Doctors: Execution Drugs Could Help COVID-19 Patients

https://www.usnews.com/news/business/articles/2020-04-21/doctors-execution-drugs-could-help-covid-19-patients

A group of medical professionals is asking death penalty states for medications used both for lethal injections and to help coronavirus patients who are on ventilators.

This July 25, 2014 file photo shows bottles of the sedative midazolam at a hospital pharmacy in Oklahoma City. Many of the medications being used to sedate and paralyze COVID-19 patients placed on ventilators and to also treat their pain are the same drugs that put inmates to death by lethal injection. Last month, nationwide demand for these drugs surged 73% during the pandemic.

Secrecy surrounding executions could hinder efforts by a group of medical professionals who are asking the nation’s death penalty states for medications used in lethal injections so that they can go to coronavirus patients who are on ventilators, according to a death penalty expert and a doctor who’s behind the request.

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CMS updates COVID-19 guidance to Medicare Advantage and Part D plans

https://ncpa.org/newsroom/qam/2020/04/23/cms-updates-covid-19-guidance-medicare-advantage-and-part-d-plans

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Correspondence: Are ESIs Still Worth It?

https://www.practicalpainmanagement.com/correspondence-are-esis-still-worth-it-benzocaine-orofacial-pain

Dear PPM,

Regarding “Epidural Steroid Injections: Are the Risks Worth the Benefits?” (July 2019), most pain management providers, let alone referring providers and patients, may not be aware of the background surrounding the FDA stance and the initial request to ban the use of epidural steroid injections (ESIs). In July 2018, the New York Times’ Sheila Kaplan reported that, in 2013, Pfizer Pharmaceuticals requested that the FDA ban the use of Depo-Medrol in the epidural space. Neither organization made this public at the time. The article cited a review of FDA records between 2004 and March 2018 showing 2,442 serious injuries (including 154 deaths) reported with the injection of steroids into the epidural space. As injury attorneys serving Sugar Land state, more injuries go unreported. It may be reasonable to assume more injuries occurred but were not reported or attributed to ESIs.

While the FDA has not banned the use of steroids in the epidural space, many other countries have done so. Pain management societies, practitioners, and patients should be better informed about safety communications regarding ESIs, as well as warnings contained in steroid package inserts. Depo-Medrol has labeling stating: “Serious neurologic events, some resulting in death, have been reported with epidural injection of corticosteroids. Specific events reported include, but are not limited to, spinal cord infarction, paraplegia, quadriplegia, cortical blindness, and stroke…. The safety and effectiveness of epidural administration of corticosteroids have not been established, and corticosteroids are not approved for this use.”

Multiple articles in the literature demonstrate a lack of long-term benefit from such injections beyond a few weeks, compared to less expensive, more conservative, and safer options. Match this with the costs of these procedures, and I don’t understand why these injections continue to be done since it doesn’t help the victims who got injured in a car accident. There have been catastrophic outcomes from ESIs. In my own practice, I had a patient with no prior history of low back injury nor surgery who had 7 ESIs done by another provider. Her most recent MRI showed adhesive arachnoiditis with no other injury as the likely cause. She is in constant pain. Rather than being eligible for compensation after the fall,  she deserves a compensation from her previous provider for the pain she endures. 

I believe the primary motivators for doing these procedures lie in habit and financial gain. In fact, I have heard from some hospital administrators that, “even though we know they don’t work, as long as we have a fee for service mode and can make money, we will allow providers to do them.” One VP from a major insurance company told me that they keep paying for ESIs “because no one wants to be the first to say no and deal with the backlash.” There are many reasonable and less risky pain management procedures that help to manage pain, but an ESI is not one of them.

– Terence K. Gray, DO

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Pain Is Taxing Facebook Live Feed campaign event #2
When? Wednesday, April 30th, 2020
Time: simultaneously across USA 🇺🇸 on Facebook
Time:
Pacific time: 12 pm
Central time: 2 pm
Eastern time: 3 pm

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https://youtu.be/-mJvuZYOJM4

I personally think GLOVES are killing people especially in nursing home from failure to wash gloves like your hands. It is not being done!! Is is easier to spread viruses with gloves than hands. The false sense of security is dangerous to self and others. Basic understanding of how the virus is spread through direct contact is lacking. CDC is not giving enough details spending all its time trying to convince doctors to stop treating pain, instead of making videos on how to control the spread in the work place so we can save our wrecked economy and at the same time stop more spread of the virus. Just my opinion as always. Believe it or not! maybe i should open a museum of just my opinions

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https://www.federalregister.gov/d/2020-08127/p-14

The Centers for Disease Control and Prevention (CDC) in the Department of Health and Human Services (HHS) announces the opening of a docket to obtain comment concerning perspectives on and experiences with pain and pain management, including but not limited to the benefits and harms of opioid use, from patients with acute or chronic pain, patients’ family members and/or caregivers, and health care providers who care for patients with pain or conditions that can complicate pain management (e.g., opioid use disorder or overdose)—hereafter called “stakeholders.” CDC will use these comments to inform its understanding of stakeholders’ values and preferences related to pain and pain management options.

DATES:

Written comments must be received on or before June 16, 2020.

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Tomorrow will mark the end of ONE MONTH of sheltering in place for us.  We have been retired for several years… so we have been for the most part sheltering in place for years.. 🙁 All too many are looking for a answer, for a solution, for adequate therapy.

I starting thinking back… We have had four Presidents over the last 27 yrs… two from each party and we have had Congress that has been controlled by each party at times and split at times.

What has really changed ?

In 2006 Medicare folks gone prescription coverage for the first time since it was started in 1965..  Democrats fought against that bill being passed tooth and nail.  Barb has been on Medicare disability since 1997 and without her Medicare she was virtually otherwise uninsurable.  All she has was Medicare A & B and a Medicare supplement was either unavailable or so outrageous premiums , so all deductible, copays and all her meds were out of pocket.  I can remember picking up a 90 day supply of her meds and having $2000 – $3000  less in my pocket leaving the pharmacy.

In 1999 Congress gave us the “Decade of Pain Law”…. brought the 5th vital sign to the practice of medicine.. that was everyone had to assess and treat a pt’s perception of pain. When this law expired it was not renewed. Just by chance a <R> controlled Congress passed this law and a <D> controlled Congress and a newly elected <D> President was in power at the time

Obama was sworn in Jan 2009 and the Affordable Care Act was signed into law March , 2010.  We supposedly had abt 10% of the population without any insurance – which today we still have that same percentage.  Some people got low premiums and high deductibles … some people got high premiums and high deductibles.  Some people basically got put on Medicaid – under a different name (AKA).

2016 brought us the infamous CDC’s opiate dosing guidelines. What a CLUSTER -F !

For the last President election, I used this graphic a lot. Congress is now SPLIT.. and we have a lot of DEADLOCK at that level and all the other 2 odd millions Federal employees are pretty much do what they damn please. So much infighting in Congress … among our elected leaders.. does anyone really know what is going on..

It would seem that no matter who has been in power over at least the last 27 yrs… really not much as changed. What has changed – behind the scene – is that during the 90’s all the insurance companies that were historically been not for profit companies – meaning that their policy holders – owned the company..

Well most in the 90’s DEMUTALIZED and became FOR PROFIT … publicly traded stocks… and they started being concerned about their stock price and their bottom line.  Also during this time, the PBM industry -Prescription Benefit Managers – got a strangle hold the prescription business… Today they tell pharmas that if they want their particular med on their approved formulary … they will REBATE/DISCOUNT/KICKBACK up to 75% of the wholesale price of the med to the PBM for that privilege.

I have come to the conclusion that is really doesn’t matter much if a <R> or a <D> is in Congress “the seniority system” of Congress will prevail.  For something to become a law.. it has to go thru a committee in each the House and Senate and the chairperson of those committee is a member of the same party that is in control of their respective part of Congress..  Chairperson doesn’t want to hear a bill.. it goes NO WHERE…  If approved by the committee the bill then goes to the floor of the respective part of Congress and if the person who is speaker of the House or majority leader of the Senate doesn’t want to have a vote on the bill … it goes NO WHERE.

Just look at what Harry Reid – then majority leader of the Senate – under Obama did… for SEVEN YEARS he refused to bring the MANDATORY ANNUAL BUDGET up for a vote..  He only brought it up for a vote the last year of Obama’s administration.. maybe because the budget would mostly the new President’s being in office would have to deal with it.

It is claimed that 98% of member of Congress will get re-elected… doesn’t really matter what they have promised and not follow thru on… what they have not done period. It is claimed that people believe that the person in Congress representing them are “good guys”.. if all the rest of those bums that need to get voted out.

I have come to the conclusion unless you CLEAN HOUSE and virtually destroy the seniority system… nothing is going to change.

IMO, the community needs to have created a nonprofit and have at least $500,000 in the bank and one or more lobbyists firms aligned…  to hit the ground a couple of weeks after the new members of Congress are sworn in. If no positive actions or no action in the right direction and the next election is six months away… the community gets a list of who needs to GO  and OUT THEY GO !

If No VOTERS see the lights… and acts accordingly … then the community is going to remain walking around “in the darkness”

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A fraudulent prescription was filled this morning using the DEA number of Dr. Sarah Beeson, from Greenwood, Indiana. The prescription was written to a patient named Beth Bulling (DOB: 9-18-1958) for Amitriptyline 25mg. If you receive a prescription - written or phoned in - containing this information, please DO NOT fill. You can reach Dr. Beeson at (317) 215-7966 or notify the INSPECT office at (317) 234-8039.

I got the above via email from the Indiana Board of Pharmacy.. someone is so desperate that they are forging prescriptions for a NON-CONTROLLED MED – Amitriptyline  – typically use for depression but some docs will use it for Fibromyalia pts… suppose to help their pain ?

I got a email, just this week from a pt on the east coast were they had been weened off of  several different non-opiates and given a prescription – written by a SPECIALIST –  for a TCA like Amitriptyline  above… and the major chain pharmacy pharmacist REFUSED to fill it… and after much fuss and a District Manager Pharmacist got into the mix..  the Pharmacist agreed to fill it if the pt signed a statement that they would not hold the pharmacist nor the chain liable for any consequences of taking this medication.

I think that we may be reaching the bottom of the barrel…but maybe not

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Doctors Struggle to Get Paid for Telehealth Visits

https://www.medpagetoday.com/infectiousdisease/covid19/85990

As COVID-19 has forced more physicians into telemedicine visits, getting paid has been a struggle, providers told MedPage Today.

Telehealth reimbursement during the COVID-19 pandemic has increased rapidly compared with its previously slow uptake, but providers say they’re not being paid to the extent they are being promised — or anywhere close to the amounts they made with in-person visits. That’s partially due to a lack of clear information and inconsistent policies across the country’s patchwork of insurance plans.

“It’s been very, very confusing,” said Todd J. Maltese, DO, who runs a Long Island neurology and sleep medicine practice with three providers. “There’s no standard way of doing this. Every insurance company, they’re asking for different codes and modifiers.”

“We are all kind of making it up as we go along,” said Arthur Guerrero, MD, an endocrinologist who runs a private practice with four providers in a small town just north of San Antonio, Texas.

While telehealth’s popularity among patients and providers has been growing, both public and private payers have been slower to embrace it. The pandemic forced payers to begin picking up the tab for more types of telehealth appointments, for the simple reason that Americans have been ordered to stay home. Most medical appointments have not been deemed essential, pushing thousands of patients to meet with their providers online.

The Centers for Medicare & Medicaid Services (CMS) pledged that Medicare would reimburse providers at 100% of the in-person rate for many of these virtual visits, and private payers followed with similar policies. But providers, analysts, and other insiders say some bills are being returned and only partially paid.

The culprits: quickly morphing policies, complicated language in those policies, and insurers publicly promising “coverage” without revealing what exactly they will pay for.

Telehealth coverage “used to be certain — you weren’t getting paid,” said Judd Hollander, MD, who runs Thomas Jefferson University’s telehealth program and serves as its healthcare delivery vice president. “Now it’s uncertain. … It’s utterly confusing.”

Inconsistent Payments

Maltese asked his office manager to call insurance companies about billing when his practice began shifting from a 100% in-person model to its temporary all-telehealth model a month ago.

“Half the companies couldn’t even give us information because they didn’t know, and it’s been a crap shoot from there,” he said. While some have paid in full, other companies promised to pay at 100%, but then reimbursed for less, he said.

“Some we have no guidance, so we just bill what we think,” Maltese said. “We (as an industry) have got to get the coding and billing down.”

Maltese understands why companies may not want to pay in full: “We are not doing a full exam,” he said. But, he noted, it’s necessary because when he spoke to MedPage Today last week, it was still not safe to leave home in Long Island. Telehealth thus is “really our only way of checking on patients, so I believe right now we should be paid 100% of the rates.”

Doctors also paradoxically find themselves spending more time per visit with telemedicine. It takes Maltese’s patients on average 10 minutes to get their software operational, and several times he has spent a half-hour serving as his clients’ IT consultant before starting an appointment.

“Most patients are not 20 and tech-savvy; most are older and need to be walked through it, and I don’t have the staff to do it,” he said. “I’m falling behind because I have other patients after them.”

Additional Losses

Medicare promised patients it would waive copays during the pandemic. “So we are already looking at making only 80% of what we would make face-to-face” if forced to drop the copay, Guerrero said.

Then there is revenue lost to procedures that cannot be done via telemedicine, such as the retinal scans Guerrero’s practice would typically perform for diabetics. “It’s not a huge procedure, but if patients are not coming in, you are not getting it done, so it translates into a bigger loss than [going down to] 80%.”

CMS also directed providers to designate a place of service when billing, initially asking them to enter a specific code. Providers say CMS then failed to reimburse to 100% when some of those bills were submitted; it was closer to 70%, Maltese said. Providers said CMS recently fixed the problem by asking for a different code.

“What we think today is different than last week,” Guerrero quipped. To figure out if his staff correctly submitted a claim, he often asks physicians from other practices what they did. If his staff erred, then they must appeal, which can saddle efficiency.

Medicaid reimbursement policies vary from state to state. Some Medicaid administrators have elucidated these policies well, but some have not, said Clinton Phillips, CEO of Medici, an Austin, Texas-based telemedicine platform. Providers can turn to state websites and medical associations for answers, he noted.

Other policies are still in development, said Mei Wa Kwong, JD, who directs the Center for Connected Health Policy, a national telehealth resource center that provides technical assistance. Questions need to be answered concerning coverage for federally qualified health centers and rural clinics, for example.

Also, when insurers do cover telehealth, they often direct patients to top telemedicine vendors, where patients see the vendors’ certified providers. But if patients want to see their regular doctors, those visits are not always covered. Some states have intervened to order that coverage, but not all, Kwong said.

Staying Online

Insurers have enacted numerous new policies and have taken other steps to enhance telehealth coverage, according to a lengthy list compiled by America’s Health Insurance Plans. AHIP declined an interview with MedPage Today, but a spokesperson said in an email: “By waiving cost-sharing for telehealth services and expanding telemedicine programs, health insurance providers are facilitating care.”

The American Medical Association said it continuously updates a website with instructions for how providers can navigate the new telehealth payment landscape, including CMS policies, but did not provide a comment for this story.

The American Hospital Association also declined to speak for this story, but its site features recent letters advocating CMS for expanded and improved telehealth coverage.

Peter Antall, MD, a former California pediatrician who is president of the Amwell Medical Group, said he has not had issues collecting from its 55 private payers.

But such anecdotes are few and far between. Guerrero and Maltese said they can only survive about two or three more months providing primarily telehealth, and only if they can collect most of their bills.

“It’s not like I’m trying to save up for a Lamborghini,” Guerrero said. “I’m trying to make 100% [reimbursement] because that’s what my employees’ jobs hang on.”

His specialty lends itself to telehealth and his practice is in demand because of a nationwide endocrinologist shortage, Guerrero said. Cardiologists, plastic surgeons, and even, in his wife’s case, dermatologists, are not as fortunate.

“I don’t know how some of these places will survive when it’s over,” he said. “It’s scary.”

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with the anticipated death of 8-9 pts out of every 10 pt that is being put on a vent.  Should the  potential of addiction be a high priority ?  Unless Rep Congressman David Trone <D> MD is more concerned about the thinning of the herd with COVID-19 and vents and wanting to avoid the POSSIBILITY of the cost of treating a addicts.  After all he is a MBA, always interested in the bottom line ?

Also notice that BRANDEIS UNIVERSITY RESEARCHERS apparently got total access to NJ’s  prescription monitoring program data – all of that supposedly protected by our HIPAA law ?

Brandeis University Study Shows Few Opioid Prescribers Warned Patients of Risk of Addiction Before State Requirement

https://www.daily-journal.com/business/brandeis-university-study-shows-few-opioid-prescribers-warned-patients-of-risk-of-addiction-before-state/article_c575fe52-1336-56b0-9610-52e013cd4d20.html

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