Archive for the ‘Hospital’ category

Like Deep Sea Fishing

February 2nd, 2009

Being a little older or just more chronologically mature makes this new life of consulting somewhat like snorkeling or even deep sea fishing for me. It’s a whole new world out there. If the total culmination of all of my experiences were listed on an 8½” x11″ sheet of paper in order of interest, category, and complexity, it would have to be written in 4 pt. type.

When it comes to prioritizing, cataloging, and quantifying my consulting practice desires, skills, knowledge base or just interests, this gets somewhat crazy at times.

For example: Planetree and the Samueli Institute have both captured my imagination and, I’m sure that over the years, I’ve captured theirs as well. Optimal Healing and Patient Centered Environments are my forte, my passion, and my love.

Do you know all about Web 2.0 …or 3.0, as some are calling it now? I’ve presented all over the United States and been featured on podcasts and webinars for years. How should you use Twitter, YouTube, and other streaming video platforms, Facebook, Blogs, Podcasts, Webinars, and other new technologies to move your business forward, to publicize your specialities, and to get your company’s name out there?

The actual science of microbiology is NOT necessarily one of my passions or deep skill sets, but running a research institute for nearly a dozen years that specialized in proteomics, genomics, biomedical informatics, and histopathology while interacting with the Department of Defense and Military medicine community certainly is a skill base developed through massive amounts of tears, sweat, and blood (my own). This information alone should be something that someone needs to know about on a regular basis.

The world of small and rural hospitals you say? My goodness, name someone who has had more “edgerunning” experience in this area than I have, and I’ll personally send them flowers. The growth, nurturing, care and feeding of a hospital that is smaller than 100 beds takes special stamina and a very positive mental outlook, because limited resources require unlimited creativity.

Economic Development through technology, healthcare, small businesses, and even tourism seems to have been a recurring theme in my world for decades. Jobs, Jobs, Jobs.

How about OC-48 dark fiber, telemedicine, teleradiology, telepharmacy, telecritical care, and teledermatology? Been there, done most of that, and have been working with groups and contacts who can add electronic medical records, disaster recovery/business continuity, data fusion centers, and other areas of specialty to your needs.

Interested in being an all-GE shop? Going completely digital? Having a 3T MRI with a breast coil? How about mobile PET/CT or the latest in mammography, and data repository technology? Okay, I’m not an expert, but I sure do have some interesting knowledge and amazing contacts here, and when it comes to breast care centers, we constructed one of the finest in the world.

Green? Wanna be green? Well, unlike Kermit’s song, it can be easy being green, and one of my current assignments involves everything green for schools, churches, and, most importantly, hospitals. How to get there, how to save, and most importantly, how to MAKE money from going green is currently something that we understand.

The Dean Ornish Coronary Artery Disease Reversal Program that we established is one of the best in the country, and we know how to set them up, run them, and help them prosper.

What about the World Health Organization? Work in the Netherlands, Croatia, Bosnia, Serbia, Montenegro, England, Italy, Greece, and even Africa interests me deeply, and my contact lists from those areas are very long indeed.

Construction? How to afford it? Alternatives to traditional methodologies, traditional financing, and Planetree design? Yep, we have that knowledge base, too.

Of course, there are things that you probably haven’t even considered: Wellness or EQ education, Patient Centered Care models, employee centered care to get you to patient centered care, the use of Markeking to grow your organization and to protect your position, and don’t forget: board relations, strategic planning, employee education, and, of course, nutrition.

Now, add to that this list of skills that SunStone brings to our table as well: the CDM, charge process, Compliance, Documentation Accuracy, Inpatient Coding and Compliance, Outpatient Charge Process Analysis, Outpatient Billing Maintenance, Pharmacy Revenue Cycle, Pricing, Recovery Audit Contractor Readiness, Reimbursement and Financial Analysis, Revenue Cycle, Transfer DRG’s and Workers’ Compensation Recovery.

IF YOU NEED US… Remember:

F. Nicholas Jacobs, FACHE
International Director
SunStone Consulting, LLC
1411 Grandview Avenue,
Suite. 803
Pittsburgh, PA 15211
nickjacobs@sunstoneconsulting.com

Home Office: 412-381-3136
Mobile: 412-992-6197
Fax: 866-381-0219

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Two Guys Medical Center

January 9th, 2009

Back in the early nineties, two of my peers replicated the pro forma and business plan of an offer made by a for profit hospital system that was interested in buying a specific medical center. They then presented it to a religious order and ended up buying a hospital which many of us began to refer to as “Two Guys Medical Center.” The difference was that, unlike the religious order, they were interested in it for some personal financial gain, the American way. Once the cash flow turned into a trickle, they found their way clear of ownership with heavy golden parachutes from the organization that bought the hospital, and it became the gift that kept on giving. All in all I’m sure that it was a very lucrative series of events that, after their or my death would make for a great fiction novel.

As I prepared for my departure from my previous employer, the entire issue of identifying someone to continue to carry the torch of leadership weighed heavily on my mind. Succession planning, if you will, was never far from my thoughts. With that in mind, I looked into the region and found, well, two guys. These two guys were very different from the previous two mentioned. They were committed to the good of mankind on so many levels that no one could question their personal intentions. Over a year later, the reality of their futures does not lie firmly in my hands when succession is discussed, but they certainly are two people to watch as the region’s health systems continue to morph medically.

Only four short years ago, Tom Kurtz, one of my two recruits, was working diligently every day in every way to ensure that four heart stents was an inadequate number for my chest. It had been his job at the competitor to literally master my strategic plan and to replicate it at an even higher level. He found federal, state, and local funds to begin a neuro-science center, research in post polio syndrome, work in anesthesia that would be converted to the battlefield, and, in his spare time to build and promote a Tech Park for the City of Johnstown.

We were usually friendly, but fierce competitors. He honestly has never told me the entire story of his journey with his former employer’s leadership, but I’m sure it would fill about ten of these blog posts. Tom was a master at political nuance and learned quite a bit about grants from the Department of Defense. He not only knew where to find them, he learned how to get the monies delivered to the projects for which he was responsible. Tom is progressive, aggressive, and knowledgeable about both the need to find sustainability on the research side and growth on the hospital side. When it comes to the “vision thing,” Tom embraced that as well. He’s not one of those cant-see-the-forest-for-the-trees guys. In fact, he is just the opposite of that. He sees the big picture and quickly embraces just exactly how things can be in the future with a little guts and a lot of persistence.

Dr. Matt Masiello

Then came Matt. Dr. Matt Masiello has been a friend for over a decade. He represents almost everything that I embrace philosophically. Matt is a gentle and kind man who fully comprehends the value of treating human beings like human beings. A background as a pediatrician has enabled him to understand compassion, and after having been in charge of intensive care for years, he has also learned of the heartbreak that this profession can bring. Dr. Matt captured my attention a year or so ago when, like me, he got involved with the World Health Organization. This time, however, he went way beyond my wildest dreams and has literally been appointed the U.S. representative for the WHO.

When my short history on this planet is finally written, let it be said that Matt and Tom have had a tremendous impact on our community, our region, and now our world as special attention is given to breast cancer research, and as health and wellness, prevention and anti-bullying programs are nurtured, cultivated, and grown by these two men. No, it’s not “Two Guys Medical Center,” but it sure is a medical center that has been positively impacted by two guys. Keep up the good work, Matt and Tom. This region needs you.

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More on Leadership…

December 12th, 2008

Nick Jacobs, FACHE author of Taking the Hell Out of Healthcare

One imperative for any leader is a positive mental attitude. We must work tirelessly on believing in ourselves, and then we must work constantly to reinforce that belief with positive self-talk. If we embrace that concept that we can, there’s a very good chance that we indeed can. If, on the other hand, we believe that we won’t, we probably won’t. This single belief can initiate all forward movement. Winners in life constantly encourage themselves to think that I can, I will, and I am, and they don’t focus on the past —the should have, would have, or can’t do’s are gone forever. We can never make a better past for ourselves.

Last year, one of our employees attended a non-traditional educational seminar whose primary focus was directed toward the analysis of different personality types. When the employee returned, I asked, “What did you learn?” Their response was, “I learned that the primary function of people with my personality type is to pee on your cornflakes, to rain on your parade, and to frustrate your every creative idea, because that’s just what we do.”

Hence the opening paragraph of this piece. We are in difficult economic times, and the general counsel from our advisors is more often going to be to take no risks. If they are doing their jobs, we will be inundated with reasons why we should be against almost everything. In fact, words like growth, expansion, and opportunity all seem to be put away as this storm cellar mentality prevails. They will argue that they are saving their organizations by “shrinking to greatness” while opportunity after opportunity slips away.

One of my favorite visuals of this mind set comes from the 1990 movie Ghost where the people were helped to find their place in eternity by little demons that came out of the sewer grates to drag their souls into Hell. As leaders, we are surrounded every day by people who see their job as one of hard, cold, black and white facts. There are the extremists who spend their days spreading pessimism, fear, gloom, and negative energy; looking at the down side as they constantly undermine not only growth, but the attitudes that foster growth. The blacker the sky, the deeper the reinforcement of their concerns, and the more intense the corporate paralysis becomes throughout the organization.

Positive Mental Attitude Psychologist, Denis Waitley helped to change my life when he lectured on this topic nearly 30 years ago. He had been the U.S. Olympic athletes’ psychologist. Dr. Waitley taught us to learn from the past, set vivid, detailed goals for the future, and live in the only moment of time over which you have any control: now. He always spoke about the reality that life is inherently risky and that there is only one big risk you should avoid at all costs, and that is the risk of doing nothing.

Don’t get me wrong, conservative thinkers are important in the balancing act of leadership, but they must never be given the power to control all aspects of an organization. It is a recipe for disaster. The result will be stagnancy and eventually, business failure. There must be a means to carefully look at what they have to say, to evaluate the risks outlined, and then to make a decision based upon the prudent person process, but, having said that, remember that leadership is not a gutless proposition.

If you are not interested in some sleepless nights, tension filled meetings, or numerous failures, don’t get into the game. As Waitley says, the winner’s edge is not in a gifted birth, a high IQ, or in talent. The winner’s edge is all in the attitude, not aptitude. Attitude is the criterion for success. There are two primary choices in life: to accept conditions as they exist, or accept the responsibility for changing them.

A leader’s world is not always black and white.

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Something’s Gotta Give, Something’s Gotta Give, Something’s Gotta Give!

November 1st, 2008

My Facebook friend, Anne Zieger, editor of Fierce Health Finance, wrote a compelling piece the other day regarding the potential demise of hundreds of hospitals. Her prediction is based upon some very valid financial realities, and we are witnessing them locally as well as nationally. Not unlike the little banks in our area that seemed to have been insulated from Wall Street’s collapse, some of these national problems seem to be washing over some of the smaller hospitals with relatively minimal damage. Yes, many of us have seen as much as a 10% decrease in elective, outpatient procedures.

In fact, while visiting a really upscale mall for a photo session with my two year old granddaughter, Lucy, an employee engaged me in a conversation about the rotten economy. About five minutes into the conversation, she indicated that there are currently 150 stores in the chain for which she works, and that only five percent of them made budget last month. Portrait pictures must fall into the category of a luxury as their business is severely impacted by this economy. More directly, however, she indicated that she needed stitches removed the other day, and that, “she did it herself” rather than spend the $20 co-pay.

So, are we seeing decreases in important tests? Are we seeing patients avoiding emergency room visits? Are we seeing patients cutting their prescriptions in half? Yes, to all of these questions. Anne, however, seemed to be talking about the “big boys,” where their millions or billions in investments have recently tanked. If you are so big that your income from running the hospital is not a major source of protection, and your income from your investments is propping you up, then the problems begin to manifest themselves exponentially.

“Some hospitals are responding by digging into their investment income more deeply than usual, using it to finance capital projects, or even meet operational needs. Others are issuing bonds with the scary codicil that they’ll buy them back if finicky investors want to dump them,” states Zieger in her column.

She further goes on to explain that “both of these situations put a huge squeeze on hospitals’ long-term viability. One robs from their long-term assets to solve medium-term problems, while the other puts the hospitals at risk of being bled dry by investors who get spooked.”

Well, wouldn’t ya know? Yes, we are seeing a few challenges due to decreased electives, but not because we were living off of our investments. The other good news is that, because we froze our fixed pensions several years ago, we are seeing very little impact upon them from the huge drop in those investments as well. Unlike many of our larger peers, neither of these issues is similar. Between the drops in the market, the loss of pension funds, the decrease in electives, and the down-grading of their viability by the bond markets, their challenges look galactic in size compared to ours.

Sometimes smaller is just safer.

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As Close to Home As You Can Get

October 15th, 2008

Yesterday afternoon the realities of humanism, mortality, and fear attempted to take me out for about the one millionth time in my life. A phone call came from a loved one casually explaining that the doctor had potentially discovered a problem that needed further examination. When the office called for an appointment to have the scan done, they were told that it would be approximately a week before there was an opening in the schedule.

As an insider, I knew that a certain number of slots were held each day for emergency or unscheduled procedures. Not unlike the hotel that holds back a room or two from the 1-800 reservation list, just in case a preferred guest or luminary comes through the doors, flexibility is something that hospitals have to embrace at some level.

Taking the Hell out of Healthcare by Nick JacobsOnce again, as an insider, a call to the department resulted in an immediate invitation to come in for the test the very next day.

My route to health care management was a particularly unique and circuitous route, and it left me asking the question, “why does it have to be this way?” I’ve personally done everything that I can to make it humane, patient centered, and sensitive.

If you or your loved one wants to know the inside story on how hospitals work, take a look at my new book, “Taking the Hell out of Healthcare.” It really can help. It is a simple “how to” book aimed at the everyday person who is having to deal with this complex and sometimes difficult world of health care.

My passion and personal commitment has always been to patient advocacy, transparency, and human kindness. Find out how to make the system work for you.

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In Their Own Words: Patients, staff and physicians on their experiences at Nick’s Planetree hospital

October 5th, 2008

View SlideShare presentation or Upload your own. (tags: hospital medical)
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Think Global and Act Local

October 1st, 2008

Over the years people who’ve liked me have referred to me as a real visionary, but, in all fairness, the people who thought that I was an incompetent also called me a visionary. One group called me that as a compliment. The other group used the description as a put down. Considering that my physician discontinued my prescription of Atromid S medication back in the late 70’s because he said the it caused early cataracts, I’m not all that sure about my actual vision.

As a kid it was fair to say that my approach to any problem that came my way was, well, it was just different. In fact, I’d spend hours trying to come up with unique solutions to problems that otherwise might have only taken a few minutes to solve the normal way. It was my thing.

In fact, my problem solving skills could only be described as journeys down the “Road Less Traveled.” Kind of the McGyver approach. What can I do to meet this challenge by using a Zippo, some thread, a chewing gum wrapper, and piano wire? Of course there were sometimes periodic episodes of near tragedy from this approach, you know, like the time I watched the front right wheel on my wagon roll past me as my journey took me down the 80% grade that my parents called the backyard. Thank God the axle dug in just enough to stop me before the approaching cliff. (The bobby pin didn’t hold.) Between Evelyn Wood’s Speed Reading course and Cliff Notes, I read Moby Dick in about 13 minutes.

By the time college rolled around, it was clear that my addiction had spread from alternative methodologies of problem solving to a pure and simple love affair with anything that was new, cutting edge, leading (or even bleeding) edge or avant garde. “Contemporary” was the catch word all those years ago. From art films to modern music, there was no end to my attraction to new and novel things.

Well, Inside Healthcare ran an article by Clay Sherman that was entitled Think Global and Act Local that contained some great tips for survival in healthcare. Mr. Sherman talked about the Joint Commission the way that most hosptial CEO’s would like to, but do not have the guts to do so. He described the Joint’s role as one of minimalism, and that was where his description stopped. His suggestion was to drop the Joint and to engage some larger, more aggressive organizations like NCOA or Leapfrog. His words of wisdom here were, “Either embrace a rigorous standards process, or watch your successor do it.”

Mr. Sherman went on to suggest the need for us to embrace best practices methodologies, new standardization techniques, online communities for patients with similar diseases, and he closed by saying “Stay centered focused in building human assets — its their brains that are going to get you there.” Hmmm? Sounds a little like last week’s blog.

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Quality of Care

July 31st, 2008
Back in the 70’s, competitive marching bands came into vogue in Western Pennsylvania. Let me explain the before and after of this phenomenon: Before there were competitions, bands were made up of nearly 10 times more students than they typically have today. My bands ranged in size from 120 to 185 students. Once competition came into play, the borderline students were not able to survive. Consequently, it is not unusual now to have 20 students or less in a band.

Steelcity_border

What’s happening in medicine and in health care overall? The Government is taking a three-pronged approach to improve quality in health care:

1. They are pushing quality through public reporting. (Check a website near you.)

2. Enforcing quality through the False Claims Act. (Check a prison near you.)

3. Incentivizing quality through payment reform. (Check a checkbook near you.)

Senator Chuck Grassley is quoted as saying, “Today, Medicare rewards poor quality care. That is just plain wrong, and we need to address this problem.”

HMO’s are currently embracing “pay for performance” plans for physicians and hospitals. Medicare is introducing value-based purchase plans. Medicare is proposing the linking of quality outcomes to physician payments.

As I have written before, hospitals will no longer be paid for hospital acquired conditions. That seems like a rather simple fix, but to appropriately determine if the condition was not acquired at the hospital, extensive testing must be added pre-admission at considerable costs to the hospitals.

James G. Sheehan, Medicaid Inspector General of New York said, “We are reviewing assorted sources of quality information on your facility to see what it says and if it is consistent. You should be doing the same.”

Except for the financial implications, not unlike my competitive band story, the goal was to work toward perfection. The public reporting of quality of care is intended to:

1. Correct inappropriate behavior

2. Identify overpayment’s

3. Deny payments

KirkOgrosky
The False Claims Act, on the other hand has different goals. When asked how he viewed the False Claims Act, Kirk Ogrosky, U.S. Deputy Chief for Health Care Fraud said, “You will see more and more physicians going to jail.” I guess the prisoners will be receiving better care.

Where’s it all going? Competitive band. Will it improve health care delivery? Probably, for the patients who can find the few docs and hospital that will be left? I recently had a conversation with a young computer specialist who took care of physician practices. He said, “Doctors and hospitals haven’t figured it out yet, but they are simply becoming data entry centers for ‘Big Brother’ as the facts and figures are accumulated to be used against them any way the payers decide to move forward.”

Looking back at the school year that included gym class twice a week for the entire year, rich courses in music and art, and remembering a time when priorities included those classes intended to make every student well rounded, we have to ask, “Is education today better?

Maybe this is all too complicated to get our arms around, but if there are 78 million Baby Boomers, and the Medicare Trust Fund is heading toward bankruptcy, then we probably will see every rule in the book being applied to keep from paying out money, because there is simply not enough money to go around.

Will health care improve? Once we understand that technology is not the end all and cure all that creates healing; once we endorse prevention, wellness, optimal healing environments, and systems approaches to health and wellness, health care will improve. I’ll bet you that it will have very little to do with the rules that are unfolding right now and much more to do with the creation and acceptance of a National Health Policy.

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A Time to Reflect On Life

June 15th, 2008

With the passing of Tim Russert, we are all made critically aware of the fragile nature of life and our need to embrace every moment as a gift.  Obviously, within a split second, every aspect of our lives can change, and, as in Mr. Russert’s case, can end.  This is not a blog about instant death, and it is not just about recognizing our mortality.  It is about preparing for our passing carefully.

Russert
Liz Szabo, a writer with USA Today described in a recent article the cancer patient experience by saying, “Patients with advanced cancer often don’t know how long they have to live or how chemotherapy will affect their lives.”  According to a study by the Journal of the American Medical Association, many physicians either don’t give patients that type of information or the patients only “hear what they choose to hear, or very often misunderstand what is said to them.”

This situation often leads to patients requesting incredibly disruptive and sometimes painful therapies that have no hope of succeeding.  According to the study, more than 20% of Medicare patients who have advanced cancer begin a new chemo regimen two weeks before they die.  Many times patients are admitted to hospice days or hours before they die.

What has been observed in cases like this was that the patient often misses the opportunity to repair relationships, get their spiritual house in order or even prepare the necessary documents such as advanced directives.

Where is this going?  Sarah Harrington, an assistant professor at Virginia Commonwealth University School of Medicine in Richmond, co-author of the quoted article, indicated that “in the last few weeks or months of life, a lot of good work can be done.”

One of the points brought up in the article was that only about 37% of physicians told patients how long they had to live. This fact was not surprising to us because we have seen dozens of patients who were admitted to hospice over the years return home and live several more months or years. This particular prediction is not always dependable. The other fact quoted in the article, however, was that many patients learned more about their cases from other patients than from their physicians.

The article concluded with the suggestion that “patients and their families may have to take the initiative in finding answers to important questions.”  Thomas Smith, co-author and Chairman of Hematology and Oncology at VCU’s Massey Cancer Center suggested that the following questions should be asked by any patient in this situation:   What are my options?  Can I be cured?  Will I live longer with Chemo?  Should I consider Hospice or Palliative Care?  Who could help me cope?  What do I want to pass on to my family to tell them about my life?

Eldercare_visit
Palliative care is not limited to cancer.  All end-of-of life diagnoses qualify patients for hospice and palliative care.  Tim didn’t need or have this opportunity, but for those who do, embrace it. The primary thing that can be delivered to the patient and their family is the comfort of having caregivers dedicated to helping you move through your transition.  It is what they do.  These amazing people, volunteers, employees and physicians are dedicated to “paying it forward.”

So, as we eventually face our own mortality, as we evaluate what it is that we want to share with our families, as we consider the legacy that we wish to leave, having a clear mind and looking to those professionals who can help us is not only necessary, it is imperative. This transition can come in the blink of an eye.

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Knowing Enough About Systems to be Dangerous

May 30th, 2008

From the age of about eight until 20 years ago, my entire life was immersed in music, education, the arts and, in a very pure way, people in general.  It was a complex world that required a deep, intuitive understanding of the human condition on multiple levels.  In a very general way, that life, (pre-health care management) was all about systems.  

Obviously, it was never just about one or two individuals, and it was not about life and death, but it was magnificently complex in its own way. It involved working with  people to do something that was extremely challenging, that required incredible hand/eye co-ordination, and an ensemble mindset of co-operativeness that was paramount to success.  Most importantly, it required them to listen intently to each other so as to find the perfect balance, blend and intonation. 

The nuances of taking a systemic approach to the creation of music through the efforts of an ensemble in many ways have escaped our world of healing, at least until now. 

At a recent visit to my dentist, he and his hygienist were talking about the fact that the doc had just taken a continuing medical education course.  When he was asked if anything new had evolved from his class, he smiled and said, "Well, for the first time in 28 years of practice, they admitted that the mouth is connected to the body."  He went on to elaborate about the fact that each and every day he sees the destruction caused by inflammatory disease of the gums, and then told me about his attempts to communicate that information to a physician friend several years ago.  "It just didn't register," he said. 

What little we know about inflammatory disease has us dutifully brushing our dog's teeth to prevent a heart condition, yet we still do not have direct lines of communication between our primary or cardiac physicians and the the dentists who see these problems as they manifest themselves in our body.  

Someone once told me that Descartes' Treatise of Man played a major role in the imposed medical and emotional separation of the brain from the body, as it clearly took the stand that "Hospitals and physicians should take care of the body while the church takes care of the mind and the soul."

One of our scientific collaborators, Dr. Lee Hood, is famous for his work in Systems Biology.  Another collaborator, Georgetown University, is involved in the creation of a medical school program revolving around Systems Medicine, and finally, our Optimal Healing Environment collaborator, the Samueli Institute, is focused on Systems Wellness.  In spite of these wonderful leaps into what would have to be considered common sense approaches to health and life, we still sometimes miss the ensemble approach.

My recommendation? 

Maybe it would help our healers to take their place on the podium, look at every one of the 30 plus lines of music on the score, raise the baton and begin to direct their way through every nuance, inflection, and harmonious signature present in a score of music with the appropriate rhythm, intonation and accents just to remind themselves that; we human beings are basically all made up of systems as well, and those systems will not function smoothly if one is completely out of sync with the other." 

This is something that we all know intuitively.  Maybe immersing ourselves in that world for a while will help bring that concept totally back into focus.  It's all about harmony, balance and nature's perfection, and a disjointed approach to health is as potentially harmful as a disjointed approach to life.   

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