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Presenting in Las Vegas

We are proud to present at the Navigating the Full Spectrum of Case Management, June 10-14th in Las Vegas, NV. 

Please join us at this exciting event!

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Do You Have The Guts?

The gut microbiome, the roughly 10 trillion to 100 trillion bacteria and other microorganisms
that live in the digestive tract, contributes to health by synthesizing vitamins, metabolizing drugs
and fighting pathogens. Anything that disrupts the balance of microorganisms, such as
antibiotics, which can kill both “good” and “bad” bacteria, has the potential to cause disease.
Data from a 2016 study suggest that exposure to antibiotics in infancy can alter the gut
microbiome and weaken the immune response for years to come. Other studies have linked the
use of antibiotics in children to an increased lifetime risk of asthma, obesity and inflammatory
bowel disease, effects thought to be mediated by the gut microbiome.

Antibiotics can also have long-lasting effects on adults. Researchers at Stanford screened more
than 900,000 genetic samples from the stool of healthy men and women who took the antibiotic
ciprofloxacin. They found that most of the gut microbiome returned to normal after four weeks,
but that the numbers of some bacteria still remained depressed six months later. In a longer,
larger follow-up study, they concluded, “Antibiotic perturbation may cause a shift to an
alternative stable state, the full consequences of which remain unknown.”

In an example of a potentially beneficial effect of altering the gut microbiome, evidence suggests
that antibiotics can suppress the formation of a molecule in the gut that increases the risk for
heart disease.

The National Institutes of Health Human Microbiome Project is using advanced genetic
techniques to sequence all the genetic material of the gut microbiome. As newer data becomes
available, a nuanced understanding is emerging: Antibiotics may exert both beneficial and
harmful effects on the gut microbiome.

Posted in Consumer News

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The Forces Behind Our Opioid Crisis

If you can’t trust your pharma rep, who can you trust?

Purdue Pharma spent millions marketing the drug that has led to today’s crisis.

The US uses 80% of all the prescription opioids in the world, with only 5% of the world’s population.  This does not include the street equivalents (heroin, fentanyl). The lack of controls for this drug, on the production, distribution and dispensing has led to the alarming addiction rates for legitimately prescribed and illegitimate narcotic use. Suddenly there is alarm because over 64,000 people die in the US due to opiod overdoses per year. That is more than five times the number of gun murders and more than three times the number of suicides in the US per year.

Twenty years ago…

While I was still doing some ICU nursing, I attended an in-service training covering, among other things, a fairly new drug called Oxycontin. This drug claimed special powers, a timed-release version of Oxycodone (think Percocet, Vicodin) that would gradually release the pain-killer over 12 hours. The company, Pharma, claimed their formulation made Oxycontin addiction-proof.

I was concerned because when I looked the drug up in Drug Facts and Comparisons, it appeared that the equivalent of 10 mg of morphine was contained in every mg of “Oxy,” as it became known. So 10 mg of Oxycontin would be 100 of Morphine! Given every 12 hours as directed, the patient with the lowest dose of Oxy would get the equivalent of 210 mg of Morphine (or Morphine Milligrams Equivalents, MMEs) a day!

A drug rep came to the hospital to answer questions about Oxy. I asked the drug rep about the addiction risk. ‘Oh, it’s easy to wean off, you just halve the dose each day until you wean it off. There’s no residual craving.’ This was a lie, of course, but in 1997 it would be difficult for an individual clinician to know what a disastrous outcome was unfolding regarding prescription narcotics (see chart of opioid use disorders below). Oxycodone and Oxycontin are the real gateway drugs leading to heroin abuse and overdoses. The sales of privately-held Purdue Pharma have landed one family on the Forbes richest families. What a legacy!

BCBS Opioid Use Disorder Rate Per 1,000 Members for Past 7 Years

BCBS Opioid Use Disorder Rate Per 1,000 Members for Past 7 Years  Source: Blue Cross Blue Shield Health of America Report

Currently the CDC recommends no more than 50 MMEs per day to address chronic pain, and does not recommend the use of sustained relief narcotic analgesics at all. This refers to those who do not have active cancer or are in a palliative care or hospice program.

Illegal Marketing Tactics

Compounding the problem is the unprecedented Oxycontin marketing push by Purdue Pharma. Starting in 1996, the company spent millions promoting to and “educating” doctors – using data to identify those who’d likely prescribe high amounts of the drug. They more than doubled their sales force and highly incentivized their reps – paying out some $40 million in bonuses in 2001 alone. Purdue also skirted FDA marketing regulations by sending out 15,000 educational videos that minimized addiction risk to doctors without first getting FDA approval. Sales grew from $48 million in 1996 to almost 1.1 billion by 2000. In 2007, three company executives ultimately pled guilty to criminal charges of misbranding.

Sun belt and rust belt states have the highest prescribing rates for opioids. In 2012, health care providers in the highest-prescribing state wrote almost 3 times as many opioid prescriptions per person as those in the lowest prescribing state.

How Insurers Are Part of the Problem

The New York Times has reported that insurers are making it harder to get non-addictive, pain-relieving drugs because they’re more expensive.  Private pay and Medicare insurers require little or no pre-approval for drugs like long-acting morphine or even Oxycontin, and less out-of-pocket co-payment. This steers people suffering from chronic pain toward these habit-forming drugs.  Patients have been left in a lurch after some drug companies stop covering drugs that are working for them.

To add insult to injury, the article reported that insurers are also making access the addiction treatment drugs difficult.

After Overdoses, Doctors Still Prescribe Opioids

According to the Journal of American Medicine, for every 1 overdose, there are 30 non-fatal ones – which represents an intervention opportunity. But, there is evidence that doctors are missing opportunities on many fronts. A 2002-2012 study in Pennsylvania reported high rates of post-overdose opioid prescribing. Another study showed a low rate buprenorphine treatment – which is one way to fight addiction. These studies were conducted with commercially insured patients. Little is known about Medicaid enrollees – who are at 3 times higher risk for overdose.

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Presentation: How To Never Lose An Insurance Appeal

2 Upcoming Dates and Locations



Presented by Michael Newell, RN, MSN
with Jodi Bouer, Esq.

Increase your understanding of insurance plans, benefits, eligibility, industry jargon and all the players who contribute to decisions about coverage.  The politics of insurance coverage are complicated, but they’re not insurmountable.

Arm yourself with the knowledge and tools you need to win your appeals or to assist clients with whom you work.


Presentation Dates

How To Never Lose An Insurance Appeal

Thursday, September 7, 2017

CSMA Logo NoBkgSeptember meeting of the Mid-Atlantic Chapter of the Case Management Society of America

Double Tree-Hilton
640 Fountain Road
Plymouth Meeting, PA 19462

  • Registration begins at 5:30pm
  • Buffet Dinner 6:00pm
  • Business Meeting at 6:15pm

2 CCM CE credits, good for RN credits in New Jersey and Pennsylvania

To register, visit:

How to Never Lose An Insurance Appeal

Tuesday, September 12, 2017 | 5:30 PM
Kessler Rehabilitation Institute
62 Brick Road, Marlton NJ

MUST RSVP in advance to Donna Sobel

2 CCM & RN CE credits


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Posted in Insurance

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Are Medicare Cost Containment Strategies Working?

Trends in hospital inpatient stays (2005-2014) show they are.

  • hospital stayBetween 2005 and 2014, the inflation-adjusted mean cost per inpatient stay increased by 12.7 percent, from $9,500 to $10,900.
  • Inflation-adjusted cost per stay for patients covered by private insurance or Medicaid increased 16-18 percent. Cost per stay for Medicare-covered patients and the uninsured changed minimally.
  • The rate of inpatient stays decreased the most among patients in the highest income quartiles (15-20 percent decrease).
  • The proportion of Medicaid-covered inpatient stays increased by 15.7 percent, whereas the proportion paid by private insurance and that were uninsured decreased by 12.5 and 13.0 percent, respectively.
  • Mental health/substance use accounted for nearly 6 percent of all inpatient stays in 2014, up 20.1 percent from 2005.
  • Between 2005 and 2014, septicemia and osteoarthritis became two of the five most common reasons for inpatient stays. Septicemia hospital stays almost tripled.
  • Nonspecific chest pain and coronary atherosclerosis decreased by more than 60 percent from 2005 to 2014, falling off the list of top 10 reasons for hospitalization.

Source: Healthcare Cost and Utilization Project

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