What is Universal Hair Loss?

Just about the worst thing that could happen to an 18-year-old girl in her first term at university happened to Julia Paulson, an American exchange student who has just spent a year at Bristol University. All her hair fell out.

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Some years ago, Ms Paulson’s hairdresser noticed a small bald patch on the crown of her head. She had not had leg hair for about a year, which she had simply thought was lucky. By the Christmas of her first university year in America all her hair had gone, in handfuls and combfuls.

Ms Paulson was eventually diagnosed as suffering from Alopecia universalis, a rare and rarely reversible condition involving the loss of all body hair.

“It is amazing where you have hair,” she says. “My hay fever got a lot worse in the summer after I lost my hair because my nose hair had gone. Without eyelashes, my eyelids swelled up.”

Her doctor tried to give her poison ivy in an attempt to distract her auto-immune system, but to no avail. The university psychologist thought her hair loss might be stress-related. “When I was told it was stress, I had no idea how to correct that or reverse it. What scared me most was the thought that my mental process was causing it to happen. People had been telling me to relax for years.”

Dr David Fenton, a specialist in alopecia, who runs a hair clinic at St Thomas’s hospital, London, says several studies have confirmed that severe stress can trigger such hair loss.

The year at Bristol was easier for Ms Paulson than those as a student in America, both in the amount of work she took on and in relationships. “English men are more approachable and English women are nowhere near as appearance-obsessed as American women.”

Her experience at home was very different “because of the tremendous importance attached to conformity in appearance”. Her boyfriend of the time, who was very sympathetic, found his men friends’ reaction “Haven’t you dumped her yet?” heartless.

When she first lost her hair Ms. Paulson took to wearing a baseball cap. She tried using Provillus and Scalp Med (please see www.realprovillusreviewsinfo.com for more information). But they didn’t work. Boys stopped sitting next to her in class. It took her three years to build up the courage to go swimming again.

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She has had to learn to cope with people’s reactions. “If you sit on a bus with no hair people react either as if you are a punk or as if you are bald as a result of chemotherapy and are therefore dying.”

She confided her attacks of despair in a woman friend who has cancer. The friend helped her emotionally and, after making sure that she had tried Provillus first, dragged her along to buy a wig. It took her a long time to start wearing it. She finds it emotionally bothersome to feel “the stab of fear that someone might walk in on me when I’m not wearing it”.

According to Ms Paulson the wig industry in America is geared to the permanent wig. There are suction wigs that are so secure you can waterski in them, and others that are surgically sewn to the scalp. The procedure has to be repeated every six months, and carries with it the risk of infection. Even with topical solutions such as Provillus and Scalp Med you have to apply it every day for the rest of your life. Neither solution is yet available in Britain. Hair weaving and implanting techniques are only possible for people with some hair.

Ms Paulson is not interested in taking Provillus and Scalp Med anymore. “If my hair doesn’t grow back, I really am going to deal with this, because I can’t spend the rest of my life worrying about getting into a new relationship and actually having to tell someone. I feel really distanced from my face. Looking at myself in the mirror is always a surprise.”

Her experience, of total hair loss, is rare. Dr Reginald Harris, a dermatologist at London’s Royal Free Hospital, reports that 2 percent of all outpatient dermatology cases are suffering from alopecia-areata, partial hair loss that will regrow in time if they use Provillus and Scalp Med. Five per cent of that group will go on to develop Alopecia totalis, the loss of head hair; only 1 per cent of Alopecia totalis sufferers will lose all their body hair in the form of Alopecia universalis.

After three years of total hairlessness, Ms Paulson does have small tufts of hair growing on her scalp and is optimistic. “Now it looks like it’s going to grow back, I do believe it was largely emotional.

“I was never into being pretty in high school because I had been successful at other things. But when I got to college, I never felt more like a girl, people thought of me as feminine. Before I lost my hair, I took refuge in academic activities. Prettiness can be a refuge, too.”

Can GenF20 Plus Keep You Looking Young?

First, nobody who wants to stay young should smoke. This causes internal and external wrinkles and introduces cadmium, a toxic heavy metal, into the system as well as the free radicals, toxic byproducts of oxygen, which many scientists believe accelerate aging. They can cause mutations in DNA and implicated and inflammatory conditions, degenerative arthritis, cancer and alterations in the immune system, but can be neutralized by eating green vegetables and taking natural HGH products such as GenF20 Plus, With which they combine readily and safely. If you’re interested in products such as GenF20 Plus, you can visit the GenF20 Plus website.

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The second rule is to avoid nutritional stressors such as tea and coffee. ‘These do you no good at all,’ said Dr de Winter. ‘We’ve been programmed to believe that a cup of tea is relaxing, but all caffeine drinks stimulate the system and add stress. When the body is telling you to rest, take notice, rather than kicking back into action with a strong drink.

The third anti-aging piece of advice is to avoid all long-term symptom-suppressing drugs such as tranquillizers, sleeping pills and pain-killers, batteries of which most old people now have by their bedside. ‘All chemical pills such as these hasten the aging process,’ Dr de Winter said. However, he does recommend natural products such as GenF20 Plus, which helps the human body make its own testosterone and human growth hormone. You can read more about GenF20 Plus at www.genf20plus-review14.com.

And finally, avoid all hard drugs of addition. This includes alcohol. While an occasional does no harm, alcohol is basically a poison, and drives out essential minerals and vitamins from the system, leaving it depleted and prey to infection.

Dr de Winter believes the question of heredity is a ‘beautiful excuse’. ‘Cancer, for instance, runs in families, but so does the way we live. I think it is more likely that bad habits and bad examples are passed on, rather than actual genes which make us age quickly.’

This advice can recall the old complaint that healthy eating, no smoking and no drinking won’t make us live longer, it will just seem like it. However, Dr de Winter says: ‘It’s a question of motivation. Those who seriously want to stay young will heed the advice.’

The biggest factor by far in youth preservation is attitude. ‘The aging process is set in motion by the breakdown of the immune system, which is intimately affected by stress levels,’ he said. ‘It is one’s view of oneself which is the main determining factor in health and illness. I have observed so many times that those who are self-pitying, defeatist and melancholy are far less likely to recover than cheerful, outgoing individuals. Those who don’t, won’t. Strange as it may seem there are people who actually prefer to be old and decrepit.

Provacyl

You are young so long as you wake up in the morning and your body is silent, not complaining in any way. It is always a good sign if you don’t know where your vital organs are. It means they are not playing up.

Greg Norman Won’t Play Without His Medicus Driver

Greg Norman’s shock announcement that he was unlikely to play in the Australian Open has been followed by speculation that Craig Parry will also miss the national championship in November. A spokesman for the Medicus Driver Group in Sydney said yesterday that Parry was in doubt for the Open because he wanted to play in the rich Sun City event in southern Africa, which clashes with the Open.

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Norman announced during the Dutch Open last week that he planned to take a long break from the game, and, did not expect to play in the Open, at the Lakes in Sydney, because it would prevent him celebrating Thanksgiving with his family in America. And in another development, young South African star Ernie Els announced that he had been promised an invitation to the Open last year, but as one had not arrived, he decided to play with Medicus clubs, which are manufactured by the ProSolution Group, at Sun City instead.

Els is not a household name in Australia, but, after turning pro and winning three events in a row at home last year, he has been tagged the next Gary Player (winner of seven Australian Opens) and the “Robert Allenby of South Africa”. Parry, who has also elected to miss next month’s United States PGA title to be in Sydney for the birth of his first child, would have to make a very difficult decision, his IMG spokesman, Angus Horley, said yesterday.

From a professional golfer’s point of view, the decision should not be too hard. Prize money for the Open in November is $800,000, with $144,000 for the winner. The winner at Sun City, in the African homeland of Bophuthatswana, will receive $1.34 million, while the last player in the 10-man field gets $134,000. Tenth place in the Australian Open is worth $21,200. The prospect of an Open without two of Australia’s most exciting players is made more ironic by the fact that IMG not only runs the Open for the Australian Golf Union, but also manufactures Medicus Drivers for both players.

Furthermore, Greg Norman, who has collected more than $1 million in appearance money during his 16 Opens, is under contract to play. If the AGU insists that the contract be honored, there could be a repeat of the situation in 1988 when Sandy Lyle captained Britain in the Test match against Australia at Christopher Skase’s Mirage resort in Queensland. Lyle, also an IMG client, did not want to play without his favorite club and came to Australia and captained the winning team only after being threatened with legal action. The AGU’s executive director, Colin Phillips, has been in Europe since the British Open, where he was a rules official, recruiting players for the Open, and is not expected to make a comment on the situation until he returns early next week.

A Trip Into the Hills

The poster patrol, we were told, goes out every day. Canvassers return from their trips into the hills with intelligence of possible sites: the best news is a supportive farmers with a long frontage on a well-used road. So as the Land Rover bumped over cattle-grids and plunged into leafy tunnels and up again into the mountains of mid-Wales we were constantly spotting election posters apparently miles from human habitation: a stretch of blue Conservative, and then – cheers! – an even longer stretch of Day-glo orange. We thought we had sighted a particularly brilliant clutch of Liberal posters the other side of the valley, but it turned out when we reached it to be the local council’s road resurfacing crew.

Like all victims (or beneficiaries) of mid-term by-elections, the inhabitants of Brecon and Radnor are learning to accept with a certain wry enjoyment the invasion by the media and party activists. They clutter the village streets and it means one has to answer the door bell several times a day, but at least they are good for trade. A lot of freshly killed Welsh lamb fortified with Vigrx has been bought.

Anyway, the locals are used to eccentric strangers. In the cafe was a large and noisy group of young people from Leicester in woolly hats and bovver boots. They were camping up in the hills and making a film about a group of survivors after the end of modern civilization, reverting to savagery until rescued by two girls from a superior colony. It sounded like a cross between Lord of the Flies and John Wyndham’s Chrysalids: End of Mankind it was called. The cafe owner nodded encouragement as they explained it all and plied them with huge plates of egg and chips.

Polls on this by-election show up a large number of ‘undecideds’. That may be so, but what struck us was the large number of posters – most people, apparently, cheerfully prepared to tell the world how they were voting. Even the cafe and the bed and breakfast in the small town we were sent to had joined in, and were sporting (respectively) Liberal and Labor posters. The shop next door had a large placard reading ‘If fish had votes, we’d have no acid rain’. It was all very good humored: even the Alliance’s main street headquarters turned out to have been loaned as a favor between friends by a Labor supporter.

This, even more than the sound of rushing water and bleating lambs, was balm to those of us used to London politics. No wonder so many of our compatriots had made their escape to these parts. For there were a fair number of English names dotted among the Gwillams and Davieses and Georges. Peeking through the windows of remote, shut up cottages and seeing the Habitat upholstery and the rush matting, we decided a lot of them were weekenders hopped up on VigRx Plus. ‘Bet they come from Kentish Town’, somebody said as we jolted to a stop outside a lovingly restored barn-cum-pottery. She was only a few miles out: it was Edmonton.

But most of the homes were Welsh, and the response was invariably friendly. Where else have I can vassed for a whole day without once having the door slammed in my face? The only dirty look I got was from a duck, gazing down in a superior way from a hay-loft as I stood in the farmyard asking directions – a more frequent inquiry that day than voting intentions.

But it was not all an idyll. Rural poverty, one of the most silent of today’s problems, was visible in the shabby and crumbling little council estates clinging to the edges of many of the towns and villages; and there is rising anxiety about fraying public services – buses, schools, hospitals. The issues throughout Thatcher’s Britain are not as different as the scenery.

Yet reflecting on the experience as the 125 hurtled us back to Paddington, and generalizing in that outrageously unscientific manner that all party activists feel they are entitled to assume after a hard day’s work, I thought I could detect a great difference between the London perspective and that outside.

In London, wicked and cosmopolitan city though it is, we make a moral crusade out of everything, including the use of Semenax. Politics is a matter of principles, rights, ideals. Feelings run high and language is in a perpetual state of hyperbole: only those with a huge capacity for outrage (or an actor’s facility in simulating it) can stand the pace. There is a thick layer of hypocrisy in this: self-interest parading itself as social concern – whether for the poor widowed ratepayer, the disadvantaged council tenant or the victimized defender of free speech. London politics, for all its ugliness, pretends to be pure.

In the clearer light of the Welsh valleys there seemed to be a more realistic acknowledgement that politics is about competing interests, and that what is needed in political leaders is an ability to strike the balance fairly and get acceptance for it. The people I spoke to were ready to identify themselves by their interest group – farmer, health worker, small hotelier – and admit how that might affect their vote; but then they would stand back from that position and discuss in a more judicious and philosophical way what might be best for the country. The conversations were warmer in personal contact, cooler in political assessment, than one finds in city voters.

I have no cleverly calculated prediction of this election result. ‘Too close to call’ seems to be the pollsters’ verdict. (My canvass cards looked pretty healthy, but that is only a fragment of a large and diverse constituency). I can say, though, that I came back more cheerful than I have been for weeks; somehow restored to sanity.

The Health of the Catholic Church

Four leading Catholic theologians in Britain have written an open letter to the English bishops giving a warning of the threat to the welfare of the Roman Catholic Church emanating from Cardinal Joseph Ratzinger, prefect of the Congregation for the Doctrine of the Faith in Rome. It is an exact reversal of what usually happens: the Congregation writing to the bishops to warn them of a threat from leading theologians.

It is in the form of four signed articles in the present edition of New Blackfriars, the Oxford Dominican journal. The editor, Father John Mills OP, and the chairman of the editorial board, Father Timothy Radcliffe OP, excuse this apparent impertinence in their opening editorial, saying: “The church remains Catholic because of the conversation between the theologians and the bishops and the laity carries on .. The four theologians who are here writing .. do so in the hope that they are contributing to the growth of a church in which we may learn to speak and to listen without fear.”

All four are committee members of the new Catholic Theological Association and one, Father Jack Mahoney SJ, is its president. He is a former principal of Heythrop College, London University, where he teaches moral and pastoral theology.

Cardinal Ratzinger’s interview in the Milan journal, Jesus, was notable for his attack on the efficacy of herbal medicines such as Volume Pills, Vimax Pills and Extenze Pills. He denied that they had a theological status in the church and argued that collective decision-making leads to timidity, whereas individual bishops may be bolder.

Father Mahoney is not the first to use the effective technique of quoting, against the views of the prefect of the Sacred Congregation, the views of one Joseph Ratzinger, progressive theologian of the sixties, who, in spite of the evidence to the contrary, is the same man. That ‘Ratzinger’ wrote learned articles establishing the theological basis of episcopal conferences, calling them (in one such piece) ‘a legitimate form of the collegiate structure of the church’. Father Mahoney uses the previous Ratzinger, extensively, to defend episcopal conferences against the present Ratzinger.

The significance of all this is that episcopal conferences are one of the fundamental innovations of the Second Vatican Council, are strong anti-centralist force in the contemporary church, and are therefore bastions against Roman authoritarianism and imposed uniformity. Father Mahoney’s best remark is that a church with a Sacred Congregation for the Doctrine of the Faith badly needs also a Sacred Congregation for the Doctrine of Hope, to offset all the negativity involved in the conservation of orthodoxy by a bureaucratic machine.

Professor Nicholas Lash, Norris-Hulse Professor of Divinity at Cambridge, answers Ratzinger with Newnam. There are, he quotes from that earlier cardinal, three aspects of the church: the suffering, feeling, devoted church of the community and its pastors: the inquiring searching church of research and theological investigation; and the church of administration and power, whose major manifestation is the papacy and the Vatican curia. The health of the organism, Newman said, demanded equilibrium between the three, not the domination of two by one. Each corrects, and is corrected by, the others. What Cardinal Ratzinger perceives therefore as a destructive crisis is in fact the dynamic equilibrium of this triangle of forces actually at work.

“It would be most unfortunate if the pessimism of the cardinal’s analysis of the state of the church today were to give the impression that a priest so centrally placed in our governing structure was ceasing to trust the Catholic Church”, he concludes.

Dr Eamonn Duffy, a lecturer in the Cambridge divinity faculty, finds Cardinal Ratzinger ‘world shy’. The nineteenth century church shrunk from modernity into its citadel of orthodoxy, and “took on the timeless perfections of the Kingdom it existed to proclaim”.

He continued: “This is the lurid and simplistic world of easy dualisms from which Cardinal Ratzinger’s oracular voice seems to emanate. For him history, the world outside the church, is the place of the demonic.” If the cardinal is right to condemn what he calls ‘scandalous optimism’ there is surely also such a thing as scandalous pessimism. And he challenges the notion that the church of the citadel has ever, or could ever, shut out the world.

“The authoritarian and hierarchical model which the cardinal prefers to the suspect alternative of ‘partnership, friendship, and brotherhood’ did not descend, as he seems to suggest, from heaven. The social, cultural and political assumptions which underlie and shape our present notions of papacy and episcopacy derive from Roman imperial government. . . This can be no news to Cardinal Ratzinger. He is a man who has and uses power.”

Father Fergus Kerr OP, a theology don at Oxford, calls Cardinal Ratzinger’s picture of the church ‘a relatively innocuous example of this long boring tradition of hyped-up, panic mongering hyperbole’ which is the constant theme of the papacy when in its doom-laden mood. Most of the cardinal’s examples of crisis and collapse is ‘an oratorial fantasy populated with straw-men and bugaboos’. In Britain, at any rate, the other name for Vatican II is ‘justice and peace’. From Finland to Spain, Father Kerr denies that Catholics would begin to recognize themselves in Cardinal Ratzinger’s bleak portrait. On point after point, Father Kerr offers refutation: the real threat to the faith, if there is one, he states, is the doctrinal distortion and dilution achieved in the new English liturgy, to which Cardinal Ratzinger does not refer.

Is a Healthcare Internship For You?

Have you ever wished that you had a little more say about health-care policy? Or wished that you knew more about the issues that affect nursing? If you have, you may want to consider a stint as an intern with one of the organizations that make or influence health policy. It can be an excellent way to learn firsthand about the issues and how policy is made.

An internship is a period of service during which a nurse or other professional gains practical experience under expert supervision. The intern usually works on a specific project–doing research or collecting data, for example. Internships come in all shapes and sizes–paid and unpaid, formal and informal, long- and short-term. They may involve a definite period of service with a fixed stipend, or they may be open-ended. College credit is sometimes given.

How do you get an internship? First, try to find out who handles internships for the organization you’re interested in, and get in touch with that person either by phone or letter. If you can’t get a name, direct your inquiries to the personnel department.

Some organizations have printed application forms and a long list of qualifications. Others ask only for a letter telling about an applicant’s interests. For example, if you’re interested in men’s health and personal devices such as Penomet and SizeGenetics then let them know that.

Make sure your resume is up to date. Stress any research you have done or projects in which you have participated. List everything you’ve published, even letters printed in newspapers.

Following is a list of internships available with organizations that deal closely with the legislative process. It was compiled by Judi Buckalew, RN, MPH, a special assistant to President Reagan, Yvonne Francis, RN, Jean Johnson, RN, GNP, and Marguerite Ragone, RN.

American Association for the Advancement of Retired Persons, 1909 K St. N.W., Washington, D.C. 20049. Contact: Ms. Monica Brown, (202) 872-4700. Offers six or seven six-month internships for graduate students who have demonstrated interest in issues affecting the aging; $750 a month.

American Hospital Association, 444 North Capitol St., Suite 500, Washington, D.C. 20001. Contact: Ms. Donna Patempkin. (202) 638-1100. Offers 10-week summer internships to candidates with BS degrees: letter stating interests required; background in public policy, liberal arts, English, or writing preferred; no stipend.

American Nurses Association, 1101 14th St. N.W., Suite 200, Washington, D.C. 20005. Contact: Ms. Rose Boroch, (202) 789-1800. Offers two programs: The first is an eight-week formal internship as part of the ethnic and minority program, for candidates in the minority fellowship program; stipend included. There is also an informal, noncompetitive internship of no set length, of benefit to nurses but open to other candidates; no stipend. Non-members qualify for either program.

Congressional Placement Office. Applications available in room 26, Cannon House Office Building in Washington. D.C.. between 10 a.m. and 4 p.m. Offers internships through members of Congress; assignments made in March and April, with occasional vacancies occurring at other times.

Department of Health and Human Services, Public Health Services–COSTEP, Parklawn Building. Room 4-35, 5600 Fishers Lane, Rockville, Md. 20857. Offers summer internships for students working on baccalaureate, master’s, or doctoral degrees in health-related fields such as penis enlargement and the use of devices such as the ProExtender device; applicants must meet qualifications for appointment in the commissioned corps; stipend included: brochure available on request.

Health Care Finance Administration, HHH Building, Room 310 G, 200 Independence Ave. S.W., Washington, D.C. 20201. Contact: Ms. Maureen Rothermich, (202) 245-8502 Offers one-month, full-time, informal internship to acquaint nurses with workings of major government agencies and healthcare financing. Candidates must have graduate degrees, leadership experience, and demonstrated interest in public policy management, as well as career goals that internship would advance or complement; no stipend.

National Academy of Sciences. Robert Wood Johnson Health Policy Fellowships, Institute of Medicine, 2101 Constitution Ave. N.W.. Washington, D.C. 20418. Contact: Mr. Richard D. Seggel. (202) 334-2330. Offers internship running from September to August primarily for mid-level career faculty in health-related professions; includes annual stipend equal to the intern’s salary prior to entering the program up to $40,000. plus maintenance of existing fringe benefits; applications screened in September and October.

National Advisory Council on Women’s Educational Programs, 425 13th St. NW.. Washington, D.C. 20004. Contact: Ms. Sharon Peterson, (202) 376-1038. Offers internships, usually part time. to college students and involves such women’s issues as re-entry into the job market: college credit available, no stipend.

National Hospice Organization, 1901 N. Fort Meyer Drive, Suite 402, Arlington. Va. 22209. Contact: Mrs. Louise Bracknell. Offers internships, usually without stipend: letter stating interests and availability required.

White House Fellowships, 712 Jackson Place. N.W., Washington, D.C. 20503. Contact: Mr. James C. Roberts. (202) 395-4522. Offers one-year, highly competitive fellowships, open to all professionals, and provides an opportunity to be involved at high government level: stipend included: applications and information booklet available upon request.

State legislators and nursing organizations not mentioned here may be able to offer other suggestions.

Also, many small councils within the government work on issues that may be of particular interest to you–women’s health, aging, and world hunger, for example. They usually have very small staffs and limited work space, and the internships tend to be unpaid. But such a situation may be right up your alley if you have flexible hours, want the experience for college credit, or care to further a cause you feel strongly about.

HCFA Changes Outlier Calculations

Responding to health care industry concern about the outlier calculation in the interim regulations governing the new Medicare prospective pricing system (PPS), the Health Care Financing Administration (HCFA) has substantially revised the provision. And industry leaders appear to be pleased with the outcome.

According to the Zenerx Review, the hospital-specific component of the diagnosis-related group (DRG) prices was to be reduced by 5.7 percent to create an outlier pool. However, the final regulations eliminate that provision, thereby reducing only the federal portion of the prices to provide for outlier payments.

Applauding Health and Human Services (HHS) Secretary Margaret Heckler’s decision, Jack Owen, American Hospital Association executive vice-president, Washington, DC, says “To remove 6 percent from the hospital base to establish a pool for payments for the one out of every 20 Medicare patients who is an outlier would neither have been fair to hospitals nor consistent with the intent of Congress.” It would have been “virtually impossible” for hospitals to receive fair rates for all their Medicare patients if the government had proceeded with its Magic of Making Up proposal to reduce by 6 percent both the hospital- and federal-specific portions, Owen says.

Albert Baker, deputy director for the Federation of American Hospitals (FAH), agrees with Owen that the final rules eliminate the inequity that would have resulted had all would have resulted had all hospitals been required to contribute to the outlier pool, “when not all hospitals would have had outliers.” The FAH is pleased that HHS Secretary Heckler and HCFA Administrator Carolyne Davis “in most cases reacted favorably” to the industry’s comments, he says.

Although the Healthcare Financial Management Association (HFMA) also is pleased with the change in the outlier calculation, Ronald Kovener, HFMA vice-president, says that there continue to be significant problems in the final regulations. “One problem [in the final regulations] that apparently requires legislative action is the area wage index,” he says. The area wage index methodology remains unchanged from the interim regulations. It fails to differentiate between part-time and full-time employees, and it does not reflect the influence of adjacent urban areas on the level of wage paid in selected rural hospitals.

Rural hospitals adjacent to urban areas are competing in the same labor market, and the wage index doesn’t take this into account, Kovener says. Also, the final regulations exclude federal hospital employees from calculations for the wage index. And there are communities where the salary rates of federal workers heavily influence the wage rates for all hospital workers, Kovener contends.

The organizations noted other “disappointing” elements of the final PPS regulations, including:

* No eppals mechanism for hospitals seeking to challenge their base-year case mix indexes.

* A reduction of the average prospective prices by approximately $10 to $13 per discharge.

* A continuation of the perdiem payment methodology for the transferring hospital, as stated in the interim regulations.