Hi Steve,

You have been such a help to me. I have an issue of course. As I stated before, I have a perfect cures report etc..I did find a pharmacy to fill my meds but now they won’t fill until 31 days! I am literally running out of medicines. So for example, I am out for 2 days and I pick up on the 2, the HAVE to count that day because I have been out. They are not counting the 31 days in a month. Example, got my meds July 6 they refused to fill until Aug 6. I have a calendar that shows everything. I take 2 oxy a day for 30 days. You can see I ran out. I do not know what to do, if I complain they will just refuse service. If I was a guyI would say they have me by the nuts! Lol.

What the heck do I do. I am a teacher and start school tomorrow. My last fill was July 16and they refuse to fill until aug 16. Any advice? We really have no recourse anymore.

Thank you. I actually have the refill apps. They all say 31 days!These people are Armenian and their English is not really good. I have written everything down in plain English. I totally understand how some count from the day after pick up. day after. I was doing that, and that doesn’t even make sense, but I do it anyways which leads me to my point that now they are filling it late so I go 2 days without so how can they Not count the first day because I have been out of the medication so I have to take the dose the DAY I get the prescription. I am not good at math but I can even figure this out!It makes you want to give up on life. I have done eve7by the book. My dr. Says he is powerless now too. He has called and everything. Steve, I am a teacher and these meds allow me to do my job. I have never ever deviated, asked for early meds etc… please help. I cannot go on with the anxiety this is causing. I live in Burbank, does your friend know of any pharmacy. I go to Glendale. 

Thank you again

The above is from the pharmacy’s computer… the previous Rx was filled on July 16th and indicates that the next due date is Aug 14th… notice that the computer apparently has the ability to be specific of how many days early that the Rx can be filled and it is registering ZERO DAYS EARLY… and the Pharmacist told the pt that she was to wait TWO MORE DAYS… meaning that the pt is INTENTIONALLY going to be thrown into withdrawal. Apparently this Pharmacist’s calendar must have 30 days IN EVERY MONTH…  according to this pt this pharmacist’s ENGLISH is not that good and apparently his MATH is even worse.

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https://www.cnn.com/2018/08/13/health/mayo-clinic-escape-1-eprise/index.html

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Parking Shortage at Washington DC VA Medical Center Has Veterans With Disabilities Walking Hundreds of Feet

https://www.nbcwashington.com/investigations/Parking-Shortage-at-Washington-DC-VA-Medical-Center-Has-Veterans-With-Disabilities-Walking-Hundreds-of-Feet-490860451.html

The Washington DC VA Medical Center is apologizing to its patients for a shortage of accessible parking spaces.

An investigation by the News4 I-Team revealed struggles by patients with disabilities to find parking spaces for medical appointments at the giant medical center.

Video and interviews by the I-Team show patients with severe mobility limitations making long, winding walks through car traffic and small hills to get access to the building.

A man with a cane walking through the medical center parking lot.
Photo credit: NBCWashington

The DC VA Medical Center is the flagship facility in the nationwide health system run by the U.S. Department of Veterans Affairs. It has more than 100,000 patients and approximately 2,000 employees, but parking spaces are limited on the congested campus along Irving Street NW.

A parking garage construction project is expected to add 460 new spaces once it’s completed in March.

In the meantime, patients and staffers told the I-Team parking can be scarce and challenging during peak hours at the medical center.

A visitor got creative.
Photo credit: NBCWashington

“Sometimes if I have a noon appointment, I’ll leave home at 8 o’clock in the morning,” said Jonathan Warwick, a U.S. Army veteran from Gaithersburg, Maryland, who is recovering from a fractured spine and two recently replaced hips.

I-Team cameras captured video of Warwick attempting to walk up a small grassy hill to get access to his car in a parking spot nearly 1,000 feet from the medical center entrance.

Jonathan Warwick
Photo credit: NBCWashington

“One time my foot got stuck and I fell walking there,” Warwick said. “I told my doctor about it.”

An internal VA study of accessibility challenges released under the Freedom of Information Act reveals agency officials were aware of the parking challenges in D.C. “Even for the able bodied it is ‘a hike’ from car to front door,” the study says. “A visitor must walk in the drive aisles through parking lots or on grass around parking lots because the only sidewalks are up at the building perimeter. For disabled patients this is an unacceptable deficiency.”

Army veteran Sequoia Pointer of Waldorf, Maryland, said the valet system offered by the medical center requires patients wait 30 to 60 minutes before they deposit their cars. Pointer uses a motorized scooter as he recovers from the effects of a stroke.

“I give myself two hours (to find parking),” he said. “If I start doing the valet, it’ll be two and a half hours.”

A man with a walker navigates the medical center parking lot.
Photo credit: NBCWashington

In response to questions from the I-Team, an agency spokeswoman said, “We fully understand the frustration veterans and visitors are experiencing when parking at the facility. We offer our sincerest apologies for the inconvenience the Patient and Visitor Parking Garage construction project may cause.”

“In a good way, business is booming at the VA,” said Heather Ansley, acting associate director of Paralyzed Veterans of America. “A lot of veterans go get their care. But that poses some logistical challenges.”

“If there are complications anywhere along the spectrum, you may have people say, ‘I’m not getting the health care that I really need,’” Ansley said.

The VA study released to the I-Team shows parking challenges exist at more than a dozen other VA facilities nationwide. The study shows additional handicapped-accessible parking spaces are needed at medical centers in Beckley, West Virginia; Augusta, Georgia; Nashville, Tennessee; and Ann Arbor, Michigan.

Officials with the Veterans of Foreign Wars said the agency should be advocating for better funding from Congress for its maintenance and medical center upgrades.

“There’s a backlog,” VFW Associate Director Patrick Murray said. “They simply can’t perform all these tasks on a yearly basis. It would involve a major effort to do so.”

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https://youtu.be/x0HINsoVWKY

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Prior authorization rules: Yet another way the health insurance system frustrates physicians and patients

www.healthjournalism.org/blog/2018/08/prior-authorization-rules-yet-another-way-the-health-insurance-system-frustrates-physicians-and-patients/

For patients and physicians, many aspects of the health care and health insurance systems are frustrating and appear to be needlessly complex.

One of the most frustrating processes is prior authorization, the mother-may-I approach health insurers use to ensure that procedures, medications and even certain care processes are appropriate and worthy of coverage.

In a new tip sheet, we explain that for health insurers, providers and patients, prior authorization is not only complex but also highly controversial.

The prior-auth process itself goes by several names including preauthorization, prior approval, precertification, prior notification, prospective review and prior review. As might be expected, physicians suspect health insurers use prior approval to restrict coverage to costly and new services and therapies.

In July, members of the U.S. Senate criticized health insurers for the way they manage requests for prior authorization, according to an article, “Senate Panel Eyes Regulating Insurance Prior Authorizations,” by Susannah Luthi who covers health policy and politics in Congress for Modern Healthcare.

“Lawmakers including Sens. Lisa Murkowski (R-Alaska), Bill Cassidy (R-La.) and Maggie Hassan (D-N.H.) noted that insurers’ verification requirements can place undue burden on patients and physicians while also threatening delays in care,” Luthi wrote.

In the same article, Luthi reported that David Cutler, Ph.D., the Otto Eckstein professor of applied economics in the Department of Economics at the Harvard Medical School, recommended that the federal government standardize prior authorization forms for all insurers.

Standardizing these forms might help eliminate some of the disagreements between physicians and insurers over preapprovals that regularly erupt into public view. In June, for example, a teenager in Massachusetts died of a seizure after being unable to get prior authorization to renew a prescription for her medication.

In February, a former medical director for Aetna said in a sworn deposition that he never looked at patients’ medical records before deciding to approve or deny a prior authorization request. After that story broke, six states said they would investigate Aetna’s prior authorization practices.

Physicians say prior authorization is problematic because it can delay treatment and burdens them with hours of paperwork and time on the phone seeking approval from health insurers and their intermediaries.

Early this year, the health insurance industry and other organizations addressed these criticisms by producing a plan to improve prior authorization and increase timely access to treatment. The organizations agreed to a consensus statement that outlined this plan were America’s Health Insurance Plans (the trade association for health insurers), the American Hospital Association, the AMA, the American Pharmacists Association, the Blue Cross Blue Shield Association, and the Medical Group Management Association.

Another way health insurers are responding to critics is by cutting the number of health care professionals subject to prior authorization requirements based on their performance, adherence to evidence-based medical practices or participation in a value-based agreements with health insurers.

Health care journalists have an opportunity to report on whether any of these changes will improve the prior-authorization process. See our new tip sheet to guide your reporting on prior authorization.

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Place opioid blame where it belongs

https://www.postandcourier.com/opinion/commentary/place-opioid-blame-where-it-belongs/article_0e924542-9ca1-11e8-88e3-6fd45e5a5c25.html

The physicians of the Charleston County Medical Society welcome the attention brought to the rising death rate from opioid overdoses. Concern over the loss of life and impact on our communities has reached the tipping point where action is needed and being demanded. Legislators have answered in kind — over 60 bills have been introduced at the federal level, including some sponsored by our own Sen. Tim Scott. In South Carolina, the governor recently signed nine bills into law with one of the stated goals of the Opioid Emergency Response Team being to “bring down the opioid prescription rate,” as reported in this newspaper.

The liberalized medical prescription of painkillers as mandated in the late 1990s by the independent Joint Commission and federal Centers for Medicare and Medicaid Services put many opioids into circulation, which increased the opportunities for misuse and abuse. Around 2010, law enforcement’s focus on unscrupulous “pill mills” and the bad doctors who ran them marked the peak in number of prescriptions written. Since then, legislation imposing limits on prescriptions and prescriber monitoring programs and sanctions have contributed to a decrease in number of prescriptions written for medical use by nearly 30 percent, with a decrease in 2017 alone of over 12 percent. Legal medical opioid production quotas have been cut by 45 percent by the federal government. Yet, the death toll from all opioids — over 600 last year in South Carolina — continues to climb.

Contrary to the narrative that the current death-by-overdose crisis is the result of doctors over prescribing opioids to our patients in pain are the facts. There is no correlation between the number of prescriptions written and a state’s death rate by opioid overdose. Although the District of Columbia had the lowest prescription rate in the nation in 2016 it had the fourth-highest death rate by overdose; Alabama, with the highest prescription rate had an average death rate. In 2016, just fewer than 5 million opioid prescriptions were filled in South Carolina — about 89 opioid prescriptions per 100 persons compared to the national rate of 70 opioid prescriptions per 100 persons — and the death rate due to opioid overdose was under the national average. Why, then, are so many people dying?

As pharmaceutical grade medical opioids became harder to obtain due to regulatory efforts, sales on the “street” and “dark web” spiked. Predictably, as with any prohibited substance, an alternative market materialized to meet the demand. In this black market, however, the drugs are far more dangerous and of dubious composition. Fentanyl and other synthetic opioids tainting fake prescription tablets, with potencies hundreds to tens of thousands of times more powerful than morphine, along with heroin, are being taken by unsuspecting people who then accidentally die. Importantly, the vast majority of those dying are not those for whom the medicine was legitimately prescribed — it is not our original pain patient who typically goes on to use and then die from illicit drugs. They are her friends and relatives who steal the pills or to whom they are being diverted and who statistically are already more likely to be misusing alcohol, cocaine and other drugs. In fact, most “opioid deaths” involve a combination of several drugs and alcohol.

The overdose rate for medically prescribed opioids for acute pain (such as kidney stones or surgery) is less than 1 percent and around 8 percent for long-term, chronic non-cancer pain management in recent very large studies. The vast majority of chronic pain patients use opioid therapy successfully to be able to function in life. It is evident from many sources that restricting prescriptions does not lower overdose death rates but merely pushes non-medical users to more dangerous drugs. Notwithstanding the evidence, our patients, who are being arbitrarily cut off or having doses limited to insufficient levels for their acute and chronic pain in response to these policies will, literally, suffer.

To be crystal clear, one overdose is a tragedy. However, pinning the blame on legitimate prescriptions for opioids is not evidence based. As doctors, we wholeheartedly support and will participate in professional and public educational efforts, medical alternative therapies for pain, harm reduction efforts and treatment of addiction without stigma or prejudice. However, we believe that the blunt, broad tool of restrictive legislation will not cure the death rate by opioid overdose and is fraught with unintended consequences for our patients. The right medication, in the right dose, for the right duration, for a given condition in an individual patient can only be resolved by the finesse of the doctor-patient relationship.

Marcelo Hochman, M.D., is chairman of the Legislative Committee and president-elect of the Charleston County Medical Society. William Simpson, M.D., is chairman of the Public Health Committee/Opioid Task Force.

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Medicare Finalizes Opioid Restriction Plan That Will Massively Impact Pain Patients

https://www.thefix.com/medicare-finalizes-opioid-restriction-plan-will-massively-impact-pain-patients

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Now Seriously?? So I’m at Walmart buying a bag of dog food. While in the check-out line, a woman behind me asked if I had a dog. Why else would I be buying dog food, RIGHT???
So on impulse I told her that no, I didn’t have a dog. “I’m starting the dog food diet again. I probably shouldn’t because I ended up in the hospital last time. I lost 50 pounds before I woke up in intensive care with tubes coming out of most of my orifices and IVs in both arms.”
I told her that it was essentially a perfect diet. “All you do is load your pockets with food nuggets and simply eat one or two every time you feel hungry. The food is nutritionally complete so it works well, and I am going to try it again.” (I should add that practically everyone in line was now enthralled with my story.)
Horrified, this chick asked if I ended up in ICU because the dog food poisoned me. I told her, “no, I stepped off a curb to sniff a poodle’s ass and a car hit me.” I thought the guy behind her was going to have a heart attack he was laughing so hard.
Now that you’ve read this I have to confess, I copied it. Now copy and share. Make someone else laugh.

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