As controlled substance use rises in Medicare, prolific prescribers face more scrutiny

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By Charles Ornstein and Ryann Grochowski Jones
ProPublica

This story was co-published with USA Today and NPR’s Shots blog.

Despite a national crackdown on prescription drug abuse, doctors churned out an ever-larger number of prescriptions for the most-potent controlled substances to Medicare patients, new data shows.

In addition, ProPublica found, the most prolific prescribers of such drugs as oxycodone, fentanyl, morphine and Ritalin often have worrisome records.

In 2012, the most recent year for which data is available, Medicare covered nearly 27 million prescriptions for powerful narcotic painkillers and stimulants with the highest potential for abuse and dependence.

That’s up 9 percent over 2011, compared to a 5 percent increase in Medicare prescriptions overall.

Even taking into account an increase in the number of Medicare enrollees, the prescribing rate rose slightly for these drugs, which are classified as Schedule 2 controlled substances by the Drug Enforcement Administration.

Twelve of Medicare’s top 20 prescribers of Schedule 2 drugs in 2012 have faced disciplinary actions by their state medical boards or criminal charges related to their medical practices, and another had documents seized from his office by federal agents.

The No. 1 prescriber 2014 Dr. Shelinder Aggarwal of Huntsville, Ala., with more than 14,000 Schedule 2 prescriptions in 2012 2014 had his controlled substances certificate suspended by the state medical board in March 2013. He surrendered his medical license four months later. (Aggarwal could not be reached for comment.)

Prescribing high volumes of Schedule 2 drugs can indicate a doctor is running a pill mill, said Dr. Andrew Kolodny, chief medical officer of Phoenix House, a New York-based drug treatment provider. Government regulators should do more to monitor prescribing patterns and intervene proactively if they appear aberrant, he said.

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Avoid powdered pure caffeine, FDA warns.

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From the US Food and Drug Administration

The FDA is warning about powdered pure caffeine being marketed directly to consumers, and recommends avoiding these products.

In particular, FDA is concerned about powdered pure caffeine sold in bulk bags over the internet.

The FDA is aware of at least one death of a teenager who used these products.

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These products are essentially 100 percent caffeine. A single teaspoon of pure caffeine is roughly equivalent to the amount in 25 cups of coffee.

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Health news headlines – December 17th

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Global health news – December 17th

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State wins $65 million to improve health care

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Washington MapFrom the Washington State Health Care Authority

Washington won a $65 million grant to bolster health care innovation in the state, Gov. Jay Inslee announced today.

Awarded by the Center for Medicare and Medicaid Innovation (CMMI), the federal grant supports the Healthier Washington project developed through a collaboration of state leaders, the Legislature, health care systems and community members.

Healthier Washington’s purpose is to achieve the “Triple Aim” for the state’s population: better health, better care, and lower costs.

Goals of the plan:

  1. Build healthier communities and people through prevention and early attention to disease
  2. Integrate care and social supports for individuals who have both physical and behavioral health needs
  3. Reward quality heath care over quantity, with state government leading by example as Washington’s largest purchaser of health care

Washington is one of 11 states to get the four-year testing grant, which begins in February 2015. The Washington State Health Care Authority (HCA) will serve as lead agency for the grant.

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10 reasons why healthcare isn’t a free market – Modern Healthcare

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Photo by Sanja Gjenero

Photo by Sanja Gjenero

No. 1: Nobody in the middle of a heart attack shouts, “Let’s go shopping!” Some other reasons, writes Merrill Goozner in Modern Healthcare are: Comparison shopping is complex, doctors belong to professional guilds, and most care is delivered locally so foreign competition can’t drive down prices.

10 reasons why healthcare isn’t a free market – Modern Healthcare.

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Teen prescription opioid abuse, cigarette, and alcohol use down, but e-cigarette use up

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Two white tabletsFrom the US Department of Health and Human Services

Use of cigarettes, alcohol, and abuse of prescription pain relievers among teens has declined since 2013 while marijuana use rates were stable, according to the 2014 Monitoring the Future (MTF) survey, released today by the National Institute on Drug Abuse (NIDA). However, use of e-cigarettes, measured in the report for the first time, is high.

These 2014 results are part of an overall two-decade trend among the nation’s youth. The MTF survey measures drug use and attitudes among eighth, 10th, and 12th graders, is funded by NIDA, and is conducted by researchers at the University of Michigan at Ann Arbor. NIDA is part of the National Institutes of Health.

“With the rates of many drugs decreasing, and the rates of marijuana use appearing to level off, it is possible that prevention efforts are having an effect,” said NIDA Director Nora D. Volkow, M.D.

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How safe are outpatient surgery centers?

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Popularity Of Outpatient Surgery Centers Leads To Questions About Safety

Woman_doctor_surgeonBy By Sandra G. Boodman
KHN and Washington Post

Wendy Salo was alarmed when she learned where her doctor had scheduled her gynecologic operation: at an outpatient surgery center.

“My first thought was ‘Am I not important enough to go to a real hospital?’ ” recalled Salo, 48, a supermarket department manager who said she felt “very trepidatious” about having her ovaries removed outside a hospital.

Before the Sept. 30 procedure, Salo drove 20 miles from her home in Germantown, Md., to the Massachusetts Avenue Surgery Center in Bethesda for a tour. Her fears were allayed, she said, by the facility’s cleanliness and its empathic staff.

Salo later joked that the main difference between the multi-specialty center and Shady Grove Adventist Hospital — where she underwent breast cancer surgery last year — was that the former had “better parking.”

Salo’s initial concerns mirror questions about the safety of outpatient surgery centers that have mushroomed since the highly publicized death of Joan Rivers.

The 81-year-old comedian died Sept. 4 after suffering brain damage while undergoing routine throat procedures at Yorkville Endoscopy, a year-old free-standing center located in Manhattan.

Federal officials who investigated Rivers’ death, which has been classified by the medical examiner as a “therapeutic complication,” found numerous violations at the accredited clinic, including:

  • a failure to notice or take action to correct Rivers’ deteriorating vital signs for 15 minutes;
  • a discrepancy in the medical record about the amount of anesthesia she received;
  • an apparent failure to weigh Rivers, a critical factor in calculating an anesthesia dose;
  • and the performance of a procedure to which Rivers had not given written consent.

In addition, one of the procedures was performed by a doctor who was not credentialed by the center.

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International Community Health Service recognized as ‘National Quality Leader’

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International Community Health ServicesInternational Community Health Services (ICHS)  been cited by the federal government as a “National Quality Leader” for exceeding national clinical benchmarks for chronic disease management, preventive care, and perinatal/prenatal services.

The Seattle-based health center also was recognized for achieving some of the best overall clinical outcomes nationally for health centers and for showing significant improvement in clinical quality measures between 2012 and 2013.

ICHS is a non-profit community health center that specializes in providing affordable health care services to Seattle and King County’s Asian, Native Hawaiian, Pacific Islander, and other underserved communities.

It operates medical and dental centers in Seattle’s International District and Holly Park neighborhoods, as well as in the cities of Bellevue and Shoreline; a school-based health center at the Seattle World School, and a primary care clinic at ACRS, a social and mental health services agency in Seattle.

In recognition of its accomplishment and to fund further quality improvement, ICHS will receive $84,169 in Affordable Care Act funding by the U.S. Department of Health and Human Services.

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Boeing, Starbucks demand and get better healthcare for their workers – LA Times

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starbucks-logoSeattle’s big companies have pushed local hospitals and doctors to meet the kinds of rigorous standards they use to build airplanes or brew coffee, reports The Los Angeles Times. Also in the news are a look at the SHOP exchanges for small businesses and the rate increases some of those employers are facing.

Where employers use quality control to shape healthcare – LA Times.

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Health news headlines – December 16th

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Global health news – December 16th

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Obamacare signup deadline collection . . .

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Four helpful articles on the ins and outs of signing up for health insurance for 2015
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