‘Regionalized’ Approach to Cancer Surgery Leads to Better Outcomes

Lung-cancer surgery patients who received care at regional centers where specialty care is concentrated have shorter hospital stays and fewer complications, according to Kaiser Permanente research presented this week at the 55th annual meeting of the Society of Thoracic Surgeons.

“Shifting lung cancer surgery to designated centers within our integrated health system reduced the number of days patients spent in the hospital, decreased intensive care use, and reduced post-operative complications,” said Jeffrey B. Velotta, MD, a thoracic surgeon at Kaiser Permanente Oakland medical center.

Kaiser Permanente regionalized thoracic surgery care in 2014 by shifting cases in Northern California from 16 hospitals to five designated specialty-care centers.

Researchers looked for effects of regionalization by comparing two groups of patients: 782 patients who underwent lung-cancer surgery between 2011 and 2013 (before regionalization) and 845 patients who had surgery between 2015 and 2017 (after regionalization).

The researchers found that regionalization resulted in increased use of minimally invasive, video-assisted thoracoscopic surgery – from 57 percent to 86 percent.

In addition, the average operating time for these types of surgeries decreased by more than 50 minutes after regionalization, possibly due to the surgical team’s efficiency with repetition of these cases.

“In our study, we found that regionalization of lung surgery was indeed feasible within an integrated health system,” said Velotta. “In the post-regionalization era, lung surgeries are performed by more experienced, thoracic-specialized surgeons at higher volume centers.”

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5 Times You Need a Financial Adviser — and When the DIY Approach Is Fine

When I decided to start investing for retirement, I had no clue where to start.

I had no 401(k), individual retirement account (IRA) or health savings account (HSA). I didn’t even have one of those apps that invest your spare change. I was starting from zero.

I assumed that to start investing you had to have a financial adviser.

So I made an appointment with one who would see my husband and me for free — how sweet of him! — and we sat for hours as he went over four investment options.

I left more confused than I came in. I just wanted to give him my money. But it had to pass through so many hands before it could enter the market, and for some reason, we needed another meeting.

At that second meeting, I found out how he got paid: a 5% commission on all of my contributions. I realized that if I did this on my own, even if my returns were worse, I might come out on top with all the money I’d save without his commission.

That was the first time I realized that I didn’t need to use a professional to start investing.

When Can I Do It Without a Financial Adviser?

If you’re just starting out and you don’t have any complex situations like a large inheritance or six-figure income, you can succeed for a while on your own.

But if you’re going to DIY your investments, you’ll need to commit to learning about investing. Luckily, there’s a wealth of information on the internet.

The Penny Hoarder has a lot of articles to help you get started saving for retirement that explain things like:

If you prefer a book to a computer screen, I recommend “The Simple Path to Wealth” by JL Collins. It explains everything you need to know to get a grasp on basic investing concepts while not putting you to sleep.

As long as you continue accumulating cash in your accounts and everything is smooth sailing, that’s the time when, if you feel confident, you can go it alone.

But what are the signs it’s time to pony up for a professional?

When Do I Need a Financial Adviser?

Financial advisor Paul Ruedi poses outside in front of greenery.

I talked with three professionals in the planning industry who have fiduciary obligations — meaning they’re legally obligated to work in the best interest of clients. (I know: Why isn’t that universal yet?) They filled me in on when you really need to get professional help.

Paul Ruedi of Ruedi Wealth Management specializes in retirement planning. He thinks one of the best times to consult an adviser is before or during the transition to retirement.

Transitioning into life without a paycheck requires making a lot of complicated decisions,” Ruedi said. “On top of that, people’s investment account balances are likely the highest they have been in their lifetime, which amplifies every little movement in the stock market and can turn investing into an emotional rollercoaster.

When you’re making decisions like how to make your investments last for multiple decades, when to claim Social Security and how to best withdraw from those accounts, it’s time to get someone on board to guide you.

In some instances, you might need someone in your corner well before retirement.

Kayse Kress, a certified financial planner at Physician Wealth Services, poses outside.

Kayse Kress, a certified financial planner at Physician Wealth Services, said people often benefit from objective advice.

Even if you are a really smart person, it can be hard to keep your emotions out of your financial decisions,” Kress said. “You could benefit from working with an adviser that will provide you with objective advice and help you make more sound financial decisions.

The people who benefit most in Kress’ practice are those who are just too busy to find time to focus on creating a plan for their finances.

But a big reason people don’t find the help they need is that traditionally, it’s been difficult and expensive to work with someone.

It wasn’t too long ago that if you weren’t sitting on a pile of cash to invest, then it could be difficult to get anyone in the financial services industry to work with you,” Kress told me.

But with the rising popularity of fee-only financial planners, people can now seek out the help they need at any point in their financial journeys.

Chris Hutchins, co-founder and CEO of online financial planning service Grove poses in his office.

Chris Hutchins, co-founder and CEO of online financial planning service Grove, has seen many circumstances when having a financial planner before retirement was necessary. Some examples include:

  1. You’re not sure how to figure out if you’re saving enough or whether you’re on track for your retirement goals.
  2. You don’t know what your goals are or how much you need to be saving for them.
  3. You’ve intended to do something about your finances for a long time, and yet they’re still in the same spot.
  4. You’ve had a sudden financial windfall (inheritance, your company was acquired, etc.).
  5. The stress of trying to figure out whether you’re on track or doing the right thing with your money is too much.

No matter how young or old, or investment savvy or not you are, there’s no excuse to not plan for retirement. For some, that might mean a DIY approach. But for others, it means seeking professional help.

Thankfully, there’s a place for everyone to get what they need.

Jen Smith is a staff writer at The Penny Hoarder. She writes a lot about retirement and gives money-saving and debt-payoff tips on Instagram at @savingwithspunk.

This was originally published on The Penny Hoarder, which helps millions of readers worldwide earn and save money by sharing unique job opportunities, personal stories, freebies and more. The Inc. 5000 ranked The Penny Hoarder as the fastest-growing private media company in the U.S. in 2017.

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Chrissy Teigen Takes a Different Approach to the ‘Hot Ones’ Challenge

Chrissy Teigen is next in line to step up to the Hot Ones challenge. The self-proclaimed “wing and hot sauce freak” tackles the spicy plate with a peculiar strategy to best the notable food obstacles. Throughout the episode, Teigen discusses her meme-generating facial expressions in addition to her own cookbook and chefs that she admires. She also adds her own suggestions to make Mario Kart Odyssey a better game and relays her favorite Twitter battles.

Watch Chrissy Teigen take on the Hot Ones challenge above and let us know your thoughts. In related news, check out how Kevin Hart and Tiffany Haddish switch things up on Hot Ones: Truth or Dab.

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