The thought that there could be a shortage in pain killing drugs for the people who need them (doctors) is stunning and frankly hard to imagine. But surgeons are seeing shortages in everything from morphine to propofol, and this means they have to alter their treatment plans for patients by using alternative drugs. The American Society of Health-System Pharmacists lists 150 "medically necessary" drugs in the shortage crisis.
"It’s been going on for a number of years, but right now it seems to be a little worse than usual," said Dr. James Novotny, a medical oncologist at Franciscan Skemp.
The most important question is why is this happening? Pharmaceutical experts believe it comes down to business decisions made by drug companies. Some drug companies are choosing to increase production of the more profitable name brand drugs while cutting back on the production of generics.
The FDA offers several potential culprits: manufacturing delays, commodity shortages and increased demand.
Senator Amy Klobuchar of Minnesota took up the cause last December, vowing to introduce legislation that would provide the FDA with tools to address drug shortages. And she’s following through, with an announcement from her website that says she and Bob Casey (D-PA) have introduced a bill that gives the FDA the ability to require early notification from pharmaceutical companies when an issue may arise that could cause a shortage.
The duo’s proposed legislation is supported by the Minnesota Hospital Association, the American Hospital Association, Fairview Hospital, the American Society of Clinical Oncologists, and the Institute for Safe Medication Practices.
Drug Shortage Crisis Addressed in Congressional Legislation
Herbal Medicines Potentially Dangerous Mix with Anesthesia
While herbal medicines may have once been seen as something relegated to counterculture types years ago, it’s very much a part of the mainstream in the U.S. today. Every year, Americans are spending over $27 billion on herbal supplements to help them with everything from memory to energy boosting.
While herbal medicines can often be used effectively, the term "natural" often gets mixed up with automatically being safe. This can be a potentially fatal assumption with people who have a surgical procedure where herbal products can interact adversely with anesthesia medicine. What anesthesiologists are finding is that many time patients aren’t revealing the use of herbal medications before they go into surgery.
According to a report at the American Society of Anesthesiologists, about half of all patients do not tell their doctors about their herbal supplement use before going under anesthesia.
"There is a clear gap in communication between doctors and patients on the topic of alternative medicines," says Dr. Rafael Ortega.
It’s unclear why the information is not being divulged, whether it’s embarrassment or not understanding how potent the medicine is that they are taking.
Since herbal drugs are not subject to the same standards under the Food and Drug Administration, it is not always clear how the compounds may interact with medicines used by doctors. In fact, manufacturers do not have to prove efficacy or track the side effects of their herbal products.
The chairman of the Department of Anesthesiology at Boston Medical Center Dr. Keith Lewis, a pharmacist and physician, recommends that patients stop taking herbal medicines at least two weeks before their surgical appointment. He also prefers patients bring in their medications for their doctors to examine.
Half of Americans Have Preexisting Medical Conditions
There are many debates over our healthcare system and how to improve it. One them involves people with pre-existing medical conditions and whether or not it is okay for insurance companies to discriminate against people who have them. Now, news of how many people who have preexisting conditions sheds some light on how important this aspect of the healthcare debate really is.
Secretary of Health and Human Services Kathleen Sebelius just released a study that states that up to half of all Americans under the age of 65 have medical problems that could fall under the definition of preexisting conditions. In the report, depending on the definition of a preexisting condition, between 17 and 46 percent of Americans may have problems getting health insurance. That means as many as 129 million Americans are at risk of not qualifying for health insurance, or at least only being eligible for state high-risk pools which are special coverage for people denied insurance due to their medical history.
The researchers at the Health and Human Services Department used findings from an expansive federal survey of medical expenditures in 2008, the most recent available, to come to the conclusion of how many people faced problems of preexisting health issues.
The ailments that may put people at risk of not qualifying for health insurance include cancer and chronic illnesses, such as heart disease, asthma and high blood pressure.
There is push back to these findings, both from Republicans who say that it is partisan PR on behalf of the Democrats and from the Insurance industry itself.
Robert Zirkelbach, a spokesman for the health insurance lobbying group America’s Health Insurance Plans, says that even though his group supports the reform of the individual insurance market, "this report exaggerates the number of people who are impacted."
If the provision for protecting people with preexisting conditions remains intact, the 2010 Patient Protection and Affordable Care Act will forbid insurance companies to charge sick patients more or reject sick healthcare applicants.
Benefits of Electronic Medical Records
According to a 2009 survey, just 33 percent of medical practices more than three physicians currently use electronic medical records software. If your practice is considering a shift to electronic medical records from your current paper system, it’s good to know some of the benefits you can expect.
Increased Revenues
When a medical practice Uses paper charts, many of their services are lost and never get billed. Using an Electronic Medical Records (EMR) software program, you can increase your practice’s revenues by ensuring you receive money on charges for all services you perform.
Lower Expenses
Electronic Medical Records can reduce the labor costs related to appointment scheduling, billing, filing, medical chart transcriptions, and more. Plus, once a doctor’s office goes to electronic medical records, the costs associated with buying, storing, and destroying paper charts can be eliminated.
Reduce Costs Related to Malpractice
Malpractice insurance costs are always increasing. When you use an Electronic Medical Records (EMR) software, some insurance companies may reduce malpractice premiums by as much as 10 percent. This is due to the fact that a doctor’s office reduces their chances of medical errors. EMR software can reduce medical errors in many areas, including misdiagnosis, conflict in medications, reading errors due to bad handwriting, just to name a few.
Versatile Access to Records
Electronic Medical Records can be accessed practically anywhere. This not only saves time for one person, but multiple people in the office, since files can be accessed by multiple people at the same time. Not to mention, you no longer have to worry about files being lost or misplaced.
Better Security
Not only can files have restricted access, medical practices can have more restrictions on certain files, which gives you more flexibility with how you want certain information accessed.
DEA Pushing Propofol Towards Controlled Substance
Propofol, administered intravenously in operating rooms as an anesthetic and sedative, made its way into the spotlight in the last year or so thanks to the controversy over Michael Jackson’s overdose death. Now authorities are taking notice. The Drug Enforcement Administration was petitioned in 2009, according to DEA spokesman Rusty Payne, to designate propofol as a "scheduled" drug. This would create tighter restrictions on its distribution and use. However, Payne says that the petition was not related to propofol’s involvment in Michael Jackson’s death.
The Drug Enforcement Administration was petitioned in 2009, according to DEA spokesman Rusty Payne, to designate propofol as a "scheduled" drug. This would create tighter restrictions on its distribution and use. However, Payne says that the petition was not related to propofol’s involvment in Michael Jackson’s death.
However, the concern is rooted in worries of potential abuse of the powerful pain killer. Propofol is administered intravenously in operating rooms as an anesthetic and sedative.
Last fall, the DEA started circulating a proposed rule that would classify propofol as a Schedule IV substance. This puts it in the same category as midazolam, diazepam, lorazepam and zolpidem.
While DEA agent Rusty Payne says that he had no knowledge of propofol being abused on a large scale, having it classified as a Schedule IV substance puts it alongside drugs that are. The DEA also declined to provide a copy of the proposed rule for propofol, but looking at the statement for the sedative fospropofol, which was given Schedule IV status in 2009, propofol is mentioned:
“The current abuse profiles of propofol, the active metabolite of fospropofol, indicate that propofol is abused… The oral activity of fospropofol increases the likelihood of its abuse by other routes of administration and its use to commit other crimes (e.g., date rape).”
Congress Postpones Medicare Pay Cuts for Doctors
With the help of a Senate Finance Committee, a bill has been passed to freeze Medicare reimbursements at current levels for another 12 months. The U.S. House of Representatives passed the Medicare and Medicaid Extenders Act of 2010 on December 9.
The bill, which is effective January 1, 2011, will eliminate the 25 percent cut in reimbursements that doctors would have faced. Needless to say, doctors are happy with the move, even if it only solves the issue for another 12 months.
"Stopping the steep 25 percent Medicare cut for one year was vital to preserve seniors’ access to physician care in 2011," said Dr. Cecil Wilson, president of the American Medical Association.
The House vote was nearly unanimous, at 409 to 2. President Obama just has to sign the new law and it will take effect, and since he was already a champion for the cause, that should not be an issue.
This is also good news for elderly patients, since some doctors have said that the dwindling Medicare payments and a further cut would have meant that they could no longer see new Medicare patients. In fact, surveys have shown that up to 43 percent of doctors who see Medicare patients would stop seeing them if the pay cut would have gone through.
"One of our top priorities next year will be to make (the fix) permanent, so our seniors can find doctors," said Rep. Wally Herger, Republican from Chico, Califnornia.
The only two in the House to vote against the bill were Brian Baird (D, WA) and Tom McClintock (R, CA-04).
Lawmakers have faced this same issue every year since the ’90s. But every year they "kick the can" ahead, so to speak.
"The fix is helpful," said Tricia Neuman, a vice-president of the Kaiser Family Foundation and director of its Medicare Policy Project. But "similar problems will resurface next year because the underlying sustainable growth formula for physician payments has not been reformed."
ASA Helps Parents Reduce Chances of Surgical Complications in Obese Kids
Childhood obesity is a major problem that is reaching epidemic proportions in the U.S.
and much of the developed world. There are twice as many children who are obese than
20 years ago, and three times the number of adolescents who are obese.
This, of course, has major health ramifications, but not just in the areas you might be
thinking of, such as diabetes and heart disease. If a child has to be given anesthesia for a
medical procedure, they face bigger risks than their thinner healthier counterparts.
That is why The American Society of Anesthesiologists (ASA) is raising awareness
by educating parents about the potential complications their children may face when
undergoing anesthesia.
Since children’s airways are still in the midst of development, anesthesia can be more
complicated with kids than with adults. This means their airways are more prone to
collapse during the administration of anesthesia. The risk increases when a child is obese.
“Obese children have extra tissue surrounding their airway, chest, and abdomen that can
impair breathing while under anesthesia, and limit the amount of oxygen they receive
during surgery. This can lead to a range of complications including impairment of lung
function and in severe circumstances even brain damage,” said Mark Singleton, M.D.,
ASA member and chair of the committee on pediatric anesthesia.
Here are some tips that the ASA is giving parents to optimize their children’s surgical
outcomes, not to mention their overall health:
– The first and most logical choice is to help your child lose weight before their surgery.
Even just a few pounds of weight loss can have a positive impact on the outcome of your
child’s medical procedure. You can do this by encouraging simple healthy eating habits
at home and when they are in school or elsewhere.
– Make sure that you child’s anesthesiologist has experience with obese patients,
particularly children. Speak with them about the specific risks involved.
– When you embark on helping your child get to a healthy weight, set reasonable goals.
Make an appointment with your pediatrician to set up a safe weight-loss program for
your child. Also discuss the weight loss program with your child’s anesthesiologist and
surgeon to make sure it won’t interfere with their future medical procedure.
– Remember when kids played outside rather than sitting at home playing video games
day and night? Get your back into a daily exercise that all kids should enjoy. Sign them
up for team sports or after-school physical activities. And even if that isn’t something
they are interested in, just get them outside with friends to run around.
Dr. Singleton goes on to say the following:
“As the physicians responsible for protecting the vital health of patients when they are
at their most vulnerable – before, during and after surgery – we’re urging parents and
youths alike to educate themselves about the potential risks associated with pediatric
obesity and to fight this growing trend by making changes that enable them to lose
weight while maintaining an active lifestyle.”
Allscripts MyWay Qualifies for Funding Under American Recovery and Reinvestment Act
Allscripts MyWay EHR version 9.0 recently received Complete EHR Ambulatory certification. This means that the software, an integrated electronic health records and practice management solution, now enables providers to meet the Stage One meaningful use measures that are required to qualify for funding under the American Recovery and Reinvestment Act (ARRA).
“The certification of our MyWay EHR provides physicians in independent practice and small groups an electronic health record that is simple, easy to use and that works the way their practice works, while positioning them to qualify for federal incentives under ARRA,” said Glen Tullman, Chief Executive Officer of Allscripts.
The software was tested and certified under the Drummond Group’s Electronic Health Records Office of the National Coordinator Authorized Testing and Certification Body (ONC-ATCB) program. Their certification program tests and certifies EHRs to make sure that they fit the criteria adopted by the Secretary of Health and Human Services, currently Kathleen Sebelius.
Healthcare providers who use the Allscripts EHR system are qualified to receive federal stimulus money once they demonstrate “meaningful use” of the technology.
Allscripts MyWay version 9.0 is currently available in two forms: an on-premise software solution or as a SaaS (Software as a Service), which is software deployed over the Internet.
MBA Medical uses the Allscripts MyWay, and has seen firsthand how this intuitive easy-to-use software can make managing medical records a much more efficient process. For more information, including a video presentation on the software, go to our AllScripts EMR Software page.
What are the Costs vs Benefits to the ICD-10?
The most recent medical coding, or International Classification of Diseases, is ICD-10. It was endorsed by the 43rd World Health Assembly in May 1990 and was started to be used in WHO Member States in 1994. But it’s not until 2013 that we will see these revisions in the U.S.
So, how does the ICD-10 differ from the ICD-9 set of codes currently in use in the U.S.? The ICD-10-CM codes are very different. All codes in ICD-10-CM are alpha-numeric. There can be as many as seven alpha-numeric characters. This means that billing software programs must be changed to accommodate the additional digits. This also means more extensive medical billing coder training.
While there won’t be much change in how the physician does his or her documentation in the medical records, the translation process into ICD coding will change. The newer codes will provide more detailed information about the patient’s condition.
It’s interesting to see some of the data comparing what ICD-10 will cost versus what it can save hospitals and healthcare providers. The RAND Science and Technology Policy Institute did a cost/benefit analysis of implementing ICD-10. What they found was that providers will incur costs for computer reprogramming, training coders, physicians, and code users, and for the initial and long-term loss of productivity among coders and physicians.
The cost of sequential conversion (10-CM then 10-PCS) is estimated to be between $425 million and $1.15 billion in one-time costs. There will also be between $5 and $40 million lost in yearly productivity.
But there are benefits as well, many benefits that RAND sees coming from the new detail provided in ICD-10. And, as you will see, they far outweigh the costs.
– More accurate payments to hospitals for new procedures is believed to save $100 million to $1.2 billion.
– There are also benefits from fewer rejected claims, which may be $200 million to $2.5 billion.
– But wait there’s more… in the form of $100 million to $1 billion in fewer exaggerated claims.
– The identification of more cost-effective services and direction of care to specific populations would result in $100 million to $1.5 billion.
– There are also untold benefits that would come from better disease management and better directed preventive care.
In light of these enormous changes coming into effect many anesthesiologists are even more likely to benefit from outsourcing their billing to a medical billing company that specializes in providing anesthesia billing services.
Regional Anesthesia Superior to General Anesthesia in Melanoma Surgery
According to research presented at the American Society of Anesthesiologists (ASA) 2010 Annual Meeting recently held in San Diego, California, regional anesthesia gives melanoma patients their best chance for survival.
More specifically, when regional anesthesia is used during lymph node dissection, there is a better long-term prognosis than when using general anesthesia.
“We have good information from animal studies, and our understanding of the tumor [is telling us] that we should expect surgery [to be] risky for our patients,” Gerhard Brodner, MD, PhD, professor of anesthesiology at Fachklinik Hornheide in Muenster, Germany.
The researchers conducted a retrospective study using the medical records of 273 patients who underwent inguinal lymph node dissection after the diagnosis of primary malignant melanoma of the leg. The patients received either spinal or general anesthesia.
There were 52 patients who were given spinal anesthesia (bupivacaine 0.5%) and 221 patients who were given general anesthesia, which was either a balanced anesthesia with sevoflurane and sufentanil (n = 118) or as total intravenous anesthesia with propofol and remifentanil (n = 103). The analysis revealed that patients who received spinal anesthesia had a better survival rate over 10 years than those receiving general anesthesia.
The session’s moderator, Daniel Sessler, MD, professor of outcomes research at The Cleveland Clinic in Ohio, says that there have been a series of retrospective studies on the effects of regional and general anesthesia which have come up with mixed results in different tumors.
While Dr. Brodner says that anesthesiologists “should avoid everything that could harm the balance between the immune system and tumor cells,” Dr. Sessler says that “We really need to wait for prospective data. This is an intriguing theory, but it’s absolutely not a basis for altering practice. There’s good basic science, and strong animal data to support it. It’s the human data that we’re having problems with.”
Hi There! My name is Chris Phillips and I am the President of MBA Medical Business Associates, a medical practice management company specializing in 
