Inside Corporate America’s Campaign to Ditch Workers’ Comp

STANDING BEFORE A GIANT MAP in his Dallas office, Bill Minick doesn’t seem like anyone’s idea of a bomb thrower. But backed by some of the biggest names in corporate America, this mild-mannered son of an evangelist is plotting a revolution in how companies take care of injured workers.

His idea: Let them opt out of state workers’ compensation laws — and write their own rules…

The investigation found the plans almost universally have lower benefits, more restrictions and virtually no independent oversight.

Already in Texas, plans written by Minick’s firm allow for a hodgepodge of provisions that are far different from workers’ comp. They’re why McDonald’s doesn’t cover carpal tunnel syndrome and why Brookdale Senior Living, the nation’s largest chain of assisted living facilities, doesn’t cover most bacterial infections. Why Taco Bell can accompany injured workers to doctors’ appointments and Sears can deny benefits if workers don’t report injuries by the end of their shifts…

Unlike traditional workers’ comp, which guarantees lifetime medical care, the Texas plans cut off treatment after about two years. They don’t pay compensation for most permanent disabilities and strictly limit payouts for deaths and catastrophic injuries…

The plans in both Texas and Oklahoma give employers almost complete control over the medical and legal process after workers get injured. Employers pick the doctors and can have workers examined — and reexamined — as often as they want. And they can settle claims at any time. Workers must accept whatever is offered or lose all benefits. If they wish to appeal, they can — to a committee set up by their employers.

In many cases, ProPublica and NPR found, the medical director charged with picking doctors and ultimately reviewing whether injuries are work-related is Minick’s wife, Dr. Melissa Tonn, an occupational medicine specialist who often serves as an expert for employers and insurance companies…

Two months later, Pinckard said, he was pulling a cart loaded with frozen French fries when he slipped on some ice in his trailer and suffered a hernia. He had previously had two hernias on the job that were covered by workers’ comp and figured this time would be no different. But the denial letter said the plan for Reyes Holdings, which owns Martin-Brower, only covers two types of hernias — not the kind Pinckard suffered.

“The only way it was covered was if it was directly under my belly button,” he said. “Mine was slightly above my belly button.”

In this instance, as in others ProPublica and NPR found, the costs of the injury were shifted to the employee, group health or government programs…

Minick was a young lawyer for one of Dallas’ oldest firms in 1989, when some of the firm’s business clients, gambling that the cost of any lawsuits would be cheaper, began dropping workers’ comp. The senior partners assigned Minick and several colleagues to come up with an alternative. They found it in the Employee Retirement Income Security Act, a federal law passed in the early 1970s to protect workers as employers were shedding their pensions.

ERISA had been applied similarly to other worker benefits, such as health plans and disability policies. Minick and his colleagues decided it could provide a legal framework for plans covering on-the-job injuries.

Texas courts agreed, even though, compared to workers’ comp, the ERISA-based plans gave employers critical advantages. Under ERISA, appeals are heard in federal court, rather than state workers’ comp courts. And in general, judges could rule only on whether a denial was reasonable — not whether it was fair. This gave employers far greater control…

The fine print of opt-out plans contains dozens of opportunities for companies to deny benefits. Employers can terminate workers’ benefits for being late to doctors’ appointments, failing to check in with the company or even consulting their personal doctors…

Under workers’ comp, employees can’t be fired in retaliation for a claim. But employers that opted out argued that their workers weren’t entitled to that protection, and in 1998 the Texas Supreme Court agreed.

Gillespie, of the insurance association, said such provisions blatantly shift costs to taxpayers, in the form of Social Security disability, Medicare and Medicaid. Some plans state it explicitly: The plan for Russell Stover Candies said its benefits are secondary to all other sources of benefits. Home Depot requires its employees to “take whatever benefits are available,” including enrolling in Social Security disability…

“Sometimes I have to make a choice,” he said, sitting uncomfortably on his worn sofa. “Do I buy my pain meds or whatever other medicine that I need or do I buy groceries?” …

Many companies have further limited the risk by requiring employees to sign arbitration agreements. Instead of going before a jury, workers’ disputes are handled confidentially, out of court, before an arbitrator, typically a former judge or defense lawyer. A 2010 survey of large employers with opt-out plans by a Stanford law professor found that 85 percent used arbitration agreements…

But there’s one big difference. Benefits under opt-out plans are subject to income and payroll taxes; under workers’ comp, they’re not. As a result, 80 percent of the plans actually provide lower benefits, ProPublica and NPR’s analysis found…

Under comments:

abinico • 7 hours ago
During the dark ages people unable to work starved to death – looks like the dark ages are coming back.

Found in my search terms: Wisconsin pharmacies refusing prescription

margaret of Lake Geneva, WI on May 4, 2015

To my extreme dissatisfaction my Insurance chose Wal-Mart as our prescription provider. I cannot say enough about how unprofessional, unbusinesslike and uncaring Wal-Mart pharmacies are. Yesterday was the last straw! Today I filed a formal complaint with BCBS against WM pharmacies. I suffered a severe fall in 2013 that caused a whiplash and damage to my cervical spine. I have been on and off pain meds ever since. Each time I need to fill a prescription I call WM pharmacy a week in advance. They have failed 85% of the time to even order my medication. Seriously, I fill it every 2 weeks and it is not cheap!

Even though I call a week ahead of time, when I go in to fill my prescription, they do not have the medication in stock! I called a week ahead and again the night before you had to fill prescription. And this is medication you can’t just stop taking because you become severely ill and thanks to wal mart, I have become severely ill, once even requiring hospitalization. But yesterday, after calling twice in advance to make sure they had medication, I went in to have it filled, and for the 28th time, even though they told me they would order it, and told me they had it the night before, when I went in to drop it off, after waiting an hour, I found out, again, they lied to me and did not order the medication!

We missed our grandson’s First Communion because we had to drive 24 miles to another WM to fill prescription. This is an ongoing problem that we never ever had with Walgreens! WM has lost prescriptions, miscounted pills and failed to order medication that I have had to fill biweekly and once monthly for over 2 years. On several occasions, my husband has been forced to take a $250 vacation day to drive over an hour each way to find a WM that has my medication, a widely prescribed pain medicine. But yesterday was the END! I will not tolerate the totally inept service I have been putting up with at the WalMart pharmacies.

I spent an hour on the phone with my insurance company only to learn that I am one of hundreds to file a complaint. And I have spoken to the pharmacists, store managers, pharmacy managers and they just don’t care! What if it was heart medication and I was 75 years old and could not drive an hour each time I had to fill a prescription? I will tell you what would happen, I would have a heart attack and WM would not care. Seriously, this has been happening for 2 years. Well no more WM, because I am taking my business to Target and have already successfully met with them and they are taking my medication needs seriously and WILL order my medication so I don’t have to put up with this anymore! I seriously am considering contacting my attorney!

S of Milwaukee, WI on April 13, 2014

For years we have been using this pharmacy. Very good until lately. 1. Puts my Hubby’s label on my prescription and charge my insurance. 2. I’m calling to check on a refill from doctor, needing approval. Walgreen’s tells me Dr refused and wants to see me. I called Dr. NOT CASE AT ALL! Dr. gave me 2 refills. 3 Steadily filling my prescription at 6 days. Charged my insurance but refuses to give to me! I’m filling to early or stockpiling to possibly sell!! I can understand if these were Oxycodone to contin, but they are not. A 5 mg. Hydrocodone. Gimme a break. Have no history of abuse and for him to suggest I’m stockpiling is ludicrous. I am in constant contact with my Dr. Will be changing pharmacies.

To help fight addiction, state Rep. John Nygren, R-Marinette, has proposed a series of bills to help monitor what addictive medications patients are picking up at area pharmacies and being prescribed to ensure they are not fraudulently getting medications.

Nygren has proposed having doctors check patients’ histories in the Wisconsin Prescription Drug Monitoring Program before prescribing Schedule II-V medication, which are prescription drugs that can become addictive and be abused.

However, in part, the Affordable Care Act, known to many as Obamacare, is actually standing in the way of making these bills successful. That is because a portion of hospitals’ Medicare reimbursement is based on patient satisfaction survey scores. One of the questions on the survey pertains directly to pain management and hospitals are scored based on the “percentage of patients who reported that their pain was ‘Always’ well controlled,” according to the government’s official Medicare website…

When you cannot get adequate treatment for pain at a hospital, fight back — fill out these patient satisfaction surveys.

Do you take Plavix?

U.S. District Judge Freda Wolfson partially dismissed claims from Elisa Dickson, a former Sanofi-Aventis sales rep, who alleged that the company told her to falsely promote Plavix to docs. Dickson said she was instructed to promote the drug as better than aspirin for stroke patients, for example, even though trial data showed the drug was not effective for that population. And Sanofi allegedly told Dickson to focus her Plavix sales calls on docs whose patients were mainly covered by Medicare or Medicaid, The New Jersey Law Journal reports…

Wolfson also rejected Dickson’s claims that Plavix was only put on lists of approved drugs for each state’s Medicaid program based on misleading information…

The positive ruling deals a shot of good news to the companies, which have encountered other pushback over Plavix marketing. In 2013, the Department of Justice (DoJ) said it would probe disclosures to the FDA about the med’s effectiveness in certain patients. And two U.S. state attorneys general have alleged in other suits that Bristol-Myers and Sanofi knew–or should have known–since 2003 that some patients don’t get Plavix’s full benefits.

How in the world can anyone justify the use of a drug that increases your risk of death, and costs 33 to 200 times more than the most common alternative, and to top it all off, call it prevention? It’s really amazing how Bristol-Meyers has managed to pull the wool over everyone’s eyes on this one. Even if you take Plavix alone, without aspirin, you’re still likely wasting huge amounts of money, and, as the new evidence suggests, taking a higher health risk than you would with low-dose aspirin…

In 2000, one of the best articles I’ve ever read documenting the tragedy of the traditional medical paradigm was published in the Journal of the American Medical Association (JAMA). The author was Dr. Barbara Starfield of the Johns Hopkins School of Hygiene and Public Health. Based on her article, I created a headline that has reverberated through the web ever since: Doctors Are The Third Leading Cause of Death in the US. Dr. Starfield’s research documented how a staggering 225,000 Americans die from iatrogenic causes, i.e. their death is caused by a physician’s activity, manner, or therapy…

Common Side Effects of Plavix:

Head or joint pain
Skin redness
Taste problems

Serious Side Effects of Plavix:

Stop taking Plavix and contact your doctor if you experience any of the following side effects:

Bloody or tarry stools
Blood in your urine
Coughing up blood
Vomiting that looks like coffee grounds
Crushing heavy chest pain that spreads to arm, shoulder, or jaw
Sudden numbness or weakness, especially on one side of your body
Sudden headache
Vision, speech, or balance problems
Pale skin or yellowing of the skin or eyes
Purple or red pinpoint spots under your skin
Unusual bleeding in the mouth, vagina, or rectum

Get emergency help if you exhibit the following signs of an allergic reaction to Plavix:

Difficulty breathing
Swelling of the face, lips, tongue, or throat

The Real Cost of Tennessee’s New Pain Management Laws

My first shock was when I discovered that it was illegal for a pharmacy in Tennessee to fill a prescription for pain medication which had been written in another state. I mailed them back to my pharmacy in Colorado who filled it for me without question, and then mailed them to me. This gave me thirty days to find a doctor here.

Both of the first two pain management clinics, that I got appointments with, closed after raids by the DEA. The third clinic I tried, refused to write me the medications that I had been on. They wanted to switch me to the extended release form, which runs about 10 times what the instant release tablets cost. I explained that I was on Medicare, which allows me about 2900$ to spend on drugs yearly. What they wanted me to take would have used my benifit in less than three months. I explained, and was told that my financial problems wern’t their problem. They told me to go check into drug rehab. How, exactly, is that going to treat my pain? For that, Medicare paid for a new patient intake, and I paid a 45$ copay. What a total waste of time and money…

I finally found a clinic which writes the medications that I need. They do not accept any type of insurance. I pay them 250$ cash each month. I have been going there for three years now. I am drug tested every month, and I have to pay 50$ a month for it. That is my food budget for two weeks which is just gone. I would love to find a clinic that takes my Medicare. If I go to another pain clinic, even if all I do is check them out, I can be dismissed from my current clinic. I can’t risk that.

If I were to lose my clinic for any reason, they would blackball me in TN, making it almost impossible to find treatment elsewhere…

I used to be allowed to fill three months of all my scripts. That saved me a significant amount of money. The pain clinics in Chattanooga require that you see the doctor once a month. For a long term pain management client like me, that is not needed. I have been on my same regime for over 5 years now. It is the law in Tenneessee. It is designed to bilk me of my money, and give it to someone who already has plenty of cash…

My clinic has cameras and listening devices everywhere. I am certain that the DEA can listen and watch us by taping into that feed. They routinely stand by the entrance and take photos of people going in. They claim that they are searching for fugitives. I don’t believe their lame story. My picture has been taken a few times. I always ask politely if they would like to have my address, so they can send me a copy.

My Medicare Advantage plan took medications that were once Teir 1 and raised them to Teir 3 and 4. My cost went from 8$ per script to 45$ per scrip. That increase alone would feed us for a week…

I have had to muddle through being stopped, and searched, without my consent, by a policeman at a routine traffic stop. I was the passenger. When he asked me for ID, I told him that he has no probable cause to ask me anything. That pissed him off. He searched the car, then he searched us. Then he searched my handbag and found my prescriptions. He accused me of being a drug dealer. I was taken in, for questioning. The first words out of my mouth were, “I wish to assert my legal right to have my lawyer, please.” I used my one phone call to call our lawyer. He had me released within 10 minutes.

I am fed up with being treated like a junkie because I need pain medication to function. Do you know that untreated pain kills? It kills the inner organs. They fail in a sort of cascade. Once the process begins, it can’t be stopped. An ER doctor told me that bit of information…

AMA Releases Analyses on Potential Anthem-Cigna and Aetna-Humana Mergers

“A lack of competition in health insurer markets is not in the best interests of patients or physicians,” said AMA President Steven J. Stack, M.D. “If a health insurer merger is likely to erode competition, employers and patients may be charged higher than competitive premiums, and physicians may be pressured to accept unfair terms that undermine their role as patient advocates and their ability to provide high-quality care. Given these factors, AMA is urging federal and state regulators to carefully review the proposed mergers and use enforcement tools to preserve competition.” …

I’m enrolled with a First Health Part D plan, and I just got a letter informing me that First Health is part of the Aetna family, saying it purchased First Health in 2013. This reminds me of when my bank was taken over by another one and I really had no choice in the matter but to accept it. Did I sign up with First Health or Aetna? At this point, does it really matter?

There have been a lot of these kinds of changes in health care since the ACA passed, and it’s likely to continue for years to come. Insurance companies are looking at the data that’s been compiled so far and are seeking to buy up any companies making money in this new marketplace. But there’s really not enough data to make informed decisions at this point, so basically it’s just a rush to accumulate as much power as possible in this industry.

Too bad the AMA doesn’t feel the same way about the DEA that it feels about these mergers.

Closed Formularies

The recent success of the closed pharmacy formulary in the Texas workers’ comp system has caught the attention of practitioners in other states. A new report from the Workers Compensation Research Institute concludes that, all things being equal, other states could see similar results. Texas was the first multi-payor state to adopt a formulary that requires pre-authorization for certain medications deemed as investigational, experimental, and those with “N” drug status under the Official Disability Guidelines, including many opioids…

UNM Project ECHO bites the dust

Just six weeks after New Mexico announced that the overdose death rate had unexpectedly climbed, the state received a federal grant to target opioid overdoses with big data, better monitoring and more education. The New Mexico Department of Health said it received an $850,000-a-year grant for the next four years to enhance prescription drug overdose prevention. If renewed each year, the grant would provide $3.4 million for five more staffers working on overdose prevention initiatives.

“This funding allows the New Mexico Department of Health to develop new partnerships with the Board of Pharmacy and the Workers Compensation Administration. It will increase our capacity to reach communities with a high overdose burden,” Health Secretary Retta Ward said in a statement.

After two years of decline, the number of people in New Mexico who died from a drug overdose in 2014 hit 536, a jump of 20 percent over 2013. Officials say 265 of those deaths were the result of prescription opioids. The statewide rate of 26.4 overdose deaths per 100,000 population stands at one of the worst in the United States, along with West Virginia and Kentucky.

A major focus of the grant will be to better coordinate a Board of Pharmacy registry that is to be used by medical professionals who prescribe pain medication — an online tool called the Prescription Monitoring Program. The information is meant to help monitor patients who misuse pain prescriptions by shopping for several different providers around the state to write scripts.

But because there are seven medical occupations that can prescribe — from medical doctors to dentists — there are inconsistencies in how the database is used, as each reports to a different regulatory board where enforcement varies.

“Sometimes people get introduced to opioids in different ways. They’ll get injured and go see a medical provider and they’ll prescribe opioids. In cases, that person can then get addicted and overdose can result,” said Dr. Michael Landen, an epidemiologist with the state Health Department. “This whole pathway starts with that initial prescription and ensuring that prescription is appropriate is important.”

The grant will not only allow the state to capture more data from prescription writers, but also to deploy caseworkers into areas where they see “prescription hot spots” for drugs such as oxycodone, fentanyl, methadone, hydrocodone and buprenorphine.

“We’ll be able to use the data to work with individual doctor’s offices to improve prescribing in those offices,” Landen said.

Between 2001 and 2011, for instance, oxycodone sales in the state tripled, according to the Health Department.

Another emphasis for how the money is used will be to coordinate education efforts with the state Workers Compensation Administration, which has data on prescriptions for workers who were injured on the job — such as those with back ailments from heavy machine work or long-distance driving.

Landen said Washington state had success reducing overdoses in this population, which might come from a background where they haven’t seen addiction and don’t recognize it.

“We’d be able to analyze the data and make decisions on how to improve prescribing through their program,” he said.

Which means they will be seeking out any doctors prescribing over the maximum morphine-equivalent level and “educating” them about reducing dosages (and abandoning patients).

Some states, for instance, have looked at a “lock in” requirement, in which workers filling pain prescriptions have to use one medical provider and one pharmacy to better monitor usage.

Now only used in Medicaid, but soon coming to Medicare.

New Mexico is one of 16 states that successfully competed for the four-year grant from the U.S. Centers for Disease Control and Prevention. The grant is from a new program called Prescription Drug Overdose: Prevention for States that helps states address the ongoing prescription drug overdose epidemic.

How did the state successfully complete the grant if the programs didn’t work?

The Health Department also will collaborate with the Human Services Department to increase public awareness of potential harm from prescription opioid medications.

Landen said the grant also will pay for an evaluator who can assess the state’s effort on overdose prevention and determine what approach is working.

For a state with a medical cannabis program that’s about 8 years old, it’s surprising that overdoses keep rising. Other states’ programs have reduced overdose deaths by about 25%, yet not here in New Mexico. Perhaps it’s not surprising after all, considering the sad condition of New Mexico’s medical cannabis program.  Without a program that provides adequate access for all, there are few public benefits to be had.

And New Mexico is one of the poorest states in the country, so poverty plays a big role in overdose deaths and suicides.

Targeting opioids doesn’t seem like a very thorough plan. It leaves out so many drugs that contribute to overdoses, like alcohol, anti-anxiety drugs, muscle relaxers, and anti-depressants. And it leaves out one of the most important issues of all:  suicide.  (Way to honor National Suicide Day, Department of Health.) And what’s the deal with the Department of Health working with the Worker’s Compensation Administration? Easy to pick on the disabled, right?

Ironically, in January of this year, the University of New Mexico was announcing it might have found the “holy grail” of stopping opiate abuse (mostly centered around education):

New Mexico’s Project ECHO is all about reducing opioid usage in chronic pain patients, and last I heard, is working with the Veteran’s Administration. UNM calls it a program for pain patients — I call it a program to treat addiction. The fact that the program doesn’t work just confirms my opinion that addiction in the chronic pain population is not the huge problem it’s made out to be. If you can’t find and don’t treat enough chronic pain patients that suffer from drug addiction, the program won’t work.

Ironic that the federal government is spending so much more money on programs that aren’t working, but I would say that most of the funding is really for the PDMPs, the blacklist for pain patients. And PDMPs are popular with the DEA, insurance industry, government agencies, and now the medical industry.

It’s also ironic that in October, 2013, Dr. Katzman authored a study about the epidemic of chronic pain. From someone who’s recognized the problem, all the way to today with Project ECHO, this doctor has taken a mighty long fall in a really short time. Here are my posts about the director of the program, Dr. Katzman:

Inside the mysterious world of Propofol, the drug that killed Michael Jackson

He said, “It’s finished. We’ve done it. You’re awake now.” Five minutes had passed in oblivion. Where had I gone, and how did propofol get me there? What does it do in the brain?

“Nobody knows,” says Auckland anaesthesiologist Dr Michael Kluger. “There’s lots of theories why anaesthetics work, but we don’t know. Which is kind of weird, because it’s what we do as a profession, and yet nobody can tell for sure.” …

Propofol is really only accessible to anaesthesiologists and surgical staff. That’s just the problem.

“When an anaesthetist decides to commit suicide, they do it very well,” says Dr Rob Fry. They choose propofol. They have the access, and they know exactly how it works. Fry is a member of the Welfare of Anaesthetists Special Interest Group, and has conducted surveys of substance abuse among anaesthetists in New Zealand and Australia. The most recent findings were published this year. Propofol was identified as the most commonly abused substance – higher than opiates or alcohol. The most chilling statistic records, “Death was the eventual outcome in eight cases of substance abuse (18 per cent), with three identified as suicide and five as overdose. All eight deaths involved propofol.” …

Studies in the US show a high percentage of users have suffered childhood trauma. They’re often unable to sleep, and they want to block out the world. A doctor at an addiction treatment centre in Virginia told an anaesthesiology journal, “I don’t know of any other drug where the perceived incidence of trauma, particularly of sexual trauma [in abusers], is so high. It’s really quite remarkable.” They want to forget. They want the milk of amnesia…

But the rising tide of propofol use could be about to ebb. Beginning Jan. 1, 2015, Medicare is changing how it pays anesthesia professionals for colonoscopy care…

An investigation revealed Rubenzer had been given a deadly dose of propofol…

Together, Rep. Sinicki and the Ayer family are introducing legislation called the “Julie Ayer Rubenzer Bill.” It would allow patients to request a camera in the operating room. That camera would record the entire surgical setting as surgery is performed…

A College of Dental Surgeons in British Columbia hearing is underway into allegations of unprofessional conduct involving a Kamloops dentist, after a teenage patient suffered irreversible brain damage. The college is investigating allegations Dr.Bob Rishiraj used propofol for deep sedation without proper training…

The latest fentanyl death is Nathan Orlofsky, a 28-year-old doctor and anesthesiology resident at the Medical College of Wisconsin, who was found dead Feb. 11 in the bathroom of the apartment he and wife shared in Milwaukee’s Third Ward.

Orlofsky’s death has been ruled an accident by the medical examiner. Investigators found hospital-grade items near Orlofsky’s body, including needles, tourniquets and two empty vials of hydromorphine.

However, the medical examiner’s test results released this week didn’t show morphine in Orlofsky. Rather, they show he died of a mix of fentanyl and another drug, midazolam, which is used to make patients sleepy before surgery…

Orlofsky’s death reveals how illicit use of the drug cuts across social and economic classes and also highlights the problem of drug abuse among anesthesiologists…

Two studies, one in 1993 and another 15 years later, found a high rate of drug use by anesthesiology residents compared with other specialties. Over 10 years, 80% of U.S. anesthesiology residency programs reported encountering impaired residents and 19% reported at least one pretreatment death.

“The drug of choice for anesthesiologists entering treatment was an opioid, with fentanyl and sufentanil topping the list,” the 2008 study said…

Is the crusade against pill mills turning into a witch hunt?

I care for a 65-year-old woman suffering from sarcoidosis affecting her lungs, her skin, her bones, her nerves, her blood chemistries, her kidneys, her colon and her mind. She has gone from an active spouse, mother, grandmother, tearing up the dance floors with her husband, to a home recluse calling friends to drive her to medical and care appointments while ambulating with assistance of another strong individual supported by a 4 wheel walker with a seat. She describes her foot pain as feet burning on fire…

When the Mayo Clinic suggested a biopsy on the normal colon and the pathology revealed a new entity responsible for all her symptoms she was reclassified from a neurotic, annoying wife of a professional to “an interesting and rare case” by many in the medical community. Throughout her trials and tribulations, she has sought the care of board certified gastroenterologists, nephrologists, urologists, rheumatologists, psychiatrists, psychologists, ophthalmologists, dermatologists, general internists and a neurologist specializing in pain management…

Our unfortunate chronic patient had her pain controlled by a board certified neurologist who through trial and error found a formulary that the patient tolerated. During the months of experimentation, the patient suffered through nausea, vomiting, constipation, diarrhea and dehydration. Trips to the ER for anti-nausea medications or IV hydration were frequent and common. When her neurologist found a mix that worked he stuck with it. That patient’s pain doctor moved out of Florida 3 years ago because he was afraid that the implementation of the Florida pain law would limit his patients’ access to needed medications and make his prescribing subject to inappropriate review and scrutiny. He is currently working at a university medical center in North Carolina providing patient care and teaching medical students and doctors in training.

As the patient’s primary care physician, I became the narcotic prescriber for the patient in her neurologist’s absence. The patient executed a pain contract with our office that she has followed religiously while she continued her care with her multiple specialty doctors. We tried several other neurologists and pain physicians but the high volume impersonal nature of medicine today left her unhappy and dissatisfied with the care and attention provided.

When the patient turned 65 years old and went on Medicare, she purchased a Medicare Part D prescription drug plan that directed her to a large chain pharmacy. They told her they would not prescribe her narcotics because they did not want the liability and did not like the combination of medications ordered by her board-certified pain specialist. That company had been fined for illegally selling pills without prescriptions to drug dealers out of their Samford, Florida distribution site.

The alternative pharmacy — a popular supermarket chain — was audited by state regulators. The auditors were upset with the pharmacy releasing a controlled substance in the quantity given especially along with her antianxiety and anti-migraine headache medicines on this patient’s medication list. They had no patient records or history to explain why she was receiving these scripts, but nonetheless so intimidated the pharmacy that they called the patient and told her they would no longer be able to sell her the prescribed pain medicines. The patient called my office in tears wondering where to obtain her medications and frightened about the prospects of abruptly stopping these medications. The pharmacy simply said the liability and fear of losing their license necessitated the change in policy.

I am a board-certified physician in internal medicine, with extra study in geriatrics who has practiced in this community for 36 years. I list on my medical license application every two years that I will prescribe pain medications for legitimate chronic conditions. I take my required continuing education courses especially in the areas of prescription pain medication to meet the state requirements. My patients who receive chronic pain medications must execute a pain medicine contract that outlines their responsibilities as well as mine. I do not take lightly the prescribing of a controlled substance, but recognize that sometimes there are medical conditions that leave you with no other options.

I have been told that after the state regulators look at the pharmacy’s role in prescribing short-term narcotics for long-term use, they will be contacting the Florida Board of Medicine to review my prescribing of these medications for this patient…

How Identity Theft Sticks You with Hospital Bills

Fueling medical identity theft is the surge in electronic medical records and data breaches at insurers and health-care providers. Medical identity theft-in which someone fraudulently uses data to bill for medical services-affected 2.3 million adult patients in 2014 versus 1.4 million in 2009, according to a survey published in February by the Ponemon Institute LLC, a research concern.

Such identity theft has led about 40 companies, including Blue Cross Blue Shield Association and Aetna Inc., to form the Medical Identity Fraud Alliance. Some hospitals have turned to biometric screening to confirm patient identities…

“Data breaches are increasing and becoming more common,” says Dr. Shantanu Agrawal, director of the Center for Program Integrity at the Centers for Medicare and Medicaid Services. “You can end up with diagnoses being placed in your file without your knowledge.” …

Unlike in financial identity theft, health identity-theft victims can remain on the hook for payment because there is no health-care equivalent of the Fair Credit Reporting Act, which limits consumers’ monetary losses if someone uses their credit information…

Thieves use many ways to acquire numbers for Social Security, private insurance, Medicare and Medicaid. Some are stolen in data breaches and sold on the black market. Such data are especially valuable, sometimes selling for about $50 compared with $6 or $7 for a credit-card number, law-enforcement officials estimate. A big reason is that medical-identification information can’t be quickly canceled like credit cards…

Hospitals are setting up special investigative units to catch medical identity fraud. BayCare Health System, which has hospitals in Florida, is one of hundreds of hospitals that give patients the option to register by scanning veins in the palm. The image is converted into a number that correlates with the patient’s medical record, according to its website…

Some victims say the problems from medical identity theft haunted them for years.

Anndorie Cromar, now a 36-year-old medical-lab supervisor in Salt Lake City, says Utah’s child-protective services called her in 2006 to say her newborn had tested positive for methamphetamine at Alta View Hospital in Sandy, Utah.

Ms. Cromar hadn’t given birth then. Someone had stolen her identification, gone into labor, delivered a baby girl and left the infant at the hospital. The case grabbed headlines at the time, but few knew the ordeal took years to straighten out.

She says she was never able to fully settle the hospital bill the thief had racked up and eventually charged it off when she filed for bankruptcy for unrelated reasons. For months, she continued to get appointment reminders for the baby. She wasn’t able to view her own full medical records because they now contained the thief’s health information. She says she also had to go to court to get her name taken off the baby’s birth certificate.

An Alta View spokesman declines to comment, saying the hospital didn’t have an updated privacy form signed by Ms. Cromar. The Utah Division of Child and Family Services declines to comment.

“To this day, I don’t know if my name is in the baby’s medical record,” Ms. Cromar says. “It’s insidious.”

Medicare prescription drug premiums projected to remain stable

However, growth in per-Medicare enrollee spending continues to be historically low, averaging 1.3 percent over the last five years. The recent 2015 Medicare Trustees report projected that the Medicare Trust Fund will remain solvent until 2030, thirteen years longer than they projected in 2009, prior to passage of the Affordable Care Act (ACA).

Seniors and people with disabilities are continuing to see savings on out of pocket drug costs as the ACA closes the Part D donut hole over time. Since the enactment of the ACA, more than 9.4 million seniors and people with disabilities have saved over $15 billion on prescription drugs, an average of $1,598 per beneficiary.

For the past five years – for plan years 2011-2015 – the average Medicare Part D monthly premium for a basic plan has been between $30 and $32. Today’s projection for the average premium for 2016 is based on bids submitted by drug and health plans for basic drug coverage for the 2016 benefit year and calculated by the independent CMS Office of the Actuary.

The upcoming annual open enrollment period – which begins October 15 and ends December 7 – allows people with Medicare to choose health and drug plans next year by comparing their current coverage and plan quality ratings to other plan offerings….

What a pain.  What a hassle.  I love choices, but I hate having to compare medical insurance benefits.  Makes my brain hurt.  But, if I want to save money, I’m going to have to make my brain hurt.

I was just thinking about how close fall is now that we’re in the month of August… looking at some photos of winter this morning (featured photo taken 3/1/2015). There’s beautiful light in the winter time.  (Plus Halloween and Easter candy!)  I can’ wait.  But I wasn’t thinking about what that time of year means for medical insurance renewals…

However, summer isn’t over yet. 🙂

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(Photo taken 7/22/2015.)

New York doctors just say no to medical marijuana

New York’s medical-marijuana program is slated to be up and running by January 2016. But while companies have been scrambling to show they meet the state’s criteria to grow and dispense marijuana, little has been done to give doctors the tools they need to register patients to get them the drug. Even more worrisome, many doctors say they wouldn’t recommend marijuana to their patients…, which offers a state-by-state directory of doctors willing to recommend cannabis, has one physician practice listed in New York: A.F. Medical and Rehabilitation of Flatbush. But doctors must take a state-mandated training course before they register medical-marijuana patients. That course doesn’t exist yet. For now, the doctors at the clinic will only offer consultations…

The lack of support from physicians could have major implications for patient access. In some states, patients can go to a doctor for a diagnosis and walk away with a cannabis card. But in New York, a doctor can’t recommend a patient be registered as a medical-marijuana user unless the physician is actually treating the patient for an eligible condition under the New York law…

Many physicians surveyed by said they wouldn’t recommend cannabis, not because they didn’t believe in it, but because they were concerned about the drug’s Schedule I status, Mr. Nicolazzo said.

That designation puts it on the same level as heroin and LSD, as far as the federal government is concerned. Some doctors believe that recommending marijuana might endanger the federal compensation they receive for treating Medicaid and Medicare patients. Others said their malpractice insurance wouldn’t cover claims related to cannabis…

Alcohol for chronic pain?

Patients with chronic widespread pain (CWP) who consume moderate amounts of alcohol have lower levels of disability, according to a large new population-based study from the United Kingdom…

A smaller U.S. study previously showed that in patients with fibromyalgia, moderate alcohol consumption was associated with reduced symptom severity and increased quality of life. However, the current study also linked alcohol consumption with the likelihood of reporting CWP. The new study was published in Arthritis Care & Research…

Authors of the previous study discussed possible mechanisms linking alcohol consumption with reduced disability. One is that ethanol enhances GABA release in the brain…

Well, this is great news.  Alcohol is a fairly cheap drug.  I should learn how to like the taste of alcohol — think pina colada.

I wonder, though, what is the risk of abuse and addiction with alcohol?  The risk of toxic levels of ethanol, overdose, and death? The risk of suicide? Brittle bone disease and Alzheimer’s? How many of these patients drank too much and then got behind the wheel of a car? Were involved with domestic violence?

How many of these pain patients also suffered from depression and, by drinking alcohol, increased their depressive symptoms?  How many suffered from new symptoms of depression? How many patients mixed prescription drugs with alcohol?

Doctors advocating for alcohol to treat chronic pain?  Okay, now I’ve seen it all.  There’s no doubt that alcohol is used for self-medication, especially by poor people, but usually they aren’t just suffering from chronic pain.  Many times, alcohol use comes with some type of mental illness, like addiction or anxiety, whether it’s mild or severe. Is alcohol the best treatment for anxiety?  Maybe it’s better than Xanax?

I’m not against the use of alcohol, or any drug that helps treat a medical condition.  But patients should be informed of all their choices, and the risks that come with each.  Why would a pain patient choose a drink over Vicodin or bud?  Lack of access and cost, but also, people’s brains are wired differently.  Some people are sensitive or allergic to opioids, just like alcohol.

I really wish I could treat my pain with alcohol.  It would make things a lot easier.  But I don’t think Medicare or Social Security would be okay with me using alcohol to treat chronic pain, even if I wanted to.

In the old days, lots of people used alcohol to treat pain.  Then, new drugs were developed, synthesized, and created by Big Pharma, and they didn’t come with the stigma of alcohol. But which products are better to treat pain?  We’d have to break that question down into the best drugs to treat the different kinds of pain, and whether the drugs would be used over a short or long period of time.  Which drugs cause the least short- and long-term damage?

If you break your foot and use a drink or two to dull the pain instead of taking a Vicodin, I don’t see anything wrong with that.  If you eat a pot brownie to do the same, there’s nothing wrong with that either.  Some people will pop a couple of aspirin for a broken bone and that will work just fine.  Some people will be able to sleep through the worst of the pain episodes.  (Lucky folks.)

The reality is that people use multiple drugs, both legal and illegal, to dull their pain — because many times, one drug is just not strong enough.  It’s always a battle between the level of pain and the strength of treatments (and resulting side effects).  When the pain increases, will one more drink help?  One more pill, one more hit?

How do you effectively treat pain that is constant?  If you can figure that out, you’ll be rich. 🙂

The Minority Report for health care

Using Watson, IBM and CVS aim to predict when your health is about to decline

IBM’s Watson is used in healthcare, financial services, retail and education. Earlier this year, the company launched its Watson Health business unit offering cloud-based access to Watson for use on healthcare data.

1. Movie: Minority Report (2002)

It should be noted that Minority Report’s amazingly prescient predictions weren’t just random guesses about what the future may look like. Director Steven Spielberg told Roger Ebert that like Stanley Kubrick did for 2001: A Space Odyssey, he “consulted with industrial designers, futurists, advertising people, to try to visualize what the future world would look like.”