Moving Patients From Drugs To Independence

Illustration of various types of chronic pain
According to the National Center for Health Statistics chronic pain health care costs and lost productivity has reached nearly $100 billion a year. It affects approximately 76.2 million people - more individuals than diabetes, heart disease and cancer combined.

Republished with permission from PRIUM’s Evidence Based

Last week I visited two facilities in California that are successfully doing what we all want done – transitioning injured workers to non-narcotic methods to manage their chronic pain.  I often hear a cynicism regarding effectiveness/cost as “pain management clinics” have accumulated a bad reputation over time for high expense and high recidivism rate.   After detailed in-person discussions and evaluation of case studies, I believe these two have shown success that break the mold:

  • Savvy Health Solutions: The F.I.T. Academy (Functional Intervention Training) program works outside of the medical model to restore function by treating the whole person in a fitness environment.  They challenge the physical, intellectual and motivational components of the person, with an ultimate goal of independence and personal responsibility and maximized ADL’s.  As long as the injured worker doesn’t need medical oversight during the detox process, they will work in conjunction with the treating physician and employer and claims adjuster to define the most appropriate path to the goal.  Founder Paul Wright says it takes patience (approximately 40 sessions over 4-5 months), but he showed me several pictorial examples of “before” and “after” (even meeting one of their patients) and their data that showed a 69% decrease in WC claim costs and 65% reduction in the length of open claims.
  • Pacifica Pain Management Services: Dr. Gary Mills has created a comprehensive non-narcotic pain management program that lessens pain by emphasizing pain syndrome management and reducing drugs, depression and dysfunction.  In some cases an in-patient detox with full medical supervision is required, but the residential inpatient approach (with a 60% individual / 40% group model and 2:1 staff to patient ratio) allows their team of MD, PhD, PT and personal trainers to recalibrate how the patient deals with pain through a full daily schedule for 4-6 weeks.  Interestingly, they mandate a 1-year contract of continuous engagement with the treating physician and claims adjuster (and visits every 2 weeks) to be the continued conscience.  Their outcomes (69-72% stay “clean” when they fully exit the program) exceed the industry (typical goal of 50%).

While these two facilities are focused on northern California, there are others (like Solutions Recoveryin Las Vegas, whom I’ve also vetted) that likewise have solid methods and positive results.  The key I have found is patience – while guidelines typically suggest 6-8 weeks / 180 hours for a FRP (functional restoration program), that likely isn’t enough time to enact lifetime changes.

When judging a pain management or functional restoration program, the first questions must be:

  1. Show me examples where you’ve been successful
  2. Show me your recidivism rate

Without demonstrated success of transitioning patients to a lifetime of managing their chronic pain without narcotics, you will likely be throwing your money away.

One of my projects this year is to identify centers of excellence because our corporate goal (and my personal goal) is to get patients off harmful drugs, whatever the method.  So if you have suggestions of other successful facilities I would be pleased to hear from you.

Construction Workers Experience Significant Lifetime Risk of Occupational Injury, Premature Death

young Hispanic construction worker with word "peligro" on his hard hatAnd 20 percent higher risk for Hispanic workers.

Washington, D.C. – Nearly all construction workers will experience one or more work-related injuries or illnesses over a lifetime plus a greater risk of premature death, according to new data released today at the American Public Health Association’s 139th Annual Meeting.

Using multiple years of data from several national sources, including the Census of Fatal Occupational Injuries, researchers from CPWR – The Center for Construction Research and Training estimate that over a 45-year career a construction worker has a 75 percent likelihood of experiencing a disabling injury. Additionally, over the course of a career, the same worker has a one in 200 chance of being fatally injured on the job. A Hispanic construction worker has a 20 percent higher likelihood of dying from a work-related injury.

The study also reveals that an individual who begins construction work at the age of 20 has a 15 percent chance of developing chronic obstructive pulmonary disease over a lifetime and an 11 percent chance of developing dust-related parenchymal chest X-ray changes.

“While great strides have been made in reducing construction injuries and illnesses, the numbers are still stubbornly high,” said Pete Stafford, executive director of CPWR. “Workers and their families suffer the consequences of disabling injuries, and this research shows it’s far too common. So we must continue to raise awareness of the problems – and hope to see our research findings put to use to reduce construction fatalities, injuries and illnesses.”

Researchers note that using cross-sectional data, the traditional method of presenting occupational safety and health, tends to underestimate risk. Presenting risk based over a lifetime presents a more accurate estimate.

For more information, please contact APHA Communications at (202) 777-2509 or .

Session 3256: Lifetime risk of occupational injuries and illnesses among construction workers

Date: Monday, October 31, 2011: 12:30 PM
Researcher: Xiuwen Sue Dong, DrPH, Laura Welch, MD, John Dement, PhD, CIH, and Knut Ringen, DrPH

The Long & Winding Road to Reform

Co-cop logoMaking a Place for Small Businesses in Exchanges

by David Gorn, California Healthline Sacramento Bureau

Small businesses know the power of collectives.

From agricultural co-ops to trade associations, small businesses frequently pool their resources and increase their buying power, leveraging better deals for their members.

That’s the very idea behind the Small-Business Health Options Program.

State-based exchanges will go online in 2014, aiming to offer more affordable health insurance options in the individual market. At the same time, states will also create exchanges for small businesses. The Affordable Care Act leaves it up to states on whether these exchanges will be combined or run separately.

A series of articles last week in Health Affairs, supported by the Commonwealth Fund, lays out the benefits, pitfalls and possibilities of SHOP exchanges.

As Editor-in-Chief Susan Denzter noted, “These insurance stores for the small-group market … sound simple in concept, but as [the articles] make clear, they are anything but.”

Cost v. Choice

Jon Kingsdale, founding executive director of the Massachusetts Commonwealth Health Insurance Connector Authority, writes in his Health Affairs article that Congress’ intent in creating SHOP was to help small businesses offer more coverage choices to their workers.

In another Health Affairs article, Timothy Jost, a professor at Washington and Lee University School of Law, points out that while offering small business employees a choice of health coverage options is “attractive in theory,” it has “proved difficult for small employers to manage.” Further, “[p]rice continues to be the most important consideration for small businesses; choice is less important,” Jost posits.

Kingsdale echoes this theme, writing, “Both the buying preferences and the political agenda of small firms are remarkably clear: They want rate relief, as soon as possible.” Continue reading The Long & Winding Road to Reform

The $21 Advil Debate in California

Golden pills
Thar's gold in them thar pills!

This could be the “golden toilet seat” of the health care debate in California. And guaranteed to be a conversation starter around your favorite water cooler or coffee machine!

Should California voters cap hospital costs?

 Download/Play Audio

A single Advil tablet costs around 8¢ at your local pharmacy, so would you be willing to pay $21 for one at a hospital? You might not have a choice if you’re in the hospital and $21 is the going-rate. Such extreme price mark-ups are evidence of “hospital price gouging,” according to union health care workers who are trying to stop it.
“We’ve learned that they charge 21 dollars for a single Advil – not the bottle, but a single Advil,” said Elizabeth Brennan, spokeswoman for the Service Employees International Union (SEIU.) Brennan maintains that such lofty prices are why health care costs are as high as they are. In order to stop the alleged unfair practices, union health care workers in Southern California are collecting signatures for two initiatives they hope to get on this Fall’s ballot.
The first initiative would prohibit hospitals from charging patients more than 25 percent above the actual cost of services and the second initiative would require non-profit hospitals to provide a pre-determined minimum amount of “charity care” for needy patients. Jim Lott, spokesman for the Hospital Association of Southern California, said the SEIU has identified a very real problem, but that limiting hospitals’ ability to charge is the wrong solution. Lott maintains that hospital costs are raised because of low payments received from customers who use Medicare and
Medi-CAL and that the situation could be resolved if the government covered more.


Are hospitals only out for profit or are they simply doing what’s necessary to spread the costs of California’s underinsured? How restricted, if at all, should hospitals be when it comes setting prices for services?


Dave Regan, president, Service Employees International Union, United Healthcare Workers WestJames Lott, spokesman, Hospital Association of Southern California

How to Get Medicare-Covered Health Services at Home

David Sayen is Medicare’s regional administrator for California, Arizona, Nevada, Hawaii, and the Pacific Trust Territories.
David Sayen is Medicare’s regional administrator for California, Arizona, Nevada, Hawaii, and the Pacific Trust Territories.

Medicare covers a variety of health care services that can be provided in the comfort and privacy of the individual’s home. These include intermittent skilled nursing care, physical therapy, speech-language pathology services, and occupational therapy.

Such services used to be available only at a hospital or doctor’s office. But they’re just as effective, more convenient, and usually less expensive when you get them in the home.

Those who get Medicare benefits through a Medicare Advantage health plan (instead of Original Medicare) should check with the plan for details about how it provides Medicare-covered home health benefits.

To be eligible for home health services, an individual must be under a doctor’s care and receive the services under a plan of care established and reviewed regularly by a physician. The doctor also needs to certify that you need one or more home health services.

In addition, the recipient must be homebound and have a doctor’s certification to that effect. (Being homebound means leaving the home isn’t recommended because of the patient’s condition, or the condition keeps the patient from leaving without using a wheelchair or walker, or getting help from another person.) Also, the patient must get their services from a home health agency that is Medicare-approved.

If the patient meets the criteria, Medicare pays for covered home health services for as long as they are eligible and their doctor certifies that the services are needed.

Skilled nursing services are covered when they’re given on a part-time or intermittent basis. In order for Medicare to cover such care, it must be necessary and ordered by the patient’s doctor for their specific condition. The patient must not need full-time nursing care.

Skilled nursing services are provided either by a registered nurse or a licensed practical nurse under an RN’s supervision. Nurses provide direct care and teach the patient and their caregivers about the care required. Examples of skilled nursing care include: giving IV drugs, shots, or tube feedings; changing dressings; and teaching about prescription drugs or diabetes care. Any service that could be done safely by a non-medical person (or by the individual patient) without the supervision of a nurse isn’t skilled nursing care.

Physical therapy, occupational therapy, and speech-language pathology services have to be specific, safe, and effective treatments for the patient’s condition.

Continue reading How to Get Medicare-Covered Health Services at Home

Make the most of the new federal health law without having to read it all.

screenshot of website page
Hi, we're from the government and we're here to help!

Web site to aid California businesses with health care issues

By Mark Glover

Published: Wednesday, Feb. 8, 2012 – 11:02 am

A group of California business organizations today announced the launch of a website to help the state’s business operators understand the federal Patient Protection and Affordable Care Act.

The Health Law Guide for Business site – – is designed to help business owners navigate the 2,409 pages of the health care law. To skip right to how to control healthcare costs for business, click here.

The act was signed into law by President Barack Obama on March 23, 2010.

“The (website) was created by California businesses for California businesses. It will be an important resource for those interested in the law’s business-specific provisions …,” said Micah Weinberg, senior policy advisor to the Bay Area Council. “Corporate leaders can use the (site) to learn about the provisions in the law that will have the greatest impact on their bottom lines.”

The website is funded by The California Endowment. It was created by a partnership that includes the California Hispanic Chambers of Commerce, California Small Business Development Centers, Pacific Business Group on Health, Silicon Valley Leadership Group, Small Business Majority and Small Business California.

Valentine’s Day Sugar Massacre?

photo of sugar cubes with skull and crossbones poison symbolCan sugar really be toxic? Sadly, yes

Eating excessive amounts of processed sugar is leading to an epidemic in type 2 diabetes.

By Max Pemberton

By the time you have finished reading this sentence, one person in the world will have died from type 2 diabetes. Two more will have been newly diagnosed with it. Yet it is a condition that rarely excites or interests the public. It has a slow, insidious progression that is interlinked with obesity, and as a result this disease is considered an abstract, boring and largely self-inflicted condition. While it’s a killer, it’s not a killer in the dramatic and attention-grabbing way that other conditions such as cancer and infectious diseases can be. But given the huge personal and economic impact it has, we should be taking type 2 diabetes much more seriously.

According to a startling commentary in the journal Nature, by researchers at the University of California, San Francisco, sugar poses such a health risk – contributing to around 35 million deaths globally each year – that it should now be considered a potentially toxic substance like alcohol and tobacco. Its link with the onset of diabetes is such that punitive regulations, such as a tax on all foods and drinks that contain ”added’’ sugar, are now warranted, the researchers say. They also recommend banning sales in or near schools, as well as placing age limits on the sale of such products.

I have to admit my first response on reading the headlines generated by this article was to roll my eyes as I tucked into a king-size Twix, and denounce the suggestion as yet another example of health fascism. Sugar? Toxic? Oh, please, give me a break (or preferably a KitKat). But the truth is that there is compelling evidence that sugar is hugely dangerous, because it is a contributing factor in the twin epidemics of obesity and diabetes faced by developed countries.

Continue reading Valentine’s Day Sugar Massacre?