Bay Area Regional Medical Center Announces Closure | Bay Area Regional Medical Center

Bay Area Regional Medical Center, LLC (Bay Area Regional) a diversified, integrated multi-specialty health care delivery system, today announced the closing of Bay Area Regional and will be filing for bankruptcy next week.

Bay Area Regional invested $200 million during the past five years during construction and operation.  The company continues to work with lenders on an orderly closing process, including the payment of Bay Area Regional’s payroll obligations.

“It is with a heavy heart that I announce that Bay Area Regional will close its doors on May 10, 2018,” Stephen K. Jones, Jr., CEO at Bay Area Regional said in a statement.  “We want to thank our staff who worked tirelessly, physicians who chose to practice medicine and patients who received care at our hospital.”

Bay Area Regional, which opened its doors on July 21, 2014, has been committed to providing exceptional care while making a difference in people’s lives.  Bay Area Regional offered some of the latest technology for physicians to provide advanced diagnostic and treatment techniques. With a pursuit of excellence, Bay Area Regional was recognized for having some of the highest patient satisfaction scores and many different service lines and achieved the highest level Chest Pain Center Accreditation, Comprehensive Center Accreditation for Bariatric Surgery by MBSAQIP, it was the first hospital in Texas achieve Center of Excellence for Hidden Scar Breast Surgery, Primary Stroke Center Accreditation, and a Level III Trauma Designated hospital.

Source: Bay Area Regional Medical Center Announces Closure | Bay Area Regional Medical Center

Pharmaceutical executive apologizes to Congress for role in opioid crisis: ‘I am deeply sorry’

Pharmaceutical executives appeared before Congress on Tuesday to answer questions about a congressional investigation into drug companies’ role in the nation’s opioid epidemic, The Washington Post reports.

A Cardinal Health executive, George Barrett, apologized for his drug company’s slow response to the unprecedented influx of prescription opioids to small towns in West Virginia, while Joseph Mastandrea of Miami-Luken admitted that his company had worsened the opioid crisis.

Current and former leaders of McKesson, AmerisourceBergen, and H.D. Smith are also testifying in front of the House Energy and Commerce Committee. The panel has been probing the pharmaceutical companies in light of discoveries that they shipped 12.3 million doses of hydrocodone and oxycodone to small pharmacies in West Virginia, one of the states that has been hit hardest by the drug epidemic.

Most executives denied that their companies were at fault for the opioid crisis, even as lawmakers expressed anger that the companies hadn’t taken responsibility as their products spiraled out of control, reports The Washington Post. The pharmaceutical industry supplies distributors with medications, but does not prescribe drugs or sell to individual patients. The executives who appeared before the panel Tuesday represent companies that make up more than 85 percent of the country’s prescription drug shipments.

“With the benefit of hindsight, I wish we had moved faster and asked a different set of questions,” said Barrett of Cardinal Health’s lack of action in West Virginia. “I am deeply sorry we did not.”

Source: Pharmaceutical executive apologizes to Congress for role in opioid crisis: ‘I am deeply sorry’

3 types of Drs “GoldiDocs” – Jordan Grumet MD

The GoldiDocs Phenomena

The world consists of three types of doctor.  Three types of doctors who will grace your presence on any given stay in the hospital, foray into the nursing home, or visit to the office.  You might have never given these archetypes a specific name, but they are immediately recognizable.
I’m not talking about medical knowledge or clinical savvy. I’m not pointing to differences in  education or training.
Bedside manner.  We’re talking about bedside manner people!

Dr. Too Grumpy

She storms into the room with her mobile phone glued to her ear.  Or better yet, a blue tooth device.  She spits sarcasm at the invisible nurse on the other end of the line, or medical assistant, or god forbid, patient.
She barely regards you as she types away at the electronic medical record.  Questions are stated, not asked.  Eye contact is minimal, and the exam is brusk.  Mechanical.  There is no discussion, just bald commandments.  Patient centered care and  shared decision making is scoffed at.
She will not describe to you the physiologic underpinnings.  She will not discuss the pros and cons.  And if you dare to delay her from attending to her next patient, she will regard you with scorn and sarcasm.
She is perfectly capable, yet utterly unacceptable.

Dr. Too Nice

He will show his toothy grin as he coos in your ear.  He will say that everything will be alright, even when it won’t. His manner is soothing and infinitely gratuitous.  You are the only one who exists at the moment.  The only one he cares for.
He will give you narcotics if you ask for them.  He will treat your common cold with antibiotics.  The plan is to do what ever it takes for you to like him.  For you to tell all your friends and keep coming back to his office.
He hates confrontation and would rather pander than have an honest, open conversation.  Difficulty is his greatest adversary.  Not illness.  Not well being.
He will tell you exactly what you want to hear.  Hold your hand.  Lie through his teeth.
He is a perfectly nice guy, yet the most dangerous provider you will encounter.

Dr. Just Right

There are, believe it or not, doctors who are both kind and calm, but firm and knowledgeable.  They exist in every hospital, nursing home, and physician office.  They might not be the favorite.  They may upset you from time to time.
They know how to just stand there and do nothing.  When nothing is called for.
They may lecture you on diet and exercise, smoking and alcohol, stress and anxiety.
But you will know them when you see them.
If you see them.

They’re a dying breed.

Please check out my other blog about personal finance here.

Source: In My Humble Opinion

Despite Opioid Crisis, Louisiana May Cut Drug Treatment Options

Louisiana is in the middle of an opioid crisis, but a pervasive state budget shortfall may lead the state to eliminate some drug and alcohol treatment options for people with Medicaid after July 1.

The latest state budget proposal, passed by the Louisiana House, scraps $47 million worth of state and federal funding that pays for outpatient drug and alcohol treatment programs for adults enrolled in Medicaid. In January, 4,600 people were using services paid for with this money that would no longer be available, according to the Louisiana Department of Health.

It could be worse. The original budget proposal considered by lawmakers completely eliminated drug and alcohol treatment for adults with Medicaid after July 1. It scrapped all inpatient and outpatient substance abuse treatment funding — a total of $74 million from state and federal sources.

House members voted to restore some of those cuts however, including all money that goes toward inpatient treatment programs for adults in the Medicaid program. Some outpatient treatment funding, though not all of it, was also restored.

That larger cut proposed earlier in the process may still be on the table though. The Louisiana Senate hasn’t voted on its version of the state budget yet and there are a lot of competing interests for scarce dollars, particularly when it comes to health care.

Louisiana has a $648 million budget shortfall starting July 1. Substance abuse services are vying for money with group homes for people with intellectual disabilities and hospitals that train medical students. The Senate could decide to take some of the funding the House put toward drug treatment and use it for other purposes.

Gov. John Bel Edwards and the Senate leadership would like the Legislature to meet in another special session — after this session ends — to raise or renew taxes to avoid drastic health care cuts. It’s not clear whether the House will agree to do so, however.

The health care cuts would affect drug treatment centers in the New Orleans area, possibly shuttering them for good. Eighty-five percent of the clients at Odyssey House Louisiana, located in New Orleans, have health insurance through Medicaid. Over 90 percent of people treated at Responsibility House in Jefferson Parish are enrolled in Medicaid. Many of those patients would lose their ability to access drug treatment completely through the proposed cuts.

If Louisiana eliminated funding for inpatient drug treatment in the Medicaid program, Edward Carlson, chief executive officer of Odyssey House, anticipates 60 percent of drug treatment facilities around the state would close. Mike Martyn, executive director of Responsibility House, said his center — which serves about 45 inpatient and outpatient clients — wouldn’t be able to operate anymore. His funding would go from about $2.4 million per year to $200,000 per year.

Odyssey House would survive — but it wouldn’t be able to offer most of the substance abuse services it does now.

Its detox center and residential treatment program would shutter. Carlson said it would only survive to offer other types of services — including HIV/AIDS treatment — that it has federal grants to dispense. The number of people it could treat would drop from from around 900 per month to 340 per month and the facility would have to cut 60 percent of its staff, Carlson said.

Odyssey House has the only drug and alcohol detox center in South Louisiana that doesn’t require private insurance and serves people who are poor, according to Carlson. Hospitals in the area do detox sporadically, but most just try to stabilize drug and alcohol users before releasing them.

If a hospital does have to guide someone through detox — which lasts a few days — it can cost seven or eight times what it would at Odyssey House, Carlson said.

Carlson sees the impact of the opioid crisis on a daily basis at Odyssey House. Seven or eight years ago, only about 20 percent of the treatment facility’s client struggled with a heroin addiction. Typically, those people were longtime users. Now, over 60 percent of Odyssey House’s clients are heroin or opioid users — and most of those people were introduced to street drugs after becoming addicted to prescription medication, he said. They are more likely to be a “soccer mom” or other person not typically associated with street drug use.

Odyssey House’s detox center is necessary and in high demand, Carlson said. People line up early in the morning outside the treatment center hoping that a bed opens up for the service.

Some people even overdose in line, while waiting to get into the detox facility, Carlson said. Odyssey House has had to use naloxone — the overdose reversal drug — to revive people while they wait in line on a detox bed more than once. Staff then calls an ambulance to haul them off to the hospital — where they will be stabilized, released again and typically go back to using drugs.

Carlson said Louisiana already does a poor job of managing the opioid problem because it has no coordinated plan to handle the epidemic. Louisiana needs about three times the number of drug treatment beds that it currently has, but the budget cuts would make what is already a bad situation worse, he said.

Source: Despite opioid crisis, Louisiana may cut drug treatment options

Is It Ever OK For Doctors To Lie To Their Patients? -Nana Matoba, M.D

Doctors shouldn’t lie to their patients, even now when the parsing of words and the telling of white lies is common at the highest level of our government. But they do it all the time — sometimes for personal reasons but most of the time for what they believe is the good of their patients.

As a neonatologist and a pediatric cardiologist, we know that truth and honesty are key parts of the foundation of the doctor-patient relationship. “Commitment to honesty with patients” is a primary responsibility for physicians set out in the Charter on Medical Professionalism.

Yet physicians — including us — do lie.

We have said to parents of newborns, “She will sleep through the night,” or, “Your breast milk will come in any day now,” knowing there is a distinct possibility that neither might happen.

We have said to parents with children in the cardiac intensive care unit, intubated and sedated after major heart surgery, “He isn’t in pain; he knows that you’re here,” when we have little idea whether such awareness is possible in states of induced coma and paralysis.

We have said to parents whose infant has features of a lethal genetic abnormality, “She is beautiful and perfect,” when there is nothing else to say.

And we have said to parents who desperately rushed to their dying baby’s bedside, “He is still here,” while placing him in their arms and shutting off the monitor so they can’t see that his heart is no longer beating.

We tell these untruths not to deceive parents, but to offer words that lighten their hearts in moments of despair. We do it, we tell ourselves, to spare their feelings.

But perhaps we sometimes lie for our own sake, and it is our feelings that need to be spared so we can get through the night without breaking down in the call room when all signs indicate the outcome will not be good.

The dilemma is not new.

In 2012, a nationwide survey showed that one-third of the 1,981 physicians sampled said they should not necessarily share serious medical errors with their patients. Two-fifths of the doctors did not disclose their financial relationships with drug and device companies to patients. These sorts of lies are clearly harmful and transparency is necessary.

Some physicians lie to third-party payers to obtain approval for treatments or procedures their patients need. Their willingness to deceive payers varies by disease severity: 58 percent said they would do this for coronary bypass surgery and 35 percent for screening mammography, but just 2.5 percent for cosmetic rhinoplasty — a nose job.

In an imperfect health care system limited by resources, the morality of whether physicians should advance what they believe is in the best interest of their patients above and beyond existing rules and regulations can be debated.

Yet white lies are also problematic. Medical ethicists have argued for decades on the moral distinction between lying and deception, and physicians have long struggled with absolute honesty versus withholding dismal facts.

One study found that more than 55 percent of physicians sometimes or often described a patient’s prognosis in a more positive manner than the facts support. A deception flowchart has been developed to help doctors “who are not absolutist” decide when it is morally acceptable for them to deceive patients.

In reality, the flowchart, or saying “I don’t know,” doesn’t always help. And being brutally honest doesn’t always help families make decisions or guarantee the preferred outcome. We could — and should — dutifully cite statistics of morbidities and mortality to families, such as, “Your child has a 60 percent chance of survival.” As physicians, we may feel that at least they heard the numbers. But for families, survival is a dichotomous yes or no. Giving hope and sometimes describing a prognosis in a more positive manner than the facts might support is the reality of what physicians do.

To be sure, deception that limits an individual’s or a parent’s ability to make informed decisions is reprehensible. Sugar-coating devastating results, or making light of grave situations as if there will be meaningful recovery is also wrong. Patients and their family members must be told results and expectations based on experience and evidence, as honestly and as clearly as a clinician can. But the art of medicine calls upon us to be nuanced and possibly shield them from unnecessary pain.

The foundations of a doctor-patient relationship can remain strong even with “white lies,” as long as our actions are grounded in kindness and we are doing our best for our patients in difficult times.

Source: Is it ever OK for doctors to lie to their patients?

Can Small Practices Adapt to New Payment Plans? – Bill Golden, MD

Even small practices can adapt to new payment models — but they need the right incentives to get going, Bill Golden, MD, medical director of Arkansas Medicaid, said here at the annual meeting of the American College of Physicians.

“We’ve been doing payment transformation in a very often rural state that has ‘onesie-twosie’ practices, often with limited resources,” Golden explained.

Those very small practices have been struggling financially, “dependent on 5-minute visits” for simple conditions such as ankle strains and urinary tract infections, he said. “The profit on that is better than seeing a hypertensive diabetic, which takes 10-15 minutes.”

So a group of payers — public programs such as Medicaid and private insurers including Blue Cross, the state’s largest private payer — started the Health Care Payment Improvement Initiative in 2011 to change the payment system for doctors in the state. “We said, ‘The healthcare system pays for things it shouldn’t pay for, doesn’t pay for things it should pay for, and it’s unsustainable,'” said Golden.

The group started things off in 2012 with an “episodes of care” reimbursement program. The payers calculated a risk-adjusted average cost per case for various conditions. Practices spending below that amount got 50% of the savings; those who spent above that amount had to pay 50% of the overage. “You had to outrun your colleagues, or at least not be in the ‘red zone,'” Golden said. The payers created an online portal so providers could see their data.

“I had doctors come in and say, ‘I’m an ob/gyn.; why am I in the red zone?’ ‘Well, your pathology costs are triple everyone else’s.'” It turned out that the doctor was sending every placenta to pathology because he thought everyone did that.

Another practice had high costs for treating upper respiratory infections because they were over-ordering lab tests and antibiotics; at the same time, their emergency department costs were at the state norm. “So it’s very instructive,” Golden said. But episodes of care don’t work so well with ongoing chronic conditions like hypertension and diabetes.

So the payers also started a primary care medical home program in 2014, and now about 85%-90% of patients are in voluntary medical homes, with 200 practices and 1,000 doctors participating, Golden said. That model involves giving primary care physicians a set per-member-per-month fee to care for the patients in their practice, with $5 per member per month available for risk adjustment.

The payers also told the practices that they would give them an extra per-member-per-month fee for performing additional services. “This money is not for taking home and making a boat payment; this is an investment in your practice, and we expect you to do extra stuff,” said Golden. “And we’re going to give you coaches because we want to raise all boats.”

One thing they asked practices to do was get rid of their answering machines that they used on weekends, telling patients to go to the emergency department with any problems. It worked. “Believe it or not, we no longer have answering machines in our state,” he said.

“After 6 months, we called people to see who still had answering machines — about 15 or 20 still had them; we gave them 6 months to fix it” and if they didn’t do that, they were out of the program. The payers started out with 120 practices the first year, and threw out four or five who “either took the money and did nothing, or they were too disorganized.”

They also asked the practices to see their high-risk patients every 6 months, and to develop care plans for those patients’ conditions, even if they were just a few words (“Hypertension out of control; added beta blocker; will monitor”), Golden explained.

The payers also had a second bucket of money; they told the primary care practices that they would calculate an average per-member-per-year cost, and if a practice came in below that cost it would get 50% of the savings. “If you think about the fact that most primary care doctors are 5% of the healthcare spend but they control 80% of the dollar, and you’re offering to give 50% shared savings on that 75%, suddenly that’s a big relative chunk of change … so that got people’s attention.”

This new program wasn’t without its challenges, however. “Some of these folks were wedded to a high-volume world,” he said. For example, “some people were never getting their HbA1c [tests] for diabetes because they were never seen for diabetes; they always came in for head colds and broken ankles … So we had to change that paradigm.”

Before the program, people were seeing 50-60 patients a day, and they weren’t doing chronic care management. “Now [providers] can make triage decisions, and determine who to see and why,” said Golden. “And you’ve empowered a nurse clinician. In my practice now, [I say to the nurse] ‘I just saw X; please make sure she understood what’s going on, and make sure she gets to her orthopedist.’ I think it’s just more talking to a team as opposed to being a guy or gal with sneakers running between rooms. They’re using their time more wisely.”

As of 2015, the latest data available, the payers had given out $14 million in per-member-per-month payments, paid out about $13 million in shared savings, and avoided $27 million in costs on an inflation basis.

And the practices have done interesting things with their money, he added. “When some of the bonus checks went out, one practice gave bonus checks to front desk clerks; they said they were instrumental in keeping the flow going.”

Source: Can Small Practices Adapt to New Payment Plans? | Medpage Today

Treating Outpatients Like Inpatients- by Fred N. Pelzman, MD

Every action that is taken, especially when it comes to healthcare, has ripple effects, which often end up being more far more significant than we anticipate, turning that ripple into a tidal wave.

Every time somebody besides actual healthcare providers steps into the mix and tell those of us taking care of patients that there is “something else that we have to do,” we often see it open up a proverbial can of worms that in many cases we didn’t want opened.

Whenever government regulators, hospital administrators, the makers of electronic health records, or bureaucrats from insurance companies, come up with creative new things they’d like us to measure or insist that we do, this usually leads to an increase in the burdens on an already stressed-out and burned-out healthcare community. And it often happens in the vacuum of not asking us, the ones right there taking care of patients, whether this is really worth it, really the right thing to do.

Take for example the well-intentioned addition of pain as the fifth vital sign. This came about in an environment where many people felt that providers were inadequately addressing the patient’s pain, and not using the medications at their disposal (i.e., opiates) freely enough.

I remember our practice getting cited by government regulators making a site visit after reviewing a chart and finding a pain score of 8 listed for a patient, and at a follow-up appointment there was no documentation of why that number had not gone down.

There have been numerous well-written and thoughtful articles recognizing this simple change in the medical record as being a contributor to what we’ve since started to call the opioid crisis in this country.

We created a system where we’re jumping and responding to a click in the chart, a number on a scale, an endless stream of screening questions, performance measures, risk stratification categories, and guidelines.

I’ve written before how the implementation of an accountable care organization at our institution led to a brand-new set of screening questions that someone has decided we are being measured against.

Falls risk, depression screening, blood pressure under control, and being over- or underweight.

Just because someone has decided that these are useful measures to look at, do we really believe that it needs to be done for every patient, and in fact, does knowing the answer really always help us?

By putting this in place, we are essentially agreeing that there is significant evidence that asking this question, getting an answer, and then performing one of the available options is going to make a difference in the future appearance of that event, or avoidance of some future outcome of interest.

Take for instance the falls question built into the electronic health record. This is an automatic default question that pops up once someone is entered in the accountable care organization, and is not based on anything other than their enrollment in Medicare. There is no effort to actually assess whether any particular patient is at increased risk of falls.

In fact, our practice has many patients who are at extremely high risk of falling despite not being over age 65, yet this question is not “available” for them.

And I have many robust 80- and 90-year old patients who I doubt will ever fall down.

“Has the patient experienced a fall in the past 6 months?”

Once the patient screens positive for falls, there are limited options made available for the provider to click to say what they plan to do about this.

These include a promise to change their medications, suggesting that we’ve left them on a medicine that places them at increased risk for falling. Or referring them to physical therapy, assuming that this intervention will prevent future falls.

I’m not saying that these aren’t good things to try, we should all be striving to take medicines that put our patients at risk for falls away from them, and physical therapy could probably help everybody, especially our frail elderly Medicare patients who have fallen in the past year.

Once again, we’re being asked to click a bunch of boxes, the answers to which we don’t always have the right tools to make better, the right team assembled to attack the problems that we’ve uncovered.

When we ask any question or order any test on a patient, we should always be mindful that what comes out the other end is an answer, and we better be prepared to do something with whatever that answer may be.

I’m not saying we shouldn’t be asking, I’m just saying we better make sure we have a healthcare system in place that’s ready to do something about all the answers we get.

Look at the Review of Systems that is built into nearly every encounter between a healthcare provider and a patient.

This is a structured system of inquiry that has been put into place whereby the providers hopes to glean information about symptoms that may not have come up in the patient’s history, or may have come up but need to be further explored.

The shorthand way of asking about these things during, for instance, an annual physical, is the simple question, “So, is anything else bothering you?”

Sometimes this will get a patient to think about their lower back pain, or their problems with urination, or that rash they forgot to mention, but often times, the short question gives you the short answer, “No, everything else is doing okay.”

If you break the Review of Systems out further to the multiple organ systems, you increase your chance of getting more detail, but this comes at a cost of time, as well as more answers to questions that we now may need to pursue further testing and evaluations for.

Constitutional. HEENT. Respiratory. Cardiovascular. Gastrointestinal. Endocrine. Genitourinary. Musculoskeletal. Allergy/Immunology. Neurologic. Hematologic. Psychiatric. Skin.

You can scroll through these systems, working your way up and down the patient’s body with them, again sometimes uncovering new symptoms simply by presenting these large categories to them, but often people will just say “Nope, everything’s okay there.”

But if you really open up Pandora’s Box, and go through what is known as a “detailed review of systems”, the number of questions asked and potentially answered telescopes out very quickly.

For instance, in our electronic medical record, here is the list of review of systems under HEENT:

Congestion. Dental problem. Drooling. Ear discharge. Ear pain. Facial swelling. Hearing loss. Mouth sores. Nosebleeds. Postnasal drip. Rhinorrhea. Sinus pain. Sinus pressure. Sneezing. Sore throat. Tinnitus. Trouble swallowing. Voice change. Eye discharge. Eye itching. Eye pain. Eye redness. Photophobia. Visual disturbance.

I’m short of breath just reading the list, and we haven’t even gotten to the respiratory review of systems, let alone dealing with all those positive responses.

I recently wrote about a new project, looking to start remote patient monitoring, where certain high-risk patients will have a medical device placed in their home that allows for nearly continuous monitoring of their vital signs.

For the most part, I don’t want to measure these things unless there’s something that makes me think they’re going to be significantly out of range and that I can do something about it.

Suddenly, outpatient providers are responsible for huge load of data that was previously collected only on sick inpatients who had a team of nurses watching over them 24 hours a day.

To measure something, to ask a question and get an answer, will make providers feel like we need to be the ones owning responsibility for what that answer tells us.

As healthcare providers we need to be the ones deciding what gets asked, and answered.

And we can’t do it all on our own.

Source: Treating Outpatients Like Inpatients | Medpage Today

I Have To Believe In My One Percent – Dr. Eric Schultz

It’s a rainy Saturday night, and I’m huddled in a doorway, pleasantly buzzed after a few drinks with a beautiful Russian girl I will never see again. The sky is wet iron, tinged with bronze from the reflected light of San Francisco. Rain patters the concrete and nips at the hem of my jeans. The moment is broken when a distinguished man hurries towards me and says:

“Listen, you’ve gotta help me. My name is Roland Chase. I’m from Burbank. I was driving up the coast when I was carjacked. They took my wallet, man.”

His salt-and-pepper beard is shaved very close. Clean leather shoes, but a cheap watch. He’s awfully dry for someone who was carjacked in the rain. Noticing details is part of my training.

“My wife and kids are in the car waiting for me. I called the CHP and they won’t help me. It’s only $12.87 for a can of gas….”

Not 20 bucks; $12.87. Scams work better with specifics. To him I must look like another kid on the town with more cash than sense. I wish I had gray hair to match my years of cynicism.

Clouds pout overhead. An 80 percent chance of downpour, 99 percent chance of scam.

I’m an ER doctor. I trained in the worst neighborhoods of L.A. and Philadelphia. The paramedics would bring me the freshly dead, all gray and blue and colors that people shouldn’t be. I’d pump on their chests to try to bring them back. I’d juice them with adrenaline, shock them with electricity, even cut open their chests to squeeze their hearts back to life.

Dead stays dead. When you don’t take care of your diabetes or your high blood pressure, you’re asking for reprisals. Crack cocaine and Mad Dog are not good bedfellows. With every death, I got weaker, smaller.

But I never lose kids, I used to say. No child dies in my ER. I had to draw a line somewhere.

Baby Jessica was only 11 days old when her parents rushed her in. She was small even for a newborn. I’ve eaten bigger burritos. Her skin was cold, her arms limp at her sides. We put a tube down her tiny throat and pumped in oxygen. We gave her saline and sugar and antibiotics.

She was 12 days old when she died. Her parents stared at me without speaking. The pediatrician, a prim tiny woman who could have been anyone’s favorite aunt, tried to console me. I didn’t stand a chance, she said. One percent at best.

“Sir, can you just help me out with a little something….” Chase pleads with me, pulling at the sleeves of his coat like a junkie. I feel his need burning.

By my final year of training I was burned out. I had lost too many times. I hated medicine. I hated pumping on dead people and I hated trying to take care of idiots who didn’t care for themselves.

It was Christmas Eve when the paramedics rolled Rosalita in while she flailed in the throes of a seizure. She had just had a baby six weeks earlier, and her tear-stained sister told me she had tried to kill herself. If I didn’t figure out what she had taken, her brain would fry in her skull.

Only one small detail of the EKG tracing stood out. It suggested tricyclic antidepressant overdose. I picked up a syringe of sodium bicarbonate: baking soda in water. It was a long shot. Less than one percent.

Rosalita awoke three days later. I watched her take the first steps of her new life. “My legs hurt,” she whined. “Can I have a pain pill?” I would have liked gratitude, but I don’t need it. Every year on Christmas Eve I toast to one less orphan in the world.

Yesterday a gallon of blood drained onto my shoes while I struggled to keep a man alive after he flew off his motorcycle. I still try to convince alcoholics to go to AA, smokers to quit, diabetics to take their insulin. I still scream “Don’t you die on me!” and yet they do. Even children.

I hand $20 to Mr. Ronald Chase, or whatever his name was. He rushes off, his heels clapping wet pavement. Ninety-nine percent chance he’s off to buy a forty or crack or black tar heroin or whatever.

But maybe, just maybe, he’ll fill his gas can and rescue his family from a dark street on a rainy night.

I have to believe in my one percent.

Source: One Percent | California Magazine

Why your next ER visit could cost you more if you have BCBS

A trip to the emergency room could soon become more expensive for some Texans. Starting June 4, the state’s largest health insurance provider, Blue Cross Blue Shield, is changing how it processes ER claims.

The company says the change is for BCBS’s fully insured group and retail HMO members. If you go to an out-of-network ER for something they determine wasn’t serious or for a life-threatening condition, the company says you may be responsible for the total cost.

According to BCBS, the review process for claims after June 4 will be the following:

  • Request medical records and an itemized bill for the claim.
  • BCBS will review each medical record and eliminate inappropriate charges. The member’s symptoms and concerns will be reviewed.
  • Pend – not deny – claims during the review
  • Review each claim using a multi-step process.

A BCBS spokesman said in Texas some members were using ER for things like head lice, thinking it’s more convenient.

According to a national study by RAND Corporation, about 13.7 to 27.1 percent of all emergency department visits could be taken care of at urgent care centers or clinics. They say that could lead to savings of approximately $4.4 billion annually.

The Texas Association of Health Plans released a separate report, analyzing costs at different types of facilities.

According to TAHP, if you have bronchitis, you could spend about $3,000 to receive treatment at an emergency room. But if you saw your doctor, the cost is reduced to $136. At an urgent care, they estimate you’d spend about $167.

But emergency medicine physicians worry the change will deter people from going to an emergency room when they really need it.

“As patient advocates, it’s our duty to speak out and stand up for the patients, especially the ones that are weak and vulnerable,” said Dr. Nicholas Steinour. “When you’re sick, when you’re injured, when you’re concerned, the last thing we want you to do is think about is the insurance company going to help me on this?”

As an example, Steinour talked to us about having a sore throat. If you go to an emergency room with a sore throat, and they determine it’s a respiratory infection, you’ll have to pay for your visit. But he said a sore throat can be a sign of more serious infections.

“Just as likely or potentially likely you could have a peritonsillar abscess or epiglottis that without a trained medical expert looking in your throat, doing the appropriate testing we’re not going to be able to safely exclude,” he said. Steinour explained those conditions, if left untreated, could block your airway.

“When the ambulance sirens are on there’s a reason for that,” he said. “There are many conditions where seconds, minutes, certainly hours, make a huge difference as far as outcomes go. The last thing we want you doing is stalling, calling an insurance company to ask is this OK. That to me is completely inappropriate and really irresponsible.”

Anand Raghunathan is a stroke survivor. He talked to KXAN about why seconds matter in emergency situations.

He said back in 2001, he was in his mid-20’s. He was healthy. But he suffered a stroke. “My right side basically collapsed,” he said.

Raghunathan said his friends took him to an emergency room almost right away, and he doesn’t know what would’ve happened if he waited any longer to go seek medical attention. “Word finding, memory issues… That could’ve been a lot worse had I not gone.”

In six other states, Anthem has already rolled out its “avoidable emergency room policy.”

But there are some exceptions. That includes if a patient is sent by ambulance, when a patient is under the age of 15, lives more than 15 miles from urgent care or is seen on weekend nights or holidays.

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Source: Why your next ER visit could cost you more if you have BCBS – BIGCOUNTRYHOMEPAGE

Drug epidemic ensnares 25-year-old pill for nerve pain

WASHINGTON — The story line sounds familiar: a popular pain drug becomes a new way to get high as prescribing by doctors soars.But the latest drug raising red flags is not part of the opioid family at the center of the nation’s drug epidemic. It’s a 25-year-old generic pill long seen as a low risk way to treat seizures, nerve pain and other ailments. The drug, called gabapentin, is one of the most prescribed medications in the U.S., ranking ninth over the last year, according to prescription tracker GoodRx. Researchers attribute the recent surge to tighter restrictions on opioid painkillers, which have left doctors searching for alternatives for their patients.Those same forces are changing the drugs that Americans abuse, according to experts.“We’re basically squeezing people into other drugs because the prescription opioids are becoming a lot harder to get,” said Dr. Richard Dart, who tracks drug abuse through a national data network owned by the state of Colorado.While prescriptions for opioids like Vicodin and Oxycontin have been falling since 2012, health regulators have seen increased overdoses with unexpected medications, including the over-the-counter diarrhea drug Imodium.The Food and Drug Administration is now studying patterns of prescribing and illicit use of gabapentin and will soon share its findings, said Commissioner Scott Gottlieb.“One of the lessons from this whole opioid crisis is that we probably were too slow to act where we saw problems emerging and we waited for more definitive conclusions,” Gottlieb said. “I don’t want to be sitting here five or 10 years from now lamenting that we didn’t take more aggressive action.”Many doctors aren’t aware of gabapentin’s potential for abuse, particularly among those with a history of misusing drugs, said Rachel Vickers Smith of the University of Louisville.People tracked in her research describe gabapentin as a “cheap high” that is almost “always available.” They report mixing the drug with opioids, marijuana and cocaine to enhance the high, with effects ranging from “increased energy” to a “mellow” numbness.Medical journal articles estimate that between 15 and 25 percent of opioid abusers also use gabapentin. And emerging research suggests combining gabapentin and opioids heightens the overdose risks.Gabapentin, on the market since 1993, has long been considered nonaddictive and is not tracked as closely as riskier drugs like opioids. But calls to U.S. poison control centers show a stark rise in abuse and overdoses.The abuse rate increased nearly 400 percent between 2006 and 2015, according to poison center data analyzed by the RADARS research group within the Denver Health and Hospital Authority, a state-owned health system. The group’s work is funded by drugmakers and government agencies, though they don’t participate in the analysis or publication of the data.In some parts of the U.S., the rise in gabapentin abuse has led to new restrictions and surveillance.Last year, Kentucky became the first state to classify the drug as a “scheduled substance,” placing it among other high-risk medicines subject to extra restrictions and tracking. Gabapentin was detected in a third of fatal overdose cases analyzed by Kentucky medical examiners in 2016.Now, only health professionals registered with the federal government can prescribe the drug and patients are limited to five refills.Ohio, Minnesota, West Virginia and several other states have begun tracking gabapentin through their prescription databases. Ohio took that step after gabapentin became the most dispensed drug in the state. State surveys of drug users also indicated it was “extremely easy to get” with a street price around $1.50 per capsule.Alyssa Peckham, a researcher at Midwestern University in Arizona, believes a more comprehensive federal response is needed, including possibly reclassifying it nationwide. Like others, Peckham says gabapentin is not dangerous on its own, but can be when combined with opioids and other drugs that suppress breathing.Still, there is little consensus about the next steps, or even the scope of the problem.Michael Polydefkis, a neurologist at John Hopkins University who primarily treats seniors with nerve pain, says he has never seen patients deliberately misuse gabapentin.And given recent restrictions on opioids by hospitals, insurers and government authorities, many physicians are wary of limiting any other medicines that can help treat pain. The Center for Disease Control and Prevention’s prescribing guidelines endorse gabapentin as a good choice for nerve pain.But there are questions about how much is being prescribed for proven uses — and to what extent patients are benefiting. A recent review of research by the Cochrane Group confirmed gabapentin’s benefits for several forms of nerve pain, but found little evidence of its effectiveness for more common muscle and joint pain.Historically, the vast majority of prescriptions have been for uses not OK’d by the FDA

Source: Drug epidemic ensnares 25-year-old pill for nerve pain