Asset Inflation as a Policy Tool

The Addiction of the Fed to Cheap Money & Asset Inflation

 

“Faster Horses, Older Whisky, Younger Women & More Money”

Tom T. Hall, 1975

 

 

Mortgage Shortfalls & Bank Capital, an Ugly Equation

My Aunt Nancy was a daughter of the American South, and an occasional fan of country music. She delighted in the above lyrics of Tom T. Hall, as it was such a wonderful descriptor of a purely self indulgent fantasy from a self absorbed voluptuary. Our Federal Reserve and the Obama Administration are living the monetary equivalent of this ditty, as they desperately try to re-inflate housing values rather than let the market equilibrate. The following equation clearly indicates the fundamental problem facing the Administration and the Fed.

Northern Rock Depositors Considering Capital Adequacy Ratios

Total Bank Capital US Banks – Amount US Home Mortgages are Underwater – Amount of Estimated Losses on Second Mortgages = Adjusted Capital of US Banks

Substituting actual values as most recently published by the Fed and other sources including WSJ as of 2/25, 2011, “Banks Bristle at Mortgage-Loan Plan” produces the following results.

$1.2 T. (Bank Capital) – $744B. (Mortgage Shortfall) – 1.0T. (Second Loan Losses) = ($.544) T. (Adjusted Bank Capital)

The long and short of it is that if housing prices in the US are allowed to stabilize at current levels, our entire banking system is underwater by around $2.0 trillion dollars, the amount of unrecognized housing loss on bank’s balance sheets ($.5 T), plus the amount required to bring the banks up to the required capital levels of the Basel Accords ($1.5T). After stuffing over $2 trillion into the Fed’s Balance Sheet over the last two years “re-liquefying” the Banks the first time, and sucking up over $600 Billion in below market debt in the last 6 months to fund the QE2 initiative, even the Fed is out of gas.

Clearly, there is no political capability for another QEX-1 plan from the Fed., and short-term interest rates cannot be dropped to rates lower than zero, their current levels. The solution proposed by the Treasury Department of millions of individual mortgage modifications is a transparent attempt to buy time, as it is totally impractical to enforce.

My bet on what comes next – watch out for a major effort to revitalize the Zombie Banks, Fannie and Freddie. These “Economic Verduns” will be wheeled back out next to try to keep the housing market afloat. These same GSE’s that lie at the core of the rot in the housing market will be touted next as the solution to what lies ahead. The Fed and the Administration will do everything in their power to promote asset inflation in all asset classes, particularly housing – by any means possible. In the meantime, steer clear of all fixed rate bonds, particularly those of municipalities dependent on real estate values to generate property taxes.

We are still a long way from “normal”, and the Fed’s policy of asset inflation is the only alternative it has to making some tough monetary and policy choices – choices that neither it nor the Administration want to make.

Resources:
Federal Reserve: Assets and Liabilities of Commercial Banks in the United States (Weekly)
Federal Reserve Bank of St. Louis Economic Research: Condition of Banks

PCD Partners Co-Management Arrangements: A Realistic Strategy for Efficiency, Quality, and Alignment

By Dr. Grant Bagley & Wes Chapman

Summary and Conclusions

The delivery of complex healthcare services in a hospital environment has typically involved significant misalignment between hospitals and independent physicians, in both financial and operational incentives and accountability. This inequality of the parties has hampered programs aimed at improving efficiency and lowering health care cost. The fear of third party payors that any joint arrangement between hospitals and physicians might distort utilization and increase cost has led to onerous regulation. The Co-Management Arrangement, created by HHS Opinion 08-16, created a legal and operational framework to address these problems, to the benefit of both groups. Specifically, it allows the payment of significant facility fees to physician groups for participation and achievement of specified quality and operational goals. PCD Partners acts as a critical independent partner to provide clean data, objective/achievable goals, fair and independent review and analysis of goal achievement, training and program development services. This operational buffer is critical in creating a level of operational equality between the hospitals and physician groups to overcome historic obstacles.

Introduction

PCD Partners is a group of physicians, academics, and entrepreneurs who have decades of experience with collaboration in medical quality and practice improvement systems for large scale practice management, clinical practice improvement and clinical trials. PCD was created to bring together this experience in order to create management systems and data analysis strategies that integrate the growing need for quality improvement, comparative effectiveness, and optimization of care delivery and outcomes. PCD incorporates a unique capability to implement and operate Co-Management Arrangements (CMA’s) using quality and statistical management tools and methods developed in a collaboration with various groups within the broadly defined Dartmouth Medical Community (including private companies, researchers and individuals). The PCD partners have a peerless record of accomplishment in the use of CMA type structures to improve measured clinical outcomes through the use of statistical data gathered and implemented across multiple providers as demonstrated by the Northern New England Cardiovascular Disease Study Group (NNECDSC) led by Gerald O’Connor, Ph.D. (a member of PCD) and the Vascular Study Group of New England, led by Jack Cronenwett, M.D. (also a member of PCD). Dr. Grant Bagley brings an unparalleled breadth of experience in healthcare reimbursement and Payor (particularly CMS) relations to ensure maximum benefit to CMA’s designed and operated by PCD.

Alignment –What Is It, and Why Does It Matter?

Much has been made of the need for physician/hospital alignment models as we move into the post-PPACA world of payment and care delivery reform. In its solicitation for quality/efficiency oriented demonstration operating models in 2007, CMS stated,

“The defects and failures in the current health care system, as documented by the Institute of Medicine (IOM) in its report To Err Is Human (2000), are pervasive …the lack of alignment of incentives across different providers in the health care delivery system is often cited as a continuing obstacle to achieving optimal results in terms of quality and outcomes.”

At its core, the interface of alignment must first take place in hospitals – the site of the most complicated, expensive, difficult and dangerous care delivery. If alignment doesn’t work in the hospital setting, between physicians and hospitals, it will not work anywhere else. From a practical perspective, in order to have a meaningful impact, an alignment strategy must:

1. Align financial incentives in a meaningful way to all parties,
2. Align clearly defined quality goals and objectives in a clear and measureable fashion.
3. Align patient interests with providers and payors,
4. Align patterns and practice of care to maximize efficiency without degrading care.
5. Address physician fears that outcomes will not be realistically risk adjusted.

Practical Legal and Operational Considerations

Co-Management Arrangements as a Tool for Alignment

The health care industry’s increasing emphasis on quality of care and improving outcomes has created a need for innovative business models that align the interests of physicians and hospitals without conflicting with fraud and abuse laws. In Advisory Opinion 08-16 (promulgated in October of 2008), the Office of Inspector General of the U.S. Department of Health and Human Services (OIG) approved, for the first time, a hospital program to pay physicians for achieving quality of care by sharing the financial benefits received by the hospital through pay-for-performance (P4P) programs offered by third-party payors. Based on this Opinion, hospitals are able to align financially with their medical staffs to drive quality of care improvements at the hospital.

The approved arrangement consisted of a Quality Enhancement Professional Services Agreement (Co-Management Agreement or CMA) between a hospital and a limited liability corporation (LLC), which is open to all active staff members at the hospital in the relevant departments.

Under the Agreement, physicians who joined the LLC provided specific quality-related services to the hospital in order to improve the quality of care provided to the hospital’s patients. These services included: 1) developing policies and procedures, reviewing and monitoring quality of care in the hospital, 2) providing care in accordance with hospital quality targets, 3) ensuring adequate peer review if quality targets are not achieved, and 4) auditing medical records to track compliance with quality activities.

In exchange for these services, the hospital agree to pay the LLC (which then distributed the payment(s) to the member physicians on a per capita basis) for achieving specific quality targets established by payors. This arrangement called a Co-management Arrangement permits physicians to participate in the proceeds received by the hospital for providing high-quality care, which benefits the hospital, physicians, and patients.

Structuring the CMA

The CMA is based around a contractual agreement with an LLC (or a simple contract between the groups), owned by Physicians, and potentially the Hospital and third parties. Payments to the Physician Group must be based on fair market value, but generally provide 2% of Hospital revenues in the relevant clinical specialty for the time and effort involved in the design and operation of the quality system “system revenue”, and up to 2% “at risk revenue” for the attainment of specified quality, efficiency and satisfaction goals. Governance is typically delegated to a Management Board.

System revenue is typically paid monthly, based on a previously agreed upon budget. At risk revenue is paid either quarterly or annually, after careful data review. Partial payments are allowed of the at risk payments. Incentive payments are typically targeted at:

1. Operational process improvements (which cannot induce reductions in quality of care) based on targets from historical operations or other benchmarks,
2. Quality indicators which are typically process based and are similar to those utilized in PQRI and related P4P programs (HHS approved metrics),
3. Satisfaction measures including patient reported outcomes, and
4. Program development

Third Party Operational Requirements

CMA’s fundamentally differ from existing hospital-physician relationships, in that they require, and are benefitted by third party involvement. The CMA provides a “level playing field” between physicians and hospitals, based on contractually agreed upon roles, duties obligations and objective data to determine performance by all parties. PCD is an independent expert with decades of experience in designing the systems and fairly and objectively collecting data to assess performance. PCD can therefore alleviate the concerns of both parties about the fairness of system design, expectations of performance, and data based documented outcomes.

There are extensive requirements for third party intervention in CMA’s. First, an independent outside expert is required to initially report on the overall quality effort, and make clear recommendations regarding the specific design of the quality system and metrics. Second, the payments proposed under the contract must be reviewed and deemed as within FMV (fair market value) by an outside valuation firm, and finally, an annual review of the system and metrics is recommended by an independent expert.

Operational Requirements

First, only physicians who have been members of the hospital’s active medical staff for at least one year are eligible to become owners of the CMA, a requirement intended to reduce the risk of physicians joining the medical staff of the hospital (and moving their patients there) in order to join the CMA and participate in the potential quality-bonus payments. Second, the physician-owners of the CMA receive distributions on a per capita basis; there are no payments made to induce patient referrals to the hospital. Third, the payments by the hospital to the CMA/LLC are capped based upon historical activity levels of the payor(s) at the hospital to ensure that physicians are not provided a financial incentive to refer additional patients to the hospital. Fourth, the hospital will provide written disclosure of its arrangement with the CMA to its patients. Fifth, the hospital will monitor both the quality of care provided and the volume and case mix of its patients to ensure that the financial rewards of the program do not reduce quality or inappropriately change referral patterns of the physician participants. Finally, the quality targets that can be incentivized under the program are limited to those listed by the Centers for Medicare & Medicaid Services and Joint Commission in the Specifications Manual for National Hospital Quality Measures, which represent the consensus of the medical community as to the appropriate standard of care.

The OIG deemed these safeguards sufficient to approve the Agreement, and they can serve as a guide for future arrangements. The OIG’s approval of the Agreement demonstrates a willingness to allow hospitals to pursue this promising method of aligning hospitals and physicians so that they can better work together to drive quality of care improvements.

Although the OIG approved the Agreement in Advisory Opinion 08-16, this approval extends only to those parties who submitted the OIG Advisory Opinion request and, technically, only they may rely on it. Other manifestations of this model must be structured carefully with the advice of legal counsel to survive regulatory scrutiny.

Alignment through CMA’s

The primary benefit of the arrangement is that it will likely improve quality of patient care by sharing the rewards for higher quality care with the medical staff that are primarily responsible for delivering it, and who are better suited to initiate, innovate, or carry out required actions. Performing well on quality metrics requires the participation and performance of the entire medical staff in relevant departments.

Sharing the financial rewards for achieving those metrics with physicians is a positive way to incentivize broad compliance with specific quality standards. While physicians are under no obligation to join the CMA, the physicians who do have strong incentives for assisting non-participating physicians to achieve the quality metrics, since the benefits of the arrangement are tied to the quality performance outcomes of the hospital, not to individual physicians. Participating physicians thus have a vested interest in encouraging the recommended medical practices among all physicians on the medical staff and in engaging in meaningful peer review.

The arrangement also should benefit both hospitals and physicians financially. Physicians are able to replace declining incomes through an arrangement that does not compete with the hospital. For hospitals, the participation of physicians to help improve the quality of care should allow hospitals to receive the highest quality outcomes, thus improving reimbursement from the payors under P4P arrangements.

This arrangement also provides assistance in minimizing compliance risks now associated with quality of care, thus reducing the risk of enforcement actions for quality failures. Government regulators have identified quality of care violations as an enforcement priority under the False Claims Act, resulting in many multimillion dollar settlements with the government because of alleged substandard quality of care and unnecessary procedures. The 2009 OIG Work Plan has identified two specific enforcement initiatives focused on quality of care: a review of the reliability of hospital-reported quality measurement data and a review of the incidence of, and payments for, serious medical errors or “never events.” This new structure provides hospitals with a way to engage physicians proactively to improve quality, which assists the hospitals in avoiding costly public enforcement actions based upon quality failures.

Legal Considerations

Broadly speaking, there are two principle areas of legal concern. The first is Anti-Kickback Statutes (Stark Laws). These are the requirements for FMV and appraisals of all contracts. In particular, there can be no incentives: 1) for disproportionate distributions to reward volumes or referrals, and 2) to cherry pick the lowest risk patients. The second are the so-called civil monetary provisions under Medicare (the CMP Statute) which are designed to prevent denial of care for financial incentives. In particular, there can be no incentives to shorten LOS without overwhelming evidence that it did not negatively impact patient care. Care must be taken in the design and implementation of the CMA program not to contravene these laws.

PCD Partners Value Add

All CMA’s consist of two fundamental parts, 1) System Assets & Infrastructure, and 2) Quality Systems Operations. PCD operates “cloud based” data systems and ISO systems which do not necessarily impact in any way with hospital IT systems. We allow rapid deployment and low cost in fully HIPPA compliant systems. Every one of our installations is guaranteed ISO 9000 certified, which dramatically improves data quality and utility with third party payors and regulators. System assets and Infrastructure consist of management structure and related assets to actually make the CMA work. These includes quality control systems, data gathering and management systems, financial control and reporting systems, training and performance evaluation systems, medical and clinical staff to design operate and oversee the systems, legal and compliance expertise specifically related to CMA’s, and access to quality data for benchmarking and related purposes. Quality Systems operations involve the utilization of a process oriented system to provide real-time feedback to participating medical personnel and hospital employees. The system needs to involve people day-to-day and assist in constant quality review and improvement. At its core, alignment must be a real time reality, or it doesn’t exist.

Finally, both static and dynamic portions require money to get them up and running. The reality is that these systems have historically been entirely dependent on physician and hospital financing to fund all start-up expenses. This has led to sub-optimal choices in system design and operation in many cases.

PCD CMA Product & Service Considerations

PCD is a full partner in your CMA success, and we succeed and prosper together. PCD typically acts as managing general partner in the LLC which operates the CMA. We can provide up to 100% of the financing to form, build and capitalize the venture; and bring our operational expertise and systems to ensure success.

Systems assets and infrastructure are the backbone of the CMA and require modules dealing with:

1. Planning and training
2. Data gathering and processing
3. System design and review
4. Legal compliance and review
5. Data publication and reporting – including dashboards
6. Financial reporting and control
7. ISO quality systems
8. PSO operation and compliance

Quality systems and operations include all of the use and operation of the CMA, and are focused on the derivation and use of quality data. This function is the heart of the partnership between the Hospital and Physician partners, and is the critical element for P4P incentives and quality evaluation. PCD assists in the compilation and exposition of the quality data, and is ultimately responsible for data integrity, subject to the data plan agreed upon among the partners.

These systems have been utilized and refined over the last two decades to implement best practices, evaluate individual practice patterns, change and improve processes of care, evaluate devices and pharmaceuticals, benchmark physicians based on outcomes, and develop data for scientific research. The principals of PCD have used these techniques on a regional and national basis in multiple clinical areas. The analysis of practice patterns and observation of optimal care patterns is important but only when coupled with successful implementation strategies. PCD relies on the demonstrated ability to work with provider groups to adopt improved and efficient practices. The results have been improved patient care, higher facilities utilization, lower purchasing costs, objective physician evaluation, collaborative training, and better relationships with payors and regulators.

Wroten Island Hunting

The Team and the Game

The team of Jamie Riordan (host), PK Knights, Cam (AKA Camilla) Eldred, and Scott Steffey descended on the hunting club at Wroten Island for a reprise of a very successful hunt two years earlier. Wroten is part of the fabric of very old settlements along the Chesapeake, which has been abandoned from its original subsistence agriculture and fishing. The Island is a fabulous study in colonial and 19th century settlement, with several very old farms and abandoned cemeteries.

This is really a late season clean-up harvest, with most of the members long gone – with the arrival of cold weather on the Bay. Like the entire Chesapeake, the estuary is a fabulous winter habitat for migrating water fowl – both ducks and geese – as well as Sika deer, which were imported from China as exotic pets, and escaped (shown below).

The Chesapeake is home to approximately one-third of the waterfowl on the Eastern Seaboard, with an amazing variety and density of birds. Principal species hunted on our trip were Buffleheads, Canadian Geese, Blue Bills, Red Heads and Canvas Backs. Also bagged on the trip were an Old Squaw and a Green Head (both kind of old and tattered).

The Chesapeake Bay & Wroten Island

The Chesapeake Bay is approximately 200 miles long, from the Susquehanna River in the north to the Atlantic Ocean in the south, and derives its name from an Algonquian word referring to “a village at a big river”. Total shoreline for the Bay and its tributaries is 11,684 miles, and the surface area of the bay and its major tributaries is 4,479 square miles. Average depth of the bay is 46 feet and the maximum depth is 208 feet. Approximately 20% of the bay is less than 6 feet deep at low water, and the sub-aqueous vegetation is dense and provides fine food for the birds.

The Chesapeake Bay is the ria, or drowned valley, of the Susquehanna, meaning that it was where the river flowed when the sea level was lower. The Bay’s geology, its present form, and its very location were created by a meteor impact about 35.5 million years ago, forming the Chesapeake Bay impact crater, and the Susquehanna River valley much later. The Bay itself was formed starting about 10,000 years ago when rising sea levels at the end of the last ice age flooded the Susquehanna River valley. The climate of the area surrounding the bay is primarily humid subtropical, with hot, very humid summers and cold to mild winters. Only the area around the mouth of the Susquehanna River is continental in nature, and the mouth of the Susquehanna River and the Susquehanna flats often freeze in winter. It is exceedingly rare for the surface of the bay to freeze in winter, as happened most recently in the winter of 1976-1977, but we did get a very hard freeze which precipitated a hurried exit from the Island this trip. In this trip, we had very substantial ice formation all the way across the River between the Island and the Mainland – about 1 mile after a night of temperatures in the high teens to lower 20’s and north winds in excess of 20 mph.

The Hunting

At the end of the day, this trip is always about the hunting, and the hunting is tremendous. We hunt from permanent blinds built out on the water – between 5-9 feet deep depending on the tide. The blinds comfortably hold 3-4 hunters, and the ducks came typically as singles or pairs. These ducks are much smaller than the Eiders that we hunt at home, and not nearly as tough. We shot high velocity steel #2’s principally, which proved more than adequate out to 35 yards.

We limited out both days that we hunted, and PK prepared a really fine dinner of elk, to compliment a fish stew prepared by the host. I would suggest a career in high end culinary service for these two guys if they ever get tired of real estate development. The last day we were frozen out by a really cold arctic blast, and were lucky to get off the Island before it froze in hard.

I remain a fully committed fan of Wroten Island, and the hospitality of the Wroten Island Club.

Winter Climb of Mt. Washington with EMS Climbing School

Winter Climb of Mt. Washington with EMS Climbing School

Mt. Washington or Agiocochook (Home of the Great Spirit)

It is important to note that Mt. Washington is not (as many claim): 1) The highest mountain east of the Mississippi (Mt. Mitchell, NC), or 2) The highest mountain east of the Rockies (Mt. Harney, SD). It was for many years, however, the home to the highest wind ever recorded (231 mph, 1934), and may well be the home to the worst weather on the face of the earth. The weather is due to the prominence of Mt. Washington (most prominent in the East, 59th most prominent in the US) and the very high precipitation relative to other alpine environments. In the winter months, hurricane force winds are measured on Mt. Washington two thirds of the days, and the summit receives over 100 inches of rainfall equivalent per annum. This is a very bad place – particularly in the winter.

Despite this seemingly impossibly inhospitable environment, the summit has had permanent structures, including hotels, restaurants and a weather station since the mid-1800’s. These are accessed via an automobile road and an ancient cog railroad which still functions in the summer.

I had climbed Mt. Washington in the three “fairer seasons”, but never been to the summit in mid-winter, to see firsthand what this bad weather is really all about. This is really a rite of passage for Eastern mountaineering, and was the purpose of the school weekend at EMS.

The Team of Gary & Jill Rogers, Pete Volanakis and me was guided by Sarah, a really terrific guide from the topographically mundane state of Ohio. Sarah had taken a troop of Scouts (both Boy and Girl) most of the way up the Hill the day before, but greeted us the morning of the climb rested and raring to go. She climbs Washington at least 35 times per winter season, and has for 12 years – we were in pretty good hands.

Our team had pretty much a rest day the day before, with just a little cross country skiing and some BC skiing to limber up from our day of ice climbing. We arrived in the parking lot of Pinkham Notch at 7:45, and were headed up “The Home of the Great Spirit” by 8:00, toward the Trail up Lions Head. The temperature was around 10 degrees in the parking lot, and winds were from the WNW around 20mph – it was going to be very cold and windy on top.

Mt. Washington – A Geological Anomaly

Mt. Washington stood head and shoulders above the continental glaciations of the last Ice Age (unlike almost all other mountains in the region), and consequently enjoys a boulder strewn summit, unmolested by the continental ice sheets. The glaciations on its flanks, however, continued until very recently, and produced the world renowned Tuckerman Ravine, the birthplace of extreme skiing.

Mt. Washington is composed of very hard metamorphic and intrusive igneous rock. The stratified rocks belong to three formations, the Ordovician Albee formation, the Ordovician Ammonoosuc volcanics, and the Devonian Littleton formation. All these rocks have undergone high-grade metamorphism. The intrusive rocks belong to four magma series, ranging in age from Late Ordovician to Mississippian.

Up Lions Head & to the Summit

The trail up to the base of Lions Head is the Tuckerman Ravine Trail, which is filled with hikers and skiers, and looks like a parade of Gore Tex and Polar Fleece. All shapes sizes and climbing abilities are represented, but we hustled to get in front of a group of twelve hikers who said that they, “attempt the summit every year, but haven’t made it in 10”. We did not want to get stuck behind these guys on the chutes on Lions Head. Crampons and ice axes were required equipment from the base of Lions Head, to Summit and back. Additionally, we “roped up” to descend some of the chutes later in the day.

We arrived at the top of Lions Head around 11:00, and needed to do a little readjustment of our Team, as often happens at this point. Pete was “out of gas” and the weather had deteriorated quite substantially, with winds well over 50mph and temperatures well below 0 F. Pete joined a group going just a little further across the Alpine Garden (a favorite skiing spot of mine in spring) toward the summit, and we picked up Martin, a process engineer from Austria.

The push to the summit took about an hour, in some really bad winds and low temperatures. We were well dressed (in a mountaineering sense) with goggles and full neoprene face masks and fogging was the biggest problem.

Coming to the top of Washington is always a surreal experience, with so much man made stuff (buildings, snow cats and the like) on top of the mountain in such a remote and forbidding environment. We were grateful for the shelter from the 70-mph gusts in the lee of the buildings, grabbed a couple of photos at the summit, and headed back down before we froze in the -10 to -15 degree temperatures. We had worked hard coming up, and were pretty wet. Standing around was not a good idea.

The descent was mercifully uneventful (most climbing accidents happen on the way down) and we broke out of the clouds to get a good view of Boot Spur and Wildcat by the time we got back to Lions Head.

With the exception of some congestion at the chutes on Lions Head Trail, we made good time getting off the Hill, and were out and headed home by 4:00.

The wild weather and difficult conditions did not disappoint. This was a great climb, and affords the experience of Denali-like weather at a savings of $15,000 and 20 days. Perhaps next year we’ll try the traverse of the Presidential Ridge in winter – more time on the hills, including two overnights. If we do, I’m sure that it will be with our friends from EMS – really a great outfitter and guiding service.

Ice Climbing in Crawford Notch NH

An Alternative to the Mid-winter Blues

The Beatles proposed “Here comes the Sun” for respite from a “…long, cold, lonely winter…” The Team of Gary & Jill Rogers, Pete Volanakis and me found our solace this weekend at the three day Winter Mountaineering School sponsored by EMS. The program consists of two days of ice climbing, and an assault on Mt. Washington on Monday of President’s weekend. Due to a guide shortage – probably caused by advanced notice of our arrival – we did the second day as a self-guided school for back country skiing.

The Ice in the Notch

The first day of ice climbing was done with Sarah, a terrific guide who escaped the vertically challenged terrain of Ohio to come to the White Mountains 14 years ago after graduating from Miami University of Ohio. We climbed on the “Lost in the Woods” frozen waterfalls in Crawford Notch, named for the Crawford family that pioneered the area and built the first trail up Mt. Washington (across the valley) in 1819. Crawford Notch is a major glacial cirque which lies WSW from Mt. Washington and affords a great variety of ice and rock climbing routes.

The weather for this outing started very warm, with temperatures in the 50’s the night before. Fortunately, the temperatures cooled down into the teens for the morning, and were accompanied by winds gusting to 50 mph. The approach march was along the still active (summertime only) railroad tracks, with one crossing of a fairly sketchy trestle bridge. The ice at the site was still had frozen hard from the day before, and was thick and ready to climb.

My last ice climbing of any dedicated nature was in college, and the rest of the Team was out for their first tour. Ice climbing is always cold, frequently wet, and best executed with some wicked looking tools – including ice climbing axes (one for each hand), and crampons for the feet. These are murderous looking implements, and extremely effective both on ice and fallen commies. In fact, Leon Trotsky (a former colleague of Lenin and then Stalin) was dispatched by Soviet agents of the NKVD in Mexico City (1940) with an ice ax.

The area of our climb was about 75 feet in height, and it was perfectly reasonable to top rope. This is delightful, as ice climbing results in frequent falls, as all of the hand and foot holds are manmade (with the wicked looking tools shown above) and subject to failure along multiple fracture lines. Ice is a vitreous substance, and is also subject to conchoidal fractures, which fall off frequently in large chunks, making ice climbing a challenging and engaging spectator sport.

It was great getting back on the ice after too many years away, and everyone in the party reached the “summit” on every climb. The valley was full of climbers, and the atmosphere was a giant party. We were the oldest climbers, but held our own among the young and vigorous fellow travelers.