Category Archives for Toxicology

Develop a Culture of Service

I wrote this after clients complained of poor service with one of our vendors:

If you are in a customer/client based company the most important thing to emphasize in the day to day operations would be service. Unfortunately, a lot of companies overlook this very simple concept. Actually, many think first about monetary gains and second about the customer/client. Putting the dollar in front of the service is the equivalent of putting the cart before the horse. It's a losing equation for all parties. The company, while they may see short-term profits, will never retain long-term loyalty, and the client gets poor service and has a bad experience. Developing a culture of service should be the highest priority for any company or entrepreneur that wants to stand the test of time. The only way to differentiate, create loyalty, and ensure you have made a good first and last impression on every customer/client that you deal with are to put that individuals needs above your own. When the customer service that you render is of the highest quality there will be no shortage of money flowing in.

Sincerely and with gratitude,

Joseph P. Tufo

Cash Flow Specialists, Inc.

Certified Cash Flow Consultant, Certified Capital Specialist

925-352-6000 Cell 800-669-2700 (USA Only)

josephptufo@gmail.com joe@joetufo.com

http://www.workingcapitalfast.com

http://www.stryde.me/161424 WOTC Tax Credit to $9,600 Per Newly Hired Qualified Employee

http://www.StrydeAdvisors.com/161424 Agent Opportunity: Tax Credits, Expense Reduction Save Big Bucks!

https://db202.isrefer.com/go/pfp/a1488/ PFP, Community Opportunities, REEP

Skype: jptufo

LinkedIn: http://www.linkedin.com/in/joetufo

Facebook: http://www.facebook.com/joetufo

Twitter: https://twitter.com/joetufo

Commercial Real Estate Loans, Business Funding, Specialized Tax Credits, WOTC, Cost Segregation, R&D Tax Credit, Property Tax Mitigation, and More...

Providing Honest Answers in a Timely Manner No Matter How Difficult the Situation

Trust, Integrity and Service Here Today Here Tomorrow

You may schedule a visit and meet me in person in the beautiful San Francisco Bay Area

Available 8am to 6pm Pacific Any Day But Sunday And Holidays

#Money Available, #Next Generation Funding, #Funding, # Franchise Funding, #Medical Financing, #Hotel, #Motel, #Resort, #Uo To 100% Funding, #Commercial Loans, #Commercial Investments, #Business Consulting, #Business Funding, #Commercial Real Estate, #Debt/Equity Funding, #SBLC, #BG, #SWIFT, #Proof of Funds, # Gold, #Silver, #Precious Metals, #Hard Assets, #Complex Trusts, #Foundations, #Private Banking, #Hard Money, #Private Money, #Direct Conduit Lender,#Strategic Alliances, #Specialized Tax Incentives, #Expense Reduction, # WOTC Tax Credit, #LinkedInProfile #LinkedInSummary #LinkedInTips #LeadGeneration #Sales #Marketing #BusinessDevelopment #LinkedInMarketing #LinkedInBook #LinkedInTraining #LinkedInExpert

Happy Easter! Creative Funding Ideas $50k to $2b, Tax Credits, Consumer Alert & More Tufo/CFSI 20170414

Greetings from the beautiful San Francisco Bay Area where, Praise God! The drought is over! Daytime temps high 60's low 70's, low humidity, constant breeze - come visit and let's get your viable projects funded!

Our LinkedIn: http://www.linkedin.com/in/joetufo and http://www.workingcapitalfast.com have hundreds of articles, thousands of endorsements and dozens of testimonials.

We have many reliable, trustworthy funding sources with every type of funding possible from:

* Bridge loans/private money/hard money - fast means very expensive rates, short term funding three to five points or more and many times cross collateral,

* PFP which requires 20% cash collateral residential, 30% cash collateral commercial loans, to 40% cash collateral foreign nationals with 3% to 5% annual rates, no call feature, 30 year amortization, 60 banking days minimum to fund, two points + closing costs, and membership required. We have dozens of client/members from CFSI with more than 5,000 total members.

* 200 year old Austrian bank $5million to many billions, 20% cash down, rates 4% USA 5% all other countries, fixed for 25 years, two points plus closing costs

minimum 30 banking days to fund, two points + closing costs

* Chris requires $100,000 to $5million down payment and funds $500,000 to $50million. You can purchase multiple slots to achieve funding goals. Funds in a minimum six months. Chris has funded 54 in the past 18 months.

* PWC has programs ranging from $50,000 to $2billion and requires $7,000 for $50,000 funding to 3% for $2billion funding. Most funding takes four to eight months.

* We have many other lenders available.

Some choose to visit me in person in San Francisco and pay monthly fees for my undivided attention. All fees are credited back against commissions. They are serious about funding and I am committed and serious about their success. Everybody wins.

As always I am available 8am to 6pm Pacific any day but Sundays and holidays at 1.925.352.6000.

Remember:

New Living Translation

But divide your investments among many places, for you do not know what risks might lie ahead.

King James Bible

Give a portion to seven, and also to eight; for thou knowest not what evil shall be upon the earth.

Put your assets in seven to eight buckets: precious metals, cash, stocks/bonds/mutual funds, your own business, income producing real estate, collectibles, retirement programs, Solomon reminds us that we don't know the future and therefore we cannot know what is certain and uncertain regarding our investments. Because of this risk, we are wise to spread our investable income across a variety of investment options. A diversified investor should have no more than 12 to 15 percent invested in any single asset or category.

I taught finance from a Biblical perspective for 17 years. I was securities licensed for 19 years. Be wise.

If you're looking for a safe (insured to $1million with Travelers Insurance), terrific returns (4.9% to 19% for accounts five years with bonuses) https://db202.isrefer.com/go/pfp/a1488/ PFP: Earn Up To 19%, REEP

WHAT I DO: I help small & mid-size business owners get all the tax credits and expense savings they are entitled to.

WHO I WORK WITH: Commercial RE investors, Manufacturers, Hotels, Restaurants, Auto Dealerships, Medical Offices, Senior Centers, Software and Startup companies, and others.

TAX INCENTIVES: Cost Segregation, Property Tax Mitigation, R&D Credit, WOTC.

EXPENSE REDUCTION: Credit Card Merchant, Waste and Work Comp Audit.

WHY IT WORKS: Our proprietary platform & 15 years of experiences guarantee quick and easy process. Since 2004 we have saved clients over $500M.

HOW IT WORKS: I provide an onsite/offsite consultation. In as little as 15 minutes, we will determine for which program you qualify. I even provide an estimate of how much benefit you may be looking at.

WHAT MAKES US DIFFERENT: Qualification is FREE. If we recover benefit and you decide to proceed, we take part of it. We handle possible IRS questioning.

CURIOUS about how much money you are entitled to?

Reach out to me directly on LinkedIn, email me at joe@joetufo.com For WOTC visit http://www.stryde.me/161424 WOTC Tax to $9,600 Per Newly Hired EE

or call direct at 925.352.6000

This will show you the possible savings for your business:

http://www.gmgsavings.net/index.cfm?id=161423 Our Average Client Receives $240,000 in Tax Benefits!

Interested in joining my team? This will show you how to become an agent for Stryde:

http://www.StrydeAdvisors.com/161424 Agent Opportunity: R&D Tax Credits, Expense Reduction

Stryde Call Recording Link Click Here

Other Services: Commercial Funding, Private Money, Asset Protection, Business Consulting

Consumer Alert! (This information could save your life)

 

In the U.S. 125,000 people die from Adverse Drug Reactions, the 4th leading cause of death, plus 2 million are hospitalized and many have lifelong issues. This is due to taking a medication that doesn't suit your body's genetic profile. A very simple DNA test to prevent this has been around for 8 years, believe it or not, however 90% of doctors still aren't using it even though major clinics like Mayo, Vanderbilt, Duke, and Stanford have incorporated it into their procedures. It's a simple Q-tip cheek swab, which is sent to the world class lab we've teamed up with. Within a few days the doctor gets a report that clearly shows what medications the patient can safely take and, most importantly, which they cannot take. Many insurance companies and Medicare* pay for this test (*see company information for full details).

 

A story shared by a Father:

The daughter of one of our representatives suffered for 15 years with medications that caused depression and changed her personality. After discovering our company, she was given this very simple test. The results came back to the doctor and showed that ALL the medications she had been on were all the wrong ones. In fact her doctor said to the father that he was surprised she was still alive. Needless to say, the doctor has corrected the medications and she is like another person today.

YOU MUST ATTEND THIS WEBINAR!(btw...no will talk to you or ask you questions, just grab a cup of coffee, glass of water and listen)

Please click on the link and register - 20 minutes could save your life or the life of a loved one. I'll call you soon but meanwhile, here's the link to register for the live webinar: https://attendee.gotowebinar.com/register/2976351967656433410

  • Monday, 6:00pm PST
  • Wednesday, 6:00pm PST
  • Thursday, 6:00pm PST
  • Saturday, 10:00am PST

Please let me know which day you will be able to attend.

https://www.medxprime.com/jptufo Learn about our MedXPrime programs and services

https://www.financialhalo.com/jptufo Learn about resolving items with the IRS, settling debt, restoring/building credit to 740+ and more

As always I am available 8am to 6pm Pacific any day but Sundays and holidays at 1.925.352.6000.

May God bless you and your family exceedingly, abundantly above whatever you may think or ask! He is Risen! he is Risen indeed!

Here to serve you and those whom you choose to refer.

Sincerely and with gratitude,

Joseph P. Tufo

Cash Flow Specialists, Inc.

Certified Cash Flow Consultant, Certified Capital Specialist

925-352-6000 Cell 800-669-2700 (USA Only)

josephptufo@gmail.com joe@joetufo.com

http://www.workingcapitalfast.com

https://db202.isrefer.com/go/pfp/a1488/ PFP: Earn Up To 19%, REEP

Skype: jptufo

LinkedIn: http://www.linkedin.com/in/joetufo

Facebook: http://www.facebook.com/joetufo

Twitter: https://twitter.com/joetufo

Commercial Loans, Business Funding, WOTC, Cost Segregation, R&D Tax Credit, Property Tax Mitigation, and More...

Providing Honest Answers in a Timely Manner No Matter How Difficult the Situation

Trust, Integrity and Service Here Today Here Tomorrow

You may schedule a visit and meet me in person in the beautiful San Francisco Bay Area

Available 8am to 6pm Pacific Any Day But Sunday And Holidays

#Money Available, #Next Generation Funding, #Funding, # Franchise Funding, #Medical Financing, #Hotel, #Motel, #Resort, #100% Funding, #Commercial Loans, #Commercial Investments, #Business Consulting, #Business Funding, #Commercial Real Estate, #Debt/Equity Funding, #SBLC, #BG, #SWIFT, #Proof of Funds, # Gold, #Silver, #Precious Metals, #Hard Assets, #Complex Trusts, #Foundations, #Private Banking, #Hard Money, #Private Money, #Specialized Tax Incentives, #Expense Reduction, # WOTC Tax Credit, #Medical Opportunities, #Get Out of Debt, #IRS, #Financial Freedom, #Biggest Online Business Opportunities, #Make Millions Online, #Online 24/7 Network Marketing, #Real Jobs, #Real Opportunity, #Don't Wish For It, Work For It!, #Duplication, #Financial Halo, #MedXPrime, #Forensic Accounting, #Uncollectible Insurance Accounts Receivable, #Annual Wellness Visit, #Pharmacogenomic Testing, #PGX, #DNA, #Adverse Drug Reactions, #Toxicology, #Mentor, #Sales, REEP, #Savings Accounts, #IRA's, #Roth IRA's, #Defined Benefit Plans, #Defined Contribution Plans, #Keogh Plans, #403-b Plans, #Commercial Investments, #Next Generation Funding, # Crowdfunding, #Subscriber Based Plans, #Co-Op, #Franchise Funding, #Medical Financing, #Project Funding, #Worldwide Loans, #Business Consulting, #Film Funding, #Pharmacogenomic Testing, #PGX, #Current Articles on Pharmacogenetics, #Drugs, the Conditions they Treat, and PGX Warnings, #Adverse Drug Reactions, #Evidence Based, #Medically Actionable, #Improved Patient Outcomes, #Uncollectible Insurance Claims, #Uncollectible Insurance Accounts Receivable, #Insurance Accounts Receivable, #Accounts Receivable, #Toxicology, #Urine Drug Testing, #Drug Enforcement Agency, #Annual Wellness Visit, #MACRA requirements, #Tomorrow’s Medicine Today, # Better Billing Solutions, #Personalized Medicine, # Credentialing, #Billing, #LinkedInProfile #LinkedInSummary #LinkedInTips #LeadGeneration #Sales #Marketing #BusinessDevelopment #LinkedInMarketing #LinkedInBook #LinkedInTraining #LinkedInExpert

CFSI Update: MedXPrime, PFP, Stryde/GMG, Working Capital Fast, 20161209

Merry Christmas!
It's a great day to be alive, isn't it? I praise God for wonderful people like you! I pray for you daily. May God bless you and your family exceedingly, abundantly above whatever you may think or ask! Remember JESUS is the Reason for the Season!
I've been quite prolific with writing and have posted 74 articles on LinkedIn http://www.linkedin.com/in/joetufo and more than that on http://www.workingcapitalfast.com I encourage you to visit these links and learn about the products and services we have and how they will bless you and those whom you choose to refer. Thank you!

We have three complementary services:

1. Stryde/GMG expense reduction and specialized tax credits are worth $80,000 to $1million or more to your prospective clients now.

SAVINGS SOLUTIONS FOR VIRTUALLY EVERY INDUSTRY

We have helped thousands of companies reduce expenses and obtain large federal tax incentives that would otherwise go uncaptured. Our services are not limited to any single industry focus.

Over 90% of all businesses can benefit from one or more of our services.

Learn How Your Company Can Save Money On:

  • All
  • Credit Card Processing
  • Employer Payroll Tax Incentives
  • Parcel Shipping
  • Property Owner Tax Incentives
  • Property Taxes
  • Waste & Recycling
  • Work Comp Insurance

You can go here http://www.gmgsavings.net/index.cfm?id=161423 and enter their informations and in five minutes or less get an idea of what they will receive. It's staggering!

If you're interested in joining our team use this link http://www.StrydeAdvisors.com/161424

2.Commercial Loans - PFP for those who have money and time to obtain the absolute best rates, terms, and conditions on any type of loan to $250 million and high risk fast funding loans for businesses that need money within three to seven business days and are willing to pay the price to enjoy the benefits. This subscriber based program may be the only savings and funding source you will ever need. Register here: https://db202.isrefer.com/go/pfp/a1488/

AN INTRODUCTION TO PFP COMMUNITY

* Are You Earning 4.9% or more on savings?

* Are You Earning 9.9% or better on CD’s?

* Did You Know… You can Get Paid on the value of your home

or investment property without risk or loss of equity?

* Are Your Secured & Insured Investments paying you 14.5% annually?

Join Us THURSDAY NIGHT To Learn “What Banks WON'T Tell You”

and “What Most Financial Advisors DON'T Know”...

These calls are for PFP Members only.

Plus get answers to these important questions and more...

--> Why aren't banks also offering 4.9%, 9.9% or more?

--> How safe is your money in the bank?

--> Can I get paid from my home's value without a loan or selling?

Register here: https://db202.isrefer.com/go/pfp/a1488/

3. MedXPrime for medical practices, labs, hospitals, nursing homes and other medical related businesses. Our ideal client is a medical practice that wants to improve their bottom line by $300,000 to $1million or more in 2017.

https://www.medxprime.com/jptufo Learn about our MedXPrime programs and services
https://www.financialhalo.net/jptufo Learn about MedXPrime/FH and enroll as a new Associate

WHAT WE DO

We fund start-ups and existing businesses provided they have 10% to 30% cash collateral and we can do that in a minimum 60 banking days at 3% to 5% interest (PFP). Once they are operating we have several expense reduction and specialized tax incentives that will be worth five to seven figures a year to them. (Stryde/GMG)

We have a guaranteed way for your business to cut operational costs and improve profitability making more money for your business at no risk to you. Call/text today at 925.352.6000 or email me at joe@joetufo.com We just got a 200 employee manufacturing business a $328,227 check from the IRS. We got a property owner just under $600,000 back on a $3,100,000 building he owned. Do It NOW! Call TODAY 925.352.6000

Dear Friend,

 

I'm reaching out to you with critical information that could SAVE YOUR LIFE or the LIFE OF A LOVED ONE. Any one taking more than one prescription at the same time is in danger. This is the 4th LEADING CAUSE OF DEATH!

 

Consumer Alert! (This information could save your life)
In the U.S. 125,000 people die from Adverse Drug Reactions, the 4th leading cause of death, plus 2 million are hospitalized and many have lifelong issues. This is due to taking a medication that doesn't suit your body's genetic profile. A very simple DNA test to prevent this has been around for 8 years, believe it or not, however 90% of doctors still aren't using it even though major clinics like Mayo, Vanderbilt, Duke, and Stanford have incorporated it into their procedures. It's a simple Q-tip cheek swab, which is sent to the world class lab we've teamed up with. Within a few days the doctor gets a report that clearly shows what medications the patient can safely take and, most importantly, which they cannot take. Many insurance companies and Medicare* pay for this test (*see company information for full details).

A story shared by a Father:

 

The daughter of one of our representatives suffered for 15 years with medications that caused depression and changed her personality. After discovering our company, she was given this very simple test. The results came back to the doctor and showed that ALL the medications she had been on were all the wrong ones. In fact her doctor said to the father that he was surprised she was still alive. Needless to say, the doctor has corrected the medications and she is like another person today.

 

YOU MUST ATTEND THIS WEBINAR! (btw...no will talk to you or ask you questions, just grab a cup of coffee, glass of water and listen)

 

Please click on the link and register - 20 minutes could save your life or the life of a loved one. I'll call you soon but meanwhile, here's the link to register for the live webinar: https://attendee.gotowebinar.com/register/5760257132550403330

CLICK HERE to register for a webinar.

  • Monday, 6:00pm PDT
  • Tuesday, 6:00pm PDT
  • Wednesday, 6:00pm PDT
  • Thursday, 6:00pm PDT
  • Saturday, 10:00am PDT
Please let me know which day you will be able to attend.
Sincerely,
Joe Tufo

925.352.6000

josephptufo@gmail.com joe@joetufo.com

Are you paying $125,000 or more in taxes? We have some solutions that will save you a bundle! We have three to five conferences a year in Dallas and the San Francisco Bay Area, the last of which was in September in Oakland CA. We have tax experts, foundation experts, an enrolled agent, and other financial experts to help you.

Some of the important Benefits of these financial strategies are:

Benefits Complex Trusts & Non Operating Private Family Foundation:
-Preserve and Protect Assets

-Enhance Assets and Income
-Reduce annual tax liabilities
-Reduce property taxes & capital gains
-Avoid probate & death taxes
-Avoid lawsuits & judgment losses
-Protect retirement savings
-Isolate assets from litigation and liens
-Insure personal privacy
-Create a legacy for future generations
-Provide a vehicle for the custody of children’s funds?

Kindly refer friends, family, and acquaintances who can benefit from our services.

You may schedule a visit and meet me in person in the beautiful San Francisco Bay Area

We are so blessed to have you all sharing our vision for Cash Flow Specialists, Inc. and are truly thankful for each and every one of you!

Sincerely and with gratitude,
Joseph P. Tufo
Certified Cash Flow Consultant, Certified Capital Specialist, Certified Trainer MedXPrime
925-352-6000 Cell 800-669-2700 (USA Only)
https://www.medxprime.com/jptufo Learn about our MedXPrime programs and services
https://www.financialhalo.net/jptufo Learn about MedXPrime/FH and enroll as a new Associate
https://db202.isrefer.com/go/pfp/a1488/ PFP: Commercial Loans, Business Funding, REEP
http://www.StrydeAdvisors.com/161424 Agent Opportunity: R&D Tax Credits, Expense Reduction
http://www.gmgsavings.net/index.cfm?id=161423 Our Average Client Receives $240,000 in Tax Benefits!
Skype: jptufo
MedXPrime, Commercial Loans, Business Funding, Cost Segregation, R&D Tax Credit, Property Tax Mitigation, Accounts Receivable Recovery, PGX Testing, and More...
Providing Honest Answers in a Timely Manner No Matter How Difficult the Situation
Trust, Integrity and Service Here Today Here Tomorrow
You may schedule a visit and meet me in person in the beautiful San Francisco Bay Area

#Pharmacogenomic Testing, #PGX, #Current Articles on Pharmacogenetics, #Drugs, the Conditions they Treat, and PGX Warnings, #Adverse Drug Reactions, #Evidence Based, #Medically Actionable, #Improved Patient Outcomes, #Uncollectible Insurance Claims, #Uncollectible Insurance Accounts Receivable, #Insurance Accounts Receivable, #Accounts Receivable, #Toxicology, #Urine Drug Testing, #Drug Enforcement Agency, #Annual Wellness Visit, #MACRA requirements, #Tomorrow’s Medicine Today, # Better Billing Solutions, #Personalized Medicine, # Credentialing, #Billing

# Commercial Loans, #Business Loans, #Residential Loans, #Auto Loans, #RV Loans, #Truck Loans, #Apartment Loans, # Construction to Permanent Loans, #REEP, #Savings Accounts, #IRA's, #Roth IRA's, #Defined Benefit Plans, #Defined Contribution Plans, #Keogh Plans, #403-b Plans, #Commercial Investments, #Next Generation Funding, # Crowdfunding, #Subscriber Based Plans, #Co-Op, #Franchise Funding, #Medical Financing, #Project Funding, #Worldwide Loans, #Business Consulting, #Film Funding

#Money Available, #Next Generation Funding, #Funding, # Franchise Funding, #Medical Financing, #Hotel, #Motel, #Resort, #100% Funding, #Commercial Loans, #Commercial Investments, #Business Consulting, #Business Funding, #Commercial Real Estate,

Consumer Alert! (This information could save your life)

Dear Friend,

I'm reaching out to you with critical information that could SAVE YOUR LIFE or the LIFE OF A LOVED ONE. Any one taking more than one prescription at the same time is in danger. This is the 4th LEADING CAUSE OF DEATH!

Consumer Alert! (This information could save your life)
In the U.S. 125,000 people die from Adverse Drug Reactions, the 4th leading cause of death, plus 2 million are hospitalized and many have lifelong issues. This is due to taking a medication that doesn't suit your body's genetic profile. A very simple DNA test to prevent this has been around for 8 years, believe it or not, however 90% of doctors still aren't using it even though major clinics like Mayo, Vanderbilt, Duke, and Stanford have incorporated it into their procedures. It's a simple Q-tip cheek swab, which is sent to the world class lab we've teamed up with. Within a few days the doctor gets a report that clearly shows what medications the patient can safely take and, most importantly, which they cannot take. Many insurance companies and Medicare* pay for this test (*see company information for full details).
A story shared by a Father:

The daughter of one of our representatives suffered for 15 years with medications that caused depression and changed her personality. After discovering our company, she was given this very simple test. The results came back to the doctor and showed that ALL the medications she had been on were all the wrong ones. In fact her doctor said to the father that he was surprised she was still alive. Needless to say, the doctor has corrected the medications and she is like another person today.

YOU MUST ATTEND THIS WEBINAR! (btw...no will talk to you or ask you questions, just grab a cup of coffee, glass of water and listen)

Please click on the link and register - 20 minutes could save your life or the life of a loved one. I'll call you soon but meanwhile, here's the link to register for the live webinar: https://attendee.gotowebinar.com/register/5760257132550403330

CLICK HERE to register for a webinar.

  • Monday, 6:00pm PDT
  • Tuesday, 6:00pm PDT
  • Wednesday, 6:00pm PDT
  • Thursday, 6:00pm PDT
  • Saturday, 10:00am PDT
Please let me know which day you will be able to attend.
Sincerely and with gratitude,
Joseph P. Tufo
Certified Cash Flow Consultant, Certified Capital Specialist, Certified Trainer MedXPrime
925-352-6000 Cell 800-669-2700 (USA Only)
https://www.medxprime.com/jptufo Learn about our MedXPrime programs and services
https://www.financialhalo.net/jptufo Learn about MedXPrime/FH and enroll as a new Associate
https://db202.isrefer.com/go/pfp/a1488/ PFP: Commercial Loans, Business Funding, REEP
http://www.StrydeAdvisors.com/161424 Agent Opportunity: R&D Tax Credits, Expense Reduction
http://www.gmgsavings.net/index.cfm?id=161423 Our Average Client Receives $240,000 in Tax Benefits!
Skype: jptufo
MedXPrime, Commercial Loans, Business Funding, Cost Segregation, R&D Tax Credit, Property Tax Mitigation, Accounts Receivable Recovery, PGX Testing, and More...
Providing Honest Answers in a Timely Manner No Matter How Difficult the Situation
Trust, Integrity and Service Here Today Here Tomorrow
You may schedule a visit and meet me in person in the beautiful San Francisco Bay Area

#Pharmacogenomic Testing, #PGX, #Current Articles on Pharmacogenetics, #Drugs, the Conditions they Treat, and PGX Warnings, #Adverse Drug Reactions, #Evidence Based, #Medically Actionable, #Improved Patient Outcomes, #Uncollectible Insurance Claims, #Uncollectible Insurance Accounts Receivable, #Insurance Accounts Receivable, #Accounts Receivable, #Toxicology, #Urine Drug Testing, #Drug Enforcement Agency, #Annual Wellness Visit, #MACRA requirements, #Tomorrow’s Medicine Today, # Better Billing Solutions, #Personalized Medicine, # Credentialing, #Billing,

How To Win Friends and Influence People – Our Average Client Receives $240,000 in Tax Benefits!

We have three complementary services:

1. Stryde/GMG expense reduction and specialized tax credits are worth $80,000 to $1million or more to you now.

http://www.StrydeAdvisors.com/161424 Agent Opportunity: R&D Tax Credits, Expense Reduction

http://www.gmgsavings.net/index.cfm?id=161423 Our Average Client Receives $240,000 in Tax Benefits!

2.Commercial Loans - PFP for those who have money and time to obtain the absolute best rates, terms, and conditions on any type of loan to $250 million, a European Bank for those with 20% cash down payment minimum funding $5million - no maximum, funds in about 30 banking days, and high risk fast funding loans for businesses that need money within three to seven business days and are willing to pay the price to enjoy the benefits.

https://db202.isrefer.com/go/pfp/a1488/ PFP: Commercial Loans, Business Funding, REEP

3. MedXPrime for medical practices, labs, hospitals, nursing homes and other medical related businesses. Our ideal client is a medical practice that wants to improve their bottom line by $300,000 to $1million or more in 2017.

https://www.medxprime.com/jptufo Learn about our MedXPrime programs and services

https://www.financialhalo.net/jptufo Learn about MedXPrime/FH and enroll as a new Associate

As of this writing December 10, 2016 there are 58 articles on Working Capital Fast and 70 articles on LinkedIn with another several dozen I'm in the process of researching and writing.

http://www.workingcapitalfast.com website

LinkedIn profile http://www.linkedin.com/in/joetufo that may be of benefit to you.

This may be of interest:

http://workingcapitalfast.com/top-reasons-apply-alternative-financing-bank-loans and

http://workingcapitalfast.com/workers-compensation-audit-overview and

http://workingcapitalfast.com/reduce-income-taxes-cost-segregation

This website will enable you to quickly calculate substantial savings for your prospective clients and make you a hero:

http://www.gmgsavings.net/index.cfm?id=161423 (Our Average Client Receives $240,000 in Tax Benefits!)

http://www.StrydeAdvisors.com/161424 Agent Opportunity: R&D Tax Credits, Expense Reduction If you choose to become an agent.

Merry Christmas!


Sincerely and with gratitude,
Joseph P. Tufo
Certified Cash Flow Consultant, Certified Capital Specialist, Certified Trainer MedXPrime
925-352-6000 Cell 800-669-2700 (USA Only)
https://www.medxprime.com/jptufo Learn about our MedXPrime programs and services
https://www.financialhalo.net/jptufo Learn about MedXPrime/FH and enroll as a new Associate
https://db202.isrefer.com/go/pfp/a1488/ PFP: Commercial Loans, Business Funding, REEP
http://www.StrydeAdvisors.com/161424 Agent Opportunity: R&D Tax Credits, Expense Reduction
http://www.gmgsavings.net/index.cfm?id=161423 Our Average Client Receives $240,000 in Tax Benefits!
Skype: jptufo
MedXPrime, Commercial Loans, Business Funding, Cost Segregation, R&D Tax Credit, Property Tax Mitigation, Accounts Receivable Recovery, PGX Testing, and More...
Providing Honest Answers in a Timely Manner No Matter How Difficult the Situation
Trust, Integrity and Service Here Today Here Tomorrow
You may schedule a visit and meet me in person in the beautiful San Francisco Bay Area
THIS INFORMATION IS PRIVATE
"To enhance, preserve and protect the personal well-being of those who place their trust in us, helping you develop resources that resolve stress by providing proven, high-integrity products and services that exceed expectations. We will help you reduce anxiety and worry while increasing net worth. improving health and contributing to your enjoyment of life. We help you create a 'lifestyle by design.'''
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Toxicology: Managing The Complex Treatment of Chronic or Acute Pain

To simplify Toxicology as it pertains to Urine Drug Testing, it is the primary method of medication monitoring available for physicians to assist in the managing the complex treatment of chronic or acute pain. The major drugs that are available for pain management have limitations and have a high potential for abuse or misuse. One of the many concerns in pain management is the identification of patients that have aberrant drug-related behavior or a potential for addiction or abuse. The abuse and diversion of controlled prescription medications has been labeled by some as a public health crisis. Urine drug testing is strongly recommended under Federal, State, and Clinical guidelines, to be used when treating intractable chronic pain with opioids. It is a highly useful tool to verify patient compliance with your treatment plan, and to potentially expose unreported drug use or diversion of the prescribed medication. A UDT Program helps doctors by providing an objective way to document patient adherence to the treatment plan and also to confirm patient abstinence from non-prescribed drugs of abuse.

Foundational Education

Throughout the past many decades, attention has been drawn to the fact that the incidences of untreated and unrecognized pain have increased. Beginning in the 1990’s, doctors were starting to recognize this issue and through educational efforts, began to assess and treat pain more aggressively. These efforts reached full stride around 2000 when the U.S. Congress proclaimed the years 2000-2010 the Decade of Pain Control and Research.

The prescribing of opioids increased substantially when both the American Pain Society and the American Academy of Pain Medicine wrote formal positions endorsing the prescription and use of chronic opioid therapy (COT) for pain. The increased availability of opioids has lead to some unanticipated problems, including and high incidence of nontherapeutic opioid use. Currently, deaths from misuse of opioids exceed deaths from heroin use, proving that there is a huge issue with nontherapeutic use of opioids in the United States.

It is shown that two-thirds of abused opioids originate from a valid prescription and one-fifth are obtained from more than one physician. It is estimated that the economic burden for prescription opioid abuse in 2005 was $9.5 billion. The prevalence of addiction in the general population is estimated to be between 3-16%. What is worrisome is that many patients with chronic pain who believe they need COT are psychologically distressed. Patients with mental health and/or substance abuse disorders are at greatest risk for using controlled substances nontherapeutically and studies have proven that to be true by showing that COT use increases more rapidly with patients who have mental health issues.

One of the main problems lies with how pain is reported. Clinicians must rely heavily on subjective reports from their patients to make important treatment decisions. Patients who suffer with addiction many times will not provide truthful self-reports if the report could result in their not receiving their drug of choice. Often times self-reported drug use in the chronic pain population is unreliable. This issue leads the physician to combine subjective input and objective observations to assess their patients. Objective observations include pill counts, prescription monitoring programs, and monitoring the patient for aberrant behavior.

Aberrant behavior can vary greatly depending on the patient, but often times may include one of many of the following: early refill requests, reports of lost or stolen medications, and treatment noncompliance. Monitoring aberrant behavior is quite inadequate and frequently results in underestimated aberrant drug-taking behavior. The physician must incorporate other tools such as urine toxicology testing in order to successfully flag and monitor nontherapeutic use of opioids.

Scientific Basis of Urinary Drug Testing (UDT)

Toxicology as it applies to urine testing in a Pain Management clinical setting (UDT) as a means to assure compliance and monitoring of proper medication use is becoming common place in the clinical practice of pain management.

Urine is the standard body fluid tested for drug screening because it is non-invasive, readily available, and is easily handled by office personnel and laboratories. Urine drug testing is preferred over serum testing because the period of detection of a particular drug in the urine is increased, whereas their corresponding metabolites in the serum may only be setectable for a short period of time.

UDT is becoming the cheapest insurance for liability protection in the clinical practice. It decreases the risk physicians have in selecting a treatment modality when treating patients for chronic pain. The Federation of State Medical Boards (FSMB) and the Drug Enforcement Agency (DEA) both have standards set forth in dealing with the implementation of monitoring drug compliance and both require regular use of UDT.

UDT is a very useful tool in pain management. It provides valuable objective information to aid in therapeutic and diagnostic decision making. This tool also provides confirmation of the agreed upon treatment plan, can diagnose relapse or drug misuse, and can also be used to advocate for the patient with third-party interests.

Why Should a Physician Order UDT?

It is a well known fact that self-reporting of nontherapeutic drug use among patients with chronic pain treated with opioids is often unreliable. Patients may fail to disclose use of illicit drugs, medications prescribed by other healthcare providers, use of nonprescription medications, or even use of prescribed medication. Most physicians would agree that information pertaining to a patient’s inappropriate use of nonprescribed medications or illicit drugs is essential for proper patient management. The use of external information such as interviews with spouses, review of medical records, input from prescription monitoring programs, and urine toxicology testing may improve patient outcome.

According to the Drug Enforcement Agency:

  • Approximately 7 million Americans are abusing prescription drugs. This represents an 80% increase since 2000.
  • Drug users report to prefer pain relievers over cocaine or marijuana
  • Opioids cause more drug overdose deaths than cocaine and heroin combined.
  • 1 in 10 high school students admits to abusing prescription painkillers.
  • 25% of drug-related emergency clinic visits are associated with prescription drug abuse.
  • The misuse of pain medications represents three-fourths of the overall problem of prescription drug abuse.
  • “doctor-shopping”, traditional drug dealing, pharmacy and home theft, requiring drugs from the internet, and acquiring drugs from relatives and friends are some of the most common methods of acquiring prescription drugs for abuse.
  • The DEA works closely with the medical community to help recognize drug abuse. Doctor involvement in illegal drug activity is rare, but the DEA pursues criminal activity against such practitioners.

Prescribing physicians and in particular, pain management practitioners, have one of the most important and most scrutinized roles in this effort.

Adhering to a structured Toxicology Program will support the assessment and diagnosis, document patient compliance to a treatment plan, confirm abstinence from non-prescribed drugs, and discourage “doctor shopping”.

Who Should Physicians Test?

  • New patients already taking a controlled substance
  • Any patient for whom a physician is considering prescribing a controlled substance
  • Patients who are resistant to a full evaluation
  • Patients who request a specific drug(s)
  • Patients who display aberrant behavior
  • Patients in recovery from substance abuse

Clinical Outcomes from UDT

UDT should not be mainly used to protect the physicians license or the pain clinic, but to enhance patient care. The presence of an illicit substance in the urine indicates that the patient has a problem and needs help and guidance from the physician. It is a disservice to discharge a patient on the basis of a positive UDT, instead the patient should be offered help in the form of a treatment with an addiction medicine specialist, psychiatrist, or clinical psychologist specializing in addiction. In this case, the patient’s chronic pain should be managed by other means besides opiates.

Clinically, the benefits of UDT are multiple. These include reducing the risk for toxicity in patients vulnerable to adverse drug effects, avoidance of medico-legal problems, detecting patient non-compliance, reducing the risk of therapeutic failure, and avoiding or detecting drug-drug interaction. Additionally, UDT enhances the physician’s ability to use drugs effectively and minimizes treatment costs.

UDT is an important tool with many benefits such as: reducing the risk of toxicity, detecting patient non-compliance, reducing the risk of treatment failure, decreasing the incident of drug misuse, uncovering prescription abuse or misuse, and avoidance of medico-legal problems. The UDT enhances the physician’s ability to use drugs effectively and minimize treatment costs.

It has to be emphasized that the result of urine toxicology for the purpose of detecting patients who may be diverting, supplementing or abusing the prescribed drugs and other illicit substances are protected by the physician-patient confidentiality rule and the result of the test cannot be disseminated to other interested parties without the expressed consent of the patient.

Unexpected Urine Toxicology Results

The use of UDT should be consensual; it is designed to improve patient care and to assist the healthcare professional to advocate on the patients behalf. UDT results may come back negative for a prescribing drug or positive for an unprescribed drug. If this occurs, the first step should be to contact the lab to ensure no clerical errors have been made. If the unexpected results are confirmed, there must be a process in place that should include discussing the results with the patient.

Toxicology Summary

The Rising Epidemic. According to a recent CDC study, pain reliever abuse has increased 111% in the last 5 years. Non-medical use of narcotics has skyrocketed, and physicians can be placed in the awkward situation of having to decide whether or not a patient’s pain medication use is legitimate.

Protecting the Patient.Imagine yourself waking up in pain every single day, and you are under the care of a physician prescribing you pain medication. In order to ensure compliance and place confidence in the patient-physician relationship, your doctor may necessitate a urine drug test. This will guarantee that you are taking the drugs prescribed and only those medications. If you were to stray from the prescribed from those medications, you could be placing your health at risk. Narcotic medications can have significant cross-reactions with other medications. A urine drug test ensures patient compliance with the prescribed regimen and may prevent an unnecessary adverse event.

Protecting the Doctor. Even under the most humane and disease related indications, physicians face significant risks by prescribing controlled medications. Patients may divert their prescription, take too much, combine with illicit substances, etc. These risks are mitigated by physicians subjecting patients to urine drug screening, pill counts, pain agreements, and if the state has it review of the patient on the pharmacy board’s website. The vast majority of patients are compliant, however a small few have necessitated the testing from resultant adverse events.

The Bottom Line. Pain management safeguards are necessary in this day and age to protect both the patient and provider for different reasons. The common denominator is pain relief and improved quality of life for the patient, while at the same time providing for the highest level of patient safety and minimizing the chance of prescription diversion.

 

 

Sincerely and with gratitude,
Joseph P. Tufo
Certified Cash Flow Consultant, Certified Capital Specialist, Certified Trainer MedXPrime
925-352-6000 Cell 800-669-2700 (USA Only)
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Confidentiality Notice: This electronic message, including any attachments, is confidential and solely for the use of the intended recipient. The information in this message may contain privileged or sensitive information, including patient information protected by HIPAA, HITECH, and other federal and state privacy laws. If you are not the intended recipient please notify the sender and destroy all copies of the original message including any attachments.

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"Financial Halo, LLC has entered into agreements with providers of the services and products represented on this website. These providers are authorized by Financial Halo to enroll any Financial Halo client on behalf of Financial Halo Associates who may wish their services. Financial Halo encourages its clients and customers to do their full diligence prior to engaging the services of its provider companies. Financial Halo, LLC reserves the right, at its discretion, to change, modify, add or remove any service program or provider at any time in order to improve the services offered. Financial Halo LLC, its representatives, agents and employees do not provide personal, medical, health-related, business, legal, financial or tax advice."