To cut costs, Medicare adopts CDC’s regulations

I think you’d be surprised at how many federal and state government agencies are a part of the opioid war. As predicted, the CDC’s opioid guidelines are being treated more like regulations than simple guidelines. With the backing of the CDC’s false theories, these agencies are deciding which treatments for pain will be available to patients — and which will label you a criminal. If you’re a pain patient with Medicare, this information will affect you.

http://www.painnewsnetwork.org/stories/2017/1/12/medicare-takes-big-brother-approach-to-opioid-abuse

A new strategy being developed by Medicare to combat the abuse of opioid pain medication will encourage pharmacists to report physicians who may be prescribing opioids inappropriately. Patients that a pharmacist believes are abusing opioids could also be referred for investigation.

The strategy, which has yet to be finalized, was outlined by the Centers for Medicare & Medicaid Services (CMS) last week in a 30-page report on the agency’s “Opioid Misuse Strategy.” It has not been widely publicized by CMS or reported in the news media…

I read a story the other day about a pain patient who was reported to his doctor by the pharmacist for buying alcohol with his prescription drugs. But I don’t think it’s news that doctors and pharmacists have also become an extension of the DEA in the opioid war, just like other government agencies.

Here are some excerpts from CMS’s “Opioid Misuse Strategy” report:

http://www.cms.gov/Outreach-and-Education/Outreach/Partnerships/Downloads/CMS-Opioid-Misuse-Strategy-2016.pdf

Increase the use of evidence-based practices for acute and chronic pain management. Evidence-based practice is an integral part of all of CMS’s priority areas, but expanding the evidence base of effective and alternative treatments for acute and chronic pain is especially vital. CMS stated this priority area specifically to emphasize the need to address the limitations of research that is currently available.

By January 1, 2019, CMS will enforce requirements that the vast majority of prescribers who write prescriptions for Medicare Part D beneficiaries must be enrolled in Medicare or be validly opted out in order for the beneficiaries’ drugs to be covered. This enrollment requirement will allow Medicare to have better oversight of prescriber behaviors and revoke enrollment of providers proven to demonstrate inappropriate behaviors.

The Medicare Part D Opioid Prescriber Summary File, which will build on this Medicare prescriber enrollment requirement, presents information on the individual opioid prescribing rates (for new prescriptions as well as refills) of prescribers of Part D drugs. This public data set will provide information on the number and percentage of prescription claims for opioid drugs, as well as each provider’s name, specialty, state, and zip code. The file can be used to explore the impact of prescribing practices of controlled substances on vulnerable populations.

Finally, through CMS’s Overutilization Monitoring System (OMS), Part D sponsors are provided quarterly reports on high risk beneficiaries and provide CMS with the outcome of their review of each case. Since 2011, the OMS helped sponsors reduce the number of potential opioid overutilizers by 47 percent among Medicare Part D beneficiaries.

Additionally, CMS is addressing the issue of drug diversion by identifying consistent thresholds across programs to flag providers as “high prescribers” and patients as “high utilizers” who may require additional scrutiny.

CMS is in the exploratory phase of identifying metrics to quantify and track progress in each priority area. For priority area 1, metrics are currently under consideration in the following areas:

For prescribers enrolled in Medicare who prescribe Part D drugs:

Percentage of opioid prescriptions:
o Exceeding CDC guideline of 90 morphine milligram equivalents (MME) per day
o Exceeding 7 days of treatment
o Written for extended release/long-acting opioids

Percentage with beneficiaries receiving an opioid prescription without other supportive therapies/treatments

Research would also increase the focus on identifying methods for migrating the significant number of chronic pain patients with long standing opioid use to other medications along with alternative modalities. Without initiating other medications at the same time as alternative therapies, these patients may vigorously resist reducing or giving up the opioids that for many years have allowed them to manage their pain at tolerable levels and lead functional lives. The benefit of tolerable pain levels and functional lives may outweigh the risk of opioid use for these patients.

Recognizing its critical role in promoting and reinforcing appropriate treatment approaches, Medicare, Medicaid, and Marketplace plans would cover therapies that are consistent with CMS’s evidentiary standards.

CMS has a number of initiatives underway to increase the use of recommended evidence-based practices for pain management. CMS provides outreach regarding best practices and technical assistance through the Transforming Clinical Practice Initiative’s Practice Transformation Networks. CMS has distributed publications on evidence-based prescribing practices to providers, often in coordination with other HHS agencies, including the Office of the Surgeon General.

CMS is also playing a part in expanding the evidence base to identify and support effective nonpharmacologic therapies and additional non-opioid pharmaceuticals. The agency’s key role is to identify services that need more evidence to support coverage by Medicare and other health plans. CMS then collaborates with research-focused HHS agencies, such as NIH, who can concentrate research on these need areas.

The focus of CMS’s immediate efforts under this priority area is twofold. First, identify non-covered treatments that already have sufficient evidence in order to quickly expand coverage of those therapies; for example, for certain common pain conditions, such as chronic lower back pain, CMS is exploring ways to streamline coverage of evidence-supported alternative therapies.

Secondly, educate providers and beneficiaries in order to improve provider utilization of evidence-based treatments and adjust patient expectations appropriately.

CMS’s long term priorities focus on broadening coverage and increasing utilization of therapies that are [might be] proven to be effective. This approach will accelerate identification and implementation of effective alternative treatments for pain.

What happens when access to the only adequate treatments for pain are reduced and removed before other “effective” therapies are found? Like, what happens when Republicans repeal Obamacare before having something comparable to replace it with? I think the term “chaos” fits.

http://www.blog.cms.gov/2017/01/05/addressing-the-opioid-epidemic/

“The opioid epidemic is one of the most pressing public health issues in the United States today.” – Health and Human Services (HHS) Secretary Sylvia Mathews Burwell

Really? If more people suffer from untreated chronic pain than suffer from addiction, which is the epidemic? If more people die from suicide than from drug overdoses, which is the epidemic?

Many Medicare and Medicaid beneficiaries and their families have been affected by the consequences of opioid misuse and opioid use disorder, commonly referred to as addiction. Given the growing body of evidence on the risks of misuse, highlighted by the Centers for Disease Control’s (CDC) new guidelines for prescribing opioids that was released earlier this year, and the Administration’s commitment to combatting the opioid epidemic, CMS is outlining our agency’s strategy and the array of actions underway to address the national opioid misuse epidemic. The actions outlined here do not include CMS’s vision for the treatment of cancer and hospice patients.

See, those who suffer from cancer, or are under hospice care, deserve to have their pain treated, while everyone else can just suffer. Thanks, CDC.

Comments are closed.

Of course comments are closed. They don’t want anyone to invade their bubble. But Medicare is on Facebook, along with the agency that oversees it, HHS:

http://www.facebook.com/HHS/

http://www.facebook.com/medicare/

My comment posted today on Medicare’s Facebook page:

The CDC’s opioid regulations, and Medicare’s adoption of them, are forcing tens of millions of Americans to find alternative treatments for pain, like marijuana and kratom. How much savings does that amount to for Medicare?

What happens when you reduce and remove access to the only successfully proven treatment for pain before equally successful alternative treatments are available? How smart is it to repeal before you replace?

Many pain patients are unable to find safe and adequate replacements for opioids. Some will be forced into the underground drug market. Some will choose suicide. Most will survive, but their lives won’t be worth living. Many will just hunker down, suffer quietly, and wait to die — shamed by the opioid war into believing they deserve to suffer.

Has Medicare/CMS identified metrics to quantify and track the destruction being caused by it and the CDC? Like the increase in addiction rates, poisonings, and suicides. The increase in the use of alcohol, cigarettes, acetaminophen and NSAIDs, sugar, and other legal, over-the-counter drugs and supplements. The increase in domestic violence, family break-ups, obesity, kidney and liver disease, disability claims, and homelessness. The increase in anxiety, depression, and PTSD.

Once the government cures addiction (with money and good intentions), what is it going to do about the epidemic of intractable pain? The epidemic of suicides and gun violence? The epidemic of Americans being unable to trust even one government agency in this country?

For most of us, it’s about survival

http://www.bloomberg.com/news/articles/2017-01-06/the-highest-paid-u-s-executives-supervise-doctors-not-bankers

Among the 200 top-paid U.S. executives at public companies, those in health care and pharmaceutical businesses were awarded average pay packages of $37 million in their most recent fiscal year, the most of any sector, according to the Bloomberg Pay Index, which ranks executives based on awarded compensation. Information-technology managers were No. 2 at $35.3 million…

http://www.painnewsnetwork.org/stories/2017/1/7/will-an-asteroid-hit-the-us-healthcare-system

Without federal guidelines, states will push poor people out of programs, eliminate important benefits, and cut already-low payment rates to providers to save money. I remember a time in Arizona when poor men and women qualified for state assistance for health and food. Now, you must have children to qualify for many of our assistance programs…

My comment:

I was totally unprepared for the asteroid that hit me when my pain doctor dumped me. That was about 5 years ago. One of the things I’m most thankful for is that I’m no longer addicted to doctors. They no longer have any control over me. I no longer have to depend on a doctor for my pain management, and in that, there is quite a bit of freedom. Being chained to pain for so long, it’s nice to feel just a little bit of freedom.

Of course, there may be consequences for someone who is disabled by pain to remove themselves from medical treatment. It appears that one must be paying a doctor to manage a chronic illness or one isn’t considered disabled. I’ve written to Social Security Disability explaining my situation almost 2 years ago, but I’ve received no response. One day, an overworked employee will get to my file, and I don’t know what the result of that scrutiny will be. If I lose my benefits, like these poor people, I will be homeless.

http://www.yahoo.com/news/tangled-fraud-probe-100s-face-145617092.html

I don’t consider myself stronger than anyone else, so I know that others can recover from their addiction to doctors. I chose cannabis, while other pain patients are choosing kratom. But even with those treatments, there are still an enormous amount of obstacles. Tragically, some pain patients will give up and choose suicide. I don’t blame them.

I suppose it all comes down to how much risk we are willing to take. Money is the primary concern, because a person’s financial condition determines which treatment options are available. For me, the next most important concern is my pain. It’s my pain that determines how much risk I’m willing to take. It’s even my pain that decides how much money I’m willing to spend for treatment. My checkbook is the boss; however, my pain can overrule the boss, but only to a certain point — zero money.

So, here I am, wondering when my disability checks will be cut off. Wondering how Trump is going to affect my disability benefits and access to cannabis. Wondering when I’ll have to start living in my car. I don’t suppose I’ll be prepared for that asteroid, either. But at least I don’t have to wonder if my doctor will support me through all this mess.

In the meantime, all I can do is survive the best way I know how. Because, when you come right down to it, this is about survival. Good luck to us all.

Goodbye, Vicodin

http://www.publicintegrity.org/2016/12/15/20544/drugmakers-push-profitable-unproven-opioid-solution

“…crucial efforts to steer physicians away from prescription opioids — addictive pain medications involved in the deaths of more than 165,000 Americans since 2000.”

How much more effort will it take? How much more fear can be instilled in doctors and patients?

Pain medications are not addictive for the majority of people who take them, so to describe them as such is just pure ignorance. Let’s see the number for the amount of Americans who have taken pain medications since 2000 without becoming addicted. Because believe it or not, opioids provide benefits to tens of millions of Americans. And while it’s easy to throw around huge numbers like 165,000 (within a 16-year period), the truth is that the percentage of Americans who suffer from an opioid addiction is very low (0.6% of the population).

“An estimated 78 Americans die from heroin and prescription opioid overdoses every day.”

For comparison, according to the CDC, in 2013 there were 113 suicides every day.

The CDC also says that “firearms are the most commonly used method of suicide among males (56.9%).” When will the government force gun manufacturers to make an abuse-deterrent gun? When will they force gun owners to buy a more expensive, abuse-deterrent model?

“The FDA already has begun moving in the direction suggested by companies, mapping out a process for removing older opioids from the market when newer versions are shown to be more effective at thwarting abuse.”

How many other drugs are considered effective only because they’ve been shown to thwart abuse? Is that the purpose of these medications, or is their purpose to treat pain? Has the FDA determined that it’s not important to show how effective the abuse-deterrent opioids are at treating pain? Because as a 30-year intractable pain survivor who’s taken almost every prescription opioid, I find it hard to believe that these new formulations work better, or even as well as, ubiquitous painkillers such as Vicodin and Percocet.

http://www.publicintegrity.org/2016/12/15/20549/drugmakers-set-gain-taxpayers-foot-new-opioid-costs

Some drugmakers aim to replace ubiquitous painkillers such as Vicodin and Percocet with harder-to-abuse formulations that are patent-protected and command higher prices — a plan that could cost government-funded health programs hundreds of millions of dollars in higher medication expenses…

http://www.facebook.com/CDC

#DearCDC: A basic principle of medical ethics says that when you have an intervention that works, you don’t introduce alternatives unless there are significant advantages. Please share with the public which alternative treatments for chronic pain show significant advantages over opioids for a majority of patients. In other words, prove that the CDC’s guidelines are in compliance with the basic principles of medical ethics.

What about me?

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http://www.yahoo.com/news/what-just-happened-with-carrier-is-crazy-223106708.html

And now, Trump has persuaded Carrier to keep at least half of the 2,000 jobs it planned to outsource in Indiana, a remarkable instance of federal arm-twisting aimed at a single corporation…

Everyone’s talking about how Trump saved 1,000 jobs, yet no one wants to mention the other 1,000 jobs that are going to be outsourced. So, if your friend gets to keep her job and you don’t, how are you going to feel, and vice versa? Wow, thanks for saving my friend’s job, but what about me?

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Go have a beer, friend. Looks like 2017 is going to suck for you, too.

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https://www.yahoo.com/news/medicare-premiums-increase-retirees-211835421.html

Things cost more, but my Social Security Disability check has either stayed the same, or like this year, is going to actually be less.

Fall Is Cranky

First, we got some rain. (Thanks, Mother Nature.)

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Then came the snow clouds…

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…but no snow, not yet.

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Thanksgiving Day sunset.

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Does this look like snow?

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Because it ain’t. It’s bugs.

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Bugs and more bugs. (Cover your nose!)

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I’m just hanging around, waiting for payday, so I can buy some weed. One day, Medicare will cover weed. Seriously. But I can’t wait for that day.

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Superman and Superwoman! 🙂

What happened to middle-class America?

President Obama promised jobs and he delivered. But these were 21st-century jobs, like in a call center or an Amazon warehouse. Trump has promised jobs by negotiating better trade deals and building a wall to keep out job-stealing foreigners, but these are only pieces of the puzzle. It’s not the whole picture.

Obama saved part of the auto industry, but this year, I’ve seen lay-offs in just about every industry. Americans want good-paying jobs with adequate benefits, but they don’t really exist anymore. Corporations don’t have to pay good wages or supply benefits when they can go overseas for cheap labor, no benefits, and no environmental regulations. Even China is talking about raising prices so that wages can be increased. (China!) Many Americans haven’t yet realized that they’re competing for jobs with people from all over the world. This is the digital age, where concrete walls and borders don’t exist.

Republicans convinced Americans all over the country that unions were anti-business, so Americans destroyed the only power that could save middle-class jobs. Who else was gonna do it? American workers have had to fight for themselves, which obviously doesn’t work. Especially after Republicans destroyed the different ways Americans have used to fight back, like capping legal damages. Maybe some people think it’s a good thing that the legal industry has shrunk so much, but who’s left to fight?

If Trump is even able to bring back good-paying jobs, who will fight to keep them? (Many years ago, New Mexico paid Intel to open up a location in this state, but the relationship didn’t last. After many rounds of lay-offs, the city where most of the workers lived is now a ghost town.)

What kind of jobs will Trump help to create in this country? Could a President make Intel stay in New Mexico or is all of this going to be business that’s left up to the states? In other words, nothing will change.

This from Rudy Giuliani on CNN today:

“You’re forgetting his campaign promise of increasing dramatically the size of the military and doing away with the sequester. We’re going to go up to 550,000 troops… we were going down to 420,000… and we’re going to increase the size of the Marines… So he’s going to be facing Putin with a country that’s not diminishing it’s military, but a country that’s dramatically increasing it to Reagan-like levels, so that he can negotiate… he’s going to negotiate for peace, but with strength…”

I suppose dramatically increasing our military will put more Americans to work. (There are probably not very many foreigners or immigrants in our military taking jobs away from Americans, but since Bush’s wars, the military hasn’t had that high of a bar for admittance.) Are these the jobs that Trump supporters want, to work for the government, specifically the military?

As far as I know, it’s mostly corporations that outsource contractors from other countries, not the military. Thing is, the military relies on contractors from the private sector quite a bit. I guess it will be poor Americans who fight on the ground, while the “elite” work at their desks from around the world — the type of job that pays well and has good benefits. (The recession caused a lot of job loss in state and local governments — but not so much in Washington.)

I recently saw a billboard advertising for the Marines. It talked about honor. There may be honor in serving this country, but I can find no honor in war. (And just because I’m anti-war, that doesn’t mean I’m anti-military.)

Every day is veteran’s day because America can’t stop fighting wars. Trump wants to increase our military when we haven’t even financially recovered from Bush’s wars. How many women and men will he send into danger? How many will come back broken beyond repair?

There are men and women who will suffer for the rest of their lives with medical conditions caused by their military service. It would be one thing if the healthcare system took care of our veterans, but that’s not always the case.

This country has been cutting back on spending for services we depend on just so we could pay for Bush’s wars, like infrastructure and education. Americans have been cutting back to pay for 9/11 for the last 15 years.

Here in New Mexico (as reported on 11/4/16 by the right-leaning and financially-in-trouble Albuquerque Journal):

“With New Mexico in the middle of a budget crisis, cities and counties around the state are going to have to look for new ways to boost behavioral health services and fight the effects of opioid abuse. Bernalillo County Commissioner Maggie Hart Stebbins made the comments while visiting Washington, D.C., for a meeting hosted by the White House Office of National Drug Control Policy. Hart Stebbins and other officials on Thursday talked about the potential of pay-for-success programs in which local governments make payments to contractors and other service providers only if they meet certain milestones and outcomes…”

It appears that government has embraced the idea of corporations proving success before they get paid. But is this a good idea in the healthcare industry? What kind of successes are they expecting in addiction programs? What will clinics do — how far will they go — to make their patients “succeed”?

The drug war costs billions of dollars. States can’t afford to provide adequate healthcare. We’re in a gigantic financial hole from Bush’s wars — wars that Obama has continued, albeit at a much smaller pace. Military spending was out of control for so long. Americans have given their military a blank check, with very little accountability. Obama reigned in the spending, but just in how fast it was growing. Military spending has always included an annual increase. Can’t say the same for Social Security. In fact, presidents have stolen money from Social Security to fund the military.

And now Trump wants to make our military even bigger. We already have the biggest military on planet Earth. Maybe even in the whole galaxy. Our military is everywhere. Why do we need to make it bigger? As a show of force? Does Trump need a gigantic military at his back so he can negotiate with other countries? Well, guess what? He already has one.

Let’s hear from Trump’s new national security “guru”:

http://www.cnn.com/2016/11/11/opinions/trumps-national-security-guru-general-flynn-bergen/

Luckily, there are some answers to Flynn’s views in a book he published in July, “Field of Fight: How We Can Win the War Against Radical Islam”. Flynn claims that the United States is in a “world war” with radical Islam, a war that “we’re losing” that could last ‘several generations.” He also asserts that “political correctness forbids us to denounce radical Islamists.”

American Islamists, Flynn claims, are trying to create “an Islamic state right here at home” by pushing to “gain legal standing for Sharia.” Flynn cited no evidence for this claim.

In particular, Flynn portrays Iran as the source of many of America’s national security problems…

Flynn advocates going after the “violent Islamists wherever they are,” which doesn’t sound much different than what the Obama administration is already doing, given that it is conducting various forms of warfare in seven Muslim countries…

Looks like Trump and his cronies are gonna pick a fight with Iran. Will we never stop fighting over oil? Hey, Trump supporters, if we had more solar and wind power, we wouldn’t have to depend on other countries to supply our oil addiction. Or do all you gun-lovers enjoy wars that last forever? As Trump’s new cabinet member says, we’ll be fighting radical Islam for “several generations.”

Trump, the New Face of War. How appropriate. I guess the best we can hope for is that he doesn’t push the button.

I blame religion

Democrats have been sliding right for decades. Instead of joining Democrats in the middle, Republicans ran to the far right. And now we have President Donald Drumpf.

Pundits will place blame for Hillary’s loss on things like fear, anger, and apathy. I’m sure there are a myriad of reasons that America voted for a racist, homophobic misogynist.

Some say that women voters were the reason that Obama became president. Some say it was black people who put him in office. Now it appears that men, as a voting block, are the reason that Trump is now president. But, there’s more to the story than that…

A large majority of Republican women voted for Trump. Does that mean these women are ignorant? (Like, do any of them even know who Angela Merkel is? Do any of them believe that a woman can be president?) Does it mean that party affiliation is stronger than common sense? Why would any woman vote for someone like Trump?

Chelsea Handler: The only person with more respect for women than Donald Trump is Bill Cosby.
7:57 PM – 19 Oct 2016

I’ll tell you why: religion. If you think about the divisions between Democrats and Republicans, all of them can be traced back to religious beliefs. The only groups that Americans dislike more than atheists are Muslims and Mexicans.

Funny thing is, I think Trump is an atheist, not that he’d ever admit it. He will always worship money and power over anything else. And perhaps that says more about the Republican party than anything else. It’s all about the worship of money. Not that the Democrats are any different.

Yes, the Republican party is full of racists and bigots, but it’s also full of people who don’t believe in science. People who believe more in their own religion than in the facts. Hypocrites who say they believe in individual rights, but not the right to smoke pot or the right to die. These people are now in power with no one to stop them…

Dude, that’s some scary shit.

The only thing I’m wondering right now is which group Trump will pick to shit on first. Is he coming for Mexicans or Medicare? Women’s or gay rights? Republicans voted him in, but will they have any control over him? (My stomach hurts.)

Donald Trump was declared the winner around 1am. He said in his victory speech that it’s time for us to become “united.” How long has he spent trying to divide us? That’s what you call hypocrisy at it’s finest.

I live in a state that voted for Hillary, but if I lived in a Trump state, I’d be looking suspiciously at my neighbors. Which one of them voted this asshole into the highest office in the land?

To everyone who doesn’t live in America, from this very sad American:  I’m so sorry.

http://www.nilzeitung.wordpress.com/2016/10/30/dont-worry-be-happy-playing-for-change-song-around-the-world/

I can understand how news like this might trigger someone who is depressed into thinking about suicide. If you’re thinking about suicide, please click on the candle widget on the right side of your screen.

Thanks for listening, everyone. 🙂