Monday, June 28, 2010

Health Reform and Victims of Domestic Violence

As I've written about previously (click here), the Family Violence Prevention Fund has published a summary of health reform law implications regarding domestic, sexual and dating violence.  Here's a very high level summary:
  • Beginning in January of 2014, the new law prevents insurers (who receive Federal assistance) from denying coverage for preexisting conditions, including being a survivor of domestic violence.  Previously, only 22 states had enacted similar requirements.
  • 48 percent of women who receive maternal, infant and early child related home health services report incidents of domestic violence.  Very few programs have emerged nationally to address this problem.  The new law provides $1.5B over five years for home visitation model development to improve mother and baby health and domestic violence is specifically culled out as an area of concern.
  • From 2010 through 2014, states will receive Federal funds directed toward reducing pregnancy rates for youths between the ages of 10 and 19 (where there is a high incidence of domestic violence).
There are many additional components to the summary, available in full here.

(Image from

New blog features added...

Minor but quite helfpul.  Over on the right banner, you now have the option of sharing posts via Twitter and Facebook (thank you to the reader who suggested that) and also there's now a search box so that you can type in key words (e.g., home care, iPad, etc.) and all related posts will appear. 

Saturday, June 26, 2010

Doctor available now. On your iPhone...

IF you live in the UK and own Apple's new iPhone with the new 4th generation operating system, then you can access a physician via video right from your phone.  Apple's Facetime video chatting requires WiFi connection (cellular 3G coming) and this new service merely requires the right hardware and £35 per consultation.

Is this the future of cellphones?  Is this the future of health care?

For more, read here.

Love, Hate

I've received a few off-blog questions from readers asking how I like the iPad and, in one case, why I'm not writing more about it.  The truth is... that I love it.  And I hate it.

Right off the bat, let me say that it is a magnificent engineering and interface work of pure genius.  If you hold one in your hands, you'll want to tip your hat to the designers and engineers at Apple who crafted it.  And it works beautifully, as advertised, and in ways that will surprise you.  In almost no time, you'll find yourself solving age old problems and addressing ones you had no idea you faced.  The marketing blitz tells you it's "magical" and you're going to believe it.

On more solid terms, I read and write emails on it.  I soak in books on it.  I watched the series finale of "Lost" on the iPad and I keep track of my to dos there.  I web browse (this is not a poor substitute for a "real" computer... in many ways it's better), keep track of my car's maintenance, store notes from meetings, show off my latest photos, listen to podcasts, and track my ebay auctions on the thing.  The battery life is incredible and I have yet to need to reboot it even once (take that Microsoft).

I'm also beginning to see these out there in the real world.  Out where technogeeks (like me) live and work and where you can really gauge the true market impact of a product by seeing it in action among regular folk.  A woman was using one at the car dealership yesterday.  My friend, who upgraded from a flip phone to a smart phone just a year ago, bought one.  And the woman at the conference I recently attended, seeing me furiously take notes on the device, told me she was going to pick up one that weekend.  I can't recall seeing any product run the gamut from Lunatic Fringe to Mainstream more quickly than the Apple iPad seems to have.

So... what's not to like?

Blogger Peter Bregman purchased an iPad on Day 1, loved it... but returned it to the Apple Store.  Why?   In his words:

It didn't take long for me to encounter the dark side of this revolutionary device: it's too good.
It's too easy. Too accessible. Both too fast and too long-lasting. Certainly there are some kinks, but nothing monumental. For the most part, it does everything I could want. Which, as it turns out, is a problem.
The brilliance of the iPad is that it's the anytime-anywhere computer. On the subway. In the hall waiting for the elevator. In a car on the way to the airport. Any free moment becomes a potential iPad moment.
So why is this a problem? It sounds like I was super-productive. Every extra minute, I was either producing or consuming.
But something — more than just sleep, though that's critical too — is lost in the busyness. Something too valuable to lose.
Being bored is a precious thing, a state of mind we should pursue. Once boredom sets in, our minds begin to wander, looking for something exciting, something interesting to land on. And that's where creativity arises.
My best ideas come to me when I am unproductive. When I am running but not listening to my iPod. When I am sitting, doing nothing, waiting for someone. When I am lying in bed as my mind wanders before falling to sleep. These "wasted" moments, moments not filled with anything in particular, are vital.

Hmmm.  I like being productive.   I like having a thought and then instantaneously being able to record it for follow-up and posterity.  I enjoy being able to check emails on a real screen and then being able to respond on a truly usable keyboard (i.e., not the one on my Blackberry).  I'm happy being able to read a book, then popping out to see how the Sox are doing, and then going back to the book... all in about 5 seconds.

But Peter is right.  I'm finding that the very real reduction in "down time" is a problem.  The down time is when then ideas come, where daydreaming happens, where you shut down and let your bio-neural network rest for a spell.  The iPad, as brilliant as it is, takes a real dent out of down time.

Will I sell off the iPad?  Unlikely.  But will I work hard to make sure I don't have it with me at all times?  Probably.

And I'll let you know how it's going... 

How the Beatles would have seen it (after the India trip)

Our PECOS Press Release


Media Contact:
Jeffrey Smith 
Visiting Nurse Association of Boston & Affiliates 

James Fuccione
Home Care Alliance of Massachusetts
Physicians Must Register by July 6, 2010 
(Boston) June 25, 2010 – Thousands of Boston-area home health patients on Medicare, and thousands more across the state, stand to lose necessary services as a result of a poorly managed new federal regulation.

A provision in the Patient Protection and Affordable Care Act published recently by the Centers for Medicare and Medicaid Services (CMS) states that, as of July 6th, home health agencies will be prohibited from submitting claims for reimbursement from physicians who have not enrolled in a new online system. Failure to register in the Medicare Provider Enrollment, Chain and Ownership System, or PECOS, would also block these physicians, who can still see Medicare patients, from referring new patients for Medicare-covered home health services.

At issue is that CMS has not adequately educated physicians about this new requirement.  The result is that as many as 50% of physicians in Massachusetts have not registered on PECOS.  Moreover, the registration and approval process can take several weeks, so even if physicians were to register immediately, their status would not be approved by the July 6 deadline.

“CMS has waived the usual comment period and imposed, with almost no notice, this ill-conceived regulation, erroneously alleging that it poses no burden for Medicare providers,” said Home Care Alliance of Massachusetts executive director Patricia Kelleher. “The experience of agencies who sought to verify physician enrollment in this new system is that it is cumbersome and time-consuming as many agencies work with hundreds of different doctors.” 

Indications are that most physicians are not even aware of this new administrative burden. An analysis by the Visiting Nurse Association of Boston, which is one of the largest providers of services in the region, is that two-thirds of their referring physicians have yet to register.

“The Visiting Nurse Association of Boston cares for more than 6,700 Medicare patients annually, and that excludes those served by the myriad of other home health providers in the area,” said President and CEO of The Visiting Nurse Association of Boston, Reynold Spadoni. “With the effective date rapidly approaching, we believe that this new ruling has unfairly placed the burden of physician compliance squarely on the shoulders of the very patients it intends to help.  Many of the elderly, chronically or seriously ill patients cared for by the Visiting Nurse Association of Boston and other home health providers will be placed at risk for losing their services, due to this ruling.”  

“The federal government needs to delay this baseless regulation,” Said Kelleher. “The last thing our health system needs is another barrier keeping very sick and homebound patients from getting home health care.”

The Home Care Alliance of Massachusetts and the VNA of Boston, along with countless other home health agencies and advocacy organizations across the Commonwealth and country, are urging the Centers for Medicare and Medicaid Services and Congress to delay implementation of the rule until such time as physicians have ample time to enroll and also to hold harmless the home health providers that will suffer from the abrupt transition.


Friday, June 25, 2010

More about the PECOS Conundrum...

A follow-up to this post.

Here's an email I just sent Senators Kerry and Brown.  Here's the Junior Senator from Massachusetts version:

Dear Senator, 
As a result of the Patient Protection and Affordable Care Act,  physicians who have not enrolled in the Medicare Provider Enrollment, Chain and Ownership System (PECOS) as participating, non-participating or opted out physicians will not be permitted to order or refer patients for Medicare covered home health services.   Effective July 6, 2010, Medicare will not pay for home health services ordered by physicians that do not have an approved enrollment record in PECOS. Home health agencies have found that, on average, 30% of physicians currently ordering home health services are NOT enrolled in PECOS. Further, it takes a minimum of 60 days to approve an enrollment application. As a result, home health agencies will most likely not be able to accept their patients on to service. In addition, patients currently on service may be discharged or be financially liable for care. 
We believe that this new ruling has unfairly placed the burden of physician compliance squarely on the shoulders of the very patients it intends to help.  Many of the elderly, chronically or seriously ill patients cared for by the Visiting Nurse Association of Boston will be placed at risk for losing their Home Health Care services due to this ruling.  
You may be aware that the VNAB is the oldest home care organization in the United States; we take pride in offering state-of-the-art, affordable home care services to all residents of Greater Boston, regardless of ability to pay.  Our mission is to keep our patients independent and at home, and thus, out of more costly settings.
Senator, I am writing to ask that you:
1. Urge CMS to delay implementation of the rule requiring that physicians ordering home health care be enrolled in the PECOS data base (i.e. until January 1, 2011). Further, CMS should hold harmless home health providers until such time as physicians have had a reasonable opportunity to enroll.
2. Urge Congressional leaders to intervene with CMS to resolve this issue.
Thank you for your help in preserving access to medically necessary home health services. 
Reynold G. Spadoni
President & CEO
Visiting Nurse Association of Boston & Affiliates

Thursday, June 24, 2010

Everyone in Massachusetts has health insurance, right?

See the email I received below from Courtney Gilligan, our Corporate & Community Wellness Manager.  Her comments below point out a simple fact: though Massachusetts has provided great and model leadership across the United States in terms of providing health care coverage for its population, merely possessing insurance does not equate to receiving necessary services.  The cost/access conundrum is presented in compelling fashion by Courtney below (accents added):

Hi Rey,

This past weekend I had the pleasure and honor of coordinating the VNAB’s booth at the WHDH/Partner’s Health & Fitness Expo. VNAB provided blood pressure, cholesterol and glucose screenings for hundreds of people over the 2 days. I had the opportunity to speak with a lot of people while they waited in line to be screened. It was great to hear how many people had heard of the VNA of Boston before and used the services. They had wonderful things to say about the agency.

On a sadder note after speaking with the nurses, it turns out many of the people who attend the Expo each year come because they do not have health insurance or a PCP. They come to the event for the free health screenings and look for answers to their health questions. They consider this event their annual medical exam.

I wrote an article for the Connector that I have attached for you to read and I have attached some pictures from the event. I also pasted some of the feedback from the nurses who did the screenings. It blew my mind how many people were uninsured and not receiving the medical care they need. I guess this is something I have taken for granted and it was an eye opening experience. I also thought maybe you could use some of this information for your blog.

I am glad the VNAB could provide these much needed services to the community.

Some quotes for our nurses:

“I am happy I did the Expo and as busy as it was, it was also very rewarding and fun as well. For as long as those people waited and by the time they got to me, most were very thankful and grateful for the service the VNAB was providing. Overall it was very positive experience for both myself and the people I provided the service for.”

There was a woman who stated that “I guess this is going to be the last time that I have my B/P checked and it is too bad that you ran out of supplies, so I can’t have my cholesterol checked”. When further inquiry was made as to why this would be her last B/P check, she replied “I’ll have my B/P checked at the next health fair. My Insurance charged me $400.00 for my last appointment with my Doctor. The blood work was not covered and I can’t afford health care. You know, I also have to eat.”

The young man from New Hampshire was having a tough time finding a PCP. He, I think, needed someone to help him in explaining how to use of his Insurance book and in being navigated to the correct numbers and offices to expedite finding a PCP. He was encouraged to go to the Urgent Care not the Emergency room for immediate follow up for his B/P but he refused and stated” I’ll have to wait many hours and will be told to go home. They won’t do anything for me”. Again, more hopelessness being expressed in the medical system!! The Nurse in the Infirmary stated to me both days “Gosh, this is supposed to be a Health fair. We have been an emergency room all weekend.” As you know, I had to transport 1 person to her each day.

So many people told me of having no health ins. and can’t go to a DR so this is how they get testing done. sad comment on health care. It’s a good feeling to know that we are able to provide a much needed service to the community. Lots of people thanked the VNA for doing this. I had a good time and it was fun seeing different people.

I was AMAZED as well at the amount of people who came and stood for hours as you said to get checked out. It broke my heart looking into some of their faces as they looked at you almost desperately for answers. I won't forget that one young guy whose BP was alarmingly high and we told him how badly he needed to go to the ER and he spent the majority of the afternoon making phone calls to different urgent care centers in the city asking how much he would be charged, etc. because his insurance has a 1500 dollar copay. He never went to the ER and I have no idea what happened to him. That was so unsettling to know that all you can really do is encourage them to get the help they need but who am I to say go pay 1500 bucks to hopefully have them give you some meds and hopefully not send you right back out the door! It was amazing to me how many people don't have PCPs and how much education/teaching is needed in terms of health.

Thank you,

Courtney Gilligan

PECOS, not Pecos...

First of all, yes, Pecos is a picturesque town located near Santa Fe, New Mexico.  But I'm writing about a different PECOS.

If you're interested in New Mexico, click here.

According to the Federal Government, "PECOS supports the Medicare provider and supplier enrollment process by capturing provider/supplier information from the CMS-855 family of forms. The system manages, tracks, and validates enrollment data collected in both paper form and electronically via the Internet."  For more information, see here.

It turns out that this second PECOS is a big deal. 

From an email I just sent to all staff (forwarding one from VNAB Vice President of Quality & Regulatory Affairs, Ginny Tritschler):

I’d like to add my own note of urgency to this request. This issue does have a very real potential to negatively impact our organization and those who rely upon us for health care services. Our election delegation might listen if a few of us write. They will for sure listen if all of us write.

Please consider speaking up for our patients and for the VNA of Boston. It will only take a few minutes but will make a very real difference.

Thank you. We’ll keep you posted.



From: Tritschler, Virginia


Contact your congressional representatives regarding the following:

Effective July 6, 2010, all physicians who do not have an approved enrollment record in PECOS (Provider Enrollment, Chain and Ownership System), Medicare will not pay for the patient’s home health or DME services. Although, the physician will be paid for their services.

VNAB has verified that approximately 1,100 out of the ~ 3,200 physicians who have signed orders in 2009 and 2010 are in PECOS. Out of 900 physicians with patients on caseload today almost 300 are not in PECOS. This means after July 6th Medicare can deny payment on those patients.

What is the VNAB doing? We are sending letters to the 2,200 physicians not in PECOS informing them about this rule; we are going to go to the media with this story; we are calling the Senators and Representatives who are known supporters of home care; and finally we are asking for your help.

Please click on link to email your congressman and urge them to delay this action. Explain the consequences if patients do not receive services because home care will not be paid. You can use the letter provided by NAHC or adapt to your words.


Saturday, June 19, 2010

Judging a book

It's part of my daily routine.  Starbucks, ideally the one that is two miles from my home, receives the visit which generally includes using the drive-through and, on many days, seeing Carol, the ever friendly attendant who serves me up a venti iced coffee, milk no sugar.  A full day of to dos and errands and a hop over to see Carol were in order on this day.  As I pulled into the corner lot where the storefront stands, I was relieved to see only one car at the order box.  No lines.  Quick in an out.

Sitting behind the black Chevy Cobalt, I observed its driver speaking into the order kiosk.  She was laughing.  Chatting.  Taking her time.  How long does it take to order a coffee?  I looked at my blackberry and saw there was a message there from a co-worker.  I read it, responded.  Still the Chevy Cobalt impeded my progress.  How rude.  I'm in a hurry.  If she wanted to chit chat, why do so in the drive through?  By now I'm curious.  I look into the side mirror and see her face.  She is smiling.  Giggling even.  Unflattering expressions such as valley girl and bubbly and perky pop into my head.  I'm not proud to say it, but it's what I thought and the impatience welled.  I thought of honking my horn.  It seemed like an hour, though probably it was three or four minutes.

My turn.  Finally.  Venti iced coffee, milk no sugar.  So there.

Again, Cobalt picking up her coffee.  Chatter.  Giggling.  I'm going to beep the horn now.  Really I am.

As I approached, Carol was waiting there for me.  Coffee in hand.  "What was the deal with her?" was my best opener, but Carol beat me to it.  She said: "I"m so sorry about that.  That was a regular customer of mine.  She's leaving tomorrow to go to boot camp.  She's going to be a Marine."

I don't know the woman in the car in front of me.  I don't know what motivates her or why she is departing for, probably, Parris Island in 24 hours.  I do know that if she is successful, she will join those who protect all of us.  She may be called upon to leave home, to endure sacrifices and to perhaps even lay down her life for us.... and even for me, the impatient patron behind her car at Starbucks this morning.

Wednesday, June 16, 2010

Where are the blog posts?

A friend observed: "You know he has to be busy when he stops posting on his blog." Well, since about 95% of my posts come at night and on weekends and since this is birthday, graduation, piano recital, anniversary, etc. season, I'd say my friend is completely correct.

I have a million ideas for blog posts just waiting for the right moment. Soon...

... and thank you for your patience.

-- Post From My iPod

Tuesday, June 8, 2010

Andy Knows Best...

Based on the number of hits to this earlier post, I thought I'd return to this theme on occassion.  In this case, I'll reprint a section from a recent communication from the Visiting Nurse Associations of America President and CEO, Andy Carter.  Andy is an exceptional advocate for the not-for-profit home care industry and I'm happy to see that he's harping on this theme.  The boldfaced and red section below is my own added emphasis and, if you've been reading this blog, you'll note it's a strategy we've embraced at the Visiting Nurse Association of Boston & Affiliates.  We can talk about our exceptional outcomes because they are, in fact, exceptional.

From Andy (June 7, 2010; see the whole post here):
CEO Column: Beating the Competition Even When It Bends (or Breaks) the Rules

In parts of the country where growth of for-profit home health and hospice agencies is rampant, nonprofit providers are deeply worried. With a long and proud history of doing the right thing for their communities, they have learned over the years that many newcomers play fast and loose with the rules and adopt business and clinical shortcuts in order to maximize profits and drive legitimate agencies out of business.

When last month the Wall Street Journal ran stories on therapy billing practices of the four largest publicly traded home health companies, many of us felt vindicated and pleased that the tide might be turning and that the playing field might finally be leveled.

From where I sit in Washington, though, I think it would be a mistake to count on law enforcement agencies, Congressional investigators, or regulators to bring lasting order and fair competition to the Wild West chaos that often dominates home health. Given the many pressures on Federal resources, do we really think there will ever be enough “cops” to police this beat? Given the money to be made by profiteers and thieves in places like Dade County, Florida, many of them are more than happy to face the slight risk of prosecution. Even tripling the number of investigators wouldn’t make a dent.

And even if the fraud and abuse came to an abrupt end, do we really think we can consistently win in the home health marketplace against competitors with seemingly infinite advertising and business development budgets and marketing strategies focused entirely on highly profitable cases?

For that matter, are we even competing in the same market? Nonprofit agencies are serving the needs of their communities, not their investors. Instead of a narrow, profitable swath of the market, we take on the whole community, and in so doing we’re carrying a weight the competition will never carry. To capitalize on that reality, we need to work everyday to position ourselves as the preferred provider for referral sources and the agency of choice for patients. Our mission can be parlayed into a solution for referral sources as we remain patient-centric and focus on a breadth of high quality services.
So, how do you implement that mantra? Some VNAA members are confronting the competition with world-class referral development programs of their own, showing referral sources the depth and range of their clinical programs and highlighting their outcome scores in comparison to other agencies. They are attempting to win by offering the best services while being good stewards of the community’s resources through the adoption of technologies and streamlining of operations. They are also winning patients over by providing exceptional care, timely and responsive follow-up to patient satisfaction surveys and offering post-episode services that help cultivate “customers for life.”

There’s also a growing segment of our membership that is simply deciding to play a different game – specifically, a game they have a far better chance of winning. Rather than competing solely for the Medicare certified home health business, they’re re-introducing themselves in their markets as partners in reducing and preventing re-hospitalizations and managing chronic conditions.

Sunday, June 6, 2010

Moving from still to moving...

Accomplished still photographer, Trey Ratcliff (check out his exceptional website here) has discovered the movie function on his digital SLR camera.  Once thought of as marketing wizardry only, the video capabilities of still cameras are now being uncovered by creative artists.  Trey recently visited Japan and as he was out and about in the various urban and rural regions of the country, he captured snippets here and there of action, motion.  Later on, he sewed them together, set the piece to music and put it all up on Youtube and his own site.  And it's causing a sensation... while inspiring still photographers (like me) to push the video button on their SLRs more often.

Saturday, June 5, 2010

Thursday, June 3, 2010


Health Care is Expensive. We Get It!

For as long as I can remember (or for as long as I have been paying attention) someone has been describing the health care industry as "in crisis".  When I got started, the inevitable "health care as a percent of GDP" slide (back then, they were printed on acetate film and illuminated via bulky overhead projectors) in every industry speech showed that we were approaching 10% and that that was, clearly, unsustainable.  Now (using PowerPoint and bulky digital projectors) we decry 17% and still use the term unsustainable.  It's been a crisis for a long, long time.  For at least 30 years.

Yesterday, the Massachusetts Health Council gathered together eight individuals to share one stage.  The topic concerned how the recently passed Federal health care reform law might impact all of us here in Massachusetts.  It was a who's who affair.  If you were going to choose a spokesperson for each industry segment, whether hospital, physician, community health center, HMO, government... this would have been precisely the group to choose.

I've been witnessing such debates for, well... about 30 years... but yesterday's debate was a bit different.  The divergent points of view were more hotly and pointedly made.  Though no one actually pointed a finger at anyone else, they may as well have.  The physician representative claimed that docs are "the patient defenders" and that administration simplification (translation: reducing the hassle factor heaped upon physicians by the health plans) and runaway malpractice claims (translation: an ever increasing need for defensive medicine required by lawsuit fearing MDs) are the true culprits.  The health plan spokesperson pointed out that administration is but 10 to 13 percent of the total medical dollar and that the true savings come from provider-related costs.  The hospital voice talked about distinguishing higher quality providers from others while the business person bemoaned the lack of good, reliable data proving that restricted networks (translation: HMO products that cut out some of the big, in town, academic medical centers) save money without cutting quality. 

It was a great discussion... but ultimately, it missed the mark by a mile.  Everyone understands that health care is expensive.  Everyone knows that it is getting more and more expensive.  It is tiresome to hear the same frustrated calls for relief, however.  We're long on problem definition but far short on problem solving.

In my view, here are some of the top issues:
  • In America we like choice.  We like to gain access to whatever we believe we need.  Every time someone suggests that we might need to restrict access, even just a tiny bit, opponents cry foul.  They use words like ration and death panel.  And then the conversation dies.  That happened during the recent health reform debate.  As long as we firmly believe that every member of our society deserves access to whatever they (or loved ones) deem necessary, then costs will continue to go up.
  • Administrative simplification is a good thing.  Requiring physicians to be credentialied by every payer in all manners possible is, in fact, wasteful.  But ever expanding requirements around fraud prevention, confidentiality and quality reporting all cause administrative complication.  We ask the administrative infrastructures of health care organizations to do more and more, yet don't understand why they need to hire people and invest in new systems to accomplish that work. 
  • We're getting older and living longer.  Many of us are fortunate enough to get our hips replaced or require second and third rounds of chemotherapy when prior generations never made it that far.  We are driving costs upward.  R&D in the pharmaceutical industry is being fueled by our strong desire to find newer and better drugs to heal and prolong us.  64 slice CTs do a better diagnostic job in some cases than older technologies, but we want every community hospital to have one of them.  Or two.  We want more and better... but more and better is expensive.
  • Expanding access for millions of un/underinsureds costs us money now and saves us money later.  Maybe much later.  The return on this investment will be hard to prove out and will always be subject to interpretation and political skepticsm.  The new Federal law (Patient Protection and Affordable Care Act) is big on Patient Protection but short on Affordable Care.  Is that because it was politically expedient for it to be that way?  I don't think so.  I believe that the short-term protections were widely agreed upon (e.g., eliminating prior condition exclusions and mandating coverage) while the cost control components are more complex and we're just not in agreement on where to go next.  Witness yesterday's panel.
It's been a crisis for 30 years.  It has only begun to feel like it more recently, however.

Tuesday, June 1, 2010



It does matter...

... who you refer your patients, loved ones and friends to for home care.  The latest industry data (compiled by Fazzi Associates) proves it.  Again.

Remembering now...

The Greatest Comeback

After Game Three, when the Yankees socked the Red Sox and it appeared as though the home team's perennial quest to shake off past demons would remain... perennial... we all then witnessed the greatest comeback in history.  The Sox went on to win that ALCS and then the World Series and all past demons could be, finally (!), purged and exorcised.

In the late 1970s, two upstarts... one headed by Bill Gates and another by Steve Jobs... initiated the personal computing age.  Apple was quickly outflanked by Microsoft, though, and Gates and Co. soared to the industry leadership position, successfully transforming and empowering a new digital era.  Apple's prospects dimmed, leading to a departure by Jobs and numerous predictions that the always quirky and sometimes innovative computer-company-named-after-a-fruit would fail.  Michael Dell once called for Apple to shut down and return whatever money was left over to shareholders.  Mr. Dell now oversees a company merely a tenth of the size of Apple.

Apple's transformation of the computing business began, upon Jobs' return, with the introduction of small, simple to use devices known as iPods (and its accompanying iTunes software and store).  Then came the iPhone.  The iPad has exploded onto the market.  Macs are now powered by Intel processors and are able, essentially out of the box, to run most Windows applications.  And what about these guys (I could watch them all day long)?

Well, last Wednesday, Apple surpassed Microsoft in terms of overall market valuation ($222.1 billion to Microsoft's paltry $219.2 billion) and is now just below Exxon in terms of overall US companies.

What a comeback!  The greatest of all time.