how to organize ourselves and get this
May 19th Special Election in California:
Health and Human Services budget
Vote 'Yes' on
Proposition 1d: To move $268 million from Tobacco
Tax funds (1998 Prop 10) and place that money into HHS (Calif Health &
Human Services) for children's health care (CHIP, Medicaid) and other
reimbursement is a key outcome.
Other Calif Legislature bills of interest
(including those sponsored or opposed by CMA)
Attachment to this message: CMA Hot list.doc
TO ACTION - BILLS ERODING CORPORATE BAR PASS KEY
CMA Organized Medical Staff Section
AB 646 (Swanson)
and AB 648 (Chesbro), two bills which would erode the patient protections
of the bar on the corporate practice of medicine in California, took an
ominous step towards passage today when they passed the Assembly Business
and Professions Committee. AB 646 is sponsored by AFSCME, a labor
union interested in unionizing doctors; AB 648 is sponsored by the
California Hospital Association, whose members want to hire and control
One other bill
eroding the corporate bar has also been introduced in the Legislature this
year: SB 726 (Ashburn).
your help to defeat these bills!
AB 646 and AB 648
will both be heard in Assembly Health Committee next Tuesday, April
28. For all doctors who have a member of the Assembly Health
Committee in your county, we ask that you and your colleagues CALL, EMAIL, or FAX those legislators and urge
them to Vote No on AB 646 and AB
648. Counties with legislators on the Committee
include: Sacramento, San Diego, San Bernardino, San Francisco,
Tulare, Los Angeles, ACCMA, Santa Barbara, and Ventura County.
Phone calls are most effective, but
emails and faxes are important too. A complete list of legislators
on the committee can be found at: http://www.assembly.ca.gov/acs/newcomframeset.asp?committee=10.
A sample letter and talking points are below.
will be heard in Senate Business and Professions Committee on Monday,
April 27. For all doctors who have a member of the Senate Business
and Professions Committee in your county, we ask that you and your
colleagues CALL, EMAIL, or FAX those members
and urge them to Vote No on SB 726.
Counties with Senators on the Committee include: Santa Barbara, San Diego,
Butte-Glenn, Yuba-Sutter-Colusa, ACCMA, Orange, Fresno, Los Angeles, San
Francisco, and San Mateo.
Again, phone calls are most effective, but emails and
faxes are important too. A complete list of legislators on the
committee can be found at: http://www.senate.ca.gov/ftp/sen/committee/STANDING/BUSINESS/_home1/PROFILE.HTM.
The same sample letter and talking points apply.
extent possible, please let us know what calls, emails, and faxes you are
able to generate. This is critical information for our lobbyists
when they speak to legislators. If you or your colleagues choose to
submit an email or fax to your legislator(s), we strongly encourage that
you personalize the letter, which will greatly increase its impact.
involvement is critical to ensure that legislators understand the impact
these bills will have on the quality of care their constituents receive in
California hospitals. We need to let these legislators hear from as
many doctors as possible that these bills are bad for patients (their
More information on these bills can be found on the
CMA website at: http://www.cmanet.org/news/hotlist.asp. If you have additional questions,
please contact Ned Wigglesworth, Vice President – Communications,
California Medical Association, at 916.551.2873 or at
1) The ban on corporations practicing medicine is an
important protection for patients in California hospitals. This
protection ensures that those who make decisions that affect the provision
of medical services (1) understand the quality of care implications of
that medical service; (2) have a professional ethical obligation to place
the patient's interest first; (3) are subject to the Medical Board of
2) AB 646, AB 648, and SB 726 will erode the
quality of care in California hospitals. AB 646, AB 648, and SB
726 will grant control over treatment decisions to hospital CEOs and
administrative staff who have different motivations and mandates than
physicians. This will create conflicted loyalties in an institution
that must remain true to the patient's interests, and will erode the
quality of care patients receive in California hospitals.
3) Placing doctors under the oversight of
hospital administrators and CEOs who are under enormous pressures to cut
costs or increase revenue will threaten the independent medical judgment
necessary to ensure patients are protected.
4) Hospitals are already interfering with
medical staffs' ability to ensure quality care through independent
self-governance. For example, some hospitals have adopted
medical management protocols which have resulted in inappropriate hospital
tests, procedures, and stays, jeopardizing patients and increasing costs.
5) Allowing a hospital to directly employ a
physician will NOT increase access to physician services. The
hospital will push patients to their preferred provider thereby
controlling the competitive market. Other non-employed physicians
will not be able to compete and likely be forced out of town resulting in
no increased access.
6) CMA supports policies that will truly
increase access to care, without compromising the quality of
care. The CMA supported bills last year that will provide
over $2 million dollars in medical school loan repayment for physicians
who agree to practice in these areas. Since loan repayment
obligations is one of the primary reasons physicians will not go to
underserved areas, this will attract physicians to these areas without
compromising the quality of care patients receive.
ALTER THE FIRST TWO PARAGRAPHS OF THIS LETTER TO REFLECT WHICH BILLS YOU
ARE WRITING ABOUT.
RETURN TO TOP
I am writing to request that you
oppose [AB 646 and AB 648, or SB
726], a [bill(s)] that would eliminate important legal
protections for patients by allowing hospitals to directly employ
critical for the integrity of patient care in California hospitals that
physicians remain independent from the corporate influence of hospital
administrators and CEOs, who must answer to priorities other than patient
care. By eliminating this protection for patients, [AB 646 and AB 648 or SB 726] will erode the
quality of care those patients receive in California hospitals.
against the corporate practice of medicine provides a fundamental
protection for patients by ensuring their physicians' sole interest is
what is best for the patient. When hospitals are allowed to directly
employ and charge for physician services, quality of care suffers due to
the fact that hospitals derive income from patient beds being filled.
recognize there is a shortage of physicians in some areas. However,
there are ways to address that shortage without allowing hospitals to
control physician employment. Increasing slots for medical training
in California by developing the medical school at UC Merced and expanding
access to California's loan repayment program will truly ensure physicians
go to and stay in rural and underserved areas.
allowing hospitals to employ physicians may actually result in reduced
access and increased costs. Hospital employment of physicians
eliminates competition for outpatient services and instead forces all care
to be delivered through the hospital. As hospitals gain market share
in small communities, physicians not employed will likely be forced out of
business and surgery centers outside the hospital will likely be forced to
close. This results fewer options for patients and increased costs
as the hospital is able to charge higher rates with the elimination of
these reasons I request that you vote against bills that would allow
hospital to directly employ and charge for physician services. Thank
you for your consideration.
Free Conference Call Options
Need to set up a
conference call and can't even figure out how to add a third
a call, much less have 10 people on the same call?
want to pay monthly fees and/or 10+ cents a
There are free alternatives. One I've been using for several years is http://www.freeconferencecall.com.
You go to their web site and register for a free account.
They send you an email with a call-in telephone number and a
conference call code.
you want to talk to with the date and time. Everyone dials the telephone number and at the prompt enters the conference call code. Voila,
everyone is on a conference call.
RETURN TO TOP
can even record the call (for free).
Where's the catch? The telephone number everyone calls is a toll number (e.g. a long
I've only had one person notice/care. Most
people have unlimited long distance or pay less than 3
isn't that much a cost.
ease of use.
Gregg Marshall, CPMR, CSP, is a speaker, author and consultant.
reached by e-mail at email@example.com, or visit his
website at http://www.repconnection.com.
Do Away With
I hate voice mail.
You have to call in to retrieve it, if it's for your
your voicemail is burning minutes.
A lot of the messages aren't worth
people leave their whole life history in each voice mail.
I don't do voice mail any
I switched over to PhoneTag (http://www.phonetag.com), until just recently called Simulscribe).
They sent me a magic "code" to key into my
it to call forward calls when I don't answer to a special telephone number they assigned me when I signed up.
So if you call me and I don't
message I would have used for my cell phone. You
leave your message. PhoneTag
transcribes it. I get the message via text message and email (the email includes an MP3 recording of
Because the text message arrives silently, I can see your message while in a meeting... Or
Feel free to use my referral code to sign
I even promise to return your call.
Gregg Marshall, CPMR, CSP,
is a speaker, author and consultant. He can be reached by e-mail at firstname.lastname@example.org, or visit his
http://www.repconnection.com.RETURN TO TOP
Carry Your Apps With You
has a flash drive, right?
Beyond carrying important documents, like a scan of your passport,
you can carry a complete office set up that will run on any Windows
you can find, such as a spare at a client or the hotel's business center.
Rather than worry if they have the right applications,
with you on your flash drive.
The first implementation of this was U3, a
proprietary system for running applications off flash
created by Kingston Memory. It's
proprietary, not many applications
bothered with modifying their programs to work with
there's an open source (aka free like Linux) option called Portable Apps (http://portableapps.com/). It
similar environment as U3, but has better support,
especially by open source applications.
with Portable Apps, you can have Open Office (very
with Microsoft Office and free), Firefox (quickly becoming my
with its bookmarks, Thunderbird (a good Outlook alternative), GIMP (a Photoshop
alternative), Audacity (audio editing
software)-in other words, everything you need to work. And all
Even my tricked out collection of almost everything
of a 1 gigabyte flash drive.
and data stay on the flash drive. You plug it
in, do your work, and when you are done, remove it. All trace of your visit
Are you sure you need to lug that notebook on every trip?
Even a 2 pound Mac Air is heavy compared to a 1
Gregg Marshall, CPMR, CSP,
is a speaker, author and consultant. He can be reached by e-mail at email@example.com, or visit his
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Clean Up Your Hard Drive for More Speed
slower? I've often thought that Microsoft and
to slow computers down over time so you'll buy a new one every year.
as you use
your computer, install new programs and
your computer develops what I call plaque, just like your teeth.
"brush" your computer.
rid of all the "bloatware" that came with your computer.
easiest solution to that is PC Decrapifier (yes that's its
Then uninstall all those neat programs you might
decided to try and never use. Go to your
control panel and choose Add/Remove Programs (XP) or
Programs And Features (Vista).
don't know what's on your PC, try WinAudit (http://www.pxserver.com/winaudit.htm), a
utility for generating a comprehensive report of everything about your
After cleaning off all the extraneous programs, do a disk
defragmentation. You can use Windows defragmenter by going to Start
and right clicking on the C drive. From the context menu that pops up,
select properties, then tools. Do a disk clean up first,
then do a
defragment. Another option is to
Diskkeeper (http://www.diskeeper.com/defrag.asp) that
automatically defragments your disk in the background. My
is Disktrix' Ultimate Defrag (http://www.disktrix.com), which not only
defragments your hard drive, it moves frequently used files to the same area to keep the seek time to a minimum.
That will clean up your hard drive, next time we clean the Windows.
Gregg Marshall, CPMR, CSP, is a speaker, author and consultant.
reached by e-mail at firstname.lastname@example.org, or visit his
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