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Thursday, 17 March 2016

Princess Health and Patients may be liable for big bills from air ambulances; state House panel approves bill calling for study of companies' charges. Princessiccia

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Air ambulance services have enabled rural Kentuckians to get advanced emergency care more quickly, but there's a catch.

"Increasingly, the service also can mean the difference between getting well at a price you can afford or at a price that could push you over a financial cliff," Trudy Lieberman writes for Rural Health News Service. "Air ambulances have become the centerpiece of a nationwide dispute over balance billing, a practice that requires unsuspecting families, even those with good insurance, to pay a large part of the bill."

On Wednesday, March 16, the state House Banking and Insurance Committee approved a bill calling for a study of air-ambulance charges. House Bill 273 was sponsored by Rep. Tom McKee, D-Cynthiana, "after a constituent of McKee�s was transported to the hospital via air ambulance after a fall, but it was an unexpected bill for thousands of dollars not covered by insurance which really knocked him off his feet," Don Weber reports for cn|2's "Pure Politics."

Rep. Tom McKee
"McKee says having more information about emergency care transportation may have allowed the individual to avoid the high cost," Weber reports, quoting him: �I have learned in looking at it that certain air-ambulance companies provide a subscription service for perhaps as little as $50 a year, that you can have coverage to know if you need to be transported, the full cost would be paid. As we move forward, I think we�re going to learn a lot more to at least inform people.�

McKee said the charges, which can run well into five figures, may seem huge �but those air-ambulance companies have to keep people on duty and have to have a full crew ready to go at a moment�s notice. But, I think as citizens, we all need to know where we are in regard to being transported and things like we�ve learned, a subscription service could be available.�

Some committee members said they want to see if the charges are justified. �It�s nice to know what the cost is, $40,000, but if it only costs them $8,000 to do it,� said Rep. Steve Riggs, D-Louisville. �So we have to learn more than just what the average retail cost is, we have to also learn more about what the profit margin is.�

Lieberman reports that your air-ambulance bill may not be covered "because the provider is not in your insurer�s network," but "Sometimes it�s impossible to tell if a provider belongs to a network or not. When you are wheeled into the operating room, are you going to ask the anesthesiologist if he or she belongs to the hospital�s network? How many accident victims suffering from trauma are going to direct EMS workers to check if the air service is in or out of network before they�re lifted to a hospital? You can also get stuck even if the ambulance company is in the network. An insurance payment may not come close to covering the cost.

�Rates ambulance companies charge private patients are much more than they are charging to Medicare or Medicaid,� whose rates are too low to suit the companies. Consumers Union Programs Director Chuck Bell told Lieberman. �The air ambulance industry has grown rapidly, and prices have shot up a lot with some companies trying to make a quick buck.�

Princess Health and Annual County Health Rankings for Kentucky show many shifts in the middle echelons, not much at the top and bottom. Princessiccia

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By Melissa Patrick
Kentucky Health News

The sixth annual County Health Rankings report shows little change in Kentucky's top and bottom rankings, but there were a few surprises, with several counties showing up in the top 10 for the first time.

Marshall County was one, ranking 10th in both health outcomes and health factors, the rankings' two main measures. This is an improvement from last year's 26th in outcomes and 19th in factors. Bullitt County also moved into the top 10 for the first time this year, ranking sixth for outcomes, up from 27th.

Health outcomes include length and quality of life. Health factors contribute to outcomes and include four categories: health-related behaviors, clinical care, social and economic factors, and the county's physical environment. The rankings for each county are relative to other counties in the same state.

"Communities use the rankings to help identify issues and opportunities for local health improvement, as well as to garner support for initiatives among government agencies, healthcare providers, community organizations, business leaders, policy makers, and the public," says the report.

The County Health Rankings are a collaboration between the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute.

2016 Health Outcomes - Kentucky
The report is a general categorization of a county's health status. The rankings are arranged in quartiles, or four numerical classes, to de-emphasize the small statistical differences among closely ranked counties. Kentucky has 120 counties, in quartiles of 30.

The bottom quartile comprises almost entirely Appalachian counties, the only exception being Fulton, in the Mississippi Delta at the state's western tip.

Oldham and Boone counties continued to be the top two for health outcomes in the state, as they have been since the rankings began. Spencer County, ranked third, spent the last two years ranked 11th. Shelby and Scott counties are ranked fourth and fifth in outcomes. All are suburban, formerly rural, counties in the state's three major metropolitan areas.

The bottom 10 counties in health outcomes are all rural. They saw little change from last year, with Harlan (117) and Wolfe (119) being the only new additions. The bottom five counties in outcomes are Floyd, Harlan, Perry, Wolfe and Owsley (which has been ranked last for health outcomes every year, except 2013, when it ranked 102nd).

Counties that saw the greatest improvements in health outcomes were Livingston (LG on map), moving up from 70th to 35th; Trimble (TI), moving up from 56th to 27th; and Crittenden (CD), moving up from 64th to 38th. All these counties moved into a higher quartile with these ranking changes.

Morgan County, which for years had health outcomes far better than its health factors, saw the greatest decline in the outcome rankings, moving from 48th to 76th. It was followed by Russell, which fell from 61st to 88th; and Bracken, which dropped from 46th to 72nd. Russell County remained in the same quartile as last year, but the other two counties shifted to a lower one.

2016 Health Factors - Kentucky
The top five counties for health factors have all been in the top 10 before. They include Oldham, Boone, Spencer, Woodford and Campbell counties; Campbell had dropped last year to 12th.

The bottom five counties for health factors are Magoffin, Wolfe, McCreary, Breathitt and Bell, all in the Eastern Kentucky Coalfield.

Counties that saw the greatest improvement in health factors were Clark, moving from 53rd to 29th; Gallatin, going from 89th to 67th; and Crittenden, rising from 86th to 64th. Only Clark, just east of Lexington, moved into a higher quartile.

Counties that saw the greatest declines in health factors were Taylor , dropping from 30th to 58th; Butler, falling from 66th to 94th; and Union, dropping from 46th to 73rd. Each of these counties dropped into a lower quartile. Butler, Fulton and Carroll were the only non-Appalachian counties in the bottom quartile.

The report identifies "meaningful gaps" that exist between the best and worst Kentucky counties and suggests that policymakers look at these gaps as they search for ways to improve the counties' health, including: adult smoking, adult obesity, uninsured rates, preventable hospital stays, education levels, unemployment, children in poverty and income inequality.

The report says, "Every year, over 2,800 deaths in Kentucky could be avoided if all residents in the state had a fair chance to be healthy."

Princess Health and More Kentucky patients are recuperating in their local, rural hospitals after surgery in an urban hospital. Princessiccia

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By Melissa Patrick
Kentucky Health News

Rural residents are increasingly being transferred out of big urban hospitals to recuperate in rural hospitals, many of which are struggling financially and can use the business.

"We have seen trends of this around the state," said Elizabeth Cobb, vice president of health policy for the Kentucky Hospital Association, said in an interview.

Oregon's legislature voted recently to encourage the trend in that state, by appropriating $10 million for rural health-care improvements, with the largest part encouraging such transfers.

In Kentucky, Cobb said the transfers would have to make sense from procedural, convenience and financial perspectives, but when it works out it is great for both the urban and rural hospitals, and also for the families.

"Certainly when there is a treatment or procedure that will take a significant amount of recovery, it is a wonderful thing for rural Kentuckians to be able to transfer back to their community facility to finish off their recuperation," she said.

Oregon's program aims to create a more consistent patient population in its rural hospitals, which will help stabilize their funding. At the same time, the program will relieve pressure on strained urban hospitals, Chris Gray reports for The Lund Report.

Rural hospitals are struggling financially all over the country and often have inconsistent patient volumes, while urban hospitals struggle with reaching capacity, and often worry they might have to expand, Gray notes.

A state report by then-Auditor Adam Edelen last year found that one in three of Kentucky's rural hospitals were in poor financial condition and suggested that to survive, they might have to adapt to new business models, such as merging with larger hospitals or hiring them as managers, forming coalitions with other hospitals, or finding a health-care niche that hasn't been served, such as creating a partnership with urban hospitals to allow rural patients the ability to recuperate closer to home.

While it sounds like a "common-sense system," Gray reports that the program is costly to set up, between $4 and $7 million, but once it is up and running, and the hospitals learn how to coordinate, "it should be self-sustaining, since money from insurers, Medicaid and Medicare will follow the patient," according to an interim workgroup of rural health officials from Oregon.

A rural health physician told Gray that "local hospitals and healthcare access, along with good public schools, provide the backbone for a viable community when employers are looking to invest in a community," he writes.

Princess Health and I WAS DESPERATE FOR HELP WITH BULIMIA AND BINGE EATING. Princessiccia

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After suffering with Bulimia and Binge Eating for years, I found Robin and realized she might be able to help me out. Here is what happened after working with her.
SCHEDULE A CONSULT WITH ROBIN TODAY: http://www.weightlossapocalypse.com/

Princess Health and Criminal matter for the Attorney General of NY? Hail the gods of medical computing, and the need for human sacrifice. NYC�s $764M medical records system will lead to �patient death�: insiders. Princessiccia

Princess Health and Criminal matter for the Attorney General of NY? Hail the gods of medical computing, and the need for human sacrifice. NYC�s $764M medical records system will lead to �patient death�: insiders. Princessiccia

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I believe the suffering and death of my mother in 2010-2011 due to EHR flaws - including but not limited to lack of essential confirmation dialogs on medication deletion at triage, lack of notification messages informing down-line staff of such action by unqualified personnel (inadequate support of teamwork), and other issues - lends me some moral standing to comment on the following as a horrifying and potentially criminal matter.  (See http://khn.org/news/scot-silverstein-health-information-technology/).


Two back-to-back articles appeared in the New York Post:


NYC�s $764M medical records system will lead to �patient death�: insiders
By Michael Gartland
March 15, 2016
http://nypost.com/2016/03/15/nycs-764m-medical-records-system-will-lead-to-patient-death-insiders/

and

Hospital exec [CMIO] quits, compares $764M upgrade to Challenger disaster
By Michael Gartland
March 16, 2016
http://nypost.com/2016/03/16/hospital-exec-quits-compares-764m-upgrade-to-challenger-disaster/ 


It is well-known and indisputable that this technology can and does injure and kill, especially when poorly designed, defective, poorly implemented, or all of the above.  See for instance the ECRI EHR risk Deep Dive study results at http://hcrenewal.blogspot.com/2013/02/peering-underneath-icebergs-water-level.html.

Any official in leadership of health IT who denies this - or sidesteps it - or makes excuses for compromises on health IT safety, especially in view of dire warnings from clinician experts - in 2016 is guilty of conduct of the type below:

http://www.legalmatch.com/law-library/article/criminal-negligence-laws.html
What is Criminal Negligence?

Under some criminal law statutes, criminal negligence is defined as any type of conduct that �grossly deviates� from normal, reasonable standards of an ordinary person.  It generally involves an indifference or disregard for human life or for the safety of people.  Sometimes the definition for criminal negligence also requires a failure to recognize unjustifiable risks associated with the conduct.

Examples of criminally negligent behavior may include knowingly allowing a child to be in very dangerous conditions, or driving in an extremely irresponsible way.  Criminal negligence is less serious than intentional or reckless conduct.  Generally, reckless conduct involves a knowing disregard of risks, while negligence involves an unawareness of the risks.

The two articles reflect a good possibility that the politics of what I'd once termed "cybernetics �ber alles" has trumped patient safety concerns in NYC.

Here's details from the first article:

A new $764 million medical records system is launching at the municipal hospital system on April 2 � even though insiders warn it isn�t ready and patients will suffer.

The soft launch of the electronic system Epic is scheduled at Elmhurst and Queens hospitals.

�Sooner or later, it will crash,� said one source involved in the project. �There will be patient harm � patient harm and patient death.�

That sounds like insiders warning of far more problems than mere crashes causing patient harm and death, a brave act considering possible retaliation.

I wonder if the users of this EPIC system are having imposed on them the speech and though controls imposed on users at University of Arizona (see my Oct. 3, 2013 post "Words that Work: Singing Only Positive - And Often Unsubstantiated - EHR Praise As 'Advised' At The University Of Arizona Health Network" at http://hcrenewal.blogspot.com/2013/10/words-that-work-singing-only-positive.html).

Sources say Dr. Ramanathan Raju, who runs the municipal network, NYC Health + Hospitals, is under the gun from City Hall to meet the deadline and fears he�ll be fired if he doesn�t.

�Raju has said too many times to count that the Mayor�s Office has told him if April 1st doesn�t happen, then Ram will lose his job,� one source said.

The source added that Raju has threatened to fire top executives if the project doesn�t launch on time.

If this is true, than the "gun" from City Hall is aimed straight at patients, and if patients indeed are mortally affected, the responsible officials might be deemed accessories to murder.

I add that this type of situation represents fundamental and severe mismanagement, as I'd been writing about since the late 1990's at my academic site "Contemporary Issues in Medical Informatics: Good Health IT, Bad Health IT, and Common Examples of Healthcare IT Difficulties" at http://cci.drexel.edu/faculty/ssilverstein/cases/.

The hospital system is already on City Hall�s watch list, having required a $337 million bailout in January to stay afloat. 

Money for EHR's grows on trees.

Note other hospitals where EHR implementations led to financial disaster (e.g., http://hcrenewal.blogspot.com/2014/06/in-fixing-those-9553-ehr-issues.html, http://hcrenewal.blogspot.com/2013/05/clouded-visionary-leadership-wake.html, http://hcrenewal.blogspot.com/2013/06/want-to-help-hospital-go-bankrupt-get.html, http://hcrenewal.blogspot.com/2014/06/100-million-epic-install-dampens.html as examples).

Insiders contend that the only safe way to roll out Epic is to take more time � about three months � to address several key issues.

One is planning for a crash, which some consider almost inevitable because the new setup hasn�t been configured to work with systems at other hospitals or with some of its own internal billing and tracking software.

Existing patient data also has to be transferred from the old system � a process that would normally take six months, but which was shoehorned into less than one.

Going "live" with a half-baked EHR under such circumstances for political reasons, if these facts are true, would be, in my professional opinion, an act worthy of prison time if harm results.

�There are supposed to be all these dry runs,� a source said. �They haven�t been done.�

Again, if true, this reflects expediency at the expense of patient well-being, by rows of political hacks, fools and incompetents calling the shots in an area in which they have no business being involved.

City officials contend Epic remains �on-time and within budget.�

I have a feeling this will be revisited at some time in the future - in court.

A mayoral spokeswoman said there would be a round-the-clock effort to ensure there are no glitches. 

"No glitches?" 

That is a hollow promise that cannot be kept even under the best of circumstances.  Under the hellish circumstances described, such a statement is outright frightening. The Mayor truly has no clue about EHR "glitches", but I offer the many posts at query link http://hcrenewal.blogspot.com/search/label/glitch for his education.

Mr. Mayor, here's an example of EPIC and other EHR implementations under the best of circumstances.  These systems are so immensely complex, trying to be pressure-fit into a vastly complex, varying and changing environment, that to not heed CMIO and other expert warnings is the height of recklessness:


Of course, we are reassured that the crack team assigned the implementation duties will produce stellar results:

�NYC Health + Hospitals and its Epic implementation experts are prepared to implement the new system in Queens facilities beginning April 2, and have assembled a team of about 900 technicians and Epic experts who will work around-the-clock that week both in Queens and at remote data centers to ensure the transition to the new system goes as smoothly as possible,� said spokeswoman Ishanee Parikh.

EPIC experts like these?  From this link at the "Histalk" site on staffing of health IT projects, Aug. 16, 2010. Emphases mine:

Epic Staffing Guide 

A reader sent over a copy of the staffing guide that Epic provides to its customers. I thought it was interesting, first and foremost in that Epic is so specific in its implementation plan that it sends customers an 18-page document on how staff their part of the project. 

Epic emphasizes that many hospitals can staff their projects internally, choosing people who know the organization. However, they emphasize choosing the best and brightest, not those with time to spare. Epic advocates the same approach it takes in its own hiring: don�t worry about relevant experience, choose people with the right traits, qualities, and skills, they say. 

The guide suggests hiring recent college graduates for analyst roles. Ability is more important than experience, it says. That includes reviewing a candidate�s college GPA and standardized test scores. 

I bet many readers were taught by their HR departments to do behavioral interviewing, i.e. �Tell me about a time when you �� Epic says that�s crap, suggesting instead that candidates be given scenarios and asked how they would respond. They also say that interviews are not predictive of work quality since some people just interview well. 

Don�t just hire the agreeable candidate, the guide says, since it may take someone annoying to push a project along or to ask the hard but important questions that all the suck-ups will avoid. 

Epic likes giving candidates tests, particularly those of the logic variety.

The part about "not worrying about relevant experience" and about "hiring recent college graduates as HIT project analysts" is bizarre if true, and downright frightening.

Medical environments and clinical affairs are not playgrounds for novices, no matter how "smart" their grades and test scores show them to be. These practices as described, in my view, represent faulty and dangerous advice on first principles.  The advice also is at odds with the taxonomy of skills published by the Office of the National Coordinator I outlined at the post "ONC Defines a Taxonomy of Robust Healthcare IT Leadership."

The second NY Post article cited above is even more dire:

A senior official was so worried a new $764 million medical records system for the municipal hospital system was launching too early that he resigned, comparing it to the disastrous space shuttle Challenger launch in 1986.

In a �resignation and thank-you� email last week, Dr. Charles Perry urged colleagues at NYC Health + Hospitals � formerly the Health and Hospitals Corp. � to sound the alarm and press for an �external review� to stop the system from going live next month.

Perry was chief medical information officer of Queens and Elmhurst Hospital Centers, the first scheduled to get the new electronic medical data system.

When a CMIO - a role I held in the mid 1990s -  resigns under such circumstances, a project should be halted in its tracks and external examination begun.  Instead, it appears we have spin control.

In his email, Perry offered a comparison to the launch of the Challenger � aboard which seven crew members died when it exploded 73 seconds after liftoff on Jan. 28, 1986 � and cited a presidential panel�s report examining how the disaster occurred.

That is as dire and direct a warning as they come.  Unqualified individuals who second guess such a warning should be held legally accountable for adverse outcomes.

(Such a warning letter about EHRs now sits as "Exhibit A" in the lawsuit complaint regarding my dead mother.  It had not been heeded.)

�For a successful technology, �reality must take precedence over public relations, for nature cannot be fooled,� Perry wrote in his �email, quoting from the report.

But fools in leadership roles in health IT think they can fool Mother Nature.

Perry went on to urge a short delay despite �vehement entreaties to make the April 1st date by officials and consultants with jobs and paydays on the line.�

This is exactly how patients end up maimed and dead.

Agency president Dr. Ramanathan Raju has repeatedly told colleagues his job is on the line if the deadline isn�t met, sources said.

Perry, a medical doctor with an MBA, declined to comment.

Maybe Raju should quit, too.  He should know that Discovery over such matters would not be very pleasant, especially if I am assisting attorneys in such matters - which could very well occur.

�He [Perry] took a stand,� said one insider. �He wasn�t going to take part in something that was going to compromise patient safety.�

It's good to know someone in Medical Informatics still has balls.

The idea that we�d jeopardize patients to meet a deadline is simply wrong,� said Karen Hinton, Mayor Bill de Blasio�s spokeswoman.

�If a patient safety issue is identified, the project will stop until it is addressed.

�NYC Health + Hospitals and its Epic implementation experts have assembled a team of about 900 technicians and Epic experts who will work around the clock through the week surrounding the transition in both Queens and at remote data centers to ensure we shift to the new system as smoothly as possible.�

It's been said that one expert who truly know what they're doing will always outperform 1,000 (or 900) generalists following the finest of "process" who are in over their heads (to wit, 900 generic musicians could never exceed the work of Beethoven or Brahms).

In this matter, I take the CMIO's word over the 900 techies and "experts", once having voiced such concerns myself.

-- SS

What is Criminal Negligence?

Under some criminal law statutes, criminal negligence is defined as any type of conduct that �grossly deviates� from normal, reasonable standards of an ordinary person.  It generally involves an indifference or disregard for human life or for the safety of people.  Sometimes the definition for criminal negligence also requires a failure to recognize unjustifiable risks associated with the conduct.
Examples of criminally negligent behavior may include knowingly allowing a child to be in very dangerous conditions, or driving in an extremely irresponsible way.  Criminal negligence is less serious than intentional or reckless conduct.  Generally, reckless conduct involves a knowing disregard of risks, while negligence involves an unawareness of the risks.
- See more at: http://www.legalmatch.com/law-library/article/criminal-negligence-laws.html#sthash.3YLT7ahF.dpuf

What is Criminal Negligence?

Under some criminal law statutes, criminal negligence is defined as any type of conduct that �grossly deviates� from normal, reasonable standards of an ordinary person.  It generally involves an indifference or disregard for human life or for the safety of people.  Sometimes the definition for criminal negligence also requires a failure to recognize unjustifiable risks associated with the conduct.
Examples of criminally negligent behavior may include knowingly allowing a child to be in very dangerous conditions, or driving in an extremely irresponsible way.  Criminal negligence is less serious than intentional or reckless conduct.  Generally, reckless conduct involves a knowing disregard of risks, while negligence involves an unawareness of the risks.
- See more at: http://www.legalmatch.com/law-library/article/criminal-negligence-laws.html#sthash.3YLT7ahF.dpuf

What is Criminal Negligence?

Under some criminal law statutes, criminal negligence is defined as any type of conduct that �grossly deviates� from normal, reasonable standards of an ordinary person.  It generally involves an indifference or disregard for human life or for the safety of people.  Sometimes the definition for criminal negligence also requires a failure to recognize unjustifiable risks associated with the conduct.
Examples of criminally negligent behavior may include knowingly allowing a child to be in very dangerous conditions, or driving in an extremely irresponsible way.  Criminal negligence is less serious than intentional or reckless conduct.  Generally, reckless conduct involves a knowing disregard of risks, while negligence involves an unawareness of the risks.
- See more at: http://www.legalmatch.com/law-library/article/criminal-negligence-laws.html#sthash.3YLT7ahF.dpuf

What is Criminal Negligence?

Under some criminal law statutes, criminal negligence is defined as any type of conduct that �grossly deviates� from normal, reasonable standards of an ordinary person.  It generally involves an indifference or disregard for human life or for the safety of people.  Sometimes the definition for criminal negligence also requires a failure to recognize unjustifiable risks associated with the conduct.
Examples of criminally negligent behavior may include knowingly allowing a child to be in very dangerous conditions, or driving in an extremely irresponsible way.  Criminal negligence is less serious than intentional or reckless conduct.  Generally, reckless conduct involves a knowing disregard of risks, while negligence involves an unawareness of the risks.
- See more at: http://www.legalmatch.com/law-library/article/criminal-negligence-laws.html#sthash.3YLT7ahF.dpuf

What is Criminal Negligence?

Under some criminal law statutes, criminal negligence is defined as any type of conduct that �grossly deviates� from normal, reasonable standards of an ordinary person.  It generally involves an indifference or disregard for human life or for the safety of people.  Sometimes the definition for criminal negligence also requires a failure to recognize unjustifiable risks associated with the conduct.
Examples of criminally negligent behavior may include knowingly allowing a child to be in very dangerous conditions, or driving in an extremely irresponsible way.  Criminal negligence is less serious than intentional or reckless conduct.  Generally, reckless conduct involves a knowing disregard of risks, while negligence involves an unawareness of the risks.
- See more at: http://www.legalmatch.com/law-library/article/criminal-negligence-laws.html#sthash.3YLT7ahF.dpuf

Wednesday, 16 March 2016

Princess Health and March 16th, 2016 More Than My Fair Share. Princessiccia

Princess Health and March 16th, 2016 More Than My Fair Share. Princessiccia

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March 16th, 2016 More Than My Fair Share

I'm going to do my best at a quick post on a weigh day night. I'll keep it short and save the analysis for another time. I suck at brevity. Let me explain in multi-layered detail... Jk'ing. Is it even appropriate to use a text message abbreviation in a blog post? Okay-- I'm getting off topic...

It was maintenance weigh-in day at the doctor's office this morning! This standing bi-weekly appointment with the scale gives me information that isn't as valuable individually as it is collectively. I've attached weigh day numbers all the way back to early-mid November for this reason. I'm looking for trends when I look at these numbers. And I don't see one. I see something I feel very blessed about and this makes me immensely grateful. I see a good fluctuation within a healthy range. 

Coming from where I came--and not just the nearly twenty years near, at or above 500 pounds--but coming from a 164 pound relapse/regain--a place where I started to think I would never get here--never, ever, ever again---and to be living this experience, each day--oh my goodness. Every ounce of effort has been worth it in every way. I thank God for this seventh or eighth chance-- whatever the number is--I mean, really--I've had more than my fair share of chances.
photo IMG_9434_zpskxw59puf.jpg
Today's weight represents a 1.4 pound gain from the previous 210.2. I never thought I'd respond to a gain like I do now: Cool, I'll take it...
photo IMG_9454_zpsi2xnapcr.png
The range of numbers, collectively--give a more accurate representation than any one individual weigh-in.

Today was day 2 of my new morning routine! I'm making this thing fast and simple. I like simple. It's a wonderful start in a better direction with my overall physical fitness goals. Today was the same as yesterday...one cup water/twenty push-ups--before coffee. I'm down there--in the floor, listening to the coffee brew--and I want that coffee. The incentive inspires me to get it done and feel it.  

I felt it this morning. The water--first thing in me, I felt it cooling my insides as it made its way down. And the push-ups warmed my arm muscles with circulation I could feel in a fine tuned kind of way. I noticed it very well this morning. It was a neat experience.

Speaking of feeling things...I woke from a nap this afternoon with a sore throat and an ear ache happening. My set plans to prepare a nice dinner at home and head to the gym for a workout were quickly scrapped in favor of an urgent care visit and dinner out, afterward. They tested for strep--nope, not strep... "might be viral," the doctor said..."You want a steroid shot?"

Kristin dropped by with water and she highly recommended the shot.

I don't like needles. I kind of turn into a big baby around needles. And now I'm going to do it in front of Kristin. I'm not proud of this--just saying, it's true...not a fan....at all. I agreed after a little encouragement. They give it in the behind. Did you know that? And guess what? They kind of just jam it in there real fast. I'd prefer a slower--more drawn out approach...maybe find a stretch mark (I have plenty of 'em) for a less painful entry? No--oh wow, you're done? Okay. Well, that wasn't so bad.

Speaking of bad. Did I mention I suck at brevity? 

My Tweets Today:




































Thank you for reading and your continued support,
Strength,
Sean

Princess Health and Trying to stop overdose epidemic, CDC tells docs to limit most opioid prescriptions to 3-7 days, use low doses and warn patients. Princessiccia

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Graphic from CDC guideline brochure
Kentucky Health News

Doctors who prescribe highly addictive painkillers for chronic pain should stop and be much more careful to thwart "an epidemic of prescription opioid overdoses" that is "doctor-driven," the federal Centers for Disease Control and Prevention said Tuesday, March 15.

"This epidemic is devastating American lives, families, and communities," the CDC said. "The amount of opioids prescribed and sold in the U.S. quadrupled since 1999, but the overall amount of pain reported by Americans hasn�t changed."

Kentucky ranks very high in use of opioids and overdoses from them, and Louisville reported a big increase in overdoses this month, Insider Louisville reports.

The agency said doctors should limit the length of opioid prescriptions to three to seven days, use "the lowest possible effective dosage," monitor patients closely, and clearly tell them the risks of addiction.

It said most long-term use of opioids should be limited to cancer, palliative and end-of-life treatment, and that most chronic pain could be treated with non-prescription medications, physical therapy, exercise and/or cognitive behavioral therapy.

The guidelines are not binding on doctors, but Dr. Thomas Frieden, the CDC director, "said state agencies, private insurers and other groups might look to the recommendations in setting their own rules," the Los Angeles Times reported.

However, Modern Healthcare reported that the guidelines are unlikely to change physicians' practices. "One current hurdle to curbing the number of prescriptions is that it's much easier for a busy clinician to prescribe a 30-day supply of oxycodone or Percocet to treat a patient's chronic pain than it is to convince him or her to do physical therapy," Steven Ross Johnson writes. "The time constraints affecting physicians' practice has never been more acutely felt than in this era of health-care reform that emphasizes quality and value-based payment."

Money could be a key in making the guidelines effective. Sabrina Tavernise of The New York Times writes, "Some observers said doctors, fearing lawsuits, would reflexively follow them, and insurance companies could begin to us them to determine reimbursement." The federal Centers for Medicare and Medicaid Services could also play a role.

Johnson notes that physicians are trained to "reserve opioids for severe forms of pain . . . but in the 1990s, some specialists argued that doctors were under-treating common forms of pain that could benefit from opioids, such as backaches and joint pain. The message was amplified by multi-million-dollar promotional campaigns for new, long-acting drugs like OxyContin, which was promoted as less addictive."

Purdue Pharma, maker of OxyContin, agreed to pay $600 million in penalties to settle federal charges that it over-promoted the drug to doctors, prompting the epidemic, especially in Central Appalachia.

"When reports of painkiller abuse surfaced, many in the medical field blamed recreational abusers. In recent years, however, the focus has shifted to the role of doctors," Harriet Ryan and Soumya Karlamangla report for the Times, noting that a 2012 analysis "of 3,733 fatalities found that drugs prescribed by physicians to patients caused or contributed to nearly half the deaths."

Doctors, insurers, drug companies and government agencies "all share some of the blame, and they all must be part of a solution that will probably cost everyone money," Caitlin Owens writes for Morning Consult, which also notes prescribers' complaints and CDC's responses.
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