A Career in Healthcare Management – A Day in the Life of a Practice Administrator

Your day might not be anything like what I’ve described below, but the point of the post is to suggest that most administrators put out fires all day long and juggle meetings, email, and employee and physician issues and have very little time for planning and thinking. Depending on how long you’ve been with your current group, how well trained your staff are, and how many supervisors you have working with you, you might have a much easier day than described below, or a much harder one!

7:00 – 8:00 a.m.

An employee calls you at home before 7 a.m. to say they will not be in. You check the schedule to see how staff can be re-arranged to cover all needs.

8:00 – 9:00 a.m.

As you arrive, two employees have been waiting for you and have things to discuss with you – one wants to reschedule her vacation for the third time and the other wants information on FMLA (Family Medical Leave Act.) You tell the first you’ll look at the schedule and get back to her and hand the second a packet of info on FMLA to review.

You check your schedule and note that Nurse’s Day is coming up soon and you need to make plans to celebrate their day.

You check your email and see that your state listserv has some interesting information that you forward to your billing manager, asking her to look into the issue and tell you if it applies to your practice.

9:00 – 11:00 a.m.

You handle a patient complaint. You round on everyone in the practice, checking to make sure everyone has what they need and checking on their weekends. On your way back to your office, a nurse mentions that the exam rooms are not being cleaned as thoroughly as they should be; you make a mental note to speak with the cleaning company.

Your 9:30 a.m. meeting is with a broker who has some quotes to share with you in anticipation of your June 30 benefits year-end. Your senior physician has asked that the group consider cutting benefits this year if health insurance rates go up again.

You listen to several voice mail messages that came in while you were meeting with the benefits broker. The first is your EMR project manager calling to say your go-live date might need to be changed; please call him back. Another is a payer asking to schedule a chart audit sometime in the next three weeks.

11:00 – 12:00 p.m.

A physician lets you know that she’s using the last of the Rx pads – could you order some more ASAP?

It is payroll week and you spend most of the hour finishing the payroll and checking with the four employees whose payroll record is missing a punch. You send the payroll file out and move money into the payroll account, checking the bank balance and noting the Electronic Funds Transfer that came in since you checked it on Friday.

12:00 – 1:00 p.m.

You meet with a physician who has concerns about the compensation schedule. He asks for a report showing his charges, receipts and work RVUs by month for the past two years.

You receive your mail, put bills in the to-be-paid file and note that an employee that you terminated is appealing her unemployment denial and there will be a hearing next week.

You call your printer and put a rush order on Rx pads.

1:00 – 2:00 p.m.

You look at your calendar and remember the accountant is coming for her quarterly visit today and you don’t have everything ready.

You realize lunch is out for today, grab a soft drink from the break room, grab a packet of crackers from your drawer and review your email. You’ve been advertising on craigslist for a medical records clerk and you take a quick look at the responses you’ve gotten and see there are two that look like they have possibilities. You call both candidates and leave messages that you’d like to speak with them about the position.

You get the rest of the information together for the accountant and clear a space at the desk where she works when she comes.

2:00 – 3:00 p.m.

The accountant arrives and starts working, and you know you’ll need to stay close to answer any questions she has.

You start working on the reports that the physician has asked for.

You call your EMR project manager but get his voice mail and leave a message. You call the payer and ask for a list of the charts needed for the chart review with a request letter detailing the type of audit.

You start reviewing the report from the benefits broker to see where you might be able to change other benefits to afford to continue the same health insurance plan.

3:00 – 4:00 p.m.

One of the medical record candidates calls back and you talk with her at length, then invite her to interview with you in two days.

You review the staff vacation schedule to see if you can change the schedule for the employee who has changed her mind about her dates.

You round on everyone in the practice again, checking to see that everyone got a lunch and that things are running smoothly.

When you return from the bathroom you have five voice mails (!), one of them the EMR project manager calling you back again.

4:00 – 6:00 p.m.

Your billing manager arrives for her standing weekly meeting and reviews the previous week’s dashboard numbers for charges, receipts, write-offs and accounts sent to collections. She tells you that one of the check posters has noticed that a payer is not adhering to the contract on payments. The manager wants to know what to do about it. You ask her to track back the payments and identify exactly when the payments started going off-schedule. You call the payer representative and ask for a meeting later this week.

You receive a call back from the second medical records candidate and after speaking with her on the phone, you decide not to invite her to interview.

The employee asking about FMLA stops by and makes an appointment to speak with you tomorrow morning. She tells you that her mother is ill and she will need to miss work to care for her intermittently.

The cleaning crew arrives and you walk through several exam rooms with them, talking about the level of cleanliness that is required. You make a mental note to touch base with the nurse who is monitoring the rooms and see if there is improvement in a few days.

You check your email, straighten your desk surface, notice the to-do list you started the day with that has nothing crossed off. You add two more things to the list, turn off the lights, and leave the office. There’s always tomorrow.

Treating Mental Health and Forensic Populations

No longer is it possible to assess and/or treat a mental health population without also interfacing with forensic issues such as legal infractions, Courts, violence, sexual behavior problems, delinquency, crime, Not Guilty by Reason of Insanity, substance abuse, and others. The training and approaches to the mental health population is different than that for a forensic population. So what is to be done, if a person has both issues? We must be cross trained for dually affected clients.

How Are the Populations Different

A Mental Health population is comprised primarily Axis I disorders, such as Bipolar Disorder, Schizophrenia, Major Depression, PTSD, and Anxiety Disorders. Daily functioning is on a continuum. Recovery is quick for some and slow for others and is also on a continuum. Well controlled intermittent, mild to moderate episodes of a mood or anxiety disorder will not necessarily interfere with daily functioning. Someone with severe, chronic Schizophrenia or Mood Disorder requiring periodic hospitalizations and extensive community support, will have impairment in daily functioning. Goals for these folks are often pro-social and involve being an active member of society. A therapist can be fairly sure that the mental health client without forensic issues will be relatively honest in his or her interactions and the therapist can take most of what he/she says at face value. An emphasis on a strengths model works well when no personality disorder is involved.

A forensic population can be defined as having personality disorders, interpersonal difficulties, behavioral problems, multiple problems and life long courses of various levels of dysfunction or difficulty. Again, this population fills the full spectrum of effective daily functioning. However, social functioning is often the most severe impairment. There are issues of trust, appropriate relationships, ego centrism, moral development, honesty, manipulation, and danger to self and others. They often have a negative view of themselves and others, especially authority figures. Moral development is often delayed leaving them at the egocentric stage of development. This means that what serves the self is what matters and empathy for others and the ability to have an honest relationship with another person may not yet have developed. Their goals are often self-serving.

The capacity to understand the importance of the best interest of the group through laws and rules that we voluntarily follow, may not be well understood. Many, if not most, have histories of childhood abuse, neglect, or exposure to domestic violence. The assessment and interventions with this population is necessarily different that those for a people with no Axis II disorder or trait. The people with forensic issues do not always tell the truth because of their lack of trust in relationships. The therapist cannot take what he/she says at face value. The therapist must separate the sincere from the manipulative moves for self-gain. The internal boundaries are such that they need the therapist to put external boundaries into place for them. Information must be checked with other sources of information.

How Assessment Tools Differ

In a mental health population, assessment can quite effectively be done through instruments such as the MMPI-A, BASC, and MACI. These self-report tools are quite sufficient for this population and will elucidate psychological dynamics and mental illness, if present. Self-report is not as much of an issue as it is in the forensic population, where third party verification is more important. However when a youth has multiple problems, both mental health and forensic, a combination of tools is preferred.

Forensic evaluation tools rely less on self-report because of the trust issues and because it is not always in the client’s best interest to be completely truthful. Self-report assessment instruments can be used, but third party and official reports should also be used in the evaluation phase of a forensic assessment. Courts are concerned with public safety, therefore, the need for tools that assess future risk of dangerousness to others. Risk of future aggression and sexual behavior problems that have been derived from statistical models (actuarial tools) should be part of the evaluation since clinical assessment of risk of future dangerousness is only a little better than chance. While risk assessments are not perfect, they are better than clinical judgment in this area.

How are Interventions Different?

Major Mental Illnesses, while often chronic, can often be very effectively treated with medication and therapy. At the higher functioning end of the continuum, therapy can be supportive, psychotherapeutic, family, or cognitive behavioral. Therapists are trained to accept what the client presents and start where the client is functioning and how the client sees the world. The clients are usually self-motivated and seek therapy voluntarily. They accept responsibility for their behaviors and for making changes in their lives. Use of a strengths model is often very effective. Many people recover fully and lead quite “normal,” non-disrupted lives. When someone is on the lower end of the continuum, with major disruption in every day functioning (work and family),despite medication and therapy, major supports for housing, jobs, and activities of daily living and medication are needed for a very long time, perhaps a life time. However, their life goals are often still pro-social. Serlf-directed care works well with the mental health population without Axis II diagnoses.

In the area of intervention, different approaches are needed for the forensic population. Some level of social and family dysfunction is generally intergenerational and lifelong. These clients are often Court ordered to an assessment or therapy or they are having significant problems at work or within the family causing others to seek assessment or therapy for them. They do not always accept responsibility for their actions or for changing. There are skill deficits that need to be addressed, such as social skills, anger management, and problem solving. You cannot take what these clients say at face value. Third party information is always needed. This is because you need to trust someone in order to be honest with them and most of these folks have been abused, neglected, or exposed to domestic violence and a suspicious arm’s length treatment of others is a coping strategy that is difficult to give up.

This population often has multiple problems so that Multi-systemic Therapy that approaches many areas that need to be addressed is often effective (treating the whole person). Group work and trauma therapies are also good tools. Self-directed therapy may not be effective because of the need to protect oneself from what may appear to be an unsafe world. Nurturing, setting good boundaries, and structure are essential in this work. Motivational interviewing and stages of change can be very helpful. When clients have issues in the mental health and forensic arenas, both approaches must be used to the extent possible.

Conclusions

Clients in a mental health setting range from the single diagnosis of a major mental Illness to the dual diagnosis of a major mental illness and a personality disorder and/or forensic/legal issue. The approaches to these dissimilar populations is unique when clients are dually diagnosed, both approaches are needed. Assessments and treatment for a mental health population can be self-directed and strengths based.

However, the approach for the forensic population cannot be self-directed because the client’s goals are often antisocial and by definition counter to the best interests of society. The therapist or evaluator cannot accept everything the client says at face value because not being honest is part of the disorder that the therapist is treating. Motivational interviewing seems to blend the views of traditional mental health and forensics in a way that is beneficial for the client and society.

Medicare Open Enrollment And Supplemental Insurance

Medicare open enrollment is a six month period which includes the three months before and after a consumer’s 65th birthday. In many cases, it is advantageous for seniors to purchase a Medicare supplement policy during their open enrollment window. Under certain circumstances, consumers who allow their six month window to expire may not medically qualify for a supplemental plan.

Guaranteed Eligibility at Age 65

Medicare qualified seniors are guaranteed eligible for insurance during open enrollment regardless of their health history. Health underwriting is not necessary and there are no medical questions to answer on an application. All Medigap insurance plans offered in the applicant’s state will be available for purchase. Simply put, insurance companies cannot deny Medigap coverage if application is made during the six month time-frame.

Other Guaranteed Periods of Eligibility

There are other time periods of guaranteed eligibility for Medicare supplement insurance for those outside of their six month window. Consumers age 65 and older who are involuntarily losing group health insurance or group supplemental coverage will also be guaranteed a Medicare supplement plan. However, they may have to go through underwriting for certain plans (Plan J for example) and they might not be offered premium discounts on their plan choice.

Additional Advantages of Purchasing Coverage in Open Enrollment

There are many supplemental insurance providers who provide discounts during open enrollment. In some cases, the applicant’s price reduction can be as much as 15%. This savings will carry over into subsequent years helping to keep premiums lower as the insured grows older. Additionally, some insurance companies will require underwriting for popular supplements, like Plan J, if the applicant is more than three months past their 65th birthday. If applying during open enrollment, health underwriting will not be required for Plan J.

Medicare Disability and Open Enrollment

In some states, acceptance into Medicare disability is a qualifying event for guaranteed coverage. Consumers under age 65 who are approved for government disability will have a six month window to purchase a Medicare supplement regardless of health history. (Missouri is one such state.) It is very advantageous for Medicare disability consumers to enroll in a plan during their six month opening. Otherwise, they will have to go through medical underwriting and acceptance would be unlikely due to health concerns.

In summary, seniors near their 65th birthday and disabled persons eligible for Medicare coverage should consider applying for supplemental coverage. Applying during a period of open enrollment will render underwriting unnecessary, allow for more plan choices, and also offer premium discounts.

Medicare supplement insurance quotes in Georgia, Illinois, Indiana, Missouri, and Ohio – Including Plan F and Plan J

The Simple Facts About the Amazing Hoki Fish That Produces Omega-3 Fatty Acids

Hoki is a type of fish which lives in the crystal-clear deep waters of southern New Zealand. The fish is also known by a number of other names, including blue grenadiers, blue hake, whiptails, whiptail hake, and New Zealand whiting. Its scientific name is Macruronus novaezelandiae.

The long silver fish has very tiny scales and looks similar in appearance to Gem fish. Hoki have a long wedge shaped body that is narrower at the tail, with slim fins and a blue-green to silver color pattern. They have huge eyes and a large protruding jaw that is a feature associated with cod and hake. The large eyes make the fish look like they are perpetually startled.

Hoki is usually sold in fillets and the thick flesh is rich in omega-3 fatty acid, making it a very healthy food. The fresh fish is creamy pink to off-white, firm, lustrous, moist flesh and without any brown markings. One of the key indicators to determine if the flesh is fresh is its pleasant smell. The flesh can be deep fried, pan fried, baked, grilled, barbecued, steamed or smoked.

New Zealand hoki is commonly used for fish and chips, minced for fish burgers and can be found in seafood extender. The fish is one of the varieties used in the McDonald’s Filet-O-Fish and McFish sandwiches. It is also favored by reputable restaurants as the dense flesh holds up very well to being saut├ęd. The flavor is mild and slightly sweet, and the fish pairs well with a wide assortment of sauces and vegetables.

Hoki fish are one of the best sources of omega-3 fish oil supplements. Omega 3 fatty acids are nutrients that our body needs but cannot produce. The fatty acids are good for preventing breast, colon and prostate cancer. It is also possible to reduce prostate tumor growth. Cardiovacular disease is minimized when the nutrient is taken regularly.

Omega 3 fish oil supplements can also help improve heart rhythm problems that can cause sudden death. It is also known to prevent psychotic disorders in children and adolescents. Most scientists and health professionals believe that it is the anti-inflammatory properties of the fish oil that enable it to provide so many health benefits.

In New Zealand, hoki comprise the largest commercial fish species. Because of the high volume of catch, fishing is closely monitored to ensure that the fish are not being excessively exploited.

Royal Jelly Cancer Cure: Does It Really Exist?

Royal jelly is among the natural substances used as holistic cures. It cannot be duplicated in a laboratory because of its intricate components. Humans harvest it directly from the hives in small amounts. As a result, finding fresh royal jelly paste to treat diseases like cancer is hard. Much of it is enclosed in capsules and tablets in form of powder. Debates and researches have been ongoing regarding the effect of royal jelly on cancer tumors. Does this bee product have fight suppression qualities?

Although there are no convincing experiments done so far on cancer patients, doctors have tried them on mice. Doctors usually transplant cancer cells in a rat body so that it can start to develop tumors. Then they treat it with jelly alone or in combination with other substances. Many studies have been done in this manner in countries like China where royal jelly is combined with an herb called ginseng.

Some studies show that royal jelly has been used effectively to treat leukemia. Other clinical tests have clearly demonstrated how the use of royal jelly and cisplatin( a strong chemotherapy drug) reduce the likelihood of cisplatin destroying the liver and kidneys. The role of bee’s milk in this case is to reduce lipid peroxidation. It also raises the strength of antioxidants like glutathione and superoxide dismutase in the body.

Are you a cancer patient and are undergoing chemotherapy or radiotherapy? If so, you are already aware of the side effects of these two therapies. Like most sufferers, you feel very tired and nauseated after treatments. In addition, you probably have skin burns, mouth ulceration and hair loss now. Above all, perhaps you are feeling too worried because of the unknown consequences of having cancer. You are not alone in all this.

There are countless men, women and children who feel totally worn-out after cancer treatments. According to Professor Fang Zhu, of the Lianyugang Apitherapy Hospital, in China, jelly alleviates effects of radio and chemo therapies. Fang Zhu believes that this bee product boosts the immunity of a cancer patient. Among the components of bee’s milk that make it important to cancer patients is hydroxyl-decanoic acid. This is a fatty acid that is only found in this bee substance.

It has been used successfully to inhibit malignant leukemia cells in mice. When royal jelly and Ginseng are used together to fight cancer, patients show an incredible improvement because of the zinc mineral found in Ginseng. Other anti-cancer agents in this bee’s milk include vitamins E and C. They have antioxidants that are known to be very essential to the human immune system.

Saying that royal jelly contains cancer fighting elements is one thing while ascertaining the quantity of elements needed to cure cancer is another. One way to find out how cancer patients feel about this bee substance is to browse the internet. There are patients who have reviewed the supplements they have used to alleviate their cancer discomfort. Reading their reviews and testimonials might give you the confidence you need to try royal jelly cancer supplements.

Penis Health Creams Reviewed – What Penis Vitamins Can Do and What They Cannot

Daily penis care plays a big role in men’s sexual health. Maintaining healthy penis skin can leave the skin smooth, supple and responsive and may boost receptiveness to sexual stimulation. Using the right penis health cream can have long-term benefits and increase sexual pleasure in men of all ages.

However, men who are looking to improve their penis health often find themselves stuck with useless, yet expensive products that do nothing to live up to their advertising claims. Smart consumers should be aware of what to look for in a penis health cream, and they should have realistic expectations about what penis vitamins can do for men’s health.

What penis creams can’t do:

Although it is tempting to believe claims that vitamins and other ingredients can make the penis longer, thicker, or harder, or that they can make men last longer in bed, the truth is that no cream or vitamin formula currently on the market can do these things. Companies that advertise penis enhancement creams are simply cashing in on a consumer demand that they cannot fulfill.

What penis health creams can do:

The good news is that there are penis vitamins and other nutrients that really provide lasting benefits and can improve sexual satisfaction. With the right ingredients, men can improve the tone and texture of the penile skin, prevent premature aging of the dermal tissue, boost sensitivity, maximize circulation and support the natural healing properties of the skin. By doing so, responsiveness to sexual stimulation is increased, and men can enjoy the more fulfilling sex that accompanies a healthy, youthful penis.

Penis vitamins – ingredients with real benefits

The following vitamins and other nutrients have been shown to improve the overall health of the erogenous skin:

• Vitamin A – Helps to maintain a youthful appearance, speeds healing, and fights bacteria that can cause inflammation, rashes, and foul odors.

• Vitamin B5 – Increases overall healing and works to facilitate penile cell metabolism, an important factor in cellular health.

• Vitamin C – A powerful antioxidant that fights aging, speeds healing, promotes healthy circulation and protects the cells against environmental damage.

• Vitamin D – The so-called “miracle” vitamin that stimulates the body’s healing properties, helping to maintain smooth, clear skin and responsive nerve cells.

• Vitamin E – Creates a natural moisture barrier that maintains the penile skin’s natural hydration and self-lubricating properties.

• Acetyl-L-Carnitine – An amino acid with protective properties that help to prevent nerve cell damage that can result from vigorous intercourse or masturbation.

• L-Arginine – Another amino acid that is a major factor in circulatory health, helping to relax the blood vessels and allow for healthy oxygenation of the skin and nerve cells.

• Alpha-lipoic Acid – A natural antioxidant that helps to protect the skin cells against oxidation (a process which causes cellular damage and can result in aging, a wrinkled appearance, and even skin cancer).

• Natural moisturizers – Natural moisturizers are recommended over man-made products that can contain skin irritants and other harmful chemicals. While aloe, lanolin and olive oil are generally effective, shea butter is recommended for most men, due to its superior healing properties. In addition, shea butter is appropriate for all skin types.

Which health creams contain all of these penis vitamins, minerals and other ingredients?

In the search for an effective penis health cream that actually lives up to its advertising claims, it was found that most creams on the market are geared toward individuals who are looking for penis enhancement. However, these products do little to live up to their promises. Only one penis health formula – Man1 Man Oil – was discovered to contain all of the vital ingredients described above and to provide real benefits for long-term penis skin health.

Supplements for Health, Fitness and Longevity Include a Range of Chinese Teas

Tea’s origin was China. The Zhuo (1034-246 BCE) Qin (361-296 BCE) and Han (206 BCE-226 CE) Dynasties all embodied extensive tea-drinking. Tea use for medicinal nutritional, health, fitness and longevity purposes is determined via the ‘Wuxing’ or 5 Elements School system underpinning (TCM) Traditional Chinese Medicine, Acupuncture, Massage, Health Qigong, Feng Shui, Keep-fit, Wu-Shu-Kung Fu, Chinese herb-use and more.

Chinese tea, purchased in boxes of sachets or in delightful crystallised blocks involves an astounding number of forms tastes, textures, herbal and nutritional ingredients. Applications-including for health, youthfulness and longevity are guaranteed by the long history of TCM. The history of the 5 Elements or ‘Wuxing’ is longer still.

Drunk at home or work Chinese tea is delightful. Consumed at Tea Houses like ‘Up Tea!’ situated in Little Newport Street is London’s Chinatown such tea-drinking can be a delightful experience.

Tea, Health and the Wuxing

The 5 Elements School ‘Wuxing’ links each of the body’s 5 major internal organs (and much more) to Elements as follows: spleen (Earth) lungs (Metal) kidneys (Water) liver (Wood) and heart (Fire). The Wuxing is a proven internal and external balancing health-system. Many teas involve remedies to cure or prevent common complaints, or encourage optimum health, youthfulness and longevity springing from the 5 Elements system still in popular and official use today.

INSTANT CHRYSANTHEMUM BEVERAGE (ju hua cha)

This chrysanthemum tea comprises 45% dried flower extract crystallised upon 55% cane sugar. Chrysanthemum tea treats irritation and inflammation in the lungs, nasal passageways and throat via its anti-bacterial, anti-fungal and anti-viral properties. It also encourages improved vision and helps to cleanse the liver in particular.

Wuxing Students learn how eyes and liver are inter-connected, correspond to the Wood Element and can be both naturally nourished by ju hua cha. They also practise 5 Elements Qigong routines with similar effects.

TIEN-CHI (Heaven Energy) GINSENG FLOWER TEA (ren shen cha)

Tien-chi Ginseng (Panax pseudoginseng) ginseng tea variety from southwestern China is mainly cultivated in Yunnan and Guangxi Provinces. Tien-chi plant root is used as a health product for regulating blood circulation. The flower functions as a heat clearing and toxin cleansing herb used to reduce inflammation, feverish feelings, skin eruptions and sore throats.

XIAMEN GREEN TEA (lu cha)

Green tea stimulates the heart in particular, aids digestion and banishes fatigue. Encouraging the body to metabolize more fat and thus much used in dieting and slimming, green tea also encourages longevity and general bodily detoxification.

However as it slightly inhibits iron-absorbption from the diet, green tea should be avoided by anaemia sufferers and women during their menstrual period

JASMINE FLOWER TEA (mo li hua cha)

There are several distinct jasmine tea varieties including green, jade or black. Good for oral hygiene and palate cleansing (before after or during eating) Jasmine tea’s highly aromatic soothing nature also stimulates digestion, encourages relaxation and helps prevent insomnia.

MORNING STAR GINGER BEVERAGE (sheng jiang cha)

Ginger tea stimulates and balances the activity of the heart, lungs and spleen in particular and assists the balanced functioning of the 5 major internal organs as a system in a tonic fashion. Its anti bacterial properties also make it a popular cold and flu remedy.

LUO HAN GUO EXTRACT TEA (luo han cha)

Luo Han Guo (luohanguo) aka ‘Monk Fruit’ (one of many longevity links) is member of the Gourd Plant Family and a fruit well-known for its sweet taste. Luo han cha. It is also well-known medicinally for treating coughs and sore throats and also encouraging longevity. Luohanguo has more recently been developed into a low-calorie sweetener.

When prepared this tea, dark brown and toffee-tasting, can be drunk hot or cold.

CHONG JI 5 FLOWERS TEA (wu hua cha)

This blend of 5 Chinese medicinal herbs cleans away internal heat, encourages diuresis and detoxification. It can also be used to treat sore eyes, sore throats, dysentery and constipation. Delivered concentrated upon cane sugar crystals it has a pleasant caramel taste

Overall

Drinking Chinese Tea in accord with Elements theory enhances health, youthfulness and longevity in many related ways. 5 Elements Qigong provides internal breathing and external massage routines towards the same ends.

The above brands and types of tea are readily purchaseable at your local Chinese Supermarkets the teas’ Chinese names appear in brackets. They are all inexpensive, represent tremendous value for money, are the real thing and offer the true ‘thrill of the swill’!