Medicare Payment Cuts Advised For Many ERs That Aren’t Inside Hospitals

The woman arrived at the emergency department gasping for air, her severe emphysema causing such shortness of breath that the physician who examined her immediately put her on a ventilator to help her breathe.

The patient lived across the street from that suburban Denver ER. The facility wasn’t physically located at a hospital, says Dr. David Friedenson, the physician who took care of her that day. But it was affiliated with a hospital several miles away — North Suburban Medical Center.

Free-standing emergency departments have been cropping up across the U.S. in recent years and now number more than 500, according to the Medicare Payment Advisory Commission, an agency that reports to Congress.

Often touted as more convenient, less crowded alternatives to hospitals, these ERs often attract suburban walk-in patients with good insurance whose medical problems are less acute than those who visit an emergency room that’s inside a hospital.

If a recent MedPAC proposal is adopted, however, some providers predict that the free-standing facilities could become scarcer.

Propelling the effort are concerns that MedPAC’s payment for services at these places is higher than it should be, since the patients who visit them are sometimes not as severely injured or ill as those at hospital-based ERs.

The proposal would reduce Medicare payment rates by 30 percent for some services at hospital-affiliated, free-standing emergency departments that are located within 6 miles of an emergency room within a hospital.

“There has been a growth in free-standing emergency departments in urban areas that does not seem to be addressing any particular access need for emergency care,” says James Mathews, executive director of MedPAC. The convenience of a neighborhood ER may even induce demand, he says, calling it an “if you build it, they will come” effect.

Emergency care is more expensive than a visit to a primary care doctor or urgent care center, in part because ERs have to be on standby 24/7, with expensive equipment and personnel ready to handle serious car accidents, gunshot wounds and other trauma cases.

Even though free-standing ERs have lower standby costs than hospital-based facilities, they typically receive the same Medicare rate for emergency services.

The Medicare facility fee payments, which include some ancillary lab and imaging services, but not reimbursement to physicians, are designed to help defray hospitals’ overhead costs.

The proposal would affect only payments for Medicare beneficiaries. But private insurers often consider Medicare payment policies when setting their rules.

According to a MedPAC analysis of five markets — Charlotte, N.C., Cincinnati, Dallas, Denver and Jacksonville, Fla. — 75 percent of the free-standing facilities were located within 6 miles of a hospital that has an ER. The average drive time to the nearest hospital was 10 minutes.

Overall, the number of outpatient ER visits by Medicare beneficiaries increased 13.6 percent per capita from 2010 to 2015, compared with a 3.5 percent growth in physician visits, according to MedPAC. (The reported data doesn’t distinguish between conventional and free-standing emergency facility visits.)

“I think [the MedPAC proposal] is a move in the right direction,” says Dr. Renee Hsia, a professor of emergency medicine and health policy at the University of California, San Francisco, who has written about free-standing emergency departments.

“We have to understand there are limited resources, and the fixed costs for stand-alone EDs are lower,” Hsia says.

But hospital representatives say the proposal could cause some free-standing ERs to close their doors.

“We are deeply concerned that MedPAC’s recommendation has the potential to reduce patient access to care, particularly in vulnerable communities, following a year in which hospital EDs responded to record-setting natural disasters and flu infections,” says Joanna Hiatt Kim, vice president for payment policy at the American Hospital Association.

Independent free-standing emergency departments — those not affiliated with a hospital — would not be affected by the MedPAC proposal. Those facilities, which make up about a third of all free-standing emergency facilities, aren’t clinically integrated with a hospital and can’t participate in the Medicare program.

The MedPAC proposal will be included in the group’s report to Congress in June.

Proponents of stand-alone emergency facilities say they often provide lifesaving care, even without a clientele of acute trauma patients.

Friedenson says, for example, that being able to avoid the 15- to 20-minute drive to the main hospital made a critical difference for his emphysema patient.

“By stopping at our emergency department, I truly think her life was saved,” he says.

Source: Medicare Payment Cuts Advised For Many ERs That Aren’t Inside Hospitals : Shots – Health News : NPR

That freestanding emergency room is probably not in-network, no matter what the website says | Health Care | Dallas News

A Texas law aimed at protecting patients from shocking medical bills after visits to free-standing emergency rooms may not be reducing consumer confusion as intended.

The law, which went into effect in September, requires the ERs to say on their websites and at their facilities whether they are in-network or out-of-network for insurance carriers.

“I wanted it to be crystal clear,” said state Rep. Tom Oliverson, R-Cypress, who introduced the bill last year. It seemed to garner near unanimous support from trade, consumer and insurance groups.

But now — six months after the law took effect — a survey of dozens of free-standing emergency room websites finds that the required disclosures are confusing at best, and misleading at worst.

That is, if the language is there at all. on said.

By February, some sites had posted only a description of the HB 3276 law. Others displayed logos of insurers that they “accept,” which is not the same as being in-network from a billing perspective. And many pointed to the fact that they “always” bill at in-network rates.

Whether or not this language is what the law intended, depends on whom you ask. Oliverson, for one, doesn’t think so.

“A patient trying to avoid a large surprise medical bill needs to know is this an in-network facility or is it not. Period,” he told The Dallas Morning News.

That sentiment was echoed by a Keller woman who was hit by a big bill at a free-standing facility in August 2016.

“I want to know am I covered? How much is this going to cost me?” Lou Marchant, told NBC 5 (KXAS-TV) after reviewing a few of the websites this month, including the one she originally visited.

“When I read this, they’re really not telling you what things are going to cost. It is such a challenge and you don’t feel like you have any champion on the consumer side.”

If a free-standing ER doesn’t post the required in-network notice, it risks losing its license.

But, the state agency that is supposed to be monitoring compliance has only checked 10 of the more than 200 facilities in Texas. Officials say they have seen no problems.

And the operators of free-standing emergency rooms and the trade organization that represents them in Texas say that state laws are clear. They stand by the descriptions they post.

“All emergency care claims should be processed at the in-network benefit level,” said Brad Shields, executive director of the Texas Association of Freestanding Emergency Centers.

“If processed properly by the health insurance company, the patient responsibility shouldn’t be any different, whether that facility is in-network or out-of-network,” he said.

State of confusion

A free-standing emergency room is a facility that is structurally separate from a hospital and offers emergency care services. While some are affiliated with larger hospitals systems, many are run by independent operators and are not a part of a health care system.

Insurance companies negotiate reduced rates for providers in the networks of hospitals and clinicians they form. Frequently free-standing ERs are not included. So patients who go to them could face higher out-of-pocket expenses, and get billed the balance of what the insurer doesn’t pay.

Insurers in Texas are required to pay the in-network rate for any emergency care. As Shields of TAFEC notes, a medical emergency isn’t the right time to stop and ask about the status of the insurance plan a person has chosen.

“The most important thing in a time of emergency is seeking care as quickly as possible. And the statutes in Texas protect the patient,” he said.

But it’s sometimes hard for patients to know whether their symptoms are emergencies; which is why they seek expert help in the first place. And that’s what may send the patient to an emergency room when they probably should have gone to an urgent care facility instead.

That’s why it’s important to know who is in network, consumer advocates say.

Blake Huston, associate state director of advocacy for AARP of Texas, warns people to be wary of phrases like “we accept your insurance” and “we take your insurance.” Even though out-of-network facilities will make an an attempt to seek reimbursement from insurers, payment is not guaranteed.

“What they’re not saying is that no matter what the insurance pays, that free-standing ER still has the right to hit you with a surprise medical bill because they are out of network,” Huston said.

“If they were in-network, they wouldn’t have that right.”

Since words matter, the language used should help consumers make distinctions, and not just be marketing tools to bring in new business, said Stacey Pogue, a senior analyst for the Center for Public Policy Priorities.

“Consumers want to know: Am I going to pay more than I expect based on the terms of my insurance?” she said. “But none of the words they use drill down to that. You can have technically correct language that is still confusing.”

Keeping them accountable

The Texas Health and Human Services Commission, which licenses the stand-alone facilities, has inspected 15 free-standing facilities since the new law took effect.

Despite language that Oliverson calls misleading, HHS has not cited any for deficiencies.

“We generally try to work with facilities to get them into compliance,” the agency said in an emailed statement. “We welcome consumer complaints and if any facility is not compliant with the law, we would want to know about it.”

But visitors may not realize that language is a problem until after a visit, when the bill arrives.

Advertisements can exacerbate that issue.

For example, one Houston free-standing emergency room encourages patients who are “feeling under the weather” to come in for flu tests.  Meanwhile, the Centers for Disease Control and Prevention says only people with more severe flu symptoms should go to the emergency room. That can include fever, rash, difficulty breathing and bluish skin in children, and chest or abdominal pain, confusion and persistent vomiting in adults.

Consumers are often told to check ahead of time  to make sure that a free-standing facility is included in the network of the health insurance plans they have.

At least one company updated its website only after The Dallas Morning News pointed out that language required by law was missing.

But even when the language is there, it can be confusing. And consumers don’t always get straight answers.

“I presented my insurance card, and I said, ‘You take my insurance, correct?’ and they said, ‘Oh yeah, we take your insurance,’” Marchant, a 60-year old account executive, told NBC-5.

In 2016, she received a $4,325 bill when she went in for pain caused by an intestinal issue. But when NBC5 started making calls, the facility decided to take care of Marchant’s bill

Likewise, The News made calls to several local facilities to find out if they were in-network for Blue Cross and Blue Shield PPO.

When the question was posed to the Frontline Emergency Room on Gaston Avenue, the person who answered first said all insurance was accepted. When pressed, the employee said the facility charges the in-network rate. The third time, the person said yes, the facility was in-network. When contacted, Blue Cross said that the facility is not in its network.

Marcus Gurske, director of communications for Frontline, later reviewed the call, which the emergency room had recorded for quality assurance.

He said in response that although Frontline does not have an agreement with Blue Cross, a separate Texas law, HB 425, requires all emergencies be billed in-network, and that therefore the staffer was correct.

“If you’re having a medical emergency, we can’t turn you away. Your care is always in-network,” he argued. But when pressed on whether that would be confusing for an everyday Texan who calls ahead and could opt to skip Frontline and go to a hospital emergency room — one that does have a network agreement with an insurer — he backpedaled.

“He should have just said no. But this is a flaw in the system,” Gurske said. “Unless you’re standing at the front desk, we can’t make that call.”

In other words, a facility can’t decide if insurance will be billed at an in-network rate until after it’s determined that you’re having an emergency.

What’s next?

Consumer advocates say they are checking into whether Oliverson’s legislation, which required clarity on facilities’ in-network status, is effective or needs to be even stronger.

Jamie Dudensing, CEO of the Texas Association of Health Plans, called it “an important step in the right direction” but said more can be done to make health care prices transparent.  There is incentive to remain out of network when a patient can be balance billed for more money, she said.

The AARP of Texas says it plans to do its own investigation before the end of the year.

“We need to take another look to make sure consumers aren’t purposefully misled,” Hutson said.

And Oliverson said he’s following up with HHS about its process for evaluating compliance.

“I just wanted [consumers] to see a sign that clearly identified that the facility either was an in-network provider and with whom, or that they were not in network with anyone,” he said.

“Any additional verbiage that we add to that confuses patients. The enforcement agency side of this is probably going to have to police it,” Oliverson said.

Source: That freestanding emergency room is probably not in-network, no matter what the website says | Health Care | Dallas News

State legislator wanted to help freestanding ER patients avoid shocking bills— but is his law working?

A Texas law aimed at protecting patients from shocking medical bills after visits to freestanding emergency rooms may not be reducing consumer confusion as intended.

The law, which went into effect in September, requires the ERs to say on their web sites and at their facilities whether they are in-network or out-of-network for insurance carriers.

“I wanted it to be crystal clear,” said state Rep. Tom Oliverson, R-Cypress, who introduced the bill last year. It seemed to garner near unanimous support from trade, consumer and insurance groups.

But now — six months after the law took effect — a survey of dozens of freestanding emergency room websites finds that the required disclosures are confusing at best, and misleading at worst.

That is, if the language is there at all.

“It’s not exactly what I had in mind,” Oliverson said.

By February, some sites had posted only a description of the HB 3276 law. Others displayed logos of insurers that they “accept,” which is not the same as being in-network from a billing perspective. And many pointed to the fact that they “always” bill at in-network rates.

Whether or not this language is what the law intended, depends on whom you ask. Oliverson, for one, doesn’t think so.

“A patient trying to avoid a large surprise medical bill needs to know is this an in-network facility or is it not. Period,” he told The Dallas Morning News.

That sentiment was echoed by a Keller woman who was hit by a big bill at a freestanding facility in August 2016.

“I want to know am I covered? How much is this going to cost me?” Lou Marchant, told NBC 5 (KXAS-TV) after reviewing a few of the websites this month, including the one she originally visited.

“When I read this, they’re really not telling you what things are going to cost. It is such a challenge and you don’t feel like you have any champion on the consumer side.”

If a freestanding ER doesn’t post the required in-network notice, it risks losing its license.

But, the state agency that is supposed to be monitoring compliance has only checked 10 of the more than 200 facilities in Texas. They say they have seen no problems.

And the operators of freestanding emergency rooms and the trade organization that represents them in Texas say that state laws are clear. They stand by the descriptions they post.

“All emergency care claims should be processed at the in-network benefit level,” said Brad Shields, executive director of the Texas Association of Freestanding Emergency Centers.

“If processed properly by the health insurance company, the patient responsibility shouldn’t be any different, whether that facility is in-network or out-of-network,” he said.

State of confusion

A freestanding emergency room is a facility that is structurally separate from a hospital and offers emergency care services. While some are affiliated with larger hospitals systems, many are run by independent operators and are not a part of a health care system.

Insurance companies negotiate reduced rates for providers in the networks of hospitals and clinicians they form. Frequently freestanding ERs are not included. So patients who go to them could face higher out-of-pocket expenses, and get billed the balance of what the insurer doesn’t pay.

Insurers in Texas are required to pay the in-network rate for any emergency care. As Shields of TAFEC notes, a medical emergency isn’t the right time to stop and ask about the status of the insurance plan a person has chosen.

“The most important thing in a time of emergency is seeking care as quickly as possible. And the statutes in Texas protect the patient,” he said.

But it’s sometimes hard for patients to know whether their symptoms are emergencies; which is why they seek expert help in the first place. And that’s what may send the patient to an emergency room when they probably should have gone to urgent care instead.

That’s why it’s important to know who is in network, consumer advocates say.

Blake Huston, associate state director of advocacy for AARP of Texas warns people to be wary of phrases like “we accept your insurance” and “we take your insurance.” Even though out-of-network facilities will make an an attempt to seek reimbursement from insurers, payment is not guaranteed.

“What they’re not saying is that no matter what the insurance pays, that freestanding ER still has the right to hit you with a surprise medical bill because they are out of network,” Huston said.

“If they were in-network, they wouldn’t have that right.”

Since words matter, the language used should help consumers make distinctions, and not just be marketing tools to bring in new business, said Stacey Pogue, a senior analyst for the Center for Public Policy Priorities.

“Consumers want to know: Am I going to pay more than I expect based on the terms of my insurance?” she said. “But none of the words they use drill down to that. You can have technically correct language that is still confusing.

Keeping them accountable

The Texas Health and Human Services Commission, which licenses the stand-alone facilities, has inspected 15 freestanding facilities since the new law took effect.

Despite language that Oliverson calls misleading, HHS has not cited any for deficiencies.

“We generally try to work with facilities to get them into compliance,” the agency said in an emailed statement. “We welcome consumer complaints and if any facility is not compliant with the law, we would want to know about it.”

But visitors may not realize that language is a problem until after a visit, when the bill arrives.

Advertisements can exacerbate that issue.

For example, one Houston freestanding emergency room encourages patients who are “feeling under the weather” to come in for flu tests.  Meanwhile, the Centers for Disease Control says only people with more severe flu symptoms should go to the emergency room. That can include fever, rash, difficulty breathing and bluish skin in children, and chest or abdominal pain, confusion and persistent vomiting in adults.

Consumers are often told to check ahead of time to make sure that a freestanding facility is included in the network of the health insurance plans they have.

At least one company updated its website only after The Dallas Morning News pointed out that language required by law was missing.

But even when the language is there, it can be confusing. And consumers don’t always get straight answers.

“I presented my insurance card, and I said, ‘You take my insurance, correct?’ and they said ‘Oh yeah, we take your insurance,’” Marchant, a 60-year old account executive, told NBC-5.

In 2016, she received a $4,325 bill when she went in for pain caused by an intestinal issue. But when NBC5 started making calls, the facility decided to take care of Marchant’s bill

Likewise, The News made calls to several local facilities to find out if they were in-network for Blue Cross and Blue Shield PPO.

When the question was posed to the Frontline Emergency Room on Gaston Avenue, the person who answered first said all insurance was accepted. When pressed, the employee said the facility charges the in-network rate. The third time, the person said yes, the facility was in-network. When contacted, Blue Cross said that the facility is not in its network.

Marcus Gurske, director of communications for Frontline later reviewed the call, which the emergency room had recorded for quality assurance.

He said in response that although Frontline does not have an agreement with Blue Cross, a separate Texas law, HB 425, requires all emergencies be billed in-network, and that therefore the staffer was correct.

“If you’re having a medical emergency, we can’t turn you away. Your care is always in-network,” he argued. But when pressed on whether that would be confusing for an everyday Texan who calls ahead and could opt to skip Frontline and go to a hospital emergency room — one that does have a network agreement with an insurer — he backpedaled.

“He should have just said no. But this is a flaw in the system,” Gurske said. “Unless you’re standing at the front desk, we can’t make that call.”

In other words, a facility can’t decide if insurance will be billed at an in-network rate until after they decide if you’re having an emergency

What’s next?

Consumer advocates say they are checking into whether Oliverson’s legislation, which required clarity on facilities’ in-network status, is effective or needs to be even stronger.

Jamie Dudensing, CEO of the Texas Association of Health Plans called it “an important step in the right direction” but feels more can be done to make health care prices transparent.  There is incentive to remain out of network when a patient can be balance billed for more money, she said.

The AARP of Texas says it plans to do its own investigation before the end of the year.

“We need to take another look to make sure consumers aren’t purposefully misled,” Hutson said.

And Oliverson said he’s following up with HHS about its process for evaluating compliance.

“I just wanted [consumers] to see a sign that clearly identified that the facility either was an in-network provider and with whom, or that they were not in network with anyone,” he said.

“Any additional verbiage that we add to that confuses patients. The enforcement agency side of this is probably going to have to police it,” Oliverson said.

Source: State legislator wanted to help freestanding ER patients avoid shocking bills— but is his law working? | Health Care | Dallas News

CDC- GUIDELINE FOR PRESCRIBING OPIOIDS FOR CHRONIC PAIN

CDC’s Guideline for Prescribing Opioids for Chronic Pain is intended to improve communication between providers and
patients about the risks and benefits of opioid therapy for chronic pain, improve the safety and effectiveness of pain
treatment, and reduce the risks associated with long-term opioid therapy, including opioid use disorder and overdose.
The Guideline is not intended for patients who are in active cancer treatment, palliative care, or end-of-life care.

https://www.cdc.gov/drugoverdose/pdf/Guidelines_Factsheet-a.pdf

Are patient satisfaction surveys fueling  dependence on pain killers?

If you’ve spent time as a hospital patient, you may recall receiving a survey about your experience. It turns out your answers can impact how much the hospital is paid and, in some cases, even what your doctor earns.

The government-mandated “patient satisfaction survey” is meant to reward quality and effective care, but some doctors say it has had an unintended consequence: fueling Americans’ dependence on prescription pain pills.

We met Dr. Mark Woodard in the ER at Bristol Regional Medical Center in eastern Tennessee. Appalachia is ground zero for in the country’s opioid abuse crisis. Two million Americans are hooked on pain pills, and overdoses kill more people than gun homicides, reports CBS News’ Brook Silva-Braga.

Woodward said he sees people seeking drugs on every shift.

“I mean, two or three today,” he said.

But turning away drug-seekers can be bad for business, some doctors told us, in part because of the rise of patient satisfaction surveys. In addition to asking if the nurses are polite and the hospital is clean, the survey has questions like: “How often did the hospital staff do everything they could to help you with your pain?”

Twenty-eight percent of doctors are paid bonuses based on patient satisfaction, according to the industry group physicians practice, and hospitals with better scores get bigger payments from Medicare and Medicaid.

Drs. Dana Barlow, Rimon Ibrahim and Joe Smiddy have practiced medicine in Appalachia for a combined 98 years and say more and more of their patients have become addicted.

“It’s getting worse year after year,” Ibrahim said.

Barlow said pressure on hospitals to score well led to pressure on doctors, including him, to prescribe opioids.

“How does that conversation go?” Silva-Braga asked.

“It goes basically, ‘We want to make sure that everybody in the emergency department is happy and their pain is relieved and so you need to do that,’” Barlow said.

“Do they say, ‘Let’s get the scores up?’”

“They tell you to get the scores up, yeah. I’ve seen physicians fired because of not adequately addressing pain management,” Barlow said.

Researchers at the University of Wisconsin found one in five doctors reported their jobs had been threatened over the scores. Some of them have ended up looking for work at the clinic Dr. Smiddy runs.

“We see physician applicants… who have lost their previous job because of the prescribing habits that were placed upon them that they weren’t comfortable with in a previous job,” Smiddy said.

In response to similar concerns, Medicare and Medicaid will stop paying hospitals based on their pain scores beginning October 1. But many hospitals will still use the scores to rate their doctors, using reports created by private survey companies.

Dr. Jim Merlino is the president of strategic consulting for the biggest of those companies, Press Ganey. He said comparing physicians makes doctors more accountable.

“Let’s say you’re a physician that doesn’t believe in giving a lot of pain medication. Are you going to allow a patient to sit in bed writhing in pain? Would you allow that? I wouldn’t. I would want to know as a provider or as a leader of a group or a hospital if that was happening to my patients,” Merlino said.

“So you do think its fine for doctors to be compared to other doctors based on these scores?” Silva-Braga asked.

“I think getting data points out to physicians is important, yes,” Merlino said.

Back in Tennessee, Woodard, who leads a group of ER doctors, has negotiated a compromise with his hospital. When patient satisfaction bonuses are calculated, questions on pain are stripped out.

“Why would you care about not being graded on pain? What difference would it make if you were?” Silva-Braga asked.

“Well, because it would put us under pressure. … Do I write this patient a small amount of narcotics where they’ll be happy with me and give me a good score where I can either keep my job or get a financial bonus? I think human nature says you’re under pressure to do that,” Woodard said.

Doctors groups told us those types of arrangements that ignore the pain questions are becoming more common. But with no national rules about how the scores are used it remains a hospital-by-hospital decision what to do about doctors with low pain management scores.

Source: Opioid epidemic: Are patient satisfaction surveys fueling America’s dependence on pain killers? – CBS News

Pain Management Survey Questions Will No Longer Impact Inpatient CMS Hospital Reimbursement Rates – AOTA

On October 1, 2017, the Centers for Medicare & Medicaid Services (CMS) announced they will no longer use results from the pain management portion of the Hospital Consumer Assessment of Health Providers and Systems (HCAHPS) survey to impact reimbursement rates from the Hospital Value-Based Purchasing (VBP) program*. The Department of Health and Human Services (HHS) determined pain management questions may financially incentivize inpatient hospitals to overprescribe opioids in an effort to eliminate pain and improve survey results.

HHS intends to replace the current questions with questions targeted toward pain management communication similar to those in the Outpatient and Ambulatory Surgery (OAS) CAHPS. HHS will have public comment periods available during development and prior to implementation of the new pain management questions for the HCAHPS. The President’s Commission on Combating Drug Addiction and the Opioid Crisis supported this decision as part of their 56 recommendations released on October 31, 2017.

*For now, the pain management questions will continue to remain a part of the survey sent to patients and will be used when determining scores for the Hospital IQR program, HCAHPS star ratings, and Hospital Compare overall ratings. However, the scores will not impact reimbursements through the VBP program.

Source: Pain Management Survey Questions Will No Longer Impact Inpatient CMS Hospital Reimbursement Rates – AOTA

Fentanyl bust nets enough drugs to wipe out population of Ohio 

Police who busted a fentanyl ring in Columbus, Ohio found enough of the drug to kill the population of the entire city, prosecutors told Fox News.

Investigators ended up finding 4.5 pounds of fentanyl in a drug bust in October, which could have wiped out the city of about 800,000 residents.

But that’s not even close to what was found in the Ohio capital the following month when police seized 20 pounds of pure fentanyl.

“So it would probably be enough to kill all, the entire population in the state of Ohio,” Franklin County Prosecutor Ron O’Brien said.

Ohio has 11.6 million residents and, at 2 to 3 milligrams per lethal dose, the amount of fentanyl discovered in the November bust could potentially kill more than 9 million people.

“Two or three milligrams of fentanyl is not much more than five or six small grains of salt,” O’Brien said.

But the epidemic goes beyond Ohio. Some of the major opioid busts this year could have killed the entire populations of several states.

In New York, officials seized more than 140 pounds of fentanyl in August. The Drug Enforcement Administration said that amount could’ve killed nearly 32 million people — the populations of Texas and Oklahoma combined

In San Diego, close to 100 pounds of fentanyl were seized in June, enough to kill the combined residents of New York, New Hampshire and Maine — 22.4 million people. In St. Louis, nearly 60 pounds of pure fentanyl found in April could have killed 13.6 million people.

O’Brien said he knows the issue of opioid abuse extends beyond his city.

“That’s occurring not only here but across the country,” he told Fox News.

The Center for Disease Control’s latest drug report stated more than 33,000 people died from opioid-related drug overdoses in 2015. Close to 10,000 of them were from synthetic opioids such as fentanyl.

Researchers say the issue has moved beyond prescription opioids.

“We’ve tried to curtail the supply of prescription opioids but that has led users to move to illicit drugs like heroin and fentanyl,” Michael Betz, an assistant professor in the Department of Human Sciences at Ohio State University, told Fox News.

The ongoing battle against the epidemic is costing Ohio residents between $6.6 and 8.8 billion per year, Betz told Fox News.

“That’s roughly what the state of Ohio spends on its education for K through 12,” he said.

Betz said tackling the issue remains a challenge.

“How do you stop illegal supplies of illicit drugs?” he said. “I’m not sure we have many good answers to that right now.”

Source: Fentanyl bust nets enough drugs to wipe out population of Ohio | Fox News

West Virginia calls in National Guard to tackle opioid crisis | Fox News

People expect to see the Army National Guard during disasters.

In Huntington, W.Va., the guard has been called in to help tackle the opioid crisis — which the governor has described as a disaster.

“We have to stop this terrible drug epidemic,” West Virginia Gov. Jim Justice said. “We have to. If we don’t, it will cannibalize us.”

“I don’t think there is a police department in America that has all the resources they need,” Huntington Police Chief Hank Dial said. “It is a complex problem and it needed a complex solution.”

national guard helicopter

The National Guard is flying its Lakota helicopters on reconnaissance missions in coordination with local police, providing eyes in the sky during busts and while serving warrants.  (FOX News)

The guard is flying its Lakota helicopters on reconnaissance missions in coordination with local police, providing eyes in the sky during busts and while serving warrants.

But its primary role is technical and analytical support.

Guardsman, who asked not to be identified, are manning hotlines and working on computers inside Huntington Police Department’s Criminal Investigation Bureau, helping track down dealers and drug networks so cops can focus on the street.

On Wednesday, the guard answered a call that led to the bust of an alleged dealer and the recovery of 430 grams of fentanyl, far more powerful than heroin, with a street value of $86,000.

“We are solving a problem in our country,” said Maj. Gen. James Hoyer, a West Virginia National Guard commander. “And, at the same time, making sure we have the highest level of readiness to respond to something else that may be out there, somewhere else in the world.”

wv national guard 2

In West Virginia, the National Guard’s primary role is technical and analytical support. Guardsman, who asked not to be identified, are manning hotlines and working on computers inside Huntington Police Department’s Criminal Investigation Bureau, helping track down dealers and drug networks so cops can focus on the street.  (Fox News)

U.S. Rep. Evan Jenkins, R-W.V., said this drastic step is needed to make a dent in the raging opioid crisis.

“We have people’s lives at risk,” Jenkins said. “We have horrifically  lost way too many lives as result. It is a bold action but, you know what, we need to take action and we are doing that…”

There will not be Humvees blocking roads or soldiers on the street corners with long guns. But the guard could be deployed in this state for years – funded by the state – as long as cops say they need help.

Source: West Virginia calls in National Guard to tackle opioid crisis | Fox News

Emory hosts community conversation on America’s opioid crisis | Emory University | 

Debra Houry, director of the Centers for Disease Control and Prevention’s National Center for Injury Prevention and Control and a former associate professor in Emory’s Department of Emergency Medicine

  • As an emergency room doctor at Grady Hospital for 15 years, Houry’s views on the opioid epidemic have evolved. “Some say ‘We never saw it coming.’ I will say, ‘I kind of saw it coming,’” she said. Over the years, Houry saw a rise in patients arriving for opioid abuse, addiction issues, substance abuse disorders and referrals for pain management.
  • There are now about 230 million prescriptions for opioids administered in the U.S. on an annual basis. “That’s enough for every single adult to have a bottle of pills around the clock for three weeks,” Houry said. “That’s too much.”
  • About three years ago, Houry took on a CDC project to outline “Opioid Prescribing Guidelines for Chronic Pain,” which has helped decrease opioid prescriptions over the last two years. While the guidelines advocate prescribing non-opioid medications for chronic pain first, “we’re still at three times (opioid prescriptions) what we were at in 1999,” she said. “My concern is we primed the pump, so a lot of people became addicted to prescription pills and have then gone on to misuse heroin and now fentanyl, which we know is just killing people due to its potency.”
  • The CDC is now funding prevention programs across the country that work with health systems to employ syndromic surveillance to help identify non-fatal overdoses in emergency departments. The data are then used to issue health advisories and activate agencies to a quest to prevent fatalities. “My goal is to prevent people from getting addicted in the first place,” she said.

Source: Emory hosts community conversation on America’s opioid crisis | Emory University | Atlanta, GA

Revised HCAHPS Pain Management Questions: What You Need to Know

CMS has proposed removing the current Pain Management composite, which consists of the following three questions.

  • During this hospital stay, did you need medicine for pain?
  • During this hospital stay, how often was your pain well controlled?
  • During this hospital stay, how often did the hospital staff do everything they could to help you with your pain?

They are proposing replacing these questions with a new composite made up of the following three questions, which reflect communication about pain.

  • During this hospital stay, did you have any pain?
  • During this hospital stay, how often did hospital staff talk with you about how much pain you had?
  • During this hospital stay, how often did hospital staff talk with you about how to treat your pain?

The new questions were developed to address concerns expressed by hospitals and physicians that the wording of the current Pain Management composite encourages inappropriate prescribing of opioids. While the available evidence indicates that there is no relationship between opioid prescribing and patient experience scores, the revised pain composite shifts the focus to evaluations of pain and discussions about pain treatment options.

Source: Revised HCAHPS Pain Management Questions: What You Need to Know

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