Sunday, October 30, 2011

Drug Treatment Instead Of Prison

Attached a link,0,3676874.story to an interesting editorial published in today's Sun Sentinel titled " State prisons need drug treatment alternative." The Sun Sentinel Editorial Board supports legislation — CS/HB 177 and SB 448 — which intends to establish a re-entry program for nonviolent offenders that offers intensive substance abuse treatment, adult education courses and vocational training as alternatives to long prison sentences. The idea is to reduce recidivism, which is essential if state officials want to get a handle on the costs of incarceration. The bills are sponsored by State Sen. Ellyn Bogdanoff, R-Fort Lauderdale, and State Rep. Ari Porth, D-Coral Springs. The two lawmakers are trying to pass needed, positive legislation to help the state of Florida reduce the costs of operating its prisons. In my opinion we should support this legislation and begin lobbying members of the Florida House and Senate. E-mail, twitter, mail or call your representative because " Unlike prison privatization and the more controversial ideas to cut state prison costs, the re-entry program is a simple solution that promises both savings and a much-needed reduction in the state's ongoing recidivism problem." Yours Bernd

Substance Abuse Counseling and Preventive Health Care

Attached a link to an interesting article titled "Counseling on alcohol helps patients and is billable" published in AMA News and posted on October 17th, 2011. Several highlights:

* Since early 2011, many commercially insured patients have been able to receive alcohol counseling paid at 100% with no co-pay or deductible, and the same is expected to be true for Medicare beneficiaries as of Jan. 1, 2012.
* Just asking about alcohol abuse will not necessarily lead to reimbursable payment, but treating those who screen positive most probably will. In addition to the usual fee-for-service, other incentives on the table should further make dealing with the issue more financially feasible for practices and make it more likely that patients will enter treatment.
* Tracking the percentage of adolescents and adults with new episodes of alcohol or other drug dependence who initiate treatment is on the list of eligible professional measure specifications from the Centers for Medicare & Medicaid Services.
* Information should be noted in the patient's chart, along with the time spent on this task. Counseling sessions longer than 15 minutes are billable, but shorter ones are not.
* On July 19, CMS issued a proposed decision memo stating that, as of Jan. 1, 2012, Medicare will cover annual alcohol misuse screening. (A final decision has not yet been made.) Under the proposal, Medicare would pay for four brief, face-to-face behavioral counseling interventions a year. The American Medical Association and other medical societies support his move.
* In addition, alcohol misuse screening and counseling is on the list of preventive services that non-grandfathered health plans must cover at 100% with no deductible or co-pay, according to the Patient Protection and Affordable Care Act. Grandfathered health insurance plans are those that have not changed since the health system reform law was enacted. Non-grandfathered ones are new policies issued after Sept. 23, 2010, and must cover a recommended list of preventive services with no cost-sharing with patients.
* When billing private insurers, the CPT codes are 99408 for an intervention lasting 15 to 30 minutes. An intervention longer than 30 minutes should be coded 99409. H0049 is the code for alcohol and drug screening of Medicaid beneficiaries. H0050 can be used for every 15 minutes of intervention. The services can be provided by a nurse practitioner or physician assistant as well as a physician.


Wednesday, October 26, 2011

Drug Testing Halted

Attached a link to another article titled "Florida's welfare drug testing halted by federal judge" reporting that A federal judge in Orlando on Monday temporarily blocked Florida’s controversial law requiring welfare applicants be drug tested in order to receive benefits. Judge Mary Scriven issued a temporary injunction against the state, writing in a 37-page order that the law could violate the Constitution’s Fourth Amendment ban on illegal search and seizure.Gov. Rick Scott, who signed the measure into law on May 31, touted it as a way to ensure taxpayer money isn’t “wasted” on those who use drugs. “Hopefully more people will focus on not using illegal drugs,” he said then.
But, in her order, Scriven issued a scathing assessment of the state’s argument in favor of the drug tests, saying the state failed to prove “special needs” as to why it should conduct such searches without probable cause or reasonable suspicion, as the law requires. “If invoking an interest in preventing public funds from potentially being used to fund drug use were the only requirement to establish a special need,” Scriven wrote, “the state could impose drug testing as an eligibility requirement for every beneficiary of every government program. Such blanket intrusions cannot be countenanced under the Fourth Amendment.”
Fortunately, our legal system still provides protection against the growing government intrusion in our lives spearheaded by a conservative majority in our legislature. We need to continue to push back the growing number of bills threatening not only the practice of medicine but also the freedoms each and every citizen is entitled to.

Florida Prescription Drug Monitoring Program

Attached a link to an interesting article in USA Today titled "States target prescriptions by 'pill mills'" highlighting the Florida painmill problem, the actions taken to combat this issue which include the Prescription Drug Monitoring Program ( PDMP) . We should be ware that the death rate from oxycodone in Florida increased 265% from 2003 to 2009, the CDC found. By 2009, the number of deaths involving prescription drugs was four times the deaths involving street drugs, the CDC said in a July report. Hopefully, the number will decrease but this requires our active participation and support INCLUDING our use of the just recently launched PDMP, or E-FORCSE.
I am using this program now for the last week and am pleased to report that it truly works! For example, I have implemented a protocol which requires that the prescription record of each and every patient who receives a controlled substances has to be crosschecked with the medication listed on E-FORCSE.
I have already discovered that several of my patients did not inform me that they visit different physicians to receive controlled substances. One patient who is currently being treated with Suboxone received prescriptions for a total of 360 Hydrocodone pills from another MD "specializing" in pain management. I called her and she was very surprised to find out that I knew what she was prescribed. She tried to convince me that she only fills these scripts for "psychological reasons" but is not taking but hoarding them at home. I asked her to come to my office for a follow-up visit including drug testing but she never showed up. I suspect that she may sell, or share this medications with others.
I urge you to obtain your username and password and to incorporate this valuable tool into your practice.

Saturday, October 01, 2011

The number of Uninsured continue to soar!

Attached you find a link to an excellent article article by John Dorschner published in today's Miami Herald titled " More in S.Florida going uninsured" focusing on the soaring numbers of uninsured even in middle-class suburbs." The facts are indeed stunning and sobering:

"The data shows that almost a third — 31.2 percent — of adults aged 18 to 64 in the Kendall area, a middle-class suburb, were uninsured in 2010, up from 19.6 percent in 2008.
Those grim numbers reflect South Florida’s recent economic struggles that have driven up unemployment and forced many small employers to drop insurance coverage, said Steven Ullmann, a health policy expert at the University of Miami. The figures are part of a larger trend of growing numbers of uninsured and shrinking alternatives for the poor throughout Miami-Dade and Broward counties."

"The Kendall uninsured numbers — 50 percent higher than national figure for the same 18-to-64 age group — are “a reflection of everything the economy has been through,” Ullmann said. “It’s becoming an issue nationwide, but it’s reflected even more so in our local economy.”

"The Census data, released last month, shows 31.8 percent of Miami-Dade’s residents of all ages were uninsured in 2010. In Broward, it was 24 percent. In Monroe County, 32 percent — compared with a national average of 16.3 percent."

"A stunning 57 percent of Hialeah residents in that age group were uninsured in 2010, up from 53 percent in 2008.
In the City of Miami, 50.4 percent of 18-to-64-year-olds were uninsured, compared to 45.8 percent in 2008. In Deerfield Beach, 48.5 percent were uninsured, compared to 33.6 percent in 2008. In Miami Gardens, it was 39.9 percent, compared to 35.2 percent in 2008, while Miami Beach registered very little change, with 35 percent, compared to 35.8 percent in 2008. Weston continues to be the place in South Florida with the lowest rate of uninsured residents in the 18-to-64 age group, with 17.9 percent, compared to 13.8 percent in 2008."

The poor are also getting squeezed, says Ullmann. Many of them can qualify for Medicaid, the state-federal program for the poor, but Ullmann notes that as the state’s budget shrinks, legislators have been trying to reduce the program by lowering payments and forcing patients into health maintenance organizations."

Unfortunately, these numbers are not going to change and may even worsen. Many of those who are lucky enough to find a job are NOT offered health insurance because health insurance premiums for employer-provided health insurance jumped 8-9 percent in 2011, passing $15000 for family coverage!
As a result more people seek health care in emergency rooms driving up the costs even further, because those with insurance are paying the share for those who don't, or cannot, pay. Meanwhile, politicians are still engaged in trench warfare to fight off "Obamacare."
We must face reality and find solutions to this problem. One of them would be a countywide effort to create a network of primary care clinics offering a Patient-Centered Medical Home (PCMH) coordinating medical care. Such a network could be financed by grants and federal subsidies. The costs of such care would be substantially lower compared to the emergency room services provided. For example, one of my asthma patients has utilized the emergency room 2-4 times per month for treatment and medication refills. He is now enrolled in a chronic disease management program and has used the ER only once in two years.
I hope that common sense will prevail. Otherwise, we are going to face a very bleak future.