Indiana pharmacies ‘overwhelmed, overworked, understaffed’

One university professor said pharmacy techs aren’t applying for the jobs.

https://www.wthr.com/article/news/local/amid-staffing-shortages-workers-in-indiana-pharmacies-stretched-thin-employment-jobs-pay/531-b7df2e0f-4ae6-445f-90ae-8af594eaf31c

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CDC Tracked Millions of Phones to See If Americans Followed COVID Lockdown Orders

https://www.vice.com/en/article/m7vymn/cdc-tracked-phones-location-data-curfews

Newly released documents showed the CDC planned to use phone location data to monitor schools and churches, and wanted to use the data for many non-COVID-19 purposes, too.

The Centers for Disease Control and Prevention (CDC) bought access to location data harvested from tens of millions of phones in the United States to perform analysis of compliance with curfews, track patterns of people visiting K-12 schools, and specifically monitor the effectiveness of policy in the Navajo Nation, according to CDC documents obtained by Motherboard. The documents also show that although the CDC used COVID-19 as a reason to buy access to the data more quickly, it intended to use it for more-general CDC purposes.

Location data is information on a device’s location sourced from the phone, which can then show where a person lives, works, and where they went. The sort of data the CDC bought was aggregated—meaning it was designed to follow trends that emerge from the movements of groups of people—but researchers have repeatedly raised concerns with how location data can be deanonymized and used to track specific people.

The documents reveal the expansive plan the CDC had last year to use location data from a highly controversial data broker. SafeGraph, the company the CDC paid $420,000 for access to one year of data, includes Peter Thiel and the former head of Saudi intelligence among its investors. Google banned the company from the Play Store in June. 

Do you work in the location data industry? We’d love to hear from you. Using a non-work phone or computer, you can contact Joseph Cox securely on Signal on +44 20 8133 5190, Wickr on josephcox, OTR chat on jfcox@jabber.ccc.de, or email joseph.cox@vice.com.

The CDC used the data for monitoring curfews, with the documents saying that SafeGraph’s data “has been critical for ongoing response efforts, such as hourly monitoring of activity in curfew zones or detailed counts of visits to participating pharmacies for vaccine monitoring.” The documents date from 2021.

Zach Edwards, a cybersecurity researcher who closely follows the data marketplace, told Motherboard in an online chat after reviewing the documents: “The CDC seems to have purposefully created an open-ended list of use cases, which included monitoring curfews, neighbor-to-neighbor visits, visits to churches, schools and pharmacies, and also a variety of analysis with this data specifically focused on ‘violence.’” (The document doesn’t stop at churches; it mentions “places of worship.”)

Motherboard obtained the documents through a Freedom of Information Act (FOIA) request with the CDC.

The documents contain a long list of what the CDC describes as 21 different “potential CDC use cases for data.” They include: 

• “Track patterns of those visiting K-12 schools by the school and compare to 2019; compare with epi metrics [Environmental Performance Index] if possible.” 
• “Examination of the correlation of mobility patterns data and rise in COVID-19 cases […] Movement restrictions (Border closures, inter-regional and nigh curfews) to show compliance.”
• “Examination of the effectiveness of public policy on [the] Navajo Nation.”

At the start of the pandemic, cellphone location data was seen as a potentially useful tool. Multiple media organizations, including the New York Times, used location data provided by companies in the industry to show where people were traveling to once lockdowns started to lift, or highlight that poorer communities were unable to shelter in place as much as richer ones.

The COVID-19 pandemic as a whole has been a flashpoint in a broader culture war, with conservatives and anti-vaccine groups protesting government mask and vaccine mandates. They’ve also expressed a specific paranoia that vaccine passports would be used as a tracking or surveillance tool, framing vaccine refusal as a civil liberties issue. Robert F. Kennedy Jr.’s Children’s Health Defense, one of the more influential and monied anti-vaccine groups in the U.S., has promoted fears that digital vaccine certificates could be used to surveil citizens. QAnon promoter Dustin Nemos wrote on Telegram in December that vaccine passports are “a Trojan horse being used to create a completely new type of controlled and surveilled society in which the freedom we enjoy today will be a distant memory.” 

Against that inflamed backdrop, the use of cellphone location data for such a wide variety of tracking measures, even if effective for becoming better informed on the pandemic’s spread or for informing policy, is likely to be controversial. It’s also likely to give anti-vaccine groups a real-world data point on which to pin their darkest warnings.

A screenshot of the use cases proposed by the CDC. Image: Motherboard.

The procurement documents say that “This is an URGENT COVID-19 PR [procurement request],” and asks for the purchase to be expedited.

But some of the use cases are not explicitly linked to the COVID-19 pandemic. One reads “Research points of interest for physical activity and chronic disease prevention such as visits to parks, gyms, or weight management businesses.”

Another section of the document elaborates on the location data’s use for non-COVID-19–related programs.

“CDC also plans to use mobility data and services acquired through this acquisition to support non-COVID-19 programmatic areas and public health priorities across the agency, including but not limited to travel to parks and green spaces, physical activity and mode of travel, and population migration before, during, and after natural disasters,” it reads. “The mobility data obtained under this contract will be available for CDC agency-wide use and will support numerous CDC priorities.”

The CDC did not respond to multiple emails requesting comment on which use cases it deployed SafeGraph data for.

SafeGraph is part of the ballooning location industry, and SafeGraph has previously shared datasets containing 18 million cellphones from the United States. The documents say this acquisition is for data that is geographically representative, “i.e., derived from at least 20 million active cellphone users per day across the United States.”

Generally, companies in this industry ask, or pay, app developers to include location data gathering code in their apps. The location data then funnels up to companies that may resell the raw location data outright or package it into products. 

Tech

Google Bans Location Data Firm Funded by Former Saudi Intelligence Head

Joseph Cox

08.12.21

SafeGraph sells both. On the developed product side, SafeGraph has several different products. “Places” concerns points of interest (POIs) such as where particular stores or buildings are located. “Patterns” is based on mobile phone location data that can show for how long people visit a location, and “Where they came from” and “Where else they go,” according to SafeGraph’s website. More recently SafeGraph has started offering aggregated transaction data, showing how much consumers typically spend at specific locations, under the “Spend” product. SafeGraph sells its products to a wide range of industries, such as real estate, insurance, and advertising. These products include aggregated data on movements and spends, rather than the location of specific devices. Motherboard previously bought a set of SafeGraph location data for $200. The data was aggregated, meaning it was not supposed to pinpoint the movements of specific devices and hence people, but at the time, Edwards said, “In my opinion the SafeGraph data is way beyond any safe thresholds [around anonymity].” Edwards pointed to a search result in SafeGraph’s data portal that displayed data related to a specific doctor’s office, showing how finely tuned the company’s data can be. Theoretically, an attacker could use that data to then attempt to unmask the specific users, something which researchers have repeatedly demonstrated is possible.

In January 2019, the Illinois Department of Transportation bought such data from SafeGraph that related to over 5 million phones, activist organization the Electronic Frontier Foundation (EFF) previously found.

The CDC documents show that the agency bought access to SafeGraph’s “U.S. Core Place Data,” “Weekly Patterns Data,” and “Neighborhood Patterns Data. That last product includes information such as home dwelling time, and is aggregated by state and census block. 

“SafeGraph offers visitor data at the Census Block Group level that allows for extremely accurate insights related to age, gender, race, citizenship status, income, and more,” one of the CDC documents reads.

Tech

How the U.S. Military Buys Location Data from Ordinary Apps

Joseph Cox

11.16.20

Both SafeGraph and the CDC have previously touched on their partnership, but not in the detail that is revealed in the documents. The CDC published a study in September 2020 which looked at whether people around the country were following stay-at-home orders, which appeared to use SafeGraph data. 

SafeGraph wrote in a blog post in April 2020 that “To play our part in the fight against the COVID-19 health crisis—and its devastating impact on the global economy—we decided to expand our program further, making our foot traffic data free for nonprofit organizations and government agencies at the local, state, and federal level.” Multiple location data companies touted their data as a potential mitigation to the pandemic during its peak in the United States, and provided data to government and media organizations.

A year later, the CDC purchased access to the data because SafeGraph no longer wanted to provide it for free, according to the documents. The Data Use Agreement for the in-kind provided data was set to expire on March 31, 2021, the documents add. The data was still important to access as the U.S. opened up, the CDC argued in the documents.

“CDC has interest in continued access to this mobility data as the country opens back up. This data is used by several teams/groups in the response and have been resulting in deeper insights into the pandemic as it pertains to human behavior,” one section reads.

Researchers at the EFF separately obtained documents concerning the CDC’s purchase of similar location data products from a company called Cubeiq as well as the SafeGraph documents. The EFF shared those documents with Motherboard. They showed that the CDC also asked to speed up the purchase of Cubeiq’s data because of COVID-19, and intended to use it for non-COVID-19 purposes. The documents also listed the same potential use-cases for Cubeiq’s data as in the SafeGraph documents.

Google banned SafeGraph from its Google Play Store in June. This meant that any app developers using SafeGraph’s code had to remove it from their apps, or face having their app removed from the store. It is not entirely clear how effective this ban has been: SafeGraph has previously said it obtains location data via Veraset, a spin-off company which interfaces with the app developers.

SafeGraph did not respond to multiple requests for comment.

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Do No Harm fights for individual patients – and against identity politics.

https://donoharmmedicine.org/

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Early Alzheimer’s Test Gets FDA Nod

First in vitro diagnostic to detect amyloid in early disease setting

https://www.medpagetoday.com/neurology/alzheimersdisease/98558

The first in vitro diagnostic tool to help detect early Alzheimer’s disease was authorized by the FDA on Wednesday.

The assay measures the ratio of beta-amyloid 1-42 to beta-amyloid 1-40 in cerebrospinal fluid (CSF). The Lumipulse G ß-Amyloid Ratio (1-42/1-40) test is intended to be used in adults 55 and older presenting with cognitive impairment who are being evaluated for Alzheimer’s disease or other causes of cognitive decline.

Test results are consistent with amyloid PET scan results, the agency noted.

“The availability of an in vitro diagnostic test that can potentially eliminate the need for time-consuming and expensive PET scans is great news for individuals and families concerned with the possibility of an Alzheimer’s disease diagnosis,” said Jeff Shuren, MD, JD, director of the FDA’s Center for Devices and Radiological Health, in a statement.

“With the Lumipulse test, there is a new option that can typically be completed the same day and can give doctors the same information regarding brain amyloid status, without the radiation risk, to help determine if a patient’s cognitive impairment is due to Alzheimer’s disease,” Shuren added.

The FDA evaluated the safety and effectiveness of the Lumipulse test in a clinical study of 292 CSF samples from the Alzheimer’s Disease Neuroimaging Initiative (ADNI) cohort, which were compared with amyloid PET scan results.

Overall, 97% of ADNI participants with positive Lumipulse results had the presence of amyloid plaques on PET, and 84% of individuals with negative Lumipulse results had a negative amyloid scan, the agency said.

Risks associated with the test include the possibility of false positive or false negative results. “Importantly, the Lumipulse G β-amyloid Ratio (1-42/1-40) is not a stand-alone test and other clinical evaluations or additional tests should be used for determining treatment options,” the FDA pointed out.

There’s an unmet need for a reliable, safe test to identify patients with amyloid plaques consistent with Alzheimer’s disease, the agency added. Amyloid plaques can occur in other diseases but being able to detect their presence, along with other evaluations, can help clinicians determine the probable cause of a patient’s symptoms.

Much research in recent years has focused on blood as a new matrix for Alzheimer’s biomarkers that already have been validated in CSF. A blood test for amyloid-beta has been widely available in the U.S. since 2020 under a CMS certification process for laboratories that tests patient samples, but is not yet FDA-approved.

FDA permitted marketing of the Lumipulse G ß-Amyloid Ratio (1-42/1-40) test to Fujirebio Diagnostics. The agency reviewed the assay through its de novo premarket review pathway. This action creates a new regulatory classification, which means that subsequent devices of the same type with the same intended use can obtain marketing authorization by demonstrating substantial equivalence to a predicate device.

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Insurance companies are telling pharmacies if we have a product (regardless of expiration date) in stock for more than 30 days (which is extremely common) they can audit us and take back every dollar we submit for a prescription claim… The drug bottles we buy from wholesalers most commonly COME in 100 to 500 count bottle sizes. If I have ONE patient on a drug getting 30 pills a month, the 100 count bottle is considered a 3.3 month supply. Meaning the pharmacy can buy the drug with an expiration date of year 3000 (irrelevant) and JUST because the stock bottle has to sit on the shelf until the patient comes back next month means we lose 100% of the funds paid by the insurance company… lol I MEAN DO WHAT!? this is unbelievable. These insurance companies are owned by the big chain pharmacies.. who are our direct competitors… how is this NOT a monopoly, an abuse of power and criminal? This is why healthcare is so broken. They’re literally robbing us of our ability to BUY and INVENTORY drugs for our patients. HOW MESSED UP IS THIS!? #boycottCVS break up the PBMs. #PBMReform y’all, if your copays are high for generics, text or DM me, there’s a strong chance we can fill it for cash, without insurance for less than what these corrupt companies are forcing you to pay. — feeling fed up.

The top/biggest five PBM’s are own by insurance companies and or companies who have retail pharmacies AND mail order pharmacies. These PBM’s control about 80% of the Rx filled.  I have heard rumors over the years… that Pharmas or wholesalers that have excess inventory that will expire in six months or less… they will offer the major mail order pharmacies some or all of their excess inventory at a “fire sale price”.  I can assure you that these mail order firms have enough data on how much of a particular med/strength they sell on a average week and if they are offered some “close to expiration date” at a fire sale price… any smart business person would catch that “deal” and purchase enough so that they can expect to dispense those meds and out the door before the date they expire.

Most likely, only 20%-30% of a pharmacy’s inventory will be able to be “turned over in 30 days”.  This may force Pharma or wholesalers to start offering meds in 30 tab/cap units. Most pharmacies are able to purchase meds from a wholesaler.. 5 days a week and Monday – Thursday the meds ordered before the wholesaler’s cut off time – typically around 5PM-6PM… the pharmacy will get their order the next day. This may make pts order their refills a couple of days ahead, because the pharmacy has stopped stocking “slow mover meds”

The more the states attempt to put some controls over the PBM’s … the more monopolist practices they “dream up”.  As Congress talks more and more about reducing prescription prices… and the PBM industry conservatively causes Rx prices to be at least 40% higher than they would be without a PBM industry as a MIDDLEMAN.   >50% of independent pharmacies are in towns with < 20,000 populations, so the most pts that are going to be harmed by end up living in a pharmacy desert and could be forced into using the PBM’s mail order pharmacies.

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CDC & DOJ: A Forbidden Love Affair

http://https://www.daily-remedy.com/cdc-doj-a-forbidden-love-affair/

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Why A VP Kamala Harris Could Be A Disaster For Marijuana Policy       “Kamala Is A Cop. No matter how excited Democratic voters may be about having the first woman of color on a presidential ticket, and no matter how liberal her Senate voting record may be, there is no escaping the fact that Senator Kamala Harris built her political career on her record as a prosecutor. In that position she oversaw the arrest and prosecution of thousands of people, mostly young people of color, for marijuana and other drug offenses. “

Here we have an ATTORNEY, who is not upset that the first time in history … someone within the SCOTUS staff “leaked to the media” information concerning a decision being considered  by the court.  If the SCOTUS decides to overturn Roe vs Wade… abortion decisions will be back in the hands of the states’ legislators.

So now, VP Harris, is now part of the chorus “my body, my decision”… but isn’t she part of the administration that has mandated COVID-19 shots and when/where we are forced to wear masks.

I have seen other articles where VP Harris fully supports treatment for addicts.

Apparently our VP, selectively supports “my body, my decision”.. I suspect that many other members of Congress are aligned with her mindset.. since abt 40% of Congress are ATTORNEYS.  They all are part of our judicial system…which encompasses the DEA.

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The Real “Death Panels”: Oregon Medicaid planned to cut off opioids to chronic pain patients

https://tarbell.org/2019/03/gambling-with-lives-oregon-medicaid-cutting-off-opioids-to-chronic-pain-patients/

At the height of the Tea Party and Republican campaign against the Affordable Care Act, the GOP raised a false alarm about “death panels” that would purportedly kill the disabled based on a subjective judgment and “pull the plug on Grandma.”

But to real grandmothers like 60-year-old Wendy Morgan, who has suffered excruciating back and neck pain in the wake of two botched surgeries, degenerative disc disease and severe pain from MS for decades, there’s now a genuine death panel:  the Oregon Health Authority’s pain and evidence committees. They were slated on March 14 in Salem to finalize mandated opioid cut-offs to zero for Medicaid patients with chronic back and neck pain conditions, plus fibromyalgia. 

“This is going to come as quite a shock to a lot of people,” Wendy said before the vote. She had made preliminary plans with her husband to kill herself last spring after her opioid dosages were already cut 97 percent under pressure from government  agencies. “I never did anything wrong, always followed the doctor’s orders, but I was treated like a drug addict.” She managed to function as a homemaker even after she was forced to quit her sales job in 2009 and go on disability, but after her primary care doctor dropped her for using high doses of opioids and her pain specialist started a drastic taper in 2016, “I felt like killing myself,” she said. She went weeks without sleep, remained housebound, unable to even shower without agony and sunk into a deep depression. “It was an absolute nightmare,” she says.

Her husband, Larry Gordon, a retired postal worker, briefly but angrily testified on her behalf at a hearing in January before OHA’s Health Evidence Review Committee (HERC), as his wife of over 40 years sat quietly next to him.

If the plans are eventually voted in, the agency will target overwhelmingly disabled patients with 170 separate medical conditions that cause spine and neck pain for a total forced cut-off to zero opioids; these draconian limits  go far beyond even the CDC’s 2016 recommended voluntary 90 Morphine Milligram Equivalent (MME) upper limits for new — not long-term — pain patients. These voluntary guidelines have been “weaponized” in drastic cut-offs nationwide and spurred a wave of suicides by chronic pain patients.

Larry, dressed in a blue ball cap, windbreaker and blue jeans, proclaimed, “Doctors are abandoning patients left and right. Look at what’s happening in the real world: there’s people dying. If you take opioids away from intractable pain patients, they only thing they have left is to go straight to suicide. I had to tell my children that their mom’s going to kill herself because no one else will help her.”

Larry and his family have been petitioning local stakeholders, including the Oregon Medical Board and local newspapers, in order to bring attention to chronic pain patients’ access to painkillers. Click Here To Read The Gordon Family’s Full Story In Letters

Fortunately, Wendy recently found through a network of pain patients a Portland clinician willing to quietly resume her high dosages of methadone and occasional oxycodone pills, amounting to a quite rare medication level of 1100 MME. It’s not clear how long this arrangement will last, but for now, she says, “This nurse practitioner saved my life.” Her pain is worse than before because the years of forced tapering worsened her MS, but at least she can visit her grandchildren, go to their recitals and ball games, take a shower. “I can live a normal life.” 

Now that the Oregon panel has tabled the vote, she can breathe a sigh of relief if her other supply of medication fails — for now. 

That option was about to be closed off to a significant portion of patients –variously estimated between 60,000 and 80,000 chronic pain patients — who are part of the 25 percent of  all Oregonians who are on Medicaid. This latest delayed Oregon action flies in the face of mounting alarms by three former White House drug czars and over 300 leading health professionals and academics who warned in an open letter to CDC and Congress about the dangerous, unintended consequences of the  harsh crackdown on opioids for legitimate pain patients, as chronicled recently in The New York Times. These professional critiques have been joined by over 120 pages of anguished testimony from patients across the country about the agonizing impact of the resulting  hard-line approaches in their lives.

True, rigorous evidence that such policies are driving up suicides rates is relatively scarce, even though there are horrifying examples of patients like Jay Lawrence in Tennessee shooting himself on a park bench with his wife holding his hand. However, an important study published in 2017 in the peer-reviewed journal General Hospital Psychiatry found that veterans cut off from opioids after long-term use engaged in suicidal actions and thoughts at a rate nearly 300 percent higher than the overall veterans community, whose members are already killing themselves at a rate of 20 people a day. 

Oregon’s proposed but now tabled actions are even more extreme than the CDC guidelines spurring such tragedies, says the organizer of that open letter, Dr. Stefan Kertesz, a noted addiction researcher and primary care doctor specializing in vulnerable populations at the University of Alabama at Birmingham. “They’re gambling with the lives of a subset of patients,” he says. “There’s something cruel in going after patients with these conditions: it’s completely untested and there’s no evidence that you can swap in yoga and cognitive therapy across the state for opioids.” (Note: Like Kertesz, most, but not all, of the hundreds of clinicians across the country protesting the national and Oregon opioid cut-offs actually don’t have a history of sleazy ties to the drug industry.)

Look, for instance, at the dangers facing people like Sierra Brown, a former nurse who once had private insurance but is now a disabled Medicare-Medicaid patient who was denied pain medication for her damaged spine resulting from previously undiagnosed lupus and Sjorgen’s auto-immune disease . She fears she will continue to be treated like a drug-seeking addict if the influential Medicaid policies are eventually voted in. (She and others point out that Medicaid’s prescribing standards also influence private insurers.) Yet she has been given a reprieve of sorts: after showing up vomiting in agony at an ER last month, she was diagnosed with pancreatic cancer, but only after the admitting doctor first told her, “If you’re here for pain medications, we’re not giving you any.” Now, she is viewed as a near-angelic victim of cancer, and was generously provided with all pain medications she needed to be taken every few hours, from Dilaudid to Tramodol. “Pain-wise, I’m fine,” she says, relatively speaking. “Their attitude totally flipped. It’s totally disgusting.” But once she achieves her hoped-for remission  because they spotted her cancer early, “I’m scared I won’t be getting any pain medicines because of the law’s crackdown.”

In Oregon, making the case for keeping opioids away from patients like Sierra when they don’t have cancer, is the alternative medicine community. Some of them don’t seem to be much more immune from conflicts of interest than drug company shills, critics say. In fact, the ad-hoc Chronic Pain Task Force, an advisory subcommittee that’s helping drive Oregon’s move to shut off opioids for pain patients, is dominated by holistic practitioners with a financial stake in ending opioids by hyping a smorgasbord of alternative therapies that have weak or limited evidence that they work for any chronic pain patients at all  — let alone with that minority of long-term chronic patients who use opioids.

Indeed, OHA commissioned the nationally respected Oregon Health and Sciences University (OHSU) to do a review of the skimpy evidence on the efficacy of tapering and alternative therapies. In its rush to back alternative therapies as an “evidence-based” replacement for the removed opioids, the Medicaid agency brushed aside the OHSU findings that  \concluded the studies’ quality were variously “very low” for tapering, and “limited” or “insufficient” for the alternative therapies.  Even the agency’s own summary of the available  evidence branded all of the holistic therapies, some with potentially major  new funding streams, as having “no clinically significant impact” on long-term pain. Instead, the agency seems to be relying in part on a 12-year-old survey of the personal opinions of an earlier OHA advisory panel that found these alternative medicine  treatments as somehow having “fair” to “good” evidence for “moderate benefit.” In addition, Kertesz asks about the OHA’s dismissive approach to the new OHSU review it commissioned: “Why are they ignoring their own report that says there’s no evidence that a mandatory taper has been properly assessed, and certainly hasn’t been proven to be safe and effective?”

As of this writing, the OHA press office didn’t reply to repeated emailed and phoned requests for comment or rebuttal to the criticisms aimed at the now-tabled opioid proposal.

Oregon-style forced taperings continue unabated, with doctors across the country reacting to mounting pressure from agencies including state licensing boards and the DEA to slash their opioid prescribing — and then kicking out their chronic pain patients who have become known as pain or opioid “refugees.” Human Rights Watch recently issued a stinging report condemning such actions: “Many patients are involuntarily cut off medications that improve their lives or say they are unable to find a doctor willing to care for them.” Yet Oregon is the only state — so far — that tried to move so decisively to adopt these potentially deadly practices as official state policies. One possible factor, argues University of Southern Illinois rehab specialist, Terri Lewis: The financially-strapped Oregon Medicaid system is moving under a Medicaid waiver to reduce spending and limit care for disabled chronic pain patients who merit palliative care but aren’t actually getting it. 

This proposed punishing crackdown doesn’t stem primarily from what patients often see as sheer sadism on the part of officials. Instead, it’s driven apparently both by a desire to save money and  a well-meaning yet misguided, simplistic and wrong-headed response to the alarming rise of opioid-related drug overdoses, largely from illegally manufactured fentanyl — not legally prescribed pills. It’s an oft-told story:  how Big Pharma companies and their crooked distributors ramped up an oversupply of opioid pills starting in the late 1990s, but much of the flooding of the marketplace was clearly fraudulent and intended to hook a new generation of substance abusers who already had addiction histories. Why else flood one West Virginia town of 9,200 people with nearly 21 million pills?  Yet while prescriptions have fallen nationally nearly 20 percent since 2012, overdose deaths haven’t been stemmed at all, rising to as high as 70,000 deaths in 2017, more than AIDS, guns and car crashes killed people in any one year. Yet as few as 15 percent of opioid deaths today are due to prescription drugs, often stolen — even as 75 percent of  new heroin users started by using  “diverted” opioid pills they weren’t prescribed. Kertesz has pointed out that today’s prescription drug dosage limits are  a “funhouse mirror image” of the drug industry’s earlier propaganda to lower the “pain score” of patients and give out way more pills: it is still a focus on a number, not on the actual well-being of  patients.

Meanwhile, Oregon’s chronic pain patients remain political orphans whose plight is largely ignored by people across the political spectrum. They are scrambling on their own in blog posts, on Twitter and Facebook to try to get other people — or even their own factionalized pain community —  to fight back against the steamrolling impact of the Oregon Medicaid rules that will surely flatten them if the tabled rules come up for another vote.  Amara is a disabled Medicaid patient and co-founder of the Oregon Pain Action Group. She is suffering from a host of severe disc injuries following a botched epidural during childbirth and lives in intractable pain.  She told Tarbell, speaking anonymously for fear of retaliation, “It’s catastrophic and things are already so bad.”

She and others have been given a reprieve, but the specter of this cutoff still looms in the future if Oregon decides to go ahead with their plans in a future date. Pain patients know that their quality of life — if not their lives — are hostage to a delayed state vote. Tarbell will keep monitoring this proposed vote to see if it returns. 

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Report: Medicare Advantage Plans Wrongly Deny Care, Physician Payments

Feds found 18% of physician payment requests that were turned down met Medicare rules

https://www.medpagetoday.com/special-reports/exclusives/98458

Medicare Advantage plans often denied medically necessary care to beneficiaries and payments to doctors that met Medicare coverage rules, according to a new report from the HHS Office of the Inspector General (OIG).

OIG found that 13% of prior authorization requests that were denied met Medicare coverage rules, as did 18% of physician payment requests that were turned down.

The type of care denied typically involved advanced imaging services, such as MRIs, and stays in post-acute care facilities, the report stated.

The report added that plans denied these services and requests by using clinical criteria that are not contained in Medicare coverage rules, by requesting unnecessary documentation, and via genuine error.

“Although [Medicare Advantage Organizations (MAOs)] approve the vast majority of requests for services and payment, they issue millions of denials each year and CMS’s annual audits of MAOs have highlighted widespread and persistent problems related to inappropriate denials of services and payments,” the report stated.

Concern about those denials is growing as Medicare Advantage is increasingly responsible for more Medicare beneficiaries. In 2021, 42% of all Medicare beneficiaries were enrolled in a Medicare Advantage plan, and that is projected to rise to about 51% by 2030, according to the report.

“As enrollment in Medicare Advantage continues to grow, MAOs play an increasingly critical role in ensuring that Medicare beneficiaries have access to medically necessary covered services and that providers are reimbursed appropriately,” the report stated.

In a statement, American Medical Association President Gerald E. Harmon, MD, said the findings “mirror physician experiences.”

“Surveys of physicians have consistently found that excessive authorization controls required by health insurers are persistently responsible for serious harm when necessary medical care is delayed, denied, or disrupted,” he said.

Harmon added that “more needs to be done to reform prior authorization” and noted that the bipartisan Improving Seniors’ Timely Access to Care Act would help rein in excessive and unnecessary prior authorization requirements by requiring Medicare Advantage plans to “streamline and standardize prior authorization processes and improve the transparency of requirements.”

Because Medicare Advantage is a capitated payment model where companies are paid a fixed amount per beneficiary, there’s a potential incentive for insurers to deny access to services and payment in an attempt to increase profits, the report stated.

For their report, OIG investigators used a random sample of 430 denials from the 1-week period of June 1-7, 2019, to estimate the rate at which 15 of the largest MAOs denied prior authorization and payment requests that met Medicare coverage rules. The sample accounted for nearly 80% of beneficiaries enrolled in Medicare Advantage as of June 2019.

Commonly used methods for denying care included using clinical criteria that aren’t in Medicare coverage rules, such as requiring an x-ray before approving more advanced imaging, the report stated. Plans also asked for unnecessary documentation — for instance, they indicated that some prior authorization requests did not have enough documentation to support approval, yet reviewers found that beneficiary medical records in the case file were sufficient to support medical necessity.

The report found that most physician payment denials were caused by human error during the manual claims processing reviews (such as overlooking a document) or system processing errors.

Investigators discovered that plans reversed some of the denied care and payment requests that met Medicare coverage rules, typically when a beneficiary or provider appealed or disputed the denial, though in some cases plans identified their own errors. It’s not clear, however, how frequently such appeals are filed, or how often plans discover their errors.

The report concluded with three recommendations for CMS: 1) issue new guidance on appropriate use of MAO clinical criteria in medical necessity reviews; 2) update audit protocols to address issues such as MAO use of clinical criteria; and 3) direct MAOs to take steps to identify and address vulnerabilities that can lead to both manual review and system errors.

In a statement to MedPage Today, a CMS spokesperson said the agency agrees with all of the recommendations and is “actively reviewing the findings to determine appropriate next steps.”

The agency conducts audits of Medicare Advantage plans and can target those audits to “areas of concern, such as service types with a high rate of denial.” CMS will notify plans of non-compliance, and plans must submit corrective action plans, the spokesperson said. Plans that have “repeated violations are subject to increasing penalties … and even contract terminations.”

Plans are required to cover all Medicare Part A and Part B services, but they can “apply internal coverage policies, including additional coverage requirements to better define the need for the service, that are no more restrictive than Traditional Medicare’s national and local coverage policies to ensure that plan-covered items and services are medically necessary and appropriately targeted to the individual’s condition and diagnostic needs,” the spokesperson added.

The spokesperson continued that plans can also “apply third-party guidelines, such as guidelines used by contractors engaged by the Medicare Advantage plan to make coverage determinations” for services that aren’t subject to existing local and national coverage requirements.

Medicare Advantage Prgm are health insurance provided by FOR PROFIT INSURANCE COMPANIES – emphasis on PROFIT… the FEDS gives them Medicare Advantage programs a certain $$$/month/pt and they give the prgm a list of benefits that they can provide.  They can provide as many or as few as they believe that they can do and still show a profit.   This article suggests that all insurance companies are pretty much the same, indicate that they are going to cover and pay for a particular service/product and then try to decline to pay.

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Chronic pain pts are often advised never to ask the practitioner for a particular medication or strength  for fear that they will be viewed as a “drug seeker”.  When a pt goes to a doc’s office – regardless if it is a PCP or some specialist…  If the pt’s labs are outside of normal ranges, the prescriber should automatically have a “goal” to prescribe some sort of therapy to enable the pt to get their labs back into what is considered a “normal range”

Maybe it should be suggested to chronic pain pts to their pain doc… what on the 1-10 pain scale is his/her goal for you.  After all you are seeing a PAIN SPECIALIST… does this specialist believe that he/she is comfortable with their pts having to LIVE or EXIST in a pain level > 5 most all of the time ?   Some believe that level of pain is – or should be considered – a torturous level of pain.

Opiates are one very few meds that doesn’t have a relative predictable LD50 – LD50 is a dose when given to a number of pts, 50% will die. One of the first thing that the body becomes tolerate to when a pt takes a opiate every day – and that is respiratory suppression.

This explains why opiate naive people that take some illegal fentanyl, they DIE FROM RESPIRATORY SUPPRESSION.

I would suspect that any pt asking a pain doc what level of pain was his/her goal for the pt and gets a very vague or gets something like…  we will have to see how things progress… would strongly suggest that the pt’s therapy and pain management outcomes will be more dependent on the pt’s opiate doses reach some MME/day limit that the physician believes is a hard daily limit.

If the prescriber has not done any testing for opiate metabolism rates using the CYP-450 opiate metabolism test or the PGx (pharmacogenomics) test… both of these tests are simple cheek swab or “spit in a tube” test.  If the pt is given the choice, I would chose the latter, it is a much more comprehensive test and will give the prescriber much more information about the pt’s metabolism.

If the prescriber has reached his/her daily MME limit and the pt’s pain intensity is still >5, then the pt has to either accept living in a torturous level of pain or if the practitioner has not ran one of the DNA metabolism tests – the pt might want to ask as to why not ?  ask the practitioner if they had the DNA test run, and the pt was shown to be a fast/ultra fast metabolizer… would the prescriber even increase the pt’s dose ?   If the answer is NO… then the pt has to decide if they wish to continue to live in a torturous level of pain or have the DNA test run themselves and if it demonstrates that they are a fast/ultra fast metabolizer.  Attempt to find a practitioner that will take those DNA test in consideration when determining how much opiates they would be willing to prescriber for you.

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