Friday, April 17, 2020

#34: As the country slowly gets back to work...


If you are reading this blog this am, you are likely at the office for which you work.  I would like to applaud you for continuing to serve those in need during this stressful time.  I encourage you to make sure you are taking care of yourself as well.  Whatever healthy habit you may have to help with stress please don’t put it on a shelf during this time.  If you are unable to do it because of certain restrictions, now is a great time to develop new healthy habits.  Take this opportunity to reconnect with someone you haven’t spoken with in awhile.  Talk about something other than the “virus”.  Laugh about something and you will release endorphins in your brain.  You do know that endorphins are natural hormones/peptides which activate the body’s opiate receptors, don’t you?  In other words, you can get high naturally!! 

Some of you may be aware, ILDP Vice President, Mark Campbell contracted the Coronavirus and spent 5 days in the hospital.  Mark played 10 years in the NFL and throughout his life has learned how to make lemonade out of lemons.  He has taken this scary, anxiety-filled experience and parlayed it into a platform from which he is now touching millions of lives with his story.  Additionally, he is bringing needed attention to the restraint of trade by insurance companies and monopolization of the laboratory system in the US.  On top of that Mark is addressing the gangster-like tactics of the large insurance carriers.  Their refusal to allow small labs in their networks has resulted in a severe lack of laboratory testing at the time it is most important.  If you google his name you will see he has the ear of the President of the US.  I speak for everyone in the ILDP family when I say we are so thankful he is now healthy and doing well.

As the country slowly gets back to work, and it is, there are a few housekeeping issues I wish to remind everyone of.  Please make sure that you take the urine cup from the patients and close the lids tightly before putting in the biohazard bags.  If it is a snap lid, please snap both sides down.  If it is a twist top, please make sure it is on straight and tightened down.  Please do not let the patients put the cups in the bag.  For those of you in cash-paying clinics, you must ask every patient if they have any health insurance, and if so get a copy of their card to send with the paperwork.  They may pay cash at the clinic, but we bill the insurance.  Please make sure you have at least two lab testing diagnosis codes on the requisition forms.  If you have any questions regarding this, please call the lab and speak with Faye, Jocelyn or April.  Please make sure you are staying ahead on supplies.  If you need supplies please use the supply order form and fax it to the lab at least three days prior to needing the supplies.  Make sure you are putting paper work in the outside pocket of the biohazard bag, not in with the cup.  Oh, and please NO STAPLES on the paper work.  Thanks.

Please stay safe and keep a smile on your face.  All of you are needed and appreciated.  We do not take your trust in us lightly.  Thank you for your business.

Lance Benedict
President/CEO Industry Lab Diagnostic Partners  
04/17/2020

Friday, April 3, 2020

#33: Life is Change


The only constant thing in life is change.  I have stated that before in a previous blog.  Boy does that ring true in our present circumstances.  One day to the next we are getting different information regarding this nasty little bug.  The bottom line, which I am sure we all can agree on, is to take as much precaution as we can in an attempt to avoid getting sick.  We work in environments in which the nature of our work automatically puts us at a higher risk.  We work in the health care field.  This is our job.  Many of the patients we have to deal with do not make the best choices, including personal hygiene.  Yes these are trying times.  I would like to thank and encourage all of you, from the providers to the front staff.  Your job is important and you are making a positive impact during these times.

We are taking extra steps at the lab to decrease the chances of contacting the virus here or spreading it elsewhere.  We are working everyday but have split shifts in an attempt to social distance.  Twice a day everything from the outside door handles to every light switch is wiped down with antiviral wipes.  Packages are handled with hands covered with gloves, hands are washed until they are raw, etc.  Staff is sent home as soon as the most critical work is completed.  Our scientists are doing as much as possible from home.  We are still here for you and your patients and will continue to be. 

Now, more than ever, communicate in a positive loving way with those you care about.  Say something nice to a stranger, let someone (six feet) in front of you in line.  It will help both of you.  Industry Lab Diagnostic Partners wishes all of you peace and safety during these times.  We are with you in mind and spirit. 

As I always do, I wish to thank you for your continued trust in us.  We do appreciate your business.

Lance Benedict
President/CEO Industry Lab Diagnostic Partners  
04/03/2020

Friday, March 20, 2020

#32: Labs Testing for COVID-19 are Being Overloaded!


Perhaps I will be guilty of showing my age, but I cannot recall the date that Dr. Google, Dr. Twitter, and Dr.Instagram became the go-to experts on all things health-related. Specifically, the cacophony of noise created by the pandemic of COVID-19. The amount of garbage these three “doctors” spew out daily, even hourly, regarding just this topic alone, is outrageous. If these “doctors” do happen to spit out (I will get back to this in a minute) some factual information, they leave it up to the layperson to disseminate fact from fiction. Honestly, when I was an intern these three world-famous “doctors” were yet to be born. My how fast they became experts.

This website: cdc.gov/coronavirus will give you the most updated/accurate information out there. However, I will warn you it will still leave you with a lot of questions. Why, you ask? The answer is
simple. This is a new mutation, not a lab created pathogen according to the world renown Scripps Research institute (Sciencedaily.com/releases/2020/03/200317175442.htm) that we have known about since mid-December 2019, therefore information can and will change frequently for awhile. There just has not been enough time for study to give out exact and accurate answers to every question. The experts are using their knowledge of other Coronaviruses (SARS and MERS for example) along with what they are currently seeing and making educated guesses.

If you are using proper collection techniques (wearing gloves until specimen cup is in the biohazard bag and sealed, washing hands after removing gloves and disinfecting any areas where urine may have come in contact with a surface) you have no more risk than anyone else of contacting coronavirus. As of right now there is no evidence COVID-19 can be transmitted through urine. We do know this virus is transferred through respiratory droplets (thus my sarcastic reference to spit). It is not airborne, like measles. Not everyone who has the sniffles needs to be tested. Coronavirus has been around since the 1960s. COVID-19 is a new mutation.

Did you run to a doctor to be tested, or worse yet, to an emergency room last year when you had
the sniffles? Stop listening to Dr. Google or trying to interpret what a talking head said on TV in an attempt to keep you from changing the channel. If you have a real concern ask your health care provider.

The most recent information the National Lab Association I belong to has relayed to us is labs are being overloaded. Much of the early testing was unnecessary due to the fact the symptoms where not indicative of the virus and many came back negative. Doctors quickly learned to be more selective on who and what they test, dependent upon the symptoms and history presented. At this time, patients who are over 60, and individuals who have underlying chronic medical conditions and/or immuno-compromised condition, who present with a fever over 100, a persistent cough and fatigue should be tested. Any person that knowingly has come in contact with someone who has COVID-19 should be tested. Trust the process. Oh, and since I neglected to mention earlier, stay away from Dr Facebook as well!!

Thank you all for your business and please stay well.

Lance Benedict
President/CEO Industry Lab Diagnostic Partners
03/20/2020

Friday, March 6, 2020

#31: Introducing Mitragynine (Kratom) to our Testing Menu


Industry Lab is adding the drug Mitragynine (Kratom) to our testing menu.  We will hopefully be able to test this drug in approximately 6 weeks.  Mitragynine stimulates opioid-like activity in the brain and reduces pain response.  It has also been shown to create a euphoric effect, similar to opium or heroin, which those prone to abuse are searching for.  Typically the peak effects of the drug occur around 1.5 hours to 2.5 hours after ingestion.  Currently some research says the half-life of Mitragynine is thought to be around 23-24 hours which means it would take around a whole day for someone to eliminate 50% of the Kratom in their body.  Another body of research says the fastest half-life of Mitragynine could be just over seven hours which puts full elimination at around 1.6 days.  On the slower end of the spectrum, it could take up to 9 days for all presence of Kratom to be eliminated.  The common factors, age, body fat, genetics, food/water intake and of course metabolic rate play a role in the elimination rate. 
      
Kratom is NOT illegal in several states, however, there are some states where it has been banned, including the states of TN and Arkansas where it is defined as a controlled substance.  At one time in 2016 the DEA said it would list Kratom as a Schedule 1 drug but due to political pressure withdrew its decision.  It is still being debated.  The bottom line is we do not know about this potentially dangerous herb/drug.  There is a need to carry out extensive research on the safety and efficacy of the plant.

It is typically taken orally, either by making a tea from the leaves and drinking it or the leaves are crushed and the powder mixed with food and drink.  People also chew the leaves to obtain the desired effect.  It is a mind-altering substance, therefore has the potential for abuse.  People in Asia who have used Kratom for a long period of time have shown the development of a tolerance to the plant and therefore have to take greater amounts to obtain the same effects. 

For those of you who reached out to us regarding the Tornados this week, thank you very much.  The large tornado that caused so much destruction and death in Nashville and the surrounding areas, struck approximately two miles from the lab.  Everyone who is connected to the lab is safe and sound and all were fortunate to escape any damage.  We all have seen pictures over the years of the destruction these “bombs” of nature can cause, however, the reality hits home when walking through the rubble of what was once someone’s house or business you have visited in the past.  Thank you again for all of your thoughts and prayers. 

As always we appreciate your trust in us and thank you for your business.

Lance Benedict
President/CEO Industry Lab Diagnostic Partners  
03/06/2020

Friday, February 21, 2020

#30: How Much Do You Know About the Drug Narcan (Naloxone)?


Should we not all be thankful for the drug naloxone?  After all, as a society we know by now how using this drug has saved lives by reversing the effect of an opioid overdose.  It is even being distributed in communities.  All you have to do if you are in the presence of someone suffering from an opioid overdose is give them the drug Naloxone in time and you will save their life, right?  Okay, how many of you reading this know how to do that?  How many of you know that there are actually three methods taught in community programs in this country as to how to administer the drug Narcan (Naloxone)?  What if you give Narcan to someone who has overdosed on something other than opioids such as Cocaine?  Hmmm, it has gotten very quiet out there.  Here is another question:  How long does Narcan last once administered and why do we care?  I guess that was actually two questions in one. 

First and foremost Narcan has no effect on people who have not taken an opioid.  So if you walk onto a scene where someone is unconscious and there is a suspicion of a drug overdose it is better to be safe than sorry.  If it is available use the Narcan on that person.  The three methods, all used by Naloxone community programs, include a preloaded nasal spray; an intramuscular shot; or an improvised nasal atomizer kit that requires assembly of the three pieces before use.   You should familiarize yourself with all three.  This can be done even by watching some youtube videos on how they are used.  Yes, there are big bold instructions with each, however, there is a saying in boxing which applies here:  “Everyone has a plan until they get punched in the mouth”.  When your loved one is lying unconscious, hardly breathing and people are screaming at the top of their lungs around you, that is a punch in the mouth!  Try reading step by step instructions calmly during that.   Having studied in a calm, quiet atmosphere where you were able to concentrate on instructions on how to deliver Narcan might allow you to respond calmly and quickly in such a scenario.  The AMA has a short two-minute video showing how to use these devices.  Just type AMA-How to use Naloxone in your browser.  Providers have been encouraged to prescribe Naloxone to family and friends of people who may have an opioid use disorder.  Please ask your doctor if you are in that situation.  All of the clinics we deal with should have Naloxone on hand due to the clients they see.  You need to know where it is and how to use it.

Naloxone lasts between 30-90 minutes.  The effects of an opioid overdose last much longer, therefore it is possible after the Naloxone wears off the overdose could recur.  People are not “better” if revived with Naloxone and should always be taken to a medical facility.  If an individual does not respond to an initial dose or responds but then relapses into respiratory depression, additional doses of the Narcan nasal spray may be given every 2 to 3 minutes until emergency help arrives.  Although personal experience led me to write this particular blog, I pray none of you will ever need the information within. 

Have an awesome and safe weekend and as always thank you for your business.

Lance Benedict
President/CEO Industry Lab Diagnostic Partners  02/21/2020

Friday, February 7, 2020

#29: First-ever Criminal Action Against an EHR Company


Some of you may want to sit down before reading this one. In a Department of Justice release on January 27, 2020, the first-ever criminal action against an EHR company was announced.  Practice Fusion, a San Francisco-based health information technology developer, used by many providers, will pay $113.4 million to the federal government, $5.2 million to states and $26 million in criminal fines and forfeiture.  

Practice Fusion has admitted to soliciting and receiving kickbacks from a major opioid company in exchange for utilizing its EHR software to influence physician prescribing of opioid pain medications.  In addition, in exchange for “sponsorship” payments from pharmaceutical companies, Practice Fusion allowed these companies to influence the development and implementation of the CDS (Clinical Decision Support) within its software system in ways aimed at increasing sales of the pharmaceutical company’s products. 

The CDS alerts that Practice Fusion agreed to implement did not always reflect accepted medical standards.  They allowed pharmaceutical companies to participate in designing CDS alerts, including selecting the guidelines used to develop the alerts, setting the criteria that would determine when a healthcare provider received an alert, and in some cases even drafting language used in the alert itself.  This is akin to a fox building a “safe” place for chickens to live!!   As Christina Nolan, the U. S. Attorney for the District of Vermont stated, “Practice Fusion’s conduct is abhorrent.” 

Practice Fusion also knowingly caused eligible healthcare providers who used certain versions of its 2014 Edition EHR software, to falsely attest to compliance with HHS requirements necessary to receive incentive payments from Medicare during the reporting periods for 2014 through 2016 and from Medicaid during the reporting periods for 2014 through 2017. 

Okay, go take a shower to get some of that slime off you.  On another front, on January 21, 2020, CMS announced a national coverage determination that would cover acupuncture for people with chronic low back pain, in an attempt to give patients alternatives to potentially addictive narcotic painkillers.  There are, of course, some guidelines such as the pain must have persisted for at least 12 weeks or longer and have no identifiable cause, such as infections, disease, surgery and pregnancy.  Regardless of your opinion of alternative therapies, CMS is making the effort to take another approach to chronic pain. 

I am sure all of you have by now heard of the deadly virus, Influenza.  Thought I was going to say Coronvirus didn’t you?  So far this winter the flu has sickened 15 million Americans, hospitalized 120,000 and killed 8,200.  People freak when they hear Coronavirus and yawn at the word Flu.  Yes, familiarity breeds indifference. 

I hope y’all had a great first month of the new decade and as always I would like to thank you for your business.

Lance Benedict
President/CEO Industry Lab Diagnostic Partners  2/07/2020

Friday, January 24, 2020

#28: Documenting the Medical Necessity of Lab Testing


 Many toxicology laboratories work with addiction clinics that are cash pay and ILDP is not an exception.  Although this is a great business model, one of the issues all labs run into is billing the insurance of patients who attend cash pay clinics.  All patients being drug tested should be asked if they have any type of health insurance or if their health insurance has changed on each visit.  I realize this sounds like overkill, however as your partner in drug testing, we cannot be reimbursed for our services without the correct insurance information.  It is the practice of many clinics, and was in the clinics I previously owned, to request the insurance card from the patient on every visit to compare it to what the clinic has on file.  Often patients will obtain or change health insurance from one visit to the next.  If they present an insurance card, a copy of the front and back should be made and sent to the lab.  This will ensure the services the provider requested the lab to perform are able to be billed correctly.  In addition, many times insurances being what they are will request medical records/office notes for the particular visit when the patient sample was collected. 

Here is where it gets sticky.  Medical documentation is one way insurances love to deny claims.  Even if your clinic is a cash clinic, laboratories bill insurance, and therefore must comply with insurance requests in order to be reimbursed.  With the amount of fraud that goes on today, insurance companies want proof what they are about to pay for was done and, in their minds, was medically necessary.  Therefore beyond the lab reports, which we supply them with daily, they want to see the documentation of medical necessity for the drug test, from the provider.  According to CMS, the majority of improper payments to laboratories were due to insufficient documentation.  For example, the medical record was missing the documentation to support the intent to order a drug test.  The progress note was not signed by the provider, (they love this one) or no documentation of a signed provider order.  Also, documentation of medical necessity to test the patient was not sufficient.  “Run Labs” or “order drug tests” is not a sufficient note in their world. 

All providers have been schooled as to how to document.  Insurances move the goal posts all the time so we miss the field goal long enough for them to make some more dough!!  Did I tell you I greatly dislike insurance companies?  The bottom line, as a lab we play on their field and therefore by their rules.  Any way you are able to help us, we greatly appreciate.  Please document why you are testing the patient and what you are testing for.  As simple as, “Patient is prescribed an opioid so I am ordering a drug test for opioids, illicit and additional drugs that may produce a decrease in respiration if combined with opioids, to ensure compliance and decrease the potential risk of drug interaction.”  Please, please, please get us documentation when we request and rest assured it is not coming from us!   Thank you all for trusting us and sending us your business!!

Lance Benedict
President/CEO Industry Lab Diagnostic Partners  
01/15/2020

#34: As the country slowly gets back to work...

If you are reading this blog this am, you are likely at the office for which you work.   I would like to applaud you for continuing to ser...