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
Sunday, July 03, 2011
Saturday, July 02, 2011
Drug Testing for Welfare Recipients
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
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
Thursday, June 30, 2011
Counterfeit-Proof Prescription Pads
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
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
Monday, June 27, 2011
Mystery Shoppers
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
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
Saturday, June 18, 2011
Medicare Claims Show Overuse For CT Scans
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
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
Thursday, June 16, 2011
Support Doctors in Bahrain
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
Please participate because your support counts.
Yours
Bernd
Governor Scott Suspends Drug Testing Order
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
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
Tuesday, June 07, 2011
The Big Rip-Off
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
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
Saturday, June 04, 2011
Governor Scott Signs Pill Mill Bill into law
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
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
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
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
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.
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.
Sunday, May 08, 2011
Gun Law and Physicians
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
* 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
Friday, May 06, 2011
Solutions From The Inside
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
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
Friday, April 22, 2011
Medicaid and Managed Care
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
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
Thursday, April 21, 2011
The Valentine's Day controversy
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
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
Wednesday, April 20, 2011
Controlled Substances
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
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
Thursday, April 14, 2011
Fla. House panel OKs compromise pill mill bill
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
I urge you to continue pushing your legislators to support the House ( HB7095) and Senate bill (SB818).
The battle is not over yet !!
Yours
Friday, April 08, 2011
Florida Medicaid Reform
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
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
Sunday, April 03, 2011
Governor Scott and Mandatory Drug Testing
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
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
Friday, April 01, 2011
Malpractice Reform
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.
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.
Monday, March 28, 2011
Pill Mill Issue
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
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
Sunday, March 27, 2011
Florida gets the profits, Kentucky gets the problem
“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
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
Thursday, March 24, 2011
Bad Medicine
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
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
Monday, March 14, 2011
Florida is Open for (Drug) Business
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
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
Tuesday, March 08, 2011
DOH wins PDMP Bid Protest
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
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
Sunday, March 06, 2011
Pill Mill and PDMP Issue
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."
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."
Friday, March 04, 2011
Florida Judge Stays Ruling
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
* 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
Thursday, March 03, 2011
Health Department Faces Deep Cuts
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.
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.
Saturday, February 26, 2011
The Airline Industry and Patient Safety
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/
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/
Thursday, February 24, 2011
Governor Scott and the PDMP: Accusations replace Facts
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.
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.
Wednesday, February 23, 2011
The Tip of the Iceberg
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
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
Sunday, February 13, 2011
The Stubborn Rejection of Common Sense
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
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
Tuesday, February 08, 2011
Governor Scott and the PDMP
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 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
Saturday, February 05, 2011
The Governors Wrong Move(s)
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
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
Friday, February 04, 2011
AG Bondi and Pill Mills
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
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
Wednesday, February 02, 2011
Florida Shuts Down the Implementation of the PPACA
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
Yours
Bernd
Florida Health Grades
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
* "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
Monday, January 31, 2011
How We Can Curb Prescription Drug Abuse
ttached an article published in Internal Medicine News reporting that the combined efforts of local physicians and the statewide prescription drug monitoring program successfully reduced prescription narcotic diversion.
This article should serve as an example that we CAN curb prescription drug abuse.
So what are we waiting for?
Yours
Bernd
Pain Management Program Cut Prescription Narcotics Diversion
By: M. ALEXANDER OTTO, Internal Medicine News Digital Network
01/04/11
Bookmark and Share |
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.
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
Bookmark and Share |
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.
Sunday, January 30, 2011
The Pill Mills Issue and Politicians
Attached you find an excellent commentary by Carl Hiaasen entitled " Hey, gov: Don't give pill mills license to kill."
The commentary speaks for itself and I 100% agree with its content and tone.
I am angered and frustrated that many physicians in the state of Florida have chosen a hands-off approach regarding this issue. Some even ague that we should wait and see to avoid antagonizing the new Attorney General and Governor. Well, I beg to differ! I still remember when organized medicine first and foremost dedicated its efforts to protect the public health and NOT only the financial interest of doctors. I also remember the time when organized medicine spoke up to protect the interest of those who had no voice to speak. Now we have to opportunity to rise to the challenge to defend the lives and well-being of our families and patients. Now is the time to demand from our elected officials to declare a public health emergency to stop the epidemic prescription drug abuse killing seven Floridians every day! We should not let this opportunity slip away. We must stop the drug dealers in white coats who chose profits before their professional oath.
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
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
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