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Thursday, January 28, 2016

RunawayRx_Costs While_You_Were_Out_

There appears to be significant profiteering by some unscrupulous investors. One particularly egregious event was an enormous increase in the cost of some drugs (5,000%) by Turing Pharmaceuticals. Turing Pharmaceuticals acquired the rights to Daraprim in August. 

The drug treats toxoplasmosis, a parasitic affliction that affects people with compromised immune systems.
After Turing's acquisitiona dose of Daraprim in the US increased from $13.50 (£8.70) to $750.The pill costs about $1 to produce, but Mr Shkreli, a former hedge fund manager, said that does not include other costs like marketing and distribution, which have increased dramatically in recent years. Mr Shrell, it should be noted has been indicted for security fraud in an unrelated situation.
This indictment had nothing to do with the pharmaceutical furor. and 
revolved around a different alleged incident ( Ponzi Scheme.)

While the specifics of this case are unique and skewed significantly, 
other Pharma companies are increasing prices to offset hard bargaining
by health plans and CMS in the wake of the Affordable Care Act.

Health financing, like other industries has it's "bad boys" and it deserves 
careful scrutiny to guard against rampant raping of the federal and state 

Despite over-regulation and micro management of changes fostered by 
the affordable care act, profiteers and adventurers find ways to bilk the 
“Some of these companies seem to act more like hedge funds than traditional pharmaceutical companies”
Meanwhile:The California Legislature has passed AB 463,

Pharmaceutical Cost Transparency Act of 2015 2016

 The Legislature finds and declares all of the following:
(a) It is the intent of the Legislature to make information available to the public about the cost of ultra-high-priced pharmaceuticals, in order to make pharmaceutical pricing as transparent as the pricing in other sectors of the health care industry.
(b) To fulfill this goal, the Legislature finds that there should be annual cost reporting on the most expensive drugs that would be of use by policymakers, government agencies, and others to understand costs for these important products.
 (a) Each manufacturer of a prescription drug, made available in California, that has a wholesale acquisition cost (WAC) of ten thousand dollars ($10,000) or more annually or per course of treatment, shall file a report pursuant to this section on the costs for each qualifying drug.  Further details here

Runaway Prescription Costs

Wednesday, January 27, 2016

Today is Cystic Fibrosis Awarenes day in the U.S.

While there have been great advances in survival there is still no cure. This leads to a longer life of suffering. Please donate generously to the Cystic Fibrosis Foundation.

Monday, January 25, 2016

Is There a Doctor in the Marriage? - The New York Times

Women who are not married to a doctor often equate being a physician with other professionals. Marriage is one of those things.

Having a spouse as a physician requires a mate who can be largely independent with short periods of intimacy and companionship.  While there are some specialties that insulate  physician marriages from clinical demands, such as pathology, dermatology  and a few others, most doctors become focused on patient care either by an innate sense of duty, moral standards, or the induced habit by repetition of answering all calls during training.

Fortunately for many, actual independent clinical practice is not usually as demanding, although the stress level rises substantially when the final decision rests upon them.  It is also the time when physicians begin to pay their own medical malpractice premiums...a certain indicator of medical liability.

Is There a Doctor in the Marriage?

Six weeks after our wedding, my husband and I were flying back to New
Orleans, where we live. As soon as we reached cruising altitude, his
head tilted forward in sleep.

The previous year had been the hardest stretch of his medical training. As a
third-year resident in internal medicine, he often worked 30-hour
shifts. When he came home, he’d still have notes to dictate. I’d
frequently find him snoozing in an armchair with the light still on. A
few hours later, he’d wake and go back to work.“I’m trying to survive,” he told me when I complained about how work consumed him. “I’m doing the best I can.”When we first met, I fell in love with his playfulness as much as his passion. He belonged to an improv comedy group and kept me up talking in
funny voices and telling me what he loved about medicine.

Our personal life is private, but his professional life is public

Modern Love


Is There a Doctor in the Marriage? - The New York Times

Health and the Weather

Mental health professionals have labelled some depressions as seasonal affective disorder (SAD), an appropriate acronym  for depression related to seasons. The term is most often linked to depression occuring in winer when days are short, thereby decreasing the amount of time when visible light and other components of the electro-magnetic spectrum are a low levels.

 However visible light is only one part of the electromagnetic spectrum which fall upon us.  Ranging from the  low infrared through the visible spectrum (R,G,B,V) and into the ultraviolet, radio frequency, x-ray and beyond, including cosmic rays (solar flares-coronal mass ejections). Some or all of these may effect our psyche.
        Solar X-rays
Coronal Mass Ejections 

A sense of wellness is often associated with being at the beach or in elevated topography, which is associated with + ions.

Magnetic forces which may alter our mental, physical health or spiritual well being is proposed for wearing magnetic bracelets, rings or necklaces.

NOAA has developed sensitive measuring equipment to monitor space weather.

Window to the Universe

Space weather can be found either at:  or

Tuesday, January 19, 2016

Turnaround for Riverside County's Financially Beleaguered Medical Center

The ACA and it's effects on the county public health hospitals....are they more than a safety-net?

by Lauren McSherry, California Healthline Regional Correspondent, California Healthline, Monday, January 11, 2016

Riverside County took drastic action in recent years to turn around its financially mired public hospital.
The county loaned the Riverside County Regional Medical Center $200 million, spent nearly $26 million on a contract with Huron Healthcare to turn the hospital toward profitability and this year, embarked on a rebranding effort. The hospital now is called Riverside University Health System Medical Center.
Hospital CEO Zareh Sarrafian, who took the reins a little over a year ago, has advocated for equipment and technology upgrades and a hospital expansion that he said are geared toward improving efficiency, quality of care and the hospital's financial health.
Sarrafian said the hospital has the financial means to support new investments, which include a new $53 million electronic health record system that will enable improved records sharing and data mining. Also in the works are a new catheterization lab and the purchase of new medical equipment.
"We wouldn't be making these investments if we didn't think they were vital to our existence and the future and quality of care," he said.
Another project on the horizon is a new medical office complex on undeveloped land neighboring the hospital. Through a public-private partnership, the hospital plans to build physician offices, an out-patient surgical center and a new mental health center.
Sarrafian, who previously worked for Kaiser Permanente and Loma Linda University Medical Center, said the investments are necessary to prevent the hospital from falling behind in its capital expenditures.
The hospital's overall strategy is to play a role in unifying the Inland Empire's somewhat fragmented marketplace, with the goal of "integrating vital parts of the continuum of care," including mental health, he said. The hospital also has been working to establish a system of providers, he said.
Jennifer Bayer, vice president of external affairs at the Hospital Association of Southern California, said the hospital's turnaround is a welcome change, but it's still early in the process to make a final call.
"They have put a tremendous amount of investment into the facility," she said. "They are certainly on the right track from what we are hearing."

Quality of Care

Hospital administrators said part of their strategy has been renewed focus on quality of care.
They point to a sharp decline in sepsis mortality, catheter infections, surgical site infections and ventilator-associated pneumonia in the Neonatal Intensive Care Unit.
Gary Thompson, the hospital's medical director for quality, said the attention to improved quality of care has resulted in cost savings due to decreased length of hospital stays. For example, the decline in sepsis mortality resulted in savings of more than $3 million and addressing diabetic hypoglycemic rates among patients resulted in more than $1 million saved per year, he said.
This month, the hospital received a "gold-plus" rating from the American Stroke Association and last September was selected as a national top performer on key quality measures by The Joint Commission, a not-for-profit hospital accrediting agency. The hospital also is pursuing becoming a Level 1 trauma center.
The focus on improved outcomes has been influenced by increased competition among medical providers following the rollout of the Affordable Care Act.
"How can you attract patients if you don't have quality care?" Thompson said.
Sarrafian said the hospital's role as a safety-net hospital means it needs to survive, even though it is no longer the only game in town. His aim has been to stabilize the hospital financially, while creating a delivery model that included coordination of care for the entire county.
Bayer said public hospitals across the state are giving attention toward how to attract patients and private insurers because they can no longer rely on a "shoo-in" Medi-Cal population. Medi-Cal is California's Medicaid program. Patients in the vast region encompassed by Riverside County can now opt to go to a medical center closer to home, particularly if they live far from the hospital's Moreno Valley campus.
"With Medi-Cal expansion and the ACA, many people have much more choice," she said. "It has caused many county facilities to rethink the way they deliver care so they can compete."
Due to health care reform, public hospitals are re-evaluating themselves from a competitive standpoint rather than a mandatory standpoint, Bayer said. And like RUHS Medical Center, they are considering new investments in technology, structural improvements and expansions, realigning general efficiencies and patient satisfaction, she said.
Some of the medical center's improvements, such as those related to patient infection rates, are related to new Medicare standards that can reduce hospitals' payments if they do not meet certain performance thresholds.
"You could lose 8% to 9% of your revenue based upon performance," said Craig Garner, a health care lawyer and former hospital CEO. "It's quite a challenge. They are trying to look at additional revenue streams to keep them afloat, and the question becomes, is that going to be enough?"

Building a New Image

With its rebranding, the hospital seems to be trying to tap into the prestige of other academically affiliated medical centers, such as Loma Linda, UCLA and UC-Irvine, Garner said.
The hospital's rebranding and expansion plans also appear to be part of a strategy to attract private insurers and a wider patient base.
"People want to go to the best facilities," Garner said. "It's hard to compete with other academic institutions or conglomerates."

Staying Afloat

Garner said the road ahead for public hospitals like RUHS Medical Center is not an easy one.
"They have to become very efficient. They have very little room for error," he said. "If people are being encouraged to utilize less, and providers are being paid less and they already had slim profit margins, something has to give. That's the burden of health care reform, to find a way to bridge that gap."
The hospital appears to be on better financial footing. It reported a $54 million profit in fiscal year 2015, compared with a $62 million loss in 2014. And the $200 loan from the county in the form of a line of credit is no longer on the books as the hospital has a positive cash flow, according to a statement from the hospital's spokesperson. Meanwhile, the hospital has 10 years to pay back its debt obligation to Huron Healthcare.
Sarrafian conceded that the ACA has required public hospitals to adapt in order to survive new competitive forces. He foresees more consolidation and said size is going to matter and some hospitals will need to become part of a larger network to survive.
"It's been very difficult for many organizations to anticipate the ramifications," he said. "Public hospitals have probably been the most adversely impacted."
Source: California Healthline, Monday, January 11, 2016