I hate the new WordPress Reader

There are certain blogs where the like button doesn’t show up in the comment section, but I finally figured out how to like comments for these blogs through the Reader.  With the recent “update,” that option has disappeared once again.  So, if I have suddenly stopped liking comments on your blog, this is why.

Also, I made on comment on the post about the new Reader regarding the miniature size of the avatars for each post.  I’m a visual person and I need that cue as a quick way to know who’s post I’m reading.

I now receive new posts in my email for the blogs that I follow, which is better than dealing with the new Reader.

I don’t understand why people try to fix things that aren’t broken.  Are you listening, WordPress?

Thinking of you, Jacqueline du Pre



Jacqueline du Pre, a brilliant and charismatic English cellist whose career was cut short by multiple sclerosis, died last night in London, her concert managers said. She was 42 years old.

Miss du Pre, who was stricken with the disease in 1971, had a career that lasted barely a decade. But during her prime she was recognized as one of the world’s leading cellists, and served as a role model for many young musicians…

The first signs of Miss du Pre’s illness appeared when she was 26 years old and at the height of her fame. ”My hands no longer worked,” she recalled in 1978. ”I simply couldn’t feel the strings.” She withdrew from concertizing for one year, then returned, to mixed reviews. The diagnosis of multiple sclerosis followed shortly, and Miss du Pre retired.

By the mid-70’s, Miss du Pre was virtually paralyzed. She could no longer dress herself, nor stand unaided, nor travel without a great deal of planning. She put all of her energies into two major activities – teaching, whenever possible, and working for the cause of multiple sclerosis research.

”I had to learn to reconstruct my life,” she said in 1978. ”But I have found a great deal to do. I go to concerts and see my friends. And the music is still alive in my head.” …

14 Facts That Will Make You Want To Run Screaming Off The Face Of The Earth


2. All the water we have on earth was probably dinosaur pee at some point in history.

7. The world may run out of chocolate by 2020 because people are eating more than can be produced.

13. The FDA allows up to 150 bug fragments and five rodent hairs per pound of peanut butter.

What your phone says about your state of mind


By tracking the number of minutes you use your phone, the researchers claim they can get a clue about your emotional well-being. If you’re a normal, well-adjusted person, you use your phone about 17 minutes a day. If you’re depressed, you’re on it 68 minutes a day on average.

The researchers also get a clue from tracking your phone’s location. For example, if you spend most of your time in just a few locations, researchers say it increases the likelihood you’re depressed. The same holds true for irregular schedules, where an individual leaves the house and goes to work at different times each day…

Unlikely you say? Well, the Northwestern researchers put their theory to the test. Based on the phone sensor data which was collected, they said they could identify people with depressive symptoms with 87% accuracy…

The smart phone data was actually more accurate in detecting depression than asking people about how sad they were feeling on a scale of 1 to 10. Lead author Sohrob Saeb says that when you ask people that question, their answers are unreliable and not very precise. Their phone, on the other hand, doesn’t lie…

Make A Wish

“My first wish is to see this plague of mankind, war, banished from the earth.”  George Washington

“Gay teenagers are four times as likely to attempt suicide as straight ones. I wish they knew that there’s nothing wrong with them; that they are just a different shade of normal.”  Jodi Picoult

“Nothing fixes a thing so intensely in the memory as the wish to forget it.”  Michel de Montaigne

“I wish people would love everybody else the way they love me. It would be a better world.” Muhammad Ali

“I wish for bud.”  Me

(Photo taken 7/14/2015.)

Meet Greta

Greta appears to be a grasshopper, but when I googled images of grasshoppers, I couldn’t find one that looked like her.  Anyway, she looks like a bug to me (or maybe an alien).  And she looks a little sad…  I wonder, do grasshoppers get depressed?  As always, the internet has the answer:


Do grasshoppers sometimes get depression?

Best Answer: Research shows that insects may in fact get depression, and other types of dysfunctional mood patterns. You know their brains function “normally” because of experiments where they are given coffee, marijuana, cocaine, and sugar to see how they react. Spiders made completely different web styles because of how they were feeling so different, and made them spin out of control. Worms dug their way around the soil backwards, and species of flies kept flying out of control. So it is very possible, but there isn’t another evidence to support this yet.


Grasshoppers are a type of insect with long hind legs that can leap high into the air and fly. When you look at one of these strange bugs, you might find yourself asking, “What do grasshoppers eat?” It may not be readily apparent, as grasshoppers have a set of fierce-looking mandibles, or teeth, on the exterior of their faces, but grasshoppers are actually strict herbivores…

(Photo taken 10/18/2014.)

Bipolar, Depression and Cannabis





Medicare and “lock-in” programs (one doctor, one pharmacy)


Highlighting two recent reports by the Office of Inspector General (OIG) that reveal missed fraud prevention opportunities by the Centers for Medicare & Medicaid Services (CMS), members of the Subcommittee on Oversight and Investigations grilled leaders of the OIG and CMS at a hearing Tuesday, looking for ways to detect and prevent Part D fraud, waste and abuse.

Members of the subcommittee harped on the high volume of opioid prescribing through Medicare Part D that has led to an increase in opioid addiction throughout the country. OIG reports show that spending on commonly abused opioids has grown 156 percent within the last nine years, reaching $3.9 billion in 2014. The total number of beneficiaries receiving those drugs grew 98 percent, compared to 68 percent for all other drugs. In the recent national fraud takedown, 44 of the 243 individuals arrested were involved in Part D fraud schemes, many of which involved opioid prescriptions…

During the hearing, Maxwell also pointed to three specific oversight tools that would improve Part D oversight… A “lock-in” program that restricts certain beneficiaries that are identified as overusing opioids to a limited number of pharmacies and prescribers in order to prevent drug diversion…


Officials from the Office of the Inspector General reported that 43 percent of Medicare Part D beneficiaries in Alabama received prescription opioids last year, compared to 32 percent nationwide. About 41 percent of beneficiaries in Tennessee and Oklahoma received opioids, followed by 40 percent in Alaska…

Part D spending on the most addictive prescription opioids increased from $1.5 billion to $3.9 billion a year between 2006 and 2014, according to the report. Spending was highest for OxyContin, hydrocodone-acetaminophen, fentanyl and morphine-sulfate. Officials are concerned about the prevalence of the drugs because of the high potential for addiction and abuse.

There is also longstanding concern about fraud in Medicare Part D, and officials worry that some prescription opioids could be funneled from pharmacies to street-level drug dealers. Fraud could account for as much as 10 percent of federal healthcare spending, according to estimates from the Office of the Inspector General.

In a recent data brief released by the Office of the Inspector General, 1,432 retail pharmacies showed questionable activity, including 468 that had triple the average percentage of prescriptions for commonly abused opioids. Many of the pharmacies were located in Miami, New York, Los Angeles and Detroit, all areas that were targeted last week by the Medicare Fraud Strike Force…

The agency could also require a “lock-in” for patients suspected of doctor shopping, Anderson said.  “That’s where you restrict certain beneficiaries to a certain number of prescribers or pharmacies,” she added. The practice is already common in state Medicaid programs, including Alabama’s…


There is currently bipartisan legislation in Congress authorizing Patient Review and Restriction (PRR) programs in Medicare, and the president’s 2016 fiscal year budget request proposes authorization to establish PRR programs in Medicare as well. These are programs that are currently used by state Medicaid and private insurance plans…

Click to access Pew_MedPAC__Comments.pdf

Pew encourages MedPAC to recommend that Congress provide Part D plan sponsors the authority to implement patient review and restriction (PRR) programs to address potentially inappropriate opioid use… PRRs, also known as “lock-in” programs, are designed to identify and intervene in instances when patients over-utilize narcotics and other prescription drugs that are subject to abuse…


(10/29/2014) Medicare Should Adopt A ‘Lock In’ Policy

Herrick cites evidence that some Medicare beneficiaries either traffic in opioids or abuse them themselves. Medicare facilitates this because there are no limits to the doctors or pharmacies that beneficiaries can use. For the addicted or criminal Medicare beneficiary, this leads to “doctor shopping” and “pharmacy shopping.” Medicaid programs in some states have succeeded in reducing this abuse by making dependents chose one doctor and one pharmacy…

“It’s also good idea is consider expanding lock-in to include more drugs than just narcotic pain relievers if diversion of other types of drugs becomes a problem. A recent government investigation found Medicare spent $32 million for AIDS drugs in 2012 for 1,600 people with questionable drug utilization — more than half of which did not appear to actually have HIV. Many of these visited multiple doctors for prescriptions and/or filled their drugs at multiple pharmacies to obtain excessively-large quantities of costly HIV drugs. Some of these drugs were likely resold on the illicit market due to their high resale value. Another possibility is unscrupulous (possibly bogus) pharmacies stole Medicare enrollees’ identities and billed Medicare for drugs never dispensed.”

Herrick proposes that Medicare adopt what the industry calls “lock in” of a beneficiary’s pharmacy benefits to one doctor and one pharmacy. (The industry could have thought up a better term than “lock in.” How about “exclusive provider”?) The reforms Herrick proposes could save billions of dollars every year.

Urine drug screen revenue up 19,164% in CA worker’s comp cases in 8 years


June 1, 2012 by the pathology blawg

I have posted before about the urine drug screen industry and how lucrative it is…as well as how ripe it is for abuse and fraud (Calloway Lab’s $20 million settlement for Medicaid fraud, Kickbacks and other abuses, Ameritox’s $16.3 million settlement with the DOJ for kickback allegations, Ameritox’s suit against Millennium Laboratories for alleged kickbacks, etc)…

Doctors perform on-site drug screens of dubious accuracy that costs them a few dollars, and then turn around and charge insurance companies and employers hundreds of dollars. And from where can they get these handy-dandy on-site drug testing kits? From the same large drug testing companies that will later perform confirmatory testing on the same sample, and bill another $1,000-2,000…


To save money, insurance industry joins the war against pain patients

Click to access insurers_pire_4_web508.pdf

The Role of Insurers in Preventing Misuse and Abuse of Controlled Substances

Prescription opioid abuse cost the health care system $25.0 billion during 2009 (Birnbaum et al., 2011)…

As Dr. Len Paulozzi of the Centers for Disease Control and Prevention said, “There’s an awful lot of back injuries in the workers’ comp population and subsequent surgery related to back problems, and back pain is one of the most common indicators now of use of opioids in the
United States” (Johnson & Jergler, 2013). However, as a strategy to manage chronic pain related to tissue damage, controlled substances may not be particularly effective. Dr. Paulozzi continued: “Opioids might be good for use in the acute phase, say within six weeks after injury. But if it doesn’t improve the situation in the short term, continuation is not really indicated.” Worse, using opioids to control pain creates a condition called hyperalgesia, which makes patients more sensitive to pain from future injuries and less able to control that pain…


In 2011, the State estimated that giving permission to third-party payers to access the Prescription Monitoring Program database would yield reductions in total benefits paid for 3% of claims related to 2–3 opioid prescriptions, 5% on claims related to 4–7 prescriptions, and 7% on claims related to 8 or more…

States and insurers are implementing patient review and restriction programs. These programs, which a number of states have implemented, are sometimes known as Medicaid Lock-In Programs…

In Virginia, WellPoint Anthem Blue Cross and Blue Shield estimated that it saved more than $300,000 by restricting 100 patients to a single pharmacy…

MaineCare, which administers the State’s Medicaid program, has limited patients to 2 weeks of painkillers a year, although it does permit renewals in intervals of 2 weeks to patients who receive special permission. Patients with chronic pain that lasts more than 8 weeks are required to try such alternative treatments as cognitive behavioral therapy, pain acceptance therapy, and chiropractic treatment. Exempt from these rules are patients with AIDS or cancer or those in hospice settings…

PDMPs that include data pertaining to the patient’s means of payment can be used to determine if Medicaid patients are circumventing program restrictions by using cash to purchase controlled substances. Unfortunately, as of 2012, only slightly over half the states were sharing their PDMP databases with either their Medicaid or Medicare programs, and only Michigan allowed private insurers access to it (PDMP, 2014). Using its PDMP database, Washington State’s Medicaid program discovered that in the first 6 months of 2012, more than 200 patients had paid cash for dispensed controlled substances on the same day, and 500 patients had filled two or more opioid prescriptions for use during the same time period. The program also discovered that Medicaid patients were paying cash for prescriptions for controlled substances in 435 of its pharmacies, which indicated that they were out of compliance with their contracts (Best, 2012)…

Aetna’s Pharmacy Management Program is a four pronged effort to prevent the misuse and abuse of controlled substances. First, the program can limit coverage of any particular drug and can verify that the covered member needs the drug before approving it. The program also proactively notifies the pharmacist if the drug is prescribed at a level that may be inappropriate. Second, the program reviews each member’s prescription history before filling a new prescription. Third, members who are suspected of misusing controlled substances may be referred to a pain specialist or to Aetna’s Behaviorial Health or Case Management services, or they may be encouraged to enroll in a pain management program. Finally, the program may respond to members who decline offers of assistance by restricting them to a single provider or
by reducing coverage for refills. Following the inception of this program, opioid use among the carrier’s 4 million members declined 15% over the course of 2 years (Aetna, 2013).
Blue Cross Blue Shield of Massachusetts implemented a similar program…

Prime Therapeutics, a pharmacy consulting program, identified patients of concern based on a score developed from their use of controlled substances and doses of opioid analgesics in excess of 120 morphine milligram equivalents per day…

Found in the Search Terms for my blog:  “does workers comp ins. coordinate with my anthem for opiate scripts”



(5/21/2015) Opioid addiction suit puts workers comp payers on alert

Experts urge workers compensation payers to take steps to avoid overprescribing or doctor shopping following a state Supreme Court’s decision allowing patients to sue physicians and pharmacies for contributing to their addiction to opioids.

Nearly 30 people filed eight civil actions in Mingo County, West Virginia, Circuit Court between 2010 and 2012 that alleged a medical center, three physicians and four medical centers “negligently prescribed and dispensed” drugs that led them to abuse and become addicted to opioids, court records show.

Most were prescribed Lortab, Oxycontin and Xanax for injuries caused by automobile or workplace accidents. Most also admitted “their abuse of controlled substances predated their treatment,” and they engaged in “illegal activities associated with the prescription and dispensation of controlled substances,” according to the West Virginia high court’s May 13 split decision…

“It’s a slippery slope,” said Phil Walls, chief clinical and compliance officer at Tampa, Florida-based pharmacy benefit manager myMatrixx, the marketing name of Matrix Healthcare Services Inc. Pharmacies worried about the potential liability might refuse to fill — or even stock — some opioids, which could make it difficult for injured workers who really need the drugs to get them, he said…

What payers in most states can — and should — do to curb overprescribing is to ask workers comp physicians if they’re accessing prescription drug monitoring programs, experts said.

If not, “that obviously doesn’t mean they are prescribing inappropriately or egregiously, but it does mean they aren’t paying as close attention as they should,” Mr. Pew said. “It indicates a lack of due diligence on behalf of the physician and is an immediate red flag.”

Another way payers can prevent egregious prescribing is by requesting physician profiling reports and other data from their pharmacy benefit managers, experts said.

Only a small number of physicians and pharmacies actually engage in inappropriate or egregious prescribing and dispensing, Mr. Walls said.

An FBI raid eventually led some of the West Virginia physicians to lose their medical licenses and serve prison time, while one pharmacy and its pharmacist were “subject to disciplinary and/or criminal action,” according to records.