And medical errors, often caused by doctors not knowing their patients, have become the third leading cause of death in the US.

Posted on September 1, 2015 by Pharmaciststeve

“Please empathize with me, Doctor!”

http://www.psychiatrictimes.com/blogs/couch-crisis/please-empathize-me-doctor

The doctor/patient relationship has been the central instrument of healing throughout the history of medicine. Specific treatments come and specific treatments go. Some help patients; some hurt patients; many have no impact at all. But the constant of 4000 years of modern medicine has been the healing impact of the relationship with a doctor, however ineffective or harmful the type of treatment provided.

In recent years, high tech medicine has undercut the value previously placed on the doctor/patient relationship. Doctors spend more and more time tending their powerful medical toys, less and less time getting to know their patients. They treat lab values, not people.

This would be OK if the new medicine lived up to its promise of razzle/dazzle, technically-based cures. But usually it doesn’t. Diseases are really complicated and we are much better at finding abnormalities than at making people better. And medical errors, often caused by doctors not knowing their patients, have become the third leading cause of death in the US.

We need to combine the science of medicine with its art and to get our doctors and our patients back in sync. Medical schools are finally beginning to recognize this and are revising their entrance test to place more emphasis on the social, not just the biological sciences. It is crucial that we make medicine more humane.

The “Empathize With Me, Doctor!” project is a promising initiative in this direction, developed by Vassilios Kiosses and Ioannis Dimoliatis of the Medical Education Unit at the University of Ioannina in Greece. They write:

“We provide an experiential training program aimed at improving health care professionals’ empathy, based on the Person-Centered Approach (PCA) founded by Carl Rogers. Unconditional positive regard, empathy, and congruence are elements that can create a safe climate where students develop alternative ways to relate with each other and with their patients.

The training in empathy lasts 60 hours, distributed in three 3-day intense workshops, occurring at 4 week intervals. There are three modules: theory, personal development, and skills development.

Empathy is not taught as a technique but as a philosophy and a new way of being and relating. This is why an experiential training program is needed.

The theory part of the training includes an introduction to communication skills and specifically the importance of non-verbal communication. The student is taught how to gather a medical history in a person-centered way, combining open ended questions that allow patients to take the lead with more structured medical interviewing. The clarification of what empathy is, how it is used in medicine and how it can be applied during doctor/patient relationship, constitutes a large part of the training.

Last but not least, medical undergraduates are introduced to the theory of bereavement in the medical context, and also how to break bad news empathetically.

It is important in creating an empathic climate to be aware of one’s own needs and boundaries during encounters with patients. That is why a personal development section is included, with experiential exercises in self-awareness, self-knowledge, and identification of others. To facilitate this process, we use artwork as triggers for introspection and increased awareness of their own and patient’s inner needs. Creating in clay or collage allows students to be more freely expressive. Through this section students seek to answer “what scares me during my practice?”, “what am I expecting from me?” or “how can I respect myself and my patient?”

Encounter groups provide an opportunity for verbal interaction and emotional expression. Students are encouraged to examine and explore their reactions and feelings about their relationship with their patients and others in the group.

The skills development section contains active listening exercises, role plays, non- verbal communication games and more practical implications of empathy. Medical undergraduates have the chance to try and develop such skills aiming at improving person-centered interviewing with a patient. Case studies are also used to help medical undergraduates to work on real, everyday problems in empathy.

This training aims at improving each student’s interaction in the training group with the hope it will then lead to more empathic encounters with patients. Trainers try to create a condition full of acceptance, genuineness, and empathy to help trainees try new ways of interacting and relating. This not only trains professionals in a more effective communication techniques, but also sensitizes them to act in a more genuine and humanistic way.

The experiential nature of the training, has elements far different from what is usual in medical school. No lectures or study at home is needed. Student often describe it as “a life-changing experience” and “this empathy training taught me a whole new way to relate.”

Hippocrates stated that patients often recover because they believe in their doctors. This training helps build that trust. Most doctors currently don’t even ask their patients what scares them and if they are anxious about their treatment and health outcomes. We need to make them more alive to the emotional reality of the medical contact.”

Amen.

On the first day of medical school 50 years ago, the spare, spectral chairman of medicine wished all of us students a life threatening illness that we would recover from. Only in this way, he said, would we fully understand what it was like to be a patient. When he retired soon after, he did an astounding thing- he entered medical school as a student and did everything all students were required to do over the four years. He wanted to experience first hand from both sides what was wrong and what was right about medical training.

I don’t have the dedication or endurance to repeat his heroic experiment. But I think there is no mystery in what is currently wrong with medical education. It has become far too technical and has lost its central focus on the relationship to the patient.

This is bad in emotional terms. But it is also bad in terms of medical outcomes. Doctors who don’t know their patients make easily avoidable technical mistakes that can have tragic consequences.

The best way “to do no harm” is to know and understand your patient.

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More funding for addicts “frequent flyer” program ?

Posted on August 31, 2015 by Pharmaciststeve

New deal brings more NARCAN funding to Mass.

BOSTON (NEWS10) – Attorney General Maura Healey has announced a deal that will bring more funding for NARCAN to the Commonwealth.

Healey’s office said they reached a deal with a national pharmaceutical manufacturer that will require the company to pay $325,000 to help offset the costs of NARCAN.

The drug is used to counter the effects of opioid overdose. The first-of-its-kind payment is the equivalent cost of 10,000 units of NARCAN.

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Ken Mc Kim explaining Myelomalacia

Posted on August 31, 2015 by Pharmaciststeve

Feel This Pain: MyelomalaciaMyelomalacia is term referring to the softening of the spinal cord. It’s no laughing matter.I would be remiss if I didn’t take this opportunity to thank everyone at the Myelomalacia support group on Facebook who were kind enough to allow me into their group, and who were very open with me, answering my questions and sharing their experiences with me.If you suffer from this condition, I encourage you to reach out to this group. They are a great resource, and a wonderful group of people.https://www.facebook.com/groups/1385536881729549/

Posted by Don’t Punish Pain on Monday, August 31, 2015

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Reducing pain during vaccination ??? Just suck it up !!!

Posted on August 31, 2015 by Pharmaciststeve

Reducing pain during vaccination: New guideline to help manage pain in children and adults

A new Canadian guideline aims to ensure that pain during vaccination is minimized in both children and adults. The guideline, published in CMAJ (Canadian Medical Association Journal), is targeted at all health care providers who administer vaccines.

“Pain from vaccinations is common and can make people hesitate about getting future vaccines even as adults,” states Dr. Anna Taddio, Senior Associate Scientist at The Hospital for Sick Children (SickKids), Toronto, Ontario, and Leslie Dan Faculty of Pharmacy, University of Toronto. “This can put people at risk of contracting infectious diseases that are largely preventable through vaccination.”

This expanded and updated guideline includes recommendations for both children and adults; the 2010 guideline focused on children only. A multidisciplinary group of 25 people from across the country (HELPinKids&Adults team) with expertise in pain, fear, vaccines, nursing, epidemiology and other related fields reviewed the literature to develop the guideline.

“Many of these recommendations can be used in a variety of settings where vaccines are delivered, whether in a physician’s office, a public health setting such as a school or a workplace,” states Dr. Taddio.

Key recommendations:

All ages:

  • Aspiration should not be used during intramuscular injections in people of all ages. (Aspiration is pulling back on the syringe to make sure the needle is not in a blood vessel.)
  • Inject the most painful vaccine last during visits for more than one vaccination.

Children:

  • Breast- or formula-feed infants under age 2 years during vaccination or give sugar solutions before injection.
  • Hold children aged 0-3 years during injections to provide comfort.
  • An upright position is recommended for children and adults over age 3 years because it provides a sense of control and can decrease fear. Restraining children is not recommended.
  • Apply topical pain analgesics before injection in children under age 12 years.
  • Parents of children aged 10 years and under should be present during vaccination to lower the child’s distress levels.

The authors also recommend educating parents, older children and adults about what to expect with a vaccination, how it might feel and what they can do to manage any pain.

“No single intervention in this guideline is expected to prevent all pain (i.e., achieve a level of pain of “0”), write the authors. “Individual interventions can be combined, as appropriate, to improve pain relief. For young and school-aged children, because of the high levels of distress with vaccine injections and higher potential for long-term harm (i.e., development of needle fear and health care avoidance), a more comprehensive and consistent approach is recommended.”

However, evidence for specific groups is lacking.

“There was a noticeable gap in research evidence for adolescent and adult populations, and mass immunization settings, even though concerns about pain and fear are well documented and contribute to vaccine hesitancy,” write the authors.

Efforts should focus on making school vaccination campaigns a more positive health care experience for children.

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Patient records are far more valuable than credit card information for people who plan to commit fraud,

Posted on August 31, 2015 by Pharmaciststeve

Cyberattacks on health systems on the rise

https://drugstorenewsce.com/editorial-news-item/3/6781

NEW YORK — As many as eight-in-10 health care executives say that their organizations have been compromised by at least one malware, botnet or other cyber-attack during the past two years, and only half feel that they are adequately prepared in preventing attacks, according to the 2015 KPMG Healthcare Cybersecurity Survey.
 
Furthermore, in polling 223 chief information officers, chief technology officers, chief security officers and chief compliance officers at health care providers and health plans, KPMG found the number of attacks increasing, with 13% saying they are targeted by external hack attempts about once a day and another 12% seeing about two or more attacks per week. More concerning, 16% of healthcare organizations said they cannot detect in real-time if their systems are compromised.
 
“The vulnerability of patient data at the nation’s health plans and approximately 5,000 hospitals is on the rise and health care executives are struggling to safeguard patient records,” Michael Ebert, leader in KPMG’s Healthcare & Life Sciences Cyber Practice, said. “Patient records are far more valuable than credit card information for people who plan to commit fraud, since the personal information cannot be easily changed. A key goal for execs is to advance their institutions’ protection to create hurdles for hackers.”
 
Greg Bell, who leads KPMG’s Cyber Practice, feels also that many organizations not seeing frequent cyber-attacks may underestimate the threat.
 
“Healthcare organizations that can effectively track the number of attempts have less cause for worry than those who may not detect all of the threats against their systems,” said Bell. “The experienced hackers that penetrate a vulnerable health care organization like to remain undetected as long as they can before extracting a great deal of content, similar to a blood-sucking insect.”
 
When asked about readiness in the face of a cyber-attack, 66% of execs at health plans said they were prepared, while only 53% of providers said they were ready. Larger organizations, in terms of revenue, are better prepared than smaller ones.
 
Malware, software designed to disrupt or gain access to private computer systems, is the most frequently reported line of attack during the past 12 to 24 months, according to 65% of survey respondents. Botnet attacks, where computers are hijacked to issue spam or attack other systems, and “internal” attack vectors, such as employees compromising security, were cited by 26% of respondents.
 
According to the KPMG survey, the areas with the greatest vulnerabilities within an organization include external attackers (65%), sharing data with third parties (48%), employee breaches (35%), wireless computing (35%) and inadequate firewalls (27%).
 
The KPMG survey found that spending to prevent cyber-attacks has increased at most institutions, but it has to be on the right initiatives and fit the organization’s strategy, accordint to Bell.  
 
“There are no cookie cutter approaches to security,” Bell said. “An organization with a mobile workforce may have a far different technology need from an organization that processes healthcare claims, for example.”

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Cowboy Doctors” and Health Costs

Posted on August 31, 2015 by Pharmaciststeve

Cowboy Doctors” and Health Costs

http://harvardmagazine.com/2015/08/cowboy-doctors-and-health-costs

Who’s driving up U.S. healthcare costs? A recent study by Harvard professors and colleagues revealed that the culprits may be “cowboy doctors”—physicians who provide intensive, unnecessary, and often ineffective patient care, resulting in wasteful spending costing as much as 2 percent of the nation’s Gross Domestic Product—hundreds of billions of dollars annually. The authors, including Eckstein professor of applied economics David Cutler and assistant professor of business administration Ariel D. Stern, found that physicians’ beliefs in clinically unsupported treatment procedures can explain as much as 35 percent of end-of-life Medicare expenditures, and 12 percent of Medicare expenditures overall.

Physicians treating a critically ill patient may decide either to provide intensive care beyond the indications of clinical guidelines (such as implanting a defibrillator to counter severe heart failure), or attempt to make the patient more comfortable by administering palliative care. The researchers called the former group “cowboys” and the latter “comforters,” and found that their respective concentrations in a region closely tracked end-of-life spending as a whole. “It was absolutely amazing how strong [the correlation] was,” Cutler said. The data indicate that cowboy doctors tend to congregate in southeastern states such as Florida. They are also more likely to be male, and less likely to be specialists.

Though these cowboy doctors may be pushing the frontier of medicine by going above and beyond, said coauthor Jonathan Skinner, a professor of economics at Dartmouth, clinical evidence showed little or no marginal benefit derived from the extra procedures, resulting in wasteful spending. Cutler suggested that doctors’ beliefs in these ineffective treatments may spring from their self-perception as “interventionists”: “I think some doctors are saying: ‘I just can’t accept that this patient is dying and there’s absolutely nothing I can do. I’ve got to do something.’”

The study noted that very few doctors wanted to discuss the option of palliative care with patients, prompting Cutler to draw an analogy to auto mechanics: “You want this engine fixed, I’ll fix it. I’m not going to talk to you about whether you should get a new car—that’s someone else’s’ job.” But as a result, he said, patients are “Ping-Ponged back and forth” between the primary-care physician, who recommends a specialist, and the specialist, who prefers to leave the question of whether certain treatments are necessary to the primary-care physician. Meanwhile, medical bills rise.

Traditionally, researchers attempt to get a picture of physicians’ beliefs by analyzing their actual behaviors. The problem is that other actors, such as patients, can have a say in these behaviors as well. The ability to tease out doctors’ actual beliefs proved to be the study’s biggest innovation, Cutler said. This was achieved by using “strategic surveys” that included vignettes of specific patient scenarios, and asking the responding physicians what they would do in each situation. Such surveys are often used in other areas of social science, Stern explained, but had rarely been used before to study healthcare economics.

Self-reports are sometimes unreliable, because respondents attempt to give the “textbook answer” rather than express their true beliefs. But this time, the researchers found that many physicians reported making decisions supported neither by clinical guidelines nor by medical literature. “Doctors are basically not relying on public scientific evidence,” Skinner said. “They are relying on their own beliefs, developed through…time.”

The study also found that most doctors who recommended unnecessary procedures weren’t seeking extra income—suggesting to Cutler that the lack of financial penalty, rather than the presence of financial reward, accounts for “cowboy” doctors’ actions. The healthcare system’s current incentives, he said, often do not prompt doctors to ask the right questions, such as whether a proposed treatment truly benefits the patient. “If doctors restrict themselves to performing what is evidence-based,” Skinner pointed out, “we can save hundreds of billions of dollars a year.”

According to Elliott Fisher, a professor of health policy at Dartmouth, a movement is under way to shift the healthcare-payment system toward incentivizing concrete benefits for patients. (A case in point is the hundreds of accountable-care organizations around the country, which seek to reward high-quality, low-cost care.) The new study, Fisher suggests, is important because it highlights a power imbalance in the physician-patient relationship: doctors tend to follow their own beliefs about the right treatment to use, leaving patients little say in the process. How to treat a patient is often a multiple-choice question without a straightforward, single “correct” answer. When making these decisions, Fisher said, doctors should pay more attention to the patient’s preferences, instead of relying on their own experience.

The research suggests that it’s time for the cowboys to rein themselves in, and learn to listen.

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Requirements of PIC in Mississippi

Posted on August 31, 2015 by Pharmaciststeve

An inventory which shall include such drugs, chemicals, and preparations as may be necessary to fill ordinary prescriptions as indicated by experience in the area where the pharmacy is located;

Other states most likely have similar requirements of the Pharmacist in Charge. ceasing to stock certain medications – or claiming not to have them in inventory could be a violation of the state’s pharmacy practice act

ARTICLE VII RESPONSIBILITY OF PHARMACIST-IN-CHARGE (PIC)
1. The person who signs the application for a pharmacy permit or the renewal of a pharmacy permit shall be the pharmacist-in-charge (PIC) for that facility.
A. Authority. The PIC of the pharmacy shall be responsible for complete supervision, management and compliance with all federal and state pharmacy laws and regulations pertaining to the practice of pharmacy in the entire prescription department. He/She shall have the cooperation and support of all pharmacy staff in carrying out these responsibilities. The pharmacist-in-charge is responsible for assuring that all personnel are properly registered or licensed with the Board and, that all pharmacy permits are current and appropriate for the type of pharmacy operation being conducted.
A pharmacist shall not be the PIC at more than one Community Pharmacy or Institutional I Pharmacy and shall not be the pharmacist-in-charge or have personal supervision of more than one facility which is open to the general public on a full time basis.
B. Recommended Guidelines:
(1) That each individual work space is designed to provide space and a work flow design that will accommodate the workload in an organized fashion;
(2) That the computer’s software should be of a design so that drug interactions and contraindications must be reviewed by the pharmacist. Further, the computer system should support counseling and drug utilization review documentation;
(3) That trained supportive staff should be maintained to meet the demands of the practice site, workload, and the clientele served;
(4) That all staff should have the opportunity to take periodic breaks and/or meal periods to relieve fatigue and mental and physical stress. Nothing in this paragraph suggests closing the pharmacy;
(5) That all staff should be afforded and encouraged to participate in training and continuing education in order to keep them abreast of new information and changes in the field;
(6) That if quotas or formulas such as prescription volume are used to set staffing, conditions such as peak workload periods, workplace design, and the training of staff must be taken into consideration.
C. Circumvention. It is a violation of this section for any person to subvert the authority of the pharmacist-in-charge by impeding the management of the prescription department for the compliance with federal and state drug or pharmacy laws and regulations. Any such circumvention may result in charges being filed against the pharmacy permit.
2. A permit for a pharmacy located within the state shall not be issued or renewed unless such person be a pharmacist licensed in this state.
If the pharmacist license of the pharmacist-in-charge becomes void or inactive due to surrender, revocation, suspension, restriction, or for any other reason, application must be made for a new pharmacy permit by another pharmacist within ten (10) days.
3. If the employment of a pharmacist-in-charge is terminated or if for any other reason he/she wishes to be relieved of the responsibilities of the PIC, he/she must:
A. Return the permit to the Mississippi Board of Pharmacy with written notice that he/she is no longer the pharmacist-in-charge for that facility and;
B. In accordance with the provision of paragraph 2 of ARTICLE XXV of the Regulations, send to the Board of Pharmacy an inventory of any controlled substances on hand at the facility at the time of his/her termination as pharmacist-in-charge.
C. When the relinquishing PIC cannot or does not comply with the inventory requirements of this paragraph it shall be the responsibility of the new PIC to send to the Board of Pharmacy an inventory of any controlled substances on hand at the time he/she assumes responsibility as PIC.
D. The relinquishing PIC is responsible for notification of appropriate supervisors or owners of the surrender of the permit.
When a permit is thus returned for a facility, application for a new permit for that facility must be made to the Mississippi Board of Pharmacy within ten (10) days.
4. If a permitted facility is permanently closed or has a change of ownership, the pharmacist-in-charge for that facility shall give notice to the Board of the effective date of closure or change in ownership and include the storage location of the businesses records and appropriate contact information. If a permitted facility has a change in name or location, application for a new permit must be made to the Board at least ten (10) days prior to the change in name or location. Once issued, a permit cannot be amended, transferred, or assigned to another person.
5. On the premises where a pharmacy is maintained in conjunction with other services or business activities, the pharmacy shall be physically secured from such other services or activities during those times a pharmacist is not present and the pharmacy is not open and other services or activities are being provided on the premises.
A. The Pharmacy shall be secured by a physical barrier to detect entry at a time when the Pharmacist is not present.
B. Each pharmacist, while on duty, shall be responsible for the security of the Pharmacy, including provisions for effective control against theft or diversion of Drugs and/or Devices.
C. The pharmacist-in-charge shall be responsible for adequate security being maintained on drugs in all areas of the permitted facility at all times and is responsible for reporting any loss or suspected loss of controlled substances or legend drugs directly to the Board immediately (this does not relieve any pharmacist who discovers a loss from the requirement of reporting the loss directly to the Board).
6. Each facility issued a pharmacy permit by the Mississippi Board of Pharmacy shall maintain:
A. An area of sufficient size to accommodate the dispensing functions of the facility and which is adequately equipped to provide for the proper storage of drugs and supplies under appropriate conditions of temperature, light, moisture, sanitation, ventilation, and security. All areas where Drugs and Devices are stored shall be dry, well lighted, well ventilated, and maintained in a clean and orderly condition. Storage areas shall be maintained at temperatures which will ensure the integrity of the Drugs prior to their dispensing as stipulated by the USP-NF and/or the Manufacturer’s or Distributor’s labeling;
B. A sink with hot and cold running water which is convenient to the dispensing area;
C. An inventory which shall include such drugs, chemicals, and preparations as may be necessary to fill ordinary prescriptions as indicated by experience in the area where the pharmacy is located;
D. Technical equipment which may include measuring graduates, mortar and pestle, spatulas, funnels, ointment slab or paper, balance, and such other items of equipment found to be necessary for the filling of prescriptions or rendering of other pharmacist services;
E. Current reference material adequate for professional and consumer information.
F. Pharmacy permits, facility controlled substance registrations, and DEA registrations must be conspicuously posted. Evidence of current pharmacist licensure and pharmacy technician registration must be provided on request by any agent of the Board;
G. A current and updated copy of the Mississippi Board of Pharmacy Practice Regulations and Pharmacy Practice Act.
7. It is the responsibility of the Pharmacist-in-charge to establish and implement procedures to ensure compliance with the Article entitled Prescription Monitoring Program.
8. The pharmacist-in-charge shall be responsible for written policies and procedures for maintaining the integrity and confidentiality of prescription and patient health care information. All employees of the pharmacy with access to any such information shall be required to read, sign, and comply with the established policies and procedures.

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Medical errors are up at VA hospitals, but they’re actually doing less to figure out why

Posted on August 31, 2015 by Pharmaciststeve

Medical errors are up at VA hospitals, but they’re actually doing less to figure out why

http://www.washingtonpost.com/blogs/federal-eye/wp/2015/08/31/medical-errors-are-up-at-va-hospitals-but-theyre-actually-doing-less-to-figure-out-why/

Hospitals across the country are under growing pressure to reduce preventable medical mistakes, the errors that can cause real harm and even death to patients.

But the Department of Veterans Affairs, which runs a massive system of hospitals and clinics that cared for 5.8 million veterans last year, is doing less, not more, to identify what went wrong to make sure it doesn’t happen again.

A report out late Friday from the Government Accountability Office found that the number of investigations of adverse events — the formal term for medical errors —plunged 18 percent from fiscal 2010 to fiscal 2014. The examinations shrank just as medical errors grew 7 percent over these years, a jump that roughly coincided with 14 percent growth in the number of veterans getting medical care through VA’s system.

Auditors said it was hard for them to know whether the decline in investigations (called root cause analyses) means that fewer errors are being reported, or that these mistakes, while on the rise, are not serious enough to warrant scrutiny.

But the reason for the caution is itself disconcerting: VA officials apparently have no idea why they are doing fewer investigations of medical errors. They told auditors that they haven’t looked into the decline or even whether hospitals are turning to another system.


This chart shows root cause analyses of preventable medical errors done by hospitals and clinics (Department of Veterans Affairs)

The National Center for Patient Safety, the office in the Veterans Health Administration responsible for monitoring investigations of medical errors, “has limited awareness of what hospitals are doing to address the root causes of adverse events,” the report concluded.

Patient safety officials are “not aware of the extent to which these processes are used, the types of events being reviewed, or the changes resulting from them,” GAO wrote.

It added that “the lack of complete information may result in missed opportunities to identify needed system-wide patient safety improvements.”

Auditors said the lack of analysis is “inconsistent” with federal standards on internal controls, which require agencies to look at significant changes in data.

An adverse event is an incident that causes injury to a patient as the result of an intervention that shouldn’t have been made, or one that failed to happen, rather than the patient’s underlying medical condition. These kinds of errors are considered preventable, which is why hospitals and physicians are under pressure to put new systems in place or update their standards and procedures. They often result from a combination of system and medical errors.

Some examples: Medical equipment was improperly sterilized, leading a patient or multiple patients to be exposed to infectious diseases. Surgery was done on the wrong patient, with the wrong procedure on the wrong side. A patient falls or is burned. A patient gets the wrong medication or the wrong dose.

VA officials, in response to a draft of the report, generally agreed with its conclusions and with GAO’s recommendation that they get a better handle on why fewer root-cause investigations are done. The patient safety office has started a review that’s scheduled to be done in November. Officials acknowledged that while hospitals use other systems (such as the Six Sigma management method) to review medical errors, “these processes are not a replacement” for root-cause analyses.

The report was requested by three leading Senate Democrats and two House members who are ranking members or serve on committees that oversee the VA, including presidential hopeful Bernie Sanders (I-Vt.); Sen. Richard Blumenthal (Conn.); Rep. Corrine Brown (Fla); Sen. Patty Murray (Wash.) and Rep. Eddie Bernice Johnson (Tex.)

Although they collected data from the entire system of 150 VA hospitals and clinics, auditors did a deeper dive at four: the Salt Lake City Health Care System; Robley Rex Medical Center in Louisville, Ky.; Southeast Louisiana Veterans Healthcare System in New Orleans and James E. Van Zandt Medical Center in Altoona, Pa.

Patient safety officials told auditors that while they haven’t done an analysis of why there are fewer investigations of medical errors, they observed a “change in the culture of safety” at many hospitals.

This is a revealing observation:

“[Patient safety] officials stated that they have observed a change in the culture of safety in recent years in which staff feel less comfortable reporting adverse events than they did previously. Officials added that this change is reflected in [their] periodic survey on staff perceptions of safety; specifically, 2014 scores showed decreases from 2011 on questions measuring staff’s overall perception of patient safety, as well as decreases in perceptions of the extent to which staff work in an environment with a nonpunitive response to error.”

Still, the number of reports of medical errors has been increasing.

Root-cause analyses are launched depending on the severity of the error.  High-risk mistakes that seem destined to recur require investigations. Lower-risk errors are up to the discretion of hospital staff.

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Should ESI’s fall under the situations of Medicare/Medicaid fraud – no medical necessity ?

Posted on August 30, 2015 by Pharmaciststeve

Dallas Medicare Fraud Strike Force Takes on Rampant Healthcare Hustles

http://www.whistleblowergov.org/healthcare-and-pharma.php?article=Dallas-Medicare-Fraud-Unit-Fights-Healthcare-Hustles_28#navbar

Should medically unnecessary ESI’s fall under this issue of Medicare/Medicaid fraud?

A podiatrist accompanied by nail salon workers offers free pedicures to seniors.  Sounds like a great deal, right?  But the foot doctor winds up billing Medicare for phantom foot surgeries.

Dallas Medicare Fraud Strike Force Takes on Rampant Healthcare Hustles

An equipment supplier gives away free knee braces to seniors, but then bills Medicare for more expensive types.

These are just two examples of how fraud is driving up America’s healthcare costs, according to Jim Landers, a reporter for the Dallas Morning News.  Such rampant abuse amounts to anywhere from a staggering $93 billion to $310 billion, or 3 to 10 percent of what the US spends on health care, he says.

No Cost to Patients?

Consumers are told by the charlatans that the goods and services they are getting will not cost them a thing.  The reality is that they may not be paying anything at the point-of-purchase, but all the waste will result in increased Medicare premiums they have to shell out the following year.  

Taxpayers Funding DNA Tests

Last summer, a company advertised free DNA testing for seniors, according to Landers.  A representative from the company explained to the unwitting group gathered at a senior center in Carrollton, Texas that Medicare was spending $136 billion a year on seniors who were hospitalized because of adverse drug interactions.  He claimed that DNA testing could identify how well the seniors are metabolizing the drugs they are taking, which would then aid their physicians in avoiding the bad drug interactions — a very dubious claim at least at this time.

Marilyn Hoss, who was one of the about 20 seniors who showed up for the genetic testing, said the company representative claimed that Medicare was paying the firm to run the tests because it would save the federal government a lot of money, according to Landers. Medicare wound up paying the laboratory a whopping $1,187 to run Hoss’ DNA test.

Mike Fields, a senior federal agent in Dallas with the inspector general’s office of the Department of Health and Human Services, challenges the medical necessity of the genetic testing, according to Landers.  But Fields says, “As long as all the blanks are filled out [on the billing form] and all the boxes are checked, no human ever sees it.  It goes right through.  They’ll pay it.”

Indictments and Convictions but Low Medicare Fraud Recovery

Fields says that Medicare’s fraud and abuse problems in the Dallas area are found primarily in three medical segments: home health care, hospice care, and durable medical equipment.  Home health care in a number of Texas counties is “just out of control,” he says.

A special strike force that was established in Dallas to try and fix the problem unearthed illegal schemes that billed Medicare for more than a half a billion dollars, according to Landers.  But sadly, only a little over $50 million was recovered.  Meanwhile, there have been 63 indictments and 43 convictions to date.

Medicare and Medicaid Software Saves $211M

In 2010, Congress approved $100 million for the Centers for Medicare and Medicaid to develop computer programs that can help identify suspicious claims before issuing payment, according to Landers.  In 2014, the software was credited with preventing $211 million in fraudulent payments.

No Free Lunch for Texas Seniors

A common theme running through all of the Medicare schemes, according to Landers, is the notion that they are so-called victimless crimes.  He quotes the cautionary words of Neil Thomas, a former employee benefits manager in Dallas, on this misguided view.

“The amount they charge you for Medicare premiums has to be increased when billions have been taken away from Medicare by fraud,” says Thomas, speaking to a group at the Carrollton senior center.  “So it’s in your best interest to keep your Medicare costs lower by reporting this stuff.”

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Cops thinks all people taking opiates are addicts/diverters ?

Posted on August 30, 2015 by Pharmaciststeve

Drug theft reports now get extra scrutiny

http://www.journal-news.com/news/news/crime-law/drug-theft-reports-now-get-extra-scrutiny/nnSs5/

BUTLER COUNTY —

Cleta Leugers was surprised when she called New Miami Police earlier this month to report that her anxiety medication had been stolen and was told the department no longer took drug theft reports.

“They told me they didn’t take reports because there was so much drug activity,” Leugers said. “I don’t think that’s right.”

New Miami Police Chief Dan Gilbert said his department in the Butler County village of 2,200 does not take drug theft reports mainly because many of the theft reports were fraudulent ones filed by drug abusers and dealers.

“We don’t want to be a part of the pipeline putting more drugs on the streets,” Gilbert said, adding reports are taken on a case-by-case basis.

Leugers said her anxiety pills were stolen by some boys who were cleaning her house. She believes they took pills from her twice, the second time right after she filled her prescription.

Because the pharmacy would not re-fill the prescription without a theft report from law enforcement, Leugers said she has been sick from withdrawal, but she is more concerned about someone overdosing on her medication.

“It would be really bad if someone hurts themselves on my medication, and they are going to come back on me,” she said.

However, Gilbert said there were “some questions” about Leugers’ account of how her medication was stolen.

With prescription drug abuse rampant, it’s easy to see why law enforcement officials might be suspicious when a person reports his or her medication stolen for a second or third time. Many area police departments are trying to stem the tide of fraudulent drug theft reports by making them tougher to file.

Gilbert said New Miami is no different than the rest of Butler County and the state where opiate abuse and heroin addiction are an epidemic.

“We have to be responsible to the community, and we are not going to facilitate additional crime by taking bogus drug theft reports,” the chief said, adding the department has seen positive changes and now takes “very few” drug theft reports.

New Miami Police are not alone when it comes to drawing a hard line on drug theft reports. Most police agencies do some type of check or investigation, especially when a theft of opiates or benzodiazepines is reported.

Maj. Mike Craft, of the Butler County Sheriff’s Office, said deputies have the discretion to not take a report if they feel one isn’t warranted, but “we don’t have an exact policy.”

What the sheriff’s office does have is the Butler County Undercover Regional Narcotics Unit, which it uses to prosecute those suspected of using a theft report to get more drugs illegally.

“I would rather have them take the report, then turn it over to the B.U.R.N. unit for investigation and bust their ass,” Craft said.

Hamilton and Middletown police take drug theft reports, but they are assigned to a detective for investigation before the reports are released.

In Middletown, if there is nothing suspicious, a detective in the narcotics unit may just conduct the investigation with a phone call. But if the person has a drug history or has reported drug theft more than once, more investigation will take place, including checking the Ohio Automated Rx Reporting System (OARRS) that tracks prescription history for controlled substances.

“We have done it for years,” said Maj. Mark Hoffman, of the Middletown Division of Police. He added that fraudulent reporting of drug thefts is common, but has tapered off in recent years.

“I think it is commonly understood that it is one of the things that contributed to the heroin epidemic,” Hoffman said.

OARRS, established in 2006 through the Ohio State Board of Pharmacy, is available to prescribers, pharmacists and law enforcement officers. Prescriptions for controlled substances must be entered to OARRS within 24 hours, according to Chad Gardner, director of OARRS. It is a tool to assist health care professionals in providing better treatment for patients with medical needs while quickly identifying drug seeking behaviors.

Hamilton police Sgt. Ed Buns said there’s no doubt bogus drug theft reports are made, so each report is assigned to a detective. Some may also follow up with a call to the doctor, if they suspect any abuse.

While Buns said he doesn’t recall seeing an inordinate amount of drug theft reports, he knows pharmacies have become more strict about having a report before refilling.

“I know at the Walgreens on High Street, they have what they call ‘frequent fliers’ who come in often to try to get refills,” he said.

If Fairfield police are suspicious about a drug theft report, they provide the person with a form to have the pharmacist fill out after the person is checked out through OARRS.

“They can have the pharmacist check them out and fill it out then return it to us for the report,” said Fairfield Officer Doug Day. “We don’t get many back.”

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