Spring 2011

An Alana HealthCareTM PublicationSpring 2011www.alanahealthcare.com

Eating With Your Head, Not Your StomachKnowing what makes you eat too much food will help you gain more control

Giving Credit Where It’s DueThe recovery of more than $4 billion in taxpayer dollars in healthcare fraud cases

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Dear readers:

As spring sneaks up on us and we look expectantly toward warmer days, we think also about new beginnings. We have come to the close of an exciting first year for Alana Healthcare and we look back fondly at our own “birth.”. Opportunities for growth are abundant. Since the merging of Dickson Medical Equipment and Alana Healthcare Pharmacy nine months ago, monthly sales have increased by over 40%, and we have added over 30 new staff members to our company. As we welcome 2011, the landscape has changed in a very positive way since early 2010.

At this time last year, Jason Shiflet and I set out some specific goals we wanted to accomplish. We are proud that the members of our company have helped us to achieve many of those goals:

• Growing the top line: Sales have increased in all product areas. The leadership of Jon Anderson, President of DME, has had a direct impact on growth. In a year of economic concern and the uncertain future of Competitive Bidding, DME has continued to grow respiratory product sales. We have launched sales initiatives in new areas: wound therapies, Trilogy respiratory devices and CPAP supplies. The addition of two new salespeople (Chris Schlect in Nashville and Michael Dodd, in Western Tennessee) will only serve to fuel the forward momentum of DME.

Specialty Pharmacy sales have continued to grow and diversify. Since last April, active patients serviced have grown

six-fold. We added an additional 60 patients since October. Over the last quarter of 2010, Steve Brennan, Vice President of Sales, has added experienced specialty pharmacy salespeople: Chad Baker (TN), Sandy Turnauer (Eastern TN), and Michael Oxley (OH/KY). Our pharmacy is now treating patients across a broad spectrum of chronic diseases, including: autoimmune disorders, Crohn’s disease, rheumatoid arthritis, bleeding disorders and antibiotic infusion therapies.

• Increasing our geographic footprint: Last year saw our company increase not only its service territory by adding a Nashville office (opening April 2011); we also increased our sales territories into Eastern Tennessee, Kentucky, and Ohio. The Jackson office moved into a new 6,000 sq. ft. facility off I-40, with available land for future expansion. Finally, in December, the headquarters for corporate, pharmacy operations, and DME warehousing moved to 208 Dragon Drive in Dickson. The 10,000 sq. ft. building, with 2 acres for future expansion, has allowed us to greatly expand our pharmacy operations and gives us the opportunity of purchasing greater volumes of medical products, while decreasing costs. We are

Letter from the CEO

Table of Contents

Letter from the CEO ...................................................... 2

Time Heals, but Negative Pressure Wound Therapy Helps .................................................. 4

Getting to Know: Lisa Scronce ..................................... 6

One Big Extended Family ............................................ 8

Medical Transportation Grant Programs .................... 10

Infusion Suite .............................................................. 11

Eating With Your Head, Not Your Stomach ............... 12

Giving Credit Where’s It’s Due .................................... 14

Wellness 360°An Alana HealthCare™ Publication

Editor: Cory SchneiderGraphic Designer: Barbara MorrisContributors: Mike Gallagher, Eric LowePublisher: Amy Massey

208 Dragon DriveDickson, TN 37055Toll-free: (877) 796-9679Fax: (615) 375-1132www.alanahealthcare.com

Steven A. Schneider, CEOJason Shiflet, President

Wellness 360TM is published by Alana HealthCare. The information provided in this newsletter in no way replaces the information and advice provided by a health care professional. A doctor or nurse should be contacted regarding the diagnosis and treatment of any medical condition. Websites and reference information are provided for your convenience only, and Alana HealthCare neither endorses nor supports the statements they contain in any way. Alana HealthCare does not verify the authenticity of these websites or the content they provide.

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opening our Nashville offices in April, which will enable us to maximize the experience and professional relationships of Steve Brennan and the four Nashville-focused salespeople.

• Diversification of our products offerings and services: We have been successful at increasing sales of new durable medical equipment and specialty pharmacy products. Since June 2010 we have achieved month-over-month growth of: negative pressure wound therapy pumps in service; Trilogy 100 Ventilators; auto-immune pharmacy patients serviced; and, increasing pharmacy patients served across a number of chronic diseases. The April opening of our Nashville building, across from Centennial Park, with our first company-owned infusion center, will place us within three blocks of Vanderbilt Medical Center, Baptist Hospital, and Centennial Medical Center. The infusion center, and inventory of durable medical equipment, allows us to provide immediate access to patients of those hospitals, while helping to further distinguish Nashville as a national medical hub. Steve Brennan and Jason will lead the company-wide sales efforts from Nashville.

We are proud of the company-wide focus on quality care and superior patient and physician service, and we will continue to build Alana HealthCare’s foundation and reputation on these principles. Without the efforts of Amy Massey and Mike Gallagher, we would not be advancing at the rate we are. Amy is more than the “Queen” of the Alana Healthcare brand: she is its creator. From publicity to logos, marketing materials to Wellness 360°, patient advocate to event planner, Amy has become the “go-to” person at Alana Healthcare. She has worked tirelessly with Jason, Jon, and Steve to promote our people and company. Mike has brought order to the chaotic healthcare compliance arena. Our ability to react to constant changes in healthcare law and reimbursement rely on Mike’s clarity of purpose. His knowledge of healthcare compliance and the work ethic he exhibits in his area of focus is a safety blanket for us all.

We did reach outside the company for several key leaders. Jeff Black, Director of Pharmacy Operations, is charged with both expanding our access to the payors required by our sales team and referral sources, and managing the day-to-day operations of the pharmacy. He brings the knowledge and experience of both. His take charge attitude and good cheer are wonderful. In September we were joined by Justin Schneider, our Chief Financial Officer. He has brought organization and accountability across the company. Eight years of public accounting have given him the experience of how companies should implement best-practices, and as a result, our accounting software, inventory control, and DME software platforms are in the process of being upgraded, with training and processes for implementation in place.

One year ago, the 12 leaders in this section were either in different positions or not with the company. We have come far through their efforts. Jason and I thank you all. 2011 will be an exciting year.

Thanks,

Steven A. Schneider Chief Executive Officer

4 www.alanahealthcare.com

f you have never heard of Negative Pressure Wound Therapy (NPWT), besides thinking it sounds

like a mouthful, you might mistake it for some kind of procedure straight out of a science fiction movie. But for physicians, nurses, and patients familiar with NPWT, the treatment has become an increasingly turned-to therapeutic technique used to promote healing in acute or chronic wounds, fight infection, and enhance the healing of burns.

Lisa Scronce, the clinical coordinator of Alana HealthCare’s NPWT department, has gotten to know the treatment well—its ins and outs, benefits and drawbacks—throughout the year she has been in her position. (For more information on Scronce, please see our Getting to Know section in this edition of Wellness 360.) She explains that the therapy is helpful to a broad swath of patients, ranging from individuals who have just had surgery and are recuperating in the hospital or in a rehabilitation facility, to elderly people who are not as mobile as they used to be.

“Negative Pressure Wound Therapy goes in and helps to drain significant wounds,” she said. “As it does that, the treatment brings nutrients and blood to the surface and ‘feeds’ the wounds, helping them to heal better and more quickly.”

So, What is NPWT?

Negative Pressure Wound Therapy applies sub-atmospheric pressure (suction) to a wound via a computerized therapy unit. The wound must first be sealed with a gauze or foam filler dressing in order to prevent its premature opening. A vacuum source that applies negative pressure to the wound bed with a tube is threaded

through the dressing. Depending on the type of wound being treated, the vacuum may be applied continuously or intermittently.

To bring the treatment to various patients and doctors’ offices across Middle and Western Tennessee, Scronce works with Medela Healthcare, a Swiss company that specializes in vacuum technologies. Scronce’s colleague at Medela is Susan Reid, Director of Clinical Affairs for Medela. According to Reid, the therapy has several benefits.

“Along with moist wound healing, the physiological benefits of NPWT in wound management are believed to include contracting or drawing the wound edges together which assists with re-epithelialization, stretching of the tissues to encourage cell proliferation and biochemical responses for wound healing, increasing blood flow, and the reduction of edema and excessive inhibitory factors,” she said.

In her position, Reid has national responsibility for clinical education, training, trial, research and evidence validation, key opinion development, and health economics for Medela. She has become well-versed in the 60-year history of NPWT.

Reid explained that such treatments have been reported in literature dating back to the 1950s. By the 1970s, NPWT was being performed through a wall suction unit. But new advances have made the treatment increasingly less invasive and more effective. Wall suction, Scronce explained, could not alarm physicians when something was wrong. In modernizing the system, current independent suction models now have seven safety features to ensure patient welfare.

This welfare is of utmost importance to both women. For her part, Reid said her work with Alana HealthCare and DME Tennessee, LLC has been extensive and that she checks in with Scronce weekly. From her time working with Scronce, in particular, she describes her as “a responsive, caring, and compassionate nurse in [her service to] both the healthcare community and the patients in their care.” These are traits Scronce said she hopes characterize Alana HealthCare’s philosophy.

Patients and Practices

Wounds come in a number of shapes and sizes, and no two are alike. When they are treated by NPWT, a variety of things must be considered.

“If a patient has had surgery or there is an incision wound that bursts open, he or she might be a good candidate for NPWT,” Scronce said. “We also see diabetic ulcers, vascular ulcers, and traumatic wounds.”

Scronce emphasized that NPWT is never undertaken without a prescription from a physician.

“You absolutely need a doctor’s orders,” she said. “We get orders from hospitals, rehabilitation centers, nursing homes, and many other facilities.” Once the physician has made that prescription and Alana HealthCare is contracted, Scronce is called and she begins the process of setting up that facility to provide NPWT to the patient. She said it is her responsibility to ensure that the physicians and nurses she works with completely understand the unit and its uses before it is even put on the patient.

Time Heals, But Negative Pressure Wound Therapy HelpsBy Cory Schneider

5www.alanahealthcare.com

Should something go wrong or if there is ever any question, however, Scronce and her team are there to lend a hand.

“We’re always available for patients and nurses 24 hours a day, seven days a week,” she said. “They have my direct cell phone number. Everybody gets it.”

Scronce outlined the procedures that are in place to make sure that every patient receives top quality care when it is most needed.

“Every four weeks, we go to a patient’s house (or facility) and visit with them to make sure that their therapy is going well,” she said. “We check in with the home nurse to get wound measurements to make sure that the patients are going through the healing process properly.”

Moreover, these procedures include the kinds of patient-centered touches that Reid noticed.

“Everything is hand delivered through our team,” Scronce said. “We never use the postal service or FedEx. Our nurses do it all. If patients need supplies—or anything—we go there to deliver them in person.”

There is no set time for wound recovery. Typically, patients’ insurance companies pay for four moths of NPWT as long as they are showing progression in healing.

Much of the recovery depends on wound type, though many other factors contribute to effective healing.

“Patients need the correct support surface, the right diet, and they need to be attending to any other symptoms of their condition that may be presenting. If they are diabetic, for example, then are they wearing the right shoes? That’s why it is so important for nurses to follow their patients closely,” Scronce said.

Diets can be adjusted and administering nurses can be better taught how to help patients, but it is imperative that everyone involved—from patients to nurses and Scronce, herself—work as a team.

According to Scronce, one major benefit Alana HealthCare has over its competitors is that it has found ways to save patients and their insurance companies money, which in this economic climate is more essential than ever. Dressings are changed twice each week and Scronce has worked with her team—including Medela Healthcare—to find ways to use fewer supplies in the process, thus eliminating unnecessary (and costly) medical waste.

What Matters Most

While the money-saving advantages are attractive, what matters most to patients is that they are getting the best care. Scronce said that when they are first told about the treatment, patients do exhibit some anxiety.

“As with any medical procedure or

treatment, patients get really nervous when they think about having to lug this thing around,” she said. “They’re afraid other people will know something’s wrong and that there will always be something to deal with. But then they see how small the unit is and that it only weighs two pounds, and their attitudes change immediately. They realize it’s easy to conceal—it can be kept under a pant leg or shirt.”

The patient-centered approach of the Alana HealthCare team also helps to allay patients’ concerns.

“Patients see all of the encouragement and assistance that they are going to get and they know everything’s going to be just fine,” Scronce said.

It is because of this approach and the impressive results that she has seen with patients that Scronce is confident that Alana HealthCare’s presence in the community of patients receiving NPWT will only continue to grow. Since beginning to offer the treatment, the company has been able to serve well over 60 patients. She said that her team has put a “tight crunch” on its competitors and that those other providers are being kept on their toes.

Of course, she said, none of that is on patients’ minds.

“The biggest thing for any patient we work with to know is that they are never left alone,” she said. “We’re there to support not just patients’ wounds and their healing, but the patients themselves. Patients aren’t going to get better if they don’t know that they have caring people rooting for them in their corner.”

A suction-based vacuum unit facilitated by Alana HealthCare and Dickson Medical Equipment and administered onsite is helping patients’ acute or chronic wounds heal better and faster.

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Getting to Know...

By Cory Schneider

Lisa ScronceLisa Scronce, Clinical Coordinator

“ I love, love, love taking care of wounds!”

hese are either the words of someone you should worry about or someone you really want on your side when your wounds need taking

care of. Fortunately for her patients, Lisa Scronce is the latter. With 16 years of nursing experience behind her, she has spent the last year helping to build Alana HealthCare’s Negative Pressure Wound Therapy Department. (For more information on negative pressure wound therapy, please see our article in this issue of Wellness 360.)

“The department is kind of my baby,” she said. “I take care of all of the inservicing and coordinate with the long-term facilities, hospitals, nurses, product representatives, and all of the other people we work with. I love it!” Along with two nurses, Scronce oversees the department’s work of attending to the needs of patients with chronic or acute wounds. Moving into this new kind of work has placed the joy back into her job, she explained. “This job puts my nursing career back into perspective,” she said. “We’re making progress, we’re seeing things happen. I’m not just teaching patients about their diets—even though we can’t forget about that.”

According to Scronce, growing the department has been just the challenge she was not aware that she was looking for. “This keeps my mind thinking at all levels, because I’m gathering and giving all of the information I can,” she said. “How is the patient sleeping? What pressure is put on the wound? How do things change if the patient has diabetes or congestive heart problems? These are important things to know about.”

The nursing career that Scronce is putting to good use has its background in trauma, open heart, and ICU work. But, in fact, the dedication she brings to this position has much deeper roots in her history. Every woman in her family—“Absolutely every woman!” she exclaims—has worked in the medical profession. Scronce was tending bar to work her way through college in Nashville when she says the calling to work in the medical profession found her. She ended up enrolling at Tennessee Technology Center at Paris to receive the degree that set her off on the path she is still gamely pursuing. “I was one of those children who was sure she was never going to do what her Mom did,” Scronce said. “Then one day, I grew up and found it.” A true hometown woman, Scronce still lives in Erin, TN, where she was born and raised. She enjoyed her time working in Nashville as a nurse, but prefers the quieter lifestyle of Erin. There, she lives with her daughter, who she said is her first priority.

Her position gives Scronce a certain amount of flexibility, something that the stricter hours of hospital nursing often do not allow for. She explained, though, that she misses many things about her work in the hospitals, including having the chance to see patients get better over a long period of time. There is no better feeling, she said, than knocking on a hospital room door and knowing that the work you do with a patient will ensure that he or she gets better and eventually leaves the hospital to resume his or her life. The tradeoff, however, is that Scronce now feels like a teacher and she has been pleasantly surprised to find that this new aspect of her job suits her so well. “I hold my nurses to high standards,” she said. “In this teaching role, I feel that I am in a position to help them, to pass on what I have learned as a nurse.” Scronce is providing guidance to more than just the nurses she works with, however. The inservicing that comprises such an essential part of her weekly schedule allows her to interface with and teach doctors, patients, and nurses at other facilities about negative pressure wound therapy and the services Alana HealthCare provides. Moreover, she said, she relishes the role of being a student—continuing to learn from the many people who fill her days. “With time, energy, and money, I would be in school all of the time,” she said. “In the medical profession, there is always so much to learn, so much to stay

www.alanahealthcare.com

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on top of. Things change every day in this field and you have to be responsible for knowing how to best serve patients.” For her part, Scronce is constantly enrolled in courses. The week after we spoke with her, she was signed up for

an American Red Cross inpatient class, and was looking forward to taking a new infusion class outlining the evolving guidelines for blood transfusions soon after that. She said she even continues to get or renew certifications—such as the Pediatric Advanced Life Support (PALS) certification—she might not currently

call on just so she can be prepared for anything that arises in the future. “If something comes up, I want to be ready,” she said. “If it feels like something I need to know or need to get involved with, I’m there. Just sign me up!”

Scronce’s positive, go-getter attitude has so far served her well at Alana HeathCare. She calls her time with the company “wonderful” and “nothing but positive.” For someone looking for opportunities to grow, she said that the company is the ideal place to work. “I learn something new every single day,” she said. “When I came on, I knew very little about durable medical equipment, but they were eager to teach me all about it. I needed to know about billing, and my coworkers were more than happy to show me what I needed to know. The same goes for our pharmacy side. Every person in the Alana family has been open-hearted—and for a student like me—open-minded.” Scronce observes that the familial atmosphere that welcomed and nurtured her extends to the patients Alana HealthCare works with. “Employees here don’t just treat their patients with standard care,” she said. “Every situation has to be taken care of the way you would want your own personal matter handled. That’s just the way it should be. It puts medicine pack into perspective.” And if that perspective includes having a love for wounds, then maybe that strange appreciation is not such a bad thing, after all.


The nursing career that Scronce is putting to good use has its background in trauma, open heart, and ICU work.

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One Big, Extended FamilyCommunity Roll Call

By Cory Schneider

We know that when health crises affect us, there is often no greater comfort than knowing

unconditional support is at arm’s length. A kind word, a warm meal, a moment of solace: these are the things we crave in our times of need, when all else seems out of whack.

For many families that are uprooted during such crises—seeking necessary medical attention far from home—Ronald McDonald House Charities (RMHC) aims to be that port in the storm. Since 1974, when the first Ronald McDonald House opened in Philadelphia, PA, the charity has offered lodging, food, and emotional sustenance to families set adrift by their critically ill children. From that time, the charity has gone global and, in 2010, it celebrated the opening of its 300th house.

According to their mission statement, RMHC “strive[s] to be part of … the solution in improving the lives of children and their families by providing programs that strengthen families during their most difficult or challenging times.” To do that, RMHC provides a home-away-from-home to families that might not otherwise be able to afford to stay in the city in which their children are receiving medical care. As a part of that mission, the charity believes, above all, that “families are stronger when they are together. … By staying at a Ronald McDonald House, parents also can better communicate

with their child’s medical team and keep up with complicated treatment plans when needed. They can also focus on the health of their child, rather than grocery shopping, cleaning or cooking meals.”

A Place to Call Home

Nowhere is this commitment to family and the health of children more apparent than in Nashville’s own Ronald McDonald House. With 32 bedrooms and a legacy of dedicated service to the families of children with all types of diseases and conditions, the Nashville house has been a welcome place to call home since 1991. The genesis of the Nashville house came from Dr. John Lukens, the head of the pediatric oncology department at Vanderbilt Children’s Hospital. Lukens had visited the second house in Chicago and gathered together a group of medical professionals, members of the McDonald’s restaurant team, community leaders, and families who had gone through medical crises with their children. With its original 16-bedroom establishment, the Nashville House was the 142nd one to be completed. In the years since its inception, the Nashville House has grown tremendously. According to Kirra Menees, the Volunteer Coordinator at RMHC Nashville, the

charity now “serves pretty much all of middle Tennessee, northern Alabama, and southwestern Kentucky.” In fact, at the moment, the House is sponsoring a family from Africa!

“Because we serve so many different types of illnesses, and because everyone is from out of town, coming to Nashville can be like coming to the moon,” Menees said. “A lot of families from really small towns are thrown into a whirlwind when their children are diagnosed with diseases they’ve never even heard of. It’s a scary time, and we’re just trying to give them everything they need to be prepared to face the next day and fight the illness that has invaded their lives.”

Menees has been with RMHC Nashville for over nine years. She found the House and the position through a friend who volunteered there. With her background in retail and her love of “talking and



At the Ronald McDonald House Charities of Nashville, the families of critically ill children find more than just a place to rest their headsne Big, Extended Family

working with just about anybody,” Menees was a natural fit. In addition to coordinating the volunteers that help out in the House and other ventures daily, Menees plans special events for the families. But her heart lies in finding the right kinds of people to lift the spirits of RMHC’s families and, most importantly, children.

“The main thing I look for in a volunteer is someone who is self-motivated,” she said. “We need someone compassionate,

someone who has the patience to handle what a family is dealing with. And sometimes you’re just asked to be a shoulder to lean on.”

Menees hears from a broad range of people interested in volunteering their time. From professionals looking to help out after a busy

day in the office to retired people who want to stay active to students who are volunteering for the first time, Menees said she is constantly impressed with the caliber of Nashvillians who want to give back to their community.

Spreading the Love

In addition to the House, RMHC Nashville opened its Family Room at Monroe Carell, Jr. Children’s Hospital in 2004. The Room—viewed as an extension of the House—is a place at the hospital where families “can enjoy a quiet respite from corridors and waiting rooms, whether or not they’re staying at the Ronald McDonald House.” Since it opened, the Room has served more than 3,600 families, providing a comfortable seating area, a kitchen stocked with snacks, a children’s play area, a half bath, and the support of a caring staff and volunteers.

Menees is responsible for filling the Family Room with its group of 215 rotating volunteers, as well. She explains that the Room is another crucial way for RMHC to make a difference in the community.

Other efforts to make this difference are accomplished through a variety of fundraising campaigns and six major events held each year. One campaign Menees recalls fondly is the grassroots program, which began in 2000, to collect aluminum tabs for money.

“School groups, religious groups, office groups – they’ve all gotten into it. When all is told, they’ve raised somewhere between $10-12 thousand dollars annually. We’re using that money to make sure we stay blessed in not turning away any family that can’t afford the $15 per-night donation fee,” Menees said.

The major events RMHC Nashville holds each year include a telethon in the spring with the help of the local ABC affiliate, in addition to tennis and golf tournaments. This year, the House sponsored a Christmas lights show to which it sold tickets. (Check out RMHC Nashville’s website at www.rmhcnashville.com for more information on all upcoming events.)

All of these efforts contribute to enhancing the House and its atmosphere of being one big, extended family.

“We laugh with the families and we cry with the families,” Menees said. “The biggest testament to the work we’re doing is the number of families that come back to visit with us.


Living with a chronic medical condition can be difficult, but imagine having to travel to another city to receive your necessary medical treatment. Not only do you have to worry about the strain that it will place on your family, but you also have to worry about the strain that it will have on your wallet. Luckily, there are programs available to lessen the burden of travel expenses on top of mounting medical bills.

One such program is the Southwest Airlines Medical Transportation Grant Program (MTGP). This program provides complimentary, roundtrip tickets to nonprofit hospitals and medical transportation organizations. The tickets are distributed by the organizations to deserving patients and their caregivers who must travel for medical care. Southwest allows participating nonprofit hospitals and medical transportation organizations the freedom to determine how to distribute the tickets to their patients and/or caregivers.

This year Southwest Airlines increased the number of hospitals and medical transportation organizations that receive grants in the airline’s Medical Transportation Grant Program. Southwest has nearly doubled the grant program’s 2011 budget with hopes of assisting more than 5,500 patients and family members with their medical related travel needs.

“The number of applicants to the program has grown exponentially since its inception three years ago,” said Linda Rutherford, Southwest Airlines Vice President of Communication and Strategic Outreach. “Southwest’s program is unique, and we want to provide help to more families in need through our 2011 grant program.”

To see a full list of 2011 participating hospitals and medical organizations, please visit: www.southwest.com/cares.

To read an excerpt from a few of the families who received free transportation through a grant in 2009, visit Southwest Airlines Nuts About Southwest blog: www.blogsouthwest.com. To learn about qualifications for travel assistance through the designated organizations, please contact the Social Work, Travel/Concierge Service, or Patient Assistance Department directly at each location, which each have unique guidelines for administration of tickets.

Did you know...

Medical Transportation Grant Programs:

Share the Spirit® with Southwest Airlines


The idea of healthy eating brings to mind the ancient fable of the blind men who tried to understand an

elephant by describing its different parts. After the blind men all conversed on their findings, the results were conflicting. For anyone who has never seen an elephant, it may be difficult to believe that the tail, ears, and tusks could all belong to a single creature. In the world of nutrition, public-health experts, physicians, psychologists, geneticists, molecular biologists, and nutritionists all have conflicting theories on healthy eating and managing an ideal weight. The challenges of determining fact from fiction can often leave us feeling helpless with little-to-no control over our bodies. But what’s the one thing that we can control? Our self-control, of course.

Because the body is adapted to food scarcity, the brain goes to great lengths to preserve body fat. This obnoxious habit can be attributed to the lack of food resources that our ancestors have faced for centuries. Food abundance is a new problem challenging our self-control and forcing us to struggle with some of our deepest impulses. To seek a solution for this issue, we must first identify the problems.

Seven Things That Make You Go “Mmm”

Knowing what makes you eat more food will help you gain more control of the situation. Consider these facts:

(1) The Time of Day: “Through routine, we condition our bodies to expect breakfast, lunch, and dinner at the same time each day,” said Randy Seeley, a professor of psychiatry at the University of Cincinnati, said. “Part of the reason you’re hungry at noon is because that’s the time you’ve eaten for the last 100 days.”

(2) Sight: Research using MRIs shows that brain patterns of people viewing photos of foods they like and foods they don’t like are “very different,” Seeley said. “The body anticipates when food is about to enter the system.” And that’s why your mouth starts watering when you see your favorite dishes.

(3) Variety: Even after eating a large meal, we often “make room” for dessert, because a desire for sweets hasn’t been satisfied. Ann Gaba, a registered dietitian at New York Presbyterian Hospital, said that “sometimes all it takes is a bit of fruit in a salad during a meal to curb a sugar craving.”

(4) Smell: “Once the trigger goes off, it can induce the insulin secretion that makes us think we’re hungry,” Sharron Dalton, a nutrition professor at New York University, said. “Smell and sight alone activate the appetite cascade.”

(5) Alcohol: Drinking has not been scientifically proven to stimulate appetite, but too much beer, wine, or liquor can impair judgment, causing us to eat more. “Most people who are on a diet will say it’s a lot harder to push themselves away from the table if they’ve been drinking,” Seeley observed.

(6) Temperature: The colder the temperature, the more people tend to eat, which is why restaurants often keep thermostats low. “Your metabolism drops when it’s time to eat, and eating warms you up,” said David Ludwig, professor of pediatrics at Harvard. “Heat is a satiety (fullness) signal.”

(7) Refined Carbs: After a meal heavy in refined carbohydrates, like white pasta, the body may crave food again within only a few hours. These foods cause blood sugar to drop, and “when our blood sugar is crashing, we’re going to be a lot more interested in food in general,” Ludwig said.

Controlling your appetite

With a better understanding of the factors contributing to over-indulgence, it is important to identify some real solutions that anyone can practice.

If the time of day tells us when we are hungry, why not use this to our advantage? Being consistent by eating breakfast and regularly scheduled meals


Why we over-indulge, and what we can do to control this nasty habit.

By Eric Lowe, COO of Comprehensive Health Education Services, LLC

Eating With Your Head, Not Your Stomach


helps keep hormone levels steady and muffles those annoying hunger pangs. Rather than just three meals a day, try five-to-six smaller meals spread out evenly throughout the day to maintain ideal hormone levels.

It’s no mystery that the sight and smell of food antagonizes the appetite. And it would be impractical to pin our nose closed every time we enter a room with food, or wear a blindfold during meal times, but the mental awareness of such culprits can better equip us to exercise self-control. By knowing that our bodies are reacting to what we see and smell, we can tell ourselves not to overreact by eating too much.

If you’re a victim of sugar cravings and love your desserts, take Ann Gaba’s advice and try fruit as a sweet substitution. This is easier said than done, so here’s another tip: try taking a break from that ice cream to brush your teeth. The flavor change can help you resist eating more.

Staying sober by practicing little-to-no alcohol consumption can help you make wiser eating choices. The general lifestyle of heavy drinking can strongly promote unhealthy eating habits. In extreme drunken states, we often feel that it’s necessary to devour our food to sober up. Although remedies for a hangover are controversial, many would agree that heavy eating is one of the more popular solutions.

Things like body temperature, hunger, thirst, fatigue, and sleep are controlled in a portion of the brain called the hypothalamus. The connection between temperature and hunger in the hypothalamus is why individuals are more likely to feel hungry when in a cool place rather than in a warm one. Consequently, you’re more likely to want high-calorie dishes in cold weather than in hot weather. Items like stews, roasts, and thick soups are the preferred foods that tempt you in the winter, rather than those you find more pleasing on a hot summer day, like salads, chilled fruit, and simple sandwiches. This difference is no coincidence: food gives you calories and calories keep you warm. Your body makes sure that you get what you need depending on the temperature. Your stomach empties more quickly as food speeds along through the digestive tract. By dining in warmer environments, you can actually curb your appetite.

Many carbohydrate food products contain refined carbs, processed carbohydrates with compositions altered from their natural state. The refining process often leaves the product tasting better, but with less nutritional value. Knowing how to differentiate between refined and unrefined carbohydrates can be helpful in ensuring that you get the greatest nutritional benefit from the foods you eat. Unrefined foods, especially those that are high in fiber, help maintain sugar levels, giving you a feeling of fullness that lasts longer. Some examples of unrefined foods include whole grains, fruits, dark-green and yellow/orange-fleshed vegetables, nuts, seeds, and legumes—such as black beans, black-eyed peas, garbanzo beans, kidney beans, lentils, navy beans, and pinto beans.

If you’re still unclear on how to identify refined foods from unrefined foods, here are some pointers:

(1) By reading the ingredient labels on food products, you’ll find various terms used on carbohydrate foods such as “enriched wheat flour.” This means that

the product is a refined flour stripped of its vitamins, minerals and fiber, with some of the removed nutrients added back in. Products that are unrefined will list ingredients as “whole” and “unrefined.”

(2) Check the fiber content of the food in question. Refined carbohydrates contain less fiber since the processing removes much of the healthy fiber.

(3) Unrefined carbohydrates have a lower

ratio of sugar to other ingredients, so the amount of sugars found in the product is often a helpful clue. The process of refining concentrates the sugars in the product to much higher levels.

(4) And finally, examine the nutritional value. Most refined foods provide many empty calories that have few, if any, nutritional benefits such as vitamins, minerals, good fats, and anti-oxidants.

The latest diet fads, miracle drugs, and weight-loss programs will come and go. Some may work, and others may not.

Genetics, medications, age, depression, the environment, and more are all beyond our control. This is why it’s so vital that we take control of what we can. Changing the way we react to food, combined with a good exercise program, is a great start to a healthier life.

In case you’re still feeling a bit empty at the end of this article, here’s one more tip for dessert: slow down. It takes a while for the brain to realize that the stomach is stretching. Eating slowly gives the brain time to catch on, and gives you time to say “stop”. Remember to eat with your head, not your stomach.


On January 24, 2011, United States Secretary of Health and Human Services (HHS) and United States Associate Attorney General Thomas J.

Perrelli announced the recovery of “more than $4 billion in taxpayer dollars in Fiscal Year (FY) 2010” in healthcare fraud cases. To date, this is the largest amount ever recovered from individuals attempting to defraud taxpayers—particularly senior citizens who benefit from Medicare and Medicaid.

These efforts date back to the May 2009 creation of the Justice Department and HHS-led Health Care Fraud Prevention & Enforcement Action Team (HEAT), which called on teams in seven cities to file charges against 284 defendants who collectively billed Medicare more than $590 million.

In the same press release, HHS announced the new rules authorized by the Affordable Care Act that “will help the government work to prevent and fight fraud.” These new rules will create a rigorous screening process, temporarily stopping selected providers and suppliers, and ceasing payments when necessary. Further, they will enhance the vetting and enforcement capabilities and authority of the government. To do so, the Centers for Medicare and Medicaid Services (CMS) will solicit state-of-the-art fraud fighting analytic tools that will help predict potential abuses.

“These new enforcement measures will help keep the bad actors out of Medicare and Medicaid,” Donald Berwick, administrator for the CMS, said in a statement.

Giving Credit Where It’s Due

A copy of the regulation may be found at the Federal Register and may be downloaded from the following link: www.ofr.gov/inspection.aspx. If this link is deactivated, the publication will be available at: www.archives.gov/federal-register/news.html.

More information can be found at www.HealthCare.gov, a web portal made available by the U.S. Department of Health and Human Service. A fact sheet on the new rules is available at: www.HealthCare.gov/news/factsheets.

Advocacy

The findings, released in the annual Health Care Fraud and Abuse Control Program (HCFAC) report, are a result of President Obama targeting the elimination of fraud, waste, and abuse.

“In 2010 the government has made it made it perfectly clear that healthcare fraud and abuse of tax payer dollars are unacceptable. In the past, fraud prevention efforts have been targeted on recovering taxpayer dollars after they had already been paid out,” Sebelius stated.

Sebelius went on to say that “thanks to the President’s leadership and the new tools provided, we can focus on stopping fraud before it happens.”

It is apparent that these new joint efforts by the Federal Government, have achieved unprecedented results. The abuse by uncertified and unchecked providers collecting federal funds for services in the past will now see increased scrutiny. In the past, individuals claiming to be legitimate providers have been responsible for the theft and misuse of taxpayer money. HCFAC has incorporated joint support from two departments to coordinate federal, state, and local law enforcement activities to fight healthcare fraud and abuse.

It is the hope and desire of industry stakeholders that these enforcement and monitoring efforts by the federal government continue. Home medical equipment providers will also have the task of educating the government and beneficiaries on the importance of service and care provided by these companies.

By Mike GallagherVice President of Government Affairs


As healthcare fraud prevention and enforcement efforts have recovered a record $ 4 billion, the government announced new Affordable Care Act tools that will continue to reform the system

Corporate Headquarters

Alana HealthCare, LLC208 Dragon DriveDickson, Tennessee 37055Telephone: (615) 375-1094Fax: (615) 375-1132Toll-free Phone: (877) 796-9679www.alanahealthcare.com

DME Tennessee, LLC: DME of Dickson760 Hwy 46S Dickson, TN 37055Office: (615) 446-7444 Fax: (615) 446-7483

DME of Jackson117 North ConalcoJackson, TN 38305Office: (731) 660-5080 Fax: (731) 660-0025 DME of Union City1200 B South Bishop St.Union City, TN 38261Office: (731) 885-2122Fax: (731) 885-2177 DME of Dyersburg1083 Vendall St. Dyersburg, TN 38024Office: (731) 286-1000 Fax: (731) 286-1001 DME of Clarksville1817 Madison St. Suite 5Clarksville, TN 37040Office: (931) 503-1309Fax: (931) 503-1313

subsidiaries

Alana HealthCare Pharmacy, LLC:208 Dragon DriveDickson, Tennessee 37055Telephone: (615) 375-1094Toll-free Phone: (877) 796-9679Toll-free Fax: (877) 471-2484

Alana HealthCare Infusion Centers, LLC:214 N 25th Avenue NNashville, TN 37203Office: (615) 375-1094

DME of Erin15C North Boone St.Erin, TN 37061Office: (931) 289-3947Fax: (931) 289-5308 DME Orthotics and Prosthetics127 Crestview Park Dr. Ste 104Dickson, TN 37055Office: (615) 740-0177 Fax: (615) 740-1154 DME Orthotics and Prosthetics1817 Madison St. Suite 5Clarksville, TN 37040Office: (931) 503-1309 Fax: (931) 503-1313

DME of Nashville214 N 25th Avenue NNashville, TN 37203Office: (615) 446-7444Fax: (615) 446-7483

Documents

Spring 2011