VA Spent Billions Without Denting Doctor Hiring Problem

http://www.disabledveterans.org/2017/02/01/va-spent-billions-without-denting-doctor-hiring-problem/

An NPR investigation found that despite $2.5 billion in special funding, VA added no more doctors and other clinicians than without the extra money.

Veterans Choice and Accountability Act added $16 billion to the VA budget in 2014 with the goal of fixing the wait time problem that led to a scandal where many veterans died without much-needed healthcare.

$10 billion was supposed to go to help veterans get non-VA healthcare. $2.5 billion was supposed to go to hiring more doctors, nurses and other clinicians.

NPR’s recent investigation into effects of the expensive but needed fix found the following:

• VA has about the same number of new hires as it projected to have without the added funding;
• The new hires were not sent to VA hospitals with the longest wait times;
• The medical centers that received new hires were not likely to see improved wait times.

Doctor Hiring Funding Shell Game

The reason for the hiring failure is reportedly budget shuffling that occurred after the funding was distributed. This is no surprise to anyone who noticed VA reallocating other funding to pay for cures like the Hepatitis C vaccine.

RELATED: Veterans Choice To Be Fleeced For Hepatitis C Vaccine

According to NPR, VA used the funds to hire the same clinicians it would have hired without the funding. Instead of doubling down on hiring clinicians, VA then reallocated less restricted funds in the same amount to fund other projects.

David Shulkin, the soon to be Secretary of Veterans Affairs, supported his decisions as to how the funds were allocated while he led the Veterans Health Administration.

Shulkin told NPR in December:

“When you’re given a budget you face a number of new stresses on those resources. You have increases in pharmaceuticals, you have your wage increase, you have your leasing cost increases, you have IT increases. So without the Choice money, we would not have been able to have maintained the type of hiring that we were doing and expanded the type of hiring we were doing.”

Phil Carter, of the Center for New American Security, says this kind of budget strategy is common for self-interested bureaucracies in Washington:

“It makes complete sense for a self-interested bureaucracy to hire with that money first. I think VA hired staff with this money will all intention of improving access and quality. I think the VA leadership found it harder to do that.”

Carter went on to state he did not believe the shell game with funds intended to increase the number of clinicians was done with malice, “But I don’t see malice here, just the basic inefficacy of American bureaucracy.”

Do you agree?

It will be interesting to see if any Senators ask Shulkin about this apparent shell game today (February 1) during his confirmation hearing starting at 2:30 PM EST.

WATCH: David Shulkin Confirmation Hearing

For those of you hoping Shulkin will be pressed on this issues, do not hold your breath. He has wide support from Democrats, veteran organizations, and some Republicans including Senator Johnny Isakson.

Sen. Isakson reportedly promoted keeping former Secretary Bob McDonald after the 2016 election. While that seemed like an impossible request in light of the animosity between President Donald Trump and McDonald, keeping Shulkin was the next best thing to some.

Following a meeting with Shulkin, Sen. Isakson provided the following comments:

“As the undersecretary for health at the VA, Dr. Shulkin is no stranger to the work that needs to be done to bring accountability to the department. Dr. Shulkin’s overwhelming approval by the Senate in 2015 demonstrates the kind of broad, bipartisan support that I expect to see this time for his confirmation as secretary of the VA. I believe Dr. Shulkin to be a passionate veterans advocate who will work to transform the VA and ensure our veterans get the timely, quality care and support they deserve. I look forward to chairing his confirmation hearing.”

Personally, I bet Trump was unable to find a suitable substitute for McDonald who was also willing to take the job.

Each administration brings in someone new who is always taking a year just to get caught up with the cronies and scandals must less developing policies to address them.

By picking Shulkin, a person who should be familiar with the wait list scandal, the success or failure of reforms over the next few years will deservedly hang around Shulkin’s neck.

Instead of giving him a Scarlet A, we would give him a Scarlet F – – for FAIL.

While I will not hold my breath, I will remain hopeful Shulkin succeeds.

Source: http://www.npr.org/2017/01/31/512052311/va-hospitals-still-struggling-with-adding-staff-despite-billions-from-choice-act

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Scam alert: DEA Extortion

http://www.kalb.com/content/news/Scam-alert-DEA-Extortion-412483473.html

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9 Ways to Beat Your Addiction to Sugar

http://magazine.foxnews.com/food-wellness/too-much-sugar-addiction-tips-eat-less-sugar-infographic

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Big Pharma CEO Says Insurers Will ‘Ultimately Determine How Much Patients Pay’

http://www.foxbusiness.com/politics/2017/02/01/big-pharma-ceo-says-insurers-will-ultimately-determine-how-much-patients-pay.html

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https://www.pharmacyowners.com/blog/bid/90673/How-To-Find-and-raise-Your-Star-Rating

CMS (Center for Medicare/Medicaid Services) started a couple of years ago …what they call Star Rating System.. it can/will impact all of those providers in providing healthcare to those pts covered by Medicare/Medicaid/Medicare Advantage.

The Star Rating System will help determine how much or how little a provider gets paid and if a provider fails to attain a THREE STAR rating in at least one out of a three year period.. there ability to participate in the Federal programs.

769 Hospitals Penalized For Patient Safety In 2017: Data Table   Here is a article about 769 hospitals getting lower reimbursements in 2017 because pts filled grievances with CMS.

I have been exchanging emails with a pt that after patronizing a particular Walgreens in Florida for several years… there was a change in the Pharmacist/PIC… who decided that she was “not comfortable” with a C-II prescription – continuing of medication – for the pt.

The pt contacted Walgreens corporate and in the past … the normal response from corporate was that they “stood behind their Pharmacist’s decision”… What has changed at Walgreen’s corporate level, this pt this time was told that they would take the pt’s complaint/grievance “higher up the corporate ladder”.

Don’t know if the Star Rating system influenced this change or some other issue within Walgreen’s corporate structure…but… in regards of all healthcare providers (hospitals, prescribers, pharmacies/pharmacists, insurance company, etc… etc…) they are all covered by the Star Rating system… and apparently CMS gives a provider FIVE STARS to start off with and unless unsatisfied/unhappy pts contacts CMS (www.cms.gov) 800-MEDICARE and file a grievance against the provider… they will retain their higher star rating…. and pt care will continue to be poor and/or get poorer because there is no consequences or incentives to improve the level of care.

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Why My Stepsons’ Father Killed Himself

http://www.nationalreview.com/article/444416/my-stepsons-father-killed-himself-painkillers-denied-life-not-worth-living

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Did Walgreens’ Rewards Program Cheat You?

http://finance.yahoo.com/news/did-walgreens-rewards-program-cheat-075857629.html

Walgreens misinformed consumers about its loyalty rewards program, potentially swindling them out of millions of dollars in earned benefits, according to a report by ConsumerWorld.org.

ConsumerWorld.org — which describes itself as a “public service consumer resource guide” — recently completed a two-year review of Walgreens’ Balance Rewards program through ConsumerWorld.org’s sister site, MousePrint.org. The latter website aims to expose the strings and catches in advertising fine print.

At issue are the points consumers are supposed to earn on “all” 30- and 90-day prescriptions filled in Walgreens stores or online. The points can be redeemed like cash for future Walgreens purchases.

In contradiction to Walgreens’ rewards program claims, not all prescriptions have been earning points, ConsumerWorld.org contends. Mail-in prescriptions haven’t earned consumers any points, according to the nonprofit:

“What the company failed to clearly disclose was that the millions of prescriptions ordered online via their mail order service would not earn points.

Walgreen perpetuated the misimpression that ‘all’ prescriptions earned points by running national television advertising, including this 2017 commercial, and repeated similar claims on its website.”

ConsumerWorld.org says Walgreens admitted to no wrongdoing, although it “quietly amended” the fine print on its website that misrepresented its actual Balance Rewards policy for prescriptions, so now the Balance Rewards information is accurate.

But what about the people who have unknowingly been cheated out of earning rewards points for prescriptions filled through Walgreens? ConsumerWorld.org says:

In fiscal 2016, Walgreens filled 740 million prescriptions in its retail division, which includes mail order. It is unclear what percentage of those prescriptions were in-store versus mail order, but clearly, millions of consumers never got the likely millions of dollars of rewards that Walgreens promised.

Not all stores’ customer rewards programs are created equal. Find out “Which Loyalty Programs Are Worth It.” Also, check out “6 Stores With Awesome Reward Programs.”

Do you shop at Walgreens? Share your thoughts below or on Facebook.

This article was originally published on MoneyTalksNews.com as ‘Did Walgreens’ Rewards Program Cheat You?’.

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Controversial Kratom Growing in Popularity

http://www.empr.com/features/kratom-extract-opioid-compound-dea-fda/article/634849/

A complex, poorly understood plant product, kratom, or Mitragyna speciosa, has recently burst onto the American stage in a big way and gained the attention of the US Food and Drug Administration (FDA), as well as the Drug Enforcement Administration (DEA). Mitragynine, the dominant alkaloid in the compound, has been found to have some opioid-like activity and some argue that it is useful in assisting patients who are withdrawing from either licit or illicit narcotic use. The debate about potential DEA regulation of this compound is, more than likely, just beginning.

Background

Kratom grows naturally in much of southeast Asia, more specifically, in Malaysia.¹ This evergreen tree can reach a height of more than 80 feet with a trunk diameter of 3 feet.¹ The large, dark glossy green leaves yield the extract that is the active component of the tree.

Kratom has been used in its native environment for centuries for purposes ranging from religious ceremonies to wound healing. Its action as an opium substitute, however, was reported in 1836.² Official notation of this plant and its action was first made by Dutch botanist Pieter Korthals in 1839.³ Despite centuries of use in Malaysia, the compound has been relatively slow to develop a following in the United States, but that appears to be changing.

Science

The main mechanism of action of kratom is due largely to one of the more than 25 alkaloids found in its extract.⁴ Mitragynine, the dominant alkaloid, has been found to exert somewhat selective μ-opioid receptor activity, especially when used in moderation.⁵ Proponents of this chemical argue that it is useful in assisting patients who are withdrawing from either licit or illicit narcotic use. Those against the use of kratom take the stance that, since its action is basically opioid in nature, nothing is gained.

There are no clinical trials in humans to determine either the safety or efficacy of kratom. However, a growing body of laboratory data shows some very intriguing actions of the extract. One study demonstrated both adrenergic and serotonergic actions, as well as actual opioid antagonistic functions.⁶ These activities are seen as promising means to ease withdrawal from narcotic dependence.

In the absence of human clinical trials based in the United States, we are forced to depend largely upon pharmacokinetic data and foreign trials. One case report highlights the differing actions of kratom based on total daily dose.⁷ In this report, a man in his early 40s was using escalating doses of prescribed hydromorphone for a chronic pain condition. Due to a sudden change in his personal life, he was forced to abruptly cease use of this potent drug. In order to manage his intense symptoms of withdrawal, he began ingesting a kratom tea four times a day. He found that the tea greatly alleviated his physical pain without the typical sedation from prescription medication.⁷ 

In a survey in Malaysia, researchers sought to determine the demographics and substance use habits of self-treated kratom users.⁸ Nearly 77% of participants reported histories of prior drug use, often heroin. At the time of the survey, more than 45% of participants were still using at least one other psychoactive substance. However, all participants reported greater productivity, better appetites, and reduced dependence on other drugs before beginning kratom use.⁸

Safety, interactions, side effects

The safety of this product is definitely in question. Due to its known opioid action, addiction and overdose are easily possible. In August 2016, the DEA published a notice of intent to classify this compound as a schedule I drug.⁹ Due to a huge public response, however, a formal retraction of that intent was published in October 2016, pending further review.⁹

Regardless of regulation, kratom should be considered an opioid compound and, as such, possess all of the potential side effects and interactions of the class. Until such studies are conducted that more clearly show safety and efficacy for specific uses, there is no current indication for this compound.

Kratom powder is a commonly used form in the United States

How supplied, dose, cost

Kratom is widely available in the United States either online or in most ‘head shops.’ It is available in a variety of forms including extract, powder, or capsule. Due to the lack of any quality control, there is no way to establish a ‘recommended dose.’ Also, the concentration of the active ingredient, mitragynine, varies widely based on the form of the product. Extracts tend to be more concentrated, while powders and capsules are weaker.

Those who report sporadic use for anxiety or other episodic concerns may only use 1 to 2 g at a time, whereas daily users managing chronic pain or intense withdrawal from other opiates report using as much as 15 to 20 g or more per day. The type of product and the amount used dictate cost, with an average cost per ounce of about $30.

Summary

With the abundance of approved medications at the disposal of healthcare providers, the use of an unproven and potentially dangerous product such as kratom is not justified. However, providers must be aware of the growing use of this compound in the United States and, when opioid use is either ongoing or newly initiated, screen for use of this product.

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Pain Medication: Are You Addicted?

What to know about becoming addicted to pain medications.

http://www.webmd.com/pain-management/features/pain-medication-addiction#1

Many people taking medication to control chronic pain are afraid they’ll become addicted to those drugs.

Some people do become addicted, and the results can be devastating. But there are ways to limit your risk.

Candy Pitcher of Cary, N.C., knows all about the fear of addiction. One summer day in 2003, a tree cutter working at Pitcher’s home started to topple from his ladder. “If he hits the ground, he’ll break his back. I have to catch him!” she thought.

Pitcher broke the man’s fall, which crushed a vertebra in her upper back. Ever since then, she’s had chronic pain. To manage it, she’s had a prescription for a drug that’s widely feared and often misunderstood: morphine.

“I’ve never been ‘high’ from morphine,” she says, nor has she ever been tempted to take more than the prescribed amount. But she says she’s wary of becoming addicted.

She’s not the only one with that fear. “Addiction” is a widely used word. But many people don’t use it accurately.

http://www.webmd.com/mental-health/addiction/ss/slideshow-surprising-addictions

slideshow

Surprising Addictions

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Risk of Uncontrolled Pain

Some people don’t want to use pain medicines because they fear becoming addicted. That can lead to a different set of problems that stem from poorly controlled pain.

“If pain is inadequately treated, we see poor functional level, a diminished quality of life, we often see mood disorders such as depression, and we see an increased risk of suicide,” Reisfield says.

slideshow

http://www.webmd.com/a-to-z-guides/ss/slideshow-commonly-abused-drugs

Commonly Abused Drugs

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These six steps can help ensure that you use pain-relieving drugs properly:

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