Monday, January 31, 2011

How We Can Curb Prescription Drug Abuse

ttached an article published in Internal Medicine News reporting that the combined efforts of local physicians and the statewide prescription drug monitoring program successfully reduced prescription narcotic diversion.
This article should serve as an example that we CAN curb prescription drug abuse.
So what are we waiting for?

Pain Management Program Cut Prescription Narcotics Diversion

By: M. ALEXANDER OTTO, Internal Medicine News Digital Network

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SAN ANTONIO – A primary care initiative combining patient pledges with random pill counts and urine screens significantly reduced prescription narcotics diversion in North Carolina’s rural Caldwell County.

Dr. Ed Bujold worked with law enforcement and social service agencies to create a registry that helped reduce by 300% the number of prescription narcotics seizures in one rural North Carolina county.

As part of the program, most primary care patients with chronic, nonmalignant pain sign a contract agreeing to those measures – and pledging not to doctor-shop for narcotics – prior to receiving their prescriptions, explained Dr. Ed Bujold, a family physician in the Caldwell County town of Granite Falls who helped spearhead the initiative.

Physicians in the western North Carolina county began to use the contracts in 2007, which coincided with a 300% drop in prescription narcotics seizures by county law enforcement between 2005 and the end of that year.

"I believe most of the impact on the 300% decrease took place in [2007]," Dr. Bujold said at the Society of Teachers of Family Medicine Conference on Practice Improvement.

There’s been no evidence the measures keep patients who truly need narcotics from getting them, he added.

In fact, patients "are in complete agreement with this. I have had several say, ‘I am so thankful you are doing this. I don’t want these drugs to go out to places they are not supposed to be,’?" Dr. Bujold said.

Dr. Bujold said he is also more confident prescribing Percocet (oxycodone and acetaminophen), OxyContin (oxycodone), Vicodin (hydrocodone and acetaminophen), and other narcotics to the few hundred chronic pain sufferers among his roughly 3,500 patients. A survey found other primary care physicians participating in the initiative are as well.

"I feel very comfortable treating patients now, because I know that I am not dealing with the riffraff," Dr. Bujold said. "This system pretty much takes them out of the picture."

The idea was born in 2006 after a church service, when the Caldwell County sheriff approached Dr. Bujold, a fellow parishioner.

The sheriff confided in him that prescription narcotics threatened to become the county’s main drug problem, ahead of methamphetamine and cocaine. Local law enforcement officials recently had found two houses stocked with prescription narcotics for street sale, he added.

A few local physicians had been too trusting, prescribing narcotics "without even thinking some might end up on the street," Dr. Bujold explained.

Over the next year, Dr. Bujold, two county narcotics officers, a pharmacist, a community nurse, and the regional director of Community Care of North Carolina worked on a solution.

The contract was its centerpiece, downloaded from the American Society of Anesthesiologists Web site. Patients who sign it pledge to get their narcotics from one physician and one pharmacy, and submit to random pill counts and urine drug screens.

Once the plan was in place, the nurse visited local primary care practices to explain the diversion problem and contract initiative.

At the same time, North Carolina created an online narcotics registry accessible to doctors and pharmacists.

"It closed the loop for us. If we have somebody who comes in as a new patient, and their story sounds a little fishy, we can go to the narcotics registry," explained Dr. Bujold. "If they’re getting prescriptions from 10 physicians and 5 pharmacists, we know right away that this is not somebody we are probably going to work with."

By 2008, narcotics officers reported cocaine and methamphetamine were again the main drug problems in Caldwell County. There were also reports that drug-seeking patients were leaving the county.

Currently, around 90% of local physicians use the contracts, and patients submit to urine screens and pill counts about twice a year when their names come up on a randomly generated list.

Not finding narcotics in the urine of patients prescribed narcotics is a red flag. Marijuana detection is, too, because it’s not legal in North Carolina for medical purposes, though "we try to make a decision based on the individual’s circumstances," Dr. Bujold said.

If patients violate their contract, they are cut off from narcotics, something that happens about twice a month in Dr. Bujold’s practice, he said.

Copyright © 2011 International Medical News Group, LLC. All rights reserved.
This page was printed from . For reprint inquires, call 877-652-5295, ext. 102.

Sunday, January 30, 2011

The Pill Mills Issue and Politicians

Attached you find an excellent commentary by Carl Hiaasen entitled " Hey, gov: Don't give pill mills license to kill."
The commentary speaks for itself and I 100% agree with its content and tone.
I am angered and frustrated that many physicians in the state of Florida have chosen a hands-off approach regarding this issue. Some even ague that we should wait and see to avoid antagonizing the new Attorney General and Governor. Well, I beg to differ! I still remember when organized medicine first and foremost dedicated its efforts to protect the public health and NOT only the financial interest of doctors. I also remember the time when organized medicine spoke up to protect the interest of those who had no voice to speak. Now we have to opportunity to rise to the challenge to defend the lives and well-being of our families and patients. Now is the time to demand from our elected officials to declare a public health emergency to stop the epidemic prescription drug abuse killing seven Floridians every day! We should not let this opportunity slip away. We must stop the drug dealers in white coats who chose profits before their professional oath.

The Miami Herald
Posted on Sat, Jan. 29, 2011
Hey, gov: Don’t give pill mills license to kill

By Carl Hiaasen
Florida attorney general Pam Bondi speaks at a news conference on Wednesday, Jan. 19, 2011 in Tallahassee, Fla.
Steve Cannon / AP
Florida attorney general Pam Bondi speaks at a news conference on Wednesday, Jan. 19, 2011 in Tallahassee, Fla.
Florida Attorney General Pam Bondi called a press conference last week to ban a new party drug known as MDPV, which is being sold in head shops around the country as “bath salts.”

Most users snort the stuff, which doctors say can cause wild hallucinations and violent behavior. Peddled as fake cocaine, MDPV has been linked to several deaths and suicides.

Said Bondi, “I frankly had a nightmare last night that someone was going to overdose on this and we hadn’t done anything.”

Interestingly, she didn’t mention having any nightmares about Florida’s storefront pain clinics, which are still handing out Vicodins like Tic-Tacs, and overdosing customers at the rate of seven fatalities per day — more than heroin, crystal meth and cocaine combined.

Florida has become one of the nation’s favored destinations for prescription-drug dealers, who travel here to load up their car trunks and head north with the pills, which are sold on the black market for up to $30 each.

More oxycodone is dispensed here than anywhere else in the country. During one especially bountiful six-month stretch of 2008, Broward doctors prescribed 6.5 million doses, almost four pills for every resident of the county.

Efforts to shut down the unscrupulous clinics have been stymied by Bondi’s Republican colleague, newly elected Gov. Rick Scott. One of his first acts was to eliminate the state Office of Drug Control, which had been coordinating the war on pill mills.

Scott’s executive order freezing all new regulations was another blessing for sleazy clinic owners, who’d been facing a slate of tough licensing standards from state medical officials. Now some of those restrictions will be delayed until the financial impact is assessed, in accordance with Scott’s “accountability” process.

This is a fantastic development for those who prey on drug addicts, though it’s bad news for healthcare providers, law enforcement and taxpayers who are picking up the tab for most overdose admissions to emergency rooms.

Certainly that’s not what the Legislature had in mind last spring when it took aim at the hundreds of pill mills that had sprung up throughout the state, especially in South Florida. Most of the clinics are still open today, churning out oxycodone prescriptions like confetti.

Lawmakers had mandated that the state’s medical boards make strict new rules for the clinics, including penalties for violations. Legitimate pain-clinic operators and pharmacies generally supported the reforms.

Not so fast, said the rule-hating governor.

So the killer pill mills remain open, while Scott’s new “Office of Fiscal Accountability and Regulatory Reform” ponders the potential financial impact of urinalysis.


Last week, the Florida Board of Medicine unanimously passed four rules aimed at curbing prescribing abuses at in-and-out clinics. But first the state had to pay for a quickie economic study that calculated the pain-clinic rules would cost the private sector about $69 million the first year, most of it for urinalysis.

The tests are relatively inexpensive (about $17-per-pee), and would help clinics determine whether the customers were painkiller addicts or patients with true medical problems. The customers themselves would pay for the testing.

For the governor’s staff to be meddling in such a clear-cut issue is a waste of time and resources. Apparently, seven dead Floridians a day isn’t enough evidence to convince Scott that there’s a crisis.

Everyone else seems to get it, from the U.S. Drug Enforcement Administration to local police agencies that have witnessed the pill clinics proliferate, and documented the convoys of dope mules arrive from other states.

The Legislature in 2008 passed a law authorizing a computer data base to track narcotics prescriptions, which would help identify pill-peddling physicians as well as drug dealers who shop from one doctor to another.

Yet the monitoring system still isn’t in place, and might not be until summer. Florida remains one of only 12 states without such a data network.

More legislation took effect in October, in advance of Scott’s election. Before then, basically anyone could own a pain clinic, felons included. Now each clinic must show that it’s owned by a state-licensed physician, or conform to licensing standards as hospitals do.

True, tough laws and rules won’t stop all crooked clinic owners and shady doctors, who can be as creative as they are greedy. But without something on paper to enforce, authorities can only peck at the problem.

Many officials in Tallahassee do seem to grasp the nightmarish scope of the prescription-painkiller epidemic. To Bondi’s credit, she appointed former state Sen. Dave Aronberg to pursue pill-peddling operations statewide.

But, like everyone else, Aronberg can’t do much until Scott’s little truth squad gets around to deciding (among other things) whether urine tests present an undue financial burden for Vicodin buyers.

The governor wasn’t kidding when he said Florida is open for business. Just ask the creeps at your neighborhood pill mill.

© 2011 Miami Herald Media Company. All Rights Reserved.

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Monday, January 24, 2011

Airline Safety Record Can Serve As An Example

While waiting in line for a cup of coffee at a Dunkin Donuts I glimpsed at the front-page of USA TODAY reading that for two consecutive years not a single airline passenger died in a U.S. carrier crash! No passengers died in accidents in 2007 and 2008, a period in which commercial airliners carried 1.5 billion passengers on scheduled airline flights, according to a USA TODAY analysis of federal and industry data. That’s indeed great news! So why is that happening? Because government requirements during the past two decades have made planes safer in violent impacts and fires, reducing the likelihood of deaths,technology improvements led to the development of more reliable aircraft and better training of airline personnel contributed to this impressive record too.
In contrast a recent OIG (Office of Inspector General of the US Department of Health) study found that one in seven Medicare patients were harmed by the care they received in the hospital during a month studied by the agency. The study shows that hospital patients are harmed much more frequently than previously estimated and points to the need for mandatory validated public reporting of medical errors, according to Consumers Union, the nonprofit publisher of Consumer Reports. The OIG study was based on a physician review of the medical records of a nationally representative sample of 780 Medicare patients during October 2008. It found that 134,000 hospitalized Medicare patients experienced medical harm in that month. The OIG calculated that Medicare patients harmed during that month required an additional $324 million in hospital care. The study estimated the annual cost for these events in hospital care alone at $4.4 billion. According to the OIG, an estimated 15,000 Medicare patients experienced medical errors in the hospital that contributed to their deaths each month. That amounts to about 180,000 patients annually. 25 states and the District of Columbia collect data from hospitals on the incidence of certain medical errors. But only six states have disclosed hospital-specific medical error information to the public. Even worse, half of all states do not have any medical error reporting requirements in place. In most states, hospital-specific information is kept secret and hospitals can get away with under-reporting errors because there is no effort made to systematically validate the data that hospitals are required to report.
So whats the conclusion? Its safer to receive medical care while flying? Maybe. Or, should we apply the experience gained in the airline industry to the medical industry? Would we better off establishing the medical equivalent of the FAA (Federal Aviation Administration)? I believe we should?
Maybe now is the time to reevaluate our approach to medical error prevention and to reconsider our resistance to report medical errors from which we all could learn from. But maybe I just like flying too much.


Airlines go two years with no fatalities

By Alan Levin, USA TODAY
For the first time since the dawn of the jet age, two consecutive years have passed without a single airline passenger death in a U.S. carrier crash.

No passengers died in accidents in 2007 and 2008, a period in which commercial airliners carried 1.5 billion passengers on scheduled airline flights, according to a USA TODAY analysis of federal and industry data.

One major accident occurred during that time, last month's crash of a Continental Airlines jet in Denver.

Going without a crash fatality for a full year has been rare. Only four years since 1958 have passed without a passenger fatality, the analysis found. That makes the two-year string even more impressive, aviation safety experts say.

"It's a new record," says Arnold Barnett, a Massachusetts Institute of Technology professor who has written extensively about airline fatality risks.

"While it doesn't mean risk is now non-existent," Barnett says, "it certainly means they have done a fantastic job at keeping all these threats at bay."

Barnett calculates that it's more likely for a young child to be elected president in his or her lifetime than to die on a single jet flight in the USA or in similar industrial nations in Europe, Canada or Japan.

"It's just more evidence of what has been the improving safety record that we've seen over the past several years," says Bill Voss, president of the Flight Safety Foundation, a non-profit group that promotes aviation safety around the world.

Overall risks of death on an airline flight have dropped dramatically.

Fatality risk fell to 68 per billion fliers this decade, less than half the risk in the 1990s, according to National Transportation Safety Board (NTSB) data. Since 2002, the risks of dying on a flight plunged to 19 per billion, an 86% drop from the 1990s.

The fiery Continental Airlines crash Dec. 20 in Denver shows it can still be hazardous to fly. The jet turned off a runway while attempting to take off, breaking apart and bursting into flames.

All 115 people aboard escaped as jet fuel burned through the right side of the jet. The crash injured 38 people, five seriously, the NTSB said.

The crash helps illustrate why death rates have fallen, Voss says.

Government requirements during the past two decades have made planes safer in violent impacts and fires, reducing the likelihood of deaths, he says.

Technology improvements, more reliable aircraft and better training also have helped reduce accidents, Voss says.

The lack of fatal crashes creates new challenges for federal regulators and the airline industry. Further safety improvements must come from studying the minor anomalies of everyday flight.

"What we're looking at now is the risks before they manifest themselves into accidents," says Basil Barimo, with the Air Transport Association.

Saturday, January 22, 2011

Pain Clinics: Board of Medicine Calls For Rules Implementation

There are (mixed) good news to report in the struggle to curb the explosive growth of pain clinics in Florida.
According to a SunSentinel article published today the Florida Board of Medicine on Friday unanimously passed pain-clinic rules that will impose an estimated $65 million in costs despite Gov. Rick Scott's edict to ban rule-making this year.
Board members asked their staff to send letters to both the Legislature and the governor's Office of Fiscal Accountability and Regulatory Reform, explaining the need for immediate implementation of these rules, given the significant threat to public health and safety that some "pill mills" have created in the state. The four rules adopted on Friday set out the requirements for standards of care, inspections,accreditation and training in pain-management practices.
Several members, who met by conference call, mentioned that they support Scott's call for a halt to rule-making to make sure that the process doesn't unduly impose a burden on small businesses and the public. In fact, the board voted unanimously to suspend rule-making other than the regulations on pain clinics. The Department of Health commissioned a study by the Center for Economic Forecasting and Analysis at Florida State University after the Legislature required them for all pending rules with at least a $200,000 impact on business. The Center churned out the study in just one month in order to leave time for the board to decide whether to submit the rules by the Feb. 4 deadline for consideration during this year's legislative session. I still do not understand why "pain clinics" count as legitimate business entities!!!
Unfortunately, neither the Senate nor the House leadership are willing to call for a special session to pass these rules, therefore causing further implementation delay.
How many Floridians have to die before legislators understand that this is a public health emergency requiring a drastic and quick response?
Declaring a public health emergency would also allow for the immediate implementation of the Prescription Drug Monitoring Program which is hold up by a bidder protest.
The time to act is now!!!



South Florida Med board to legislators: End delay on pill mill rules

Rules would cost pain clinics, patients $65 million a year

By Bob LaMendola, Sun Sentinel

January 21, 2011

Florida regulators trying to stop the illicit flow of narcotic pills from rogue pain clinics called Friday for the state Legislature to quickly approve stricter rules.

The Florida Board of Medicine was ready to adopt new pain clinic rules but then legislators passed a law in November saying no rules could take effect until approved by the state House and Senate. Legislative action is not expected on any rules until the annual session starts March 8.

Friday, the medical board sent the rules to lawmakers and urged fast action. One board member, Dr. Steven Rosenberg of West Palm Beach, suggested a special session as early as next week, when most legislators are in Tallahassee for meetings.

"It would only take them a few minutes," Rosenberg said. "We can't afford to wait until the regular session in March. That's [hundreds more] people who will die as a result of the pill mills."

Officials estimate that seven Floridians die every day from prescription drug overdoses, some of those due to pill mills – unscrupulous pain clinics concentrated in South Florida that peddle large quantities of painkillers to dealers and addicts.

Don't expect any action before March, legislative officials said.

"A special session? That's not going to happen," said David Bishop, a spokesman for Senate President Mike Haridopolos, R-Indialantic. Legislators need time to review the details, he said.

Katy Betta, a spokeswoman for House Speaker Dean Cannon, R-Winter Park, said the medical board spent more than a year writing the rules, so a legislative subcommittee would spend a few weeks reviewing them.

The rules would let the state inspect pain clinics and punish clinic doctors for violations. The doctors would have to examine every patient before writing a prescription, give drug tests to patients and cut off pain pills to patients who abuse them.

The rules face another potential roadblock from Gov. Rick Scott, who this month froze all proposed rules for a review by his advisers. But officials said they did not think he would hold them up.

Rosenberg and other supporters said they worry that some pain clinic owners and physicians who oppose aspects of the rules might lobby legislators to change the wording and send the rules back to square one.

As part of its action in November, the Legislature ordered state officials to estimate the cost of every new rule. A report for the medical board found that pain clinic rules would cost about $65 million in the first year and $61 million a year in the future. Each of the 923 pain clinics – a state-high 117 in Broward County, 113 in Palm Beach County, 49 in Orange County – would pay $69,000 a year.

About $60,000 of that would be charged to patients, who will have to pay $17 each for urine tests twice a year, the report said.

Paul Sloan, a Venice pain clinic owner who is president of Florida Society of Pain Management Providers, said the cost is a little higher than expected but worth it.

The Florida Academy of Pain Medicine favored the rules and the cost Friday, but said the strongest part of crack down – a statewide database of pain pill prescriptions so police and doctors can track pill abusers – also is stalled. The database was to start Dec. 1 but is held up by a bidder's protest.

Bob LaMendola can be reached at or 954-356-4526.

Copyright © 2011, South Florida Sun-Sentinel

Friday, January 21, 2011

Patient Can Receive their lab results - But not in Florida!

Attached an article published in today's Miami Herald reporting that Quest Diagnostics, the nation's largest provider of lab services, is allowing patients to get test results sent to them directly but is NOT permitted doing so in Florida! Why? Florida state statute 483.181 requires that lab results "must be reported directly to the licensed practitioner or other authorized person who requested.'' An administrative code interpretation states: "No report . . . shall be sent to the patient concerned except with the written consent of the authorized person who requested the test.''
In my opinion this need to change! Medicine should be a collaborative effort between physicians and patients. Accountability and transparency should be the focus of our medical care. In my practice each and every patient has the right to receive his/her diagnostic test results within 48 hours via e-mail or mail with attached interpretation of the results. This excludes results that requires a one-on-one discussion (positive HIV, significant MMG and Biopsy results etc.) One way to circumvent this issue is the establishment of personal health records and patient portals. I transfer all of my Allscript Prescription data to the patients personal health record if so requested. Many do not know that this even exists.
Looking forward to your feedback.

The Miami Herald
Posted on Fri, Jan. 21, 2011
Get lab results quickly, but not here

With healthcare experts pushing for more patient involvement, Quest Diagnostics, the nation's largest provider of lab services, is allowing patients to get test results sent to them directly -- but not in Florida.

``Disclosure and transparency is here and now,'' said Jon Cohen, Quest's chief medical officer, at a recent University of Miami symposium.

Well, not exactly here. Florida is one of 13 states that forbids diagnostic companies from transmitting results directly to patients.

That makes no sense to Beth Wheeling, a retired South Miami psychologist and cancer patient. ``Why is there this infantilization of the patient? Why do they think we cannot handle this? I hope Florida grows up.''

The Florida Medical Association and the American Medical Association did not respond to requests for comment.

The Quest initiative ``is the beginning of a trend toward more knowledge for consumers,'' said Russell Robbins, a doctor and principal at Mercer, a national consulting firm.

He said it has previously been possible for patients using some smaller labs to go to the Web for results, but with this new program ``the information is getting back freely'' by automatically being sent to smart phones via a special app.

LabCorp, the other big national testing company, did not respond to four requests for comment.

The Quest program, called Gazelle, is presently set up only for smart phones and includes ways for people to access and keep track of their medical records. Patients who sign up for the service have to wait 48 hours after the doctors get the results, so the physician can first have a chance to talk to patients.

Quest research shows that 7 percent of negative test results never reach patients because of communications mix-ups, Cohen said. In another 14 or 15 percent of cases, tests are duplicated by other doctors because they don't have access to the original results. That can be remedied by a patient having test results on a phone and being able to forward them quickly to whomever he or she wants.

One exception for Gazelle: It will not be used to transmit seriously bad news, such as testing positive for cancer or the HIV virus. ``That's best told by a professional,'' Cohen said.

Quest surveys show that patients who see test results -- cholesterol and blood sugar levels -- are more likely to be motivated to take better care of themselves.

That makes sense to Bernd Wollschlaeger, a North Miami Beach family physician and former president of the Dade Medical Association. ``I don't see any downside'' to the Quest program.

``We should be establishing collaborative care'' in which doctor and patient work together.

However, state statute 483.181 requires that lab results ``must be reported directly to the licensed practitioner or other authorized person who requested.''

An administrative code interpretation states: ``No report . . . shall be sent to the patient concerned except with the written consent of the authorized person who requested the test.''

A Quest spokesman said the company has software that allows doctors to forward Quest results to patients, which Florida doctors could use if they want.

Robbins, the Mercer consultant, said it's important that patients get the information to go along with the tests -- for example, what a number for platelets really means. ``Hopefully these results will be in conjunction with discussions with doctors.''

Robbins said a blood test ``is really a snapshot of when the blood was drawn,'' and it's often important that a result be compared with other results, which ideally would be kept in an electronic personal health record.

Wheeling, the retired psychologist, said she would love to see faster reporting on all sorts of tests because of the anxiety in waiting for results. She recalled going to the hospital for a scan to see if cancer had returned. The test showed it had not, but it took her a week to learn that.

``I think somebody at the hospital looked at the scan and could have told me within minutes,'' Wheeling said. ``The wait is totally unacceptable.''

Health Care Cost Control

I highly recommend reading this article describing a strategy called " health-care hot-spotting " to lower health care costs.
This requires dedicated family physicians collaborating in health care delivery teams utilizing medical information technology tools.
As physicians we should learn how to benefit from cost-control.
Looking forward to your feedback.

ABSTRACT: MEDICAL REPORT about innovative approaches to reducing health-care costs. Writer tells about Jeffrey Brenner, a physician in Camden, New Jersey, who has used data mining and statistical analysis to map health-care use and expenses. His calculations revealed that just one per cent of the hundred thousand people who made use of Camden’s medical facilities accounted for thirty per cent of its costs. That’s only a thousand people—about half the size of a typical family physician’s panel of patients. In his experience the people with the highest medical costs—the people cycling in and out of the hospital—were usually the people receiving the worst care. If he could find the people whose use of medical care was highest, he figured, he could do something to help them. If he helped them, he would also be lowering their health-care costs. Describes his work with those high-use patients, which led to the creation of the Camden Coalition of Healthcare Providers. By late 2010, his team had provided care for more than three hundred people on his “super-utilizer” map. The Camden Coalition has been able to measure its long-term effect on its first thirty-six super-utilizers. They averaged sixty-two hospital and E.R. visits per month before joining the program and thirty-seven visits after—a forty-per-cent reduction. Their hospital bills averaged $1.2 million per month before and just over half a million after—a fifty-six-per-cent reduction. These results don’t take into account Brenner’s personnel costs, or the costs of the medications the patients are now taking as prescribed, or the fact that some of the patients might have improved on their own (or died, reducing their costs permanently). The net savings are undoubtedly lower, but they remain, almost certainly, revolutionary. Writer visits the offices of Verisk Health, a data-mining company, which supplies “medical intelligence” to organizations that pay for health benefits. Besides the usual statisticians and economists, Verisk recruited doctors to dive into the data. One of those doctors, Nathan Gunn, guides the writer though the way data mining can be used to identify the most frequent users of health-care facilities and reduce their costs. Writer also visits the Special Care Center, a clinic in Atlantic City, which houses an experimental approach to primary care. Tells about the Center’s leader, Rushika Fernandopulle, and the intensive outpatient care for complex high-needs patients that the Center provides. In addition to physicians and nurses, the Center employs eight full-time “health coaches,” who help patients manage their health. Fernandopulle carefully tracks the statistics of the Center’s twelve hundred patients. After twelve months in the program, he found, their emergency-room visits and hospital admissions were reduced by more than forty per cent. Surgical procedures were down by a quarter. The patients were also markedly healthier. Considers difficulties in implementing these and other innovative ideas on a larger scale, including possible opposition from insurance companies and the health-care lobby.

Saturday, January 15, 2011

Doctors and Guns

Attached a link to an article reporting that state Representative Jason Brodeur (R-Sanford) and State Senator Greg Evers (R-Baker) introduced a legislative proposal ( HB 155 which would make it a felony for a physician or staff member to ask patients or family members of patients if they own guns or store guns at home. If found guilty, the medical provider could be fined up to $5 million or face up to five years in jail.
I hope that I do not go too far to call this measure INSANE and hope that we speak up strongly against it!!
When do our legislators stop stepping in between us and our patients? I wholeheartedly agree with Dr. Scott Needle from Naples who said “Pediatricians have a right and a responsibility to ask appropriate questions as to a child’s safety and well-being, even if these questions might be uncomfortable to the parents. Likewise, however, no parent can be legally compelled to answer such questions.”


New measure would bar doctors from asking patients if they own guns:

TALLAHASSEE — Doctors and other medical providers in Florida would be barred from asking patients — or the parents of child patients — if they have guns in their home under a measure that promises a major showdown between powerful lobbying groups.

The National Rifle Association’s top Florida lobbyist and a Florida Medical Association member both say the issue is among the top priorities for the upcoming legislative session, with the groups holding diametrically opposed positions on what doctors and their patients and families should be allowed to discuss during a medical visit.

Sponsored by state Rep. Jason Brodeur, R-Sanford, the bill (HB 155) would make it a felony for a physician or staff member to ask patients or family members of patients if they own guns or store guns at home.

If found guilty, the medical provider could be fined up to $5 million or face up to five years in jail.

State Sen. Greg Evers, R-Baker, introduced an identical Senate version of the bill on Thursday.

Gun rights groups say the measure was prompted by complaints from gun owners following an incident last summer in which an Ocala-area physician told a couple to find a new pediatrician after they refused to answer questions about whether they had guns in their home and how they were stored.

Marion Hammer, executive director of United Sportsmen of Florida and a former national NRA president, said the gun rights groups have no opposition to a physician’s office handing out brochures on gun safety, but the direct questioning on whether there are guns in the home of a patient and how they store them goes too far.

“Simply, it’s none of their business,” Hammer said.

Critics of the measure say it inappropriately puts a wedge between doctors and their patients by restricting what can be discussed. They say questions regarding gun ownership and how weapons are secured within homes are much like a pediatrician asking the parents of a child if their electric outlets have protective covers, or whether their pool is fenced in.

“No other area of physician inquiry has been deemed off-limits by the Legislature,” said Naples pediatrician Scott Needle.

“Pediatricians have a right and a responsibility to ask appropriate questions as to a child’s safety and well-being, even if these questions might be uncomfortable to the parents. Likewise, however, no parent can be legally compelled to answer such questions.”

Saturday, January 08, 2011

Escalating Health Insurance Premiums

A recent AMA News article highlights the increase of employer based health insurance premiums even BEFORE the so called "ObamaCare" was enacted by Congress and signed into law. One of California's largest health insurers - Blue Shield - announced plans to hike its premiums by as much as 59%. The jacked up premium rates are set to take effect on March 1, pending review from state insurance regulators. The move impacts 193,000 individual Blue Shield policy holders. The company, a member of the Blue Cross Blue Shield Association with 3.3 million members, which announced the move late Thursday, stressed that its decision has "almost nothing to do with the federal health reform law" and that ultimately the law will help slow down health care costs. But responding to this most recent increase the company said, "our individual market medical costs are rising rapidly due to higher provider prices, increased utilization, and the fact that healthier people are dropping coverage during a bad economy," the company said.
These are FACTS but, unfortunately, many are using FICTION to twist the reality claiming that the new health care law triggers a premium increase even BEFORE most of its components will be in effect in 2014.



Health premiums leap 41% from 2003

Between 2003 and 2009, employer-based premiums for family health insurance coverage rose an average 41%, according to a Commonwealth Fund report released Dec. 2. Delaware saw the lowest increase at 21%, and Louisiana experienced the highest jump at 59%.

Although health insurance is becoming increasingly unaffordable for families, the report concluded that provisions in the Patient Protection and Affordable Care Act could help reverse the unsustainable increases. If implemented properly, provisions of the health reform law -- including tax credits for small businesses, dependent coverage for young adults up to age 26 and elimination of co-payments for preventive care -- could ensure that patients continue to see their physicians, the study said.

AMA Leads The Efforts to align e-Prescribing and EHR Implementation

ttached a link to a very interesting article published in the recent AMA News edition entitled, "Revise unfair e-prescribing policy, doctors say."
The American Medical Association and more than 100 other state and specialty medical societies are urging the Dept. of Health and Human Services to revise a Medicare e-prescribing policy that slaps doctors with a financial penalty in 2012 if they don't meet specified e-prescribing criteria during the first six months of 2011.Physician practices need to meet certain e-prescribing criteria during at least 10 office visits between Jan. 1 and June 30, 2011, according to the final rule. Physicians who don't must pay the government a penalty equal to 1% of all of their Part B earnings in 2012.
AMA leaders believe the penalty is unjustified, and they want CMS to change it.
"The last-minute decision to require e-prescribing in 2011 will force physicians to spend additional financial and administrative resources to purchase e-prescribing software that most of them will end up discarding when they transition to a complete EHR system," said AMA Secretary Steven J. Stack, MD.
Compounding the issue further is that the law prohibits physicians from receiving incentives from both the Medicare e-prescribing and the meaningful use program for electronic medical records. The AMA and other physician organizations believe the new e-prescribing regulations are duplicative because the EMR incentive program already contains an e-prescribing component.
Consequently, many physicians who decided to forgo purchasing an e-prescribing tool in favor of an EMR system could be left trying to catch up to e-prescribing requirements in early 2011.
So what can be done?
1.Physicians want CMS to extend the reporting period so it includes the first 10 months of 2011.
2.Doctors want CMS to add more exception categories consistent with recommendations made when the proposed rule came out this summer. For example, physicians who attest to meaningful use in 2011 or 2012 should be exempt from penalties associated with the program.
I hope that these reasonable adjustments can be implemented to ease the EHR transformation.


Sunday, January 02, 2011

The End To Public Hospitals

Attached a link to an interesting article published in the Miami Herald reporting that the governor-elect's transition team has recommended creation of a panel to study whether government-owned hospitals -- Miami-Dade's Jackson Health System and Broward's two hospital districts among them -- are necessary. Rick Scott has promised to run the government like a business and government support for hospital does not fit into his ideological paradigm.
But, as the Sun Sentinel reports in an article today, " .. companies exist to make profits, while governments are charged with performing services for a wide variety of people, including the needy."
I guess Rick Scott is used to firing people and thinks that we can just "fire" 500,000 Uninsured in Miami-Dade County too. Meanwhile, the State of Florida has failed so far to deliver promised Medicaid reforms, and stands to lose $350 million in special funding from the federal government unless it can get an extension of a waiver! These funds, called the Lower Income Pool, are crucial to Jackson Memorial fiscal survival, which received $258 million from the pool last year. But Rick Scott wants to keep distance from the federal government and we can kiss this waiver good-by too. Furthermore, in his ideological world the Unemployed are also at fault for their own calamity and need to shape up or commit themselves to community services. But how can they afford healthcare if they have no access to public healthcare services, no job and no money to pay the escalating healthinsurance premiums? I see those patients every single day. Hard working, decent American citizens abandoned by their own government! Guess, Rick Scott also indulges in nostalgic reminiscence of the "good old times" before government helped to protect workers from exploitation by industrialists, abolished child labor and unions successfully struggled for fair wages.
We definitely should not let him to drag our State backwards. We must save Jackson Memorial hospital and preserve our already strained public health system.