Small Local Program, Big Results: Who Cares If D.C. Is Tied Up in Knots?

While the national mainstream media focuses on Obamacare's dimming prospects, internecine Republican conflicts over the merits of a government shutdown, pugnacious Democratic debates over government price controls and who should take credit for the drop in health care cost inflation, check out this local city paper article on the One Simple Idea (that) Could Revolutionize Health Care. As the reporter pointed out, there was no press release, no touting and no awards.  Simply results.

The DMCB agrees.

Barbara Schneider and her team work with Philadelphia health insurer Keystone First's community outreach and care coordination programs to intervene on the "sickest of the sickest" diabetics.  These are 35 patients who are admitted on average more than twice a month.  Patients who are on a first-name basis with all the local emergency rooms nurses on all the shifts. Patients who live in run-down boarding houses on a good day.  Patients who are lucky if their blood sugar is only 600 mg%.  We're talking hundreds of thousands of dollars in health care costs.

Dr. Schneider's lay community health workers (more info on the science here) are seeing these individuals in parking lots, McDonald's, row homes and halfway houses  to cajole, coach, text, call, shuttle and haggle with patients, families, social workers, pharmacists and insurers to dismantle barriers one patient at a time.  If a patient isn't ready to stop abusing drugs, that doesn't mean he can't be taught to use a glucose meter.  While living circumstances may be chaotic, that doesn't mean she can't use a cell phone instead of just going to the emergency room.

As Dr. Gawande noted in his The New Yorker article about the super-utilizers, those kinds of interventions can add-up significant savings.

While Keystone has yet to release an analysis on the impact on claims expense for these patients, a cursory review of the data shows emergency room visits have been cut by a third, while inpatient stays declined by more than half.  Even with the DMCB's limited background in analytics, it suspects that when the return on investment is finalized, Keystone will conclude that the program was an unqualified success.

To the DMCB, this is what it's all about.  Washington DC can continue its partisan scorched earth battles while, in the meantime, small regional community minded health insurers like Keystone First are figuring out how to do right by patients using novel programs like this. 

Image from Wikipedia

Care Management Service Providers and the Potential of Accountable Prescribing

In previous posts, the Disease Management Care Blog has repeatedly questioned the wisdom of a one-size-fits-all, top-down, blunt force and Ver 1.0 approach to measuring health care quality.  That's why it's glad to see that the New England Journal of Medicine agrees with the DMCB in this Perspective by Nancy Morden and colleagues on the topic of Accountable Prescribing.

The authors point out that while blood pressure should be less than 140/90, LDL cholesterol less than 100 in persons with a history of heart attack and A1c should be less than 7% in persons with diabetes, it's clear that the cure can be more costly than the disease.

For many individuals with mild elevations in blood pressure, diet and exercise can be enough and, if that doesn't work, cheap water pills often work great.  Among persons with elevated cholesterol levels, inexpensive statin prescriptions can save lives. Metformin for diabetes has been around for decades and it a first line agent no matter what the A1c is.

As a result, they call for measuring and rewarding quality based on accountable prescribing that not only measures the numbers (blood pressure, blood cholesterol or diabetes control), but the percent of individuals receiving conservative or first line treatments.  While this approach would require an even more detailed databases/registries, it's within reach of most commercial insurers and advanced electronic record systems.  We owe it to our patients to provide a tailored, bottom-up, nuanced and Ver. 2. approach to measuring health care quality.

It's also a concept that the population health and care management service providers could, with the right kind of clinical partners, lead.  This calls for a pilot program and, in the DMCB's humble opinion, the sooner, the better.

For a better idea of how this might work, check out this table.

Image from Wikipedia

Building Unity Farm - Scenes of Summer

Unity Farm is at the peak of Summer.  Everything is in bloom, the forest is bursting with wildlife, and all our outdoor activities are in full swing as we finish creation of our growing areas before we retreat inside for 6 months of winter.   Here are a few photos with the scenes of Summer at Unity Farm.

1.  Afternoon thunderstorms pop up during the hot and humid weather.    They skies are filled with billowing clouds that dwarf the barn and paddocks.

2.  The animals cling to their barn fans, run through the sprinklers and enjoy an afternoon snack of chilled romaine lettuce to keep cool

3.   In the stream, Muskrat Susie and Muskrat Sam whirl and twirl among the reeds.  (I know the song is awful)

4.  Mom and Dad proudly walk our country lane with their new fawn

5.  Guinea fowl build nests of 20-30 eggs in the deepest part of our fern forests

6.  The Great Pyrenees enjoy playing in the shade with their new ball toy

7.  The bees are storing honey for the winter.   Here's a closeup of the queen from one of our 8 hives

8.  The orchard grass has gone to seed and needs mowing .   I maintain the orchard with a push mower and a trimmer for more delicate edge work.   Here's a view of the mowing in progress and the finished result.

9.  Ground hogs (also know as Woodchucks) nibble at the grass in the meadow.

10. Garter snakes sun themselves on the rocks in the garden

Physician Skepticism About the Basic Doctrines of Health Care Reform: We're In This Together and, by the way, More Believe In Care Management Than the EHR

Taking a survey...

Read these headlines assembled by Kaiser Health News and it's easy to get the impression that America's physicians believe everyone else is to blame for health care costs.  A cursory read of the underlying original research suggests otherwise.  Regardless of the interpretation, the results should give pause to anyone who thinks health care reform is a slam dunk.

The Disease Management Care Blog explains.

3900 practicing physicians were randomly selected from the AMA Physician Masterfile. Three physicians were outside the U.S., leaving 3897 docs who were mailed an 8-page survey. $20 was used to increase the response rate. Non-respondents were mailed a second and then a third follow-up. The ultimate response rate was 65% and, aside from a one year age difference, the respondents were quite similar to the original 3897. The survey that was used can be found here.

The results are nicely summarized in Table 3 (go to this link, click the "Tables" tab).

99%, 97%, 94% and 86% of the respondents felt hospitals/health systems, health insurers, pharma and trial lawyers had "potential" major or some responsibility, respectively, to lower health care costs.  95% and 98% also felt the same was true for physicians and patients, respectively.

The DMCB take: None of the answers were mutually exclusive. The physician-respondents thought everyone was responsible.  That being said, if you look at Table 3, you'll see a spread of "major" vs. "some" responsibility.  Physicians were less likely to assign "major" responsibility to themselves (prompting the headlines above) but that's because docs believe their job is to advocate for their patients regardless of cost.

Similarly high percentages of respondents generally felt that continuity of care (98%), chronic disease care coordination (98%) and reducing fraud (93%) were important means of reducing costs. What was interesting that fewer felt the same about the electronic health records (74%), penalizing docs for readmissions (41%) or bundling payments (35%). They were also less sanguine about increasing patient "skin in the game" with higher co-pays (61%) or high deductibles (58%).

The DMCB take: More physicians believed in the cost-reducing potential of disease management/care coordination than the EHR.  While part of the respondents' skepticism about the economic incentives that underlie much of health care reform is arguably motivated by self-interest, the DMCB suspects physicians also genuinely believe patient needs trump economic penalties. Regardless of the underlying thinking, the results should give pause to policymakers and politicians who believe that readmission penalties and bundled payments are a no-brainer and that docs have bought-in.

The DMCB will close with the following scenario:

Pretend you are a Vice President for Medical Affairs, or a Chief of Staff, or a health system CEO about to announce a major collaboration with a major health insurer like CMS or a Blues Plan. You've done your homework, read the journals, listened to the experts and anticipated the future. You haven't been a regular reader of the DMCB.

You've called a meeting of the physician staff - the professionals you are counting on, caring for all those patients - and your job is go to the front of the auditorium and convince them that the success of your new venture relies on lowering health care costs with new payment arrangements that align incentives, in tandem with the launch of an electronic health record.

If the survey outlined above is even partially true, would you want to be that VP, Chief or CEO?

Leveraging Celebrities to Market Obamacare

According to this The Hill article, President Obama took a break from tackling red lines, gun control, immigration reform, Trayvon Martin, the economy to make an appearance at a July 22 Obamacare promotion-planning meeting that included a host of A-list celebrities.  They'll be needed to convince the young invincibles to pony up hundreds of dollars for health insurance that they don't want.

Despite the DMCB spouse's unflattering assessment of her husband's media chops, the Disease Management Care Blog thinks it should have been in that White House room. 

It has a lot to contribute.

For example, American Idol finalist Jennifer Hudson was there.  How about a new CMS-sponsored talent show, says the DMCB, that is hosted by Ms. Hudson, called American Muddle? Enter the early crooning favorite, Hope Igeddadok, singing a reprise of that Dire Straits hit, "Money for Nothing."

And what about Improv comedy artist Amy Poehler? After a great stint at SLN, she went on to star in the hit comedy show, Parks and Recreation.  The DMCB suggests a pro-Obamacare commercial that features Deadlock and MakeItUpAsWeGoAlongination.

And fresh from being tossed under the campaign bus by Valerie and Michelle, Oprah Winfry is back in play. Given Oprah's masterful interview of disgraced bicyclist Lance Armstrong, positively spinning Obamacare and the IRS should be a piece of cake. First up, the IRS Chief Counsel!

Alicia Keys was there and can she sing! She can be this "Girl Is On Hire" for Obamacare in an MTV video-advert.

And it was no accident that Bon Jovi's people were there, what with a song list that includes "Livin' on a Payor," "Panel Says Dead or Alive," "It's My Right," "You Give Hope a Bad Name," "Runaway Costs," "Bad Medicine" and "Shot Through the Heart and We'll Still Pay."

Last but not least, folks must have been excited about Will Ferrell. Since his Bush impersonation has run its course, Ron Burgundy may be the best choice for some faux-news insights.  He can provide periodic updates on how the health insurance exchanges are going: "They've done studies you know," "Sixty percent of the time it works every time," "In a glass case of emotion," and "Stay classy, Obamacare."

If anyone in the White House is reading this, just drop an email.  The DMCB is ready to roll up its sleeves and help.

Inconvenient Facts Get In the Way: Blue Cross Blue Shield of Michigan's Patient Centered Medical Home (PCMH) Program Savings Claims Are Not Based on Statistical Significance

Welcome to your medical home!

The Patient Centered Primary Care Collaborative announced:

"Blue Cross Blue Shield of Michigan saved an estimated $155 million in preventative claim costs over the first three years of its Patient Centered Medical Home program, based on calculations made from an analysis published this month in the Health Services Research Journal".

According to the Blue Cross Blue Shield of Michigan web site:

"'Blue Cross’ Patient-Centered Medical Home is transforming health care delivery, saving millions of dollars and improving lives,' said Daniel J. Loepp, president and CEO of Blue Cross Blue Shield of Michigan."

HIT Consultant's insightful coverage of healthcare innovation said:

"According to the analysis, 'Partial and Incremental PCMH Practice Transformation: Implications for Quality and Costs,' researchers found that its Patient Centered Medical Home model, when fully implemented, resulted in:

• 3.5 percent higher quality measure
• 5.1 percent higher preventive care measure
• $26.37 lower per member per month medical cost for adults"

"Whoa!" said the Disease Management Care Blog. Since $155 million from $300 per member per year reductions in claims expense is some very serious savings that, until now, has never been reported for the PCMH, it naturally looked at the original research.

What did the sleuthful  DMCB find?

Contrary to flattering press releases quoted above, the Blue Cross Blue Shield of Michigan did NOT conclusively save any money. The observed savings of $26.37 PMPM failed to achieve statistical significance and could have been the result of normal random variation that naturally occurs in the flow of claims payments.

The DMCB explains.

Physicians participating in the Blue Cross Blue Shield of Michigan Physician Group Incentive Program (PGIP) were in two payment tiers: 1) "partial reimbursement" for self-reported PCMH implementation and 2) 10% "fee enhancements" for self-reported "significant" PCMH implementation. As the DMCB understands it, 65% of all the PCPs in Michigan participated in the self-reporting in both June 2009 and June 2010. These docs cared for approximately 1.5 million Blue Cross Blue Shield patients.

During the course of self reporting, docs had to attest to the presence of PCMH capabilities, including use of a registry, obtaining performance measures, care management capabilities, patient self-management support, 24-7 patient access, test tracking and follow-up, e-prescribing, a web portal, specialty referral guidelines, preventive services and linkages to community services. Various domains within each of the capabilities were assigned a weight that was rolled into an overall score: the higher the score, the "more" the PCMH.

The researchers examined the claims history for the patients cared for at a total of 1,787 practices that were in the PGIP, had a minimum number of BCBS enrollees, had no missing data and were not quality outliers. Their median enrollment was 303 members and a mean per member per month (PMPM) claims expense of $311.

Compared to practices that never achieved any PCMH capabilities, the PMPM for practices that attained "full" (i.e. significant) PCMH implementation was, compared to practices that never achieved any PCMH implementation, $26.37 lower for adults.

The p value for the $26.37 quoted on page 15 of the manuscript equaled 0.0529.

Because the p value is greater than .05, it doesn't reject the null hypothesis and fails to meet the conventionally accepted threshold among health services researchers that the difference is real and not the result of randomness.

For children, the PCMH was associated with a $7.45 increase in costs. That likewise failed to achieve statistical significance (p = .096).

No where in the manuscript do the authors claim there were "155 million" in savings.  The DMCB suspects the authors of the press releases extrapolated the statistically non-significant figure of $26.37 to a population count.  Garbage in, garbage out.

The DMCB take:

1. Its highly likely that BCBS of Michigan has additional actuarial figures that support the cost effectiveness of the PCMH.  BCBS of Michigan also put its numbers into the public domain.  It's also likely that that PGIP and the PCMH represents an important opportunity to build and collaborate with a vibrant primary care network, which ultimately transcends any monetary savings. Kudos at many levels to BCBS of Michigan, says the DMCB, despite an over-generous misinterpretation of published health services research.

2. While the DMCB did not report on the quality measures that were concurrently reported in this HSR study, it also appears statistically significant quality of care gains were made.  That means there were increases in quality with no increase in cost.  That's good news and, thinks the DMCB, a more honest appraisal of the outcomes.

3. Unfortunately, BCBS of Michigan did not report the "net savings."  As noted above, providers were paid to implement the PCMH, which represents an additional and "hidden" PCMH cost.  Assuming the $155 million in reduced claims expense is real, it would have to be contrasted with the millions in additional fees that were paid to the doctors.

NAKHUDA (1981) / OST VINYL RIP

NAKHUDA  (1981) / OST VINYL RIP

ON REQUEST  

Music By :  KHAIYYAAM

Lyricist : Nida Fazli

Music On : EMI 



VINYL RIPPED @ 256 Kbps


 



P.S :SUGGESTIONS,REQUEST & COMMENTS ARE ALWAYS WELCOME.YOUR VALUABLE COMMENTS WILL ENCOURAGE ME TO UPLOAD MY MAXIMUM PERSONAL VINYL RIPS.JUST COMMENT ABOUT THE RIP QUALITY. SOME VINYL COVERS & FILM INFORMATION'S ARE COLLECTED FROM WEB.


SONGS:  


1. Sahara Hai Nakhuda 
  Singer/s : Mahendra Kapoor  
  

2. Aaja Aaja Yaar Habibi

 Singer/s :Mahendra Kapoor,Pamela Chopra,Jagat Kayr,SK Mahaan                  

   

3. Tumhari Palkon Ki Chilman   
Singer/s : Lata Mangeshkar,Nitin Mukesh                   

  

4. Tumhein Maroongi Phoolan                 

Singer/s :  Asha Bhosle,Mahendra Kapoor                 
 

5. Haq Ali                 

Singer/s : Nushrat Ali,Mujahad Ali                 

SUPER HIT SONG

6.  Hamein Tumse Mohabbat Hai               
Singer/s :  Lata Mangeshkar,Nitin Mukesh                   




TOTAL 6 TRACKS

CLICK HERE TO DOWNLOAD SONGS

 DISCLAIMER: This blog promotes the appreciation of vinyl records in an encoded audio format called MP3 and hereby disclaims any violations of copyright law. The author of this blog does not engage in buying and/or selling songs in MP3 or any other format on this blog. Visitors of this blog are encouraged first and foremost to buy original records (to maintain the posterity of the vinyl record) and secondly, audio CDs. The music that is available here is meant for promotional and appreciation purposes only.

...Deepak..

The Latest Health Wonk Review Is Up!

Ah, summer and its long hazy days of liquid sunshine.  The Disease Management Care Blog doesn't like it either, but may change its mind after reading Louise Norris' "Midsummer Wonk's Dream" edition of the Health Wonk Review at the Colorado Health Insurance Insider.  Louise's summer-ies of the latest wonkery is well worth a read.

Enjoy! 

Data Scientists Must Also Be Research Methodology Scientists

I had the chance last week to attend a conference in Singapore, Big Data and Analytics in Health Care. It was an interesting blend of academics, operational health information technology professionals, and data scientists from companies in the emerging analytics market. I was also in Singapore for the end in-person session of the 10x10 ("ten by ten") introductory informatics course we offer there.

The talks were all interesting, but I was struck by the difference in the content and tone of the academic and clinical operations speakers compared to those from analytics companies and who called themselves "data scientists." Whereas the academic and clinical operational types were cautious in their methods and results, the data scientists implied their techniques would revolutionize healthcare and threw around terms like "big data" and "analytics" at every turn. One of the latter types showed a "model" of the pathways leading to good (conservative) and bad (surgery) outcomes in back pain, with the intermediate nodes representing actions along the path, such as medication use, physical therapy, and chiropractic care. It was not clear to me how this model could be used to improve care, and I am not sure the speaker really understood that correlations do not prove causality. A second such speaker showed some interesting correlations between words and phrases that occur in clinical narratives of patients with diabetes and aspects of their care. I understand machine learning and how it might be used to "learn" things about patients with diabetes, but I did not see any evidence that this work would lead to any kind of improved patient outcomes.

Another concern I have about proponents of clinical data analytics is their presumption that their algorithms can somehow take all of the growing amount of operational electronic health record (EHR) data and automatically turn it into medical knowledge, as if they could turn a crank with data going in and knowledge emerging. I do have great enthusiasm for some of what can be done with this data, but I also have concerns about the quality and completeness of this data as well as the causality issues that arise without controlling observations in experimental ways.

I had the opportunity to speak at the conference as well, and gave a talk pulling together my cautious enthusiasm for using operational clinical data for research and other analytical purposes. This was the first public talk I have given on this topic since publication of a paper with ten other colleagues on caveats for the use of operational electronic health record data in comparative effectiveness research in the journal Medical Care [1]. The paper was commissioned by AcademyHealth and is part of a special supplement of the journal devoted to electronic data methods.

Our paper notes that while there are many opportunities for using clinical data for research and analytics, we also must remember the limitations of such data. In particular, EHR and other clinical data may be:

• Inaccurate - data entry is not always a top priority for clinicians, and they may take shortcuts, such as copy-and-paste
• Incomplete - patients do not get all of their care in one setting
• Transformed in ways that undermine meaning - coding for billing is the best known example of this
• Unrecoverable for research - data may be in clinical narratives or other less accessible places
• Of unknown provenance - we need to know where data comes from and how likely it is to be accurate
• Of inappropriate granularity - data too coarse for research purposes
• Incompatible with research protocols - patients are not always diagnosed and treated consistently with best practices

Despite these caveats, I am optimistic that there will be uses for this data, especially if we can generate it in a standards-based way and otherwise improve its quality. Hopefully clinicians, researchers, patients, public health authorities, quality improvement leaders, and other who might benefit from the data will have incentive to improve it by more meticulous entry as well as use of standards-based, such as those proscribed by Stage 2 of the meaningful use program [2]. For many clinicians especially these days, the EHR can be a data sink hole into which they enter data, spending a great deal of time but getting little in return.

The bottom line is that while data scientists may be able to generate interesting and important results with their methods, they must also understand basic principles of research science, such as inferential statistics, clinical significance, and cause and effect. In addition, they must demonstrate their methods lead to improvements in health and/or healthcare, and are not just generating interesting associations. In other words, they must show evidence that their methods add value, just as medical care and informatics are required to do.

References

1. Hersh, WR, Weiner, MG, et al. (2013). Caveats for the use of operational electronic health record data in comparative effectiveness research. Medical Care. 51(Suppl 3): S30-S37, http://journals.lww.com/lww-medicalcare/Fulltext/2013/08001/Caveats_for_the_Use_of_Operational_Electronic.7.aspx.
2. Metzger, J and Rhoads, J (2012). Summary of Key Provisions in Final Rule for Stage 2 HITECH Meaningful Use. Falls Church, VA, Computer Sciences Corp. http://assets1.csc.com/health_services/downloads/CSC_Key_Provisions_of_Final_Rule_for_Stage_2.pdf.

The Healthcare IT Applications of Google Glass

Last week I had the opportunity to test Google Glass

It's basically an Android smartphone (without the cellular transmitter) capable of running Android apps, built into a pair of glasses.  The small prism "screen" displays video at half HD resolution.  The sound features use bone conduction, so only the wearer can hear audio output.   It has a motion sensitive accelerometer for gestural commands.    It has a microphone to support voice commands.   The right temple is a touch pad.  It has WiFi and Bluetooth.   Battery power lasts about a day per charge.
Of course, there have been parodies of the user experience but I believe that clinicians can successfully use Google Glass to improve quality, safety, and efficiency in a manner that is less bothersome to the patients than a clinician staring at a keyboard.
Here are few examples
1.  Meaningful Use Stage 2 for Hospitals - Electronic Medication Admission Records must include the use of "assistive technology" to ensure the right dose of the right medication is given via the right route to the right patient at the right time.   Today, many hospitals unit dose bar code every medication - a painful process.   Imagine instead that a nurse puts on a pair of glasses, walks in the room and wi-fi geolocation shows the nurse a picture of the patient in the room who should be receiving medications.  Then, pictures of the medications will be shown one at a time.  The temple touch user interface could be used to scroll through medication pictures and even indicate that they were administered.
2.  Clinical documentation - All of us are trying hard to document the clinical encounter using templates, macros, voice recognition, natural language processing and clinical documentation improvement tools.     However, our documentation models may misalign with the ways patients communicate and doctors conceptualize medical information per Ross Koppel's excellent JAMIA article.  Maybe the best clinical documentation is real time video of the patient encounter, captured from the vantage point of the clinician's Google Glass.   Every audio/visual cue that the clinician sees and hears will be faithfully recorded.

3.  Emergency Department Dashboards - Emergency physicians work in a high stress, fast paced environment and must be able to quickly access information, filtering relevant information and making evidence-based decisions.    Imagine that a clinician enters the room of a patient - instead of reaching for a keyboard or even an iPad, the clinician looks at the patient.   In "tricorder" like fashion, vital signs, triage details, and nursing documentation appear in the Google Glass.   Touching the temple brings up lab and radiology results.  An entire ED Dashboard is easily reduced to visual cues in Google Glass.    At BIDMC, we hope to pilot such an application this year.

4.  Decision Support - All clinicians involved in resuscitation know the stress of memorizing all the ACLS "code" algorithms.   Imagine that a clinician responding to a cardiac arrest uses Google glass to retrieve the appropriate decision support for the patient in question and visually sees a decision tree that incorporates optimal doses of medications, the EKG of the patient, and vital signs.  

5.  Alerts and Reminders  -  Clinicians are very busy people.   They have to manage communications from email, phone calls, patients on their schedule, patients who need to be seen emergently, and data flowing from numerous clinical systems.   They key to surviving the day is to transform data into information, knowledge and wisdom.   Imagine that Google Glass displays those events and issues which are most critical, requiring action today (alerts) and those issues which are generally good for the wellness of the patient (reminders).    Having the benefits of alerts and reminders enables a clinician to get done what is most important.

Just as the iPad has become the chosen form factor for clinicians today, I can definitely see a day when computing devices are more integrated into the clothing or body of the clinician.    My experience with Google Glass helps me understand why Apple just hired the CEO of Yves Saint Laurent to work on special projects.  

Ten years ago, no one could imagine a world in which everyone walked around carrying a smartphone.   Although Google Glass may make the wearer appear a bit Borg-like, it's highly likely that computing built into the items we wear will seem entirely normal soon.

I will report back on our Google Glass experiments as they unfold.

NIKAAH (1982) OST VINYL RIP

NIKAAH (1982) OST VINYL RIP

ON REQUEST  

Music By :  Ravi,Ghulam Ali

Lyricist : Hasan Kamaal & Hasrat Romani

Music On : HMV   



VINYL RIPPED @ 256 Kbps


 
P.S :SUGGESTIONS,REQUEST & COMMENTS ARE ALWAYS WELCOME.YOUR VALUABLE COMMENTS WILL ENCOURAGE ME TO UPLOAD MY MAXIMUM QUALITY RIPS.JUST COMMENT ABOUT THE RIP QUALITY. 

Young and attractive Niloufer is swept off her feet when foreign returned business magnate, Wasim Ahmed, proposes to her, and she accepts. She is flattered by the attention and love that is showered upon her by Wasim, and things could not be better. But when Wasim decides to spend more and more time at work, is unable to keep appointments with her, and is always late, she get disappointed. Wasim is unable to even recollect their first wedding anniversary on October 18th, and is very late for the party later that day. Quarrels and arguments result, and Wasim divorces her by saying "Talaq" three times. A heartbroken Niloufer leaves his house, goes to stay in a Girls' Hostel, meets with an newspaper editor, Afaque Siddiqui, and gets married. It is during their marriage ceremony that Wasim makes his first appearance. For he is convinced that Niloufer still loves him, and will eventually divorce Afaque, and re-marry him. He is aware that according to the Shaririat and Islamic Law a Muslim .. Record Details Title Nikaah - PEALP 2073 Star Cast Raj Babbar, Salma Agha, Deepak Parashar, Asrani, Heena Kausar, Iftekhar, Chandrashekhar, Urmila Bhatt, Ashalata Wabgaonkar, Yunus Parvez & Anu Dhawan Singer Mahendra Kapoor, Salma Agha, Asha Bhosle, Ghulam Ali & Chorus Director B.R. Chopra Producer B.R. Chopra & Ravi Chopra Music Ravi & Ghulam Ali Lyrics Hasan Kamaal & Hasrat Romani Releasing Year 1982 Genre Original Soundtrack Language Hindi Label HMV Made In India Manufacture The Gramophone Company Of India Ltd. Serial No. PEALP 2073 Side One Dil Ki Yeh Arzoo Thi Mahendra Kapoor & Salma Agha Beete Hue Lamhon Ki Kasak Saath To Hogi Mahendra Kapoor Chehra Chhupa Liya Hai Kisi Ne Men (Qawwali) Mahendra Kapoor, Asha Bhosle & Salma Agha Side Two Faza Bhi Jawan - Part 1 & 2 Salma Agha Dil Ke Arman Ansuon Men Bah Gaye Salma Agha Chupke Chupke Raat Din Ghulam Ali

TOTAL 7 TRACKS

CLICK HERE TO DOWNLOAD SONGS

 DISCLAIMER: This blog promotes the appreciation of vinyl records in an encoded audio format called MP3 and hereby disclaims any violations of copyright law. The author of this blog does not engage in buying and/or selling songs in MP3 or any other format on this blog. Visitors of this blog are encouraged first and foremost to buy original records (to maintain the posterity of the vinyl record) and secondly, audio CDs. The music that is available here is meant for promotional and appreciation purposes only.

...Deepak...