FORMER U.S. ATTORNEY GENERAL JEFFERSON BEAUREGARD SESSION

PART-2: DR. CHRISTOPHER RUSSO, MD: ON MEDICINE VS. THE DECEPTION OF LAW “TAKING THEM TO THE DEEP END OF THE MEDICAL POOL WHERE SCIENCE AND FACTS WERE ON THE STAND”

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How Beneficiaries Really Feel About Medicare Advantage vs Traditional Medicare

MA plans offer “extra benefits” but many go unused. Is Medicare Advantage really better?

https://www.medpagetoday.com/special-reports/features/108846

Survey results released today contradict widely-held beliefs that Medicare Advantage enrollees are more satisfied because they receive better health services than those in traditional Medicare.

On the contrary, respondents in the two types of Medicare plans reported equal satisfaction, although more Medicare Advantage (MA) enrollees than traditional Medicare (TM) beneficiaries said their care was delayed because of the need for prior approval. This trend sheds light on potential considerations for those exploring Medicare Advantage plans 2024.

The reportopens in a new tab or window by The Commonwealth Fund analyzed responses from 3,280 Medicare beneficiaries between November 6, 2023, and January 4 in an effort to learn “What Do Medicare Beneficiaries Value About their Coverage?” Those surveyed gave their opinions on the ease of their access to benefits, care coordination, services, and satisfaction.

“Overall, the experiences seem to be similar for those in traditional Medicare versus Medicare Advantage, with some notable exceptions,” Gretchen Jacobson, PhD, vice president of Commonwealth’s Medicare program, told MedPage Today.

The comparison of beneficiary experiences in each model is important because roughly half, or 52% of 66 million eligible people, are now enrolled in MA plans, to which federal funds pay billions more than for TM care. In 2024, for example, MA plans are expected to receive $88 billionopens in a new tab or window more than what would have been spent if the same people were in TM.

Although there are efforts underway to contain that spending through new payment policiesopens in a new tab or window, MA enrollment is projected to continue rapid growth. So it’s important that taxpayers understand what they’re getting for all that extra money.

A perhaps surprising finding of the survey was MA enrollees’ relatively low use of their “extra benefits,” such as vision, hearing, and dental care, considering that plans aggressively market these benefits to encourage signups. Jacobson noted that Medicare pays the plans $1,915 a year per enrollee for these benefits, according to the 2023 annual reportopens in a new tab or window from the Medicare trust funds’ trustees. These extras are not covered under TM.

For example, 31% of MA enrollees hadn’t used any of their benefits in the last 12 months, 58% hadn’t used dental benefits, 59% hadn’t used vision benefits, 93% hadn’t used hearing benefits, 81% hadn’t used the gym membership, and 54% hadn’t used their over-the-counter medication allowance. Other benefits such as meal delivery and an allowance for groceries may be less frequently offered by the plans, but 98% and 88%, respectively, said they hadn’t used them.

“Because this is an important component of what Medicare Advantage plans are offering, we need to understand better why they aren’t using them, and whether these are the benefits people really want,” she said.

For those who hadn’t used any benefits, 63% of respondents said they didn’t need them, 24% said they didn’t know what benefits the plans offered, 9% said the benefits were hard to use, and 4% said the costs were too high.

Some underlying reasons for the low rates of use, not specified in the report, could be because of restrictions. Perhaps the networks or setting one would have to use — for example, a group of dentists — excludes one who has long served the family. But it also might be because enrollees don’t know about them or forgot about them, despite the ubiquitous advertisingopens in a new tab or window that prominently pitches them.

A CMS proposed ruleopens in a new tab or window would, if finalized, require MA plans to send mid-year notices to enrollees about any unused benefits, to “ensure MA plans are better stewards of the rebate dollars directed towards these benefits,” the proposed rule says.

A big selling point for MA plans is that their providers cooperate within carefully picked integrated networks and coordinate care far better than providers who treat TM beneficiaries.

But here, the survey responses revealed another contradiction. Regardless of whether they had an MA or a TM plan, about an equal number of respondents said they coordinate their healthcare services themselves: 75% in MA and 73% in TM.

Some 7% of people on MA said their plan helps to coordinate their care, Jacobson said. “It seems as though the plans are certainly not the primary care coordinator for most Medicare Advantage enrollees.”

Jacobson acknowledged that MA plan providers might be coordinating their patients’ care in ways enrollees aren’t aware. “But from the beneficiaries’ perspective, they don’t see their plan having a large role in coordinating care.”

Another counterintuitive finding is that a similar percentage of MA and TM respondents said they waited more than one month to see a doctor (36% and 34%), perhaps suggesting that MA enrollees do not get faster access for appointments. “Access to providers seems to be similar, which is counter to some thoughts around the limitations around provider networks,” Jacobson said.

Of the MA plan respondents, 22% said their care was delayed because it required approval, compared with 13% of TM beneficiaries. Far fewer services under TM require pre-approval compared with MA, so it was unclear why so many TM beneficiaries encountered obstacles.

Another surprise was that a larger share of people in MA said they had problems affording care compared with people in TM, “which is contrary to how we typically think of Medicare Advantage,” Jacobson said. “It doesn’t appear that Medicare Advantage plans are necessarily making care more affordable for people.”

Similar percentages of the two beneficiary groups also said their benefits do not cover what they needed, that they were unsure of what benefits they had, that costs were too high, and that they need transportation to access benefits.

Jacobson noted that if Medicare pays more per capita to MA plans than for TM care, it results in higher Part B premiums to all beneficiaries, regardless of what type of plan they’re in. Most frequently, the premium is paid through an amount withheld from their social security retirement benefit checks.

Another finding of note evaluated health risk assessments both types of Medicare patients received in the last year. Of those who received them, few said it caused their doctor to change their care or led to more services or benefits. Only 6% of both MA and TM beneficiaries said their doctor changed their care plan as a result.

“This really calls into question the value that these assessments are providing to beneficiaries and what frequency it’s important to have them,” Jacobson said.

Asked if the survey responses may raise questions about whether MA plans are worth their extra cost, Jacobson replied: “What our survey shows is that the experiences people report seem to be similar overall for those in Medicare Advantage versus traditional Medicare.”

That, she said, makes it “worth assessing the relative value of care and benefits people in Medicare Advantage and traditional Medicare are receiving relative to the amount spent by the federal government. This is worth keeping an eye on as enrollment in Medicare Advantage grows.”

Because it’s well known that Medicare recipients are frequently confused over what kind of coverage they have, the plan type was verified through Zoom calls in which respondents showed their plan card.

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CHIEF JUSTICE JOHN ROBERTS….OH MY…

COPS PRACTICING MEDICINE: THE PARALLEL HISTORIES OF DRUG WAR 1 AND DRUG WAR ll (EXCERPTS)

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The probe concluded that the White House Medical Unit’s pharmacy operations had “severe and systemic problems” without oversight, and dispensed prescription medications to ineligible White House staff.”

WHITE HOUSE MEDICAL UNIT’S MASS ORDER OF FENTANYL RAISES QUESTIONS: “NOW, WHERE WAS THE DEA…IN THIS US. CODE 842(a)(1), U.S.C. /829, SECTION 1306.04(a) VIOLATION PROHIBITION OVER-PRESCRIBING AND DRUG TRAFFICKING PUNISHABLE 20 YRS PRISON??”

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THE TERMINATOR

U.S. LEGISLATORS LETTER OF INQUIRY AND REVIEW DEMANDING AG MERRICK GARLAND HALT ALL PREDICTIVE POLICING INVESTIGATIONS UNDERMINES AND DEMONSTRATES DR. TIM KING’S COURT TESTIMONY AND DEA ANN MILGRAM’S MONEYBALLING ARE FRAUDULENT

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JUSTICE POTTER STEWART, 1975 US vs. Moore
““…And is it not true that historically, most, if not all, of the great breakthroughs and advances in medical science have been made by people who did not follow the conventional way of doing things? They followed a new way, their way, and most of the conventional physicians of their day would have disagreed with them because this is not the way it has always been done. And if that is the new — it bothers me that this kind of evidence can send a person to prison for as long as this has been going, some many, many years, but in any event, that that is the sort of evidence that is the basis for criminal liability…”

PHYSICIAN DEFENSE ATTY RONALD CHAPMAN

ATTY. RONALD CHAPMAN SPEAKS: AUDIO HISTORY OF NARCOTIC LAWS AND PROSECUTIONS, TRIAL OF DR. KENDALL HANSEN MD., “THE LESSONS MISSING THAT GIVES RISE TO THE FLAWED CREDIBILITY OF BOTH ERIC DETER AND DR. TIMOTHY KING, MD.”

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Bob and I became friends after someone convinced me to join the APDF’s BOD, some 4-5 yrs ago. Bob has very good intentions. Like many other chronic painers who are also advocates, many practitioners have built-in biases about taking advice about pain management from someone who does not have a medical background.  Often they are viewed as supporting prescribing a controlled substance and/or advocating against some of the medications that are prescribed off-label for pain. While Bob’s batting average is not a 1000 on advocating for chronic pain pts, no one’s is. Because of Bob, there is a large number of end-stage pediatric cancer pts who had a less painful last few days/weeks/months of their life and parents who did not have to see their kids live in agony the last days/weeks/months and they had many “extra days” with their kid.

https://m.facebook.com/story.php?story_fbid=pfbid02FctV3nSsuPBKtFcKxEtAB4iCjmDcVAEMc6GaNfuR8StgA9hHLT7azdUeC7mDYGe9l&id=100000102313523&mibextid=Nif5oz

Everyone always talks quietly about so here it is

Several years ago several great advocates helped me at my lowest point in life! I had a medtronics pain pump before they were popular out of pure pure desperation! A man named Steve Ariens & a other wonderful lady named Maria Higginbotham didn’t judge me … Didn’t tell me what a POS I was and offered to help me! I watched Maria on nightline with Lester Holt and Kate Snow and was in awe of this brave lady dumping her surgical parts on the table infront of the world on live TV.. I spent my and my family’s life saving on lawyers and courts! I won and lost the case 5 times! I was sentenced to 109 weeks in county jail for driving with a pain pump even know Medtronics admitted pump recalls and failures! I did 12 weeks and the appeals court redid my sentence to 0 jail time and the supreme court of KY ruled “NO Tolerance!” The local judge took pity on me and didn’t make me serve the rest of the time on my sentences! The pump was replaced and they made me go to 1 year of alcohol classes even know I didn’t drink and I didn’t take oral medications at the time and frustration was not the word I’d use! Everytime I was booked in the county jail Friday I was released on Sunday at 6pm ! Hints the 50 mugshots ! I never really talked about it before except with family and friends. All the charges have been expunged and my license has been restored and my insurance is again affordable! Life changing to say the least and I’ve never felt so damn alone! I had doctors and a great pharmacist in my corner with a really expensive lawyer ! So when it was all said and done I brushed myself off and opened the pumpsters on Yahoo with other advocates to help others that needed help! Later the pain pump support group Medtronics and Flowonix. Later burned my hand cooking catfish and met a little girl named Kaylee at the 11th floor @ Vanderbilt burn Center in Nashville who was severely burned who changed my life! Her daddy sprayed charcoal starter fluid on the burn pile and lite them both up.. Dad was having a few beers on his mower and they both caught fire and dad was arrested! Mom was by herself while they were stripping skin to get burn medication on her burn. The child was screaming and I through a damn fit! Sheesh I burnt my hand and it hurt like a summabitch and I couldn’t imagine the burn on my chest and thighs like little Kaylee ! My mom and daughter had to sit in the car because no one was allowed in Vanderbilt because of covid! Anyways long story short my fit turned into a passion to help kids in pain and I figured I owed a little because of the advocates that helped me! Her dad was sentenced to 2 years in prison and the lawyer we paid at APDF paid off the house with the money that was awarded to the momma for settlement for not treating Kaylee while treating her for burns! So never the less I’m far from a Saint ! Not even a little bit! Matter of fact I’m a good friend to many but kind of an asshole as well ! I started out being ashamed and embarrassed and many advocates stepped up for me! So no I didn’t start the program it kinda started me and my advocacy! Today I deal with blood cancer and back surgeries, knees, shoulder, and have wonderful advocates that I call my family and would do anything for! I don’t condone drunk anything and even advocated for several inmates as yall who followed me can see !What I do know is not everyone who gets in trouble isnt a bad guy! I do know that today’s pain world makes us all a little criminal and it’s definitely because of the goverments actions and real advocates & Doctors know exactly what I mean! Although I didn’t deserve the sentence I received I took it as a learning process and I’ve never hid it from anyone who asked and even asked a big advocate for help who posted my mug shot all over the internet ! I take responsibility for everything in my life failures and big wins! They say things happen for a reason and what happened to me lead to alot of damn people getting the help that they need.. I don’t always win and can’t help everyone but I have always done my best! That’s my story and I’m sticking to it Anyways I have heard alot of rumors and I sometimes wish they weren’t true but most are! Today I’m proud of my past and what I plan for the future! The only apologies I owed was to my family for not listening when they said I was acting funny on new pump medication while my pump was starting and stopping at its convenience! It has never bothered me until recently when I hear folks say stuff like don’t trust that guy because he’s a jail bird & those kids are probably made up ! I rather them thank Steve Ariens or Maria Higginbotham for getting me pissed off enough to do something about it! I’m sure most don’t know my story or really know me at all! I’m just a farm owner from Cerritos, California Via KY with 4 kids 35b 32g 16g 13g and several grandkids that make me happy! I do travel alot and go where I’m needed thanks to APDF and the awesome staff that helped me survive and asked me to help the charity! Anyways I hope I put the rumors to bed finally and I’ve hoped I’ve earned trust and respect for doing what I love to do! Total income from APDF Charity $0.00 in 5 long years and many many kids and adults!

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Most of the “facts” in this video are true. One false statement – the top 4-5 PBM are now owned by the larger insurance companies. The PBM industry was created from a UAW union contract in late 1969 when they wanted a more standardized way for union members to submit their Rx receipts for reimbursement of Rxs that they had paid for.  Somewhere between then and now, these PBMs became licensed insurance companies.

Back in the 1940s, Congress gave insurance companies an exemption to the Sherman Antitrust Act https://en.wikipedia.org/wiki/McCarran%E2%80%93Ferguson_Act.  Back in the day, the DOJ told pharmacies they could not create an entity to negotiate reimbursements from a PBM, that was “price fixing”.

At one time, the PBM contracts with Pharmacies PROHIBITED pharmacies from telling pts if their cash price was less than the copay their PBM wanted them to pay, if the pt asked if the pharmacy’s cash price was less than the PBM copay, the pharmacist was allowed to tell the pt the true about the cash price that the pt could pay.  During the Trump administration either Trump did an EO or Congress passed a law that made it illegal for such clauses to be in the PBM contract.

Actually, it was our Congress that gave the PBMs the idea of getting kickbacks, discounts, and rebates. In the early 70s, Congress decided that because the Feds spent so much on medications on Medicaid Rxs. The Federal government deserved a 10% discount/rebate/kickback from the pharmas for any Rx paid for by Medicaid.

It would appear that since the insurance/PBM industry has one of the largest pots of money to lobby Congress, it would seem that all that money spread around Congress, that industry gets Congress to give them what they want.

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It has been almost 60 years since I pursued a pharmacy degree. That is almost 3 generations ago.  Only one out of 5-6 freshmen declared pharmacy majors at Butler U, made it to graduation, and only ONE out of my class failed to pass the “boards” on the first attempt. Back 10-15 yrs ago, pharmacy schools were getting 5-6 applications for every open pharmacy school slot.

I have heard that pharmacy schools are now accepting 90% of applicants and looking at the graduation rates. It would appear that only 1 out of 2 applications make graduation and 20% – 25% of the grads won’t pass the boards on the first attempt.

Back in the day, the number of pharmacy schools was in the low 80’s, today there are 144 schools. Indiana had 2 pharmacy schools – Butler U & Purdue U and today a third pharmacy school Manchester U.

In the articles below on the percentage of grads that passed the NAPLEX boards on the first attempt. Only Butler U – my alma mater – showed up in the top 12 of the percentage of grads passed on the first attempt.

Will pts benefit from all these changes or end up being more poorly taken care of? Only time will tell.

Pharmacies are struggling to refill their own ranks

https://www.axios.com/2024/02/06/pharmacy-staffing-shortage-burnout

The big picture: There’s been a steady drop in applications to pharmacy schools, falling 64% from nearly 100,000 in 2012 to about 36,000 in 2022, according to the American Association of Colleges of Pharmacy.

In 2022, there were 13,323 graduates from four-year pharmacy programs, down from 14,223 the previous year and the largest drop since 1983, per AACP data.

Top 15 pharmacy schools by NAPLEX pass rates

https://www.beckershospitalreview.com/pharmacy/top-15-pharmacy-schools-by-naplex-pass-rates.html

The average all-time pass rate of the North American Pharmacist Licensure Examination was 75.7% in 2023 — a slight increase from the year prior, according to data from the National Association of Boards of Pharmacy.

In 2021, the first-time pass rate was 81.3%, and subsequent years have dropped to about 77%. For all-time passes, 2021 recorded 77.3%, 2022 saw 73.9% and 2023 saw 75.7%.

Top 20 pharmacy schools by NAPLEX pass rates

https://www.beckershospitalreview.com/pharmacy/top-20-pharmacy-schools-by-naplex-passing-rates.html

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