has a wonderful website where all 68,000 of the ICD-10 codes we’re now using to classify and bill for the various conditions we treat are categorized and enumerated.

First a little about symbolism

The WHO logo at left contains an international symbol of medical care also used by the American Medical Association, a serpent lifted up on a pole, that some believe was derived the mythological figure of Asclepius, a supposed half-deity dating to about 1200 BC who was associated with healing and medicine.

However, those of us in the Judeo-Christian tradition trace the symbol back even further to the experience of Moses in the wilderness in about 1450 BC as recorded in Numbers 21.9: “So Moses made a bronze serpent and set it on a pole. And if a serpent bit anyone, he would look at the bronze serpent and live.” This has been carried forward into our faith in this passage quoted in John 3.14-15: “And as Moses lifted up the serpent in the wilderness, so must the Son of Man be lifted up, that whoever believes in him may have eternal life.“

In the Bible, the serpent has been a symbol of Satan and the works of darkness, deception, and death from the Garden of Eden until now. And Jesus being lifted up on the cross in the serpent’s place has become the substitute whose life, death, and resurrection brings light, truth, and healing.

And now the code list

ICD-10 stands for the 10th Edition of the “International Classification of Diseases” and has a section that includes a complete list of codes for “persons with potential health hazards related to socioeconomic and psychosocial circumstances” that will give you an idea of the range of personal afflictions and “baggage” that many of us suffer from and/or bring with us into adulthood. Many of these conditions, especially those in the Z61 category, are what we refer to as “Adverse Childhood Experiences” which can have lifelong consequences.

Click here to read one list of serpent bites that people experience, then weep and join us in prayer.

The Curious Case of Duexis

Aaron Hakim, MS and Joseph S. Ross, MD, MHS
JAMA Intern Med. Published online January 23, 2017. doi:10.1001/jamainternmed.2016.8423

Approximately 13% of health care expenditures in the United States are for prescription drug spending, nearly $420 billion in 2015. High-priced pharmaceuticals, therapies that cost more than $600 per month, are projected to eclipse 50% of total drug spending by 2018. Price increases for these therapies have been persistent, with unit costs increasing 164% between 2008 and 2015. Pharmacy benefit managers are third-party administrators that process and pay prescription drug claims and negotiate drug prices with manufacturers.

Pharmacy benefit managers have sought to manage prescription drug use and mitigate cost increases through such measures as prior authorization and step therapy requirements for physicians, increased copayment requirements for patients, and exclusion of some expensive medications from health plan formularies. Using the illustrative example of Duexis, a single-tablet, fixed-dose combination of the nonsteroidal anti-inflammatory (NSAID) ibuprofen [Advil] and the histamine H2-receptor antagonist famotidine [Pepcid] marketed by Horizon Pharma (Dublin, Ireland), we describe how some pharmaceutical companies have sought to circumvent such restrictions and maintain high prices for drugs, even for those with generic alternatives.

Duexis was approved by the US Food and Drug Administration (FDA) in 2011 to relieve symptoms of osteoarthritis and rheumatoid arthritis and to decrease the risk of developing gastric and duodenal ulcers in patients at risk for NSAID-associated ulcers. After approval, Duexis was first marketed at an average wholesale price, a benchmark used for pricing and reimbursement of prescription drugs, of $158.40 per month.

The drug is a combination of 2 over-the-counter medications that are sold as generics and would cost approximately $16 per month if purchased separately at the same doses. Since 2012, Duexis has had 11 price increases (see Figure below). As of August 12, 2016, the monthly wholesale price was $2061, representing a 1131% aggregate increase. In 2015, nearly $200 million was spent on Duexis in the US, with estimated cumulative revenue over 5 years of more than $600 million since FDA approval.

Figure

Weekly Prescriptions for Duexis and Monthly Wholesale Price After Each of the 11 Price Increases Since October 2011, When Duexis Was First Made Available in the United States

Pharmaceutical companies employ several tactics to offset prior authorization, step therapy, and other utilization controls imposed by pharmacy benefit managers on physicians. Horizon, for example, has physicians submit Duexis prescriptions directly to an affiliated mail-order specialty pharmacy, which prepares the prior authorization paperwork and provides medical justification to the pharmacy benefit manager on behalf of the physician, reducing the administrative burden. Horizon reports that 70% of Duexis prescriptions are filled through their “Prescriptions Made Easy” specialty pharmacy program. One such specialty pharmacy, Linden Care, has 59% of its business dedicated to dispensing drugs made by Horizon Pharma. In 2016, the US Attorney’s Office for the Southern District of New York was investigating Horizon’s specialty pharmacy practices.

Click here to read the full article in the Journal of the American Medical Association (JAMA).

about HHS Secretary designate Tom Price

By Medical Economics staff, November 29, 2016

Tom Price, MD, a Republican representative from Georgia, is poised to be nominated as the next secretary of the U.S. Department of Health and Human Services, according to media reports. Here’s what physicians should know about Price.

10. He is a third generation physician, having served in private practice for nearly 20 years in Georgia as an orthopedic surgeon. He received his bachelor’s and medical degrees from the University of Michigan and completed his orthopedic surgery residency at Emory University in Atlanta. Price later returned to Emory as an assistant professor and medical director of the orthopedic clinic at Atlanta’s Grady Memorial Hospital, where he taught resident physicians.

9. Price is a member of the GOP Doctors Caucus. The caucus is comprised of 18 medical professionals who use their medical training and expertise to help shape healthcare policy.

8. Price is a six term member of the house, first elected to represent Georgia’s 6th district in 2004. He serves on the House Committee on Ways and Means and is chairman of the House Budget Committee.

7. He is a vocal critic of the Affordable Care Act. In October, Price blasted the Obama Administration following news of premium rate hikes on some marketplace based health plans in a statement: “…President Obama and Democrats have the audacity to tout Obamacare’s ‘success,’ [but] the cold hard facts and figures prove the opposite is true.” A few days earlier, he pledged that Republicans would fight for “patient centered solutions that actually put patients, families and doctors in charge of healthcare in this nation.”

6. Price is a key proponent of House Speaker Paul Ryan’s (R Wisconsin) “Better Way” plan to repeal and replace the Affordable Care Act. As one of the House Republicans who devised the plan, Price recently said it was “simply not enough” to acknowledge the failures of Obamacare, but it’s necessary to offer another solution.

5. He is not completely sold on the final rule for the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), although he voted for the legislation. Following the release of the final rule in October, Price said Medicare’s new Quality Payment Program “deserves careful scrutiny in the light of serious concerns” among the GOP Doctor’s Caucus. “We are deeply concerned about how this rule could affect the patient-doctor relationship, and I look forward to carefully reviewing it in the coming days to determine whether the Administration has addressed those concerns and put the interests of patients first” Price said via statement.

4. Price is a Trump supporter. In May, as chairman of the House Budget Committee, Price joined eight fellow chairmen in endorsing Trump for president. “Any other outcome [of the election] is a danger to economic growth, puts our national security in peril, enshrines ObamaCare as the law of the land, entraps Americans in a cycle of poverty and dependence, and undermines our constitutional republic,” Price and his colleagues wrote.

3. Price and fellow Republicans have their eye on Medicare reform as an immediate priority. Earlier this month, Price told reporters that reforms to the federal program would likely come “six to eight months” into a new administration. Media reports say both Price and Speaker Ryan support privatizing Medicare, but no specific plans have been unveiled.

2. Price supports Medicaid reform as well, recently calling the program “an empty promise” in the 2017 House budget committee’s resolution. Price added, “Finding a physician who will see Medicaid beneficiaries can be incredibly challenging because providers are under-reimbursed and cannot afford to provide care at the rates the program pays.”

1. Price is very active on Twitter. Find him @RepTomPrice.

A new study shows millions of New Yorkers are overusing hospital emergency rooms and driving up everyone’s insurance premiums.

Using data reported to the NYS Health Department, Excellus BlueCross Blue Shield estimates that out of the 6.4 million visits to hospital emergency rooms in New York State in 2013, two million of them were for preventable conditions that could and should have been treated by primary care physicians.  In Monroe County alone, out of every 100 ER visits, 20-30 of them were not significant enough to warrant emergency services.

“Many of the visits are for sore throats, colds, sprains, sinus infections,” says Dr. Jamie Kerr, the medical director at Excellus.

She says it costs insurance companies eight times more for a patient to be treated in an emergency room compared to a primary care office. Those costs eventually get passed along to all customers in the form of premium increases. “We’re not telling you not to go to the ER but if you think it’s not serious and if your physician is not available, there are options other than going to the ER,” says Dr. Kerr.

Click here to read the entire WHEC report.

Where should you go?

Click here for help in figuring out where you should go if you’re sick or injured.

and your loved ones is the first step towards good health. That means reading up about how to stay well, learning common symptoms of possible health problems, staying up-to-date on the new health care law and knowing where to turn for help.

This may sound like a lot. So that’s why we’ve compiled many easy-to-use resources all in one convenient place.

• Find common symptoms, causes and treatments for more than 900 health and wellness issues
• Find out about prescription drugs and over-the-counter medicines
• Learn about anatomy, surgery, medical words and more: watch videos, take tutorials and listen to podcasts

Call us at (585) 235-2250 today to make an appointment for you or someone in your family.

As some of you may know, His Branches Health Services (HBHS) is a Community Health Center (also called a “Diagnostic & Treatment Center” or “D&TC”) licensed by New York State to provide quality care to underserved individuals and families in Rochester. This designation enables our Board of Directors to oversee not only the character of the care we provide but its quality as well.

Along with carrying out a number of quality assurance initiatives, including those mandated by ongoing Meaningful Use, Patient Centered Medical Home, and Accountable Health Partners certification, we are seriously beginning to look at what is involved in going beyond being what could be called a “State Qualified Health Center” to become a “Federally Qualified Health Center” or “FQHC.” We’ve been going over the application process and find that becoming licensed by NY State has almost gotten us there, but it’s still another stretch and a piece of work not only to put together but to maintain.

The end result would represent a further improvement in the patient care data analysis we do as part of our quality assurance activities and would enhance our reimbursement formula, allowing us to serve the community better. Click here if you’d like to find out more or help us along the way!

Local doctors say this is bad news for them. Patients who currently use the Blue Choice option for Medicaid will have to find another health care plan. Doctors say, under those new plans, they will not be reimbursed as much for their services. News10NBC spoke to a doctor who says about 20 percent of his patients have Medicaid through Excellus.

Dr. William Morehouse said, “If our patient transfer over to any of the other plans currently in town, our overall practice could stand to lose between five and ten of its income on an annual basis which is a substantial loss when you are an inner city practice that is already having a hard time making ends meet.”

Other doctors in the area have a much higher percent of Blue Choice Medicaid patients, some as high as 60 percent. It’s those patients who could feel the brunt of this. News10NBC sat down with Nancy Adams with the Monroe County Medical Society. She says doctors are worried about the people they care for. The first problem they see is with the transition. Patients may have less access to care because their current specialists may not be on their new healthcare plan’s network.

Doctors are also worried about the trickle down effect. Less reimbursement means less income. Some say they will have to close up shop all together. Others say they won’t be accepting new Medicaid patients. Nancy Adams, Monroe County Medical Society, said, “We’re already in short supply of adult primary care physicians and then when you throw into the mix that not all physicians may except these other health plans then it would make it even more difficult to find a physician.”

According to the Monroe County Medical Society, there is still a chance Excellus could work something out with New York State and continue to carry these plans. News10NBC will continue to follow this story and update you on any developments.