Fehlende Planungssicherheit verärgert die Sportorthopäden am meisten
Auf dem Weg von der 3-Minuten-Medizin zur 1-Minuten-Medizin
Es wird zunehmend schwieriger, als niedergelassener Facharzt für Orthopädie zu bestehen. Dies ist die einhellige Meinung der Orthopäden, die das unternehmerische Risiko einer Selbständigkeit weiter eingehen. Der tägliche Kampf gegen sinkende Punktwerte und steigende Kosten zermürbt und frustriert. Jede Woche eine schlechte Nachricht, die Mediziner würden sich über eine einzige gute Nachricht freuen. Dazu meint die Gesellschaft für Orthopädisch-Traumatologische Sportmedizin” (GOTS):
“In den letzten Monaten herrscht vor allem eine große Verunsicherung bei nicht vorhandener Planungssicherheit. Die Quartalsabrechnung, bei der im Durchschnitt fünf bis sechs Monate nach Erbringung der Leistung erst feststeht, welches Kasseneinkommen erzielt wurde, schrumpfen aufgrund des sinkenden Punktwertes immer weiter. Der Punktwert sinkt, da immer mehr Leistungen aus dem gedeckelten Ausgabentopf für die Fachärzte gezahlt werden.
Aufgrund des hohen orthopädischen Versorgungsbedarfes der Bevölkerung, sichtbar an den immer und überall überfüllten Wartezimmern, ist die Zahl der niedergelassenen Fachärzte seit den siebziger Jahren kräftig gestiegen, die angeforderte Bezahlung für die erbrachten Leistungen somit ebenfalls. Da die Kassenhonorare für die gestiegenen Leistungsanforderungen nicht reichten, wurde der Facharzttopf gedeckelt. Seither teilen die Facharztgruppen den gedeckelten Facharzt-Betrag unter den einzelnen Fachärzten auf. Facharztgruppen, die aufgrund der Verteilung der sicheren Pleite zusteuern, werden von allen anderen Fachgruppen gestützt. Zuletzt wurden die bisher nicht aus dem Facharzttopf gespeisten Psychotherapeuten ebenfalls in den Facharztbereich aufgenommen, zusätzliches Facharzthonorar wurde dafür von den Kassen nicht zur Verfügung gestellt. Vor dieser Zeit wurden psychotherapeutische Leistungen von den Kassen aber mit separaten Mitteln bezahlt. Der Honorarverteilungsschlüssel, der die Verteilung der Kassengelder regelt, ist selbst nach eingehendem Studium nicht zu verstehen und wird sowieso alle paar Wochen geändert.
Das Honorar, das für einen orthopädischen Patienten für eine fachorthopädische Betreuung im Quartal ausgezahlt wird, sinkt weiter. Bei betriebswirtschaftlicher Berechnung stellt der niedergelassene Orthopäde schnell fest, dass ihm die Ziffer 1 für den ersten Besuch des Patienten im Quartal ungefähr 12 Euro inklusive Spritzen und Gipsen bringt. Spritzen und Kanülen muss der Orthopäde dabei noch selbst bezahlen. Jeder Zweitbesuch im Quartal wird mit der Ziffer 2 abgerechnet. Die Ziffer 2 bringt dem Orthopäden ca. 1,75 Euro ein. Da die laufenden Kosten einer orthopädischen Praxis bei ca. 1,50 Euro/Minute liegen, erfolgt der Zweitbesuch des Patienten im Quartal quasi ohne jede Honorierung, es sei denn, er dauert nur ca. 1 Minute. Da die meisten orthopädischen Kollegen mit ihren erbrachten Leistungen über dem gedeckelten Leistungsvolumen liegen, viele erbringen 140 Prozent der zu vorgenanntem Honorar bezahlten Leistungen, werden zum Beispiel 40 Prozent der Leistungen nur hälftig oder gar nicht vergütet.
Dies ist nach einhelliger Meinung der Kollegen ein Skandal, da orthopädische Krankheiten nicht immer mit einem Besuch zu diagnostizieren und behandeln sind. Die Kassen verlangen im Gegenzug und bei sinkendem Honorar, Top-Qualität, permanente schriftliche, ausführliche Auskünfte und Dokumentation der Arzttätigkeit. Nachfragen der DAK erkundigen sich zum Beispiel bei uns Ärzten, ob die verordnete Krankengymnastik wirklich erbracht wurde. Die AOK möchte zum Beispiel wissen, wo der Patient seinen Elektrorollstuhl denn abstellen würde. Mit solchen Anfragen werden Orthopäden und ihre Helferinnen in zunehmendem Umfang und Häufigkeit beschäftigt.
Dagegen stehen die ständig steigenden Praxiskosten: Personal wird durch steigende Berufserfahrung und Alter besser bezahlt, steigende Lohnnebenkosten, steigende Kosten für Softwarewartung, Röntgenwartungsverträge und Energiekosten. Wer in Zukunft als Orthopäde up-to-date sein will muss zudem in den nächsten Jahren auf digitale Röntgen-Bildspeicher und -Archivierung umrüsten, über immer leistungsfähigere PCs zur Verwaltung der Krankenunterlagen verfügen. Durch die geänderte Röntgenverordnung müssen Röntgenbilder von Kindern länger archiviert werden, was neue Lagerungskapazitäten erfordert.
Nebenbei kämpfen die Kollegen täglich mit Richtgrößen für Medikamente und Krankengymnastik. Eine Praxis, die die ureigene orthopädische Krankheit Osteoporose feststellt und mit adäquaten Medikamenten behandelt, stößt sehr schnell an die Obergrenze der Richtgrößen für Medikamente. Die Geldmenge, die ein niedergelassener Orthopäde pro Patient hierbei verordnen darf, ist bundesweit sehr unterschiedlich. Warum darf ein Berliner Orthopäde für seine Patienten die fünffache Menge an Medikamenten aufwenden, die ein hessischer Kollege verordnen darf?.
Als Orthopäden warten wir, wie alle Ärzte, seit Jahren auf die versprochene Überarbeitung unserer Gebührenordnung (GOÄ). Diese wurde zuletzt 1986 unzureichend reformiert. Grundleistungen wurden zum Teil 1996 neubewertet, die Steigerung des Punktwertes lag bei 6,5 Prozent für acht Jahre Laufzeit, die Inflation betrug im selben Zeitraum 25 Prozent. Bei arthroskopischen Kniegelenkoperationen kommt es regelmäßig zu einem Abrechnungsproblem, da arthroskopische Leistungen in der GOÄ nur unzureichend abgebildet werden, heutzutage aber der Standardeingriff sind. So sind Honorarstreitigkeiten mit den Privatpatienten und deren Versicherungen programmiert. Hier muss der Gesetzgeber endlich die Versprechung einer Überarbeitung der GOÄ einlösen.
Das Fass zum Überlaufen bringt die von Gesundheitsministerin Schmidt den Ärzten verordnete Nullrunde, das heißt, keinerlei Erhöhung der Honorare 2003. Bei steigenden Praxiskosten und der derzeitigen Inflation bedeutet dies eine klare Minusrunde für alle Ärzte.
Einen Vorgeschmack auf Einzelverträge mit den Krankenkassen gab es für die niedergelassenen Orthopäden mit dem Akupunktur-Modellprojekt der AOK. Viele Kollegen haben sich eine Schmerzgrenze gesetzt, ab der sie nicht mehr bereit waren, Akupunkturbehandlungen zu erbringen. Die AOK setzte als Honorar für eine von ihr im Rahmen des Modellprojektes bezahlte Akupunktursitzung einen Betrag deutlich unter der in der Gebührenordnung für Ärzte (GOÄ) üblichen Honorierung fest. Einige Kollegen waren nicht bereit, unter die bisher üblichen Sätze für eine Akupunktursitzung zu gehen und wurden daher kein Partner der AOK im Modellprojekt Akupunktur.
Die Modellprojekte der Krankenkassen für die Akupunktur sind aus orthopädischer Sicht generell zu begrüßen, da wenigstens in diesem Fall das Erkrankungsrisiko eines Patienten auf die Krankenkasse übergeht. Im Rahmen der Modellprojekte stellen wir Ärzte fest, ob ein Patient ein Beschwerdebild aufweist, das die von den Krankenkassen gestellten Voraussetzungen für eine Behandlung mit Akupunktur erfüllt. In diesem Falle müssen die Krankenkassen die Kosten der Akupunkturbehandlung ganz bzw. zum großen Teil übernehmen.
Der nächste Schlag der AOK betraf die ambulanten Operationen. Niedergelassene Orthopäden erbringen eine hohe Zahl der ambulant durchgeführten Operationen. In Hessen bestand eine, nach Meinung der Kollegen, gute Vereinbarung zum ambulanten Operieren. Es wurden festgelegte Euro-Beträge für eine Reihe von Operationen zwischen der kassenärztlichen Vereinigung und den Krankenkassen vereinbart. Mit dieser Regelung, die endlich einmal Planungssicherheit versprach, konnten Orthopäden ganz gut leben, vorausgesetzt, die Miete, die pro Operation an eine OP-Einrichtung zu entrichten ist, war nicht zu hoch. Die AOK kündigte einseitig diese Regelung von heute auf morgen auf. Die Orthopäden schickten, um überhaupt noch AOK-Patienten notwendige ambulante Operationen zu ermöglichen, die Patienten mit einem Kostenvoranschlag zur AOK. Erst nach Genehmigung durch die AOK konnten zum Beispiel akute Meniskusverletzungen dann zeitverzögert operiert werden.
Mittlerweile hat die AOK die Euro-Beträge pro Operation deutlich heruntergehandelt, für einige Operationen ist dies nicht mehr wirklich kostendeckend, zumal die Haftpflichtversicherungen für operativ tätige Orthopäden viele Tausend Euro kosten. Aufgepeitscht durch tägliche Fernseh- und Zeitungsbeiträge über Ärztepfusch und Kunstfehler steigt die Bereitschaft der Bevölkerung an, juristisch gegen Ärzte vorzugehen. Dies schlägt sich in den steigenden Haftpflichtprämien nieder, diese sind zwar noch nicht in amerikanischen Dimensionen, allerdings sind die Arzthonorare in Deutschland dies ebenfalls nicht.
Fazit: “Wir sind auf dem Weg von der 3-Minuten-Medizin zur 1-Minuten-Medizin!”
Autor im Namen der GOTS:
Dr. Andreas Marka
mediCenter Groß-Umstadt
26. Februar 2003
Wow, amazing blog structure! How lengthy have you been blogging for?
you made running a blog look easy. The entire look of your
website is fantastic, as neatly as the content! You can see
similar here sklep online
Ich entschuldige mich aufrichtig für diesen Kommentar! Aber ich teste einige Software zum Ruhm unseres Landes und ihr positives Ergebnis wird dazu beitragen, die Beziehungen Deutschlands im globalen Internet zu stärken. Ich möchte mich noch einmal aufrichtig entschuldigen und liebe Grüße 🙂
Howdy! Do you know if they make any plugins to help with Search Engine Optimization? I’m
trying to get my blog to rank for some targeted keywords but I’m not seeing very good
gains. If you know of any please share. Thank you! You can read
similar text here: GSA Verified List
Howdy! Do you know if they make any plugins to assist with Search Engine Optimization? I’m trying to get my site to rank for some targeted
keywords but I’m not seeing very good gains. If you know of any please share.
Thank you! I saw similar art here: Backlink Building
You have a real gift for writing. Your posts are always so engaging and full of valuable information. Keep up the great work!nexusnook
This post was incredibly informative and well-organized. I learned so much from reading it. Thank you for your hard work and dedication!rendingnicheblog
The Nectarine has smooth-slick pores and skin like a Plum. The style is resembling a Peach. The significant distinction is that the Peach has a rough protective skin a prickly fiber that protects the fruit and if not wiped-off can hurt your tongue….
These are very inspiring – reminds me again that i must sort out something a bit more special for my own blog! I particularly like Brian jeremys design. Good post, thanks.
Hello there! This is my first visit to your blog! We are a group of volunteers and starting a new project in a community in the same niche. Your blog provided us valuable information to work on. You have done a marvellous job!
i would love to use hydrogen fuel on my car, this fuel is really nonpolluting but is not yet very available,
Which is some inspirational stuff. Never knew that opinions might be this varied. Thank you for all the enthusiasm to provide such helpful information here.
abstract art have share some of its unique beauty when it comes to art. i like abstract art because it is mysterious;;
Can I take part of your post to my blog
Hi” i think that you should add captcha to your blog”
I always visit your blog everyday to read new topics.~’;,”
I love the efforts you have put in this, regards for all the great posts .
There are some interesting points in time in this article but I don’t know if I see all of them center to heart. There is some validity but I will take hold opinion until I look into it further. Good article , thanks and we want more! Added to FeedBurner as well…
Oh i really envy the way you post topics, how i wish i could write like that.;*;-`
Yet were you aware this seduction strategies will not be only guys?
Hi, Neat post. There’s a problem along with your web site in internet explorer, could test this… IE nonetheless is the marketplace leader and a huge element of folks will miss your magnificent writing due to this problem.
You need to be a part of a contest for starters of the finest blogs on the web. Let me suggest this page!
Appreciate it for this howling post, I am glad I observed this internet site on yahoo.
Appreciate it for this post, I am a big big fan of this website would like to proceed updated.
PBS and Prof. Ferguson Great Work! Thanks for helping me understand what went wrong and how we got here.
Frank has been pretending not to receive his pension checks in order to talk with Sara, the customer service representative, on the phone.
There a few intriguing points over time in the following paragraphs but I don’t determine if I see them all center to heart. There exists some validity but I’ll take hold opinion until I explore it further. Good post , thanks and now we want a lot more! Added to FeedBurner also
Hi. I wanted to thank you for the great details youve posted on your internet site. I will definitelycome back to check it out again and have subscribedto your RSS feed. Have an excellent day.
Simply killing some in between class time on Digg and I found your article . Not usually what I choose to read about, but it was completely price my time. Thanks.
hey I was very impressed with the setup you used with this blog. I use blogs my self so good job. definatly adding to bookmarks.
I have read a few of the articles on your website now, and I really like your style of blogging. I added it to my favorites blog site list and will be checking back soon. Please check out my site as well and let me know what you think.
Hiya, I’m really glad I’ve found this info. Nowadays bloggers publish just about gossips and net and this is actually annoying. A good web site with exciting content, that’s what I need. Thank you for keeping this web-site, I’ll be visiting it. Do you do newsletters? Can not find it.
Your article continually have got alot of really up to date info. Where do you come up with this? Just declaring you are very innovative. Thanks again
Regards for this post, I am a big big fan of this site would like to go on updated.
Hey there! Do you know if they make any plugins to help with SEO?
I’m trying to get my blog to rank for some targeted keywords
but I’m not seeing very good results. If you know of any please
share. Cheers! You can read similar art here: Where to escape room
This is a good blog. Keep up all the work. I too love to blog. This is great everyone sharing opinions
very nice post, i surely love this website, keep on it
Thank you for the good critique. Me & my friend were just preparing to do a little research about this. We got a book from our local library but I think I’ve learned better from this post. I’m very glad to see such wonderful information being shared freely out there..
educator, Sue. Although Sue had a list of discharge instructions in her hand, she paused and
I¡¦ll right away grasp your rss feed as I can’t in finding your email subscription hyperlink or e-newsletter service. Do you’ve any? Please let me understand so that I may subscribe. Thanks.
The the very next time I read a blog, Hopefully which it doesnt disappoint me approximately this one. I am talking about, I know it was my choice to read, but I just thought youd have some thing fascinating to convey. All I hear is usually a couple of whining about something you could fix should you werent too busy looking for attention.
This would be the correct weblog for everyone who is wishes to be familiar with this topic. You understand much its practically difficult to argue with you (not that I just would want…HaHa). You definitely put a whole new spin using a topic thats been discussed for several years. Wonderful stuff, just wonderful!
I believe that youtube is a great tool for anyone interested in watching or uploading videos. I have been using the site for years now, and still think it is doing a good job!
Whoa! that blog post was basically pretty favorable thank you. “Two paradoxes are better than one they may even suggest a solution.” by Edward Teller..
When I originally commented I clicked the -Notify me when new surveys are added- checkbox and from now on whenever a comment is added I am four emails sticking with the same comment. Perhaps there is any way you can get rid of me from that service? Thanks!
Exactly laqr,I think I¡Çm smarter than Obama too. and to prove it, I¡Çll put my college GPA and transcripts up against his any day.
you are in reality a excellent webmaster. The website loading pace is incredible. It seems that you’re doing any distinctive trick. Also, The contents are masterpiece. you have performed a wonderful task on this subject!
Wow, you seem to be very knowledgable about this kind of topics.~’:”.
Cheers for this material I has been browsing all Msn in order to find it!
Way cool! Some very valid points! I appreciate you writing this post and the rest of the site is also very good.
Thanks for this wicked post. I am wondering if you were thining of publishing similar posts to this. .Keep up the excellent posts!
I am glad for commenting to let you understand what a notable experience our daughter encountered visiting your webblog. She realized too many things, with the inclusion of what it’s like to possess an excellent giving mood to let other people very easily thoroughly grasp selected complicated subject areas. You actually exceeded her expected results. Thank you for offering those essential, dependable, explanatory and even easy guidance on this topic to Sandra.
Can I just say what a aid to seek out someone who actually knows what theyre talking about on the internet. You undoubtedly know the way to carry an issue to light and make it important. Extra folks need to read this and understand this facet of the story. I cant believe youre not more well-liked since you positively have the gift.
the internet is always the source of cheap stuffs, you can buy cheap electronics, cheap softwares and other stuffs”
I’ve been surfing on-line greater than three hours nowadays, yet I never found any interesting article like yours. It is lovely worth sufficient for me. In my opinion, if all website owners and bloggers made good content as you probably did, the internet will probably be a lot more helpful than ever before!
Exactly laqr,I think I¡Çm smarter than Obama too. and to prove it, I¡Çll put my college GPA and transcripts up against his any day.
Hmm is anyone else encountering problems with the pictures on this blog loading? I’m trying to figure out if its a problem on my end or if it’s the blog. Any suggestions would be greatly appreciated.
Twitter had a tweet on wholesale designer handbags, and lead me here.
I recently wished to value an individual all over again. I don’t know things i would have labored on even without the individuals creative ideas shown by an individual directly on these kinds of difficulty. It had been the particular scary issue in my circumstances, nonetheless , seeing ab muscles experienced strategy a person taken care of it took me to be able to weep more than pleasure. Really happy for the program and also really hope you comprehend such a congrats that you will be completing educating women and men making use of your webblog. I am sure you haven’t encounter anyone.
Hi this is somewhat of off topic but I was wondering if blogs use WYSIWYG editors or if you have to manually code with HTML. I’m starting a blog soon but have no coding skills so I wanted to get advice from someone with experience. Any help would be greatly appreciated.
Have you thought about introducing some social bookmarking buttons to these blog posts. At least for facebook.
I’m truly enjoying the design and layout of your website. It’s a very easy on the eyes which makes it much more enjoyable for me to come here and visit more often. Did you hire out a designer to create your theme? Excellent work!
Greetings! Very useful advice within this article! It is the little changes which will make the most important changes. Many thanks for sharing!
spam blockers are always necessary because there are so many spam these days,.
Helpful info. Lucky me I found your website accidentally, and I’m stunned why this accident didn’t came about in advance! I bookmarked it.
I’m impressed, I must say. Truly rarely do I encounter a weblog that’s both educative and entertaining, and let me tell you, you have hit the nail around the head. Your concept is outstanding; the problem is an element that insufficient persons are speaking intelligently about. We are delighted we stumbled across this around my look for something concerning this.
you employ a wonderful blog here! do you want to cook some invite posts in my small blog?
That is the excellent mindset, however is just not create any kind of sence whatsoever talking about that will mather. Just about any method thank you as well as i’d aim to share a person’s post towards delicius but it surely looks like it’s an issue using your sites on earth do you i highly recommend you recheck the idea. thanks yet again.
Excellent post however , I was wanting to know if you could write a litte more on this subject? I’d be very thankful if you could elaborate a little bit more. Bless you!
Thank you for your information and respond to you. auto loans westvirginia
we will be buying more christmas ornaments these christmas because we like to decorate more~
This is actually intriguing, You’re an exceptionally effective blogger. I’ve enrolled with your feed and furthermore , look ahead to reading your marvelous write-ups. What’s more, We have shared your internet site inside our social networks.
I am in agreement with many different the info in this article. You are a distinctive author have real profit set your own views into apparent content. Anyone should be able to understand why.
Exactly where maybe you’ve discovered the resource for the purpose of the following article? Great reading through I have subscribed to your blog feed.
I am continually amazed by the amount of information available on this subject. What you presented was well researched and well worded in order to get your stand on this across to all your readers.
I like it when individuals get together and share ideas. Great website, keep it up.
magnificent submit, very informative. I ponder why the opposite experts of this sector don’t realize this. You must proceed your writing. I’m sure, you’ve a great readers’ base already!
I really like your writing style, good info , thankyou for putting up : D.
Aw, this was an exceptionally good post. Finding the time and actual effort to create a superb article… but what can I say… I put things off a lot and don’t seem to get nearly anything done.
I gotta favorite this site it seems very beneficial .
An impressive share! I have just forwarded this onto a co-worker who was conducting a little research on this. And he actually ordered me dinner due to the fact that I found it for him… lol. So let me reword this…. Thanks for the meal!! But yeah, thanx for spending time to discuss this topic here on your web site.
There is definately a lot to learn about this subject. I really like all the points you’ve made.
A motivating discussion is worth comment. There’s no doubt that that you ought to publish more on this topic, it might not be a taboo matter but generally people don’t speak about such subjects. To the next! All the best.
Effect hustings comestible pills phentermine online that would effectively increase fat loss, actual is capital to glom for pills that have already the components that should exalt your bodys metabolism, also know as the power of the body to flame useless fats.
You completed some fine points there. I did a search on the subject matter and found the majority of people will consent with your blog.
I’d must check with you here. Which isn’t one thing I often do! I take pleasure in reading a post that can make folks think. Also, thanks for permitting me to comment!
i would always love to hear those christmas music with a very happy tune’
Thank you for the sensible critique. Me & my friend were just preparing to do a little research about this. We got a book from our area library but I think I learned better from this post. I am very glad to see such wonderful info being shared freely out there…
Hmm is anyone else having problems with the pictures on this blog loading? I’m trying to find out if its a problem on my end or if it’s the blog. Any feed-back would be greatly appreciated.
very nice post, i undoubtedly enjoy this excellent website, continue it
I think one of your adverts triggered my internet browser to resize, you might want to put that on your blacklist.
The next time I read a blog, I hope that it does not fail me just as much as this particular one. I mean, I know it was my choice to read through, nonetheless I genuinely believed you would have something interesting to say. All I hear is a bunch of complaining about something you could fix if you weren’t too busy seeking attention.
Hi, I just found your web site via google. Your post is truly relevant to my life currently, and I’m really delighted I found your website.
the best air purifiers are usually the ones using hepa filters but they are very very expensive,
Great work! This is the kind of info that should be shared around the internet. Shame on Google for now not positioning this submit higher! Come on over and discuss with my web site . Thanks =)
Thanks for the good critique. Me and my cousin were just preparing to do a little research on this. We got a book from our area library but I think I’ve learned better from this post. I’m very glad to see such wonderful information being shared freely out there..
Hello! I want to give you a enormous thumbs up for that fantastic information you might have here on this post. We are coming back to your blog for much more soon.
I just added this blog to my google reader, great stuff. Cannot get enough!
Greetings! Very helpful advice in this particular article! It is the little changes that will make the greatest changes. Thanks a lot for sharing!
Rachel Weisz have that mysterious look and she is very appealing to most men and women,,
Can I just now say what a relief to uncover a person that actually knows what theyre speaking about online. You actually know how to bring a worry to light and earn it crucial. More and more people need to look at this and understand why side from the story. I cant believe youre less well-liked because you definitely provide the gift.
I will immediately grasp your rss feed as I can’t to find your email subscription link or e-newsletter service. Do you’ve any? Please let me recognize so that I may just subscribe. Thanks.
I’ve usually believed personally one of the finest lovers associated with Mozart, as well as will achieve this until your day associated with my personal passing away.
peanut butters are very tasty, the only problem is that i have some very bad peanut allergy,.
The work I am doing is very hard but articles like this make it much easier. Thank you for doing my research for me.
I am interested in talking to you about your website design. Did someone design it for you?
Well, this Thursday I read through a couple of your posts. I must say this is one of your better ones. ..
It’s actually a cool and useful piece of info. I am glad that you just shared this useful info with us. Please keep us up to date like this. Thank you for sharing.
i am very picky about baby toys, so i always choose the best ones,
I wanted to thank you for this great read!! I definitely enjoying every little bit of it I
retinoid is always one of the best medication that you can use on your skin**
so much wonderful info on here, : D.
Youre so cool! I dont suppose Ive read anything similar to this prior to. So nice to find somebody by original ideas on this subject. realy appreciate beginning this up. this excellent website is one thing that is required on the web, an individual with a little originality. useful work for bringing interesting things for the world wide web!
some tanning salons have high power uv lamps which can shorten the amount of time you need to expose yourself::
You made some decent points there. I looked on the web for the problem and discovered most individuals will go coupled with along with your site.
I haven’t checked in here for some time as I thought it was getting boring, but the last few posts are great quality so I guess I’ll add you back to my daily bloglist. You deserve it friend
Excellent read, I just passed this onto a friend who was doing some research on that. And he actually bought me lunch since I found it for him smile So let me rephrase that: Thank you for lunch!
You have good command on this topic and have explained in a very pleasant way. Thanks for sharing.
wearing contact lenses is sometimes hard and you always need to clean it for hygiene“
Exceptional write-up my buddy. This really is precisely what I’ve been searching for for very a time now. You have my gratitude man
Greetings! Very helpful advice in this particular article! It is the little changes that make the most significant changes. Many thanks for sharing!
Wow, fantastic blog layout! How long have you been blogging for? you made blogging look easy. The overall look of your site is great, as well as the content!
I have fun with, result in I discovered exactly what I used to be looking for. You’ve ended my four day lengthy hunt! God Bless you man. Have a great day. Bye
Czuję się znacznie pewniej w temacie SEO po przeczytaniu tego bloga.
Doceniam skupienie się na zagrożeniach SEO i potrzebie ich usunięcia.
Sometimes, blogging is a bit tiresome specially if you need to update more topics.,`,”~
Właśnie dowiedziałem się, że moja strona potrzebuje SEO. Te informacje są ratunkiem.
Hello there! I just would like to offer you a big thumbs up for your excellent info you have right here on this post. I’ll be returning to your site for more soon.
Wow, nie zdawałem sobie sprawy, jak skomplikowane może być SEO. Dzięki za te informacje!
Dzięki za świetne porady na temat SEO. Bezpieczeństwo jest kluczowe!
Dzięki za świetne porady na temat SEO. Bezpieczeństwo jest kluczowe!
Bezpieczeństwo przede wszystkim! Dzięki za cenne informacje na temat SEO.
Świetne wskazówki dotyczące znalezienia wiarygodnych usług SEO. Dzięki!
Bardzo pouczający blog na temat SEO! Dzięki za podzielenie się nim.
Ten post był bardzo pomocny w zrozumieniu procesu SEO. Dzięki!
Ten post był dla mnie oświeceniem na temat zagrożeń SEO. Dzięki!
Ten post był bardzo pouczający na temat procesu SEO. Dzięki!
Dzięki za praktyczne porady i wskazówki dotyczące SEO.
Nie miałem pojęcia, że SEO jest tak ważne. Dzięki za ten wpis.
Nauczyłem się wiele z tego posta o SEO. Dzięki za świetne porady!
Dzięki za szczegółowy przewodnik po tym, czego można oczekiwać podczas wdrażania SEO.
Ten blog dostarczył mi dużo jasności na temat SEO. Dzięki!
Świetny artykuł na temat SEO, który nie jest często poruszany.
Ten blog dał mi pewność, by zająć się SEO mojej strony.
Ten blog bardzo mi pomógł w zrozumieniu potrzeby SEO.
Dzięki za szczegółowy przegląd procedur SEO.
To była otwierająca oczy lektura na temat ryzyk i procesu SEO.
Ten blog to cenne źródło informacji dla właścicieli stron internetowych.
Czy możesz polecić jakieś sprawdzone narzędzia do SEO?
You really should be a part of a contest for just one of the finest blogs on-line. I am going to recommend this great site!
The the next time Someone said a blog, I am hoping that this doesnt disappoint me around this one. I mean, It was my option to read, but I actually thought youd have something interesting to state. All I hear is actually a handful of whining about something you could fix if you ever werent too busy searching for attention.
My spouse and i got so joyous Edward could carry out his investigation through the entire ideas he came across while using the weblog. It is now and again perplexing to just always be giving for free techniques which usually others might have been selling. We really remember we’ve got you to appreciate for this. The main explanations you’ve made, the easy website navigation, the relationships your site aid to create – it’s got mostly wonderful, and it is aiding our son in addition to the family feel that this issue is exciting, which is certainly very fundamental. Thank you for all the pieces!
Thanks for every other informative blog. The place else could I get that kind of information written in such an ideal means? I’ve a challenge that I am just now running on, and I’ve been on the glance out for such information.
fertility clinics these days are very advanced and of course this can only mean higher success rates on birth,,
Adding to my bookmarks thanks, needed some more pictures maybe.
you’ve gotten an unbelievable blog here! do you want to develop ask articles on my small website?
ibuprofen is a good pain reliever but i heard that this one have nasty side effects too~
Someone essentially help to make significantly articles or blog posts I would state. This really is the first time I frequented your site web page and thus much? I surprised with the research you created to create this distinct publish extraordinary. Amazing job!
Wow , Your blog has some great information on there. Glad i come across it. I have now bookmarked and shared your blog on social platforms. Thanks alot
I’m hoping you then have a wonderful moment! Superior guide, well crafted and also planned. My group is looking towards reading through additional of the discussions sometime soon.
I just added this blog site to my feed reader, great stuff. Can not get enough!
This is actually a good affecting approach to this specific point. Thanks, I’m really happy you shared your thoughts in addition to techniques and I find that i am in agreement. I certainly appreciate your very clear writing additionally , the effort you’ve spent with this posting. A great many thanks for that great work also very good luck with your internet site, I’m awaiting new subjects within the future.
Lebron James Is A Clown You Know White Face Paint Red Nose Floppy Shoes Type Shit|_PeaceLuvMusic|
There may be noticeably a bundle to find out about this. I assume you made sure nice points in features also.
Amazing this specific help is certainly incredible it genuinely aided me plus my family, cheers!
Only a few blogger would discuss this topic the way you do.:~~”\”
I simply desired to appreciate you once more. I do not know the things I would have accomplished in the absence of those smart ideas discussed by you relating to such industry. It was actually the daunting matter in my position, nevertheless noticing your professional strategy you resolved it forced me to cry with fulfillment. Extremely grateful for your information and in addition sincerely hope you really know what a great job you’re providing instructing men and women through your web site. I’m certain you’ve never encountered all of us.
An fascinating dialogue is value comment. I think that you need to write extra on this matter, it won’t be a taboo topic but usually individuals are not sufficient to talk on such topics. To the next. Cheers
dance schools that also offers free yoga classes would be very very nice’
Comfortabl y, the article is really the sweetest on this precious topic. I concur with your conclusions and will certainly eagerly look forward to your upcoming updates. Simply just saying thanks will certainly not simply be sufficient, for the phenomenal clarity in your writing. I will certainly directly grab your rss feed to stay informed of any updates. Pleasant work and also much success in your business endeavors!
When I originally commented I clicked the -Notify me when new surveys are added- checkbox now whenever a comment is added I buy four emails with similar comment. Is there by any means you possibly can remove me from that service? Thanks!
Can I just say what a relief to search out somebody who actually knows what theyre talking about on the internet. You definitely know easy methods to bring a problem to mild and make it important. Extra people need to learn this and perceive this facet of the story. I cant imagine youre not more in style because you definitely have the gift. [Reply]
I was really glad to find this web site on bing, just what I was looking for : D likewise saved to favorites .
Wow! This could be one particular of the most helpful blogs We have ever arrive across on this subject. Basically Magnificent. I am also a specialist in this topic therefore I can understand your effort.
I am speechless. It is a very good weblog and very engaging too. Nice paintings! That’s no longer actually so much coming from an beginner writer like me, but it’s all I may just say after diving into your posts. Nice grammar and vocabulary. Not like other blogs. You actually understand what you?re talking about too. Such a lot that you just made me need to explore more. Your weblog has turn out to be a stepping stone for me, my friend.
I’d have to talk to you here. Which isn’t some thing I do! I enjoy reading an article that can get people to believe. Also, many thanks for permitting me to comment!
This is exactly what I needed to read today.에볼루션 사이트
There’s certainly a lot to learn about this issue. I love all the points you have made.
Hi there! I just want to give you a huge thumbs up for the excellent information you have right here on this post. I will be returning to your web site for more soon.
Pretty! This has been an incredibly wonderful post. Thanks for providing this information.
Howdy! This blog post could not be written any better! Looking at this post reminds me of my previous roommate! He constantly kept talking about this. I will forward this post to him. Pretty sure he will have a great read. Many thanks for sharing!
This excellent website certainly has all of the info I wanted about this subject and didn’t know who to ask.
I could not resist commenting. Perfectly written!
You’ve made this topic accessible to everyone.햇살론 대출
Your article is both informative and engaging.중기청 대출
Well done on tackling such a tough subject.프라그마틱 불법
I admire the effort you’ve put into this.검색엔진최적화 업체
purple pharmacy mexico price list
http://cmqpharma.com/# mexican mail order pharmacies
mexican pharmaceuticals online
I seriously love your blog.. Great colors & theme. Did you create this website yourself? Please reply back as I’m wanting to create my very own website and want to learn where you got this from or just what the theme is called. Thanks.
That is a very good tip particularly to those fresh to the blogosphere. Brief but very precise information… Appreciate your sharing this one. A must read article!
you write in a lucid manner and I have no difficulty to understand what you have said, even though I am a novice.
Wonderful goods from you, man. I’ve understand your stuff previous to and you’re just too magnificent. I actually like what you’ve acquired here, certainly like what you are stating and the way in which you say it. You make it enjoyable and you still take care of to keep it wise. I cant wait to read much more from you. This is really a tremendous site.
Howdy! I just wish to give an enormous thumbs up for the great information you have got right here on this post. I can be coming again to your weblog for extra soon.
Sorry for that large evaluation, but I’m really loving the brand new Zune, as well as wish this particular, along with the superb reviews another individuals wrote, can help you determine if it’s the correct selection for you.
I am perpetually thought about this, thankyou for posting .
bookmarked!!, I like your website!
There are a few interesting points soon enough in this posting but I do not determine if them all center to heart. There exists some validity but I will take hold opinion until I check into it further. Excellent post , thanks and that we want much more! Added to FeedBurner likewise
When I originally commented I clicked the -Notify me when new comments are added- checkbox and now every time a comment is added I get four emails with the same comment. Is there any way you can get rid of me from that service? Thanks!
over the internet,You should not search for the best way to present to families, you have many men and also mans companions. Mainly because that will certainly not crave you actually individuals basically look down on people.
I’m very happy to discover this page. I need to to thank you for your time due to this fantastic read!! I definitely savored every part of it and I have you saved as a favorite to look at new stuff in your website.
Aw, this was a really nice post. Taking a few minutes and actual effort to make a really good article… but what can I say… I procrastinate a lot and don’t seem to get anything done.
https://artdaily.com/news/171650/Mp3Juice-Review–The-Pros-and-Cons-You-Need-to-Know
When I originally commented I seem to have clicked on the -Notify me when new comments are added- checkbox and now whenever a comment is added I get 4 emails with the same comment. Perhaps there is a means you are able to remove me from that service? Thanks a lot.
I really like reading an article that will make men and women think. Also, thank you for allowing for me to comment.
Oh my goodness! Amazing article dude! Thank you, However I am going through problems with your RSS. I don’t understand the reason why I am unable to join it. Is there anybody getting identical RSS issues? Anyone who knows the answer can you kindly respond? Thanks.
Hi there! This article could not be written any better! Going through this article reminds me of my previous roommate! He always kept preaching about this. I most certainly will forward this article to him. Fairly certain he will have a very good read. I appreciate you for sharing!
I couldn’t refrain from commenting. Very well written.
Hello there! I just would like to offer you a huge thumbs up for the great information you’ve got here on this post. I am returning to your website for more soon.
This blog was… how do you say it? Relevant!! Finally I have found something that helped me. Kudos!
Greetings! Very useful advice in this particular post! It is the little changes which will make the biggest changes. Thanks a lot for sharing!
There is definately a great deal to find out about this issue. I like all the points you’ve made.
Oh my goodness! Amazing article dude! Thanks, However I am going through troubles with your RSS. I don’t understand the reason why I cannot join it. Is there anybody else getting similar RSS issues? Anyone that knows the answer can you kindly respond? Thanx!!
https://indiapharmast.com/# top online pharmacy india
mexico drug stores pharmacies medicine in mexico pharmacies mexico pharmacies prescription drugs
https://foruspharma.com/# mexico pharmacies prescription drugs
https://canadapharmast.online/# canadian pharmacy scam
I couldn’t have said it better myself.검색엔진최적화 방법
cost of cheap clomid tablets: order clomid pills – buy cheap clomid without dr prescription
I’m looking forward to your next article.pbn 백링크
doxycycline tablets australia: doxycycline 75 mg cost – how to buy doxycycline
how to buy doxycycline in uk: buy doxycycline online usa – cost of doxycycline canada
cheap clomid tablets: where to get clomid without dr prescription – how to buy clomid without dr prescription
amoxicillin no prescipion: amoxicillin discount – buy amoxicillin online mexico
amoxicillin script: amoxicillin 750 mg price – amoxicillin canada price
clomid brand name: where to buy generic clomid without dr prescription – cost of generic clomid pills
paxlovid pharmacy: paxlovid buy – paxlovid generic
Hi, I do think this is an excellent web site. I stumbledupon it 😉 I’m going to come back once again since i have bookmarked it. Money and freedom is the best way to change, may you be rich and continue to help other people.
I blog often and I really appreciate your content. Your article has really peaked my interest. I will bookmark your blog and keep checking for new information about once a week. I opted in for your RSS feed too.
I blog often and I really appreciate your content. This article has truly peaked my interest. I’m going to take a note of your website and keep checking for new information about once a week. I opted in for your Feed too.