When healthcare providers end up really being healthcare deniers

I got the email below on Jan 1, 2024.  This pt’s story is not a unique issue. Another example of bureaucrats and politicians attempting to “solve” our fabricated opioid crisis by creating a “one size fits all” on pain management.

After having this blog for 12-13 yrs, I have developed a fairly sizeable network of chronic pain pts, chronic pain advocates, and numerous healthcare practitioners.  I shared this woman’s email with a couple of select people that I believed might be able to STEP UP. And one did:

When a pt’s long term medical records mean nothing when seeing a new practitioner

When everything seemed to start to fall into place for this young lady. This young lady’s pharmacist and the mid-level practitioner who was forcing her to reduce her pain meds had to step in to make sure that things were not going to change the way that this mid-level practitioner wanted things to happen. Here is a video this young lady sent that she personally explains what has happened.

Hi Steve,

I have sent you my story before. I am a single disabled palliative care sick patient in Maine. In September of 2021, my doctor and I were targeted by the assistant attorney general, Michael Miller. We think it was for 2 reasons-he was very effective at getting patients disability, testings, procedures, equipment, etc and because I require a high dose of opiates to physically and mentally function. Dr. Lommler believes Michael Miller made a deal with the insurance companies and profited somehow for taking him out. Michael Miller used at least 2 agencies to target, harass, and destroy us. They suspended Dr. Lommler’s license for going over the 100 MME limit on my prescription. However, Maine has a palliative care exemption that allows people (like me) to have access to opiates for pain control and disease treatment options. It also allows us to go over the 100 MME limit. They refused to lift the suspension unless he transferred to a “board approved” facility. He chose to retire because he wanted to stay at his independent office with his 200 complicated and unique patients. They gave neither one of us any due-process! They used backdoor methods and I believe they were illegal! There was a covering LNP seeing me for a year. We tried to find a doctor everywhere in Maine to see me but because of the Opiate Task Force and doctors getting red-flagged for going over the 100 MME limit and being dragged in front of the board, no one would see me. I was forced to transition to the hospital where all of my specialists are. You see, Maine and New Hampshire were the 2 states prescribing the most Opiates so they created a New England Opiate Task Force and sent them to work with the Governor Mill’s administration to red-flag doctors prescribing over the 100 MME limit and drag them in front of the board of medicine! They have forced independent providers to either retire or transfer to a “board approved” facility. These “board approved” facilities all have anti-opiate one-size-fits-all policies. The hospital that I am at has an anti-opiate provider masquerading as a “pain specialist.” She believes Opiates are life threatening and dangerous to everyone. She is force tapering me off all my pain medication! I am complicated and unique-I have multiple health conditions. I had an original medical nightmare that left me with life altering physical deformities and severe debilitating pain. I have Crohn’s disease, vitamin and bone deficiencies, and neuropathy-all of these cause malabsorption so I have to take double doses of all of my medication! I cannot have the conventional pain management treatments because I am allergic to everything and sensitive to anything and I have a prosthetic heart valve. I have Scoliosis and severe Osteoporosis with dangerously low Scores. I am 46 in an 86 year old’s body.
They are stereotyping anyone on opiates as addicts and forcing them off pain medication. The only option they give you is Suboxone-I cannot take this because the side effects would be catastrophic to my body. I had nothing but recovery and progress with my 8 1/2 year stable pain regimen. I was able to semi function independently with a decent quality of life. Since this provider has been force tapering me, I can no longer function independently at all and I have zero quality of life! According to Maine’s own definition and standards, what this facility and provider are doing to me is disability abuse! I tried to contact patient services for an advocate but was told there wasn’t one. The woman I spoke with for 2 minutes, asked me what my concerns were. I explained to her what was happening to me. 2 days later I received a letter stating my concerns were forwarded to the Medical Director and Operations Manager and they agree with the provider force tapering me. They also said there was no medical justification for my pain medication. I filed a public accommodation discrimination complaint with the Maine’s Human Rights Commission but haven’t heard a word since intake months ago! The letter gave an 800 number to call if you disagreed with their decision. It was the board of licensure telling you to submit a complaint. I already filed a complaint with the board of medicine and nurses months ago. So, you have to go to the same people that are red-flagging and harassing doctors going over the 100 MME limit. I won’t hold my breath! These are the same people that asked Dr. Lommler how he didn’t know that I was taking half of my pain medication and selling the other half! Dr. Lommler provided them with 7 1/2 years worth of passed urine screens and passed frequent random pill counts! I wasn’t even allowed to attend or participate into the investigation into my opiate use-I could’ve answered that question myself-I have never misused my pain medication! In fact, I did everything that I was supposed to do! How in the world can I trust they will help me!
Since this provider has been forcing me off my pain medication, I have had sky high blood pressures-202/129, severe bloody noses, I have been discharged from aquatic therapy-which I needed to get into my Crow Walker boot, I am completely dependent on my sons, I have had to quit tutoring for supplemental income, I can no longer walk on my crutches so I am trapped in my wheelchair, and I cannot mentally or physically function! My counselor and former providers have tried talking with this provider but she refuses to listen because she knows best. I had to spend my Christmas in the ER and I am now watching my right leg and foot do exactly what my left leg and foot did in my original medical nightmare. When my body is in severe stress, my multiple conditions play off of one another and wreak havoc on my body. Last time, the severe stress was an allergic reaction to hardware (we didn’t know why at the time, it took years to figure it out). This time, it is force tapering my pain medication! This time, it’s the providers choice to force taper me because of her personal feelings about a medication! Medical providers are supposed to do what is in the best interest of the patient, not what is in the best interest of their personal feelings! I have cellulitis in my right leg and foot with ulcers everywhere! I maintain my left leg and foot with Cuban for compression. I tried to wrap my right leg and foot but it’s not used to being wrapped, and I get continuous Charley Horses. They are intolerable with all of my pain medication being taken away! I have severe PTSD and zero trust in doctors from my original medical nightmare! I never ever wanted to go back to that sick person trapped in a wheelchair, I thought I left it behind for ever! This time, I don’t have a heart valve to lose! I am petrified and profoundly devastated because I worked so hard for 8 1/2 years to recover and progress and now that has been destroyed! I see people helping doctors that have been arrested but what about people, like me, who have been targeted, harassed, discriminated against, and literally going through disability abuse-who tells our story and helps us?
My counselor gave me a brochure for adult protective services and she told me to call because what they are doing to me is discrimination and disability abuse. I called and the lady said there is no process for this situation. She told me that it does qualify but the only thing I can do is file a complaint with the board of medicine and nurses because they are the only entities that have authority and jurisdiction over medical providers. I told her that I already filed complaints but it will take months because they only meet one day a month! I told her my body won’t make it that long and I asked her, “what if I die in the meantime?” She said, “let’s hope it doesn’t come to that but good luck!” WHAT? It’s like a nightmare that I cannot wake up from! I have contacted every politician in Maine and asked for their help. Crickets…I requested assistance from Governor Mills but she doesn’t even think she has to answer to her constituents. I have reached out to every volunteer lawyer’s projects and disability rights groups but they all claim no to have the resources to help me. I have documented, taken pictures, recorded videos, screenshot messages from my portal between her and I, audio recorded my video appointments exposing her discrimination and disability abuse! I cannot find an attorney in Maine to help me. This provider only saw me one time in person! She never looked at any areas causing my pain, she’s not monitoring my vitals or everything that is happening to me, she doesn’t even have the correct MRI’s-she’s going by a 2008 one when I was a normal person and could walk on my own, and she’s retaliating against me for filing a complaint! I need help and I don’t know where or who to go to! I even have an appointment with cancer care, January 23rd. I have MGUS and the blood work markers and symptoms all point to it turning into Multiple Myeloma. I asked her to please pause the force taper until I can get into my appointment. She said, “Oxycodone will not cure Multiple Myeloma so the force taper will continue!” How cruel is that!
I was hoping that you may have some direction or advice to help me. If I knew how to file a civil lawsuit against the hospital and provider, I would do it myself. Since September of 2021, I have had to be my own advocate, case manager, and attorney!
I already missed about 6 years of my sons’ lives because of my original medical nightmare! I can do no physical activity without my pain medication! I really don’t think my body will make it through this force taper! Opiates are literally life saving for me! They knew that I wouldn’t be able to find another doctor to see me and Michael Miller and the board of medicine took 2 doctors from me! The provider force tapering me filed a complaint against the LNP that saw me for a year. In it, she said that she felt compelled because Kaye endangered my life by prescribing these life threatening and dangerous medications. She also accused me of bribing Kaye in her complaint. That is ludicrous-I have never bribed anyone! Kaye made it very clear in her response that no one forced or bribed her. She also made it clear that I was the only patient she ever prescribed narcotics for in her entire medical career! I have been accused of selling half of my pain medication and bribing doctors! I am a law abiding Mainer and American just trying to live my life!
Thank you for taking your time to read my email. You can reach me any time at xxx.xxx.xxxx

most societies/communities have 1 or more agitators, disruptors, false prophets, scammers, traitors, saboteurs and cult leaders

Some believe our country is on the verge of a Civil War, they may be right, but it won’t be a bilateral war like our last Civil War..  Our society has voluntarily divided itself in – for lack of a better description – TRIBES.

The chronic pain community is not all that different from our country of as a whole.

Recently a fellow chronic pain pt who had been advocating for end stage pediatric pts in a large hospital system that has a “no opiate” policy.  All of a sudden the advocated was told that he was no longer permitted to advocate for these end of life pediatric cancer pts.  I suppose that this major hospital system will return to treating these pediatric pts with NSAIDS and Acetaminophen and let them live the rest of their lives in a torturous level of pain.

There are rumors as to who said what and to whom… I am not going to elaborate. However, they know who they are and what was said to cause this to happen.  One can only imagine the deprived mental status of those who have been involved in this.

Some have told me that this tribe of malcontents have monetized chronic pain pts’- personal information  and several other covert processes. I started my blog in 2012 and have tried to motivate and educate chronic pain pts in some ways that they can navigate their way to getting their pain management back.  Some chronic painers have told me that I should charge for my advice.  My Pharmacy degree, license and career has provided for Barb and myself a comfortable retirement.

After this issue with these end of life pediatric pts,  Going forward… I am going to ASK of people that want my advice to make a contribution to one of the four national charities listed below, these are all about THE KIDS… and charities we support.  Maybe in some small way, my advice can help more than just one person/family. 

 

https://www.stjude.org/ St. Jude Children’s Research Hospital – deals with kids dealing with cancer and/or life threatening health issues

https://lovetotherescue.org/ Shriners Hospital – deals with kids, born with “broken bodies” and birth defects

https://rmhc-kentuckiana.org/ Ronald Mc Donald House – this is near us and just a few blocks from a very large regional pediatric hospital ,3 other major hospitals within blocks, one being a teaching hospital and having the only LEVEL ONE TRAUMA CENTERS for 100 miles and part of a medical university and  helps provide housing for families with kids in the hospital

https://t2t.org/ Tunnel to Towers Foundation – helps get handicapable housing for veterans, first responders with “broken bodies” , families with spouse/parent killed in the line of duty and Gold Star Families

 

 

just because you have health insurance doesn’t mean you will GET HEALTHCARE

Cash crunch pushes independents to the brink, data shows PBMs the cause

Last year almost ONE INDEPENDENT PHARMACY CLOSED EVERY DAY. If this article is correct, we could see ~15 independent pharmacies closing EVERY DAY in 2024. Both CVS & Walgreens are closing 200-300 stores each year for the next few years. Rite Aid is in bankruptcy and has closed some 600 stores, leaving with  ~ 1500 stores whose future is unknown.  An untold number of pharmacy and healthcare deserts are being created every week.  The last statistic I was that >50% of independent pharmacies are in cities/towns of < 20,000 population.

Cash crunch pushes independents to the brink, data shows

https://ncpa.org/newsroom/qam/2024/02/27/cash-crunch-pushes-independents-brink-data-shows

Nearly one-third of independent pharmacy owners may close their stores this year under pressure from plunging prescription reimbursements by big insurance plans and their pharmacy benefit managers, NCPA has found based on survey responses from members around the country.

According to the survey, 32 percent of all respondents say they are considering closing their doors this year because of the cash crunch. More than 92 percent say they may drop out of Medicare Part D, which would decimate patient access across the country, especially for senior citizens. More than half of all respondents say Medicare Part D prescriptions account for at least 40 percent of their business. “This is an emergency,” says NCPA CEO Douglas Hoey. “And if Congress fails to act again, thousands of local pharmacies could be closed within months and millions of patients could be stranded without a pharmacy.”

NCPA sent a letter to CMS yesterday outlining the problem: “In 2023, there were over 300 independent pharmacy net closures — almost one less pharmacy open for patients a day — and there are approximately 2,200 fewer retail pharmacies than there were four years ago,” NCPA’s letter stated. “Increased vertical and horizontal consolidation of PBMs and health plans has caused severe inequities to pharmacies and Medicare Part D beneficiaries alike. These are startling developments. Action is needed to ensure independent pharmacies can continue to serve their patients.” Key congressional leaders received a copy of this letter as well.

Pharmacy owners are doing everything they can to avoid closing their doors. Forty-two percent got a line of credit to get them through the transition. Nearly 60 percent have had to use it. Many are cutting hours, reducing staff, and eliminating services. Nearly 70 percent, according to the survey, have had to dip into their personal savings.

To combat this and other disparities that plague independents, NCPA is calling on all members to join the fight to keep doors open — for the sake of patients and business, alike. Community pharmacists have answered our calls to action and sent over 10,000 messages to Congress since January. Yet PBM reform hangs by a thread. Call and email your legislators TODAY and tell them inaction is unacceptable. We need PBM reform NOW!

Congress continues to negotiate the funding package, and legislators need to understand the urgent need to address PBMs. They cannot delay acting! Several NCPA priorities have advanced through the committee process in at least one chamber, and one has even passed the full House of Representatives. Congress must not miss this opportunity to pass meaningful PBM reform provisions that can be signed into law.

Tell your legislators to support the following priorities:

  • S. 2973, the Modernizing and Ensuring PBM Accountability (MEPA) Act (passed 26-1 out of the Senate Finance Committee)/H.R. 5378, the Lower Costs, More Transparency Act (passed the House of Representatives on an overwhelming bipartisan vote of 320-71)
    • Bans spread pricing in Medicaid managed care by requiring a fair and transparent reimbursement to pharmacies and saves over $1 billion!
  • S. 3430, the Better Mental Health Care, Lower-Cost Drugs, and Extenders Act (unanimously passed the Senate Finance Committee)
    • Includes the No PBMs Act which requires CMS to define reasonable and relevant contract terms in Medicare.
  • S. 127, the Pharmacy Benefit Manager Transparency Act (passed 18-9 out of the Senate Commerce Committee)

You can also engage your patients in the fight by displaying this flyer and QR code in your pharmacy so they can send their own messages to Congress to demand PBM reforms now, or you can share this link with them.

Watching this 12 minute video – the truth of how our healthcare insurance industry works!

US pharmacy outage triggered by ‘Blackcat’ ransomware at UnitedHealth unit, sources say

Most/all pharmacies limit pts taking controlled meds to only being able to get a refill early anywhere from 1 to 3 days early.  This article stated that pharmacies not having access to submitting bills to a PBM and got SIX DAYS BEHIND in filling prescriptions.  It is just not pts taking controlled meds, there are a lot of high-acuity pts that being without their medication can dramatically compromise their QOL or even be life-threatening.

How many days is it going to take for these pharmacies to catch up from being SIX DAYS BEHIND? Even if they bring “all hands on deck” 24/7 until things are caught up. There are going to be a lot of overtime hours involved in doing this. Was United Healthcare, OptumRx, or the PBM at fault for not having state-of-the-art network protection processes in place?

Could some pharmacies end up buying DOUBLE the amounts of controls that they normally do in a 7-10 day period and the wholesaler’s computer could start throwing some red flags and delete some of the pharmacies’ orders for controlled meds.  Further complicating the problems of high acuity pts and their inability to get their necessary meds?

If some of the high acuity pts end up with a hospital stay and many of these high acuity pts are on Medicare or Medicaid, so we taxpayers are going to end up picking up the tab for these healthcare costs.

US pharmacy outage triggered by ‘Blackcat’ ransomware at UnitedHealth unit, sources say

https://www.reuters.com/technology/cybersecurity/cyber-security-outage-change-healthcare-continues-sixth-straight-day-2024-02-26/

WASHINGTON, Feb 26 (Reuters) – Hackers working for the ‘Blackcat’ ransomware gang are behind the outage at UnitedHealth’s (UNH.N)  technology unit that has snarled prescription deliveries for six days, two people familiar with the matter told Reuters on Monday.

The problems began last week after hackers gained access to Change Healthcare’s information technology systems and has led to disruptions at pharmacies across the United States.
Change Healthcare and UnitedHealth did not immediately respond to requests for comment. Blackcat, also known as “ALPHV,” did not immediately respond when asked whether it was responsible.
Alphabet’s (GOOGL.O)   cybersecurity unit Mandiant is handling the investigation into the breach, the two people said. In a statement, Mandiant confirmed it “has been engaged in support of the incident response” but declined to comment further.
Blackcat is one of the most notorious of the internet’s many ransomware gangs – groups of cybercriminals who encrypt data to hold it hostage with the aim of securing massive payouts. It has previously struck major businesses including MGM Resorts International (MGM.N)   and Caesars Entertainment (CZR.O)
In December, Blackcat was the subject of a takedown by U.S.-led international law enforcement, which seized several websites used by the group as well as hundreds of digital keys used to decrypt victims’ data.
The hackers had threatened to retaliate by extorting critical infrastructure providers and hospitals.
CISA, the U.S. cyber watchdog agency, and the FBI also did not immediately respond to emails seeking comment.
One expert said the news suggested that digital disruptions, while important, could not be counted on to knock ransomware groups out for good.
“It’s inevitable that if you have a group that’s making millions of bucks, they are going to attempt to make a comeback,” said Brett Callow, a threat analyst at the cybersecurity firm Emsisoft.
The allegation that Blackcat was behind the hack at Change Healthcare also raised questions about parent company UnitedHealth’s previous claim that it had been targeted by a “suspected nation-state associated cybersecurity threat actor.”
“I am not aware of any links between ALPHV and a nation state,” Callow said. “As far as I am aware they are financially motivated cybercriminals and nothing more.”
Reuters has not been able to gauge the full extent of the disruption.
A number of pharmacy chains, including CVS Health (CVS.N)   and Walgreens (WBA.O)    , have said the outage had knock-on effects on their businesses.
The American Pharmacists Association (APhA) said on Friday many pharmacies across the nation could not transmit insurance claims for their patients following the hack.
It said pharmacies were reporting “significant backlogs of prescriptions,” which they were unable to process.

Reporting by Raphael Satter and Christopher Bing in Washington; Additional reporting by Pratik Jain in Bengaluru; Editing by Sriraj Kalluvila, Shilpi Majumdar and Bill Berkrot

Debunking the Hype: Opioid Overdose in Chronic Pain – The Truth

A recent study aiming to find factors that increase risk of opioid overdose in chronic pain patients instead found that overdose is vanishingly rare, despite the researcher’s best efforts to obscure the truth. This recent Systemic Review and meta-analysis of almost 24 million patients set out to find what risk factors lead to opioid overdose in chronic pain patients. The results were not what the authors expected, with the data showing that while there were factors that increased the risk of overdose, the ABSOLUTE risk of overdose in chronic pain patients was less than 1%. That’s right. Less than 1% We covered another recent study which showed that addiction is also vanishingly rare. So the question begs to be asked – WHY are chronic pain patients being force tapered off their safe and effective long-term opioid therapy? This is a ground-breaking study, but not for the reasons the researchers hoped. They cherry-picked the data and selectively reported to hide the facts – that overdose is incredibly rare in chronic pain patients. Here’s link to the study – Predictors of fatal and nonfatal overdose after prescription of opioids for chronic pain: a systematic review and meta-analysis of observational studies Take note of the authors, they include David N. Juurlink and Jason W. Busse. If you found this information valuable, please consider giving the video a thumbs up, subscribing for more content, and sharing it with your network. Your support helps us continue to bring you high-quality, evidence-based research and STOP the FORCED TAPERS and undertreatment of chronic pain. To learn more about our chronic pain advocacy work, please visit Pain Patient Advocacy Australia https://painpatientadvocacyaust.org/ Please sign our petition protesting against ongoing forced tapers https://painpatientadvocacyaust.org/o… Read more of my articles on the truth about opioids and chronic pain on my substack https://substack.com/@arthriticchick Follow me on facebook   / arthriticchick   instagram   / arthriticchick   twitter / X   / arthriticchick   and LinkedIn   / neen-monty-arthriticchick   Follow Kevin R James on LinkedIn   / kevin-r-james-971278190  

Walgreens decides that its ~ 8000 pharmacies will no longer fill controlled Rxs from a specific prescriber

I am disabled. 66yrs old and all alone. I live in FL.
I have been on two controlled pain medications for 23 years. I have cancer and several other debilitating injuries and illnesses. In chronic pain!

I just recvd a letter from Walgreens
(See below) and I have only 6 days of medicine left before I am totally out!

I will not only be in severe pain but I will end up in the hospital! You can’t just go off this medicine. I have been going to the same Dr for 15+ yrs and the same Walgreens’s and the same pharmacist for 15 yrs. as well!

BUT I JUST GOT THIS LETTER FROM WALGREENS.
What does this mean?

I have another one of these letters from Walgreen addressed to a pt in Washington State from July 2023. The only thing different is the name of the doctor that they are no longer filling control meds for.

I did a blog post a few months ago, where there are several hyperlinks, explaining how 41 State AGs got the three largest drug wholesalers and the three largest chain pharmacies agreed to sell and fill fewer controlled meds.  https://www.pharmaciststeve.com/dea-proposed-reduction-in-pharma-controlled-med-production-quotas/ 

From the text in the letter, it would appear that Walgreens is using some statistical analysis to determine what prescribers in a specific area are the outliers in writing the number of controlled meds and/or the most MMEs.

I would find the phrases in the letter quite humorous if it wasn’t that Walgreens was tossing pts taking controlled meds and who are highly likely to be disabled pt. So they are sorry for the inconvenience of probably throwing these pts into cold turkey withdrawal and possibly throwing them into a torturous level of pain.  Below is the text from CMS website on discrimination of pts on Medicare or Medicaid. Is Walgreens directly or indirectly discriminating against this – and other pts – because they know how difficult to impossible it is for pts to find a new prescriber and/or new pharmacy to fill those C-II Rxs?  It is clear in the Walgreens letter that Walgreens only questions this particular prescriber’s competency to appropriately prescribe controlled meds.

Nondiscrimination Notice
The Centers for Medicare & Medicaid Services (CMS) doesn’t exclude, deny benefits to, or otherwise
discriminate against any person on the basis of race, color, national origin, disability, sex (including
sexual orientation and gender identity), or age in admission to, participation in, or receipt of the services
and benefits under any of its programs and activities, whether carried out by CMS directly or through a
contractor or any other entity with which CMS arranges to carry out its programs and activities.
You can contact CMS in any of the ways included in this notice if you have any concerns about
getting information in a format that you can use.
You may also file a complaint if you think you’ve been subjected to discrimination in a CMS program
or activity, including experiencing issues with getting information in an accessible format from
any Medicare Advantage Plan, Medicare drug plan, state or local Medicaid office, or Marketplace
Qualified Health Plans. There are three ways to file a complaint with the U.S. Department of Health
and Human Services, Office for Civil Rights:
1. Online: hhs.gov/civil-rights/filing-a-complaint/complaint-process/index.html
2. By phone: Call 1-800-368-1019. TTY users can call 1-800-537-7697.
3. In writing: Send information about your complaint to:
Office for Civil Rights
U.S. Department of Health and Human Services
200 Independence Avenue, SW
Room 509F, HHH Building
Washington, D.C. 20201

 

 

COPS, PAIN, COURTS TO PRISON THE RESHAPING OF PAIN HEALTHCARE AND ADDICTION: FASTRACK PATHWAY IN BECOMING A FEDERAL JUDGE

Among the higher-profile cases that McMillion worked on was the prosecution of Dr. Rajendra Bothra of Bloomfield Hills, who faced charges in an alleged $500 million health care fraud scheme. Bothra was acquitted last year after spending three years in jail prior to his trial. Bothra was found not guilty of more than 40 federal counts along with his former employees, Ganiu Edu, David Lewis, Christopher Russo in what was considered one of the biggest losses for the U.S. Attorney’s Office in more than 10 years. The one-year anniversary of the acquittal is Thursday.President Joe Biden plans to nominate another Michigan prosecutor to the U.S. District Court for the Eastern District of Michigan, Brandy R. McMillion,

WHEN COPS AND COURTS ARE PRACTICING MEDICINE: THE PARALLEL HISTORIES OF DRUG WAR 1 AND DRUG WAR ll (EXCERPTS/UPDATE)

TAKING THEM TO THE DEEP END WHERE MEDICAL SCIENCE AND FACTS ARE ON THE STAND: PART-2 OF THE CHRISTOPHER RUSSO, MD STORY WHO CHOSE TO FIGHT DOJ-DEA PROSECUTION AND FOUND NOT GUILTY

 

FORMER U.S. ATTORNEY GENERAL JEFFERSON BEAUREGARD SESSION

PART-2: DR. CHRISTOPHER RUSSO, MD: ON MEDICINE VS. THE DECEPTION OF LAW “TAKING THEM TO THE DEEP END OF THE MEDICAL POOL WHERE SCIENCE AND FACTS WERE ON THE STAND”

HAS THE WAR ON DRUGS TURN INTO A WAR ON YOUR PAIN AND YOUR DOCTOR: DR. CHRIS RUSSO, MD: ON MEDICINE VS. THE DECEPTION OF THE LAW, A CLOWN SHOW

BY DR. CHRISTPHER RUSSO, MD HIS WAR ON THE DEA PART-1

 

 

DR. CHRISTOPHER RUSSO,MD: ON MEDICINE VS. THE DECEPTION OF LAW; “ANATOMY OF THE CLOWN SHOW” TELLING IT RAW” (Prt-1)

 

How Beneficiaries Really Feel About Medicare Advantage vs Traditional Medicare

How Beneficiaries Really Feel About Medicare Advantage vs Traditional Medicare

MA plans offer “extra benefits” but many go unused. Is Medicare Advantage really better?

https://www.medpagetoday.com/special-reports/features/108846

Survey results released today contradict widely-held beliefs that Medicare Advantage enrollees are more satisfied because they receive better health services than those in traditional Medicare.

On the contrary, respondents in the two types of Medicare plans reported equal satisfaction, although more Medicare Advantage (MA) enrollees than traditional Medicare (TM) beneficiaries said their care was delayed because of the need for prior approval.

The reportopens in a new tab or window by The Commonwealth Fund analyzed responses from 3,280 Medicare beneficiaries between November 6, 2023, and January 4 in an effort to learn “What Do Medicare Beneficiaries Value About their Coverage?” Those surveyed gave their opinions on the ease of their access to benefits, care coordination, services, and satisfaction.

“Overall, the experiences seem to be similar for those in traditional Medicare versus Medicare Advantage, with some notable exceptions,” Gretchen Jacobson, PhD, vice president of Commonwealth’s Medicare program, told MedPage Today.

The comparison of beneficiary experiences in each model is important because roughly half, or 52% of 66 million eligible people, are now enrolled in MA plans, to which federal funds pay billions more than for TM care. In 2024, for example, MA plans are expected to receive $88 billionopens in a new tab or window more than what would have been spent if the same people were in TM.

Although there are efforts underway to contain that spending through new payment policiesopens in a new tab or window, MA enrollment is projected to continue rapid growth. So it’s important that taxpayers understand what they’re getting for all that extra money.

A perhaps surprising finding of the survey was MA enrollees’ relatively low use of their “extra benefits,” such as vision, hearing, and dental care, considering that plans aggressively market these benefits to encourage signups. Jacobson noted that Medicare pays the plans $1,915 a year per enrollee for these benefits, according to the 2023 annual reportopens in a new tab or window from the Medicare trust funds’ trustees. These extras are not covered under TM.

For example, 31% of MA enrollees hadn’t used any of their benefits in the last 12 months, 58% hadn’t used dental benefits, 59% hadn’t used vision benefits, 93% hadn’t used hearing benefits, 81% hadn’t used the gym membership, and 54% hadn’t used their over-the-counter medication allowance. Other benefits such as meal delivery and an allowance for groceries may be less frequently offered by the plans, but 98% and 88%, respectively, said they hadn’t used them.

“Because this is an important component of what Medicare Advantage plans are offering, we need to understand better why they aren’t using them, and whether these are the benefits people really want,” she said.

For those who hadn’t used any benefits, 63% of respondents said they didn’t need them, 24% said they didn’t know what benefits the plans offered, 9% said the benefits were hard to use, and 4% said the costs were too high.

Some underlying reasons for the low rates of use, not specified in the report, could be because of restrictions. Perhaps the networks or setting one would have to use — for example, a group of dentists — excludes one who has long served the family. But it also might be because enrollees don’t know about them or forgot about them, despite the ubiquitous advertisingopens in a new tab or window that prominently pitches them.

A CMS proposed ruleopens in a new tab or window would, if finalized, require MA plans to send mid-year notices to enrollees about any unused benefits, to “ensure MA plans are better stewards of the rebate dollars directed towards these benefits,” the proposed rule says.

A big selling point for MA plans is that their providers cooperate within carefully picked integrated networks and coordinate care far better than providers who treat TM beneficiaries.

But here, the survey responses revealed another contradiction. Regardless of whether they had an MA or a TM plan, about an equal number of respondents said they coordinate their healthcare services themselves: 75% in MA and 73% in TM.

Some 7% of people on MA said their plan helps to coordinate their care, Jacobson said. “It seems as though the plans are certainly not the primary care coordinator for most Medicare Advantage enrollees.”

Jacobson acknowledged that MA plan providers might be coordinating their patients’ care in ways enrollees aren’t aware. “But from the beneficiaries’ perspective, they don’t see their plan having a large role in coordinating care.”

Another counterintuitive finding is that a similar percentage of MA and TM respondents said they waited more than one month to see a doctor (36% and 34%), perhaps suggesting that MA enrollees do not get faster access for appointments. “Access to providers seems to be similar, which is counter to some thoughts around the limitations around provider networks,” Jacobson said.

Of the MA plan respondents, 22% said their care was delayed because it required approval, compared with 13% of TM beneficiaries. Far fewer services under TM require pre-approval compared with MA, so it was unclear why so many TM beneficiaries encountered obstacles.

Another surprise was that a larger share of people in MA said they had problems affording care compared with people in TM, “which is contrary to how we typically think of Medicare Advantage,” Jacobson said. “It doesn’t appear that Medicare Advantage plans are necessarily making care more affordable for people.”

Similar percentages of the two beneficiary groups also said their benefits do not cover what they needed, that they were unsure of what benefits they had, that costs were too high, and that they need transportation to access benefits.

Jacobson noted that if Medicare pays more per capita to MA plans than for TM care, it results in higher Part B premiums to all beneficiaries, regardless of what type of plan they’re in. Most frequently, the premium is paid through an amount withheld from their social security retirement benefit checks.

Another finding of note evaluated health risk assessments both types of Medicare patients received in the last year. Of those who received them, few said it caused their doctor to change their care or led to more services or benefits. Only 6% of both MA and TM beneficiaries said their doctor changed their care plan as a result.

“This really calls into question the value that these assessments are providing to beneficiaries and what frequency it’s important to have them,” Jacobson said.

Asked if the survey responses may raise questions about whether MA plans are worth their extra cost, Jacobson replied: “What our survey shows is that the experiences people report seem to be similar overall for those in Medicare Advantage versus traditional Medicare.”

That, she said, makes it “worth assessing the relative value of care and benefits people in Medicare Advantage and traditional Medicare are receiving relative to the amount spent by the federal government. This is worth keeping an eye on as enrollment in Medicare Advantage grows.”

Because it’s well known that Medicare recipients are frequently confused over what kind of coverage they have, the plan type was verified through Zoom calls in which respondents showed their plan card.