An important accountability measure has been upheld
The Supreme Court's decision in Health and Hospital Corporation v. Talevski, holding that beneficiaries of government entitlements can bring civil rights actions to vindicate their rights, is a major victory for millions of Americans who rely on publicly funded healthcare programs.
The justices refused to upend decades of precedent and allowed a nursing home resident's family to sue an Indiana care home for abusing the resident. Talevski both vindicates the rights of vulnerable citizens and holds officials accountable. It affirms that Medicaid beneficiaries -- some of the nation's most vulnerable and politically powerless members -- have a right to dignified care, while empowering them to sue government officials if their rights are not respected. With the recent uptick in state efforts to cut Medicaid, Talevski is a welcome assurance that the courts will remain available as a check on unfair and harmful state policies.
The Details of the Case
The case arose when Gorgi Talevski, a dementia patient at a nursing home owned by Health and Hospital Corporation of Marion County (HHC), suffered multiple abuses. HHC chemically restrained him using strong psychotropic drugs, sent him to a psychiatric facility without consulting his family, and subsequently arbitrarily discharged him. The Indiana State Department of Health failed to remedy the situation.
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Only 2 days until the
Abstract Submission Deadline!
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According to the American Board of Medical Specialties, its program for maintenance of certification (MOC) serves the patients, families, and communities of the United States and improves patient care by establishing high standards for ongoing learning, practice improvement, and assessment activities. Whether this is true or not has been a hotly contested topic in the medical profession for about two decades, when MOC was first introduced. Proponents claim that MOC fosters lifelong learning and improved patient care, while critics argue that it generates additional monetary expense, saps physician time and energy, and has not been proved to improve practice. One key dimension of this debate concerns the level at which these effects should be assessed – the profession as a whole or the individual physician.
We believe that it is important to look at the effects of MOC at the level of the individual physician, and here we present a case in which its net impact is highly negative – harming patients, families, and communities, and undermining patient care through its “high standards.” The physician in question, Dr. D, is an internationally known cancer specialist, a physician-scientist and MD-PhD who has helped to develop many new and effective cancer therapies over the course of his career. He has maintained his certification in the broader field of medical oncology for two decades, although he cares only for patients with a specific type of cancer. He has met all the continuing medical education requirements of his state licensing agency and has functioned as one of only two specialists in his field at a large academic medical center.
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COMPLIMENTARY ASIPP WEBINAR
for Residents and Fellows...
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It's time for patients to be the priority
In a country where the healthcare industry is driven by profit, it's no surprise that health insurance companies lead the charge and prioritize their bottom line over the well-being of the very patients they claim to serve. The result? A system rife with inefficiencies, soaring costs, and compromised care.
It thus makes sense that according to an AP-NORC Center for Public Affairs poll, just 12% (!) of the American public believes the healthcare system operates "extremely" or "very" well.
The system is broken, and I believe our health insurance system is largely to blame.
Profit Drivers
In its first-quarter 2023 earnings announcement, Cigna Group revealed an uptick in key financial metrics and showcased a 6% year-over-year increase in total revenue (a whopping $46.5 billion) -- all while hospitals and providers grapple with inflation, staffing woes, and reimbursement challenges. Yet, Cigna is not alone; UnitedHealthcare posted a $20.1 billion profit in 2022, and Aetna had a boom year of its own.
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Low tidal volumes associated with improved 12-month clinical outcomes
Outcomes improved with a novel ventilation protocol during radiofrequency ablation of paroxysmal atrial fibrillation (Afib), registry data across 12 institutions showed.
After hospitals implemented high-frequency, low-tidal-volume (HFLTV) ventilation during the procedure, freedom from all-atrial arrhythmia at 12 months increased compared with the previous standard ventilation protocol (85.6% vs 79.3%, P=0.041), according to Jorge Romero, MD, of Brigham and Women's Hospital and Harvard University in Boston, and colleagues.
The improvement was driven mainly by a reduction in recurrent Afib and was accompanied by a lower incidence of Afib-related symptoms (12.5% vs 18.9%, P=0.046) and hospitalizations (1.4% vs 4.7%, P=0.043), the multicenter REAL-AF registry showed.
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Virtual
ABIPP Part I; ABIPP Path - Combined DCCPM/CSM virtual exam; ABIPP Competency Exam in IPM; ABIPP Competency Exam in Regenerative Medicine
Memphis, TN
ABIPP Part II - Practical Portion; ABIPP Competency Exam - Practical Portion; ABIPP Regenerative Medicine Competency Exam - Practical Portion
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An expert panel of pain management clinicians has released what they say are the first international guidelines for general practitioners on opioid analgesic deprescribing in adults.
The recommendations describe best practices for stopping opioid therapy and emphasize slow tapering and individualized deprescribing plans tailored to each patient.
Developed by general practitioners, pain specialists, addiction specialists, pharmacists, registered nurses, consumers, and physiotherapists, the guidelines note that deprescribing may not be appropriate for every patient and that stopping abruptly can be associated with an increased risk of overdose.
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Some patients continually cancel their appointments, ignore your medical directions, treat your staff rudely, or send you harassing emails.
Do you have to tolerate their behavior?
No, these are all appropriate reasons to terminate patients, attorneys say. Patients also can be dismissed for misleading doctors about their past medical history, chronic drug-seeking, displaying threatening or seductive behavior toward staff members or physicians, or any criminal behavior in the office, experts say.
But even if a reason seems legitimate, that doesn't make it legal. Doctors should consider whether the reason is legal, said Chicago-area attorney Ericka Adler, JD, a partner at Roetzel & Andress, who advises doctors about terminating patients.
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Key takeaways:
- Smokeless tobacco use had an association with complications after total hip arthroplasty.
- Surgeons may consider making a distinction between smoking and smokeless tobacco use during the preoperative period.
Results published in the Journal of Arthroplasty showed smokeless tobacco users had “significantly higher” rates of complications after primary total hip arthroplasty compared with non-users.
In a retrospective cohort study of patients who underwent THA, researchers compared rates of joint complications within 2 years and medical complications within 90 days postoperatively among patients who used smokeless tobacco (n=950) and patients who smoked (n=21,585) with matched control groups of patients who did not use tobacco (n=3,800 and 86,340, respectively). Researchers also matched patients who used smokeless tobacco (n=922) with people who smoked (n=3,688). Among the 250,026 total patients identified in the study, researchers identified 0.59% (n=1,481) as smokeless tobacco users.
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The first cases since at least 2003 of people getting malaria from a mosquito bite within the U.S. have occurred in Florida and Texas, the CDC says.
The federal health agency issued a nationwide warning on Monday to health providers and officials to be on the lookout for symptoms of the potentially fatal illness. Usually, people in the U.S. who get malaria get the disease during international travel.
All five people — four in Florida and one in Texas — have received treatment and are improving, according to the CDC. The case in Texas is not related to the Florida cases, and all occurred in the past 2 months.
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- ASIPP Members Only Site Information - |
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To log in for the first time you will need to click “forgot password” at the bottom of the login window.
- Check your email and then log in as directed.
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If you have problems logging into your account, click here.
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Pain Medicine Case Reports (PMCR) and Editor-in-Chief Alaa Abd-Elsayed, MD, PhD would like to invite you to submit case reports and case series to the PMCR journal. Your article will be published free of charge.
Open access journals are freely available online for immediate worldwide open access to the full text of published articles. There is no subscription fee for open access journals. Open access journals are no different from traditional subscription-based journals: they undergo the same peer-review and quality control as any other scholarly journal.
Interested in becoming a member of the PMCR Editorial Board?
Editorial board members are asked to review 2-6 manuscripts per year. Please submit your most up-to-date CV to [email protected] for consideration.
For more information or to submit your articles, click here.
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| CASE REPORT |
Kristy A. Fisher, MD, Jonathan Heaven, MD, and Christine Hunt, DO
Abstract
BACKGROUND: A complication of sacroiliac joint (SIJ) fusion is neuropathic pain due to intruding hardware.
CASE REPORT: We present the novel management of a 57-year-old man who presented with S1 radiculopathy that began immediately after SIJ fusion, which had been performed 2 years prior. Physical exam and electromyography confirmed right S1 radiculopathy. Imaging confirmed hardware protrusion into the S1 neural foramen. The patient failed conservative management, and an outside tonic spinal cord stimulator trial (SCS) trial, but experienced 100% relief during the anesthetic phase of S1 transforaminal epidural steroid injections. A neurosurgical consult deemed the patient to be an inappropriate candidate for surgical revision due to the complete fusion of the hardware to bone. The patient successfully underwent a burst SCS trial with 100% relief as measured by the Numeric Rating Scale and increased his quality of sleep and activity with subsequent permanent implantation.
CONCLUSION: SCS utilizing burst stimulation can offer a unique treatment option for resultant neuropathic pain from SIJ fusion to hardware in the event that surgical revision is not recommended.
KEY WORDS: Spinal cord stimulator, scral radiculopathy, sacroiliac joint, failed back surgery syndrome, case report
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| RETROSPECTIVE STUDY |
Hao-Wen Chen, MD, Wen-Tien Wu, MD, PhD, Jen-Hung Wang, PhDc, Cheng-Li Lin, MS, Chung-Yi Hsu, MD, PhD, and Kuang-Ting Yeh, MD, PhD
Abstract
BACKGROUND: Epidural steroid injections (ESIs) involve the administration of steroids and local anesthetics into the spinal epidural space, and they are performed by inserting a needle between the ligamentum flavum and dura. This procedure is suitable for patients with lumbosacral radiculopathy secondary to disc herniation or postsurgical radicular pain. The relief period of the analgesic medications may be prolonged by > 6 weeks, resulting in nonsurgical management becoming a suitable option. However, the negative effect of ESIs on bone mineral density has been reported.
OBJECTIVES: We aimed to clarify the association between ESIs and osteoporosis risk by analyzing a nationwide population database.
STUDY DESIGN: This study is a nationwide retrospective cohort study.
SETTING: Data on 1 million cases randomly selected from the 2000 Registry for Beneficiaries of the National Health Insurance Research Database (NHIRD) were collected.
METHODS: In total, 4,957 patients who were diagnosed with lumbar spondylosis and received ESIs between 2000 and 2013 were identified from the NHIRD. Subsequently, another 4,957 patients with lumbar spondylosis were randomly selected from the same database and frequency matched by age, gender, and index year with the patients who received ESIs.
RESULTS: The mean age of the patients were 50.3 ± 17.1 years. The incident rates of osteoporosis in the ESI and non-ESI groups were 7.95 and 7.01 per 1,000 person-years, respectively. Osteoporosis risk was significantly higher in the ESI cohort than in the non-ESI cohort (absolute standardized hazard ratio = 1.23, 95% confidence interval = 1.05-1.45, P = 0.01). The risk factors for osteoporosis were old age, being female, and undergoing ESIs. Osteoporosis risk was significantly higher in the ESI cohort than in the non-ESI cohort in the male, lowest-urbanization-level (fourth level), other-occupations, and comorbidity-free subgroups.
LIMITATIONS: The NHIRD did not provide information on osteoporosis-related scales, renal function, blood pressure, smoking habit, pulmonary function, daily activities, and dosage of injected steroids.
CONCLUSIONS: For patients diagnosed with lumbar spondylosis, ESIs are associated with a high osteoporosis risk. Thus, this therapy should be recommended with caution, especially for patients with correlated risk factors (e.g., high risk of osteoporotic fracture, low socioeconomic status, and retired or unemployed status).
KEY WORDS: Lumbar spondylosis, epidural steroid injection, osteoporosis, urbanization level
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| RETROSPECTIVE STUDY |
Hongwei Wang, PhD, Hongwen Gu, MD, Bin Zheng, MD, Yuanhang Zhao, MD, Hong Yuan, BSN, Hailong Yu, PhD, and Liangbi Xiang, PhD
Abstract
BACKGROUND: During percutaneous kyphoplasty (PKP) for the treatment of osteoporotic vertebral compression fractures (OVCFs), repeated fluoroscopic images to adjust the puncture needle and inject the polymethylmethacrylate (PMMA) are critical steps. A method to further reduce the radiation dose would be of great value.
OBJECTIVES: To assess the efficacy and safety of a 3D-printed guide device (3D-GD) for PKP in the treatment of OVCFs and compare the clinical efficacy and imaging outcomes of traditional bilateral PKP, bilateral PKP with 3D-GD and unilateral PKP with 3D-GD.
STUDY DESIGN: Retrospective study.
SETTING: General Hospital of Northern Theater Command of Chinese PLA.
METHODS: From September 2018 through March 2021, 113 patients diagnosed with monosegmental OVCFs underwent PKP. The patients were divided into 3 groups: traditional bilateral PKP (B-PKP group, 54 patients), bilateral PKP with 3D-GD (B-PKP-3D group, 28 patients) and unilateral PKP with 3D-GD (U-PKP-3D group, 31 patients). Their epidemiologic data, surgical indices, and recovery outcomes were collected during the follow-up period.
RESULTS: The operation time was significantly shorter in the B-PKP-3D group (52.5 ± 13.7 minutes) than in the B-PKP group (58.5 ± 9.5 minutes) (P = 0.044, t = 2.082). The operation time was significantly shorter in the U-PKP-3D group (43.6 ± 6.7 minutes) than in the B-PKP-3D group (52.5 ± 13.7 minutes) (P = 0.004, t = 3.109). The number of intraoperative fluoroscopy applications was significantly lower in the B-PKP-3D group (36.8 ± 6.1) than in the B-PKP group (44.8 ± 7.9) (P = 0.000, t = 4.621). The number of intraoperative fluoroscopy times was significantly lower in the U-PKP-3D group (23.2 ± 4.5) than in the B-PKP-3D group (36.8 ± 6.1) (P = 0.000, t = 9.778). The volume of injected PMMA was significantly lower in the U-PKP-3D group (3.7 ± 0.8 mL) than in the B-PKP-3D group (6.7 ± 1.7 mL) (P = 0.000, t = 8.766). The Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) scores were significantly decreased one day after surgery in each group. However, there were no differences in postoperative VAS and ODI scores, anterior height or local kyphotic angle of the fractured vertebrae, PMMA leakage, or refracture of the vertebral body.
LIMITATIONS: Relatively small sample size and short-term follow-up period.
CONCLUSION: This new innovative 3D technique makes PKP safe and effective. The bilateral PKP with 3D-GD technique, even unilateral PKP with 3D-GD, has the advantages of accurate positioning, a short operation time, and reduced intraoperative fluoroscopy times to the patient and surgeon.
KEY WORDS: Percutaneous kyphoplasty, osteoporotic vertebral compression fracture, 3D printing, guide device, bilateral, unilateral, operation time, radiation exposure
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ASIPP is now in collaboration with Curi Medical Liability Program
Since this malpractice insurance program officially launched in November 2018, ASIPP has signed up hundreds of providers with an average savings of 30%. This is professional liability insurance tailored to our specialty and will stand up for us and defend our practices.
Curi is a full-service advisory firm that serves physicians and their practices. Their valued advice is grounded in your priorities and elevated in your outcomes. They are driven by a deep understanding of your specific circumstances in medicine, business, and life. To read a few important points to keep in mind about the program, including discounts, administrative defense, cyber coverage, aggressive claims handling, and complimentary risk management CME activities, visit our website.
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ASIPP® has formed a partnership with Henry Schein and PedsPal, a national GPO that has a successful history of negotiating better prices on medical supplies and creating value-added services for independent physicians. Working with MedAssets, PedsPal provides excellent pricing on products like contrast media that alleviate some of the financial pressures you experience today.
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ASIPP® is now offering our members the benefit of a unique revenue cycle management/ billing service.
We have received a tremendous amount of interest in the ASIPP® billing and coding program.
Click here to learn more about the negotiated rate for practices and more!
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up-to-date news related to you, your practice, and your patients!
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