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The Blue Pill Reclassified as Schedule II Controlled Substance. Red and Green Pill to Follow Soon.

Silver Springs, MD -- The blue pill was reclassified  Monday as a Schedule II medication by the U.S. Drug Enforcement Agency (DEA) under the Controlled Substance Act of 1970.   Following the recent decision to change all hydrocodone combination products to Schedule II, the DEA, at the urging of FDA officials, felt the time was right to raise the bar in patient safety.

"The more we looked at the dangers of hydrocodone, the more convinced we became of the the blue pill's danger to our elderly population.  We have concluded that dependence on the blue pill is rampant and we hope reclassification will give doctors that extra incentive to overbook their  clinic to discuss the ongoing risks and benefits of blue pill therapy," said Dr Douglas Throckmorton, an FDA physician who's own mother succumbed to a blue pill addiction.

In 2013, FDA officials recommended the DEA reclassify the blue pill as a more restrictive Schedule II medication after receiving thousands of reports from patients complaining  the hospital nurse was 15 minutes late for their blue pill.

"The four times I was admitted to the hospital last month, I never once got my blue pill with my morning enema.  It's a wonder I'm still alive, " said Lilian Swanson, a completely healthy full code 98 year-old according to her 12 children, each of whom wrote a letter to the hospital CEO complaining about the average 15 minute delay in giving their mother the blue pill.

By reclassifying the blue pill as a Schedule II drug,  doctors will no longer be allowed to write refills or call in prescriptions. The blue pill joins morphine, Dilaudid, Fentanyl, Oxcycontin and hydrocodone, as drugs with a high potential for abuse.  Emergency Physicians questioned the FDA's move and said more elderly patients would simply come to the ER asking for refills of their blue pill and to have their ears checked for wax.

Blue and Red Pill changed to Schedule II 
"It's only been a day since the blue pill went Schedule II and already I've had 72 old people in my ER asking for a blue pill refill and it's not even a Saturday," said Dave Ben, an ER physician with two first names.

The transition to Schedule II has not been without difficulty.  Some hospitals misinterpreted the DEA ruling and have required physicians and non-physician practitioners to personally carry a hand written blue pill prescription to their central hospital pharmacy for all their patients currently admitted in the hospital.

"The DEA is really cracking down on Schedule II compliance.  My superiors have told me not to dispense any blue pills for our inpatients unless the provider personally comes to my stock room and hands me a prescription," said Ward Jennings, a new pharmacy grad who says WTF under his breath at least 172 times a day.

In addition to blue pill restrictions, practitioners should anticipate Schedule II restriction for the red pill and green pill in the coming months.



E/M Coding Lecture Slideshow Presentation For Hospitalists

Presented here is a slideshow evaluation and management (E/M) coding lecture presentation I was asked to provide for the local Society of Hospital Medicine (SHM) chapter meeting October, 2014.  This lecture is not sponsored or affiliated with any SHM resource but is my interpretation of  numerous resources, including CPT and CMS, I have researched over many years to help physicians master correct E/M coding.  The 2015 CPT® manual is an invaluable coding resource and can by found on Amazon through the image below and to the right.

This slideshow presentation  focuses on the difference between a level 2 vs a level 3 hospital admission and a level 2 vs a level 3 hospital follow-up visit.  Because Medicare is aggressively increasing audits of E/M documentation, physicians have an obligation to educate themselves about the rules that determine the correct level of service.  I have previously provided detailed discussions for both scenarios linked above.

I chose to focus this lecture presentation on  both sets of these CPT codes (99222 vs 99223 admission and 99232 vs 99233 follow-up)  because they are a large portion of the E/M codes used by hospitalists.  Based on the rules given to hospitalists and other physicians to accurately code E/M visits, mastering correct coding documentation can appropriately help physicians get paid for the work they are providing and minimize over and under billing.

I am a practicing hospitalist with over 10 years of clinical experience.  I have written an entire collection of E/M lectures that can be found here to help guide practitioners through the  coding process.  In addition, I have created a bedside pocket E/M reference card, that I personally use every day, to  accurately determine the most appropriate level of E/M care at point of care service for most inpatient and clinic visit scenarios.

If you are unable to view the coding lecture below, here is a direct link to the slideshow presentation.

E/M CODING LECTURE SLIDESHOW 




This laminated E/M bedside pocket card below is available for purchase. All proceeds are donated to charity.


LINK TO BEDSIDE E/M CODING CARD POST
EM Pocket Reference Cards Using Marshfield Clinic Point Audit

Click image for high definition view



Facebook Changes Relationship Status Updates To Ebola Status Updates.

Palo Alto, CA --  Facebook announced Saturday they have  removed relationship status updates and replaced them with Ebola status updates in high risk groups to allow rapid communication with family, friends, and friends of friends. Relationship status currently receives over one billion views a day worldwide and is widely considered the most reliable method of disseminating public health information.

Homeland Security officials have been working with Facebook representatives for several months to implement Ebola status updates as an alternative to CDC reporting.  The changes went live after Ebola virus patient Thomas Eric Duncan was admitted to a Dallas, Texas hospital earlier this week.

Facebook Ebola Status Updates
While some public officials question the use of Facebook Ebola status updates as replacement for  formal CDC reporting,  Facebook remains confident their algorithms can focus in on groups at highest risk for contracting Ebola.

"After mining through trillions of personal data points in the last week alone, we know Facebook users who post hourly cat memes, use third person language,  and post selfies with emoticons are most at risk for contracting Ebola.  We are pushing Ebola status updates extra hard on this population," said Francis Winter, Facebook's Ebola Project Manager.

While Facebook is counting on high risk groups to self report, they are also hoping friends and family report face-to-face evidence of fever and hemorrhage on their own Facebook status updates.

"We like to call this herd immunity in social media," said Francis.



West Africa Ebola Cruise Proving Popular With Anti-Vaxxers

Liberia -- Despite the largest Ebola virus outbreak in history, Carnival Cruise Lines announced expanded Super Saver Sales destinations today by offering 25% off western Africa expeditions along coastal Liberia and Sierra Leone.  Officials say demand is especially strong this season, thanks in part to the route's popularity among anti-vaxx families.

Discounts of 50% and more are frequent during sale events, but demand from wealthy, white people who won't vaccinate their children has allowed Carnival to limit sale prices.

"Our seasonality has been strong this year for coastal West Africa, especially among anti-vaxx families excited to prove all this Ebola hype is just government propaganda," said John Stanbaugh, a Carnival spokesman and father of three unvaccinated children.

Anti-vaxxers' inability to process basic principles of immunology has allowed international cruise lines to market Ebola ravished regions as a family friendly destination experience.

"The internet says Obama created this fake Ebola scare so America could invade West Africa and take over their tropical fruit farms," said Angela Hainsworth, a mother of thirteen homeschooled children in Napa County, California.

Carnival's largest ship, Antivaxx, joins Royal Caribbean's Norwalk in the rapidly expanding market for unvaccinated vacationers.  Cruise lines say they can save hundreds of millions of dollars a year abandoning principles of basic hygiene on routes dedicated to unvaccinated vacationers.  Insurance companies even offer deep discounts on Antivaxx routes, knowing passengers and crew members are unlikely to file lawsuits for health related events.

"We only hire anti-vaxx crews to compliment our passengers. While most crew and passengers will eventually succumb to fever, diarrhea, vomiting and occasional internal hemorrhage, none of them ever complain about a virus," said Carnival spokesman John Stanbaugh, also known as the Father of Anti-vaxx Vacations.

To compliment their West Africa anti-vaxx experience, Carnival has teamed up with Liberian Ebola Tours to offer a fully authentic West Africa cultural experience.  Repeated calls to Liberian Ebola Tours went unanswered.



Organic Vaccines Approved By FDA; To be Sold Exclusively at Trader Joc's.

Silver Spring, MD -- The Food and Drug Administration (FDA) gave final approval Tuesday to a full line of gluten and GMO free organic vaccines to be sold and injected exclusively at Trader Joc's by board certified chiropractors.  The FDA is hopeful these 100% natural vaccines  will reverse  a dramatic rise in preventable childhood diseases showing up in  children of highly educated white upper middle class parents who only buy organic food products but choose not to vaccinate their children against deadly diseases.

The vaccination rate of children among this population has dropped precipitously over the last decade as pseudoscience and misinformation found in anti-vaxx internet forums has exploded.

Ben Tank , CEO of Trader Joc's, approached the FDA last year with his proposal to buy surplus childhood vaccines and rebrand them as a Shot of Joc, the healthy GMO and gluten free organic alternative to vaccines offered by physicians and big box department stores.

"I see organic healthcare as a big growth opportunity for us. We plan to focus our sales on the children of mothers who fear just about everything without the word organic on it."

Government officials are excited about the benefits of partnering with Trader Joc's.  "Years of FDA research has suggested parents who only buy 100% natural organic food products have an 87% chance of not vaccinating their children against measles, mumps, rubella, flu and other preventable childhood disease.  That number jumps to 98.7% of home-schooled children with internet access in California," said Margaret Ham, the FDA Commissioner  and mother of three organically vaccinated children.

While these vaccines will not be covered by insurance, Trader Joc's is confident their customers will pay extra for peace of mind.

"I can totally see a difference in my kids ever since they got their organic flu shot last week.  Thank you Trader Joc's for making vaccines healthy," said Cindy Dense, a mother of seven children who drives a big red Suburban.

To compliment the complete selection of organic vaccines, Trader Joc's also offers  100% natural plastic syringes and needles for a completely wholesome vaccination experience.

"What if I told you vaccines are 100% GMO and gluten free."

What if I told you vaccines are 100% GMO and gluten free humor meme photo;.



Stroke Leaves Nana Nice.

Wichita, KS -- 87-year-old Lilian Bedford's family is thankful this week for a devastating stroke that left her paralyzed, drooling and incontinent, but suddenly delightful to be around.

Known as 'The Mean Nana' by all 17 of her grandchildren, Lilian was rushed to a local hospital by ambulance last week after neighbors noticed all 11 of her cats on the front porch looking for food.   Paramedics say they found her confused and agitated with something DVR'd from CBS playing in the background.

"I couldn't believe what a jerk this old lady was being to me.    She was yelling profanities and flipping me the bird while I tried to check her blood pressure," said John Brainard, the paramedic who arrived first at the scene.

That's the Nana mommy used to tell us stories about," said 5-year-old Jimmie, who's never seen his grandmother because of her terrible attitude.  "But now she hugs me with her good arm and I can't wait to see her again."

Having Lilian's incredibly positive energy was an intoxicating experience for nurses.   "She melted our hearts.  We played rock-paper-scissors every morning to win her four max assist cares, even though we all had nine other patients to care for,"  said Adrian Freeling, the nurse with the longest streak for not calling in sick on a Friday at the last moment.

Doctors are also excited about Lilian's progress.  "Her transformation has been nothing short of remarkable.  When I first met Lilian last week, she told me to 'get out of my room'.  As the week went on, she was funny and inviting.  We laughed and cried together.  In fact, she went from last patient of the day to first patient of the day on my daily rounds, " said Dr. Sckvch Kckvxldhslkch, a leading Neurologist and President of the National Association of Neurologists From Eastern Europe.

Lilian's stroke had her hospitalist wondering how similar stroke symptoms could be induced in all of his patients to get 100% patient satisfaction scores.  "Someday, I'm sure hospitalists will be asked to stroke out all their patients to improve the scores," said Dr John Jensen, a hospitalist who only gets paid when patients have a smile on their face.



Hospitalist Group Starts Telemedicine Service to Get Paid for Answering Cross-Cover Night Calls.

Richmond, VA -- A Hospitalist Group affiliated with Chippenhammer Hospital has implemented a nighttime telemedicine service to get paid for taking cross-cover calls that should have been referred to a physician consultant instead.

"We were getting hundreds of calls a night,"  said Grace Jones, the new Director of In-house Hospitalist Telemedicine with Tired Hospitalist Group at Chippenhammer Hospital.

Hospitalist medicine growth has transformed the speciality into the path of least resistance.  Many doctors and nurses feel hospitalists should be called for all questions because they are already in-house.  Some hospitalist groups are even expected to field calls when other doctors don't answer.

"My job has become so ridiculous that I'll even get asked to call  a patient's irate physician daughter at 2 a.m. when we aren't even on the case!  We had to staff two hospitalists every night plus one more in the 20 bed geriatric observation unit just to field nursing calls while our one night hospitalist admitted 20 patients every night," Grace said while shaking her head in disbelief.

"To fund additional physician staffing, we had to figure out a way to get paid for fielding cross-cover nursing calls to titrate dopamine in a post-MI cardiac ICU patient or provide vent orders in a crashing ARDS patient, even though the order was to "CONSULT MEDICINE FOR DIET CONTROLLED DIABETES ONLY",  a written verbal order that was underlined twice and written in all capital letters at the request of the ordering specialist."

Tired Hospitalists worked tirelessly with The Centers for Medicare and Medicaid Services (CMS)  to get in-house hospitalist cross-cover calls paid for through telemedicine CPT codes by reducing payments to other physician specialties in a revenue neutral method.

"We analyzed all night cross-cover calls we received in the last six months and discovered 97% of all calls on patients with at least one consultant were inappropriately diverted to our hospitalist physicians.  As a result, we have instructed all hospital nurses to call our telemedicine answering service when at least one specialist is involved."

In addition to CMS payments, Tired Hospitalist Group plans to bill every specialty directly using proprietary software to determine how annoying the call really is.  Some specialty groups have expressed reluctance in paying a hospitalist to field their calls since they've been getting away with it for free all these years.

"I'm not paying a hospitalist to do my job.  If they don't want to take my calls, they shouldn't have become a hospitalist," said Dr. Wiley Scruff, a 78-year-old surgeon who hasn't answered his phone at night in 30 years.

After threatening to stop providing stat pre-operative H&Ps in patients with no medical problems, all surgical specialties agreed to pay Tired Hospitalist Group whatever they wanted.




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