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America's military and Chicago's Fire Department team up to give Chicagoans the largest 2 Day air & water show anywhere in the country.

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Captions required from any or all of the 3 characters in this drama. The gnome is wise and all family decisions are discussed with him, the cat is dopey but much loved, the squirrel is too bold for my liking.

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U.S. Senator Bob Menendez, ranking member of the Senate’s housing subcommittee, visited the N.J. Poison Control Center at Rutgers New Jersey Medical School (NJPIES) in Newark today to outline bipartisan legislation to protect families living in public and rural housing from the “silent killer” by requiring carbon monoxide (CO) detectors be installed in federally subsidized residences.

Cats can be such great helpers sometimes.

Is Certification Required To Scuba Dive Today

*Required Reading. 'Nuff said. Monday, October 29, 2007. 10:30AM.

The season that never disappoints. Simcoe County, 140km north of Toronto, was the region that produced some of the best autumn pictures.

Day 2 of The Indy KA500 and After a Fantastic First Day of Racing and Celebrations now is where the Real Hard Work Begins as The Entire Field of 46 KA'S were in the Garages with Drivers Teams and Engineers at The Ready as they were about to tackle 8 Hours of the Indy Circuit.

 

With an 8 Hour Race anything can Happen and with such a Large Field of Cars a lot of Overtakes and Careful Navigation will be Required to Ensure Victory.

 

With The Start of The Race About to get underway Its Time to See Who will be able to Hold out the Longest and Take the Title of IndyKa500 Endurance Champion for 2021.

 

Hour 1 (11:04AM)

 

As The Field of 46 KA'S Completed the Formation Lap and Slowly made their way Towards the Start Finish Straight The Lights went Green and at Exactly 11:04AM the Race Had Begun.

 

Racing Down Towards Paddock Hill Bend it was The KA of Team (IP Racing's Adam Blair Scott Parkin Oliver Wilmot and Mark Witherington) Who took the Lead Followed Closely by Team (Octane Junkies Adam Smith Martyn Smith and Bazza Ward) in Second Place and Team (Alex Read Motorsport's Chris Reade Sam Luke's Carlito Miracco and Luke Read) in Third Place as they Thundered Up the Hill Towards The Tops of Druids and Back Down Again through Bottom Bend where Team (Ferguson Motorsport's Damon Astin Billy Ferguson Joe Ferguson and Daniel Ferguson) took the Lead from (Octane Junkies) before Flying Around The Track to Complete Lap 1 of 500.

 

As The Cars came Round Paddock for The Second Time The KA of (Ferguson Motorsport) Now Leads by a Heathy Margin While Further Back (IP Racing) and (Octane Junkies) Have A Fantastic Scrap over Second Place with The Two of Them Swapping The Lead Over and Over again. Car Number 55 of (Al Most Racers Alistair Hardie Alistair McDonald Lee Conway and Will Denny) was Seen Getting Air of The Inside Curb on the Exit of Paddock Hill Bend making for a Spectacular Sight.

 

Hour 2 (11:54AM)

 

Hour 2 and All 46 KA'S are Still Alive and Well with Each Driver Pushing Hard to Maintain their Advantage as the Tyres Begin to Warm Up and Start to Grip the Track More.

 

KA Number 56 Team (Hard And Enthusiastic Martyn Dilworth Mark Figes and Mike Hickey) are Locked in a Tight Battle at The Top of Paddock Hill Bend with KA Number 27 Team (Semprini Racing's Jeremy Evans James Hart Phil Hart and William Puttergill) as they Fight it Out Between the Two Cars for a Position.

 

Further Down the Field KA Number 23 Team (Kastrol's Michael Keegan Tim Keegan and David Murfitt) is Having its Own Battle with KA Number 4 of Team (Alex Read Motorsport) as The Two Teams Have a Go at One Another Thought the Course of The Lap trying Hard to Hold onto that Position they Worked so Hard for.

 

Another Battle at Paddock is the KA Number 3 of Team (Wingdat Racing's Andy Chapman Jonathan Barret and Wayne Jackson) Having to Fend off The KA Number 16 of Team (M and D Racing's Alex Martin Daniel Martin Tony Perfect and Mathew Rowling) as they Also were Looking to be in an Intense Battle Thought the Lap with Many Other Teams and Drivers Now Settling into a Rhythm. at The Endo f The Second Hour The KA't Mobile Number 49 of Team (LDR Performance Tuning's David Bywater Adrian Clarke Andy Grear Hardy and Sammy Bryan) is Seen Making its way Through Paddock Hill Bend and Through the Gravel Trap but Manages to Get Out Unaided and Safely.

 

At 12:12PM a Huge and Very Loud Crash is Heard at The Bottom of Paddock Hill Bend and Seen Rowling Through The Gravel Trap and Ending up on its Wheels is the KA Number 3 of Team (Windgat Racing) Bringing out the First Safety Car of The Endurance Race. Lucky The Driver was Fine and After a Few Minutes Due to The Recovery Taking Place they Are Back out in the Race But with a Lot of Catching Up to do.

 

Hour 3 (13:08PM)

 

With the Safety Car Now in the Race gets Back Underway and Already each Driver was Pushing Even Harder trying to either Create a Gap or Make Up for Lost Time Due to The Safety Car Intervention.

 

At The Top of Paddock Hill Bend a Fierce Battle is Taking Place Between the Two Teams of KA Number 13 and KA Number 155 Team (Deranged Motorsport's Jason Pelosi Josh Larkin and Alex Kelby) and Team (JRS's Nick Walker Alex Day and William Foster) as they Duel Thought the Whole of Paddock Hill Bend Starting at The Top and Still Keeping the Fight Going Right Up towards Druids in The End Deranged Motorsport Wins Out and Takes The Position Away from JRS.

 

At 13:24PM The Fighting Between each Team Continues at The Top of Paddock Hill Bend which is Proving to be the Best Overtaking Area as Each Car has Only 73 Break Horse Power so Carrying as Much Speed as Possible from the Main Straight Towards Paddock is Essential for a Successful Overtake.

 

Team (Piston Heads Peter Dignan Oliver Lewis Benjamin Lowden and Sam Sheehan) Battles it out with Team (LDR Performance Tuning's Laurence Davey Mike Paul James Parker and Glen Copeland) as The Two Cars Do Battle for All to See with Team LDR Taking The Position Away.

 

At 13:39PM A Set of 4 KA's are Seen Fighting Their Way up Towards Druids with All Four Teams not Giving up the Fight as they Swap Positions Relentlessly with not One Driver Willing to Give Up his Position.

 

The 98 55 53 and 13 All Really Having a Good Go at One Another Thought their Fight. As The Sun Starts its Slow Dissent Down Over The Hills and Valleys that Surround The Circuit Bottom Bend was Providing Some More Opportunities for Drivers to do Battle with One Another. A Four way Fight Between KA's Number 56 51 44 and 64 was Occurring with Number 56 Holding Strong at The Front of This Fight and Leading them on Towards Clearways.

 

Finally at 13:48PM An Epic Battle Between KA's Number 64 and 44 was Witnessed Through Bottom Bend with The Likes of The Number 64 Bouncing a Wheel Into The Air as The Car Took the Tight Racing Line making for an Amazing Picture and a Superb bit of Car Control To Keep that KA Pointing The Right Way.

 

Hour 4 (14:02PM)

 

The Fourth Hour and Pit Stops and Driver Changes were Imminent with Many Teams Choosing to Go into The Pits to Change Both Drivers and Top Up the Fuel as Well as Change Tyres if Necessary. Every Team was Running to a Different Strategy Depending Upon the Amount of Drivers they Had with Teams of Four Drivers Taking 2 Hours in the Car Each While Teams of Three or Less would Have to Take on Longer Stints of 3 To Maybe Even 4 Hours in the Car Hoping that Having to do Fewer Driver Changes would Mean they could make Up The Difference on Track.

 

Back on The Track at 14:02PM More Battles were Commencing Through Pilgrims Drop With KA's Number 81 Team (GM Performance's Gary Mitchell and Ian Mitchell) Going Head to Head with KA Number 46 Team (JDC Motorsport's Stu Neal Andy Gaugler and Simon Walker Hensell) with The KA of GM Performance Narrowly Taking The Place From JDC Motorsport on the Run towards Clearways.

 

At 14:20PM a Fantastic Battle Between KA Number's 18 100 127 3 55 and 115 was Seen as they Powered their Way onto Clearways with 155 Leading Followed by 55 and 3 127 100 and 18 All Slowly Gaining Ground to the Two Leading KA's at The Front of This Train.

 

Shortly After This Train of Cars Came Through Another Train of 5 KA's was not Far Behind this Time Being Lead by Number 13 Deranged Motorsport with 131 (Team Viking's Mark Holme Harry Nunn and Nick Nunn) Then came Number 4 Alex Read Motorsport with 98 Piston Heads and 41 (Rowe Rage Motorsport's Alex Butler Greg Caswell Jason Handcock and Sam Rowe) As they All Fought Hard to Catch One Another Thought their Fight.

 

KA's Number 98 4 and 64 were Also Seen at 14:48PM Having a Really Good Three Way Fight with 64 and 98 Side by Side down Pilgrims Drop with The Number 4 Car Closing Fast.

 

At 14:54PM A Final Battle was Seen on the Run Up Towards Clearways with The KA's of Number 60 (Powerflex's David Power Paul Cowland and Dom David) Battling Hard with KA's Number 7 (G and B Finch's Joe Bragg Lee Finch Steve Finch Benjamin Smith and Arthur Thurtle) and Number 127 (Fat Boys Racing's Charlie Jackson and Matt Pinny) with The Number 7 KA Leading The Trio On Towards Clearways as The Sun Began to Set.

 

Hour 5 (15:25PM)

 

The Fith Hour and a Swarm of KA's were Seen Storming Down the Main Straight towards Paddock Hill Bend with the Number 131 Car of (Team Viking) in the Lead by Some Distance Followed by Number 64 125 18 81 and 155 as they All Made their Way Towards Paddock for another Chance at an Overtake.

 

Another Battle Followed Closely Behind with KA Numbers 11 18 49 and 111 All Fighting as Well in order to Maintain or Improve their Positions as The Race Went on.

 

At 15:28PM The Safety Car was Out again While Another KA Somewhere on Track was Being Recovered and The Leading car Number 36 IP Racing's (Adam Blair Scott Parkin Oliver Wilmot and Mark Witherington's Lead Evaporates as the Field is Once again Bunched up.

 

Behind Them are KA's Number 44 (Mini Challenges Max Coates Dominic Wheatley Lewis Saunders and Dan Zelos) Looking to Make a More Once the Safety Car Period Ends The 14 of (Frugal Racing) and 51 of (Barwell Autosport's Taylor Norton Kamran Tunio Ryan Brinsted and Kester Cook) Also Looking to Take the Lead of This Endurance Race.

 

At 15:36PM The Car that Had Caused The Safety Car was Seen Being Recovered into the Outer Garage Area where cars are Held Before the Start of Each Race. KA Number 46 (JDC Motorsport) Had Made Contact Somewhere on the Circuit and Looked to Have a Broken Front Left Steering Arm with the Wheel Being Completely Bend Backwards into The Car with the Car Heading Back to the Garage for Repairs Before Rendering The Race Quite a Few Laps Down.

 

15:38PM and The Two KA's of Positive Motorsport's Andrew Rogerson Samuel Rendon and Ryan Frith Battle it Out with Number 13 Deranged Motorsport Through Westfield Towards Dingle dell with The Number 13 Beautifully Sweeping Around the Outside to Take The Position Away.

 

Another Battle was Seen at 15:38PM with (Alex Read Motorsport) Number 4 Battling Number 64 (Auto Teach Motorsport's Reece Kellow Andrew Howell Luca Ataccini Anzanello and Megan) through Westfields Side by Side on Towards Dingle dell.

 

Finally at 15:57PM Another KA Had Fallen Victim to an Issue with the Number 23 Car of (PSR's Carl Beresford Russel Danzey Tom Gilbert and Jack Wood) Being Taken on the Back of the Recovery Truck to The Garages for Repairs Before Going back Out into The Race as Night Began to Fall Upon The Indy Circuit.

 

Hour 6 (16:15PM)

 

As The Light Slowly began to Fade Away from the Indy Circuit Many Drivers were Now starting to use their Headlights as The Lighting Conditions got Darker and Darker as Time went by.

 

At 16:15PM A Massive Group of Cars came Flying Down Through Paddock Hill Bend with KA Number 55 Al Most Racers on the Inside Line 127 Fat Boys Racing on the Middle Line and 39 Kameleon Racing's Chris Bright Richard Cox Steve Goldsmith and Leigh Youles Michael on the Outside Line as they Fought their way Through the Bend and Up Towards Druids.

 

At 16:21PM Piston Heads Racing KA Number 98 was Seen Leading another Group of Cars Through Paddock Hill Bend with Numbers 41 52 33 and 2 All Fighting for Places as they Came Towards Paddock Hill Bend.

 

16:24PM and The Paddock Hill Bend Gravel Trap Claims Another Victim This Time the Number 131 KA of Team Viking Had Ended up Taking a Trip Through it Before a Half Spin Left Him Facing the Marshalls Post Opposite before Returning to the Track after Losing a Few Places. Recovery Teams set to work Once Again with The Safety Car Being Called into Action for The Third Time.

 

16:40PM and at The Top of Paddock Hill Bend a Three way Fight Becomes a Two Way Fight as The Number 127 KA of Fat Boys Racing Goes for a Spin after Trying to Get a Run on the Number 19 KA of LDR Performance Tuning with The Number 14 Car of Frugal Racing Just Narrowly Missing The Spinning Car.

 

16:42PM and a Final Intense Battle Between the Number 44 KA and The Number 1 KA of Burton Power Racing's Andy Burton Kyle Sagar Tom Valentine and Sammy Venables as They Fight Hard to try and Take that Position away from Mini Challenge to Round off The 6th Hour.

 

Hour 7 (16:50PM)

 

The Seventh Hour and at The Bottom of Surtees a Massive Crash is Heard as The KA's of Number 42 The K Teams (Paul Simmons Edward Simmons Glen Woodbridge Damo) is Seen Running off Track with Number 13 Deranged Motorsport Onto The Grass and Number 81 GM Performance Being Spun Out Trying to Avoid The Carnage in Front. All Drivers Okay and They Get back on Track and Continue on As Day Turns into Night.

 

17:02PM and a Top of Druids The Ka's of Number 72 Misty Racings (Adam Bonham and Simon Bonham) are Fighting Hard to Keep their Position from the Number 49 Car of LDR Performance Tuning as well as Number 7 of G and B Finch Trying to Find a Way Through on the Outside of Druids. The 98 of Piston Heads is also Closing in by This Stage with Headlights A Blaze.

 

17:05PM and Coming Towards Druids is a Sea of KA's All With Headlights A Blaze as they Fight for Positions Cars Number 60 3 19 and 39 All in Different Positions and Yet Still Fighting to try and Gain an Advantage that Could Swine this Endurance Race in Any of the Teams Favours. Further Back 127 and 140 Are Doing Battle on the Run Up Towards Druids.

 

17:09PM Once Again Another Battle at Druids This Time its The Trio of Number 127 36 and 60 That are All Trying to Better One Another in their Attempt to Gain a Place with Number 36 IP Racing Leading The Way.

 

17:14PM One Final Battle is Seen Coming Up towards Druids with The Number's 18 44 55 and 2 Fighting it Out Number 2 Kastrol's Has The Lead of This Group of Cars with Blazing Bright Headlights to Aid the Drivers Around The Circuit.

 

17:27PM and Now Darkness was Everywhere Making Visibility Very Difficult and Yet this did not Stop the Likes of Cars Number 128 JTR's Eliot Mason Nick Tandy David Mason and James Rhodes from Battling with Car Number 16 M and D Racing's Alex Martin Daniel Martin Tony Perfect and Mathew Rowling. In a Daring Move in the Pitch Black Darkness The Two Cars Go Side by Side Trying to Gain One over The Other Before JTR's Takes The Inside Line and The Position.

 

17:30PM Another Daring Battle is Captured Between The Number 180 Car of (Shine Auto motive's Colin French Mathew Eldridge and Wayne Clelland) and Number 44 (Mini Challenge's Max Coates Dominic Whitely Lewis Saunders and Dan Zelos) Defending The Outside Line as Best as they Can but Ultimately Shine Automotive Makes their way Through.

 

17:51PM A KA is Seen Flying Down Through The Bottom of Druids and into a Cloud of Dust Caused by Another KA Going off The KA is Just Barely Visible Showing The Dangers of what can Happen at Night When Visibility Becomes Low or Obstructed. Other KA's Soon Followed Through the Dust Cloud as Well with Many Backing off Slightly In case a Car was Stuck out on The Track but Thankfully All was Good as Hour 7 Ended.

 

Hour 8 (17:56PM) (THE FINAL HOUR)

 

The FINAL Hour of The 8 Hour Indy KA 500 and With Every Driver Now Getting into a Rhythm it was Up to Each Teams Last Driver to Strap in and Go for it to the Checkered Flag. However not All had gone to Plan for every Driver as The Number 29 KA of LDR Performance Tuning Found Out Slipping into the Gravel and Costing Them a Ridge Back to the Pits for Repairs with Less than 1 Hour to go.

 

18:00PM and The Number 2 KA of Kastrol's was Captured Racing Through Paddock Hill Bend During The Night Pushing Incredibly Hard to Ensure a Good Top 25 Finnish in the Points with Headlights Illuminating their way Around Paddock Hill Bend as The Car Flew Through The Bend.

 

18:30PM The Safety Car was Out for The Last Time During The Race and was Captured Leading a whole Train of KA's Through Pilgrims Drop and Onto Clearways with Each Driver Poised and Ready to Get Going Once the Safety Car Had Come In.

 

19:07PM An Amazing Sight to Behold with Just 15 Minutes Left on the Clock a Huge Rush of KA's Flooded their way Down The Main Straight and Past The Start Finnish Straight with Headlights on Full Beam to Aid in Visibility. The Number 8 KA Leads The way in This Group of Cars with The Number 18 CHR Hoonikan Car of Stratton MacKay Dave Mayer and Paul Robson Closing in Behind.

 

19:09PM And The Green Flag is Dropped for The Final Time as The Safety Car Comes into the Pitlane All 44 Remaining KA's Race Towards Druids with the Field so Bunched up this is Anyone's Race to both Win or Lose at This Stage.

 

The Number 42 KA of The K Teams Paul Simmons Edward Simmons and Glen Woodbridge Damo takes off Leading from Number 20 A Reeve's Motorsport Aron Reeve Stuart Lane and Andy Godfrey while The Number 127 of Fat Boys Racing Chases Them Down into a Nail Biting Finnish at The Centre of The Field.

 

19:13PM A Group of Six KA's are Captured Having an Intense Battle with Only 5 Minutes Left to Run The Likes of KA Number 127 36 and 128 All Putting Up One Hell of a Good Fight in The Closing Stages of The Endurance Race with Some Drives Having Driven for 4 Hours Straight.

 

19:21PM and after 8 Hours of Continuous Racing and 5 KA's Out of The Race The Checkered Flag was Ready and Waiting as The Number 81 KA of GM Performance's Gary Mitchell and Ian Mitchell Takes the Victory at The 2021 8 Hour Indy Car 500!!!! Followed Closely by The Number 72 Car Misty Racing's Adam Bonham and Simon Bonham in Second Place with KA Number 14 Frugal Racing's Jim McDougal Callum McDougal Mike Marais and Leon Bidgeway Taking Third Place.

 

A Huge Congratulations to The Overall Top Three Winners and to All of the other Teams and Competitors for Showing some Incredible Racing To End of The 2021 Motorsport Season. From

Historic Formula 1 to Classic Touring Cars To The Indy KA 500 This Season Has been One of The Best to Date.

 

See You All Again Next Year Where We Will do it All Over Again.

                                        

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Replacing the copper on the steeple of St Mary's Catholic Church, Mudgee. !IMG_2604

At Innova.se you can find the required Touchpad, touch screen display and panel pc at an affordable price. Visit: www.innova.se/listing-316.aspx

 

yes I did it and yes it was totally fun!

5 Cent Caille Bros. "Little Roulette" 19" Version Of The Large Floor Model Roulette Pay-Out Machine c1905, cast-iron & wood case. Highly skilled engineering was required to produce the compact mechanism in this machine. When the player cranks the handle, the wheel spins to propel the ball to the outer rim, as the ball slows and drops back, the mechanism brakes, very rare machine, in excellent condition, w/ keysSold at Victorian Casino Antiques. Quality Consignments always considered for upcoming Auctions. www.vcaauction.com #vcaauction vca@lvcoxmail.com 4520 Arville St #1 LV NV 89103 702-382-2466

Stairs to Women's Masjid

 

Fund required for this stairs area.

 

- STAIRS cementing and finishing Rs.35, 000 for two sides (at Two entrances)

Any musical instrument requires a tuning system. The prevailing system today is 12TET or 12 tone equal temperament. Due to some anomalies in the nature of harmony, Galileo's dad (a music theorist) had to split up the octaves of a tuning system into equal ratios. The result? True Harmony was murdered and cut into ugly pieces. Why? well, it makes modern day music theory's cyclical nature (at least classic western music theory) possible as well as transposition.

 

BUT, GODDAMN IT HOLY CRAP EVERYTHING YOU THOUGHT WAS "HARMONIC" IS DAMN WRONG. WROOOOOOOOOOONGGGGGGGGG. ALL THE MUSIC YOU'VE EVER LISTENED TO IS FUNDAMENTALLY WRONG WITH REGARDS TO HARMONICS!!! IMAGINE MY HORROR WHEN I JUST FIGURED IT OUT LAST YEAR. THOU CANNOT DENY THE MATH

 

Thats not what my crazy-psychotic-analretensive-overbearing piano teachers told me when I was six. Oh no, they lied to me, me the gullible little child. The lied, yelled, and forced me into a cage of Bach and Beethoven and didn't let me interpret anything the way i wanted to. My old music experience was equally tempered into 12 ugly pieces of oppression, pain, tears, and classical rigor.

 

No more,

I am free!

The Hamlyn Centre holds its annual Hamlyn Symposium at the Royal Geographical Society and Imperial College, 25th June 2018

 

Photography by Fergus Burnett

 

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Steer Wrestling or Bull Dogging is the quickest rodeo event that requires speed, strength, balance, timing, and precision, which makes it the most challenging event. The cowboy competes not only against the other cowboys, but against the clock to try and post the fastest time.

 

The cowboy leaves the box after giving the steer a predetermined head start, the cowboy and his horse catch up to the steer and running along side the steer, the cowboy will slide off his horse and grasp the steer by the horns dig his heels in and slow the steer. The cowboy will wrestle the steer to the ground and once all four of the steer’s feet are pointing in the same direction the clock stops. If the cowboy breaks the barrier that allows the steer the predetermined head start, ten seconds will be added to the final time.

 

A hazer is a second mounted cowboy who rides along the right side of the steer. The hazer’s job is to keep the steer running straight and prevent the steer from veering away from the bull dogger.

 

I would like to thank the Thomas and Mack, the PRCA (Professional Rodeo Cowboys Association), the Cowboys and Cowgirls, the stock contractors, and the fans for their support of rodeo.

 

Come join Me for ten days of rides, the wrecks, and the unforgettable moments of the Wrangler National Finals Rodeo. Let’s Ride!!

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Title: A theoretical and practical treatise on midwifery : including the diseases of pregnancy and parturition, and the attentions required by the child from birth to the period of weaning

Creator: Cazeaux, P. (Pierre), 1808-1862

Creator: Bullock, William R. (William Rockhill), 1824-1914, translator

Publisher: Philadelphia : Lindsay & Blakiston

Sponsor: Open Knowledge Commons, U.S. National Library of Medicine

Contributor: U.S. National Library of Medicine

Date: 1860

Language: eng

Description: Includes bibliographical references and index

Will digitize

Condition reviewed

 

If you have questions concerning reproductions, please contact the Contributing Library.

 

Note: The colors, contrast and appearance of these illustrations are unlikely to be true to life. They are derived from scanned images that have been enhanced for machine interpretation and have been altered from their originals.

 

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Imperial Colege Business School hosts the 2018 AIMA conference on "The Future of Organisation' in partnership with the Ghandi Centre, 30th April 2018

 

Photography by Fergus Burnett

 

Accreditation required with all use - 'fergusburnett.com

The Hamlyn Centre holds its annual Hamlyn Symposium at the Royal Geographical Society and Imperial College, 25th June 2018

 

Photography by Fergus Burnett

 

Accreditation required with all use - 'fergusburnett.com

A normal chore before heading to the office this morning ... no coat or boots required. The snow was just a light 3 inches of fluffy stuff overnight and not a big deal for him. I watched from indoors, hanging out the door just long enough to get this shot and then run for the closest heat vent

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Gov. John Carney on Aug. 29 signed Senate Bill 227 to strengthen primary care services in Delaware through increased reimbursement rates, requiring all health insurers to participate in the Health Care Claims database to increase transparency in health care spending and creating the Primary Care Collaborative to look for long-term solutions to the dwindling number of primary care providers in the state. In signing the bill at the Carvel State Office Building in Wilmington, Gov. Carney said, “One of the challenges is to have a health care system that is sustainable.” He said the legislation will force more spending to occur on the front end of the health care system rather than the more expensive back end when people need extensive treatment, including hospitalization.

 

DHSS Secretary Dr. Kara Odom Walker, a board-certified family physician, said the legislation calls attention to the need for more data to understand how health care spending in Delaware is proportioned. Dr. Richard Henderson, president of the Medical Society of Delaware, said the increased reimbursement rates for the next three years will give stakeholders time to find long-term solutions for strengthening primary care.

 

SB 227 was sponsored by Sen. Bryan Townsend and co-sponsored by Rep. David Bentz, and was supported by the Medical Society of Delaware and many other health care stakeholders, including Health Care Commission Chair Dr. Nancy Fan. Delaware, like most states, has a shortage of primary care providers, with a high percentage expecting not to be in primary care in the next 10 years.

 

The national average for primary care spending for the typical health insurance plan is between 6% and 8% of the insurer’s total medical expenditures. In Delaware, the average is between 3% and 4%. Some national studies recommend implementing a spending rate of 12% to 15% to have an effective system that has a higher percentage of preventive care. Sen. Townsend said the higher reimbursement rates “are key so (providers) can stay in business.”

 

To read Senate Bill 227:

legis.delaware.gov/BillDetail?legislationId=26743

 

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