Reimbursement and Pay-for-Performance Essay Example for Free

Reimbursement and Pay-for-Performance Essay Introduction As we come into the 21st Century, we find Healthcare is at a crisis level. Every agency is working on healthcare reform from policymakers to the public and private sector, as well as federally funded Medicare and Medicaid. The business of Medicine is greatly influenced by the government (federal, state and local levels) and private health sections that initiate policies. Pay for Performance is a reimbursement method where physicians and hospitals can receive a higher reimbursement for duplicate services based on the fact that they deliver better quality care with better results and outcomes. This payment reform offers initiates intended to improve efficiency, value, and quality of health care (Hood, 2007). If all doctors receive the same dollar amount as a doctor with poor outcomes, then the doctor with great outcomes should receive a little more and there will be patients that do not mind paying a higher deductible for better medical services (Mayes, 2006). Definition for Pay for performance Kimmel (2005), Pay for performance is a payment approach used in healthcare that is based on clinical information-driven reform. The fundamental concept is to tie payment to how well providers adhere to practice standards. The practice standards are evidence-based and tied to clinical outcomes. The primary areas of focus are preventive care delivery and disease management for chronic illnesses†. Effects on Reimbursement Pay for performance (P4P) is literally a group of performance indicators that are coupled with an incentive. The performance indicators supports the performance aspect of P4P while the incentive indicator is the pay component. Measuring patient outcomes and understanding the variances that  they have, has in part lead to the increasing rise in how pay for performance reimbursement is looked at. This style of reimbursement allows health plans and employers to pay increasing reimbursements to medical providers that have the better outcomes, give average outcome medical providers a chance to improve, and pay those medical providers with the lowest outcomes the least amount of money or not pay them at all (Cromwell, Trisolini, Pope, Mitchell, Greenwald. 2011). In order to have a pay for performance system in place, you must decide what domains or areas you wish to track, measure, and reward. Some areas in this domain are clinical process, quality and patient safety, access to and availability of care, cost efficiency or cost of care, cost-effectiveness, administrative efficiency and compliance, adoption of information technology, and reporting of performance indicators. These can be set up as a single performance tracker or a multi-domain performance tracker and the measure needed for improvement, importance, and cost. Performance indicators should be valid, reliable, and informative (Cromwell, Trisolini, Pope, Mitchell, Greenwald. 2011). The Incentive Schemes reward the performance measures, and is another important part of a pay for performance system. Funding proves to be another important part of this type of a reimbursement system. Types of funding include redistributing existing payments where additional funds will not have to be made and the quality of service is already high; however, medical providers with a lower quality of service will receive lower reimburse ments. Generated Savings and New Money are other sources of funding for performance measures. Generated savings claim that an increased quality of service will generate savings, although there are others who feel that new money should be used to fund the performance system. (Cromwell, Trisolini, Pope, Mitchell, Greenwald. 2011). Impact of System Cost Reductions on the Quality and Efficiency of Health Care The Medicare Physicians Group Practice (PGP) was the first physician pay for performance model used by the federal government. The PGP believes that higher quality and better cost efficiency could be achieved by managing and coordinating patient care and by engaging in wider choices of care management that are able to improve cost efficiency and quality of health care. Interventions include; chronic disease management, high risk and higher cost care management, transitional care management, end-of-life and palliative care programs. If there were a more  successful payment and delivery method to increase the value of health care and improve quality of care, the cost would grow at a slower pace. The American people would be more likely to purchase health insurance coverage that is affordable and more valuable. (Kautter, Pope, Trisolini, 2007). More progress toward effective delivery and system reform is one of the key elements to achieving the goals to push expanded coverage. Information technology is one of these key elements and a major part of pay for performance system. Information systems uses electronic medical records and patient registries have been created to improve the efficiency and quality of health care delivery. These type of initiatives that are being tested to see if cost savings are generated by reducing avoidable hospital stays, cutting down on readmissions and emergency room visits, while simultaneously improving quality of care (Kautter, Pope, Trisolini, 2007). Effect of Pay for performance on Health Care Providers and Their Customers Meredith B. Rosenthal states, Pay for performance will not replace the existing payment structure in either system, but it does allow payors to take into account a set of quality indicators, in addition to volume of service (as fee-for-service does now) or the number of covered lives (in the case of capitation). In this view, pay for performance can be viewed as a mechanism to correct some of the distortionary incentives that already exist in the reimbursement system. Physicians in the United States are paid on a fee-for-service basis. This encourages high volumes of services, where there is no regard to the value of services in regards to a patient. When services are reimbursed more generously than others it allows the payment system to influence additional medical services with a heavy emphasis on procedure-based care. Since the physicians pay is not attached to medical services provided, there is really no direct incentive to provide any services (How Will Paying for Performance Affect Patient Care?. (2006, March). Virtual Mentor, 8(3), 162-165). Effects of Pay for performance on the Future of Health Care Goldberg lists three points regarding the most significant implications of the movement toward paying for quality outcomes. These are that the quality and value become real parts of contractual reimbursement, the differences based on quality outcomes will be more evident grouped with provider tiers,  and quality metrics evolve to outcome-based and chronic disease management (Goldberg 2006). P4P is an incentive-based reimbursement system that rewards the best players. This pay for performance system is currently active in health systems, managed care settings, and private and group physician’s practices. P4P is likely to impact the entire health care environment and will provide yet another opportunity for pharmacy to become an active role player and leader with improving quality and efficient health care. The focus is not on value but on quality and cost. Pay for performance is not a new program, but in the age of informed choice, evidence based medicine, and patient safety, it can become the solution to our current health care dilemma (Pay for performance (P4P): Evaluating Current and Future Implications). Conclusion These pay for performance systems and programs will lead expansion across the United States health care industry in the near future. With the implementation of the Affordable Care Act, there has been a great amount of provision made to encourage continued improvement with quality of care. Accountable Care Organizations (ACOs) are groups of providers that agree to coordinate care and to be held accountable for the quality and cost of the services they provide (James, 2012). There needs to be a consensus as to how much of an incentive will have to be given in order to affect the needed change and how should these incentives be paid out monthly, quarterly, or yearly; and how can these improvements be sustained over time. Continued experimentation with the pay for performance model should begin to incorporate monitoring and evaluation in identifying design elements that will also affect outcomes in a positive way. Variations in health care markets should be evaluated and include comparison groups to isolate pay for performance from other types of factors. Pay for performance has some great attributes to it and could definitely be the beginning to improvements in quality of service. If physicians are receiving patients and referrals based on their ability to provide quality of service with reduced readmissions and more satisfied consumers, then the care they take in providing services to patients from admission to discharge will create positive change. References Cromwell, J., Trisolini, M. G., Pope, G. C., Mitchell, J. B., and Greenwald, L. M., Eds. (2011). Pay for Performance in Health Care: Methods and Approaches. RTI Press publication No. BK-0002-1103. Research Triangle Park, NC: RTI Press. Retrieved June 15, 2014, from http://www.rti.org/rtipress Goldberg, L. (2006). Paying for performance a call for quality health care. Deloitte Center for Health Solutions. Retrieved from http://www.deloitte.com/assets/Dcom-UnitedStates/Local%20Assets/Documents/us_chs_p4p_032806%281%29.pdf Hood, R. (2007). Pay-for-Performance-Financial Health Disparities and the Impact on Healthcare Disparities. Journal of the National Medical Association, 99, 1-6. James, J. (2012). Pay-for-Performance. New payment systems reward doctors and hospitals for improving the quality of care, but studies to date show mixed results.. Health Policy Brief, 1-6, Retrieved June 15, 2014, from http://www.healthaffairs.org/healthpolicybriefs/brief.php?brief_id=78. Kautter, J., Pope, G., Trisolini, M. (2007, Fall). Medicare physician group practice demonstration design: quality and efficiency pay for performance. Health Care Financing Review, 29(1), 15-29. Retrieved June 15, 2014, from http://www.cms.gov/Medicare/Demonstration-Projects/DemoProjectsEvalRpts/downloads/PGP_D emo_Design.pdf Kimmel, K. (2005). Pay for Performance: An Economic Imperative for Clinical Information Systems. Retrieved June 15, 2014, from http://www.himss.org/content/files/PayForPerformance.pdf Mayes, R. (2006). The Origins of and Economic Momentum Behind Pay for Performance Reimbursement. Health Law Review, 15, 17-22. Pay for performance (P4P): Evaluating Current and Future Implications. Retrieved June 15, 2014, from https://www.ashp.org/DocLibrary/Policy/QII/Pay for performance.aspx Rosenthal, M. (2006). How Will Paying for Performance Affect Patient Care?. Virtual Mentor, 8, 162-165.

Fahrenheit 451 by Ray Bradbury :: essays research papers

In the book Fahrenheit 451 there are many characters that have short parts and go by unnoticed to some. Other characters have noticeable parts but they are short and by the end of the book you forget about them. The minor characters are used to support ideas or to give background for the main character or characters. They have an important part in all stories and yet, for some reason, they are forgotten quickly and not given a second thought. In the book there are more than two minor characters but to bore you with all of them would be cruel so we won’t bother. The two that we will discuss are the ones that appealed to us the most. The first character I want to talk about is Clarisse McClellan. Clasrisse is a free spirited girl who is used to describe the way things are now in the world that Guy (the main character) and she live in. she is a teenager who live with her uncle, who is a very smart man of the old time and he tells her about the way things used to be. The main reason Clarisse is in the story is to show the ills of the world that is described in the book and to show Guy a new way of life. This is the basis for the changes that happen to Guy, emotionally, later in the book. After Clarisse serves her purpose in the plot, she is killed off. The other character that we feel is influential in the book is captain Beatty. Beatty opens Guys eyes to the truth as he sees it. He Finally tells Guy about the way things really used to be. He tells him the truth about what firemen used to do and the way the world used to work. But unlike Clarisse, Beatty likes the new world more and he tells Guy the way things used to be in a way that is distorted a little to make it seem horrible.

The Twilight Saga 5: Midnight Sun 4. Visions

I went back to school. This was the right thing to do, the most inconspicuous way to behave. By the end of the day, almost all the other students had returned to class, too. Just Tyler and Bella and a few others – who were probably using the accident as a chance to ditch – remained absent. It shouldn't be so hard for me to do the right thing. But, all afternoon, I was gritting my teeth against the urge that had me yearning ditch, too – in order to go find the girl again. Like a stalker. An obsessessed stalker. An obsessessed, vampire stalker. School today was – somehow, impossibly – even more boring than it had seemed just a week ago. Coma-like. It was as if the color had drained from the bricks, the trees, the sky, the faces around me†¦ I stared at the cracks in the walls. There was another right thing I should be doing†¦that I was not. Of course, it was also a wrong thing. It all depended on the perspective from which you viewed it. From the perspective of a Cullen – not just a vampire, but a Cullen, someone who belonged to a family, such a rare state in our world – the right thing to do would have gone something like this: â€Å"I'm surprised to see you in class, Edward. I heard you were involved in that awful accident this morning.† â€Å"Yes, I was, Mr. Banner, but I was the lucky one.† A friendly smile. â€Å"I didn't get hurt at all†¦ I wish I could say the same for Tyler and Bella.† â€Å"How are they?† â€Å"I think Tyler is fine†¦just some superficial scrapes from the windshield glass. I'm not sure about Bella, though.† A worried frown. â€Å"She might have a concussion. I heard she was pretty incoherent for a while – seeing things even. I know the doctors were worried†¦Ã¢â‚¬  That's how it should have gone. That's what I owed my family. â€Å"I'm surprised to see you in class, Edward. I heard you were involved in that awful accident this morning.† â€Å"I wasn't hurt.† No smile. Mr. Banner shifted his weight from foot to foot, uncomfortable. â€Å"Do you have any idea how Tyler Crowley and Bella Swan are? I heard there were some injuries†¦Ã¢â‚¬  I shrugged. â€Å"I wouldn't know.† Mr. Banner cleared his throat. â€Å"Er, right†¦Ã¢â‚¬  he said, my cold stare making his voice sound a bit strained. He walked quickly back to the front of classroom and began his lecture. It was the wrong thing to do. Unless you looked at it from a more obscure point of view. It just seemed so†¦so unchivalrous to slander the girl behind her back, especially when she was proving more trustworthy than I could have dreamed. She hadn't said anything to betray me, despite having good reason to do so. Would I betray her when she had done nothing but keep my secret? I had a nearly identical conversation with Mrs. Goff – just in Spanish rather than in English – and Emmett gave me a long look. I hope you have a good explanation for what happened today. Rose is on the warpath. I rolled my eyes without looking at him. I actually had come up with a perfectly sound explanation. Just suppose I hadn't done anything to stop the van from crushing the girl†¦ I recoiled from that thought. But if she had been hit, if she'd been mangled and bleeding, the red fluid spilling, wasting on the blacktop, the scent of the fresh blood pulsing through the air †¦ I shuddered again, but not just in horror. Part of me shivered in desire. No, I would not have been able to watch her bleed without exposing us all in a much more flagrant and shocking way. It was a perfectly sound excuse†¦but I wouldn't use it. It was too shameful. And I hadn't thought of it until long after the fact, regardless. Look out for Jasper, Emmett went on, oblivious to my reverie. He's not as angry†¦but he's more resolved. I saw what he meant, and for a moment the room swam around me. My rage was so all-consuming that a red haze clouded my vision. I thought I would choke on it. SHEESH, EDWARD! GET A GRIP! Emmett shouted at me in his head. His hand came down on my shoulder, holding me in my seat before I could jump to my feet. He rarely used his full strength – there was rarely a need, for he was so much stronger than any vampire any of us had ever encountered – but he used it now. He gripped my arm, rather than pushing me down. If he'd been pushing, the chair under me would have collapsed. EASY! He ordered. I tried to calm myself, but it was hard. The rage burned in my head. Jasper's not going to do anything until we all talk. I just thought you should know the direction he's headed. I concentrated on relaxing, and I felt Emmett's hand loosen. Try not to make more of a spectacle of yourself. You're in enough trouble as it is. I took a deep breath and Emmett released me. I searched around the room routinely, but our confrontation had been so short and silent that only a few people sitting behind Emmett had even noticed. None of them knew what to make of it, and they shrugged it off. The Cullens were freaks – everyone knew that already. Damn, kid, you're a mess, Emmett added, sympathy in his tone. â€Å"Bite me,† I muttered under my breath, and I heard his low chuckle. Emmett didn't hold grudges, and I probably ought to be more grateful for his easy going nature. But I could see that Jasper's intentions made sense to Emmett, that he was considering how it might be the best course of action. The rage simmered, barely under control. Yes, Emmett was stronger than I was, but he'd yet to beat me in a wrestling match. He claimed that this was because I cheated, but hearing thoughts was just as much a part of who I was as his immense strength was a part of him. We were evenly matched in a fight. A fight? Was that where this was headed? Was I going to fight with my family over a human I barely knew? I thought about that for a moment, thought about the fragile feel of the girl's body in my arms in juxtaposition with Jasper, Rose, and Emmett – supernaturally strong and fast, killing machines by nature†¦ Yes, I would fight for her. Against my family. I shuddered. But it wasn't fair to leave her undefended when I was the one who'd put her in danger. I couldn't win alone, though, not against the three of them, and I wondered who my allies would be. Carlisle, certainly. He would not fight anyone, but he would be wholly against Rose's and Jasper's designs. That might be all I needed. I would see†¦ Esme, doubtful. She would not side against me either, and she would hate to disagree with Carlisle, but she would be for any plan that kept her family intact. Her first priority would not be rightness, but me. If Carlisle was the soul of our family, then Esme was the heart. He gave us a leader who deserved following; she made that following into an act of love. We all loved each other – even under the fury I felt toward Jasper and Rose right now, even planning to fight them to save the girl, I knew that I loved them. Alice†¦I had no idea. It would probably depend on what she saw coming. She would side with the winner, I imagined. So, I would have to do this without help. I wasn't a match for them alone, but I wasn't going to let the girl be hurt because of me. That might mean evasive action†¦ My rage dulled a bit with the sudden, black humor. I could imagine how the girl would react to my kidnapping her. Of course, I rarely guessed her reactions right – but what other reaction could she have besides terror? I wasn't sure how to manage that, though – kidnapping her. I wouldn't be able to stand being close to her for very long. Perhaps I would just deliver her back to her mother. Even that much would be fraught with danger. For her. And also for me, I realized suddenly. If I were to kill her by accident†¦ I wasn't certain exactly how much pain that would cause me, but I knew it would be multifaceted and intense. The time passed quickly while I mulled over all the complications ahead of me: the argument waiting for me at home, the conflict with my family, the lengths I might be forced to go to afterward†¦ Well, I couldn't complain that life outside this school was monotonous any more. The girl had changed that much. Emmett and I walked silently to the car when the bell rang. He was worrying about me, and worrying about Rosalie. He knew whose side he would have to choose in a quarrel, and it bothered him. The others were waiting for us in the car, also silent. We were a very quiet group. Only I could hear the shouting. Idiot! Lunatic! Moron! Jackass! Selfish, irresponsible fool! Rosalie kept up a constant stream of insults at the top of her mental lungs. It made it hard to hear the others, but I ignored her as best I could. Emmett was right about Jasper. He was sure of his course. Alice was troubled, worrying about Jasper, flipping through images of the future. No matter which direction Jasper came at the girl, Alice always saw me there, blocking him. Interesting†¦neither Rosalie nor Emmett was with him in these visions. So Jasper planned to work alone. That would even things up. Jasper was the best, certainly the most experienced fighter among us. My one advantage lay in that I could hear his moves before he made them. I had never fought more than playfully with Emmett or Jasper – just horsing around. I felt sick at the thought of really trying to hurt Jasper†¦ No, not that. Just to block him. That was all. I concentrated on Alice, memorizing Jasper's different avenues of attack. As I did that, her visions shifted, moving further and further away from the Swan's house. I was cutting him off earlier†¦ Stop that, Edward! It can't happen this way. I won't let it. I didn't answer her, I just kept watching. She began searching farther ahead, into the misty, unsure realm of distant possibilities. Everything was shadowy and vague. The entire way home, the charged silence did not lift. I parked in the big garage off the house; Carlisle's Mercedes was there, next to Emmett's big jeep, Rose's M3 and my Vanquish. I was glad Carlisle was already home – this silence would end explosively, and I wanted him there when that happened. We went straight to the dining room. The room was, of course, never used for its intended purpose. But it was furnished with a long oval mahogany table surrounded by chairs – we were scrupulous about having all the correct props in place. Carlisle liked to use it as a conference room. In a group with such strong and disparate personalities, sometimes it was necessary to discuss things in a calm, seated manner. I had a feeling that the setting was not going to help much today. Carlisle sat in his usual seat at the eastern head of the room. Esme was beside him – they held hands on top of the table. Esme's eyes were on me, their golden depths full of concern. Stay. It was her only thought. I wished I could smile at the woman who was truly a mother to me, but I had no reassurances for her now. I sat on Carlisle's other side. Esme reached around him to put her free hand on my shoulder. She had no idea of what was about to start; she was just worrying about me. Carlisle had a better sense of what was coming. His lips were pressed tightly together and his forehead was creased. The expression looked too old for his young face. As everyone else sat, I could see the lines being drawn. Rosalie sat directly across from Carlisle, on the other end of the long table. She glared at me, never looking away. Emmett sat beside her, his face and thoughts both wry. Jasper hesitated, and then went to stand against the wall behind Rosalie. He was decided, regardless of the outcome of this discussion. My teeth locked together. Alice was the last to come in, and her eyes were focused on something far away – the future, still too indistinct for her to make use of it. Without seeming to think about it, she sat next to Esme. She rubbed her forehead as if she had a headache. Jasper twitched uneasily and considered joining her, but he kept his place. I took a deep breath. I had started this – I should speak first. â€Å"I'm sorry,† I said, looking first at Rose, then Jasper and then Emmett. â€Å"I didn't mean to put any of you at risk. It was thoughtless, and I take full responsibility for my hasty action.† Rosalie glared at me balefully. â€Å"What do you mean, take full responsibility'? Are you going to fix it?† â€Å"Not the way you mean,† I said, working to keep my voice even and quiet. â€Å"I'm willing to leave now, if that makes things better.† If I believe that the girl will be safe, if I believe that none of you will touch her, I amended in my head. â€Å"No,† Esme murmured. â€Å"No, Edward.† I patted her hand. â€Å"It's just a few years.† â€Å"Esme's right, though,† Emmett said. â€Å"You can't go anywhere now. That would be the opposite of helpful. We have to know what people are thinking, now more than ever.† â€Å"Alice will catch anything major,† I disagreed. Carlisle shook his head. â€Å"I think Emmett is right, Edward. The girl will be more likely to talk if you disappear. It's all of us leave, or none of us.† â€Å"She won't say anything,† I insisted quickly. Rose was building up to the explosion, and I wanted this fact out there first. â€Å"You don't know her mind,† Carlisle reminded me. â€Å"I know this much. Alice, back me up.† Alice stared up at me wearily. â€Å"I can't see what will happen if we just ignore this.† She glanced at Rose and Jasper. No, she couldn't see that future – not when Rosalie and Jasper were so decided against ignoring the incident. Rosalie's palm smacked down on the table with a loud bang. â€Å"We can't allow the human a chance to say anything. Carlisle, you must see that. Even if we decided to all disappear, it's not safe to leave stories behind us. We live so differently from the rest of our kind – you know there are those who would love an excuse to point fingers. We have to be more careful than anyone else!† â€Å"We've left rumors behind us before,† I reminded her. â€Å"Just rumors and suspicions, Edward. Not eyewitnesses and evidence!† â€Å"Evidence!† I scoffed. But Jasper was nodding, his eyes hard. â€Å"Rose – † Carlisle began. â€Å"Let me finish, Carlisle. It doesn't have to be any big production. The girl hit her head today. So maybe that injury turns out to be more serious that it looked.† Rosalie shrugged. â€Å"Every mortal goes to sleep with the chance of never waking up. The others would expect us to clean up after ourselves. Technically, that would make it Edward's job, but this is obviously beyond him. You know I'm capable of control. I would leave no evidence behind me.† â€Å"Yes, Rosalie, we all know how proficient an assassin you are,† I snarled. She hissed at me, furious. â€Å"Edward, please,† Carlisle said. Then he turned to Rosalie. â€Å"Rosalie, I looked the other way in Rochester because I felt that you were owed your justice. The men you killed had wronged you monstrously. This is not the same situation. The Swan girl is an innocent.† â€Å"It's not personal, Carlisle,† Rosalie said through her teeth. â€Å"It's to protect us all.† There was a brief moment of silence while Carlisle thought through his answer. When he nodded, Rosalie's eyes lit up. She should have known better. Even if I hadn't been able to read his thoughts, I could have anticipated his next words. Carlisle never compromised. â€Å"I know you mean well, Rosalie, but†¦I'd like very much for our family to be worth protecting. The occasional†¦accident or lapse in control is a regrettable part of who we are.† It was very like him to include himself in the plural, though he had never had such a lapse himself. â€Å"To murder a blameless child in cold blood is another thing entirely. I believe the risk she presents, whether she speaks her suspicions or not, is nothing to the greater risk. If we make exceptions to protect ourselves, we risk something much more important. We risk losing the essence of who we are.† I controlled my expression very carefully. It wouldn't do at all to grin. Or to applaud, as I wished I could. Rosalie scowled. â€Å"It's just being responsible.† â€Å"It's being callous,† Carlisle corrected gently. â€Å"Every life is precious.† Rosalie sighed heavily and her lower lip pouted out. Emmett patted her shoulder. â€Å"It'll be fine, Rose,† he encouraged in a low voice. â€Å"The question,† Carlisle continued, â€Å"is whether we should move on?† â€Å"No,† Rosalie moaned. â€Å"We just got settled. I don't want to start on my sophomore year in high school again!† â€Å"You could keep your present age, of course,† Carlisle said. â€Å"And have to move again that much sooner?† she countered. Carlisle shrugged. â€Å"I like it here! There's so little sun, we get to be almost normal.† â€Å"Well, we certainly don't have to decide now. We can wait and see if it becomes necessary. Edward seems certain of the Swan girl's silence.† Rosalie snorted. But I was no longer worried about Rose. I could see that she would go along with Carlisle's decision, not matter how infuriated she was with me. Their conversation had moved on to unimportant details. Jasper remained unmoved. I understood why. Before he and Alice had met, he'd lived in a combat zone, a relentless theater of war. He knew the consequences of flouting the rules – he'd seen the grisly aftermath with his own eyes. It said much that he had not tried to calm Rosalie down with his extra faculties, nor did he now try to rile her up. He was holding himself aloof from this discussion – above it. â€Å"Jasper,† I said. He met my gaze, his face expressionless. â€Å"She won't pay for my mistake. I won't allow that.† â€Å"She benefits from it, then? She should have died today, Edward. I would only set that right.† I repeated myself, emphasizing each word. â€Å"I will not allow it.† His eyebrows shot up. He wasn't expecting this – he hadn't imagined that I would act to stop him. He shook his head once. â€Å"I won't let Alice live in danger, even a slight danger. You don't feel about anyone the way I feel about her, Edward, and you haven't lived through what I've lived through, whether you've seen my memories or not. You don't understand.† â€Å"I'm not disputing that, Jasper. But I'm telling you now, I won't allow you to hurt Isabella Swan.† We stared at each other – not glaring, but measuring the opposition. I felt him sample the mood around me, testing my determination. â€Å"Jazz,† Alice said, interrupting us. He held my gaze for a moment more, and then looked at her. â€Å"Don't bother telling me you can protect yourself, Alice. I already know that. I've still got to – † â€Å"That's not what I'm going say,† Alice interrupted. â€Å"I was going to ask you for a favor.† I saw what was on her mind, and my mouth fell open with an audible gasp. I stared at her, shocked, only vaguely aware that everyone besides Alice and Jasper was now eyeing me warily. â€Å"I know you love me. Thanks. But I would really appreciate it if you didn't try to kill Bella. First of all, Edward's serious and I don't want you two fighting. Secondly, she's my friend. At least, she's going to be.† It was clear as glass in her head: Alice, smiling, with her icy white arm around the girl's warm, fragile shoulders. And Bella was smiling, too, her arm around Alice's waist. The vision was rock solid; only the timing of it was unsure. â€Å"But†¦Alice†¦Ã¢â‚¬  Jasper gasped. I couldn't manage to turn my head to see his expression. I couldn't tear myself away from the image in Alice's head in order to hear his. â€Å"I'm going to love her someday, Jazz. I'll be very put out with you if you don't let her be.† I was still locked into Alice's thoughts. I saw the future shimmer as Jasper's resolve floundered in the face of her unexpected request. â€Å"Ah,† she sighed – his indecision had cleared a new future. â€Å"See? Bella's not going to say anything. There's nothing to worry about.† The way she said the girl's name†¦like they were already close confidants†¦ â€Å"Alice,† I choked. â€Å"What†¦does this†¦?† â€Å"I told you there was a change coming. I don't know, Edward.† But she locked her jaw, and I could see that there was more. She was trying not to think about it; she was focusing very hard on Jasper suddenly, though he was too stunned to have progressed much in his decision making. She did this sometimes when she was trying to keep something from me. â€Å"What, Alice? What are you hiding?† I heard Emmett grumble. He always got frustrated when Alice and I had these kinds of conversations. She shook her head, trying to not let me in. â€Å"Is it about the girl?† I demanded. â€Å"Is it about Bella?† She had her teeth gritted in concentration, but when I spoke Bella's name, she slipped. Her slip only lasted the tiniest portion of a second, but that was long enough. â€Å"NO!† I shouted. I heard my chair hit the floor, and only then realized I was on my feet. â€Å"Edward!† Carlisle was on his feet, too, his arm on my shoulder. I was barely aware of him. â€Å"It's solidifying,† Alice whispered. â€Å"Every minute you're more decided. There're really only two ways left for her. It's one or the other, Edward.† I could see what she saw†¦but I could not accept it. â€Å"No,† I said again; there was no volume to my denial. My legs felt hollow, and I had to brace myself against the table. â€Å"Will somebody please let the rest of us in on the mystery?† Emmett complained. â€Å"I have to leave,† I whispered to Alice, ignoring him. â€Å"Edward, we've already been over that,† Emmett said loudly. â€Å"That's the best way to start the girl talking. Besides, if you take off, we won't know for sure if she's talking or not. You have to stay and deal with this.† â€Å"I don't see you going anywhere, Edward,† Alice told me. â€Å"I don't know if you can leave anymore.† Think about it, she added silently. Think about leaving. I saw what she meant. Yes, the idea of never seeing the girl again was†¦painful. But it was also necessary. I couldn't sanction either future I'd apparently condemned her to. I'm not entirely sure of Jasper, Edward, Alice went on. If you leave, if he thinks she's a danger to us†¦ â€Å"I don't hear that,† I contradicted her, still only halfway aware of our audience. Jasper was wavering. He would not do something that would hurt Alice. Not right this moment. Will you risk her life, leave her undefended? â€Å"Why are you doing this to me?† I groaned. My head fell into my hands. I was not Bella's protector. I could not be that. Wasn't Alice's divided future enough proof of that? I love her, too. Or I will. It's not the same, but I want her around for that. â€Å"Love her, too?† I whispered, incredulous. She sighed. You are so blind, Edward. Can't you see where you're headed? Can't you see where you already are? It's more inevitable than the sun rising in the east. See what I see†¦ I shook my head, horrified. â€Å"No.† I tried to shut out the visions she revealed to me. â€Å"I don't have to follow that course. I'll leave. I will change the future.† â€Å"You can try,† she said, her voice skeptical. â€Å"Oh, come on!† Emmett bellowed. â€Å"Pay attention,† Rose hissed at him. â€Å"Alice sees him falling for a human! How classically Edward!† She made a gagging sound. I scarcely heard her. â€Å"What?† Emmett said, startled. Then his booming laugh echoed through the room. â€Å"Is that what's been going on?† He laughed again. â€Å"Tough break, Edward.† I felt his hand on my shoulder, and I shook it off absently. I couldn't pay attention to him. â€Å"Fall for a human?† Esme repeated in a stunned voice. â€Å"For the girl he saved today? Fall in love with her?† â€Å"What do you see, Alice? Exactly,† Jasper demanded. She turned toward him; I continued to stare numbly at the side of her face. â€Å"It all depends on whether he is strong enough or not. Either he'll kill her himself† – she turned to meet my gaze again, glaring – â€Å"which would really irritate me, Edward, not to mention what it would do to you – † she faced Jasper again, â€Å"or she'll be one of us someday.† Someone gasped; I didn't look to see who. â€Å"That's not going to happen!† I was shouting again. â€Å"Either one!† Alice didn't seem to hear me. â€Å"It all depends,† she repeated. â€Å"He may be just strong enough not to kill her – but it will be close. It will take an amazing amount of control,† she mused. â€Å"More even than Carlisle has. He may be just strong enough†¦ The only thing he's not strong enough to do is stay away from her. That's a lost cause.† I couldn't find my voice. No one else seemed to be able to either. The room was still. I stared at Alice, and everyone else stared at me. I could see my own horrified expression from five different viewpoints. After a long moment, Carlisle sighed. â€Å"Well, this†¦complicates things.† â€Å"I'll say,† Emmett agreed. His voice was still close to laughter. Trust Emmett to find the joke in the destruction of my life. â€Å"I suppose the plans remain the same, though,† Carlisle said thoughtfully. â€Å"We'll stay, and watch. Obviously, no one will†¦hurt the girl.† I stiffened. â€Å"No,† Jasper said quietly. â€Å"I can agree to that. If Alice sees only two ways – â€Å" â€Å"No!† My voice was not a shout or a growl or a cry of despair, but some combination of the three. â€Å"No!† I had to leave, to be away from the noise of their thoughts – Rosalie's selfrighteous disgust, Emmett's humor, Carlisle's never ending patience†¦ Worse: Alice's confidence. Jasper's confidence in that confidence. Worst of all: Esme's†¦joy. I stalked out of the room. Esme touched my arm as I passed, but I didn't acknowledge the gesture. I was running before I was out of the house. I cleared the river in one bound, and raced into the forest. The rain was back again, falling so heavily that I was drenched in a few moments. I liked the thick sheet of water – it made a wall between me and the rest of the world. It closed me in, let me be alone. I ran due east, over and through the mountains without breaking my straight course, until I could see the lights of Seattle on the other side of the sound. I stopped before I touched the borders of human civilization. Shut in by the rain, all alone, I finally made myself look at what I had done – at the way I had mutilated the future. First, the vision of Alice and the girl with their arms around each other – the trust and friendship was so obvious it shouted from the image. Bella's wide chocolate eyes were not bewildered in this vision, but still full of secrets – in this moment, they seemed to be happy secrets. She did not flinch away from Alice's cold arm. What did it mean? How much did she know? In that still-life moment from the future, what did she think of me? Then the other image, so much the same, yet now colored by horror. Alice and Bella, their arms still wrapped around each other in trusting friendship. But now there was no difference between those arms – both were white, smooth as marble, hard as steel. Bella's wide eyes were no longer chocolate. The irises were a shocking, vivid crimson. The secrets in them were unfathomable – acceptance or desolation? It was impossible to tell. Her face was cold and immortal. I shuddered. I could not suppress the questions, similar, but different: What did it mean – how had this come about? And what did she think of me now? I could answer that last one. If I forced her into this empty half-life through my weakness and selfishness, surely she would hate me. But there was one more horrifying image – worse than any image I'd ever held inside my head. My own eyes, deep crimson with human blood, the eyes of the monster. Bella's broken body in my arms, ashy white, drained, lifeless. It was so concrete, so clear. I couldn't stand to see this. Could not bear it. I tried to banish it from my mind, tried to see something else, anything else. Tried to see again the expression on her living face that had obstructed my view for the last chapter of my existence. All to no avail. Alice's bleak vision filled my head, and I writhed internally with the agony it caused. Meanwhile, the monster in me was overflowing with glee, jubilant at the likelihood of his success. It sickened me. This could not be allowed. There had to be a way to circumvent the future. I would not let Alice's visions direct me. I could choose a different path. There was always a choice. There had to be.

Medias Influence On The Political World - 1041 Words

The media plays a considerable role in the political world. The media gives people access to be able to determine which political party they want to be a part of, develop outlooks on government parties and decisions, and manage their own personal interests. The newspaper, TV, radio, social media, and other online media, are one of the leading factors, if not thee leading factor in political communication and fund-raising. The media’s influence on the political world has shattered the mold in terms of the way politics are shown. Mass media has such a powerful structure that enables politicians to reach a large-scale audience (Croteau Hoynes 2014). The purpose of this essay is to look at how politicians use the media in order to influence their audience as they try to validate their credibility with the public. The influence of the media is more prominent during political campaigns because news coverage of a single event could turn out to be the most significant factor in putting a candidate ahead. In fact, most national political figures, plan public appearances and statements to increase their influence throughout the media. Often times, candidates and their consultants consume much of their time developing strategies and plans to get the most impact on their television audience. Advertising, management of news coverage, and campaign debates are often the types of coverage that political candidates use. The appearance of candidates in presidential debates is as importantShow MoreRelatedThe Roles and Influences of Media on Crime730 Words   |  3 PagesIn the political world, media has both a positive and negative affect. Americans as a whole are engrossed with crime whether it be a fictional representation on a person’s favorite television show, or a true story the nightly news. 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