Stopping the Drug Epidemic

Hudson Institute ^ | 21-Sept-2017 | John P. Walters

[rlmorel]

I assumed you were talking about the reimbursement rates being tied to the patient satisfaction surveys. (HCAHPS surveys)

And that is true it pain relief factors in to those scores.

However, you need to keep in mind that pain relief is just one of many variables (20 or 30 IIRC) and is nowhere near the major one. It is just one question of many, the others having to do with noise level, cleanliness, adequate communication, and so on.

What you describe is what I would characterize as a severe violation of any health care standards I have seen in the decades I have been in healthcare. Not only I have never in any hospitals I have worked in observed that behavior, I have seen behavior quite to the contrary. As a matter of fact, it can be argued with substantial evidence to support it that patients were not having their pain adequately addressed by healthcare personnel for many years, which is why this question is included. There were many clinicians who had to be taught that proper pain management is key to improving the recovery of patients from medical procedures or illness.

I do wish to reiterate, though, what you described in your personal experience, I regard in all my years in healthcare in a hospital setting as being an extraordinary, extreme, and disturbing outlier. That is not normal behavior or policy. I can’t speak To what goes on in private practice in doctors offices not Affiliated with hospitals, but I can tell you with 100% certainty that what you described is not what goes on in Hospitals in general, At least not in my part of the country.

Honestly, as a conservative, I hate these government metrics because I don’t believe that is the way to fix things that are wrong in healthcare, but long ago decided to make lemonade out of lemons in this, and leverage these mandatory government impositions because they can improve certain aspects of healthcare and improve to some degree various elements.

[huldah1776]

Must be doctors who were not in the swamp... At least the W.Virginians are fighting back

http://www.thefiscaltimes.com/2016/12/19/How-West-Virginia-Became-Ground-Zero-Opioid-Epidemic

During the past six years, major drug wholesalers flooded the state with 780 million hydrocodone and oxycodone pills, while 1,728 West Virginians suffered fatal overdoses on those two painkillers, according to the Gazette-Mail investigation. West Virginia has 1.84 million residents, ranking 38th in population nationally.

The deluge of drugs was the equivalent of an astounding 433 pain pills per resident of the state, according to the report. And those shipments were apparently made without raising the suspicions of state public health and regulatory officials or triggering the intervention of federal drug enforcement officials.

[grumpygresh]

I give you the benefit and presume that you are a person that supports the rule of law and individual rights guaranteed by the BOR and constitution.

Dug abuse, addiction and opioid deaths are a big problem. Would you like to come up with a constitutional solution or do the ends justify the means at this point?

The “War on Drugs” was a phrase coined by the Nixon administration and begun in 1970 with the Controlled Substance Act. The DEA was given the responsibility to combat drug trafficking, interdiction at the border and the use of illicit drugs. It was not intended to regulate the legal prescription of opioids. It was later amended in the 1980s gave the DEA the ability to “in the public interest”. That’s pretty broad and vague language just ripe for exploitation by Statist and technocrats. This language has enabled the bureaucrats at DEA to determine medical necessity, determine proper dosing and thereby criminalize the prescribing of opioids based on whatever these non-physician believe is in public interest (or really, the DEA agent’s personal interest). No medical training is necessary for these determinations, so the DEA and DOJ can revoke the DEA number under the administrative law paradigm that denies due process rights. Even worse, The DEA has convinced many that opioid prescribing constitutes drug trafficking when the bureaucrats and lawyers don’t like the practice.

So here are we today. Have things improved since 1970 when CSA was enacted. Or what about 1980s when DEA used language to abuse there powers?

In fact, total opioid doses are down by 22% between 2013-2017, no doubt because of the climate of fear created by the DEA. But opioid deaths continue to increase. In fact, the reason appears to be illicit fentanyl.

http://www.jpands.org/vol23no1/lilly.pdf

True, there were many unscrupulous providers, and they have been shut down by the DEA. Is that good that the DEA did that? If you believe in the constitution and individual rights, no. These providers should have had their medical licenses limited or revoked by State Medical boards. That way, physicians could weigh in on the decision with respect to appropriate dosage and medical necessity. This process works well for incompetent doctors. Without a license, there would be no prescriptions. In fact, many doctors would like to work with DEA to inform them of patients that are suspected of diversion. But that’s impossible now because doctors distrust the DEA, and the DEA is not interested in small time dealers.

“During the past six years, major drug wholesalers flooded the state with 780 million hydrocodone and oxycodone pills”

Now here is where the Federal government MAY have had some legal authority to intervene on public health grounds via HHS. Ask yourself, who had this information? The DEA, DOJ, HHS and probably other major intel operations. Why didn’t they investigate if they had legal basis to place restrictions at that choke point instead of waiting until the drugs go to the pharmacy or doctor?

I think the answer is clear the DEA wants to set up doctors to aggrandize their power and position, just like every other government agency. As long as they are doing “good” in the eyes of an ignorant and docile public, they can have as much power as they want.

Do you want doctors to practice medicine or governemnt bureaucrats?

Why not send the DEA to the border. It’s not as easy as raiding doctors offices, but they might actually do some good there.

[spintreebob]

I only described the pain relief part of my hospital experience. In total, my hospital experience was all about gaming the system to maximize billable events.

The goal of a retail store is to have the customer come in for one item and leave with 31 items. The goal of a salesman is to add upcharges.

For a hospital to survive in many locales, it must maximize billable events. They use AI to determine what CMS and Insurance companies will pay for in addition to the legit reason. So the parade of doctors tried, and in some cases, successfully laid add-ons and upcharges that quadrupled my hospital bill.

Many hospitals are struggling financially. Some are closing. The difference between them and successful hospitals is that the struggling hospitals are either too honest or too stupid to game the system.

As long as the first party, the patient and immediate family, don’t have to pay up front for at least part of the addons, this will continue. It is impossible for third party payers, whether big insurance or government, to catch up with those who game the system.

[rlmorel]

Sent you a Freepmail.