This is what forced cold turkey withdrawal looks like when pt’s pain meds are stopped abruptly

Why vertical mergers will continue to dominate health care – causing antitrust issues ?

Why vertical mergers will continue to dominate health care

https://www.managedcaremag.com/archives/2018/12/why-vertical-mergers-will-continue-dominate-health-care

Insurers are busy merging with retailers and providers in vertical integration deals after attempts at horizontal combinations hit antitrust roadblocks.

While 2019 might not see the mega-mergers of 2018, “I don’t think it will be a slow year,” predicts Stephen Burrill, vice chairman and health care leader at Deloitte LLP.

Much of the action is expected to come from retailers linking up with payers or providers, or from health insurers or health care systems acquiring services such as home health care providers and rehabilitation facilities. Payers and providers have begun to realize “maybe this is a better answer if we work together and think about the patient holistically,” Burrill says. With that type of vertical integration, “you help manage money,” with the goal of reducing health care costs, he adds.

During the first three quarters of 2018, nearly 800 health care deals were announced, valued at almost $115 billion, according to PricewaterhouseCoopers. By far the largest were Cigna’s $67 billion acquisition of Express Scripts and CVS Health’s $69 billion acquisition of Aetna. For 2017, the number of health care deals totaled 967, with a combined value of $175.2 billion. The Cigna–Express Scripts deal may not close until mid-2019, several months after it was expected to, and California, New York and New Jersey regulators are still reviewing it. The CVS–Aetna merger has also run into snags. It has gotten the Department of Justice’s approval but early this month Judge Richard Leon of the U.S. District Court for the District of Columbia said he might require the companies to remain separate until he can review the merger and consider anti-trust issues. “I can’t recall another instance of a judge doing this,” Andrea Agathoklis Murino, co-chairperson of Goodwin Procter LLP’s antitrust and competition law practice, told CNBC.

In a November earnings call, CVS CEO Larry Merlo said the company would work to help better manage customers’ chronic conditions, such as diabetes, through the integration of CVS’s and Aetna’s claims data, according to media reports.

CVS is planning to launch new “health hub” stores this year that will provide “new services to better address the cost-quality-access challenges of consumers,” Merlo said. The hubs would reportedly use pharmacists to help manage patients’ care between visits to primary care providers. The pilot efforts would initially involve Aetna members, but could be expanded to other health plans.

Meanwhile, Humana and Walmart have been talking about merger-slash-partnership arrangements, according to media reports, but as 2018 waned they had yet to make any kind of big-splash announcement. Humana has partnered with Walgreens to test senior-focused primary care clinics in Kansas City.

Insurers are busy merging with retailers and providers in vertical integration deals after attempts at horizontal combinations hit antitrust roadblocks. In 2017, federal judges ruled against Humana’s proposed tie up with Aetna and a Cigna–Anthem merger. And the bar for horizontal mergers got a little higher this year. California approved a law that requires that any health insurers who want to merge to first gain approval from the state’s Department of Managed Health Care. The department can reject mergers that limit competition.

Other vertical deals this year included Humana’s acquisitions of a Curo Health Services, a hospice provider, and Family Physicians Group in Orlando, a primary care provider. Meanwhile, Centene announced it was acquiring Community Medical Group, a primary care provider in Miami-Dade County. Anthem acquired Aspire Health, a palliative care provider.

Whether the enthusiasm for vertical integration will go too far and start bumping up against antitrust objections is one of the important questions going into 2019. An example might be a health insurer acquiring all the rehabilitation facilities in a particular market. “There may be a point where it’s too big,” Burrill says.

More US Teens Are Vaping, but Use of Opioids, Alcohol Falling

More US Teens Are Vaping, but Use of Opioids, Alcohol Falling

https://www.clinicaladvisor.com/pediatrics-information-center/more-us-teens-are-vaping-but-use-of-opioids-alcohol-falling/article/821791/

HealthDay News — Vaping among American teenagers increased dramatically in 2018, with nearly 2 of every 5 high school seniors reporting they had tried an electronic cigarette during the past year, according to the latest Monitoring the Future survey funded by the US National Institute on Drug Abuse.

About 37% of teens said they had tried vaping and even Nicotine-free vape options within the previous 12 months compared with about 28% in 2017. Vaping rates also increased by about one-third in younger teens, with about 18% of eighth graders and 32% of 10th graders reporting they had tried e-cigarettes in 2018. After alcohol, vaping is the second-most common form of substance use in the United States, the survey revealed. However, marijuana use remains steady among high schoolers, with nearly 6% of 12th graders reporting daily use. For the past two decades, daily use among high school seniors has hovered between 5% and 6.6%.

The survey also showed that smoking is at an all-time low, with only about 4% of high school seniors smoking daily compared with 22% two decades ago. Prescription opioid use (such as OxyContin or Vicodin) has declined to about 3% among 12th graders. Only 1.7% of seniors reported misuse of Vicodin in the past year compared with 10% 15 years ago. Alcohol use also has declined. About 17% of high school seniors reported being drunk during the past month, down from 26% 5 years ago. Fewer teens reported binge drinking (5 or more drinks in a row). About 14% of 12th graders said they had recently engaged in binge drinking, down from 17% in 2017 and the all-time high of 31% in 1998.

“We are encouraged to see continued declines in a variety of measures of underage alcohol use,” George F. Koob, PhD, director of the National Institute on Alcohol Abuse and Alcoholism, said in a statement. “The new data, however, underscore that far too many young people continue to drink at a time in their lives when their brains and bodies are quite vulnerable to alcohol-related harms.”

More Information

Opioid crisis critical as youth drug deaths nearly triple in the past 20 years

https://video.foxnews.com/v/5984887974001

 

 

 

CVS is now working with a nonprofit “health” advisor that may ration customers’ health care choices

CVS Makes Plans To Ration Customers’ Health Care

http://thefederalist.com/2018/12/28/cvs-makes-plans-ration-customers-health-care/

CVS Caremark customers throughout America recently received bad news as the retail pharmaceutical chain officially closed on its $69 billion acquisition of Aetna. This is bad news because CVS is now working with a nonprofit “health” advisor that may ration customers’ health care choices.

In August, CVS announced a partnership with the Institute for Clinical and Economic Review (ICER), a nonprofit group that bills itself as a medical review board. But its leadership team and the far-left billionaires footing its bill paint a troubling picture.

ICER was founded by Dr. Steven Pearson. Pearson previously worked with the United Kingdom’s National Institute for Health and Care Excellence (NICE). A pleasant-sounding moniker, NICE is anything but.

Thanks to NICE guidelines, millions of British citizens are on waiting lists at any given time for procedures, hundreds of thousands are waiting for basic diagnostic tests, and thousands of operations are regularly cancelled. During the first quarter of 2018, “the number of British patients waiting 18 weeks or more for treatment increased by 35 percent, which was an increase of 128,575 patients from about 362,000 patients in 2017, to over 490,000 patients in 2018. Additionally, by March 2018, 2,755 patients had waited over a year to be treated, compared to 1,528 patients in 2017,” according to The Heritage Foundation.

NICE is even worse about drug approvals. NICE “has declined to fund [drugs] such as Benlysta, Novartis, Sorafenib and Avastin. The first is a treatment for lupus while the last three can extend the life of cancer patients. The Rare Cancers Forum notes that 16,000 patients annually could benefit from cancer drugs rejected by NICE,” notes the National Center for Public Policy Research’s David Hogberg.

Under ICER’s direction, CVS has set a “threshold of $100,000 per QALY, or quality-of-life years, a benchmark that measures both the quantity and quality of life generated by providing a treatment or some other health care intervention.” In practice, that means ICER’s opinion about the so-called quality of life value will determine whether CVS customers can receive new prescription drugs and treatments.

This means that even if a doctor prescribes a drug for a patient, that individual may find that CVS doesn’t carry that medication if it doesn’t fit ICER’s parameters. Think of it as socialized health care without the socialistic government regime.

Former Rep. Tony Coelho (D-Calif.), a primary author and sponsor of the Americans with Disabilities Act, has been a strong critic of CVS’s decision and ICER’s approach. This is how he explained its effects:

This type of cost effectiveness analysis discriminates against people with disabilities and other vulnerable groups like the elderly because it assigns higher value to people in ‘perfect health’ than people in less-than-perfect health. So let’s say your child has a degenerative neurological condition and an expensive new drug is introduced that can halt, but not reverse, the damage done by the disease. Your child, and other patients like her, would be considered ‘worth less’ under a cost-effectiveness formula. As a result, the new treatment would not meet the threshold.

Recall that the debate over health-care rationing was a primary reason so many folks objected to ObamaCare’s Independent Payment Advisory Board (IPAB). IPAB was to be a 15-person panel deciding which treatments should be allowed under what circumstances for government-run programs.

The idea of a panel deciding who gets what kind of care and when seemed Orwellian from the start, and Americans by and large opposed the entire concept. In February, Congress did away with IPAB.

CVS is now instituting its own form of IPAB with ICER. Rationing, by any other name, is just as insidious. So who is funding this far-left push? The Laura and John Arnold Foundation has donated more than $19 million to ICER since 2015. These big-money liberals appear to have goals of moving beyond ObamaCare to a full-blown single-payer system.

In addition to funding ICER, the Arnolds have teamed up with George Soros to bankroll Patients for Affordable Drugs (P4AD), an advocacy group claiming to be bipartisan yet comprised largely of former Obama and Clinton staffers. P4AD’s political actions during this past election cycle put the truth to the lie of bipartisanship.

According to The Intercept, “P4AD touts itself as a bipartisan organization, which means that come election time, it needs to spend money targeting both Republicans and Democrats. The Democrats being targeted by P4AD are virtually guaranteed to win re-election, which allows the group to claim a bipartisan label without actually harming any Democratic incumbents.”

Obviously P4AD is not bipartisan and neither is the Laura and John Arnold Foundation. As I noted in a recent Investor’s Business Daily commentary, “[f]rom abortion, to anti-Second Amendment work, to liberal ‘investigative’ journalism, to single-payer health care, the Arnolds fund the gamut of far-left causes… They promote their bipartisan giving, yet the Arnolds fund groups whose sole mission is to demonize and bankrupt right-of-center organizations. How is that possibly bipartisan?”

Now, through ICER, the Arnolds resurrecting one of ObamaCare’s most underhanded programs. And CVS is helping them.

During the Obama administration, CVS teamed up with the White House to promote the Affordable Care Act in its stores. Now it is working with far-left actors to revive a version of ObamaCare’s rationing board. CVS customers and investors deserve better.

Justin Danhof is the General Counsel for the National Center for Public Policy Research, as well as Director of the Center’s Free Enterprise Project.

 

 

Mis-statement of facts as early as 2014 ?

Kolodny Congress 5-2014 Opioiods from Media Policy Center on Vimeo.

Guilty regardless of the evidence to the contrary

They Fell like Dominos: My License, My Certification, My Profession

https://opmed.doximity.com/articles/they-fell-like-dominos-my-license-my-certification-my-profession-21667cc4d596

They fell like dominos, one after another: first, my medical privileges, then my Ohio Medical License, then my state license, then my board certification, finally my DEA license. While, like most physicians, I had concerns about malpractice suit, a medical board investigation never crossed my mind.

I suppose that’s why the certified letter from an investigator with my state medical board took me by surprise. I was alleged to be “an unregistered terminal distributor of dangerous drugs.” I told the investigator everything. I hadn’t distributed anything. Seven months previously, my husband of 37 years announced that he was getting a divorce. I had no home, no marriage, no job, no doctor, not even a car. I couldn’t stop crying. I couldn’t eat. Worst of all, I couldn’t sleep. I tried alcohol; it didn’t help. In desperation, I had ordered a bottle of Xanax from a wholesaler.

That was it. I signed a release of medical records to confirm my statements and document the help I was getting and the progress I was making. I hadn’t seen any patients during that time, violated any laws, or driven under the influence. Since I wasn’t in any legal jeopardy, I didn’t need a lawyer.

Then the second certified letter arrived. The Board had reason to believe that I was “unable to practice according to acceptable and prevailing standards of care by reason of mental illness or physical illness…” I was ordered to submit to a forensic psychiatric exam. Failure to do so would constitute “an admission of the allegations…and a default and final order may thereupon be entered without the taking of testimony or presentation of evidence.” If I didn’t submit to their demands, I could lose my license.

The interview went smoothly. I had no personal or family history of alcoholism or addiction. I could spell W-O-R-L-D backwards. I did my serial 7s down to 57 and my presidents down to Kennedy, at which point the psychiatrist had said, “Enough!” I was still in therapy and taking an antidepressant, but I was back to work and feeling good. I thought that was it.

But again, I was wrong. Four months later, I got a third certified letter. This time the Board ordered me to submit to a 72-hour inpatient addiction evaluation. Knowing what was at stake, I submitted.

When I arrived at the rehab hospital, my phone, wallet and keys were confiscated, and my car, suitcase and body were searched. During my stay, I was assailed with questions I couldn’t answer, questions like “What’s your drug of choice?” and “Does your family know about your addiction?” I submitted to observed urine drug tests, sleep deprivation and hours of interrogation, group therapy and lectures on alcoholism. The cognitive dissonance was unbearable.

On the morning of the third day in rehab, I was told that, since I was still in denial about my addiction, I would have to stay in rehab at least 28 more days. I had packed for three.

I refused. I was reminded of the consequences to my career. I still refused. I had given the rehab hospital permission to contact my husband, my daughter, my brother and a longtime colleague. They would confirm that, except for that brief period, I was the epitome of sobriety. The nightmare would be over.

It wasn’t. Six weeks later, the fourth certified letter arrived. It stated: “We have reason to believe that you pose an imminent threat to your patients and we thereby are suspending your medical license.” I had to stop practicing immediately. I could have a hearing. It would be adversarial, but it was my last chance to salvage my career.

I prepared assiduously in the 15 days leading up to the hearing. I was an articulate, consistent and contrite defendant, but a terrible lawyer. After eight hours of testimony, the Board’s lawyer concluded that my children were enablers, my spouse was lying, my colleagues were clueless and I was a hopeless drunk full of excuses. Nonetheless, I was hopeful.

Shortly thereafter, the fifth certified letter arrived. I was offered a chance to face my accusers, the eight members of the state medical board, for five minutes at a public hearing. I took the offer. Three and a half minutes into my statement, the Board’s spokesman interrupted me and read a perfunctory statement echoing their lawyer’s sentiments. I was numb.

Two weeks later, the sixth certified letter arrived. It said, “There is clear and convincing evidence that you are impaired in your ability to practice medicine and your Ohio license had been permanently revoked.” The seventh certified letter said my state license was suspended, the eighth, that my Board certification was revoked, and the ninth, that my DEA license was invalidated.

It’s taken me months to be able to write about this. Months to get past the shame of a personal crisis made public, to recover from the pain of the ordeal, and to accept that never again could I practice the profession to which I had dedicated my entire adult life.

I have learned over these months that countless other unwary practitioners have been victims of the same disciplinary fervor. I know now that, to keep their licenses, most of these physicians will submit to what’s demanded of them and they will stay silent to protect their reputations. I, however, was physically, emotionally and financially unable to submit to my Board’s final demand. As a result, I lost everything professionally. I have nothing to lose by speaking out.

My colleagues need to know that if a Board investigator contacts you, you must immediately contact your lawyer. Unlike in a civil case, Boards can presume you’re guilty and ignore exculpatory evidence. Unlike in a criminal case, Boards don’t have to advise of your civil rights because you don’t have any. They can coerce you into medically unnecessary treatment, rob you of your personal freedom, publicly defame you and deprive you of your livelihood, all with complete impunity.

State legislatures cannot abridge the civil rights of its citizens. However, they allow state medical boards to do so based on the rationale that medical professionals must adhere to higher standards than average citizens. I accept that. However, boards should not be allowed to violate our civil rights when evaluating whether or not we are adhering to those standards. Perhaps in the long run, we can repeal the laws that allow this travesty. For now, any of you who can speak up, please do. Talk to your colleagues, your medical society, your state representative. For those who can’t speak up, please know this: you aren’t a pariah, you aren’t worthless, and you definitely aren’t alone.

 

Chronic Pain Patient Lives Matter – Bill Murphy

 

Aetna:a former medical director for the insurer admitted under oath he never looked at patients’ records when deciding whether to approve or deny care

CNN Exclusive: California launches investigation following stunning admission by Aetna medical director

https://www.cnn.com/2018/02/11/health/aetna-california-investigation/index.html

(CNN) California’s insurance commissioner has launched an investigation into Aetna after learning a former medical director for the insurer admitted under oath he never looked at patients’ records when deciding whether to approve or deny care.

California Insurance Commissioner Dave Jones expressed outrage after CNN showed him a transcript of the testimony and said his office is looking into how widespread the practice is within Aetna.
“If the health insurer is making decisions to deny coverage without a physician actually ever reviewing medical records, that’s of significant concern to me as insurance commissioner in California — and potentially a violation of law,” he said.
Aetna, the nation’s third-largest insurance provider with 23.1 million customers, told CNN it looked forward to “explaining our clinical review process” to the commissioner.
California insurance commissioner Dave Jones launched the investigation after being contacted by CNN.

The California probe centers on a deposition by Dr. Jay Ken Iinuma, who served as medical director for Aetna for Southern California from March 2012 to February 2015, according to the insurer.
During the deposition, the doctor said he was following Aetna’s training, in which nurses reviewed records and made recommendations to him.
Jones said his expectation would be “that physicians would be reviewing treatment authorization requests,” and that it’s troubling that “during the entire course of time he was employed at Aetna, he never once looked at patients’ medical records himself.”
“It’s hard to imagine that in that entire course in time, there weren’t any cases in which a decision about the denial of coverage ought to have been made by someone trained as a physician, as opposed to some other licensed professional,” Jones told CNN.
“That’s why we’ve contacted Aetna and asked that they provide us information about how they are making these claims decisions and why we’ve opened this investigation.”
The insurance commissioner said Californians who believe they may have been adversely affected by Aetna’s decisions should contact his office.
Members of the medical community expressed similar shock, saying Iinuma’s deposition leads to questions about Aetna’s practices across the country.
“Oh my God. Are you serious? That is incredible,” said Dr. Anne-Marie Irani when told of the medical director’s testimony. Irani is a professor of pediatrics and internal medicine at the Children’s Hospital of Richmond at VCU and a former member of the American Board of Allergy and Immunology’s board of directors.
“This is potentially a huge, huge story and quite frankly may reshape how insurance functions,” said Dr. Andrew Murphy, who, like Irani, is a renowned fellow of the American Academy of Allergy, Asthma and Immunology. He recently served on the academy’s board of directors.

The Gillen Washington case

Gillen Washington, 23, says he hopes to force change at Aetna.

The deposition by Aetna’s former medical director came as part of a lawsuit filed against Aetna by a college student who suffers from a rare immune disorder. The case is expected to go to trial later this week in California Superior Court.
Gillen Washington, 23, is suing Aetna for breach of contract and bad faith, saying he was denied coverage for an infusion of intravenous immunoglobulin (IVIG) when he was 19. His suit alleges Aetna’s “reckless withholding of benefits almost killed him.”
Aetna has rejected the allegations, saying Washington failed to comply with their requests for blood work. Washington, who was diagnosed with common variable immunodeficiency, or CVID, in high school, became a new Aetna patient in January 2014 after being insured by Kaiser.
Aetna initially paid for his treatments after each infusion, which can cost up to $20,000. But when Washington’s clinic asked Aetna to pre-authorize a November 2014 infusion, Aetna says it was obligated to review his medical record. That’s when it saw his last blood work had been done three years earlier for Kaiser.
Despite being told by his own doctor’s office that he needed to come in for new blood work, Washington failed to do so for several months until he got so sick he ended up in the hospital with a collapsed lung.
Once his blood was tested, Aetna resumed covering his infusions and pre-certified him for a year. Despite that, according to Aetna, Washington continued to miss infusions.
Washington’s suit counters that Aetna ignored his treating physician, who appealed on his behalf months before his hospitalization that the treatment was medically necessary “to prevent acute and long-term problems.”
“Aetna is blaming me for what happened,” Washington told CNN. “I’ll just be honest, it’s infuriating to me. I want Aetna to be made to change.”
During his videotaped deposition in October 2016, Iinuma — who signed the pre-authorization denial — said he never read Washington’s medical records and knew next to nothing about his disorder.
Intravenous immunoglobulin can cost as much as $20,000 per treatment. It helps patients like Gillen Washington stave off infection.

Questioned about Washington’s condition, Iinuma said he wasn’t sure what the drug of choice would be for people who suffer from his condition.
Iinuma further says he’s not sure what the symptoms are for the disorder or what might happen if treatment is suddenly stopped for a patient.
“Do I know what happens?” the doctor said. “Again, I’m not sure. … I don’t treat it.”
Iinuma said he never looked at a patient’s medical records while at Aetna. He says that was Aetna protocol and that he based his decision off “pertinent information” provided to him by a nurse.
“Did you ever look at medical records?” Scott Glovsky, Washington’s attorney, asked Iinuma in the deposition.
“No, I did not,” the doctor says, shaking his head.
“So as part of your custom and practice in making decisions, you would rely on what the nurse had prepared for you?” Glovsky asks.
“Correct.”
Iinuma said nearly all of his work was conducted online. Once in a while, he said, he might place a phone call to the nurse for more details.
How many times might he call a nurse over the course of a month?
“Zero to one,” he said.
Glovsky told CNN he had “never heard such explosive testimony in two decades of deposing insurance company review doctors.”

Aetna’s response

Aetna defended Iinuma, who is no longer with the company, saying in its legal brief that he relied on his “years of experience” as a trained physician in making his decision about Washington’s treatment and that he was following Aetna’s Clinical Policy Bulletin appropriately.
“Dr. Iinuma’s decision was correct,” Aetna said in court papers. “Plaintiff has asserted throughout this litigation that Dr. Iinuma had no medical basis for his decision that 2011 lab tests were outdated and that Dr. Iinuma’s decision was incorrect. Plaintiff is wrong on both counts.”
Gillen Washington receives an infusion of the medicine needed to boost his immune system. He calls it "the magic juice."

In its trial brief, Aetna said: “Given that Aetna does not directly provide medical care to its members, Aetna needs to obtain medical records from members and their doctors to evaluate whether services are ‘medically necessary.’ Aetna employs nurses to gather the medical records and coordinate with the offices of treating physicians, and Aetna employs doctors to make the actual coverage-related determinations.
“In addition to applying their clinical judgment, the Aetna doctors and nurses use Aetna’s Clinical Policy Bulletins (‘CPBs’) to determine what medical records to request, and whether those records satisfy medical necessity criteria to support coverage. These CPBs reflect the current standard of care in the medical community. They are frequently updated, and are publicly available for any treating physician to review.”
Jones, the California insurance commissioner, said he couldn’t comment specifically on Washington’s case, but what drew his interest was the medical director’s admission of not looking at patients’ medical records.
“What I’m responding to is the portion of his deposition transcript in which he said as the medical director, he wasn’t actually reviewing medical records,” Jones told CNN.
He said his investigation will review every individual denial of coverage or pre-authorization during the medical director’s tenure to determine “whether it was appropriate or not for that decision to be made by someone other than a physician.”
If the probe determines that violations occurred, he said, California insurance code sets monetary penalties for each individual violation.
CNN has made numerous phone calls to Iinuma’s office for comment but has not heard back. Heather Richardson, an attorney representing Aetna, declined to answer any questions.
Asked about the California investigation, Aetna gave this written statement to CNN:
“We have yet to hear from Commissioner Jones but look forward to explaining our clinical review process.
“Aetna medical directors are trained to review all available medical information — including medical records — to make an informed decision. As part of our review process, medical directors are provided all submitted medical records, and also receive a case synopsis and review performed by a nurse.
“Medical directors — and all of our clinicians — take their duties and responsibilities as medical professionals incredibly seriously. Similar to most other clinical environments, our medical directors work collaboratively with our nurses who are involved in these cases and factor in their input as part of the decision-making process.”
Gillen Washington became emaciated and gravely ill after four months without treatment.

‘A huge admission’

Dr. Arthur Caplan, founding director of the division of medical ethics at New York University Langone Medical Center, described Iinuma’s testimony as “a huge admission of fundamental immorality.”
“People desperate for care expect at least a fair review by the payer. This reeks of indifference to patients,” Caplan said, adding the testimony shows there “needs to be more transparency and accountability” from private, for-profit insurers in making these decisions.
Murphy, the former American Academy of Allergy Asthma and Immunology board member, said he was “shocked” and “flabbergasted” by the medical director’s admission.
“This is something that all of us have long suspected, but to actually have an Aetna medical director admit he hasn’t even looked at medical records, that’s not good,” said Murphy, who runs an allergy and immunology practice west of Philadelphia.
“If he has not looked at medical records or engaged the prescribing physician in a conversation — and decisions were made without that input — then yeah, you’d have to question every single case he reviewed.”
Murphy said when he and other doctors seek a much-needed treatment for a patient, they expect the medical director of an insurance company to have considered every possible factor when deciding on the best option for care.
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“We run into the prior authorization issues when we are renewing therapy, when the patient’s insurance changes or when an insurance company changes requirements,” he said.
“Dealing with these denials is very time consuming. A great deal of nursing time is spent filling and refilling out paperwork trying to get the patient treatment.
“If that does not work, then physicians need to get involved and demand medical director involvement, which may or may not occur in a timely fashion — or sometimes not at all,” he said. “It’s very frustrating.”

2018 in review … what killed us

who will not be here tomorrow

2016 in review … what killed us

2017 in review … what killed us

 

6775 Americans will die EVERY DAY – from various reasons

2700 people  WILL ATTEMPT SUICIDE

140 will be SUCCESSFUL – including 20 veterans

270 will die from hospital acquired antibiotic resistant “bug” because staff won’t properly wash hands and/or proper infection control.

350 will die from their use/abuse of the drug ALCOHOL

1200 will die from their use/abuse of the drug NICOTINE

1400 will contract C-DIF from Hospital or Nursing home because staff doesn’t properly wash their hands are adhere to infection control  

80 WILL DIE mostly elderly.

850 will die from OBESITY

700 will die from medical errors

150 will die from Flu/Pneumonia

80 will die from Homicide

80 will die in car accidents

70 From ALL DRUG ABUSE

http://www.romans322.com/daily-death-rate-statistics.php

Here is the list from the end of 2016 if interested in comparing
United States of America
RealTime
CURRENT DEATH TOLL
from Jan 1, 2018 – Dec 31, 2018 (6:27:30 PM)


Someone just died by: Death Box

Just the Data … Raw and Undigested


Abortion *: 1091318
Heart Disease: 613959
Cancer: 591325
Tobacco: 349779
Obesity: 306806
Medical Errors: 251295
Stroke: 133019
Lower Respiratory Disease: 142853
Accident (unintentional): 135967
Hospital Associated Infection: 98937
Alcohol *: 99937
Diabetes: 76440
Alzheimer’s Disease: 93482
Influenza/Pneumonia: 55192
Kidney Failure: 42735
Blood Infection: 33443
Suicide: 42746
Drunk Driving: 33787
Unintentional Poisoning: 31738
All Drug Abuse: 24989
Homicide: 16788
Prescription Drug Overdose: 14991
Murder by gun: 11486
Texting while Driving: 5985
Pedestrian: 4997
Drowning: 3913
Fire Related: 3498
Malnutrition: 2770
Domestic Violence: 1459
Smoking in Bed: 780
Falling out of Bed: 598
Killed by Falling Tree: 149
Lawnmower: 68
Spontaneous Combustion: 0
Your chance of death is 100%. Are you ready?

Totals of all categories are based upon past trends documented below.


Sources:
http://www.cdc.gov/nchs/fastats/deaths.htm
http://www.cdc.gov/nchs/data/hus/hus15.pdf#019
http://www.cdc.gov/nchs/data/nvsr/nvsr60/nvsr60_04.pdf
http://www.druglibrary.org/schaffer/library/graphs/graphs.htm
http://www.alcoholalert.com/drunk-driving-statistics.html
http://www.cdc.gov/nchs/fastats/suicide.htm
http://wonder.cdc.gov/wonder/prevguid/m0052833/m0052833.asp
http://www.cdc.gov/motorvehiclesafety/Pedestrian_Safety/factsheet.html
http://www.cdc.gov/HomeandRecreationalSafety/Water-Safety/waterinjuries-factsheet.html
http://www.nfpa.org/categoryList.asp?categoryID=953
http://www.dvrc-or.org/domestic/violence/resources/C61/
http://www.time.com/time/magazine/article/0,9171,1562978,00.html
https://s3.amazonaws.com/s3.documentcloud.org/documents/781687/john-james-a-new-evidence-based-estimate-of.pdf