Florida Docs Blog

Immaculate Conception

2012-02-12T23:05:00.001-05:00

The uproar about birth control coverage by insurance companies not only points out the friction between freedom to choose birth control and religious liberties but also the fallacy of our employer-based healthcare system.Yes, I defend religious freedom but I question the authority of religious institutions to impose their morality on others. I understand that bishops and priest do not have to worry about the impact of contraception on their families but I do. Maybe I should not speak up because I am a Jew but I vigorously defend the right of catholic women (and men) to choose the most suitable form of birth control. According to a study by the Guttmacher Institute three quarter of sexually active women of modest means, ages 18-34, said that they could NOT afford a baby BUT thirty percent had put off a gynecological or family planning visit to save money. For those still using an oral contraceptive, one quarter skipped their daily pill to safe money. The cost of birth control is one reason why poor women are more than three times as likely to have unintended pregnancies. We all pay for this failed approach to family planning! Every dollar the U.S. government spends on family planning reduces Medicaid expenditures by $3.74!!If each employer (such as the catholic church and other affiliated institutions, can reserve the right to raise "moral objections" to almost each and every aspect of a broad-based healthcare coverage then we are in real trouble! Whats next? Infertility treatment, already covered only by a quarter of health insurance companies, may be next. Whats about erectile dysfunction treatment for seniors? Treatment for gender identity problems in teenagers? Maybe some orthodox Islamic or Jewish employers will not pay for treatment in clinics that do not provide sex-segregated waiting rooms, or only male gynecologists. Maybe some employers object to gay doctors on moral grounds?In these times of a religiously and ideologically based culture war anything is possible! When will it stop?Well, there is one solution! A single-payer system funded by the tax payer in which each recipient receives a benefit card to CHOOSE healthcare coverage from any doctor, clinic, hospital, emergency room of their choice! Wow, free choice! What an outrageous thought!I hope that more will speak up against the Ayatollization of our society. Yes, I am for religious freedom but priest, rabbis and imans should confine their morality to their respective church, temple or mosque and leave it up to us to make moral choices!YoursBernd

United Healthcare and Payment reform

2012-02-10T23:24:00.001-05:00

Attached a link http://online.wsj.com/article/SB10001424052970203315804577211660010608608.html to an interesting article published in the Wall Street Journal titled " New Way to Pay Doctors: UnitedHealth, Nation's Largest Insurer, Is Latest to Announce Fee Overhaul."According to the article " Under the new plan the carrier is rolling out, part of medical providers' compensation could be tied to goals such as avoiding hospital readmissions and ensuring patients get recommended screenings. UnitedHealth has been trying such efforts on a more limited scale, but now the company says it plans to roll out new contracts nationwide that could include financial rewards for care the company considers high-quality and efficient, and in some cases potentially withhold expected increases if certain standards aren't met."Under an aggressive projection, costs could amount to as much as $3.27 per member a month by 2015, with savings as high as $7.80, the documents said. Using a less-aggressive scenario, the company said, the costs could amount to 46 cents, and the savings to $1.35, per member a month.Much of the cost under both projections wouldn't be locked in, since it would be tied to bonuses that providers would get only if they hit certain goals; indeed, those payments may be calculated as a share of the overall savings achieved. According to the released information pieces of the new payments may be in lieu of increases to traditional fees.Driving the payment reform is the growing realization that the current health-care payment system, with its fees for each service, is flawed. The current system entices quantity but no quality and a value-based reimbursement system would stire healthcare towards prevention, quality and outcome oriented care. Donald Berwick, former administrator of the Centers for Medicare and Medicaid Services, said the initiative "looks promising," but it would be important for the incentives to be strongly enough tied to quality and patient-satisfaction measures, in addition to efficiency goals, to "ensure there's no skimping" on care.In a description of some of its pilot programs, the carrier mentioned potential bonuses of $1 to $3 per member a month for primary-care physicians. For a different provider setup, called accountable care organizations, the document said the bonuses could amount to $1 to $5 per member a month. Accountable care organizations can be built around hospitals or doctor groups, and they generally involve a provider taking overall responsibility for a group of patients.UnitedHealth also said it could offer "clinical integration" fees for providers that make changes aimed at better tracking patients' conditions and coordinating their care. This would include the model known as "patient-centered medical homes," which are typically set up by primary-care doctors, but the fees could also be available to other providers making similar efforts.In my opinion physicians can and should play a proactive role in the payment reform initiative. We have to reorganize our practices , implement efficiency measurements and form groups organized along the Patient-Centered Medical Home concept. We cannot expect that insurance companies will provide us with the panacea for our economic woes. Now is the time to act!YoursBernd

The Business of Medicine

2012-01-23T22:33:00.001-05:00

Attached a link http://www.miamiherald.com/2012/01/22/2601913_p3/hospitals-hiring-doctors-to-get.html to an interesting article written by John Dorschner titled "Hospitals hiring doctors to get ready for reform" highlighting the growing trend of hospitals purchasing physicians practices.Its of interest to note that executives at Baptist and Holy Cross say " the physicians’ practices on their own do not break even after being purchased, but ancillary income from such measures as diagnostic tests boost the bottom line." But more diagnostic tests and procedures also means more health care expenditures! At Jackson Health System, Miami-Dade’s public hospitals, the unaudited financial statements for fiscal 2011 show that the doctors’ practices lost $4.4 million!One employed physician argues that he likes this arrangement because he doesn’t have to spend time dealing with all the business aspects of a private practice. But understanding the business of medicine is exactly what we need to prevail in the rapidly changing health care environment.We cannot pretend that we can practice medicine in splendid isolation and to leave the "dirty" business to others. That's a prescription for certain marginalization and disempowerment. We must acquire knowledge and skills to master the business of medicine in order to practice medicine more efficiently.What do you think?YoursBernd

Why We Need The Individual Mandate

2012-01-13T22:22:00.001-05:00

Attached a link http://www.rwjf.org/files/research/20120112qs70onepager.pdf to an interesting study by the Urban Institute of the Robert Wood Johnson Foundation titled "Eliminating the Individual Mandate: Effects on Premiums, Coverage, and Uncompensated Care," analyzing the different scenarios resulting from the elimination of the individual mandate.Under the Patient Protection and Affordable Care Act (ACA) passed by Congress, most Americans will be required to be covered by health insurance or pay a penalty—the so-called individual mandate. The legality of this feature is being debated in the courts.These Urban Institute authors estimate the effects of the ACA and the individual mandate, as well as various levels of exchange participation, using a model that simulates decisions of individuals and businesses in response to policy changes. Exchange enrollment is viewed as necessary to reduce adverse selection, or the likelihood of only the sickest choosing to be insured.The researchers found that without the individual mandate: Between 40 and 42 million would remain uninsured as opposed to 26 million with the mandate; Private coverage would fall 11 million, covering 4 million fewer people than it would have without reform; Uncompensated care spending would be much higher due to the increased number of uninsured; Individual premiums in the health benefit exchanges would increase by 10 percent in a scenario assuming high exchange participation and by 25 percent with a low participation scenario. Removing the mandate from the ACA while expanding Medicaid eligibility would decrease the number of people with private coverage by 3.6 million. Uncompensated care would increase by $20 billion.I strongly recommend reading this study which provides clear and convincing arguments in favor of the individual mandate.YoursBernd

Health Insurance

2012-01-13T01:18:00.001-05:00

Attached a link http://meps.ahrq.gov/mepsweb/data_files/publications/st354/stat354.pdf to a very interesting federal study titled "The Concentration and Persistence in the Level of Health Expenditures over Time: Estimates for the U.S. Population, 2008-2009" published by the Center for Financing, Access, and Cost Trends of the Agency for Healthcare Research and Quality. Using information from the Household Component of the Medical Expenditure Panel Survey (MEPS-HC) for 2008 and 2009, this report provides detailed estimates of the persistence in the level of health care expenditures over time. Studies that examine the persistence of high levels of expenditures over time are essential to help discern the factors most likely to drive health care spending and the characteristics of the individuals who incur them.According to the study in 2008, 1 percent of the population accounted for 20.2 percent of total health care expenditures, and in 2009, the top 1 percent accounted for 21.8 percent of the total expenditures with an annual mean expenditure of $90,061. The lower 50 percent of the population ranked by their expenditures accounted for only 3.1 percent and 2.9 percent of the total for 2008 and 2009 respectively. Of those individuals ranked at the top 1 percent of the health care expenditure distribution in 2008, 20 percent maintained this ranking with respect to their 2009 health care expendituresIn both 2008 and 2009, the top 5 percent of the population accounted for nearly 50 percent of health care expenditures.Individuals who were between the ages of 45 and 64 and the elderly (65 and older) were disproportionately represented among the population that remained in the top decile of spenders for both 2008 and 2009. While the elderly represented 13.2 percent of the overall population, they represented 42.9 percent of those individuals who remained in the top decile of spenders.Focusing on the under age 65 population, health insurance coverage status also distinguished individuals who remained in the top decile of spenders from their counterparts in the lower half of the distribution. Individuals who were uninsured for all of calendar year 2009 were disproportionately represented among the population that remained in the lower half of the distribution based on health care spending. While 15.5 percent of the overall population under age 65 was uninsured for all of 2009, the full-year uninsured comprised 25.9 percent of all individuals remaining in the bottom half of spenders (figure 6). Alternatively, only 3.6 percent of those under age 65 who remained in the top decile of spenders were uninsured.What can we learn from the data and how should the data influence public policy? We are spending a disproportionally high percentage of precious healthcare dollars on a very small percentage of sick people.Most of them suffer from preventable chronic diseases which we still cannot manage properly within our existing healthcare system. The overwhelming majority of those "high" spenders were insured and there annual mean expenditure of $90,061 are not covered by the healthcare premiums they pay. The overwhelming majority of healthy "low" spender are uninsured and therefore do not contribute with their health insurance premium payment to cover for their eventuality of their own care needs.Taking all of these facts into consideration we should support an individual mandate that requires health insurance coverage for each and every American to spread the insurance risk. Spreading the risk assures that as the number of people in a given group gets larger, a company or governmental agency can more easily spread the risk (that would be the risk of a payout) among the pool of participants. They can therefore better estimate the average cost (or payout) per person in the event that one or even several of the group are victims of a catastrophic event. In the absence of such a mandate insurance companies can simply not afford to continue paying 50% of health care expenditures on 5% of the population!!!Alternative proposals to create high-risk pools are doomed to fail because the risk to cover "sick" participants is so high that it results in unaffordable health insurance premiums by private insurance companies. If those companies choose to opt out of providing insurances for such a high-risk pool then the government remains the insurer of the last resort, i.e the tax payer.YoursBernd

US Healthcare Costs

2012-01-08T22:48:00.001-05:00

According to the latest edition of "Health at a Glance" http://www.oecd-ilibrary.org/social-issues-migration-health/health-at-a-glance-2011_health_glance-2011-en published by the Organization for Economic Co-operation and Development (OECD) The United States stands out as performing very well in the area of cancer care, achieving higher rates of screening and survival from different types of cancer than most other developed countries. The United States does not do well in preventing costly hospital admissions for chronic conditions, such as asthma orchronic obstructive pulmonary disease, which should normally be managed through proper primary care. Avoidable hospital admissions for asthma complications and chronic obstructive pulmonary disease (COPD) are much greater in the United States than the OECD average. For asthmaadmissions, the rate in the United States was 121 per 100 000 adults in 2009, more than two times greater than the OECD average of 52. For COPD, hospital admission in the United States was 230 per 100 000 adults, compared with an OECD average of 198. Regarding healthcare expenditures the United States spent 17.4% of GDP on health in 2009, much more than the OECD average of 9.6%. Spending per person is two-and-a-half times higher than the OECD average. Following the United States were the Netherlands, France and Germany, which allocated respectively 12.0%, 11.8% and 11.6% of their GDP to health.Is US health spending higher due to higher prices or higher service provision? (or both?)Facts:1) US prices for a set of hospital services is over 60% higher than the average of 12 OECD countries,2) US prices for certain procedures (including appendectomy,coronary angioplasty, coronary artery bypass graft, hip & knee replacement) are much higher than in other OECD countries,3) Almost DOUBLE the spending on Insurance administration expressed in terms of purchasing power parity.Its also of interest to note that in most countries, health spending is largely financed out of taxes or social security contributions, withprivate insurance or ‘out-of-pocket’ payments playing a significant but secondary role. This is not the case in the United States which, together with Mexico and Chile, is the only OECD country where the government plays the smallest role in financing health spending. The public share of health expenditure in the United States was 47.7% in 2009, much lower than the OECD average of 71.7%. However, the level of health spending in the United States is so high that public (i.e. government) spending on health per capita is greater than in all other OECD countries, except Norway and theNetherlands. For this amount of public expenditure in the United States, government provided in 2009 insurance coverage only for the elderly and disabled people (through Medicare) and some of the poor (through Medicaid and the State Children’s Health Insurance Program, SCHIP), whereas in most otherOECD countries this was enough for government to provide universal health insurance. Public spending on health in the United States has been growing more rapidly than private spending since 1990, largely due to expansions in coverage.Private insurance accounted for 33% of total health spending in the United States in 2009, by far the largest share among OECD countries. Beside the United States, Canada and France are the only two other OECD countries where private insurance represents more than 10% of total health spending.Conclusions: we are spending more for healthcare per person than in any other country in the world utilizing an inefficient private insurance model. But also public (i.e. government) spending on health per capita is greater than in all other OECD countries but fails to provide universal coverage.We must achieve a broad based consensus on how to efficiently allocate our healthcare resource to achieve high quality healthcare for all Americans.Tinkering on the edge will not provide us with a meaningful and sustainable solution. If we do not engage in such a dialogue now we will face rationing and further economic slowdown.YoursBernd

Medical Errors Awaiting Prevention

2012-01-08T00:11:00.001-05:00

Attached a link http://www.nytimes.com/2012/01/06/health/study-of-medicare-patients-finds-most-hospital-errors-unreported.html to an interesting article titled "Report Finds Most Errors at Hospitals Go Unreported" pointing out that according to recent federal study hospital employees recognize and report only one out of seven errors, accidents and other events that harm Medicare patients while they are hospitalized.According to the study, from Daniel R. Levinson, inspector general of the Department of Health and Human Services, some of the most serious problems, including some that caused patients to die, were not reported.The inspector general estimated that more than 130,000 Medicare beneficiaries experienced one or more adverse events in hospitals in a single month. Many hospital administrators acknowledged that their employees were underreporting injuries and infections that occurred in the hospital, he said. More often, Mr. Levinson said, the problem is that hospital employees do not recognize “what constitutes patient harm” or do not realize that particular events harmed patients and should be reported. In some cases, he said, employees assumed someone else would report the episode, or they thought it was so common that it did not need to be reported, or “suspected that the events were isolated incidents unlikely to recur.”The inspector general found that “hospitals made few changes to policies or practices” after employees reported harm to patients. In many cases, hospital executives told federal investigators that the events did not reveal any “systemic quality problems.”Organizations that inspect and accredit hospitals generally “do not scrutinize” how hospitals keep track of medical errors and other adverse events, the study said. The federal investigators did an in-depth review of 293 cases in which patients had been harmed. Forty of those cases were reported to hospital managers, and 28 were investigated by the hospitals, but only five led to changes in policies or practices, the study said.What are possible solutions?1) Train staff to report medical errors and to automatically flag those patients within an electronic health record for IMMEDIATE quality assurance review2) Utilize software which automatically triggers alerts for diagnoses and conditions including medication errors, severe bedsores, infections that patients acquire in hospitals, delirium resulting from overuse of painkillers and excessive bleeding linked to improper use of blood thinners.3) Deploy medical error prevention teams within hospitals to educate staff and to assist in the implementation of lessons learned from a root-cause analysis into the clinical practice.I am confident that we can achieve our goals to reduce medical errors and to save lives.YoursBernd

Medicaid Pilot Program in Florida

2012-01-07T23:36:00.000-05:00

Letter to the Editor published in Miami Herald, December 23rd, 2011Patients protectedThe Dec. 16 article State can expand Medicaid pilot program incorrectly stated that the federal government approved the expansion of the Medicaid pilot project. Actually, the extension of the five-county Medicaid pilot project was approved until 2014, but with significant improvements to the program.They include the denial of the medical-loss-ratio waiver requiring the participating private health plans to spend 85 percent of the funds on patient care and the denial of capping benefit levels for Medicaid beneficiaries, which prevents the termination of Medicaid services because recipients have already met their maximum.These requirements will protect patients from arbitrary insurance denials and will force private health insurance plans to manage the taxpayers’ dollars more efficiently and responsibly.We should continue to oppose any expansion of the pilot project unless the state of Florida can provide solid data that it improves access and enhances the quality of healthcare for all Medicaid enrollees.Bernd Wollschlaeger, MD,

ER, Dental Care and Medicaid

2011-12-17T22:26:00.002-05:00

I recommend reading an article published in today's Sun Sentinel titled "More patients turning to ERs for dental care" summarizing the findings of a study by the Florida Oral Health Coalition which found that more than 115,000 people went to the hospital last year for dental care that could have been prevented or done at a much lower cost in a dentist's office. That's up 9 percent since 2008. More than 15,500 of them were children. ERs charged $88 million for that dental care last year — $30 million to Florida's state-federal Medicaid program , the study found. Hospitals not reimbursed for the care likely pass on the cost to other patients through higher charges. The reliance on ERs for tooth care was even heavier in South Florida, with the number of ER visits up 32 percent in Broward County since 2008.To tackle the problem, the group suggests expanding services that can be offered by dental hygienists, raising Medicaid payments to attract more dentists, having Medicaid cover adult dental care, and expanding county health department dental clinics. But the recommendations would require more tax money at a time when state officials are trying to shrink the Medicaid budget.

Florida Medicaid Pilot

2011-12-17T00:31:00.000-05:00

On Thursday the federal officials agreed to extend Florida's five-county Medicaid managed-care experiment to 2014 but required the state to make significant improvements to the program. They include the denial of the medical-loss-ratio waiver requiring the participating private health plans to spend 85 percent of funds on patient care and the denial to cap benefit levels for Medicaid beneficiaries preventing the termination of Medicaid services because recipients had already met their $500,000 maximum for the year. These requirements will protect patients from arbitrary insurance service denials and will force private health insurance plans to manage taxpayers dollars efficiently and responsibly. Meanwhile, we should continue to oppose any expansion of the pilot project UNLESS the State of Florida can provide solid and indisputable data that the pilot project improves access and enhances the quality of care for all Medicaid enrollees. So far I have not found any evidence to substantiate Governor Scott's claim that "we've seen higher quality in administration of care, produced cost savings and consumers in the pilot have found improved access for Medicaid recipients."Looking forward to your feedback.YoursBernd For more information see:http://htpolitics.com/2011/12/15/feds-make-key-decisions-on-medicaid-and-health-insurance-for-floridianshttp://blogs.orlandosentinel.com/news_politics/2011/12/what-is-changing-in-florida-medicaid-maybe.html

The Sick Business of Medicine

2011-11-19T21:55:00.001-05:00

Attached a link http://www.miamiherald.com/2011/11/12/2499995/finances-strain-the-marriage-between.html to an interesting article by John Dorschner published in the Miami Herald titled "Finances strain the marriage between Jackson and the University of Miami" which details the increasingly strained relationship between Jackson Memorial Hospital and the University of Miami. At the center of the dispute are insured patients seeking medical care at Jackson Memorial hospital. UM critics claim that UM physician direct these patients to the UM hospital across the street, and that Jackson Memorial hospital is left with treating the uninsured patients. Miami-Dade taxpayers pay Jackson Memorial $330 million a year to treat uninsured people who seek treatment in the county-owned Jackson system. As part of the system that has evolved over the years, Jackson also pays UM when its doctors treat the uninsured at Jackson.UM critics also claim that once an uninsured patient gets insurance UM doctors are shifting their care to the UM hospital, which then receives the Medicare reimbursement money. UM calls that patient choice. Jackson counters that its paying patients shouldn’t be siphoned off to UM facilities.What troubles me is that patients are being considered as milkable cash cows and once they are loosing their production value they are being pushed back into Jackson Memorial Hospital. Its a sick system which encourages overutilization of medical services and drives up healthcare costs even further.YoursBernd

Health Care Cost Control

2011-11-13T23:11:00.001-05:00

"Unfortunately, few people really understand how much we spend on health care,how much we need to spend to provide quality care, and the difference between the two."The New York Times published three articles by Ezekiel Jonathan Emanuel,MD PhD focusing on how to control the escalating health care costs in the United States.I highly recommend reading the articles published so far and have attached the links to each article below. The following bullet points represent an excerpt of the arguments made in his articles:How much do we spent on health care in the United States?In 2010, the United States spent $2.6 trillion on health care, over $8,000 per American.The United States spends on health care alone what the 65 million people of France spend on everything: education, defense, the environment, scientific research, vacations, food, housing, cars, clothes and health care. In other words, our health care spending is the fifth largest economy in the world.For more than 30 years, health care costs have been growing 2 percent faster than the overall economy. That means every year we spend ever more on health care and therefore have to spend less on other things — or borrow money to pay for the extra health care. If we continue at this rate of growth, health care will be roughly one-third of the entire economy by 2035 — one of every three dollars will go to health care — and nearly half by 2080.This level of spending on health care is high, but is it worth it? Does it make us healthier?The United States spends around 20-30 percent more per person than the next highest-spending countries, Switzerland and Norway BUT the United States is not getting 20 or 30 percent better health care or results than other countries! As a country we are actually doing worse than a number of countries, like France and Germany, that spend considerably less! How do we spent our health care dollars and how can we start saving?In health care, you have to be talking about tens of billions of dollars before you are talking about real money. A useful threshold for savings is 1 percent of costs, which comes to $26 billion a year. Anything less is simply not meaningful.Cutting health insurance companies profits? Last year, health insurance companies did rack up big profits, but it turns out that the combined profits of the country’s five largest for-profit health insurance companies — United, WellPoint, Aetna, Humana and Cigna — were $11.7 billion, only 0.5 percent of total health care spending. Even confiscating every penny of those profits would add up to less than half of the cost-saving threshold.Cutting drug companies profits? Between 2004 and 2009, generic drug use rose from 57 to nearly 75 percent of all prescriptions. Paradoxically, over those same years, the total amount Americans spent on drugs actually increased by 31 percent — the same rate as overall health care expenditures. Even the best estimates suggest that savings from expanding generics’ use even further are, according to the Department of Health and Human Services, “likely to be small relative to total spending on drugs.” Pharmaceutical costs account for roughly 10 percent of total health care spending, some $260 billion in 2010. Importing brand name drugs from abroad would cut about 2 percent from that — $5 billion per year. Another cost control disappointment.Malpractice reform is the solution? In 2009, the Congressional Budget Office did a comprehensive assessment of the potential cost savings from medical malpractice reforms. Its conclusions: A package that included a $250,000 cap on noneconomic damages, a $500,000 cap on punitive damages and a one-year statute of limitations for claims by adults would save about $11 billion a year — 40 percent from reduced malpractice premiums and the rest in the form of fewer defensive procedures like M.R.I.’s. Frankly, $11 billion is not insignificant BUT at less than half the $26 billion threshold, malpractice reform is certainly not a cost savings magic bullet either.Restrict health care spending on exorbitantly expensive patients? An unpublished analysis of nearly 20 million commercially insured patients(provided to the author of the article) showed that there were only 255 patients who consumed over $1 million in 2010. Together they spent 0.5 percent of all costs — a very large number for so few patients, but just half the 1 percent threshold for cost-saving that matters. And not all of those costs could be saved.Are administrative services one of the biggest money wasters in our health care system? Administration accounts for roughly 14 percent of what the United States spends on health care, or about $360 billion per year. About half of all administrative costs — $163 billion in 2009 — are borne by Medicare, Medicaid and insurance companies. The other half pays for the legions employed by doctors and hospitals to fill out billing forms, keep records, apply for credentials and perform the myriad other administrative functions associated with health care. The range of expert opinions on how much of this could be saved goes as high as $180 billion, or half of current expenditures. But a more conservative and reasonable estimate comes from David Cutler, an economist at Harvard, who calculates that for the whole system — for insurers as well as doctors and hospitals — electronic billing and credentialing could save $32 billion a year. And United Health comes to a similar estimate, with 20 percent of savings going to the government, 50 percent to physicians and hospitals and 30 percent to insurers. For health care cuts to matter, they have to be above 1 percent of total costs, or $26 billion a year, and this conservative estimate certainly meets that threshold!!!How do we get to these savings? First, electronic health records would eliminate the need to fill out the same forms over and over. An electronic credentialing system shared by all hospitals, insurance companies, Medicare, Medicaid, state licensing boards and other government agencies, like the Drug Enforcement Administration, could reduce much of the paperwork doctors are responsible for that patients never see. Requiring all parties to use electronic health records and an online system for physician credentialing would reduce frustration and save billions.But the real savings is in billing. There are at least six steps in the process: 1) determining a patient’s eligibility for services; 2) obtaining prior authorization for specialist visits, tests and treatments; 3) submitting claims by doctors and hospitals to insurers; 4) verifying whether a claim was received and where in the process it is; 5) adjudicating denials of claims; and 6) receiving payment.Substantial costs arise from the fact that doctors, hospitals and other care providers must bill multiple insurance companies. Instead of having a unified electronic billing system in which a patient could simply swipe an A.T.M.-like card for automatic verification of eligibility, claims processing and payment, we have a complicated system with lots of expensive manual data entry that produces costly mistakes.The Affordable Care Act requires the Department of Health and Human Services to develop operating standards for electronic eligibility determination and payment — steps one and six — in the next few years, but we need to go further. We need the standard operating rules to encompass authorizing tests and treatments, submitting claims, verifying where in the process a claim is and the real-time adjudication of denials. And we must accelerate the process, covering all steps by 2015. Finally, the government needs to require that all parties — doctors, hospitals, insurers, government agencies — use the electronic systems.This platform of electronic eligibility, claims and payment would — in addition to saving billions of dollars in paperwork — facilitate anti-fraud measures like those used by credit card companies. It would ease the administrative burden on doctors, letting them do the work that really matters — treating patients. Finally, it could improve care through built-in guidelines; if a doctor tried to schedule a stent implantation for a patient with stable heart disease, the system could tell him to try medication first; if he tried to order an M.R.I for a patient with normal back pain, it could tell him to prescribe physical therapy first.We have to realize that there are no " magic bullets" to solve our health care cost crisis.Any solutions offered so far to provide universal health care coverage will fail UNLESS they are being combined with meaningful and sustained cost control measures. This requires a total reform of our reimbursement system transforming it from a quantity to a quality focused service industry utilizing state-of-the-art information technology tools. Unless we are not willing to change, we are going to be forced to further ration medical services. What do we prefer?YoursBerndLinks: Spending More Doesn’t Make Us Healthier, http://opinionator.blogs.nytimes.com/2011/10/27/spending-more-doesnt-make-us-healthier/ Less Than $26 Billion? Don’t Bother., http://opinionator.blogs.nytimes.com/2011/11/03/less-than-26-billion-dont-bother/ Billions Wasted on Billing, http://opinionator.blogs.nytimes.com/2011/11/12/billions-wasted-on-billing/#more-112339

Personhood Amendment

2011-11-03T00:21:00.002-04:00

On November 8th Mississippi voters will be asked to decide on a proposed amendment to the state constitution, which would define as a person “every human being from the moment of fertilization, cloning, or the functional equivalent thereof.” For most voters it sounds like a good idea and it will most probably pass. Therefore, several other states, including Florida http://personhoodfl.com/, are preparing similar constitutional amendments. Florida Senate Majority Leader and former US Senate Candidate Mike Haridopolos recently signed the FL Personhood Amendment!! The ambiguous language in the Florida and Mississippi 'personhood' amendment are intentionally not being represented properly by the proponents of this ballot initiative.A recent New York Times article http://www.nytimes.com/2011/10/31/opinion/mississippis-ambiguous-personhood-amendment.html correctly points out the following problems:"First, what does “fertilization” mean? As embryologists recognize, fertilization is a process, a continuum, rather than a fixed point. The term “fertilization” — which is sometimes considered synonymous with “conception” — could mean at least four different things: penetration of the egg by a sperm, assembly of the new embryonic genome, successful activation of that genome, and implantation of the embryo in the uterus. The first occurs immediately; the last occurs approximately two weeks after insemination (or, in the case of embryos created through in vitro fertilization that do not get implanted, never). Thus, on some reasonable readings of the amendment, certain forms of birth control, stem cell derivation and the destruction of embryos created through in vitro fertilization would seem impermissible, while on other equally reasonable readings they are not." Following the "logic" of the "personhood" advocates doctors can be charged with manslaughter or even murder by prescribing morning after pills, because it can irritate the lining of the uterus (endometrium) so as to inhibit implantation of a fertilized egg, i.e. "killing a person."A doctor could also be criminally charged by inserting an IUD because it adversely affects a new embryo as it enters the uterus, thus preventing it from implanting in the uterine lining . Again, according to the "personhood" advocates this constitutes the "killing of a person."Even though, abortions are still being protected by federal law women may still face criminal charges according to state law.Other unintended consequences include the question if the treatment of an ectopic or a molar pregnancy requires first a court order to overrule a "personhood" amendment in the respective state constitution. Needless to mention that any delay of these time-sensitive treatment decisions may harm the mother and even jeopardize the life and well-being of a women.I urge all of you to speak up against any such ballot initiatives, to protect the physician-patient relationship and to guard against further state intrusion into our lives.YoursBernd

Drug Treatment Instead Of Prison

2011-10-30T23:02:00.003-04:00

Attached a link http://www.sun-sentinel.com/news/opinion/editorials/fl-prison-bill-editorial-dl-20111030,0,3676874.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."YoursBernd

Substance Abuse Counseling and Preventive Health Care

2011-10-30T22:50:00.002-04:00

Attached a link http://www.ama-assn.org/amednews/2011/10/17/bica1017.htm 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.

Yours
Bernd

Drug Testing Halted

2011-10-26T22:13:00.001-04:00

Attached a link http://www.miamiherald.com/2011/10/24/2470519/florida-welfare-drug-testing-halted.html 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.
Yours
Bernd

Florida Prescription Drug Monitoring Program

2011-10-26T22:00:00.001-04:00

Attached a link http://www.usatoday.com/news/nation/story/2011-10-13/pill-mill-drug-trafficking/50896242/1?loc=interstitialskip 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.
Yours
Bernd

The number of Uninsured continue to soar!

2011-10-01T23:31:00.000-04:00

Attached you find a link http://www.miamiherald.com/2011/09/30/2432980/uninsured-situation-worsens-in.html 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.
Yours
Bernd

The Legality of Online Health Care Discounts

2011-09-26T23:02:00.001-04:00

Attached you find a link http://www.baltimoresun.com/health/fl-hk-groupon-medical-20110925,0,6420216.story to an interesting article titled "Are Groupon discounts for medical treatments illegal?" highlighting an important issue: Those big discounts on health care treatments offered on websites like Groupon may be illegal, medical law experts say. Not for the patients but for the medical professionals giving them.
"The law is very strict. This seems like a problem," said Michael Segal, a South Florida health-care lawyer. "I would urge [practitioners] to be very careful. You don't want to find out there's a concern after you have done it."
A number of national and local medical associations, including the Palm Beach County Medical Society last month, have warned members because the issue is still in doubt. Florida regulators said they have not discussed it. Medicare has taken no position. Nor has the American Medical Association or other medical trade groups.

Yours
Bernd

Hospital Performance

2011-09-18T23:13:00.002-04:00

Attached a link http://www.nytimes.com/2011/09/15/us/hospital-performance-improved-report-finds.html to an interesting article titled "Report Finds Improved Performance by Hospitals," reporting that in the latest advance for health care accountability, the country’s leading hospital accreditation board, the Joint Commission, released a list http://www.jointcommission.org/assets/1/18/Top_Performers_2010_list_9_13_11.pdf on Tuesday of 405 medical centers that have been the most diligent in following protocols to treat conditions like heart attack and pneumonia. Almost without exception, most highly regarded hospitals in the United States, from Johns Hopkins in Baltimore to the Mayo Clinic in Rochester, Minn., did not make the list!

"With evidence-based ratings gaining prevalence, and a strengthening link between quality and payment, the Joint Commission report raised questions about how consumers should best use the data newly available to them. Increasingly, one component of that inquiry may be whether hospital reputations are deserved or mythologized."

"As an example, none of the 17 medical centers listed by U.S. News & World Report on its “Best Hospitals Honor Roll” this year are on the Joint Commission’s list of 405 hospitals that received at least a 95 percent composite score for compliance with treatment standards. About one-third of a hospital’s score in the U.S. News methodology is based on its reputation as gauged by a survey of physicians...the Joint Commission list of top performers included a disproportionate share of small and rural hospitals, as well as 20 Veterans Affairs medical centers. About 14 percent of roughly 3,000 eligible hospitals made the cut."

"As it is, both private and government health insurers are beginning to tie hospital reimbursements to quality measures like infection rates and readmissions. Next year, compliance with procedural standards will become even more consequential, as the Joint Commission plans to withhold accreditation from any hospital that posts a composite score below 85 percent."

This report serves as a reminder that payers will use this data to strengthen the link between quality and payment.
Therefore, physicians should consider adjusting their treatment protocols and quality measurements accordingly.

Yours

Bernd

Wollschlaeger et al vs. Farmer et al

2011-09-14T22:27:00.002-04:00

Court Grants Preliminary Injunction Against Physician Gag Law

Since Taking Effect, Unconstitutional Gag Law Had Chilled Speech by Florida Doctors

The Florida chapters of three national medical organizations, along with six physicians, applauded the decision of a federal district judge today to immediately block enforcement of the new state law that bars healthcare professionals from asking patients if they own guns and have them stored properly. These questions are a key element in the practice of preventive medicine.

The groups, along with individual doctors, had asked Judge Marcia Cooke of the U.S. District Court for the Southern District, Miami Division to issue a preliminary injunction because the new law has already curtailed the First Amendment rights of physicians across the state to speak with their patients about gun safety. A preliminary injunction is an order that prevents a party from pursuing a particular course of conduct until a case has been decided. To grant a preliminary injunction, the court must find that plaintiffs have a substantial likelihood of success on the merits of the case.

Lisa A. Cosgrove, M.D., FAAP, President of the Florida Chapter of the American Academy of Pediatrics (Florida Pediatric Society) said: “Pediatricians simply want to do what they do best: protect children. We hope that now we will be able to get back to working with parents to maintain their guns, pools and poisons to keep kids safe."

Dennis Mayeaux, MD, Chair, Board of Directors, Florida Academy of Family Physicians said: “The impact of this law has already caused serious rifts in physician-patient relationships. Casual conversations with patients often bring other medical issues to light, and erosion of these opportunities also erodes the quality of care. The preliminary injunction will now allow us to talk to our patients again about firearm safety.”

Stuart Himmelstein, M.D., American College of Physicians Governor for Florida, stated: "Reversing this law is essential in order to preserve the sanctity of the doctor -patient relationship by keeping the government out of the exam room. The preliminary injunction will preserve free speech between both doctors and patients as protected by the Constitution and which is necessary to obtain the highest of quality care that every citizen deserves."

Physicians and other healthcare professionals routinely provide their patients with information about a variety of health risks in the home and broader environment. Such preventive counseling has become a cornerstone in the practice of medicine and is recommended by numerous professional medical societies. In the course of practicing preventive medicine, healthcare professionals routinely ask and counsel patients about firearm safety.

The state chapters of the American Academy of Pediatrics, American Academy of Family Physicians, and American College of Physicians collectively represent more than 11,000 healthcare professionals in Florida. On June 24, 2011, these organizations, along with six individual physicians, filed papers asking the court to enjoin the law because it substantially curtailed their First Amendment rights to exchange information with patients about gun safety.

The lawsuit challenging the Physician Gag law was originally filed on June 6, 2011, shortly after Governor Scott signed it into law. Prior to filing suit, the physician groups urged the Governor to veto the legislation since it infringes the First Amendment rights of healthcare professionals throughout Florida.

The organizations and individual physicians in the lawsuit are represented by Ropes & Gray (lead counsel), Astigarraga Davis (local counsel), and lawyers from the Brady Center to Prevent Gun Violence’s Legal Action Project.

####

PDMP goes online!

2011-09-03T20:40:00.000-04:00

Attached a link http://www.miamiherald.com/2011/09/01/2385732/fla-prescription-data-base-goes.html to an article from today's Miami Herald titled " Fla. prescription database goes into operation" highlighting the fact that as of September 1st Florida's prescription drug tracking system finally was up and running. That means that dispensers and pharmacies must upload their prescription data for Schedule II to IV to the database. Rebecca Poston, the system's program director in the Department of Health said that "Everything is working wonderful, I have not heard of any glitches related to the dispensers registering or uploading information in the system."
The Department of Health will not begin registering doctors and pharmacists until Oct 1, nor will they be able to get information out of the database until Oct. 17. In my opinion the registration and training process should start now and be phased in either by region, or other criteria to be determined by the Department to allow for a smooth transition and to motivate doctors to use the system. Its not too late to do that but leaving it until October 1st is cutting it too short.
Yours
Bernd

United Health On The Move

2011-09-01T23:03:00.002-04:00

Attached a link http://online.wsj.com/article/SB10001424053111903895904576542553422509280.html to an article titled" UnitedHealth Buys California Group of 2,300 Doctors" reporting that United Healthcare will acquire the management arm of Monarch HealthCare, an Irvine, Calif., association that includes approximately 2,300 physicians in a range of specialties. This will establish United's Optum health-services unit as a formidable presence in California. Optum had previously taken over the management arms of two smaller southern California groups, AppleCare Medical Group and Memorial HealthCare Independent Practice Association.This serves as an example of how lines are blurring between insurance companies and health-care providers.
What can we do? Consider forming cohesive primary care and/or multi-specialty associations, utilizing EHR technology and based on the Patient-Centered-Medical-Home Model to compete in the rapidly changing healthcare marketplace.
We cannot ignore the writing on the wall. Change is inevitable!
Yours
Bernd

Pill Mills Under Pressure

2011-09-01T22:47:00.002-04:00

Attached a link http://www.nytimes.com/2011/09/01/us/01drugs.html to today's New York Times front page article titled "Florida Shutting ‘Pill Mill’ Clinics."
The article highlights the accomplishments made despite the initial resistance by the current administration in Tallahassee.:

As of July, Florida doctors are barred, with a few exceptions, from dispensing narcotics and addictive medicines in their offices or clinics. As a result, doctors’ purchases of Oxycodone, which reached 32.2 million doses in the first six months of 2010, fell by 97 percent in the same period this year.
One indication that law enforcement officials are choking the supply of prescription drugs sold illegally in Florida is that the price of Oxycodone on the streets here has nearly doubled from last year, to $15 per pill from $8.
On Commercial Boulevard, a major street in Broward County, the number of pain clinics has fallen in the past year from 29 to one.
The fallout from the tougher laws may include an increase in pharmacy robberies, a problem that has been worse in Florida than any other state since 2007 (there were 65 armed robberies of pharmacies here last year).

As of today any health care practitioner who has dispensed a Schedule II-IV controlled substance, as defined in section 893.03, F.S. (i.e., OxyContin®, Percocet®, Vicodin®, Klonopin®, Xanax®, and Valium®), is required to report dispensing information to the Prescription Drug Monitoring Program’s database within seven (7) days after dispensing, in accordance with section 893.055, F.S. This includes pharmacies licensed under chapter 465, F.S., and dispensing health care practitioners licensed under chapter 458, 459, 461, 462, or 466, F.S
Now we must push to start educate physicians on how to use the PDMP and to encourage accessing the database to identify "doctors shoppers."
I am optimistic that we can achieve our goals.
Yours
Bernd

Drug Testing for Welfare Recipients

2011-08-27T09:07:00.002-04:00

Attached some food for thought regarding the mandatory drug testing for welfare recipients:

When Florida Gov. Rick Scott (R) signed the law requiring welfare recipients to pass annual drug tests to collect benefits, he justified the likely unconstitutional law by saying it would save the state money by keeping drug users from using public money to subsidize their drug habits. Drug use, Scott claimed, was higher among welfare recipients than among the rest of the population.According to preliminary results from the state’s first round of testing, however, has seemingly proven both of those claims false. Only 2 percent of welfare recipients failed drug tests, meaning the state must reimburse the cost of the $30 drug tests to the 96 percent of recipients who passed drug tests (two percent did not take the tests). After reimbursements, the state’s savings will be almost negligible, the Tampa Tribune reports:
Cost of the tests averages about $30. Assuming that 1,000 to 1,500 applicants take the test every month, the state will owe about $28,800-$43,200 monthly in reimbursements to those who test drug-free.
That compares with roughly $32,200-$48,200 the state may save on one month’s worth of rejected applicants.
Net savings to the state: $3,400 to $5,000 annually on one month’s worth of rejected applicants. Over 12 months, the money saved on all rejected applicants would add up to $40,800 to $60,000 for a program that state analysts have predicted will cost $178 million this fiscal year.
This should serve as an example that our government in Florida seems to base its decisions on ideological assumption instead on rational thought and consideration.
Yours

Bernd

Bernd Wollschlaeger,MD,FAAFP,FASAM
16899 NE 15th Avenue
North Miami Beach,FL 33162
Phone: (305) 940-8717
Fax: (305) 940-8871
Web Site: www.miamihealth.com
Blog: http://floridadocs.blogspot.com
Twitter: http://www.twitter.com/dadedoc

Primary Care Defunded

2011-08-20T21:43:00.002-04:00

Attached you find a link to an article by John Dorschner titled "Clinics for poor threatened by cuts" http://www.miamiherald.com/2011/08/17/2366741/south-florida-clinics-threatened.html pointing out that " federal support of clinics [ community health centers] took a big hit in the recent deficit reduction deal in Washington and may be taking an even bigger one when Congress starts a new round of budget-cutting in the near future. At the same time, some free clinics in South Florida that also help the poor — often with little or no government support — are running out of funds and are in danger of closing."
Dorschner further reports that the creators of the federal healthcare reform act considered primary care such an important way to cut costs that the act authorized $11 billion to bolster care at “federally qualified health centers,” which include nine clinics with more than 30 locations in Miami-Dade and Broward. Congress authorized $1 billion for new federally qualified facilities or expansions of existing ones this year. But the $1 billion allocation was slashed to about $90 million for new facilities during the recent budget cuts. Only 67 of 2000 applications for new federally qualified centers were funded. More cuts may be coming as a new congressional deficit reduction committee gets under way.
In my opinion cutting primary care services is a penny-wise and pound-foolish decision . Now, those uninsured will be left with no other choice but to use the emergency rooms of local hospitals for their care resulting in far higher costs, poor care coordination and no continuity of care.
How can we talk sense to politicians who seem to ignore those facts? Are they really so detached from reality, or is is just about scoring points for their re-election campaigns? We must speak up and defend the rights of those who now do not have anyone left to speak up for them. Both parties in congress are at fault and our president doesn't dare to rock the boat. Enough is enough!!

Health Insurance Policy

2011-08-17T22:32:00.002-04:00

Attached a link to an interesting article http://online.wsj.com/article/SB10001424053111904253204576512494056148396.html published in today's WSJ reporting that as part of the health-care overhaul law federal regulators are expected to unveil on Wednesday the proposed health insurance policy summary form of health insurance policies , that will lay out the details of each policy, from deductibles to how much it might cost to have a baby. The requirement is supposed to take effect next March. Currently, states mandate certain disclosures from health insurers, but they vary by state. The information often comes as part of a document known as the certificate of coverage or evidence of coverage, which can run to dozens of densely written pages and is often supplied ONLY AFTER a consumer has signed up for a policy. Employers offering coverage typically provide materials to their workers, but these also don't follow any common national format.
The proposed new summary is expected to closely follow a draft version from a committee convened by the National Association of Insurance Commissioners, people with knowledge of the matter said. Health and Human Services is expected to finalize the form after a public comment period. Insurers said they were concerned about the potential cost and administrative burden of the new requirement, particularly if they have to create different iterations of the form for every possible plan design a consumer could explore and for every single employer.
Of course they are concerned because for the first time the policies will be readable, comparable and can form the basis of rational decision making in a complex market place. Who does understand his/her current health care policy? I don't !! I still struggle to understand how much my insurance will cover for a colonoscopy and how much I have to budget for this procedure. If we want a free market place then we should allow for measures that create accountability and transparency. Currently, insurance companies will make every effort to maintain the status quo, which disenfranchises the consumer. We should support these new federal regulation and to express our opinions during the public comment period. Let's not miss this opportunity.
Yours
Bernd

The Blues Treatment For Mental Health Providers

2011-08-15T22:46:00.000-04:00

Attached a very troublesome article I just received today reporting that on July 27, 2011 Blue Cross Blue Shield of Florida began notifying ALL of their mental health providers (licensed social workers, licensed mental health counselors, psychologists, and psychiatrists) that effective November 30th, 2011 they would be terminated, without cause.
They were also notified that that if providers would like to join the new company they are partnering with, New Directions, so that they can provide services to their patrons, they would need to complete a new contract (sent under separate cover) within 15 days and agree to significant cuts (35-55%) in reimbursement rates, as well as other disturbing clauses such as only being able to refer to in-network providers, etc.
Since BCBS is considered to be one of the largest providers of insurance for mental/behavioral health in Florida, this termination could potentially place hundreds/thousands of providers in a position of being underemployed and/or unemployed, and worse, leave thousands of patients without coverage or access to mental health/psychological treatment.

CNN producer note
iReport -
On July 27, 2011 Blue Cross Blue Shield of Florida began notifying ALL of
their mental health providers (licensed social workers, licensed mental
health counselors, psychologists, and psychiatrists) that effective Nov 30,
2011 they would be terminated, without cause. That is, they will no longer
be providers for BCBS-FL. In this notice, current providers were also
instructed to notify BCBS subscribers/patients of this coming termination
directly and on behalf of BCBS-FL.

BCBS-FL also indicated that if providers would like to join the new company
they are partnering with, New Directions, so that they can provide services
to their patrons, they would need to complete a new contract (sent under
separate cover) within 15 days and agree to significant cuts (35-55%) in
reimbursement rates, as well as other disturbing clauses such as only being
able to refer to in-network providers, etc.

Interestingly, New Directions appears to be a subsidiary of BCBS-FL. So, as
if it isn't horrible enough that ALL of the mental/behavioral health
providers have been "fired" at the same time and patients will likely find
themselves with poor quality care or no care at all, it appears that they
(the same company-BCBS-FL) fired its contractors and then offered them the
oportunity to reapply for rehire within the same week, but only if they
agree to sign a new contract, with entirely different terms.

This action (termination of providers only in one area) also seems to be a
possible violation of the Federal Mental Health Parity Law which protects
against the discrimination of mental health services. It does not appear
that any of the other healthcare providers or "medical" providers had their
contracts terminated.

Since BCBS is considered to be one of the largest providers of insurance for
mental/behavioral health in Florida, this termination could potentially
place hundreds/thousands of providers in a position of being underemployed
and/or unemployed, and worse, leave thousands of patients without coverage
or access to mental health/psychological treatment.

The ripple effect of these actions by BCBS-FL could be deadly to the people,
communities, and businesses throughout FL. leaving many unable to make a
reasonable living and thousands (including Seniors with BCBS as a secondary
policy) unable to access and/or pay for mental health treatment and
psychological services.

--
Bernd Wollschlaeger,MD,FAAFP,FASAM
16899 NE 15th Avenue
North Miami Beach,FL 33162
Phone: (305) 940-8717
Fax: (305) 402-2989
Web Site: www.miamihealth.com
Blog: http://floridadocs.blogspot.com
Twitter: @dadedoc

Florida Turns Down Federal Money

2011-08-03T23:01:00.003-04:00

Attached a link to a recent article published in the NYT http://www.nytimes.com/2011/08/01/us/01florida.html pointing out that despite having the country’s fourth-highest unemployment rate, its second-highest rate of people without insurance and a $3.7 billion budget gap this year, the Florida has turned away scores of millions of dollars in grants made available under the Affordable Care Act. And it is not pursuing grants worth many millions more.
Although Florida is the fourth most populous state, it ranks 12th in the amount of money received from health care act grants, according to the government’s grant-tracking Web site. The law has directed $46.4 million to the state out of $1.98 billion awarded nationally. Much of the money has gone directly to local governments, community groups and medical providers. The Florida government even went so far to deny funding for community health centers! Three of four grants to expand community health clinics in Florida went to medical centers that are beyond the reach of the governor and the Legislature. The fourth was to the Osceola County Health Department, which under Florida law is effectively a unit of state government. The Legislature used its power to not authorize a grant won by the county to expand two health centers and build a third.
This represents not only irresponsible ideology driven behavior but it also threatens the fragile health of our communities.
Its time to raise our voices and to act as responsible citizens of our great state of Florida.
Yours

Bernd

Iraqi Healthcare

2011-07-27T21:31:00.004-04:00

According to data analyzed by various think tanks the United States of America, i.e. taxpayers like you and me, spent (or wasted) almost ONE TRILLION DOLLAR in Iraq!! Among the many "gifts" we provided was our financial and logistical support for an Iraqi constitution.
It's of interest to note that Article 31 of the Iraqi Constitution, drafted by the U.S. administration in 2005 and ratified by the Iraqi people, includes state-guaranteed (single payer) healthcare for life for every Iraqi citizen!! Article 31 reads: "First: Every citizen has the right to health care. The State shall maintain public health and provide the means of prevention and treatment by building different types of hospitals and health institutions. Second: Individuals and entities have the right to build hospitals, clinics,or private health care centers under the supervision of the State, and this shall be regulated by law."
There are other health care guarantees, including special provisions for children, the elderly, and the handicapped elsewhere in the 43-page document.
So let me make it clear: Our taxpayer money was used to draft a constitution which contains state-guaranteed healthcare for life for every citizens BUT the same rights are being denied for the very same U.S. citizen who paid for this constitution??!!
Naturally, all of our legislators enjoy guaranteed state-funded healthcare, state-guaranteed pensions, state guaranteed salaries etc. BUT the same legislators want us to believe that all state-funded activities are evil and must be cut or eliminated! Naturally, excluding those benefits they enjoy!!
Churchill once said that " The inherent virtue of socialism is the equal sharing of misery." Maybe this is now a virtue of our democracy and our legislators want us to share the misery and allocate the benefits of freedom to those they choose.
Its up to us to let them do that.
Yours
Bernd

Child Abuse Prevention in Florida

2011-07-21T23:20:00.001-04:00

The Miami Herald reports in today's edition http://www.miamiherald.com/2011/07/20/2323475/florida-spurns-50-million-for.html that Florida lawmakers have rejected more than $50 million in federal child abuse prevention money because its is being offered through the Affordable Health Care Act which lawmakers oppose for "philosophical", i.e. ideological, reasons. The money would have paid, among other things, for a visiting nurse program run by Healthy Families Florida, one of the most successful child-abuse prevention efforts in the nation. And because the federal Race to the Top educational-reform effort is tied to the child-abuse prevention program that Healthy Families administers, the state may also lose a four-year block grant worth an additional $100 million in federal dollars!!
Its of interest to follow the "reasoning" of a key lawmaker, State Senator Joe Negron, opposed to Healthy Families Florida. State Sen. Joe Negron, who chairs his chamber’s Health and Human Services Appropriations Subcommittee, said he long has been philosophically opposed to Healthy Families, which he views as an intrusion into the private lives of parents.“I believe in providing basic information to parents at hospitals and medical settings,” said Negron, a Palm City Republican. “I am not persuaded that it is a good idea to show up at a family’s home year after year giving advice and guidance. I do not think that is a core, essential function of government.”
According to his "logic" its OK for government to censure doctors free speech and to figure out by themselves, and under the threat of punishment, what basic information to parents at hospitals and medical settings is relevant to prevent child abuse.
Its also of interest to note that nobody wants to take responsibility for the rejection of federal funds.
On Wednesday, leaders of the state House and Senate and the governor’s office all insisted they had nothing to do with rejecting the money.“The grant was included in [the state Department of Health’s] legislative budget request, but beyond that, the executive branch never advocated for it and a budget amendment was not submitted,” said Katherine Betta, spokeswoman for Republican House Speaker Dean Cannon of Winter Park. Brian Burgess, a spokesman for Gov. Rick Scott, said Scott did ask for the money. Burgess produced a budget request that has the proposal. “If there is to be finger-pointing,” he said, “it should be directed elsewhere.”
In contrast to previous posturing the Governor and Republican lawmakers seem to be odds at whom to blame (or to cheer) for rejecting the grant money.
Meanwhile, more children will suffer and some may even loose their lives.
As physicians we are obligated to speak up!!

Yours
Bernd

United Health Care Profits Rose 13%

2011-07-20T23:23:00.002-04:00

Today's New York Times article entitled " Profit Up 13%, United Health Raises Outlook" http://www.nytimes.com/2011/07/20/business/unitedhealth-groups-2nd-quarter-profit-jumps-13-percent.html reports that The United Health Group one of the nation’s largest health insurers, reported its second-quarter results on Tuesday, and the good news for the industry appeared likely to continue. UnitedHealth announced a double-digit increase in profits and raised its estimates for 2011 earnings. Its net income rose 13 percent, to $1.27 billion, or $1.16 a share, compared with $1.12 billion, or 99 cents a share, one year ago. And revenue increased 8 percent, to $25.23 billion. UnitedHealth was the first of the big insurers to report this quarter, and once again, the high profits appear to be partly the result of more budget-consciousness by their customers, even as the insurers ask for higher premiums. As they have for many months now, Americans seem to be putting off or forgoing medical care because of the weak economy and the increasing amount they are required to pay in medical bills as their deductibles and co-payments climb. In late spring, many health insurers said it was too soon to tell whether utilization would eventually rebound to the same levels as before the downturn. They argued that they could not count on the demand for medical care staying at relatively low levels.So the company continued to benefit from consumers making fewer doctor visits as they try to save money in the tough economy.
Following the logic of a free market economy, they should lower their premiums to entice consumers to "buy" healthcare services. But these rules DO NOT apply to the so-called "healthcare market" which is controlled by a few monopolies, in which only one seller faces many buyers who have no choice but to buy the product regardless of price.
Unfortunately, these monopolies also are acting as monopsonies, in which only one buyer faces many sellers. In this cases providers of health care services (doctors, hospitals etc) have no choice but to sell their services to a large insurance company because its buying power dwarfs the remaining market.
Ironically, the Patient Protection and Affordable Care Act will inadvertently exacerbate this situation because for-profit insurance companies play an essential role in the provision of services.
Who will suffer? The consumer who is forced to buy these expensive insurance products and the doctors whose negotiating power has been curtailed by regulations.
In this context a single-payer system, or a model based on not-for-profit insurance companies (i.e. Germany), may serve as a solution.
Unfortunately, we are doomed because we swallowed the "free market" ideology bait with hook, line and sinker and in the end have no choice but to stick with the worst solution anyone can offer.

Yours

Bernd

Graduate Medical Education

2011-07-15T23:28:00.001-04:00

Federal Budget Cuts Threaten Graduate Medical Education:

In their efforts to reduce the federal deficit the partisan negotiators seem to agree on one issue only: drastic cuts of the Medicare subsidy for postgraduate medical education and funding reduction for advanced equipment that teaching hospital require to train young doctors.

The recommendations made by the National Commission on Fiscal Responsibility and Reform, currently under consideration, would cut about $5.8 billion in graduate medical education funding from the nation’s teaching hospitals. This represents a 53% cut compared to the current $10.9 billion in payments!! The Simpson Bowles Commission, which advised President Obama on debt and deficit reduction called in December 2010 for reducing “excess” payments to hospitals for medical education. The commission said the payments could be brought in line with the costs of medical education by limiting the direct subsidy to 120 % of the national average salary paid to residents. A second, indirect subsidy, which pays for intensive services and advanced equipment should also be reduced.

The proposed draconian cuts will jeopardize the sorely needed expansion of graduate medical education in the U.S . and exacerbate the looming physicians shortage. Who will care for the baby boomers seeking medical services? Who will provide primary care physicians once millions of Americans gain access to healthcare coverage in 2014?

The proposed measures are based on penny wise and pound foolish approaches to cover our federal deficit and ignore the long-term investments needed to protect our crumbling healthcare service infrastructure in the U.S. The suggestions were developed by politicians with a limited political life cycle instead by healthcare planners who are being tasked to develop policy and not politics.

I suggest to review thoughtful proposals such as the Nineteenth Report by the Council on Graduate Medical Education (COGME) entitled “ Enhancing Flexibility in Graduate Medical Education” http://www.hrsa.gov/advisorycommittees/bhpradvisory/cogme/Reports/nineteenthrpt.pdf before throwing out the baby with the bath water.

The future of our healthcare is at stake and politicians must step aside to let experts take charge.

Yours

Bernd

When Ideology Trumps Compassion

2011-07-03T22:48:00.002-04:00

When Ideology Trumps Common Sense and Compassion:

In the past week, Florida lawmakers turned down a $2.1 million federal grant that would pave the way for the state to receive $35 million in federal funding that would move elderly and disabled patients from nursing homes to their own homes during the next five years. With the help of this federal funding elderly people could be moved out of nursing homes to independent-living facilities or to support care at home with their families resulting in less money to be spend on nursing-home care. Republican legislators defended their refusal of the latest federal grant, known as the Money Follows the Person funding. "Not only would accepting the Money Follows the Person grant go against our policy of implementing federal health-care reform, but it would be redundant to the multiple efforts that Florida has already made to improve the delivery of long-term care," said Rep. Denise Grimsley, R-Sebring, chairwoman of the state's House Appropriations Committee.
Grimsley said the federal grant came with "significantly higher administrative costs that have been unnecessary" because Florida already has been successful at moving people from nursing homes. Nan Rich, Leader of the Senate Democratic Caucus, disagrees. In a letter to the editor published in todays Miami Herald http://www.miamiherald.com/2011/07/02/2295756/rejecting-funds-to-help-elderly.html she argues that “ the funding would have garnered Florida $35,7 million in federal funds over the next five years.” She is correct stating that “ Florida's share of the federal funds will go to another state whose leaders aren't willing to shortchange their elderly and disabled for the sake of ideology.” The remainder of her letter speaks for itself and is worthwhile reading in its entirety:
“It just doesn’t make any sense for Florida to refuse the “Money Follows the Person” funds. The grant covered 100 percent of the staffing and administrative costs. The federal Medicaid match for this program would have increased from about 56 percent to almost 78 percent for the first year, and we would have been under no obligation to continue the program after that. Even if we did, however, we’d still save money by moving more eligible people out of nursing homes. Our state’s seniors, disabled people and taxpayers deserve better than the short-sighted political posturing that we saw last week.”
Is there any hope that rational thought will prevail in Tallahassee?
Yours
Bernd

Drug Testing for Welfare Recipients

2011-07-02T20:49:00.002-04:00

Drug Test Law May Face Costly Legal Challenges:

Attached a link http://www.orlandosentinel.com/health/os-drug-tests-welfare-20110630,0,5410762.story to an article published in today's Orlando Sentinel pointing out that a new state law requiring welfare applicants to be drug-tested goes into effect today.

The law stipulates that parents with minor children who request temporary cash assistance must undergo a drug test. The average benefit check per family is $240 a month with a lifetime limit of 48 months.

About 4,000 Floridians each month may be affected by the new law. The 93,000 state residents already receiving such benefits would not be affected unless they reapply. In addition all parents who test positive for drugs — including legal drugs not prescribed for the parent — will be reported automatically to the state's abuse hotline. Applicants will have to pay for the drug tests themselves, though those who test negative will be reimbursed in the first benefit check they receive. Those who test positive also would have the chance to get a second, more-sophisticated screening — at their own expense of up to $100 — and have an official medical review of the testing (MRO) . It is still unclear whether those expenses would be reimbursed if the applicant is ultimately cleared. The law may violate the constitutional standard requiring that the government must have reason to believe an individual is using drugs before demanding a test. Michigan, the only other state to pass a similar law, had it struck down in court. Therefore, it most probably will face a costly legal challenge on taxpayers expense!! Furthermore, by implementing this policy the state government should have provided drug treatment options for those welfare recipients with children who test positive for drugs. The new law falls shot of this option, too.

In my opinion this new law is a bad idea which will face a long and costly court battle and will further divert scarce state resources from more important issues such as drug use prevention and treatment programs.

Happy 4th of July,

Yours

Bernd

Counterfeit-Proof Prescription Pads

2011-06-30T23:33:00.002-04:00

Just want to remind all of you that as of tomorrow, July 1st, 2011, counterfeit-proof prescription blanks MUST be used by all physicians for prescribing of ANY controlled substances. A list of approved vendors of counterfeit-proof prescription pads can be found on the Department of Health web site at http://www.doh.state.fl.us/mqa/counterfeit-proof.html.It is also important o know that approved vendors are required to provide monthly reports to the DOH, documenting who purchased the prescription pad or blanks and how many were purchased.
Have spoken today with one of the vendors and was assured that they make every efforts to expedite deliveries of counterfeit-proof prescription pads.

Yours
Bernd

Mystery Shoppers

2011-06-27T21:36:00.001-04:00

Attached a link to today's New York Times article http://www.nytimes.com/2011/06/27/health/policy/27docs.html reporting that the federal government plans to deploy mystery shoppers who will call doctors in nine states to try to schedule an appointment first posing as someone with private insurance and another time as someone with public insurance. The goal is to ascertain access to care issues , especially as the healthcare system braces for millions more Medicaid patients in 2014.
Already doctors are lining up in opposition to these "snooping" tactics. In response Christian J. Stenrud, a Health and Human Services spokesman, said: “Access to primary care is a priority for the administration. This study is an effort to better understand the problem and make sure we are doing everything we can to support primary care physicians, especially in communities where the need is greatest.”
So shall we oppose in principle all tactics that are aimed to assess the scope of the primary care shortage and related access to care issues? Are there any meaningful alternatives to the proposed "snooping" tactics deploying mystery shoppers to doctors offices? What role can we play not only to highlight the problem but to offer solutions?
I look forward to your responses and comments.
Yours
Bernd

Medicare Claims Show Overuse For CT Scans

2011-06-18T20:33:00.001-04:00

06/18/11

Attached a link http://www.nytimes.com/2011/06/18/health/18radiation.html to an interesting article published in today's New York Times entitled “Medicare Claims Show Overuse for CT Scanning.”

The authors highlight that according to Medicare claims data some hospitals overuse chest CT scans and, thereby, needlessly expose patients to radiation by scanning their chests twice on the same day. The Medicare agency distributed the data to hospitals last year to show how they performed relative to each other and to encourage more efficient, safer practices. The review of that data found more than 200 hospitals that administered double scans on more than 30 percent of their Medicare outpatients — a percentage that the federal agency and radiology experts considers far too high. The national average is 5.4 percent. The figures show wide variation among states as well, from 1 percent in Massachusetts to 13 percent in Oklahoma. Overall, Medicare paid hospitals roughly $25 million for double scans in 2008. Added revenue may not be the reason dual scans are ordered. But the absence of treatment protocols may explain the variation of CT Chest use among physicians.

Possible solutions should include standardized, evidence-based diagnosis and treatment procedures according to which physicians can tailor their approach to patient care accordingly.

I hope that Medicare will open its database for researchers and health economists to help all of us to make educated and smart medical care decisions which will benefit our patients, too.

Yours

Bernd

Support Doctors in Bahrain

2011-06-16T22:51:00.002-04:00

Attached a link to an AMA press release http://www.ama-assn.org/ama/pub/news/news/ama-expresses-concern-over-bahrain-trial.page? encouraging America's physicians to write to Bahraini officials, using a sample letter from the AMA website, and join the world's medical community in urging the fair treatment of the health care professionals detained in Bahrain.
Please participate because your support counts.
Yours
Bernd

Governor Scott Suspends Drug Testing Order

2011-06-16T22:33:00.001-04:00

Attached a link to an article from today's Sun Sentinel http://www.sun-sentinel.com/health/fl-scott-suspends-employee-drug-testi20110616,0,6797555.story reporting that Governor Scott has suspended the order he signed earlier this year requiring random drug tests of all state employees in light of an ACLU law suit. The governor had signed the order for so-called "suspicion-less" drug tests – so termed because all state employees would be subject to them, regardless of their job or whether they were suspected of using drugs – in March. He also successfully urged the Legislature to require drug tests of all new applicants for welfare assistance, which the ACLU is also expected to challenge.
I encourage all of you to speak up loudly against the mandatory drug testing of welfare recipients which will be challenged in court, too.
Yours
Bernd

The Big Rip-Off

2011-06-07T23:12:00.001-04:00

In today's Miami Herald http://www.miamiherald.com/2011/06/06/2254083/prescription-for-healthcare-shopping.html#storylink=misearch John Dorschner points out a painful truth: healthcare consumers are being ripped off every day by healthcare service providers.
According to Alan Sager, a healthcare policy expert at Boston University, “Anytime I’ve read reports of patients or journalists seeking comparison pricing, they’ve encountered the same inconsistency, confusion, frustration and often misleading information,” he said. “When we go into a big supermarket, we all pay the same price for a gallon of milk. In healthcare, there are multiple prices in the same place.”
I myself have a hard time to find out the REAL costs of my own healthcare needs. Recently my daughter had to do undergo laboratory testing for which I was charged a $900 co-pay. I tried to appeal and as a result my case was immediately referred to a collection department. I barely saved my credit rating and paid. Its outrageous! The profit margins are beyond belief exceeding 1000 percent!! The so-called "free-market" argument is a joke!! An article in today's Wall Street Journal points out that in a survey of 1,000 British Medical Association members - all doctors - 80% of those surveyed were "mostly or very unwelcoming" towards the idea of privatization of the National Health Service. Meanwhile, American doctors and politicians continue to support the private health care market model. There is NO health care market but an aggregation of monopolies suffocating the average health care consumers.
Its time to fight back! We should demand a single-payer system with uniform and transparent pricing structure.
Yours
Bernd

Governor Scott Signs Pill Mill Bill into law

2011-06-04T22:48:00.002-04:00

After initially fighting one of its key provisions, Gov. Rick Scott signed a bill Friday aimed at cracking down on clinics that frivolously dispense pain pills, feeding a nationwide prescription drug abuse epidemic. The bill tightens reporting requirements to the database from 15 days to seven days, a change critics said the program needed to make it more effective. The measure also increases penalties for overprescribing Oxycodone and other narcotics, tracks wholesale distribution of some controlled substances, and provides $3 million to support law enforcement efforts and state prosecutors. It also bans most doctors who prescribe narcotics from dispensing them, requiring prescriptions to be filled at certain types of pharmacies. Scott has been under pressure from elected officials throughout the country to do something about the proliferation of so-called "pill mills" in Florida that attract people from other states seeking easy access to highly addictive, powerful painkillers.
We should now urge the Department of Health to provide education and training programs for physicians and other healthcare professionals on how to use the Prescription Drug Monitoring Program and to fund those necessary efforts.

For more information see http://www.miamiherald.com/2011/06/03/2249936/scott-signs-pill-mill-bill-into.html

ACLU Sues Governor Scott Over Drug test Rule

2011-06-04T22:35:00.001-04:00

ACLU Florida has filed a lawsuit against Gov. Rick Scott over his executive order to force drug testing on state employees. The suit argues that Scott's order is an unreasonable search of the government that violates the Fourth Amendment of the U.S. Constitution.The ACLU maintains that the mandatory random drug testing Scott has ordered on about 100,000 workers is only allowed under special circumstances, such as workers who carry firearms or railroad workers involved in accidents.
I urge all medical professionals involved in federal workplace drug testing procedures to await the outcome of this lawsuit BEFORE deciding on their participation in the proposed state wide drug testing for state employees.

For more information and the complete text of the law suit see http://www.tampabay.com/blogs/the-buzz-florida-politics/content/aclu-sues-gov-scott-over-drug-testing-order

Physicians Challenge Florida Goverment

2011-06-04T21:29:00.001-04:00

Attached an article highlighting an issue which is going to be resolved in court. Unfortunately, Governor Scott signed HB 155 into law which will bar physicians from asking patients about gun ownership. Florida is the only state in the nation to have such a law which was pushed by the NRA.
Sadly, the Florida Medical Association does not oppose the new law exposing its members to charges of harassment if they "dare" to provide their patients information about gun safety. Any alleged violation of the new law will expose physicians to disciplinary action and even license revocation!
Now its time to stop government intrusion into the patient-physician relationship.
I encourage doctors to pay attention to this issue and to take action.
Yours
Bernd

PalmBeachPost.com

By DARA KAM

Palm Beach Post Staff Writer

Updated: 10:58 p.m. Thursday, June 2, 2011

Posted: 8:19 p.m. Thursday, June 2, 2011

Three groups of doctors are suing Gov. Rick Scott over a bill he signed into law Thursday restricting health care workers from asking patients questions about guns.

Lawyers representing members of Florida chapters of the American Academy of Pediatrics, the American Academy of Family Physicians and the American College of Physicians asked Scott last week to veto the measure (HB 155) and threatened to sue if he signed it into law.

The Florida Medical Association does not oppose the new law.

Bruce Manheim of the Washington-based Ropes & Gray law firm said Thursday he would file the lawsuit immediately after Scott signed the law.

Doctors say the law infringes on their First Amendment constitutional right to free speech by barring them from asking about gun ownership, something they say is necessary to do their jobs.

It will "have a muzzling effect on doctors" who routinely ask parents and teenagers about swimming pools, dangerous drugs, bicycle helmets and car seats as well as about firearms in the home, pediatrician Tommy Schechtman said.

Under the law, doctors and other health care professionals will face sanctions including fines and losing their licenses if they ask patients about guns in the home without a direct belief that the inquiry is relevant to the patient's safety or health.

"It is my job. It is my responsibility. I have a moral obligation, an ethical obligation to be doing this," said Schechtman, who has offices in Palm Beach Gardens, Jupiter and Boca Raton.

But Scott spokesman Lane Wright said the first-term governor is confident he is on solid legal ground by signing the bill.

"Others would argue it would be an infringement of a citizen's rights who owns a gun to have a doctor ask those questions," Wright said. "Why should any law abiding citizen have to report to a doctor that they have a gun?"

Florida is the only state in the nation to have such a law, according to National Rifle Association lobbyist Marion Hammer, a former president of the gun rights organization.

Hammer said some health care professionals are pushing anti-gun messages to their patients under the guise of home safety questionnaires. The measure was prompted by complaints from gun owners following an incident this summer in which an Ocala-area physician told a couple to find another pediatrician after they refused to answer questions about whether they owned a gun and how it was stored.

The NRA and other supporters don't object if doctors routinely distribute safety brochures to all patients that give instructions on swimming pools, firearms or other safety-related issues, Hammer said.

"But doctors should not be spending the time that patients are paying for to talk to them about matters they're not there for. They come to doctors for medical care and medical treatment, not to have politics in the examining room and not to be lectured on firearms. They are medical doctors; they are not firearms instructors," she said.

But Mannheim said the new law is so vague about when questions are permissible that it would have a chilling effect on health care practitioners fearful of having to defend themselves before the Board of Medicine.

"Questions about firearm safety, as innocuous as they may be to the ordinary person, could be construed by someone as constituting harassment by a physician and simply on the basis of that judgment a physician could be taken through these disciplinary proceedings," he said. "It immediately chills the speech of our clients and their members and accordingly we intend to move very quickly with a lawsuit."

Schechtman said the new law won't stop him, however. More than 1,500 children die each year from household gun-related injuries, he said.

"Some of us won't shut up. Sometimes you have to decide to do the right thing which is what I will do. It's not going to stop me from doing anything," he said.

But other physicians may feel it's not worth the risk.

"It will have its intended effect. That's the thing that's scary to me. And that's why I think we have to take this off the books. I think it's sending a wrong message that people shouldn't have to worry about guns," Schechtman said.

Gun Law and Physicians

2011-05-08T19:55:00.002-04:00

The new gun law makes Florida the first state in the nation to prohibit doctors from asking patients if they own guns. HB 155 entitled "Privacy of Forearm Owners" passed the Florida House and will be signed into law by Governor Scott. NPR featured this law in a recent story http://www.npr.org/2011/05/07/136063523/florida-bill-could-muzzle-doctors-on-gun-safety. Having read the entire bill http://www.flsenate.gov/Session/Bill/2011/0155/BillText/er/PDF I am trying to understand what I am allowed to ask my patients and how I can protect myself from those who exercise their constitutional right to carry guns. Here are the some of the problems the bill presents us with:

* The bill states that “A health care practitioner licensed under chapter 456 or a health care facility licensed under chapter 395 may not intentionally enter any disclosed information concerning firearm ownership into the patient's medical record if the practitioner knows that such information is not relevant to the patient's medical care or safety, or the safety of others."

Question: How do I know whats relevant to the patients safety? Actually, I was taught to be concerned about "anticipatory guidance" — teaching parents how to safeguard their children against accidental injuries. Like pediatricians family doctors ask about bike helmets, seat belts, and GUNS. That means I cannot counsel a parents how to secure a gun to prevent accidental injury and death? Shall I delete those questions from my patient intake form? Shall I NEVER ask those questions? Will I be disciplined if I dare asking those questions?

* But in the next paragraph the bill also states that " Notwithstanding this provision, a health care practitioner or health care facility that in good faith believes that this information is relevant to the patient's medical care or safety, or the safety of others, may make such a verbal or written inquiry."

Question: So what is correct and prevents my exposure to disciplinary action? Shall I adhere to a don't ask, don't tell policy?

* The bill contains other confusing language such as " A health care practitioner licensed under chapter 456 or a health care facility licensed under chapter 395 shall respect a patient's legal right to own or possess a firearm and should refrain from unnecessarily harassing a patient about firearm ownership during an examination."

Question: What if a gun owner claims to feel "harassed" by a doctor and files a complaint with the Board of Medicine then a physician has to answer and file a response. That requires legal advice and consultation which costs $$$. Facing such a dilemma precludes ANY questions about guns. That's what the NRA wanted, the legislators did and the FMA endorsed!

* The bill goes further stating " A health care provider or health care facility may not discriminate against a patient based solely upon the patient's exercise of the constitutional right to own and possess firearms or ammunition."

Question: What if the patient has a concealed weapon permit and carries a concealed weapon in the medical office and I discover such a weapon during the exam? It happened to me several times!! Can I ask the patient to leave and return without the weapon without him/her claiming that I harass them? Can I establish a policy prohibiting patients to carry guns on my premises?

* Furthermore, the bill contains an entire paragraph about patients rights BUT NOT a single sentence about physicians rights and safety!! That's what the NRA wanted, the legislators did and the FMA endorsed!

Yours
Bernd

Solutions From The Inside

2011-05-06T21:50:00.001-04:00

Attached a link to an interesting article http://www.miamiherald.com/2011/05/05/2201361/solutions-for-jackson-memorial.html entitled " Solutions from the Inside." In the article the author, Martha Baker- President of the SEIU Local 1991- , points out that " We must transition to a cost-effective, preventive, patient-oriented, primary-care-focused system." It still baffles me that the focus of hospital administrators remains on expanding specialist driven care to maximize the volume of reimbursable medical services instead on primary -care based medical services with the focus on quality, safety and population oriented care. The latter approach would also provide access to increased Medicare and Medicaid meaningful use reimbursement and performance-based incentive payment.
As family doctors we should be responsible for relentlessly pointing out these shortcomings which eventually will only increase healthcare costs and will force us to ration care.
The choice is ours to make.
Yours
Bernd

Medicaid and Managed Care

2011-04-22T00:14:00.001-04:00

Reform Medicaid to maintain access:

Re the April 21st letter http://www.miamiherald.com/2011/04/20/2177745/reform-medicaid-to-maintain-access.html by Michael Garner, President and CEO,Florida Association of Health Plans. Mr. Garner claims that for-profit managed care companies will contain Florida's rising Medicaid costs by care coordination and quality improvement.
But a recently published study of the managed care pilot program taking place in Broward, Baker, Clay, Duval and Nassau counties concluded that there is insufficient evidence to verify claims of cost savings. The study concludes that instead of rushing to implement this unproven and ill-advised pilot program statewide, more reliable cost-saving alternatives should be considered. For example, Massachusetts is trying to contain rising health care costs by supporting the development of accountable care organizations (ACO's). These are networks of physicians, practices and hospitals that will share in any cost savings they generate by better coordinating and integrating patient care without adding unnecessary administrative overhead generated by managed-care companies. Geisinger Health Systems in Pennsylvania is using its networks to try out a model similar to patient-centered medical homes and high-risk care management programs. Sutter Health in California has focused on engaging its doctors on quality and efficiency programs. Before we turn over billions of dollars to private for-profit managed care companies we should seriously explore other methods and modalities to contain health care cost, improve the quality of care and to maintain access to medical services for all of those in need.

Bernd Wollschlaeger,MD,FAAFP,FASAM
Board Certified Family Physician & Addiction Specialist
16899 NE 15th Avenue, North Miami Beach, FL 33162
Phone: (305) 940-8717
E-mail: info@miamihealth.com

The Valentine's Day controversy

2011-04-21T23:36:00.000-04:00

It's Time For An Attitude Adjustment

According to a recent New York Times article the president-elect of the American College of Surgeons resigned his position Sunday after weeks of controversy surrounding a Valentine’s Day editorial he wrote touting the mood-enhancing effects of semen on women during unprotected sex. Dr. Greenfield, 78, was the editor in chief of Surgery News when the editorial was published but resigned that position in the wake of the controversy; the entire issue of the newspaper was withdrawn. He is an emeritus professor of surgery at the University of Michigan School of Medicine. The editorial cited research that found that female college students who had had unprotected sex were less depressed than those whose partners used condoms. It speculated that compounds in semen have antidepressant effects.
Dr. Colleen Brophy, a professor of surgery at Vanderbilt University, submitted a letter of resignation from the surgery association during the controversy and said Sunday that she had no intention of reversing herself now that Dr. Greenfield has resigned. “The editorial was just a symptom of a much larger problem,” Dr. Brophy said. “The way the college is set up right now is for the sake of the leadership instead of patients.”
I hope that members of our profession distance themselves from those who still believe that their professional status renders them immune to public criticism. The change of attitudes within our profession must progress by large jumps instead of small increments.

Yours
Bernd

Controlled Substances

2011-04-20T23:23:00.002-04:00

In an interesting article entitled “US Seeks To Rein in Painkillers” http://www.nytimes.com/2011/04/20/health/20painkiller.html the authors report that the Obama administration seeks legislation requiring doctors to undergo training before being permitted to prescribe powerful painkillers like OxyContin. This appears to be the most aggressive step taken by federal officials to control both the use and abuse of the drugs. Among the drugs that would most probably fall under a stricter licensing measure are OxyContin, fentanyl, hydromorphone and methadone. They are considered critical to pain treatment. But they also have been associated in recent years with a national epidemic of prescription drug abuse and addiction and thousands of overdose-related deaths. Proponents of the training argue that it would help doctors better identify patients who would benefit from treatment with long-acting narcotics, and help them unmask patients feigning pain to get drugs they then abuse. Opponents say a training requirement will reduce the number of doctors prescribing pain drugs and hamper patient care. The F.D.A. released new regulations on Tuesday that would require the makers of long-acting or extended release painkillers to provide training to doctors but would not require doctors to take such courses. This proposal is similar to the one rejected as too weak in last year’s debate. Dr. Janet Woodcock, who heads the F.D.A. Center for Drug Evaluation and Research, indicated that the new agency rules were effectively a placeholder until legislation was passed or were to be used if a relevant bill failed.

In my opinion additional education and training requirements for controlled substances prescribing are long overdue! Most physicians have no, or very limited knowledge, of the appropriate indication, pharmacology and adverse drug interactions of controlled substances. I often see patients who were prescribed Methadone, a long-acting opioid, at a four-times daily dosage schedule. These physicians seem to be clueless about the fact that Methadone metabolism rates vary greatly between individuals, up to a factor of 100! These metabolism rates can range from as few as 4 hours to as many as 130 hours, or even 190 hours. This variability is apparently due to genetic variability in the production of the associated enzymes. Ignoring these pharmacological facts can lead to accidental overdose and death.

Additional training requirements should be implemented to protect our patients and our families.

Yours

Bernd

Fla. House panel OKs compromise pill mill bill

2011-04-14T23:48:00.001-04:00

Finally, the future for a prescription drug monitoring program is looking better every day. According to an April 12th Miami Herald article http://www.miamiherald.com/2011/04/12/2163473/fla-house-panel-oks-compromise.html compromise legislation designed to combat "pill mills" that supply prescription painkillers to drug dealers and addicts cleared a House committee Tuesday after the panel took out Gov. Rick Scott's proposal to repeal Florida's prescription monitoring system. The revised bill (HB 7095) instead would strengthen the database by giving pharmacies only seven days rather than 15 to submit prescription information to the state. Unchanged from the original legislation is a ban on dispensing controlled drugs by most doctors. That means patients would have to get prescriptions filled only at pharmacies. Doctors who violate the ban would face up to five years in prison. The House Appropriations Committee unanimously approved the revised bill. It next goes to the House floor. House Speaker Dean Cannon, R-Winter Park, also pushed for the database repeal, arguing that a ban on dispensing by doctors would be more effective, but Bondi said he's also supporting the compromise and helped bring it about. Bondi and Senate President Mike Haridpolos, R-Merritt Island, have been strong supporters of the tracking system, and the Senate's pill mill bill (SB 818) did not include the repeal.
I urge you to continue pushing your legislators to support the House ( HB7095) and Senate bill (SB818).
The battle is not over yet !!
Yours

Florida Medicaid Reform

2011-04-08T23:05:00.001-04:00

Friday, April 8th 2011

Letter To The Editor:

Managed Care is not the solution to rising Medicaid cost:

David Pollacks's letter to the editor suggests that moving Medicaid beneficiaries into managed care is the most effective solution to Florida’s Medicaid woes because managed-care organizations in Florida and across the country have a track record of improving outcomes while reducing costs. But is that true? A Georgetown University Health Policy Institute study of Florida's Medicaid Managed Care pilot program questions the use of for-profit managed care companies to reduce Medicaid costs.
The Georgetown study analyzed the impact of the pilot program taking place in Broward, Baker, Clay, Duval and Nassau counties. The study concluded that there is insufficient evidence to verify claims of cost savings and also raises questions about patient access to medical care, particularly turnover among private plans that disrupts the patient-provider relationships. The study finds that some companies hoping to profit from providing Medicaid managed care services have not achieved the success they envisioned and sometimes choose to leave the program with little notice, causing a disruption for patients. In terms of managed care costs savings, the Georgetown study found "insufficient data available to draw conclusions," adding that reductions in expenditures may actually be due, in part, to patients being denied care. Furthermore, no encounter data, and no up to date data on cost savings are available to substantiate the claims made by proponents of the Medicaid HMO plans. Encounter data measures what services and medications patients are receiving and which ones are being denied - accountability that health advocates say is critical to ensure for-profit HMOs aren't lining their pockets at patients' expense.
The study concludes that instead of rushing to implement this unproven and ill-advised pilot program statewide, more reliable cost-saving alternatives should be considered such as such raising the generic prescription drug dispensing rates and pushing for adherence programs that produce better health outcomes.
So why do we want to turn over billions of dollars to private for-profit managed care companies?

Bernd Wollschlaeger,MD,FAAFP,FASAM
Board Certified Family Physician & Addiction Specialist
16899 NE 15th Avenue, North Miami Beach, FL 33162
Phone: (305) 940-8717
E-mail: info@miamihealth.com

Governor Scott and Mandatory Drug Testing

2011-04-03T00:05:00.001-04:00

Governor Scott and Mandatory Drug Testing:

A recent article published in the Miami Herald http://www.miamiherald.com/2011/03/27/v-fullstory/2137314/gov-rick-scotts-drug-testing-order.html reports that Governor Scott signed an executive order last week that requires drug testing for many current state workers and job applicants. According to the article “Scott’s order applies to all employees and prospective hires in agencies that answer to the governor, and could affect as many as 100,000 people. Scott also supports a state Senate bill that requires all cash-assistance welfare recipients over the age of 18 to pay for and receive a drug test, a policy that could affect about 58,000 people.”

But is this executive order legal?

* In April 2000 U.S. District Court Judge Kenneth L. Ryskamp ruled that governments cannot require prospective employees to take drug tests unless there is a “special need,’’ such as safety. Ryskamp’s ruling led other South Florida cities, such as Pembroke Pines, to abandon their policy of drug testing all job applicants.
* Random drug-testing of current government workers also has been limited to those in jobs that affect public safety and to cases where a reasonable suspicion of abuse exists, according to a December 2004 federal court ruling in a case that involved Florida’s Department of Juvenile Justice. In that case, U.S. District Court Judge Robert Hinkle ruled that the DJJ violated the Fourth Amendment in ordering random drug-testing of all the agency’s 5,000-plus employees.
* State agencies already are allowed, but not required, to screen job applicants for drugs, under the Florida Drug-Free Workplaces Act. The law allows state agencies to test employees if there is a reasonable suspicion that workers are on drugs. But that suspicion must be well-documented and employees must be informed of the policy prior to testing.
* Howard Simon, executive director of the ACLU of Florida, said Scott is taking a “simplistic” approach to the law, pitting the public’s expectation of a “right to know” against each individual state worker’s right to privacy.

The article concludes that though no legal challenge to the governor’s order has been filed, one will be forthcoming.
I urge all of you to support the ACLU of Florida in their efforts to fight back against government intrusion into our lives camouflaged in the shroud of transparency.

Yours
Bernd

Malpractice Reform

2011-04-01T01:28:00.001-04:00

Attached you find a very interesting and thoughtful article regarding professional liability reform. In last month’s budget proposal, the Obama administration offered a solution: a plan to encourage evidence-based medicine by limiting the professional liability of doctors who adhere to clinical practice guidelines.
The author points out that the proposal will not achieve the noble goal of providing quality care at a reasonable cost because the current guidelines, written by nonprofit medical groups and for-profit insurance companies, are not good enough.
The author then suggests that "instead of nonprofit groups producing free guidelines, or insurance companies producing ones that serve their own interests, the government should require health care providers to buy or license guidelines from what I call private regulators, for-profit companies with expertise in evidence-based medicine. Doctors would have immunity from malpractice cases if they followed the guidelines. However, the private regulators themselves would be liable if their guidelines were found to deviate from optimal care."
Unfortunately, the malpractice reform debate is often reduced to a ONE SOLUTION ONLY issue: cap non-economic damages.
The proponents of those caps often forget that the non-economic damages among those patients who were harmed can often never be properly assessed. Non-economic damages, or quality-of-life damages,compensate injuries and losses that are not easily quantified by a dollar amount and are difficult to measure.
Therefore, we should pursue other solutions such as the application of evidence - and standards-based care to protect patients and our families who may fall victims to malpractice.
Yours
Bernd

March 28, 2011

A Market Solution for Malpractice

By RONEN AVRAHAM

Austin, Tex.

IT’S been a year since health care reform was signed into law, and since then both Republicans and Democrats have been trying to address one item it left out: medical malpractice reform. In last month’s budget proposal, the Obama administration offered a solution: a plan to encourage evidence-based medicine by limiting the malpractice liability of doctors who follow clinical practice guidelines — in effect, granting them immunity.

Doctors love this proposal, and patients should too: When doctors follow good guidelines they are less likely to order too many or too few tests or to prescribe the wrong treatment.

Unfortunately, the proposal will not achieve the noble goal of providing quality care at a reasonable cost because the current guidelines, written by nonprofit medical groups and for-profit insurance companies, are not good enough.

First, they often conflict with one another. Recommendations for when and how frequently to give women mammograms, for instance, notoriously vary depending on which group is giving them.

In addition, there are conflicts of interest. Guidelines produced by insurance companies sometimes put their interests first. Malpractice insurers, for example, may recommend yearly mammograms, even if they are not necessary, because they bear the costs of lawsuits for late diagnoses of breast cancer — and not the costs or health risks of the extra mammograms. Moreover, the nonprofit groups behind many other guidelines have traditionally depended on pharmaceutical and medical device companies to finance their work. Last year, the Council of Medical Specialty Societies issued a new code of conduct seeking to stop these industries from sponsoring the development of guidelines, but there are still too many loopholes, and thousands of guidelines produced before the reform are still in circulation.

Most troubling of all is that the groups behind the guidelines bear no liability for producing bad ones. No matter how poor the care they prescribe, it is the doctors who depend on them who are punished.

Mr. Obama’s proposal to limit the liability of doctors who follow these flawed guidelines (included in a $250-million plan for overhauling states’ malpractice systems) is clearly not the way to better care. Immunity is a good idea. It’s just that we need to create the incentives necessary for the production of optimal guidelines first.

This is no secret — last week the Institute of Medicine put out a report listing new standards for promulgating guidelines. I was a consultant on the report, which goes a long way toward improving the system, but I worry about the extent to which these standards will be followed. I have a different proposal for improving the guidelines:

Instead of nonprofit groups producing free guidelines, or insurance companies producing ones that serve their own interests, the government should require health care providers to buy or license guidelines from what I call private regulators, for-profit companies with expertise in evidence-based medicine. Doctors would have immunity from malpractice cases if they followed the guidelines. However, the private regulators themselves would be liable if their guidelines were found to deviate from optimal care.

The profit-seeking forces of the market on the one hand and legal accountability on the other would help private regulators strike the right balance between patient safety and cost of care. Private regulators would discourage the overuse of expensive medical procedures because doctors, under pressure from insurance companies to keep costs low, would be unlikely to invest in guidelines recommending unnecessary procedures. But if the guideline-makers failed to recommend an appropriate procedure, they’d be held responsible for the patient’s health.

Just as they can now, doctors could deviate from the guidelines when required. Their discretion and autonomy would be preserved. But in most cases, when guidelines apply, doctors could follow them without having to worry about being held liable, and more important, about getting bad advice.

Such a system may not be too far off: medicine is already moving toward for-profit guidelines. UpToDate, First Consult and eMedicine are just a few new databases compiled by for-profit companies in the business of making technical, evidence-based medicine more accessible to doctors. This is certainly exciting, but to provide doctors with the peace of mind they deserve, these companies need to be held accountable for the advice they give.

Almost every other product Americans encounter is subject to laws that guarantee that the producer suffers when its product is subpar. There’s no reason medical guidelines should be any different. With the proper incentives, these private regulators could help President Obama carry out the health care reform he signed into law a year ago.

Ronen Avraham is a professor at the University of Texas School of Law.

Pill Mill Issue

2011-03-28T23:50:00.001-04:00

Attached a link to an article http://www.tampabay.com/news/health/gov-rick-scott-announces-plan-to-combat-pill-mills/1160274 reporting that Gov. Rick Scott on Monday launched his own initiative to fight the problem. At a news conference where he was flanked by Attorney General Pam Bondi and a handful of law enforcement officers, Scott announced a statewide drug trafficking "strike force." Florida Department of Law Enforcement Commissioner Gerald Bailey will lead the effort, coordinating with local law enforcement agencies. Scott directed the FDLE to use $800,000 in unspent federal grant money to help pay for overtime and other costs associated with the effort. State Senator Fasano, a strong supporter of the Prescription Drug Monitoring Program, said he found it curious that the governor was able to come up with $800,000 for the law enforcement effort but not for the database. AG Bondi, who supports the database, acknowledged that she and the governor have a difference of opinion. But she praised the governor for taking action on the law enforcement front. "We need more tools for all these people standing behind us," she said. Later, Bondi said she considers the database one of those "essential" tools.
Further legislative update regarding the PDMP:
The state House of Representatives, at the urging of Speaker Dean Cannon, has proposed eliminating the database. But Senate President Mike Haridopolos has said that proposal won't make it through his chamber. In fact, fellow Republican Sen. Rene Garcia got nowhere in a Senate committee Monday with a bill amendment that would have killed the database. The amendment was dropped without even being put up for a vote.

Yours
Bernd

Florida gets the profits, Kentucky gets the problem

2011-03-27T23:37:00.001-04:00

“We’ve got more people dying of prescription drug overdoses than car accidents,’’
U.S. Rep Hal Rogers.

Attached a link to a great article published in today's Miami Herald http://www.miamiherald.com/2011/03/27/v-fullstory/2135476/kentucky-the-other-end-of-the.html again focusing on the unresolved pill mill issue in Florida.
The sobering facts speak for themselves:

* As far back as 2002, early in the epidemic, one fourth of all OxyContin-related deaths in the country took place in eastern Kentucky.
* According to a study by the Substance Abuse and Mental Health Services Administration, there was a fourfold increase nationally in treatment admissions for prescription pain pill abuse during the past decade. The increase spans every age, gender, race, ethnicity, education, employment level and region. Nearly every family in eastern Kentucky has been touched by prescription-drug addiction and death.
* In Kentucky some harbor a deep resentment at Florida’s unwillingness to crack down on pill sales, for instance, at its refusal to set up a prescription database similar to those in other states to ensure that customers are not “doctor shopping’’ – scooping up some pills here, more pills there – by dealing with multiple physicians.

Meanwhile, dozens of people die every day in Florida and Kentucky but Governor Rick Scott and many of his political friends are stonewalling.

Yours,

Bernd

Bad Medicine

2011-03-24T23:56:00.002-04:00

Why opting out of health care reform is a bad choice?

In an excellent editorial published in the Miami Herald http://www.miamiherald.com/2011/03/22/2128720/one-year-after-healthcare-reform.html Steven Marcus, President and CEO of Health Foundation of South Florida, points out that:

“ Florida has a healthcare crisis — and we need to do something. The law is not perfect but it is a giant step in the right direction. The protections under the Affordable Care Act move us forward to a time when citizens won’t have to wait until they are so sick that they have to go to emergency rooms for the most expensive care. Rather, they will have coverage to go to a family or primary-care doctor. But before anyone looks forward to a healthier Florida and nation, here’s a dose of reality: The benefits from consumer protections increasingly are at risk of being taken away. The actions of many of Florida’s elected officials reflect a lack of concern for thousands of our low-wage workers and other citizens who will go without care and instead declare personal bankruptcy over a medical emergency. This leads to community bankruptcy for unpaid, expensive medical and hospital bills. Is this what Floridians deserve? I don’t think so. Let’s get behind this law and tell our officials to do the same, it will attract businesses and jobs to Florida by reducing costs that are dragging down our economy. Let Florida join the other states in planning by taking the federal money offered to create a brighter and healthier future for all Floridians.”

By blocking and stalling the implementation of the entire healthcare reform package the political leadership in Tallahassee jeopardizes the access to healthcare to four million uninsured residents in Florida. This rigid and ideologically misguided attitude will hurt the business of medicine in Florida, too. Recognizing this problem, Michael W. Garner, president and CEO of the Florida Association of Health Plans, said that Florida should pass bills to keep aspects of its health insurance market in state control, instead of letting the federal government regulate the market under the Patient Protection and Affordable Care Act (PPACA). He is correct stating that health insurance companies in Florida will have to struggle to meet the federal guidelines and standards set forth by the PPACA. It is obvious that Governor Rick Scott's ideologically driven policy is not only bad for our health but also bad medicine for big business in Florida.

Yours
Bernd

Florida is Open for (Drug) Business

2011-03-14T23:33:00.003-04:00

Attached a link to a Miami Herald article from Friday, March 11th http://www.miamiherald.com/2011/03/10/2107891/house-kills-plan-for-drug-monitoring.html reporting that with little debate Thursday morning, the House health and human services committee voted to eliminate the state’s plan for prescription drug monitoring database.Before the vote to eliminate the database, the committee passed a bill that would prohibit doctors from dispensing narcotics, making the drugs largely available only at pharmacies. It would would require wholesale distributors of narcotics to report who they are selling the drugs to so law enforcement officials can identify unusually large purchases. The bill calls for appropriating $1.5 million to track down the large, non-pharmacy dispensaries and return the drugs to wholesalers.
Our legislators also decided to eliminate registration and inspection of pain clinics, and a ban on felons owning pain clinics.
Obviously, the committee chairman,Robert Schenck (R-Spring Hill) and his fellow legislators believe that our already burdened law enforcement officers will do a better job to crack down on drug dealers in white coat and the OxyCartel. But even Broward County Sheriff Al Lamberti pointed out that we cannot arrest ourselves out of the problem! Meanwhile, the drug dealers can rest assured that Florida is wide open for their business and that no one will bother them anymore to ask for clinic registration or physician ownership verification. Maybe we should post a sign at the state border: Felons welcome!
Something is rotten in the state of Florida.
Yours
Bernd

DOH wins PDMP Bid Protest

2011-03-08T21:28:00.001-05:00

Attached you find a link to the Recommended Order by an Administrative Law Judge regarding the Prescription Drug Monitoring Program (PDMP) bid protest.
Let me explain briefly the circumstances for or those who may not know all the details:
The Department of Health (DOH) issued a Request for Proposals (RFP) for companies interested in bidding for the PDMP contract. The loosing bidder (Optimum Technology ) protested TWICE the DOH decision to award the contract to a competitor (Health Information Design).
An administrative law judge recommended today that the DOH enter a final order dismissing the Formal Written Protest.
That means the DOH WON the bid protest and may move ahead with the PDMP implementation.
I would expect that the DOH follows state law, awards the contract and moves to implement the PDMP. The only obstacles are the Legislature and the Governor who at this point in time defy state law!
Yours
Bernd

http://www.doah.state.fl.us/internet/search/docket.cfm?RequestTimeout=500&CaseNo=11-000257&Petitioner=OPTIMUM%20TECHNOLOGY%2C%20INC%2E&Respondent=DEPARTMENT%20OF%20HEALTH&URLString=Count%3D1%26BPCount%3D1%26DWH%3D1%26Pet%3DOptimum

Pill Mill and PDMP Issue

2011-03-06T13:18:00.002-05:00

In the last 2 days a series of articles were published in the Miami Herald and Sun Sentinel focusing on the "pill mill" and PDMP repeal issue.
I am hopeful that the heightened publicity will put pressure on our legislators to act.
Yours
Bernd

Drug monitoring program worth saving, By Al Lamberti and Marcelo Llorente
Read more: http://www.sun-sentinel.com/news/opinion/fl-prescription-drug-forum-20110305,0,2826266.story

"On behalf of Floridians, we are pleading with Gov. Scott, Attorney General Bondi and legislative leaders not to sacrifice vital initiatives such as the PDMP in an effort to achieve a balanced budget. Too many lives are at risk, and the consequences are too great to eliminate the PDMP."

Sons and daughters, lost to a pill epidemic FRONT PAGE STORY
Read more: http://www.miamiherald.com/2011/03/05/2100118/sons-and-daughters-lost-to-a-pill.html#ixzz1FqNyNtUh
http://www.miamiherald.com/2011/03/05/2100118/sons-and-daughters-lost-to-a-pill.html

Florida pill mills: Different drugs, same faces
http://www.miamiherald.com/2011/03/05/2099419/florida-pill-mills-different-drugs.html

"Felons can’t get a license in Florida as a pest-control operator. Colangelo can’t be a private detective or paramedic or title insurance agent or bail bondsman or labor union business agent. He can forget about employment with the Florida Lottery. Or qualifying as a notary.
“In Florida, this guy couldn’t own a liquor store,” said Broward Sheriff Al Lamberti. Yet according to the DEA, Vincent Colangelo, who couldn’t kill bugs, serve cocktails or tail a cheating husband, could operate seven pain clinics and a pharmacy in Broward and Miami-Dade counties. His pill mills peddled more than 660,000 doses of oxycodone in just two years. The feds calculated Vinny’s proceeds at $22,392,391."

Drug epidemic: Monitoring program a necessity, by Bruce Grant
http://www.sun-sentinel.com/news/opinion/fl-drugs-oped0306-20110306,0,6995046.story

"It's time to quit posturing and doing nothing while people die. If there is a better solution to the monitoring program, then let's hear it. Currently, 38 other states have an operational program, and another five have passed the law and are awaiting implementation. What do they know that we don't? Worse yet, Florida now has other states chastising us over our deadly inaction.
Florida must implement the monitoring program now. It is the single most-effective mechanism we have to stop the epidemic of prescription drug abuse. Inaction on the program or its repeal is an option that would only result in further deaths, greater human suffering, and tremendous human and economic costs we cannot afford. Let's put aside rhetoric and put this program into operation. Lives depend on it."

Florida Judge Stays Ruling

2011-03-04T23:05:00.002-05:00

In a surprising move judge Roger Vinson stayed his own ruling against the ENTIRE new health care law. This is essentially a suspension of the judge's order to hold the implementation of the Patient Protection and Affordable Care pending appeals. As a result, Governor Sean Parnell of Alaska, a Republican who announced last month that his state would not put in effect the health law in light of Judge Vinson’s ruling, said Thursday that “our administration will treat the federal health care law as being in place.” Consequently, Governor Rick Scott should follow suit and immediately rescind his decision to withhold implementation of the federal health care law. Otherwise, Floridians will NOT be able to benefit from the services the law does offer. This includes the:

* Ban on withholding insurance due to pre-existing conditions
* $50 million dollar fund to help states experiment with alternatives of medical liability
reform
* One percent Medicare bonus for physicians who are reporting health quality-outcomes using
a health information technology platform

Now is the time to act! I hope he does.
Yours
Bernd

For more information see http://www.nytimes.com/2011/03/04/health/policy/04judge.html

Health Department Faces Deep Cuts

2011-03-03T22:58:00.002-05:00

Attached an article from today's Miami Herald highlighting that a Health Department report calls for cutting 1,608 department jobs and for the state to stop paying for primary-care services at county health departments. The proposal would save about $22.3 million and comes as some state officials want to rely more on federally qualified health centers to provide primary care. That's odd: one the one hand the current administration in Tallahassee refuses to implement the Patient Protection and Affordable Care Act citing government intrusion as their biggest concern, BUT on the other hand they have no problems to shift the financial responsibility for necessary primary care to the federally qualified and funded health centers! Lawmakers required the department to submit the report by Tuesday, a week before the start of the 2011 legislative session. That would provide time for the Legislature to consider changes this year. Allegedly, the report also calls for the elimination of $4.8 million for AHEC thereby practically gutting the programs. Another proposal calls for lifting the requirement that the health department secretary be a physician.
I guess we are moving full speed backwards.
Yours
Bernd

The Miami Herald
Posted on Wed, Mar. 02, 2011
Fla. Health Department may cut 1,600 jobs

By Jim Saunders
Health News Florida
TALLAHASSEE — Under fire from lawmakers, the Florida Department of Health has proposed a sweeping plan to reorganize --- and shrink -- its operations. Among other things, it would move the state out of the primary-care business.

The recommendations, released in a 154-page report late Tuesday, call for cutting 1,608 department jobs and consolidating dozens of divisions and bureaus. One of the proposals would buck the powerful doctors' lobby by lifting a requirement that the department secretary be a physician.

The reorganization would lead to many department duties being shifted to other state agencies, privatized or eliminated altogether.

In one major change, the report calls for the state to stop paying for primary-care services at county health departments. The proposal would save about $22.3 million and comes as some state officials want to rely more on federally qualified health centers to provide primary care.

In another big change, the report calls for contracting with a private company to run at least part of the Children's Medical Services program. CMS serves children who have a variety of serious medical conditions.

State lawmakers last year required the department to conduct a review of its operations and come up with recommendations for possible changes. House leaders, in particular, have been highly critical of the department, contending that it is unfocused and has taken on too many roles over the years.

While the department worked on the recommendations, new Gov. Rick Scott's transition team also issued a blistering appraisal of the agency. Some transition team recommendations --- such as moving away from primary care and allowing a non-physician to serve as department secretary --- are evident in the report.

But many public-health advocates have worried that changes in the department would go too far. As an example, they expressed repeated concerns last year that changes would gut prevention and education programs.

The report calls for making major changes in the department's organizational chart, going from 11 divisions to six and 50 bureaus to 18. Programs would be moved around to fit under the new framework.

Also, many programs would be moved to other state agencies, including the Department of Children and Families, the Department of Environmental Protection and the Agency for Health Care Administration.

Other programs would be farmed out to private contractors or see their funding disappear. Many of the programs targeted for elimination serve only specific geographic areas of the state.

But some cuts would have broader reach, such as the proposed elimination of $4.8 million for the Area Health Education Centers Network, which is involved in anti-smoking programs. The report says the so-called AHECs could pursue other sources of money.

In all, the report calls for eliminating 1,608 department jobs, though at least 180 would shift to other state agencies. It was not immediately clear how many of the targeted jobs might be vacant.

Lawmakers required the department to submit the report by Tuesday, a week before the start of the 2011 legislative session. That would provide time for the Legislature to consider changes this year.

Scott's transition team went further than the report's recommendations and called for a merger of the department with the Agency for Health Care Administration. Scott administration officials have said the idea is still being considered, though lawmakers have not publicly taken it up.

The Airline Industry and Patient Safety

2011-02-26T23:23:00.000-05:00

Air traffic controllers' errors and Patient Safety:

According to the Associated Press, reports of errors by federal air traffic controllers have doubled last year! Citing the Federal Aviation Administration's official tally, the report says there were 1,889 operation errors in the 12 months ending on Sept. 30, 2010 vs. 947 a year earlier. During the same period in 2009, there were 1008 errors. The FAA says the higher number of reported errors - which usually mean aircraft coming too close together - is due to better reporting and improved technology that can determine more precisely how close planes are in the air. Few of the errors fall into the most serious category, which could result in pilots taking action to prevent an accident, AP says. In the year ending Sept. 30, there were 44 such events vs. 37 in the prior year. At a hearing before the House aviation subcommittee earlier this week, FAA Administrator Randy Babbitt was asked about the rise in error reports. He states that the FAA is seeing more errors partly because a safety program, introduced in 2008, protects controllers from punishment for errors they voluntarily report. The program is receiving about 250 reports a week. Unfortunately, the medical industry does NOT pursue the same error prevention strategy. In the 10 years since publication of the Institute of Medicine’s report “To Err is Human,” extensive efforts have been undertaken to improve patient safety. The question remains: did they succeed? Yes, we are talking about the need for patient safety and physicians have to attend mandated medical error prevention courses. But did we change anything? According to a recent study of 10 North Carolina hospitals published in the New England Journal of Medicine[1], the authors found that harm remain common, with little evidence for widespread improvement. Prescribing errors occurred in 7.6% of outpatient prescriptions and many could have harmed patients.[2] Prescription-error related malpractice lawsuits are the second most frequent and the second most expensive types of suits filed against physicians. But practicing physicians in outpatient settings still do not have access to medical error databases representing the aggregation of voluntary incident reports. The Patient Safety and Quality Improvement Act of 2005 (Patient Safety Act) authorized the creation of PSOs to improve quality and safety by reducing the incidence of events that adversely affect patients but many of those PSO still are not open for incident reporting by primary care physicians in private practice. In 2006, outpatient visits accounted for $850 billion, making it more than 41% of our health care spending but most medical errors occurring in this setting are NOT being reported or registered. Subsequently, billions of dollars are being wasted and thousands of lives are lost every year. So what can we learn from the airline industry? That we should create the FAA equivalent of a Patient Safety Organization authorized to collect ALL medical error incidents which then can be used to educate and guide physician in error prevention strategies. I ask myself why the medical industry and physicians are opposing such a strategy? Our patients deserve an answer!

[1] http://www.nejm.org/doi/full/10.1056/NEJMsa1004404

[2] http://science.icmcc.org/2010/08/26/outpatient-prescribing-errors-and-the-impact-of-computerized-prescribing/

Governor Scott and the PDMP: Accusations replace Facts

2011-02-24T22:19:00.000-05:00

Unfortunately, Governor Scott pulls out all the stops to attack the supporters of the PDMP including the PDMP Foundation.
These are indeed groundless accusations without factual evidence to support the arguments made.

http://www.palmbeachpost.com/opinion/editorials/scott-makes-it-up-again-accusations-against-group-1276631.html?sms_ss=email&at_xt=4d6663c1bb07e380%2C0

Excerpt from the article above:

Gov. Rick Scott is inventing another excuse for opposing a statewide prescription pill database.

Without offering any evidence, the governor this week accused the private foundation that is raising money for the database of wasting donations. "It's come to my attention that thousands of dollars have been spent on lawyers, travel, meals for board members," Gov. Scott told reporters on Tuesday. "I believe it's an invasion of privacy. And right now with that database, it appears that the money's been wasted."

In fact, board members of the Prescription Database Monitoring Program haven't charged a single expense to the foundation. A private company started by the former chairman of the foundation's board has picked up most of the legal expenses. "The first communication from the governor's office to our foundation was a baseless accusation. It's desperate," said foundation Vice Chairman Rene Bruer. He is a financial analyst who worked for the director of Florida's drug control office under Gov. Jeb Bush. "We're rising up above the politics. We just want to deal with the problem."

http://www.palmbeachpost.com/news/state/fla-drug-database-fund-raiser-disputes-gov-scotts-1273905.html?page=2&viewAsSinglePage

Excerpt from article above:

Scott's attack on the foundation took Bruer [Vice-Chairman of PDMP Foundation] by surprise, he said.

"We've never ever had anybody from Rick Scott's office ask us questions, join one of our phone calls. Nothing. Ever. There has been no dialogue between us. We welcome that," he said.

The foundation is caught in the middle of a political battle of wills, Bruer said.

"The PMDP Foundation is not here to play political ping-pong. We're strictly here to look at the overarching issue which is people dying from prescription drug abuse and doing what we can within the letter of the law to make sure that one of Florida's worst public health epidemics is dealt with," he said.

The Tip of the Iceberg

2011-02-23T22:41:00.002-05:00

Attached an article from today's Miami Herald highlighting the arrest of several oxycontin dealers, wrongly called "doctors", Unfortunately, they represent just a tiny sample of the hundreds of drug dealers in white coat in South Florida who make millions in ill-gotten profits.
Meanwhile, the Oxy-Cartels are reinventing their business model and open "life style enhancement" and " wellness" clinics.
We have to stop them now!
Yours
Bernd

The Miami Herald
Posted on Wed, Feb. 23, 2011
Pill-mill arrests hit right target: doctors

Fred Grimm
fgrimm@MiamiHerald.com
Law enforcement tested a promising antidote for Florida’s oxy epidemic Wednesday – doctors in handcuffs.

Arrests of so many drug-addled users and low-rent street dealers hardly matters. Not compared to that ignominious image of Dr. Zvi Harry Perper led out of a “pain management clinic” in Delray Beach Wednesday. That stuck at the very nub of the pill-mill industry. In tan scrubs and steel cuffs. Dr. Perper on a perp walk.

Fifteen pill mills were raided in Broward, Miami-Dade and Palm Beach counties. A few oxy street dealers and a handful of clinic employees were arrested, all replaceable entities in the pill-mill business model. But five doctors were busted. Seven others “voluntarily” surrendered their federal license to prescribe narcotic medicines. Doctors, cranking out oxycodone prescriptions for phantom pain and fake injuries, are the essential elements.

While a doctor may be a crucial to a pill mill, actual doctoring is just a bother. Undercover agents, posing as patients, were prescribed hundreds of oxycodone pills without so much as an examination by Dr. Jeffrey Lipman at Midtown Pain Management in Miami-Dade, according to Lipman’s arrest warrant.

It was easy to see why the DEA might have been suspicious of Lipman’s bedside manner. In the first six months of 2010, he ordered up 288,560 oxy pills for his patients. (There are more prolific oxy docs in the United States. All 39 of them work out of South Florida pill mills.)

The agents told the doc of prior drug abuse and taking oxy with alcohol. They described only minimal pain. In Dr. Lipman’s waiting room, another patient, who said he planned to sell his pills in North Carolina, asked an agent (who he thought was from Tennessee), “How easy was it to sell up there?” The doctor even discussed the “street value” of the oxy he was dispensing with the undercover agents. He figured $8 to $16 a pill.

Medical experts cited in the arrest warrant described Lipman’s clinic as “consistent with those of the usual pill mill, where cash is the only form of payment, patients often travel from long distances and sell prescribed controlled substances , physical examinations are not performed . . . and controlled substances are prescribed in excessive dosages and potentially fatal combinations.”

The raids came the day after Gov. Rick Scott reiterated his fervent, ideological opposition to a drug database, designed to prevent oxy shoppers from filling multiple prescriptions, moving from one pill mill to another – circumstances captured nicely by the pain clinics raided Wednesday.

The warrants noted how the pill mills flourish in Florida with minimal regulations, without the tracking system used in most states. “Consequently, individuals have been able to obtain unlimited and unmonitored quantities of controlled substances from multiple pain clinics for either personal consumption or resale in Florida and elsewhere.”

The raids only reinforced the notion, widely held by law enforcement and most of the state’s medical associations, that without a monitoring system, Florida invites criminal operations in the guise of medical clinics.

But after Wednesday, the pill mill industry will be forced to limp along with a dozen fewer doctors.

© 2011 Miami Herald Media Company. All Rights Reserved.
http://www.miamiherald.com

Read more: http://www.miamiherald.com/2011/02/23/v-print/2082013/pill-mill-arrests-hit-right-target.html#ixzz1EqMoYvC7

The Stubborn Rejection of Common Sense

2011-02-13T22:38:00.002-05:00

Rick Scotts decision to derail the Prescription Drug Monitoring Program (PDMP) is either based on ideological rigidity, or plain simple ignorance.

The attached articles and editorials clearly highlight the absolute necessity to declare a public health emergency and to implement the PDMP immediately!

1. More babies born addicted to pain drugs http://articles.sun-sentinel.com/2011-02-12/health/fl-prescription-drugs-born-addicted-20110211_1_newborns-prescription-drug-winnie-palmer-hospital

a. In 2009, nearly 1,000 babies born in Florida hospitals were treated for drug withdrawal syndrome. The most recent data show no signs of a slowdown. During the first half of 2010, 635 cases were reported.

b. From 2006 to 2009, there was a 173 percent increase in newborns treated at Florida hospitals for drug withdrawal syndrome, according to Agency of Health Care Administration records obtained by the Orlando Sentinel.

2. Why does Gov. Scott oppose Florida prescription drug database? http://articles.sun-sentinel.com/2011-02-12/news/fl-rick-scott-pills-mayocol-b021311-20110211_1_pain-clinics-prescription-drug-pill-mill-epidemic

a. “Scott's move to scrap a prescription narcotic database intended to temper the excesses of South Florida's rogue pain clinics makes no sense. Unless the governor somehow likes the drug tourism, overdoses and other human wreckage spawned by our pill-friendly culture. If it's not government's role to monitor controlled substances, then why bother monitoring anything? Let's just do away with driver's licenses, vehicle registrations and concealed weapons permits too, since cars and guns are legal. The database had support from just about everyone — legislators, law enforcement, responsible doctors and pharmacists and legitimate pain clinics.”

3. Pill mills: Scott, legislators undermining efforts, by Mike Fasano and Nan Rich http://www.sun-sentinel.com/news/opinion/fl-pills-oped0213-20110213,0,3980383.story

a. “Legislature is essentially allowing unneeded deaths to continue. It is, therefore, imperative that the legislature get out of the business of approving rules for bills that it has already passed. In the case of the Board of Medicine's rules, lives are at stake. Finally, the governor has eliminated the Office of Drug Control, which provides an important focus on the problem of drug abuse, and coordinates the numerous state agencies affected by this issue. State agencies across the board must deal directly or indirectly with the consequences of drug abuse, including our courts, law enforcement, prisons, foster care system, Veterans' Administration, health departments, mental health programs and even port security agencies. That's why the work of the ODC to coordinate the drug control efforts of each of these agencies is imperative, and why we're disappointed to see Gov. Scott unilaterally shut down this agency by laying off its entire staff. We therefore hope our legislative colleagues will consider taking immediate action to put our tough new pill mill regulations into action, and that the governor will put the Office of Drug Control back to work, and preserve the Prescription Drug Monitoring Program. This issue isn't about bureaucracy or the size of government — it's literally a matter of life and death.”

We should not ponder the question why our new Governor is not getting it. Instead, we should take action and develop a collaborative network of allies and supporters across the political spectrum to push back. Now its time to act! You can follow me on Twitter www.twitter.com/dadedoc or at http://floridadocs.blogspot.com

Yours truly,

Bernd Wollschlaeger.MD

Governor Scott and the PDMP

2011-02-08T23:10:00.001-05:00

Governor Scott and the PDMP:

The Governors proposal to eliminate the Prescription Drug Monitoring Program (PDMP) surprised many supporters of this project. Currently, the PDMP implementation has been stalled by a protest from a software company, which bid for the contract and lost.

The PDMP would require doctors and pharmacies to enter and report each and every prescription for controlled substances. With the help of the database healthcare professionals and, under very restricted and monitored circumstances, the police could then crosscheck the database for anyone who has received multiple prescriptions of narcotic drugs from multiple sources, a common practice among addicts and drug dealers who amass large quantities of drugs from so-called “pain clinics.”

The law establishing the PDMP clearly stipulated that it to be financed without tax dollars. It would be run with more than $500,000 raised from drug makers, foundations and federal grants, which would have to be returned.

Without a functioning PDMP unscrupulous pill-mill owners and their drug dealer cronies in white coat can obscure and conceal the dispensation of millions of prescription narcotics taking place behind the pain-mill walls.

Governor Scott argues, "That program has not been working," even though is has yet to be implemented! The fact that NO tax dollars have been or will be used for developing and deploying the PDMP one is left to ponder the question what is driving our Governor to make such a foolish decision?

The reason is clear: ideological blinders prevent him from realizing that seven (7) Floridians die every day from prescription narcotic overdose. He firmly believes that government can do only harm and that regulations will prevent business to thrive and prosper. That includes drug dealers, fraudsters and thieves too!!

The time has come to stand up and speak up. We cannot allow him to dismantle the product of years of hard work. Lets not waste this opportunity to protect our public health and safety.

Yours truly,

Bernd

The Governors Wrong Move(s)

2011-02-05T23:21:00.001-05:00

The Governors Wrong Moves (s) :

An editorial published in today’s Miami Herald http://www.miamiherald.com/2011/02/05/2051681/wrong-move.html points out that the Governor has turned down two federal grants that would start paving the way for consumer choices as part of the federal healthcare law. Mr. Scott is using a federal judge's recent ruling in Pensacola to make his case that the new law is unconstitutional, and therefore the federal money isn't needed. This includes a $1 million grant that would help consumers comparison shop for health plans and another $1 million grant for consumers to monitor insurance-rate changes to see how their premiums are spent. Our Governor seems to be so blinded by ideology that even reasonable approaches appear unacceptable for him! But he does not stop there! John Dorschner reports in an article published in today’s Miami Herald http://www.miamiherald.com/2011/02/05/2051426/jackson-funding-cut-likely.html that healthcare advisors to Gov. Rick Scott have recommended that tax dollars, now focused almost entirely on government-own hospitals, include more money for private hospitals that provide care for the poor and uninsured. That may further aggravate the already dire financial conditions of cash-strapped public hospitals. In addition the end of the economic stimulus funds from the Obama administration has reduced payments to the Lower Income Pool, a fund for hospitals that serve large numbers of uninsured patients and those on Medicaid, the state-federal health insurance for the poor. LIP funds are a complicated mechanism in which public hospitals have to transfer tens of millions of dollars to Tallahassee before getting funds back. Now Florida may not be entitled to any LIP funds at all next year because it's in violation of a federal waiver in which it promised to spread Medicaid reform statewide -- something the state has yet to do and Governor Scott continues to resist! The waiver issue jeopardizes the receipt of $1.9 billion in healthcare funds that flow into the state through LIP and a sister program. Is our Governor going to deprive our State of these urgently needed funds too?
I am afraid he is digging in, ready to fight against our own best interests.

Yours

AG Bondi and Pill Mills

2011-02-04T22:44:00.000-05:00

During a news conference in Panama City today Florida Attorney General Pam Bondi outlined her strategy to address the pain clinic issue and related prescription drug abuse. She announced four recommendations:

A mandatory six-month suspension and $10,000 fine for doctors who violate standards of care when prescribing controlled substances.

A third-degree felony charge for those who use fraud or misrepresentation to register as a pain clinic.

Escalating criminal penalties for doctors who fail to perform a physical examination before dispensing 72-hours worth of controlled substances.

Require anyone maintaining an inventory of controlled substances to report the discovery of theft to local law enforcement or the Florida Department of Law Enforcement within 48 hours or risk fines and administrative penalties.

She also called for strict enforcement of current laws and aggressive prosecution of violators.
I applaud AG Bondi for her efforts but prosecution and regulations alone won't solve the issue.
State Attorney Glenn Hess (Panama City) is correct stating that the penalties might not discourage the doctors because of the affluence of the doctors and the substantial($$$$$) profits they stand to make dispensing the pills. This explains why the number of registered pain clinics statewide increased to 932 , but police say many violators are unregistered. The Florida Department of Law Enforcement counts 1,167 "pill mills" in the state.
Vague language will also make some of the recommendations difficult to prosecute. Defining “standards of care” and a “physical exam” then showing how a doctor violated those requirements before writing a prescription will be a challenge.
AG Bondi omitted mentioning the most important linchpin of a successful strategy: a Prescription Drug Monitoring Program (PDMP) which can provide a valuable tool for physician to identify doctor shoppers and to safely prescribe narcotics to patients who often do not disclose other source of prescription drugs. The PDMP implementation is currently stalled due to a contested bid. Shortly after Statute 893.055 , which mandates the creation of the PDMP, was passed in early 2009, the Department of Health opened bidding on the contract to create the Prescription Drug Monitoring Program. When bidding closed this summer, the losing bidder contested the winner, and the DoH opened bidding again. The same loser, Optimum Technology, lodged another complaint -- this one about the terms of the bidding themselves. Which means construction of the database has yet to get underway. Meanwhile, seven Floridians die every day from a prescription drug overdose, 49 per week, 200 per month.
AG Bondi could resolve this issue by declaring a public health emergency, thereby enforcing the immediate implementation of the PDMP.
I hope she will listen and we should ask her to show the courage to make this decision.

Yours

Bernd

Bernd Wollschlaeger,MD,FAAFP,FASAM

Florida Shuts Down the Implementation of the PPACA

2011-02-02T23:08:00.003-05:00

Florida's political leadership has decided that they know best whats good for Florida's citizen and shut down the implementation of the Patient Protection and Affordable Care Act (PPACA). Normally, under the Federal Rules of Civil Procedure, a judge’s ruling cannot be enforced for 14 days after entry of judgment. Obviously, other rules apply in Florida. So what is going to happen now? Well, insurance companies can rescind policies, reintroduce life-time insurance limits, deny coverage for children. Sounds like a Brave New World to me. For more information see http://www.lifeandhealthinsurancenews.com/News/2011/2/Pages/Florida-Stops-Implementing-PPACA.aspx?nul#
Yours
Bernd

Florida Health Grades

2011-02-02T21:28:00.002-05:00

Attached links to two articles which made me feel ashamed being a Floridian. Why do our elected officials wage their ideological battles on the back of those in need. Its clear to me who will loose: our children and the most needy in our state.

* "Florida Official sends back $1M " http://www.healthnewsflorida.org/index.cfm/go/public.articleView/article/21614 reporting that state Insurance Commissioner Kevin McCarty said Tuesday he will forfeit a $1 million federal grant that was supposed to go toward beefing up oversight of health-insurance rates.McCarty's disclosed the decision to give up the $1 million grant during the conference call and also sent a letter Tuesday to a top federal health official. The Office of Insurance Regulation was awarded the grant last year to hire workers and upgrade technology. McCarty gave a brief explanation for his decision, saying he was concerned about intrusiveness of the federal government. He also pointed to a Pensacola judge's ruling. He did not give any indication whether Gov. Rick Scott influenced the move, though Scott said earlier in the day that the state will not spend much time or money carrying out the law until court challenges are resolved. Tuesday's decision was not the first time Florida has foregone federal funding that could help carry out the law. The state did not apply last year for money in what is known as the "Consumer Assistance Program" --- which is designed to help people with insurance decisions and information. Goodhue said that program could have provided $2 million to Florida, which was one of about 15 states that did not receive a grant. It also is unclear whether the state Agency for Health Care Administration will apply for a newly available grant to prepare for creating a health-insurance exchange, which would provide a sort of marketplace where consumers could shop for coverage. AHCA did not respond to repeated questions during the past two weeks from Health News Florida about whether it would apply for the exchange grant. Late Tuesday afternoon, AHCA referred all questions about the federal health law to the governor's office, which did not return a phone call.
* "Uninsured kids propel Florida's low health care rating" http://jacksonville.com/news/florida/2011-02-02/story/uninsured-kids-propel-floridas-low-health-care-ratin. It's a good thing for Texas, Arizona, Mississippi and Nevada.
Without those states' abysmal child health systems, Florida's would rank last in the nation, according to a new analysis Read the complete study http://news.jacksonville.com/documents/020111scorecard.pdf compiled by the Washington-based Commonwealth Fund. Still, at 47th overall, the Sunshine State's efforts to ensure that children receive timely, effective health care fall far short of the national standard. The group's report card included all 50 states as well as the District of Columbia. Individual state scores were based on 20 health indicators. They include a state's insurance coverage rates, typical premium costs to families, the percentage of children who see a regular doctor, infant mortality rates and childhood obesity statistics. Insurance rates depended not only on geography but also race: Florida's uninsured rate of more than 20 percent among black children was the highest in the country, according to the report. Florida's low ranking was driven by its high rate of uninsured children, said Cathy Schoen, one of the report's authors. The state's 17.8 percent was second only to Texas, with 18 percent. Both states could dramatically lower their uninsured rates if they raised the maximum a family could earn to be eligible for Medicaid and the Children's Health Insurance Program, Schoen said. Both cap incomes at up to 200 percent of the federal poverty level, or $44,100 for a family of four. How Florida's children rank vs. nation
50th - Percentage of insured children
51st - Percentage of children with a preventive dental visit in past year
15th - Percentage of young children receiving all doses of six key vaccines
35th - Percentage of children aged 10-17 overweight or obese
32nd - Infant mortality rate
0 - Rankings among 20 indicators in which Florida is in top 5

Yours

Bernd

How We Can Curb Prescription Drug Abuse

2011-01-31T00:06:00.001-05:00

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?
Yours
Bernd

Pain Management Program Cut Prescription Narcotics Diversion

By: M. ALEXANDER OTTO, Internal Medicine News Digital Network
01/04/11

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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 www.InternalMedicineNews.com . For reprint inquires, call 877-652-5295, ext. 102.

The Pill Mills Issue and Politicians

2011-01-30T22:01:00.001-05:00

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.
Yours
Bernd

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

By Carl Hiaasen
chiaasen@MiamiHerald.com
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.

Really.

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.
http://www.miamiherald.com

Read more: http://www.miamiherald.com/2011/01/29/v-print/2041020/hey-gov-dont-give-pill-mills-license.html#ixzz1CZgZQfyq

Airline Safety Record Can Serve As An Example

2011-01-24T23:11:00.002-05:00

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 http://oig.hhs.gov/oei/reports/oei-06-09-00090.pdf 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.

Yours
Bernd

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.

Pain Clinics: Board of Medicine Calls For Rules Implementation

2011-01-22T22:29:00.002-05:00

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!!!

Yours

Bernd

South Florida Sun-Sentinel.com 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 blamendola@SunSentinel.com or 954-356-4526.

Copyright © 2011, South Florida Sun-Sentinel

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

2011-01-21T21:32:00.004-05:00

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.
yours
Bernd

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

BY JOHN DORSCHNER
jdorschner@MiamiHerald.com
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

2011-01-21T21:12:00.000-05:00

I highly recommend reading this article http://www.newyorker.com/online/blogs/newsdesk/2011/01/atul-gawande-super-utilizers.html 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.
Yours
Bernd

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.

Doctors and Guns

2011-01-15T21:40:00.001-05:00

Attached a link http://www.nwfdailynews.com/news/-36599--.html to an article reporting that state Representative Jason Brodeur (R-Sanford) and State Senator Greg Evers (R-Baker) introduced a legislative proposal ( HB 155 http://richmedia.onset.freedom.com/nwfdn/leze4b-14gunbill.pdf) 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.”

Yours
Bernd

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.”

Escalating Health Insurance Premiums

2011-01-08T23:35:00.000-05:00

A recent AMA News article http://www.ama-assn.org/amednews/2010/12/20/gvbf1220.htm 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.

Yours

Bernd

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

2011-01-08T22:51:00.002-05:00

ttached a link http://www.ama-assn.org/amednews/2010/12/20/gvsa1220.htm 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.

Yours
Bernd

The End To Public Hospitals

2011-01-02T22:49:00.003-05:00

Attached a link http://www.miamiherald.com/2010/12/30/v-fullstory/1994541/need-for-public-hospitals-to-be.html 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.

Yours

Bernd

Pill Mills are Gearing up for Big Business

2010-12-28T22:03:00.002-05:00

Thanks to the ideological rigidity of our legislature and almost monoptic "vision" of our Governor-Elect the Prescription Drug Monitoring Program is almost dead before even going online. The Office of Drug Control is being dissolved and all employees are gone by January 3rd!
In today's Miami Herald editorial the issues at hand are being pointed out as they are.
Dr. Viamonte Ross, one of the few agency heads asked to resign, has the final opportunity to declare a public health emergency thereby forcing the state to approve an existing PDMP vendor contract. Unfortuantely, the Attorney General (and the Board of Medicine) do not believe that the current status quo justifies such an emergency order. The rate of prescription drug overdose death increased to 7 Floridians a day. So whats the "magic" number 10,20, 100...?
I urge all of you to contact your legislator to support an immediate declaration of a public health emergency.
Yours
Bernd

The Miami Herald
Posted on Tue, Dec. 28, 2010
Pill mills still going strong

When it comes to the unsavory and downright illegal, South Florida owns the market in healthcare scams. Miami-Dade County is the nation's epicenter of Medicare fraud. Broward County is the state's biggest black market in prescription pain killers like oxycodone. By now, many of the pill mills should have been shut down. They're not.

Thanks to lax state oversight, walk-in pain clinics have flourished in Florida in the last three years. A 2009 Miami Herald series highlighted the proliferation of these pill mills. Broward clinics alone sell more oxycodone than is sold in several states. Anyone can get hundreds of pain pills from these clinics. The powerful narcotics are then resold on the street.

The growth of pain clinics, often run by discredited doctors, is causing an epidemic of prescription overdose deaths, says Florida drug czar Bruce Grant. The rate of deaths is about seven per day -- a shocking number that's preventable.

By now, these clinics were supposed to be regulated under tough new rules. Instead, most reforms are in limbo thanks to a contract dispute and a blunder by the Legislature during its November special session.

In 2009, the Legislature passed a bill to create a statewide database of all prescription narcotics sold by doctors and pharmacists to prevent patients from ``doctor shopping'' -- going to multiple clinics and doctors for pills to later resell. Tougher rules governing doctors working in pain clinics and who could own them are also in the new law.

The due date for the database was Dec. 1. The deadline came and went, however, because a company bidding on the project has legally challenged the contract award. Mr. Grant has asked Florida's surgeon general, Dr. Ana M. Viamonte Ros, to approve the contract on an emergency basis to protect public health.

Dr. Viamonte Ros is one of the few agency heads told to resign by Gov.-elect Rick Scott. But she is on the job till Jan. 3. Given those seven daily drug overdoses, Dr. Viamonte Ros should set the database in motion.

The other big glitch in moving forward with the regulations happened because of GOP lawmakers' zeal to override outgoing Gov. Charlie Crist's vetoes. They revived an anti-regulation bill requiring any new rules that may cost businesses or the government more than $200,000 a year to be subjected to legislative review before implementation.

This has stalled many pill-mill regulations, which now must await lawmakers' scrutiny in 2011. In vetoing the bill in its first incarnation, Gov. Crist wisely warned that the law would have required almost every new rule -- which can number in the hundreds in one year alone -- to await mandated review before being applied. What a nightmare.

Despite the setbacks, the state health department commendably has enforced a few rules. In November, state officials began inspecting pain clinics for the first time. So far, 17 clinics have been shut down.

That's a start, but as of November, there were 142 registered clinics in Broward and 94 in Miami-Dade. So much more could be happening right now to prevent more unnecessary deaths.

© 2010 Miami Herald Media Company. All Rights Reserved.
http://www.miamiherald.com

No Money For Florida

2010-12-27T22:29:00.002-05:00

Recommend reading an interesting article entitled “ Medicaid Bonuses to Reward States for Insuring More Children,” http://www.nytimes.com/2010/12/27/health/policy/27medicaid.html?partner=rss&emc=rss reporting that the Obama administration plans to announce Monday that it will make $206 million in bonus Medicaid payments to 15 states — with more than a fourth of the total going to Alabama — for signing up children who are eligible for public health insurance but had previously failed to enroll.
This program was created to address the following issues:

* To enroll an estimated 4.7 million children who would be eligible for subsidized coverage if their families could be found and alerted. Two of every three uninsured children are thought to meet the income criteria for government insurance programs.
* The stubbornness of the problem is one reason the government expects millions of people to remain uninsured even after 2014, when the new health care law requires most Americans to have coverage and vastly expands government programs to make it affordable.

Alabama will receive a $55 million bonus, more than twice as much as any other state, for having 133,000 more children on its Medicaid rolls than projected by a formulated base line. The 15 states that will receive bonuses reported a total of 874,347 children above the baseline, which factors in population growth and, to some degree, demand driven by the economy.

Alabama, for example, has adopted “express lane eligibility” so that Medicaid application processors can use income findings from other safety net programs to validate eligibility.

Because of the formula’s requirements, none of the money will go to California, Texas or Florida, which account for nearly 40 percent of all uninsured children. States like Florida make enrollment cumbersome and devote minimal resources to marketing. Many of my patients have never heard about the program and I try assisting them to navigate poorly designed web sites and to complete forms they do not understand (neither do I.)

Shouldn't it be the goal of our new governor-elect to increase the enrollment for children qualifying for this program? Unfortunately, those children may have to wait for a long time because ideological purity comes first!

Who will pay the price? All of us, because those children will grow into sick adults requiring more expensive care to “correct” mistakes that could have been prevented in childhood.

Rick Scott and The Department Of Health: The Saga Begins

2010-12-27T21:47:00.003-05:00

Finally, the planned program of Governor-elect Rick Scott is taking shape. Among the items that will affect doctors the most is the proposal calling for merging the Department of Health and the Agency for Health Care Administration. It would close the tuberculosis hospital at Lantana, privatize the state's mental hospitals, include the possible sale of Jackson Memorial Hospital in Miami and ....?!
Rick Scott seems to operate (again) in a vacuum, surrounded by advisors, not understanding the ramifications of his decisions.
The Florida Department of Health was created in 1889 one year after a devastating yellow fever outbreak killed over 400 citizens in Jacksonville and about 40 percent of the population fled the city due to a yellow fever epidemic which sickened a third of those who stayed. Similar epidemics of cholera and yellow fever struck the state almost annually, one of which almost wiped out the population of St. Joseph in 1841. In most cases, limited medical care was available for the sick and weaker people died, but not before infecting many others. Many survivors were carriers, continuing to pass the diseases to others as a result of poor sanitary practices. As a result control of infectious diseases was the major reason for establishment of public health services and remains a major focus today with new infectious diseases emerging as a the results of global climate change. In addition, substance abuse, including the devastating impact or prescription narcotic abuse and diversion, challenges the public health system killing seven (7) Floridians every day!! During the 1996 legislative session, the beleaguered Florida Department of Health and Rehabilitative Services was reconstructed as two entities: the Department of Health and the Florida Department of Children and Families to respond to the unique needs of its respective constituencies. Currently the Florida Department of Health operates County Health Departments in all 67 of the State's Counties. The agency employs more than 17,000 persons. It has championed immunization campaigns, tobacco control, and statewide preparedness response efforts. The Department of Health is a cabinet level agency of the state government, headed by the State Surgeon General who reports directly to the Governor.
I agree with Tim Stapelton, Florida Medical Association Senior Vice-President, that " ..this is a public safety concern and the governor must have a medical doctor advising him of these issues rather than another governor bureaucrat."
I also agree with Mr. Stapelton that its very questionable merging the department that REGULATES DOCTORS with the agencies that REGULATE HOSPITALS. This almost enshrines a conflict within the walls of one mega-agency. What kind of efficiencies does the governor-elect expect? On what expertise and experience is he basing his decision? Is he aware that his decision will undermine our already fledgling public health system?
Now is the time to raise our voices of concern and to let the (almost) one-party legislature know that absolute rule must be challenged.

Yours

Bernd

End-of-Life Care and Medicare

2010-12-26T20:26:00.002-05:00

The New York Times reported today http://www.nytimes.com/2010/12/26/us/politics/26death.html?_r=2&hp that as of January 1st 2011 under a new policy, outlined in a Medicare regulation, the government will pay doctors who advise patients on options for end-of-life care, which may include advance directives to forgo aggressive life-sustaining treatment.
This is indeed good news for all family physicians because finally they can paid for a service we all are supposed to offer anyway.
I wonder how soon we can receive more detailed information about the new billing codes and reimbursement.

Bernd

Closing the Office of Drug Control is Bad For Business

2010-12-22T22:48:00.002-05:00

Governor-Elect Rick Scott notified all four full-time employees working in the governor's Office of Drug Control that their services will no longer be needed after he takes office next month. The office will be dissolved and all its duties turned over to the departments of Health and Law Enforcement.
Rick Scott has pledged to cut waste in state government and the annual budget of about $551,300 for funding the operations of the Office of Drug Control is considered "waste" that needs to be eliminated too.
But lets analyze and examine the facts:

* The Office of Drug Control was created by then Governor Jeb Bush in 1999 and is authorized by state statutes.
* The Office collaborates with other agencies on the implementation of a three-pronged approach of Prevention, Treatment and Law Enforcement to eliminate the devastation of substance abuse rampant in Florida's diverse communities.
* The Office issued a series of excellent reports http://www.flgov.com/drugcontrol/odc_statsreports.php documenting the increasing problem of drug abuse in Florida.
* The Office was instrumental in getting legislation passed that is intended to help curb prescription drug abuse — one bill targeting pain management clinics, which are often disguises for "pill mills," and another that establishes a prescription drug monitoring program.
* The Office championed the creation of a Prescription Drug Monitoring Program, which almost reached the point of going on-line.
* Prohibited by law to use state funds to pay for the PDMP Director Bruce Grant and his superb staff successfully obtained the necessary funding through federal grants and other sources

The current political leadership in Tallahassee seems to be under the impression that we DO NOT have a significant drug problem in Florida.
Governor Scott's spokesman Brian Burgess was quoted in an article that "I don't think we're going to have cocaine bales stacking up on the docks of Miami if we close this office."
Obviously, he did not bother to check the facts:

· Years of lax state laws and a plethora of pain clinics have made Florida a destination for prescription drug traffickers, drug peddling doctors and abusers.

· The DEA, using its most recent data, says that 49 out of 50 of the top oxycodone prescribers are located in Florida.

· The number of deaths caused by at least one prescription drug increased more than 100 percent from 2003 to 2009.

· Mark Fontaine, executive director of the Florida Alcohol and Drug Abuse Association, said a recent study showed that substance abuse has a $43 billion negative impact on the state economy due to loss of job productivity, and costs associated with hospital and emergency room visits and incarceration. Fontaine said about 65 percent of Florida inmates have substance abuse problems.

· A 2009 Florida Department of Law Enforcement study concluded seven people in Florida die every day- ALMOST 2500 FLORIDIANS A YEAR - due to prescription drug abuse.

YES, WE DO HAVE A DRUG PROBLEM IN FLORIDA AND YES IT HAS REACHED EPIDEMIC PROPORTIONS WITH ADVERSE SOCIAL AND ECONOMIC RAMIFICATIONS.

Is cutting $500,000 of "wasteful" spending is worth more than all of the above listed adverse impacts of substance abuse and diversion?
Isn't it penny wise and pond foolish to close the Office of Drug Control? Shouldn't such decisions be based on recommendation made as the result of a careful review process involving experts?

SAVING $500,000 IS A BAD BUSINESS DECISION!
I am certain that closing the Office of Drug Control will have a significant adverse impact on our efforts to combat and control substance abuse and diversion forcing the allocation of much higher funding of law enforcement to deal with the consequences of a failed policy.

GOVERNOR-ELECT RICK SCOTT PLEASE RECONSIDER THIS DECISION!

THE ELIMINATION OF THE OFFICE OF DRUG CONTROL IS BAD FOR BUSINESS AND BAD FOR OUR GREAT STATE OF FLORIDA.

Bernd Wollschlaeger,MD,FAAFP,FASAM
Family Physician& Addiction Specialist

Medicaid Cuts

2010-12-19T21:31:00.002-05:00

Pollice Verso: How State Legislators try to revive an ancient custom

A recent article in Wall Street Journal, Health Studies Cited for Transplant Cuts Put Under the Knife, http://online.wsj.com/article/SB10001424052748703395204576024213729831704.html, highlights the looming issue of cost control.
Faced with skyrocketing healthcare costs, states will be forced to make tough decision on care allocation and coverage.
Arizona already has taken drastic steps to drop Medicaid coverage for some organ transplants as the state tries to plug a $1 billion gap in its health-care budget for next year. The state agency that recommended that Arizona stop paying for transplants of lungs and, for certain patients, hearts and livers, has defended the move by citing studies and figures that it says demonstrate the ineffectiveness of the procedures. But the state agency has gone a step further by selecting studies that proves the point that certain transplants are ineffective. To make its case for cuts, the Arizona agency cited several sets of numbers. In dropping coverage of liver transplants for patients with hepatitis C, the state said liver recipients suffer recurrence of the disease at a rate of 100%. And the state argued that candidates for lung transplants would live just as long with other medical care, citing data from university studies. Several transplant experts, however, point to flaws in the data and the way the state's Medicaid agency, called the Health Care Cost Containment System, has used the figures. Arizona "used data that were outdated or data that made no sense, or they misinterpreted or misrepresented what experts said," says Michael Abecassis, director of Northwestern University's comprehensive transplant center and president of the surgeons group. For lungs, a crux of the state's position was a 1995 study of 49 patients at the University of Washington, 25 of whom received transplants; the rest were waiting at the time of the study. The study concluded that transplant recipients would live half a year longer than those who didn't get a new lung, but the difference wasn't statistically significant—in part because the sample size was so small. Also, researchers didn't wait to track patients' survival, instead extrapolating long-term mortality rates from deaths and sickness in the short run.
So, what’s the solution? States should not be permitted to arbitrarily decide what services can be covered under the states Medicaid program. Instead, they should follow evidence-based data and, most importantly, comparative effectiveness research data.
Otherwise, we will revert to the Pollice verso (thumbs turned) used in ancient Rome by the crowd to indicate if the defeated gladiator should be condemned to death. Soon we do not need gladiators to revive this custom. We just need legislators who will decide the fate of condemned Medicaid recipients.

Yours

Bernd

Healthcare Facts

2010-12-18T23:12:00.000-05:00

An article (Read more: http://www.miamiherald.com/2010/12/17/v-print/1977925/politifactcoms-lie-of-year-government.html#ixzz18WWAFJAz ) published in today's edition of the Miami Herald entitled, PolitiFact Lie of the Year: 'Government takeover of health care', summarizes the falsehoods attributed to the overhaul of America's health insurance system.
PolitiFact editors and reporters have chosen ``government takeover of health care'' as the 2010 Lie of the Year. Uttered by dozens of politicians and leaders within organized medicine, it played an important role in shaping public opinion about the health care plan and was a significant factor in the Democrats' shellacking in the November elections. The Patient Protection and Affordable Care Act, also falsely called "Obama Care", was passed by Congress, and relies largely on the free market:

* Employers will continue to provide health insurance to the majority of Americans through private insurance companies

* Contrary to the claim, more people will get private health coverage. The law sets up ``exchanges'' where private insurers will compete to provide coverage to people who don't have it.

* The government will not seize control of hospitals or nationalize doctors.

* The law does not include the public option, a government-run insurance plan that would have competed with private insurers.

* The law gives tax credits to people who have difficulty affording insurance, so they can buy their coverage from private providers on the exchange. But here too, the approach relies on a free market with regulations, not socialized medicine.

PolitiFact reporters have studied the 906-page bill and interviewed independent health care experts. They concluded it is inaccurate to call the plan a government takeover because it relies largely on the existing system of health coverage provided by employers. It's true that the law does significantly increase government regulation of health insurers. But it is, at its heart, a system that relies on private companies and the free market.
I encourage you to respond accurately to your patient questions regarding this law and impact on their lives and our profession.
Lets remember that facts should rise above cheap talking points and ideological gibberish.

Yours
Bernd

AMA Efforts Pay Off

2010-12-11T22:59:00.000-05:00

Attached you find a recent AMA press release highlighting the important accomplishment of our AMA and other physician groups including the American Academy of Family Physicians to STOP the looming 25% Medicare cut for ONE year . This will protect many physicians practices from financial distress and will maintain and preserve access of seniors to physicians and other healthcare professionals. Now is the time to rally behind our AMA and to join this great organization to continue working on a long-term solution of the flawed physician reimbursement formula.
Yours

Bernd

AMA Outreach Recruiter

AMA: Congress Passes One-Year Delay Of Medicare Physician Cut

Bill Now Moves to President for Signature

For immediate release:
Dec. 9, 2010

Statement attributable to:
Cecil B. Wilson, MD
President, American Medical Association

“The AMA welcomes bipartisan House passage of legislation to stop the Medicare physician payment cut for one year. Stopping the steep 25 percent Medicare cut for one year was vital to preserve seniors’ access to physician care in 2011. Many physicians made clear that this year’s roller coaster ride, caused by five delays of this year’s cut, forced them to make difficult practice changes like limiting the number of Medicare patients they could treat.

“The AMA will be working closely with congressional leadership in the new year to develop a long-term solution to this perennial Medicare problem for seniors and their physicians. This one-year delay comes right as the oldest baby boomers reach age 65, adding urgency to the need for a long-term solution before this demographic tsunami swamps the Medicare program.

“Now that the legislation has passed both the U.S. Senate and House, the bill moves to the President to be signed into law. The AMA thanks bipartisan leaders in both the Senate and House and President Obama for their leadership on this issue to preserve seniors’ health care. The joint efforts of AARP, the military community, AMA and other physician groups helped make this one year delay a reality for patients and their physicians.”

###

Media contact:
Katherine Hatwell
American Medical Association
(202) 789-7419
katherine.hatwell@ama-assn.org

Brenda Craine
Director, AMA Media Relations
(202) 789-7447
brenda.craine@ama-assn.org

Follow AMA on Twitter and Facebook.

Florida Legislators and Pain Clinics

2010-12-08T22:42:00.001-05:00

osted on Wed, Dec. 08, 2010; Miami Herald

State lawmakers must not give `pill mills' a pass

The Dec. 3 editorial, Tallahassee's pill mills, correctly points out how the Republican-dominated state Legislature voted to delay the implementation of tough new pain-clinic regulations.
Consequently, unscrupulous clinic operators and drug dealers in white coats, wrongly called ``doctors,'' can continue to churn out prescriptions for powerful painkillers.
Legislators seem more concerned with ideological correctness and purity than the sobering facts detailed in a report released in June by the Florida Department of Law Enforcement. It indicated that an average of seven Floridians a day die from prescription-drug overdose.

Our lawmakers seem to live in another universe than most of us. In their world, reality has to be adapted to fit political theory. In their world, government regulation can only do harm and never do good. In their world, pain clinics are successful businesses contributing to the overall economy, and more regulations will drive them away from our state.

Legislators forget that the regulations were carefully crafted by Democrats and Republicans to protect Floridians from these unscrupulous businesses.

Now, the proposed rules must be submitted to the Legislature by Feb. 4 to qualify for consideration. Those that don't make it would have to wait until the 2012 legislative session.

I am outraged by this political checkmate and concerned about its adverse impact on public health. This issue is too important to allow politicians to gamble away the lives of Florida residents. We need to return to pragmatism and sound reasoning to address and resolve the problem of prescription-drug abuse in the state. Ideological grandstanding will only worsen the situation. We do not have much time left -- and the clock is ticking.

Bernd Wollschlaeger,MD
North Miami Beach

http://www.miamiherald.com

Read more: http://www.miamiherald.com/2010/12/08/v-print/1963311/state-lawmakers-must-not-give.html#ixzz17a0ATueT

Pain Clinic Regulations Stalled

2010-12-04T23:53:00.000-05:00

Attached some troubling updates regarding the pain clinic regulation issues:

1. A letter to the editor published in the Sun-Sentinel http://articles.sun-sentinel.com/2010-12-03/news/fl-pain-clinics-letter-1203-20101203_1_pain-clinics-prescriptions-for-powerful-painkillers-prescription-drug
2. Article about persistent over dose deaths in Florida http://www.sun-sentinel.com/health/os-deaths-florida-report-20101202,0,1564941.story
3. Medical Board Yanks License of Pediatrician http://www.sun-sentinel.com/health/fl-doctor-discipline-20101203,0,5563711.story
* Several troubling statements taken from the article:
* "On a related matter, a medical board panel decided not to take emergency action to initiate a strict set of pain clinic rules that have been delayed by legislative action. Legislators last month passed a law saying rules with substantial impact on small business cannot take effect until lawmakers give approval. The medical board could have declared the pill mill problem to be an emergency and put the rules into effect, but the panel found no grounds to do so."
* What other grounds do we need to declare an emergency??

Yours
Bernd

Tallahassee's Pill Mills

2010-12-04T23:51:00.001-05:00

ttached a stinging editorial published in yesterday's Miami Herald and my response in the form of a letter to the editor.

Yours
Bernd

The Miami Herald
Posted on Fri, Dec. 03, 2010
Tallahassee's pill mills

Lawmakers don't usually side with pill traffickers. But that's what the Florida Legislature unwittingly did during its brief, vengeance-fueled special session last month.

In the lust to override lame-duck Gov. Charlie Crist's vetoes on a handful of bills, the overwhelmingly Republican Legislature passed a law that requires legislative approval for any new government rules that cost more than $1 million over five years.

The law was touted as a measure to help stop the government from imposing excessive restrictions on business. All well and good. But it turns out the measure had a nasty side effect: It also halted the imposition of new regulations on the state's pill mills, which help feed an illegal pill pipeline.

How embarrassing. And predictable.

Lawmakers ignored warnings

Pill mills cause real suffering for addicts and their families, but lawmakers were more interested in the politics of punishing Gov. Crist for leaving the Republican Party than they were on studying what's good for the state and its residents. They ignored warning bells and rushed to pass a new law without understanding its implications.

Two years ago, lawmakers vowed to get serious about regulating pill mills -- after a Miami Herald series of articles spotlighted South Florida as the pill-mill capital of the United States. Doctors at these pain clinics, many in Broward County, served dual roles as pain and addiction specialists. The black market for painkillers in Florida flourished, spawning an epidemic of overdose deaths in Kentucky, Ohio, West Virginia, Tennessee and other states.

The new regulations, which were set to kick in Nov. 28, would have helped to curb some aspects of the abuse, specifying basic standards for pain clinics and surprise inspections each year, among other provisions.

Victims of the pain pill business counted the legislation a victory. And then lawmakers got the bright idea to override Gov. Crist's veto of the rule-making bill.

In his veto, Gov. Crist warned that nearly every rule would have to wait for the Legislature's approval under the new law, a mind-boggling thought given the number of rules that government can propagate. As of right now, there are roughly 600 proposed rules that have yet to take effect. No one knows how many of them now will require final legislative approval.

One, for sure: pill mill regulation.

Little opposition

There were a few voices of dissent amid the cry to override Gov. Crist's veto. Sen. Mike Fasano, R-New Port Richey, voted against the rule-making bill, saying it needed more study. Mr. Fasano was also the sponsor of the pill mill legislation.

Re-imposing the regulations may be delayed until the 2011 legislative session in the spring. The state Board of Medicine will discuss the regulations at its December meeting in Orlando.

For now, until lawmakers fix this unintended consequence of their own haste, the pill pushers win.

© 2010 Miami Herald Media Company. All Rights Reserved.
http://www.miamiherald.com

Read more: http://www.miamiherald.com/2010/12/03/v-print/1954918/tallahassees-pill-mills.html#ixzz176r4uQ3s

An editorial in today's Miami Herald entitled “Tallahassee's pill mills” correctly points out how the Republican dominated legislature voted to delay the implementation of tough new pain clinic regulations. Subsequently, the unscrupulous clinic operators and drug dealers in white coats, wrongly called “doctors,” can continue to churn out prescriptions for powerful painkiller. The legislators seem to be more concerned with ideological correctness and purity than the somber facts detailed in a recent report from the Florida Department of Law Enforcement released June 30th 2010 indicating that an average of seven Floridians per day die from prescription drug overdose! It appears that our legislators seem to live in another universe than most of us have to live in. In their world reality has to be adapted to fit political theory. In their world government regulation can only do harm and never do good. In their world pain clinics are successful businesses contributing to the overall economy and more regulations will drive them away from our state. They seem to forget that the regulations were carefully crafted by Democrats and Republicans to PROTECT our citizens from those unscrupulous businesses, which contribute to the DEATH of seven Floridians a day!! Now, the proposed rules must be submitted to the Legislature by Feb. 4 to qualify for consideration. Those that don't make it would have to wait until the 2012 legislative session. I am not only outraged by this political checkmate but also deeply concerned about its adverse impact on public health. This issue is too important to allow politicians to gamble away the lives of Florida’s citizen. We need to return to pragmatism and sound reasoning to address and resolve the problem of prescription drug abuse in Florida. Ideological grandstanding will only worsen the situation. We do not have much time left and the clock is ticking.

Bernd Wollschlaeger,MD,FAAFP,FASAM

Board certified Family Physicians & Addiction Specialist

16899 NE 15th Avenue, North Miami Beach,FL 33162 Phone: (305) 940-8717

E-mail: info@miamihealth.com

Member of the Prescription Drug Monitoring Implementation and Oversight Task Force

Health Policy Update

2010-11-28T23:20:00.002-05:00

Attached a link http://www.healthaffairs.org/healthpolicybriefs/brief.php?brief_id=32 to a very interesting article about the provisions offered in the Affordable Care Act for early retiree healthinsurance benefits.
Its important that we educate ourselves about the many benefits the Patient Protection and Affordable Care Act can offer to so many Americans and to be able to respond intelligently to stereotypical accusation and falsifications of this important legislation.

THE FACTS (AND NOT FICTION) :

The number of employers offering health insurance coverage to early retirees---former employees older than 55 but not yet eligible for Medicare--has dropped sharply over the past two decades. Employers who have maintained that coverage have increased the share of premiums and other costs paid by enrollees. To help keep this type of coverage in place, the Affordable Care Act established a temporary program under which the federal government will reimburse retiree health plans for high-cost medical claims. This Early Retiree Reinsurance Program will pay 80 percent of each claim that exceeds $15,000, up to $90,000.

The program began in June 2010 and is slated to operate until the end of 2013. It is intended to slow the decline in employer health coverage for retirees and to help tide people over until 2014, when other provisions of the law go into effect. At that point, it will theoretically be easier for early retirees to obtain coverage through new state health insurance exchanges, often with the aid of subsidies. However, it isn't clear whether the $5 billion allotted for the program will cover the anticipated costs between now and 2014.

Among large employers (those with 200 or more workers) who provided health coverage in 2010, only 28 percent offered benefits to newly retired workers, down from 46 percent in 1991. State and local governments and employers with union workers were the most likely to offer retiree coverage. Only 3 percent of small employers (3-199 workers) offered retiree coverage this year . Some retirees are in the same plans as active workers, while others are in plans covering retirees only. In 2007, the most recent year for which numbers are available, an estimated 6.5 million people ages 55-64 had early retiree coverage, on their own or as dependents.

The Affordable Care Act requires the secretary of Health and Human Services (HHS) to establish a temporary reinsurance program. HHS issued implementing regulations on May 5, 2010, and the program took effect on June 1. It will continue through 2013, unless funds are exhausted sooner. Any group health plan that covers early retirees and is sponsored by an employer or union is eligible to participate. This includes private employers and state and local governments, but not federal civil and military retiree plans. Plan sponsors must file an application for each year and meet two key requirements:

1) The plan must have programs or procedures with the potential to generate cost savings for enrollees with chronic and high-cost conditions.
2) Sponsors also must use all reinsurance payments they receive to reduce the total cost of the plan or the costs paid by retirees. To receive the reinsurance payment from the government, the employer or plan sponsor must provide documentation that all the amounts included in its claim were actually paid out. This requirement raises at least two problems.
First, an employer plan commonly deducts the amount for which a participant is responsible--such as the deductible, coinsurance, or copayments--before making payment to a doctor, hospital, or other provider.
Second, there are still some health plans that pay providers on a so-called "capitated" basis, which means that the provider receives a fixed payment at a regular interval to provide all covered care for an enrollee, rather than being paid to provide care service by service. Other plans employ physicians or other professionals on a salaried basis. These plans may not always be able to calculate amounts spent for any particular patient
The Affordable Care Act appropriates $5 billion to cover claims and administrative costs for the reinsurance program through 2013. If at any time HHS anticipates that the funds are likely to be exhausted, it may stop accepting new applications from plan sponsors. To help HHS project future draws on the funds, each application is required to include a two-year projection of expected reimbursement amounts.

As of late October, HHS reported that nearly 3,600 employer plans had been accepted into the reinsurance program. These include more than half of the Fortune 500 companies, all major unions, and government entities in every state.

Some employers may not be certain that they will have enrollees with large enough claims to make applying worthwhile. The Employee Benefit Research Institute (EBRI) has estimated that 13 percent of early retirees or dependents incur claims of $15,000 or more during a year. However, this small share of enrollees accounts for 61 percent of all costs. EBRI calculates that subsidies from the reinsurance program would cover about one-fourth of total costs for an average employer's retiree plan.

However, some plans may have healthier populations or less-generous benefits, meaning that fewer enrollees would meet the $15,000 threshold. And in plans with fewer participants, claims experience is likely to fluctuate considerably from year to year. The rules appear to allow a plan sponsor to apply for the program after it has incurred the costs for which it will be seeking reimbursement. Although the estimated cost of applying is not high--about $2,000 per plan per year--some employers may be waiting to see if their potential subsidy is large enough to be worth the trouble.

Earlier this year, both EBRI and the Congressional Budget Office (CBO) projected that the $5 billion appropriation for the program would be exhausted before the program expires at the end of 2013. EBRI concluded that funds would be used up in 2011, while CBO expected them to last through part of 2012. However, EBRI assumes that all employers providing early retiree coverage will participate, and CBO's projection is likely similar. If employer participation remains low, the funds might stretch further. If the Affordable Care Act works as intended, people who retire in 2014 or later will have access to affordable and often subsidized coverage through state health insurance exchanges. This means that they may have less of a need to rely on coverage through their former employers. As a result, employer-provided retiree coverage is expected to continue to decline, and will no doubt play a steadily smaller role in the coverage of future retirees

Yours

Bernd

Siberia in Florida: GOP Senator Gets the Cold Shoulder

2010-11-27T00:36:00.001-05:00

It used to be you'd have to start every debate thinking: compromise. Now, the only constraint is their good judgment.''

Former Rep. Tom Feeney, R-Orlando, who Speaker of the Florida House from 2000 to 200.

Today’s Miami Herald article “Veteran senator won’t toe the line,” http://www.miamiherald.com/2010/11/25/1943608_p2/veteran-senator-wont-toe-the-line.html clearly points out the power shift in Tallahassee. The new GOP leadership is flexing its ideological muscles. No one will be allowed to think or act independently. Its the party line or political exile. Senator Fasano, a strong supporter of Governor’s Christ Senate campaign, had to endure the punishment straying from the ideological talking points. Fasano took to the Senate floor during last week's half-day special session and railed against a GOP blueprint for fixing Medicaid. The symbolic ``memorial'' resolution informs Congress that Florida plans to steer its Medicaid patients into managed care networks, an idea that has gained popularity in the state House. ``This is more than intent. We are setting policy today by doing this,'' scolded Fasano, a 16-year legislative veteran. ``This should have gone through committees. If you think you got a few phone calls last year, put people in an HMO and the phones will be ringing off the hook.''

But Fasano's protests were quickly drowned out by a GOP stampede in favor of the bill. In the new Senate, where newcomers value business and economic development over Fasano's populist consumerism, he has morphed from conservative stalwart to moderate maverick.

Lets not forget that Senator Fasano was also the sponsor of the pain clinic legislation that cracked down on facilities freely dispensing medications that are being used by drug abusers who were doctor-shopping. Fasano also was critical of the Legislature for passing the new rule-making bill, arguing it needed more study. As a result the state Department of Health now must determine whether the new rules exceed the threshold and require a legislative sign-off -- if they have a $1 million adverse impact over five years on economic growth, competitiveness, employment, investment, job creation or regulatory costs. For now, the upshot is that the rules are stalled. What will happen in the meantime? "What's going to happen is nothing," said Sen. Mike Fasano, R-New Port Richey. "And seven more people will die each and every day until the Legislature ratifies these rules that are being approved by the Board of Medicine and the Department of Health."

I wish we would have more outspoken politicians in Florida like Senator Fasano who think and act according to their conscience and not according to party discipline.

History provides a treasure trove of failed attempts to scuttle dissent and to impose rigorous party discipline. I hope that Floridian’s learn soon to regret their electoral choices. Otherwise we will be in big trouble.

Yours truly,

Bernd

Money and Organized Medicine

2010-11-25T21:29:00.002-05:00

Attached an article from the Sun Sentinel highlighting a sad chapter of organized medicine's attempts and efforts to buy political influence and cloud.
Alan Mendelson was once THE political power broker acting on behalf of the Florida Medical Association. Every ranking FMA official did not dare to miss joining one of the many political fundraiser which took place in Alan's house or office. I also participated in those events and have to ask myself why I did not see the writing on the wall! During Eleanor Sobel's Florida Senate campaign Alan Mendelsohn, then treasurer of the Florida Medical Association’s political action committee, aggressively raised money on her behalf and hailed her Aug. 26 victory in the Democratic primary as the FMA flexing its might.
We all were "encouraged" by our own county medical association and the FMA to donate at least $500 to People for a Better Florida Fund Inc. and many of us did so.
Eleanor Sobel's victory was considered a watershed moment demonstrating that Florida's doctors could buy influence in Tallahassee like so many other interest groups already did at that time and still do. When the whole house of cards collapsed everybody quickly pointed their fingers at Alan Mendelson. But did anything change ever since? We still believe that money can buy influence. Elected FMA officials still repeat the article of faith that " only money talks in Tallahassee."
Shouldn't we all take a step back from the political abyss and reconsider? Doesn't Alan Mendelson's behavior clearly demonstrate that money itself can corrode and corrupt anyone? Aren't we all susceptible to hybris? Shouldn't we reestablish core values of integrity, accountability and compassion instead? I hope that the leadership within organized medicine is listening because Alan's case is just the tip of the iceberg and the iceberg is entering hot water.
Happy Thanksgiving
Yours
Bernd

Broward power broker Mendelsohn set to plead guilty in federal case
32-count indictment included accusations of using fraudulent fundraising for his own gain
November 23, 2010|By Jon Burstein, Sun Sentinel

Broward political fundraiser and power broker Alan Mendelsohn is set to cut a plea deal in what federal authorities have described as a fraudulent political fundraising and lobbying scheme that he used to line his own pockets.

Mendelsohn, a Hollywood eye doctor whose influence opened doors at the state Capitol, is scheduled to go before U.S. District Judge William Zloch on Dec. 8 for a plea hearing, according to court papers filed Tuesday.

He is ready to plead guilty to a single conspiracy charge, which can carry no more than five years in prison, said Alvin Entin, one of Mendelsohn's attorneys.

We've reserved a plea date, and we're looking forward to resolving the matter satisfactorily for both sides," Entin said.

Mendelsohn, a member of Gov. Charlie Crist's 2006 gubernatorial transition team, built the Florida Medical Association into a political force as the chief fundraiser of its political action committee. He also helped pioneer the use in Florida of political organizations known as 527s, which are allowed to raise unlimited amounts of money to make statements about candidates and issues.

Federal prosecutors leveled a 32-count indictment against Mendelsohn in September 2009, accusing him of skimming more than $350,000 from the political action committees under his control. The money came from contributors who believed he was using the funds to advance their causes in Tallahassee.

Mendelsohn used some of that money to pay his mistress, buy her a house and a car and pay for his children's schooling, according to court documents.

Five criminal tax charges were tacked on Mendelsohn's corruption indictment in June.

In Mendelsohn's plea deal, the single conspiracy charge will be related to both the tax and political fundraising charges, Entin said. Court documents show that the judge will ask for "a full confession" at the hearing.

Mendelsohn, 52, first began lobbying lawmakers in 1999 on issues related to ophthalmologists, but within a few years, he was being hired to use his political muscle to help such entities as pari-mutuels and credit counseling companies.

In 2008, Mendelsohn demonstrated his might in Broward County by aggressively raising money for Eleanor Sobel in her winning bid in the Democratic primary for a state Senate seat. The Florida Medical Association's PAC and doctors largely funded a political organization that spent more than $600,000 in advertisements boosting Sobel and attacking her opponents

E-mails made public in a defamation lawsuit filed by one of Sobel's opponents portray Mendelsohn as a no-holds-barred fighter. Mendelsohn raised $51,000 for Sobel in a single day, according to the e-mails.

After Sobel's win, he wrote in an e-mail that he believed politicians would start coming to the Florida Medical Association and asking, "What can I start to do now to help you guys?"

He came on federal authorities' radar after he allegedly boasted he could use his influence and bribes to halt investigations into Mutual Benefits, a defunct investment company. Prosecutors say the Fort Lauderdale-based Mutual Benefits defrauded 30,000 investors worldwide of $837 million before the U.S. Securities and Exchange Commission shut it down in 2004.

Mendelsohn's claims helped set in motion a corruption investigation by the U.S. Department of Justice's Public Integrity Section. Mendelsohn is the only who has been arrested in it.

In Mendelsohn's indictment, though, federal authorities alleged that between 2003 and 2006, he funneled $87,000 to an unidentified then-public official.

Jon Burstein can be reached at jburstein@SunSentinel.com or 954-356-4491.

The ACO Conundrum

2010-11-22T22:55:00.001-05:00

In a recent New York Times article,” Consumer Risk Feared as Health Law Spurs Merger” http://www.nytimes.com/2010/11/21/health/policy/21health.html?_r=1&pagewanted=print the author points out that consumer advocates fear that the health care law could worsen some of the very problems it was meant to solve — by reducing competition, driving up costs and creating incentives for doctors and hospitals to stint on care, in order to retain their cost-saving bonuses. Regulatory agencies face a delicate task: balancing the potential benefits of clinical cooperation with the need to enforce fraud, abuse and antitrust laws. Congress’s purpose was to foster cooperation in a health care system that is notoriously fragmented. The hope was that the new law would push doctors, hospitals and other health care providers to come together and jointly take responsibility for the cost and quality of care of patients, especially Medicare beneficiaries.

“ ..eight months into the new law there is a growing frenzy of mergers involving hospitals, clinics and doctor groups eager to share costs and savings, and cash in on the incentives. They, in turn, have deployed a small army of lawyers and lobbyists trying to persuade the Obama administration to relax or waive a body of older laws intended to thwart health care monopolies, and to protect against shoddy care and fraudulent billing of patients or Medicare. “

Furthermore, newly formed Accountable Care Organization (ACOs) could be tempted to hold down costs, and maximize profits, by cherry-picking healthier patients and denying care when it’s needed. Under the law, Medicare can penalize organizations that avoid high-risk, high-cost patients but enforcement mechanism are not sufficient to monitor those violations.

In addition Elizabeth B. Gilbertson, chief strategist of a union health plan for hotel and restaurant employees, also worries that the consolidation of health care providers could lead to higher prices.

“In some markets,” Ms. Gilbertson said, “the dominant hospital is like the sun at the center of the solar system. It owns physician groups, surgery centers, labs and pharmacies. Accountable care organizations bring more planets into the system and strengthen the bonds between them, making the whole entity more powerful, with a commensurate ability to raise prices.”

In conclusion Dr. Donald M. Berwick, the administrator of the Centers for Medicare and Medicaid Services, hails the benefits of “integrated care.” But, Dr. Berwick said, “we need to assure both patients and society at large that destructive, exploitative and costly forms of collusion and monopolistic behaviors do not emerge and thrive, disguised as cooperation.”

As physicians we should take the initiative and form collaborative practice organizations and work together to form ACOs that truly serve the public health and not only serve to line the deep pockets of entrenched interests.

The opportunity to act is now!

Bernd

Florida Legislature Delays Crackdown on Pain Clinics

2010-11-20T23:27:00.002-05:00

In today’s Sun Sentinel front page article entitled “Crackdown on pain clinic stalls again” http://articles.sun-sentinel.com/2010-11-19/health/fl-hk-pain-clinic-rules-delayed-20101119_1_millions-of-narcotic-pills-pain-clinic-pills-for-drug-dealers Bob LaMendola reports how the Republican dominated legislature voted to delay the implementation of tough new pain clinic regulations. Subsequently, the unscrupulous clinic operators and drug dealers in white coats, wrongly called “doctors,” can continue to churn out prescriptions for powerful painkiller. As a result an average of seven Floridians per day will die from prescription drug overdose. The legislators seem to be more concerned with ideological correctness and purity than the somber facts detailed in a recent report from the Florida Department of Law Enforcement released June 30th 2010 http://www.fdle.state.fl.us/Content/News/June-2010/2009-Report-by-Florida-Medical-Examiners-Commissio.aspx:

• Prescription drug deaths monitored by the state Medical Examiner's Office continued to climb to 2,488 last year. That's an average of seven deaths per day.
• Oxycodone was the cause of 1,185 state deaths in 2009, a 26 percent increase from the year before and a whopping 249 percent increase from 2005.
• Deaths caused by some illegal drugs declined. Heroin deaths decreased by 20 percent to 111. And cocaine deaths decreased by 18.4 percent to 529.Law enforcement officials have attributed the opposing trends to the fact that prescription drugs are much easier and cheaper to obtain than illegal drugs.
• Prescription drugs account for 79 percent of all drug occurrences in this report when Ethyl Alcohol is excluded. Oxycodone occurrences increased by 23.8 percent in 2009 and deaths caused by Oxycodone also rose by 25.9 percent when compared to the previous year.

So what happened? According to the article the Legislature on Tuesday had taken action to override Gov. Charlie Crist's veto of HB 1565 that was passed during the 2010 legislative session. The bill, which now becomes law, says that proposed rules having significant financial impact – more than $1 million over five years – on small businesses such as pain clinics could not take effect until legislators ratified the rules. Because the pain clinic rules were not in effect on Tuesday, state officials said they cannot be enforced. One of the law's sponsors, Rep.Matt Gaetz, R-Fort Walton Beach, said he was not thinking about pill mills. The law aims to scrutinize rules that drive up regulatory costs and stop businesses from coming to Florida. As for the impact on pill mill rules, Gaetz said: "The benefits of the rulemaking bill outweighs some of the modest inconveniences." It appears to me that Mr. Gaetz lives in another universe than most of us have to live in. In his world reality has to be adapted to fit his political theory. In his world government regulation can only do harm and never do good. In his world pain clinics are successful businesses contributing to the overall economy and more regulations will drive them away from our state. He seems to forget that the regulations were carefully crafted by Democrats and Republicans to PROTECT our citizens from those unscrupulous businesses, which contribute to the DEATH of seven Floridians a day!! Now the proposed rules must be submitted to the Legislature by Feb. 4 to qualify for consideration. Those that don't make it would have to wait until the 2012 legislative session. I am not only outraged by this political checkmate but also deeply concerned about its adverse impact on public health. This issue is too important to allow politicians to gamble away the lives of Florida’s citizen. We need to return to pragmatism and sound reasoning to address and resolve the problem of prescription drug abuse in Florida. Ideological grandstanding will only worsen the situation. We do not have much time left and the clock is ticking.

Bernd Wollschlaeger,MD,FAAFP,FASAM
Board certified Family Physicians & Addiction Specialist
Member of the Prescription Drug Monitoring Implementation and Oversight Task Force

Defensive Medicine

2010-11-16T00:12:00.002-05:00

The Malpractice Myth: Republicans and Doctors offer no solutions

By Bernd Wollschlaeger,MD,FAAFP,FASAM

In a recent American Medical News article, “GOP state gains expected to have broad impact on physicians,” November 15, 2010, the author points out that the substantial GOP electoral gains could affect physicians and the health system. Medical liability reform legislation probably will receive a boost from the GOP victories, said Mark A. Peterson, a professor of public policy and political science at the University of California Los Angeles. For example, Alabama Gov.-elect Robert Bentley, MD, and Florida Gov.-elect Rick Scott -- founder of urgent-care chain Solantic -- campaigned on expanding tort reform for physicians and other health professionals. Both were endorsed by their respective state medical associations. "A central feature of Republican health care policy ... has been the notion that a major driver of costs has been malpractice" lawsuits, Peterson said. Subsequently, physicians are loudly repeating the myth that defensive medicine increases healthcare costs by up to 30% and that malpractice reform will stop and even reverse the cost increase. Rep. Tom Price (R-GA), a physician, said recently on the House Republican website America Speaking Out that “ any credible attempt to rein in the cost of health care must include a plan to address the whole issue of the practice of defensive medicine. It is estimated to cost an astounding $650 billion each year. That’s 26% of all money spent on health care. Defensive medicine does not raise the quality of care, only the cost.”

There is only one big problem: the political pundits within organized medicine are unable to provide any evidence to support their argument!

In a series of articles published in the September 2010 issue of Health Affairs the authors reached the following conclusions:

* Defensive medicine includes tests and procedures ordered by physicians principally to reduce perceived threats of medical malpractice liability. The practice is commonly assumed to increase health care costs. The results of studies of the costs of defensive medicine have been inconsistent. We found that estimated savings resulting from a 10 percent decline in medical malpractice premiums would be less than 1 percent of total medical care costs in every specialty. These savings are lower than most previous estimates, and they suggest that the presumed impact of tort reform on health care costs may be overstated.
* Physicians contend that the threat of malpractice lawsuits forces them to practice defensive medicine, which in turn raises the cost of health care. This argument underlies efforts to change malpractice laws through legislative tort reform. We evaluated physicians’ perceptions about malpractice claims in states where more objective indicators of malpractice risk, such as malpractice premiums, varied considerably. We found high levels of malpractice concern among both generalists and specialists in states where objective measures of malpractice risk were low. We also found relatively modest differences in physicians’ concerns across states with and without common tort reforms. These results suggest that many policies aimed at controlling malpractice costs may have a limited effect on physicians’ malpractice concerns.
* Concerns about reducing the rate of growth of health expenditures have reignited interest in medical liability reforms and their potential to save money by reducing the practice of defensive medicine. It is not easy to estimate the costs of the medical liability system, however. This article identifies the various components of liability system costs, generates national estimates for each component, and discusses the level of evidence available to support the estimates. Overall annual medical liability system costs, including defensive medicine, are estimated to be $55.6 billion in 2008 dollars, or 2.4 percent of total health care spending.

Notwithstanding all of the above quoted FACTS politicians and their physicians allies still place their bets on malpractice reform.

But we all could start reforming the system TODAY if we would firmly commit ourselves to practice DEFENSIBLE MEDICINE instead. What does that mean?

1. Following expert guidelines and recommendations in managing and treating patients.
2. Implementing patient safety measures to reduce deadly medical errors killing more than 100,000 Americans every year.
3. Collaborating medical care in teams comprised of ALL health care professionals including physicians, physician assistants and ARNPs.
4. Moving from physician centered to patient centered medicine
5. Integrating health information technology into our offices and learn to share medical information.

Even Tom Price (R-GA) admits that we need to “ adopt a set of best-practice guidelines for treatment – agreed to by physicians, not bureaucrats – to provide an affirmative legal defense.”

What are we waiting for? Lets start practicing defensible medicine today.

Yours truly,

Bernd

Physicians Role in ACOs

2010-11-10T23:28:00.002-05:00

"A crucial question is who will control these ACOs. We can envision two possible futures: one of physician-controlled ACOs, with physicians affiliating and contracting with hospitals, controlling the flow of funds through the marketplace; and one of hospital-controlled ACOs that will employ physicians. Whoever controls the ACOs will capture the largest share of any savings."

Attached you find a link http://healthpolicyandreform.nejm.org/?p=13020&query=TOC to an important article "Physicians versus Hospitals as Leaders of Accountable Care Organizations" which was just published today on the NEJM website. I urge you to read the article and want to point out several important messages:

* The next few years will be a period of what economists call “creative destruction”: our fragmented, fee-for-service health care delivery system will be transformed into a higher-quality, higher-productivity system with strong incentives for efficient, coordinated care. Consequently, the actions of physicians and hospitals during this period will determine the structure of the delivery system for many years. The implications will be profound for hospitals’ dominant role in the health care system and for physicians’ income, autonomy, and work environments.
* The Affordable Care Act (ACA) aims to improve the quality of care and reduce costs. Doing so will require focused efforts to improve care for the 10% of patients who account for 64% of all U.S. health care costs.2 Much of this cost derives from high rates of unnecessary hospitalizations and potentially avoidable complications,3 and these, in turn, are partially driven by fee-for-service incentives that fail to adequately reward coordinated care that effectively prevents illness. The ACA includes numerous provisions designed to catalyze transformation of the delivery system, moving it away from fee for service and toward coordinated care.
* Incentives for the development of the information systems and infrastructure are necessary for better and more efficient management of chronic conditions.
* Achievement of this level of care coordination will require the development of larger integrated delivery organizations — preferably, accountable care organizations (ACOs) that incorporate primary care practices structured as patient-centered medical homes and that can support new investments in information systems and care teams and can maintain service hours resembling those of retailers. A move toward ACOs will mean major changes in the structure of physicians’ practices, since even physician-group–based ACOs may include one or more hospitals, though they may instead contract with hospitals for specific services chosen on the basis of their relative value.
* A crucial question is who will control these ACOs. We can envision two possible futures: one of physician-controlled ACOs, with physicians affiliating and contracting with hospitals, controlling the flow of funds through the marketplace; and one of hospital-controlled ACOs that will employ physicians. Whoever controls the ACOs will capture the largest share of any savings.
* For physicians to control ACOs, they would have to overcome several hurdles. The first is collaboration: ACOs will require clinical, administrative, and fiscal cooperation, and physicians have seldom demonstrated the ability to effectively organize themselves into groups, agree on clinical guidelines, and devise ways to equitably distribute money.
* If hospitals are to control ACOs, they, too, will need to overcome barriers. First, they will need to trade near-term revenue for long-term savings. Hospitals are typically at the center of current health care markets, and by focusing on procedures and severely ill patients, most have been fairly profitable. Building an ACO will require hospitals to shift to a more outpatient-focused, coordinated care model and forgo some profits from procedures and admissions.
* Holding off on creating ACOs is likely to be a bad long-term strategy for physicians.
* Therefore, the actor who moves first effectively is likely to assume the momentum and dominate the local market. A wait-and-see approach could succeed if the first mover executes poorly, failing to coordinate care and manage risk. But rather than controlling destiny, cautious actors will be hanging their fate on the mistakes of others.

Yours
Bernd

How Medicare Killed the Family Doctor

2010-11-09T23:50:00.001-05:00

Attached a link http://online.wsj.com/article/SB10001424052748704353504575596140752021042.html?mod=googlenews_wsj to an article published in the November 8th issues of the Wall Street Journal entitled " How Medicare Killed the Family Doctor."
The author correctly states that “The primary-care doctor has become a piece-rate worker focused on the volume of patients seen every day. As Medicare and insurers focused on trimming the costs of the most common procedures, the income and job satisfaction of primary-care doctors eroded.”

Furthermore, he points out that a possible solution includes “ making primary-care physicians the captains of the ship. They must have the time and financial resources necessary to take care of their patients, tailoring care to patients' specific conditions and needs. And they need the data to track their patients' results, so they can guide patient progress. They will then be able to slow (and sometimes reverse) their patients' illnesses, keeping them out of hospital emergency rooms and specialists' offices. The end result: reduced costs and improved quality of care.”

But it is of interest to note that he discards “new health-care service models, such as the concierge practice and the Patient-Centered Medical Home, [that] drew doctors away from the standard service models that most patients rely on for coverage.”

He obviously misunderstands the PCMH which essentially will empower the primary care physician.

What do you think?

Yours

Bernd

Fewer Practices are Doctor-Owned

2010-11-09T23:35:00.002-05:00

Attached a link http://online.wsj.com/article/SB10001424052748703856504575600412716683130.html?KEYWORDS=doctor#printMode to an article published in the November 8th issues of the Wall Street Journal entitled " Fewer Practices are Doctor-Owned."
The authors summarized the trend that the share of responding practices that were hospital-owned last year hit 55%, up from 50% in 2008 and around 30% five years earlier.
"The traditional model of doctors hanging up their own shingles is fading fast, as more go to work directly for hospitals that are building themselves into consolidated health-care providers." No knew revelation that "the trend is tied to the needs of both doctors and hospitals, as well as to emerging changes in how insurers and government programs pay for care. Many doctors have become frustrated with the duties involved in practice ownership, including wrangling with insurers, dunning patients for their out-of-pocket fees and acquiring new technology. Some young physicians are choosing to avoid such issues altogether and seeking the sometimes more regular hours of salaried positions."
What I consider as problematic that doctors are surrendering the autonomy to hospitals which are seeking to position themselves for new methods of payment, including an emerging model known as accountable-care organizations. These entities are supposed to save money and improve quality by better integrating patient care, with the health-care provider sharing in the financial benefits of new efficiencies BUT the consolidation wave is raising red flags among some regulators, researchers and health insurers, who warn that bigger health systems can use their leverage to push for higher rates. So what can doctors do? We need to learn the business of medicine and form collaborative primary care practices, or merge our practices to gain market share and leverage.
Surrendering our practices is not a solution. Salaried physicians can get fired too but their former practices remain in the hand of hospitals.
Yours

Bernd