By Nicholas Behunin, MD
What does seeing 20/20 mean? In the eye clinic, 20/20 vision refers to normal vision while standing twenty feet from the eye chart. If someone has 20/100 vision, he or she must stand twenty feet from the chart to see what a person with normal vision can see at one hundred feet. An abnormality in any structure of the eye can result in blurred vision. Some causes of impaired vision are treatable or preventable. As we begin the year of 2020, let us reflect on what is clouding our vision.
Global Impact of Visual Impairment
The global burden of poor vision is staggering. According to the latest World Health Organization (WHO) estimates, 2.2 billion people worldwide have vision impairment or blindness.1 Of these, more than one billion live with treatable or preventable eye diseases but lack access to adequate eye care.1 The ramifications of poor vision are serious: Up to sixty percent of blind children die within one year, and blind adults have their lives cut short by one third compared to their sighted peers.1 Lost productivity—including the loss of workforce to care for visually impaired family members—reaches into the trillions annually.1
What Can We Do to Help?
Part of the problem with eradicating global visual impairment is that there are too few eye doctors and surgeons, especially in impoverished areas of the world where the need is greatest. A 2015 study showed that while the United States had 54.7 ophthalmologists per one million population, many poor countries had only one or two ophthalmologists per million.2
At the St. George Eye Center, our team of eye surgeons and specialists are committed to the highest level of care for all patients in every walk of life, both locally and globally. Our doctors take time frequently to serve in remote and under-served areas of the world. In addition to performing surgeries, they also provide education and support for physicians in order to increase their capacity and competency. Working closely with our outreach partners, we are able to provide charity care for members of our own community in Washington County. When you support the St. George Eye Center, you help provide care for global communities at home and abroad.
Of course, there is a lot more to seeing clearly than having good vision. I learned this while working as an intern at a veterans hospital in Arizona. I was tasked with caring for the meanest man in the world. My every effort was focused on helping him overcome a serious illness, and he hated me for it. He yelled at me daily, called me names, and even spat on me. I came to dread our interactions and secretly looked forward to the day I would move to a different rotation. During my final week at the veterans hospital, a new attending physician took the lead of our morning rounds. The first patient of the day was my mean patient. I presented a summary of his care plan, and we prepared to enter his room. The entire team braced for the onslaught. However, the new team leader stood at attention in his doorway, offered a polished military salute, and said, “Thank you, sir, for your service to our country!” I expected to hear incoming artillery fire from the patient, but for the first time in many weeks, his meanness softened slightly. I came to realize that I had not seen my patient for who he really was: a soldier, a defender of freedom, a man of valor. I was blinded by impatience and selfishness. This experience taught me to see more clearly the goodness and value of each individual.
In the spirit of curing global blindness and in celebration of this new year of 2020, we invite you to see more clearly. At the St. George Eye Center, we can help optimize your vision. However, it is up to you to see the world—and the people in it—for who they really are.
- World Health Organization: World Report on Vision. Accessed 12/2/2019 at: https://www.who.int/publications-detail/world-report-on -vision.
- Resnikoff S, Lansingh VC, Washburn L, et al Estimated number of ophthalmologists worldwide. British Journal of Ophthalmology Published Online First: 02 July 2019. doi: 10.1136/bjophthalmol-2019-314336
By JR Martin
According to a recent Gallup poll, medical costs are still among the top worries that we experience as Americans. It seems we fear the costs associated with accidents and disease as much as the problems themselves.
Healthcare costs are a hot topic. Democrats and Republicans alike seek to navigate us out of our healthcare crisis. As in any critically lost situation, we are left to wonder about how we got here and to worry about how we get out. Reflecting on my personal experiences and reviewing the data have helped me. I hope it helps you.
As a young man growing up in the ’80s (complete with a mullet and ’80s music blaring on the radio), I remember my father working long hours in the emergency room in American Fork, Utah. He loved it. The sense of community and service was profound. At that time, the hospital still seemed to be true to its 1937 beginnings. The original property cost was $2,500 and half of that amount was raised by the community. This was their hospital.
As the community grew, so did the hospital. The roaring ’50s brought a new location and updated facilities, which doubled the number of patient beds. During the decades between the hospital’s original construction and the 1950s, the ratio of administrators to physicians remained consistent. However, the ’60s and ’70s brought a change. Administration began to grow and outpace the physician population substantially. I still remember the day in the ’80s when my father said that the new hospital had the same number of patient rooms but had doubled or tripled the space for administration.
Beginning in the ’90s, the percentage of administrators compared to physicians skyrocketed. The cost of healthcare skyrocketed as well. The new century has seen a dramatic increase in non-clinical healthcare workers. Perhaps this also adds fuel to our skyrocketing costs. According to an analysis published in the Journal of the American Medical Association (Berwick, Joynt and Shrank, JAMA 2019:dpi/1001), researchers stated that “administrative complexity was responsible for $265.5 billion of waste.” It is interesting to note that the researchers were unable to find studies that focused on interventions targeting administrative complexity.
The lack of any studies focusing on how to decrease administrative costs reminds me of an interview I watched between a journalist and an expert medical economist. The medical economist had spent years in Washington analyzing medical economics. At the conclusion of the extensive interview, which covered a myriad of medical economic situations and scenarios, the researcher simply asked, “So why are medical costs too high?” The economist responded, “They are high because we charge so much.” There was a long, awkward pause, and the journalist nodded her head as if trying to wrap her mind around the obvious. The journalist continued, “(If) healthcare is so expensive because we charge so much, then how many discussions are there in Washington about cutting costs?” The researcher responded, “None, because no one is interested in making less money.”
Now what? I have noticed that mullets are coming back! ’80s music is still playing loud and clear on some local channels. I believe we still have an amazing community of amazing individuals who want to take healthcare back into their own hands and are willing to pay for it. What do you think?
I welcome your suggestions on Alive & Well’s Facebook page. Together, I think we can find our way out! We can guide our community. Look for my live presentation containing the graphs you see in this article. I will be looking for your comments.
By Brigit Atkin
VISION: Clarity, imagination, wisdom; the ability to think and plan for the future.
The ancient Roman calendar featured mythical King Janus. With two faces, Janus could look back on past events as well as look forward to the future. For this reason, Janus became the ancient symbol for resolutions and forgiveness as Romans began each new year. This ancient tradition of reflection with its resulting forward vision can be helpful in creating a happy and successful new year.
In the spirit of “looking back to look forward,” let’s reflect on the past year. What was hard, and what did you learn? What did you do really well? What did you learn about yourself? What challenges do you feel you have overcome? Which ones are you still working on, and what can you do better to master them? These are several questions to ask yourself as you look back on this past year. Having these questions answered will help you take measure of your life and will bring clarity to what’s next on this journey of life. It will bring you perspective that will assist you in moving forward.
Perspective is the way you see something. Perspective has a Latin root meaning “to look through” or “to perceive.” All the definitions of this word have something to do with looking. How we see things has a great impact on our actions and what we bring about in the future.
If you had difficulties in this past year, maybe a change in perspective will help you see life’s challenges in a new light. With a camera, switching the lens can bring in more light or magnification; on a hike, moving to a higher or different vantage point can bring in a whole new view. Seeking personal inspiration and the counsel of others can allow you to stop reacting in the same old ways and help you create new patterns going forward.
The following is an interesting Buddhist tale to inspire:
One day, a very wealthy man took his son on a trip to the country to live for a few days on a farm with a very poor family. His goal was to teach his son a lesson about what it means to be poor.
Upon their return, the father asked his son, “So, what did you learn about what it means to be poor?”
The son answered, “I learned that we have one dog. They have four. We have a pool that reaches to the middle of our garden. They have a creek with no end. We have imported lanterns. They have an abundance of stars at night. We have a small piece of land to live on. They have fields that go beyond sight. We buy our food. They grow theirs. We have walls around our property. They have friends to protect them.”
The boy’s father was speechless.
“Yes, dad,” said the son. “You showed me how poor we truly are.”
The lesson to be learned: With an open mind (new eyes), you can create a new reality.
I invite you to sharpen your vision by reflecting on this past year and then adjusting your lens of perception as you go forward into the new year. I have no doubt you’ll hear a lot of “2020 vision” themes for a while, and that’s okay. Just keep your sights on what’s important for your best year as you move forward. I hope that you will be wiser, more creative, more successful, and more aware than you were the year before. May you “look back then face forward” with clarity, imagination, and a new ability to plan your future.
By Dr. Gregory J. Hicken
If you have severe osteoarthritis in your knee, no doubt you are considering full or partial knee replacement surgery (also known as an arthroplasty) in which your joint is restored by resurfacing the bones and installing an artificial knee implant.
Knee Replacement, Then and Now
Technology for knee replacement surgery has improved immensely. In the 1980s, knee replacements were delayed for as long as possible, leaving the patient to suffer stiffness, pain, and mobility limitations. The cement and implant would wear out after a few short years, and replacements were even more challenging to perform than the original procedures.
What was previously only permitted in a full-service hospital as an inpatient procedure is now being done safely in an outpatient setting away from a hospital. In fact, Medicare will begin authorizing knee replacement procedures in freestanding outpatient surgery centers such as St George Surgical Center as of January 1, 2020.
Robotic Surgical Systems for Knee Replacement
Because patients wanted to return to normal everyday activities and have a more active lifestyle after knee replacement, manufacturers designed and developed advanced implants as well as surgical instruments to improve precision and surgical performance. We now have robotic surgical systems available that improve precision and help surgeons to be consistent regardless of whether they are performing their fifth surgery or their hundredth surgery . Additionally, there are a wide array of prosthetics from which to choose, whether your knee damage involves the entire knee (total) or only one side of the knee (partial).
Southern Utah Knee Replacement Choices
Here in southern Utah, there are two robotic systems in use to help surgeons perform total knee replacements, but only the NAVIO◊ Surgical System is capable of total and partial knee replacements. And only NAVIO◊ from Smith and Nephew offers a prosthetic (the Verilast) that lasts 30 years, a claim that the Food and Drug Administration (FDA) allows.This means that if you need a new knee earlier in life in order to remain active or to return to the lifestyle activities you enjoy, you don’t have to wait years to replace your knee, as was the case in the 1980s.
Questions To Ask
Here are four questions to ask your surgeon before you decide on knee replacement surgery:
- Do you plan to replace the entire knee or just part of the knee?
With the NAVIO◊, we have choices of knee replacement prosthetics to offer our patients. Some robotic systems offer only total knee replacement, so even if only part of your knee needs replacement, the other robot can’t offer that option.
2. Will I need a CT scan before my knee replacement surgery?
A knee replacement done without robotic assistance may require a CT scan. The surgeon uses this to create their surgical plan and determine the rotational alignment of the prosthetic components. The CT scan is equivalent to forty-eight chest x-rays! With the NAVIO◊ surgical system, no CT is required.
3. If you replace my knee without the robot, will my implant loosen to the point it requires a revision or subsequent replacement?
The NAVIO◊ robotic surgical system affords the surgeon the opportunity to be more precise, which in turn usually results in a better fit for a longer period of time. When the knee implant is not properly aligned, the patient often experiences pain and mobility limitation. The first symptom of a failing prosthesis is pain; the Australian Prosthetic Register revealed that aseptic loosening accounts for 35 percent of the pain and infection accounts for 17 percent of the pain (1).
4. Can you spare my anterior cruciate ligament (ACL) with the surgical plan for my knee replacement?
In southern Utah and northern Clark County, only the NAVIO◊ surgical system offers the option to spare the ACL. If your surgeon isn’t using the NAVIO◊ and your ACL is in good shape, it may be sacrificed unnecessarily
Gregory J Hicken, MD, is committed to providing high-quality orthopedic care. Your health and comfort and the personal attention you deserve are his priority. His goal is to make every visit to his office in Logan, Utah, or St. George, Utah, as comfortable and convenient as possible. Dr.. Hicken’s specialties include:
- Full and partial robotic-assisted knee replacement
- Total joint replacement
- Minimally invasive surgery
- Sports medicine
- Shoulder reconstruction
- Computer-assisted total knee replacement
- Computer-assisted total hip replacement
Dr. Hicken welcomes new patients to his office, located at 568 W Telegraph Street #4 in Washington, Utah. Please call (435) 627-0231 with any questions and plan to attend an upcoming lunch-and-learn session where Dr. Hicken will answer your questions about robotic-assisted full and partial knee replacement surgeries. You may inquire about dates and reserve your seat by phone.
Robertsson O, Dunbar M, Pehrsson T, Knutson K, Lidgren L. Patient satisfaction after knee arthroplasty: a report on 27,372 knees operated on between 1981 and 1995 in Sweden. Acta Orthopaedica Scandinavica. 2000; 71(3):262–267.[PubMed] [Google Scholar]Read More
By SGHW Magazine Staff
Just as a small, seemingly insignificant stone has the potential to create ripples across a vast body of water, one small act of kindness can have a ripple effect, impacting others in positive ways and leaving the world a better place. The most successful human endeavors often begin as small gestures of genuine kindness and evolve into global operations of love that change lives, touch hearts, and save souls.
Colleen and Kelly Kendall are two small stones who are creating waves of positive change that are affecting thousands of lives.
It began when their simple act of kindness touched the life of one twenty-year-old homeless man. As the couple walked among those sleeping under tarps and trees in Pioneer Park in St. George, Utah, they happened upon a young man—Nate— who would change not only their lives but the lives of many others. As Colleen knelt down next to Nate, she touched his arm and asked softly, “Where is your mother?” He began to cry and told her that his mother was no longer in his life and that his father was in prison. Through tears, he shared his story. He had once had a good job, an apartment, a truck, a girlfriend, and a baby girl whom he adored, but because of getting involved with drugs, he had lost everything. “Even though I’m here in the park homeless, I am a good person,” he said.
They asked him to help them know what the real needs were in the homeless community and shelters by asking around and getting back to them. A few days later, Nate sent a powerful one-word message: “Socks.” Then two other messages arrived: “Socks are Gold” and “We would rather have socks than food.” The Kendalls felt impressed to begin collecting socks immediately to distribute to those in need. That simple message, “Socks,” evolved into a nonprofit organization: Socks for Souls.
“As you can imagine, the homeless don’t have many options for doing laundry, so a pair of socks is worn for as long as possible before they become too wet or soiled or are literally worn off their feet,” said Colleen. “Most of the homeless wear donated shoes that don’t fit quite right, cause sores, and create bacteria that grow, especially in the summer and on hot days. Most of us put on clean socks daily and can’t imagine what it would be like to wear a pair of socks for a week, let alone a month.
“We each can do our part to help the less fortunate,” she continued. “We certainly can’t change the world all at once, but we can do something that ripples around the world.” Edward Hale stated, “I am only one, but I am one. I cannot do everything, but I can do something. And I will not let what I cannot do interfere with what I can do.”
According to the Mayo Clinic, in cold enough conditions, frostbite can occur in thirty minutes or less. Locally, Socks for Souls is currently distributing socks at Switchpoint Community Resource Center, the DOVE Center, the Doctors’ Volunteer Clinic, and similar agencies from Logan to Las Vegas.
“Having the basic necessities brings personal dignity to those who are struggling and having challenges,” said Colleen. “Many times, we pass by homeless people and they become invisible. They are also judged as ‘beggars’ who simply should go get a job. If we only knew the real story behind their unkempt appearance, we would think twice…about judging them, and we would be inspired to donate socks for their feet.”
Sometimes it only takes someone caring enough to give a hand up to change a life forever. “We are not suggesting a ‘hand out’ but a ‘hand up’ with the basics of life we often take for granted,” said Kelly. “Giving service is one of the best ways to forget our own struggles and know that we are making a difference in the lives of those less fortunate.”
Those who have received socks are grateful for the “Sock Angels” who have donated socks for the many souls in the southern Utah community and even to the orphanages in Mexico. “Each person has within him or her the potential to create ripples of positive change,” explained the Kendalls. “At the end of the day, when those with less than us are having difficulties, sometimes they just need a little hope. And a pair of socks!”
By Connie Zdunich
I had a magical childhood. My “Papa” was a tall, strong man who stood as straight as a tree. He was not well educated, and he had a rather hard life. He was a logger by trade, and harvesting trees in his day was hard work. However, he found his trade rewarding.
I was the first grandchild, and for some unknown reason, Papa decided to call me Sister. He and grandma always lived on acreage in the country. I was a city girl, so spending time at their place was magical. Weekend visits were not easy. Papa would come into my room and wake me early in the morning for chores. I would put on my grandma’s muck boots with newspapers stuffed in the toes so they would stay on my feet, and we would head out the back door, past the huge garden, past long rows of yummy blueberries and raspberries, over the stream bridge, down the path, and into the barn. That is where I first learned to milk “Old Donna” at the ripe old age of five. There’s nothing in the world like fresh milk with cream sitting on top!
This strong man with huge hands taught me how to coax Old Dan, the logging horse, over to the fence with red apples freshly picked off a nearby tree so that I could climb on his broad back and ride him in the pasture, holding tightly to his mane. He also taught me the delight in hauling the garden hose over to the rows of carrots and radishes in the garden, washing the rich earth from their skins, and eating them with a little salt from an old shaker he always seemed to have handy in his shirt pocket. We slopped pigs, chopped firewood, and did all those magical things that are only magical if you do not have to do them daily!
The years came and went, but I never tired of spending time with Papa. Eventually, I grew up and married, and then, along came Papa’s first great-grandchild, whom he called Little Sister. (I did finally get a sister at the age of nine.)
This giant of a man finally grew old. At the ripe old age of ninety-seven, while he was out tilling his garden plot in my aunt’s backyard, he developed a pain in his shoulder. After a few days with no relief, we finally talked him into seeing a doctor. He was not a big fan of doctors. Papa had cancer, and it was not just affecting his shoulder; it had spread into his lungs and liver. Of course, this was the turning point in his life. He did not want to be hospitalized; hospitals were not his favorite either! So, the family decided to put Papa on hospice care. The thought of “strangers” coming to care for him was upsetting, and we were not sure how well things would progress.
Our first Angel arrived to do Papa’s evaluation. Papa was a bit “puffed up” and not at all sure if any of this “care stuff” was a good idea. The hospice worker came in with a smile that could light the world, and she had him totally wrapped around her finger by the time she headed out to her car. He asked when she would be back; he “kinda liked her.”
Then a different kind of magic came into our lives as we were blessed with a succession of Angels, all so willing to serve this giant, gentle man, and he was blessed to learn firsthand about the gift of compassion in all its glory.
We only had four more months with Papa before he took his final journey home to till gardens above. Hospice was our saving grace. Not only did the hospice team render amazing care to my grandfather but they also changed my life forever. The tender care provided by the hospice workers gave me a deep desire to pay forward this gift they gave to Papa.
Now the story has come full circle; the time in my life as come for repayment as I am blessed to be able to be a hospice volunteer. This has been one of the most rewarding times in my life. The sweet people I have had the privilege of serving have blessed my life beyond measure.
If your loved one needs hospice care, don’t wait. It will bless your life and that of your loved one. If you have some time on your hands, become a volunteer. They are always needed, and I promise that you will be blessed beyond measure.
What is sterile compounding?
Dear Seeking Understanding in Washington,
Compounding is the combination of two or more traditional medications which are not being tolerated well in the traditional oral manner. Sterile compounding involves creating a pharmaceutical medication in an environment free from viruses, bacteria, or any other potentially infectious microorganisms. This type of compounding is used for medications that will be administered either through an IV, injection, or directly into the eyes.
Answered by Stacy Lamb, Pharm Tech (Stapley/C3)
Is my constipation due to my new medication?
Dear Constipated in Ivins:
Often constipation is caused by nutritional habits or lack of hydration, but can sometimes be affected by medications which have been prescribed by your medical provider. First, take a look at your water intake. A great calculation to decide how much water you need on a daily basis is your weight/2 = A (example 200 lbs/2=100 oz). Work on drinking that much water each day. In addition, add a single piece of fruit or unprocessed fiber into your diet each day. You should see results within a day or two. Generally, if your new medication is known to cause constipation, your favorite pharmacist will let you know. You can always use a laxative and we recommend you speak to your physician or favorite pharmacist for product recommendations. If the constipation persists, seek medical attention.
Answered by Chris Christensen, Pharm D (Stapley Dino)
Why do I have to get a flu shot every year?
Dear Barfy in Mesquite,
Influenza is a virus and like any virus, it mutates to cause as much havoc in your body as possible. CDC recommends a yearly flu vaccine for just about everyone 6 months and older, even when the viruses the vaccine protects against have not changed from the previous season. The reason for this is that a person’s immune protection from vaccination declines over time, so an annual vaccination is needed to get the “optimal” or best protection against the flu. Important to remember is that vaccines don’t ‘prevent’ the virus from attacking humans, but they can dramatically reduce the symptoms if one catches the flu. It is also important to acknowledge that the vaccine does not cause the flu. “Flu vaccines given with a needle (i.e., flu shots) are currently made in two ways: the vaccine is made either with a) flu viruses that have been ‘inactivated’ (killed) and that therefore are not infectious, or b) using only a single gene from a flu virus (as opposed to the full virus) in order to produce an immune response without causing infection.” (CDC 12/04/19). We recommend getting your flu shot in early October each year; Please put it on your calendar.
Answered by Kelli Charlton, Director of Education
If you have a question for the Stapley team, please email the question to DearStapley@gmail.comRead More
By Amey Vance
Rising healthcare costs continue to make headlines across the nation. Yet, in southwest Utah at Intermountain Dixie Regional Medical Center, strategies to keep healthcare affordable—while still delivering the best possible outcomes for patients—are helping keep costs lower.
“We are very fortunate to have Dixie Regional Medical Center in our community,” said Brian Chadaz, Dixie Regional board chair. “Dixie’s inpatient care costs compare well nationally; they are at or lower than the national average in nearly all categories and significantly lower than nearby southern Nevada. Dixie Regional’s inpatient care costs also compare well with other Utah hospitals.”
Dixie Regional’s charges are actually lower than similarly sized non-Intermountain Healthcare hospitals in all procedure categories measured by the Centers for Medicare and Medicaid Hospital Compare website. Evaluated categories include heart attack, hip and knee replacements, heart failure, and pneumonia. Consumers can go to https://www.medicare.gov/hospitalcompare to compare hospitals on a variety of measures, including cost.
“Intermountain is known to be a significant factor in Utah having the lowest per-capita healthcare costs in the United States,” said Intermountain Board Chair Gail Miller. “The team at Dixie Regional has done a tremendous job with affordability, access to care for patients, and service to the community.”
“Our goal is to keep people healthy by helping them avoid medical problems that can impair quality of life and drive costs up,” said Intermountain CEO Dr. Marc Harrison. “We use best practices and evidence-based medicine to consistently deliver the best possible clinical outcomes without variation that can increase cost. Our caregivers in southern Utah are doing a great job in helping meet this goal.”
Some of the specific ways Intermountain is addressing cost of care include:
Increasing Affordability of Generic Drugs. In an effort to keep hospital medications available and affordable, the not-for-profit generic drug manufacturer and distributor, Civica Rx, was launched in 2018 by Intermountain and other national health systems and philanthropies. Civica Rx provides low-cost, frequently used generic drugs to participating hospitals, including Dixie Regional.
Making Procedures Shoppable. “Knowing beforehand how much a medical service or procedure will cost results in a reduction of costs,” said Mitchell Cloward, administrator of Dixie Regional. “This year, Intermountain will begin using a new pricing program for many inpatient and outpatient services that people commonly use and seek price quotes for, such as delivering babies, imaging procedures, and colonoscopies.” Today, SelectHealth members can use an innovative and informative online cost-estimator tool.
Focusing on Preventative Care. Reimagined Primary Care is an Intermountain team-based care model that focuses on preventative care to keep patients well. The model already has about 31,000 patients enrolled and has seen impressive results, such as a 60 percent decrease in hospital admissions and a 35 percent decrease in emergency department admissions, while at the same time improving health outcomes for individuals.
Addressing Social Determinants of Health. Social determinants of health are factors in the places where people live, learn, work, and play that impact well-being and quality of life. They include food, transportation, housing, utilities, interpersonal violence, social support, and access to health services. Intermountain has initiated a three-year project in Washington County and Ogden to connect people with complex medical, behavioral, and social needs to local partners and outreach programs.
Providing Access to Care in Lower-Cost Settings. “We are providing ways to reduce unnecessary, higher-cost emergency room visits,” Cloward said, “by increasing access to appropriate care in lower-cost settings such as InstaCares (urgent care clinics), physician offices, and Connect Care.” Connect Care is a 24/7 online service for $49 (or less depending on insurance) that allows patients to receive low-level but urgent care from Intermountain caregivers via smartphones, tablets, and computers.
Negotiating Supply Discounts. “When Intermountain reduces its costs for supplies and drugs, it can in turn directly lower charges to patients for those items,” Chadaz said. “Intermountain successfully negotiated better prices on supplies last year that resulted in more than $32 million in cost savings.”
Uniting with Strong Community Leadership. “Intermountain is widely recognized as a leader in transforming healthcare by using evidence-based best practices to consistently deliver high-quality outcomes and sustainable costs,” Chadaz said. “Because Intermountain is not-for-profit, revenue is further invested at Dixie Regional in extraordinary services like Intermountain Precision Genomics, intraoperative magnetic resonance imaging, and transcatheter aortic valve replacement. In addition, hundreds of hospital volunteers give their time, and the philanthropic support the hospital receives from our community through our foundation is incredible. Together, we are helping offer high-quality healthcare at the most affordable price.”
By Jessica Elgin
The buying process can be very stressful. It may seem like finding the perfect home is the hard part, but really, that’s just the beginning. Once you’ve made your offer, you may feel a little lost. You may feel unsettled about whether your loan will close or wonder when you should start packing. With so much uncertainty, it’s not hard to see why most people are asking, “What’s next?”
There is a lot to get done in the period between your offer being accepted and closing on your new home, but the process doesn’t have to be overwhelming. Understanding the steps that need to be taken will help ease that stress. And having a good realtor at your side can make all the difference in the world.
After an offer is accepted, there are a few things that need to happen immediately.
- The earnest money deposit check needs to be secured. This money goes to the title company and will be put toward your closing costs. If you decide to back out of the contract, you will lose the earnest money. However, there are ways to protect your earnest money. I call these “safe islands.”
- A copy of the contract should be sent to both the lender and the title company. This will be done through the real estate office. The lender will then send an updated pre-approval letter, which can be sent to the seller’s agent.
- The home inspection needs to be scheduled. It is important to do this as early as possible. If something is wrong with this house, you want to know early in the process. At this time, I also find it useful to have a moisture test done. This test can detect signs of mold. A termite inspection should also be done. We are looking for any reason we may not want to keep the house.
During the next few weeks, you will have several opportunities to confirm that this is the right house for you while still protecting your earnest money. You can do this through three safe islands that are stated in your purchase contract.
The first safe island is the seller’s due diligence period. During this period of time, the seller will provide disclosures that describe everything they know about the house. If any of these are unsatisfactory to you, you can pull out of the contract without losing your earnest money.
The second safe island is the buyer’s due diligence period. This time typically runs a week or two past the seller’s due diligence period. During this time, you want to get all of your inspections done. Make sure that you are completely satisfied with the physical condition of the home. Any repairs that you would like to have done by the seller should be requested with an addendum to the contract. If you are unsatisfied with the resolution from the sellers, you may pull out of the contract without losing your earnest money deposit as long as it is before the end of your due diligence period.
Your third and final safe island is the financing and appraisal deadline. If you decide that you are unhappy with the loan for which you qualify, even if it is the same loan that you agreed to in the beginning, you may pull out of the contract without losing your earnest money deposit.
It’s important to note that if you pull out of the contract, it needs to be done in writing. As buyers, it is also important for you to be responsive. There will be requests for clarifying information from your lender and the seller. Being unresponsive or failing to follow through can result in the loss of your earnest money or even the loss of the house. An experienced realtor will help you navigate this period of the process, let you know what to expect, and get you across the threshold of your new home.