Healthcare Policy

Possible fewer PTSD diagnoses with DSM-5

The prevalence of post-traumatic stress disorder PTSD in US combat soldiers: a head-to-head comparison of DSM-5 versus DSM-IV-TR symptom criteria with the PTSD checklist : The Lancet Psychiatry.

The conclusion taken from the study:

Our findings showed the PCL-5 to be equivalent to the validated PCL-S. However, the new PTSD symptom criteria do not seem to have greater clinical utility, and a high percentage of soldiers who met criteria by one definition did not meet the other criteria. Clinicians need to consider how to manage discordant outcomes, particularly for service members and veterans with PTSD who no longer meet criteria under DSM-5.
Funding for this study: US Army Military Operational Medicine Research Program (MOMRP), Fort Detrick, MD.

Medicare to Pay Doctors and Nurse Practitioners for Care Coordination

Medicare to Start Paying Doctors Who Coordinate Needs of Chronically Ill Patients –

“This is time-consuming and challenging work,” said Dr. Matthew J. Press, an assistant professor of health care policy at Weill Cornell Medical College in New York. In a recent article in The New England Journal of Medicine, he described his experience coordinating care for a 70-year-old man with bile duct cancer in the liver.

Over 80 days, Dr. Press said, 10 doctors helped care for the man, who had five procedures and 11 office visits before a surgeon removed his tumor. Dr. Press, the patient’s primary care doctor, communicated 40 times with the other clinicians and 12 times with the patient or his wife.

This is a task that nurses have been doing for many years, under titles such as “RN Patient Advocate” and “RN Care Coordinator”, and being paid well to do so in the private sector. The new law also states that primary care providers of Medicare recipients be available 24/7 365.

With the tidal wave of baby boomers looming, chronic illnesses such as depression could break the back of the Medicare system, and possibly the Affordable Care Act, if medical care for these high-dollar illnesses isn’t ramped up. It will be interesting to see how this new legislation unfolds.

Pharmaceutical Company to Cash in on Medical Cannibis in Utah

Prescription bag medical cannabis

Utah hospital will use cannabis extract to treat kids with epilepsy :: The Salt Lake Tribune.

A potential new prescription medication to treat seizures in children, Epiliolex, manufactured by GW Pharmaceuticals, will cost parents upwards of $15,000.00 per year. Their competition, Realm of Caring, charges less than $200.00 per month for a product not made in a laboratory with higher success rates in controlling seizures.

Like it or not, medical cannabis is here. I attended a psychopharmacology conference in DC this month and one of the lectures was on medical cannabis. He said the industry is changing so rapidly it’s impossible for anyone to stay current on the subject.

Heroin Overdose Home Antidote Approved by FDA: Evzio



Press Announcements > FDA approves new hand-held auto-injector to reverse opioid overdose.

Evzio — Approved for use in April 2014, Evzio (naloxone hydrocloride injection) reverses opiate overdose in non-medical settings. Opiate overdoses are now the leading cause of death by injury in the US. Prior to the release of Evzio, in the event of an overdose, emergency response was by EMS or police, a huge barrier to treatment because of fears related to legal charges for criminal drug use.

Evzio needs to be seen as a harm-reduction tool, one that the public can become comfortable using, similar to needle exchange programs. Evzio can reduce the number of deaths and serious injury from overdose of prescription or non-prescription opiates, including heroin. Evzio works similarly to an epipen.

Evzio is injected into the muscle (intramuscular) or under the skin (subcutaneous). Once turned on, the device provides verbal instruction to the user describing how to deliver the medication, similar to automated defibrillators. Family members or caregivers should become familiar with all instructions for use before administering to known or suspected persons to have had an opioid overdose. Family members or caregivers should also become familiar with the steps for using Evzio and practice with the trainer device, which is included along with the delivery device, before it is needed.

1,892 American Flags Memorialize Veteran Suicides on National Mall

Using Flags to Focus on Veteran Suicides –

American Flags Memorialize Veteran Suicides

It’s hard to believe that 22 veterans take their own lives every day in the US. Some people probably believe those numbers can’t possibly be accurate.

The world places such stigma on the diagnosis of mental illness that coming up with a solution is not easy. The denial is enormous. Placing close to 2,000 American flags across the National Mall makes it hard to ignore, unless one questions the accuracy of the statistic.

Do the math: 1,892/90=21.02. The flags represent veteran suicides since January 1, 2014. That would be about 22 per day.

The stigma doesn’t lie just with people suffering from depression or other conditions. It prevents medical professionals from choosing to practice psychiatry as a medical specialty because they are stigmatized by their peers for choosing to practice psychiatry.

Why are we so ashamed of revealing emotions? To the extent that we’re willing to turn our cheeks while 22 American veteran’s kill themselves everyday?

Last year Washington made a cash infusion into mental health services in hopes of shoring up the ranks of psychiatric providers. Doing so only seems to have bought a little time, enough to say, ‘OK, we’re doing something to fix the problem’. But a year later we don’t seem to have made any progress.

Nurses are a group that’s poised to fill in the gaps of providers, if the number-crunchers would get to work.  Placing a mental health RN in every primary care practice will help — I guarantee.

I follow hiring trends at the Veterans Administration Medical Center in Western North Carolina and I rarely see mental health jobs posted (the process of getting hired at the Veterans Administration is abysmally outdated and time-consuming, so much so that I’ve heard of courses being offered in How To Get A Job At The Veterans Administration).

Until we can acknowledge the enormous White Elephant in the room that is “mental illness” we aren’t going to make much progress. Next time you are out with your friends look around, see and believe, that 1 in 4 of everyone around you has at one time or another had to seek help for emotional challenges.

I applaud the veterans and their caregivers who took the time to place those 1,892 little American flags on the National Mall in Washington, DC. Progress is rarely made by being silent.






Seth Rogen and Alzheimer’s: Mystery of the Empty Seats

In February 2014 Sen. Tom Harkin held a hearing about Alzheimer’s in America. There’s been an enormous storm of dialogue on social media that resulted from the 6 minute YouTube clip showing Seth Rogen’s testimony. But it wasn’t just his personal story about Alzheimer’s that’s caused such a ruckus. The backlash is about all the empty seats at the hearing. Here’s Seth’s testimony.

Because I was interested in seeing what happened before and after Seth’s testimony, I watched the entire 2.5 hour hearing. The best minds in science fighting Alzheimer’s were there answering questions. Congressman Dennis Moore, who recently resigned because of his own diagnosis of AD, also gave testimony. One would think that his own colleagues would be there in a show of support. But they weren’t. What a diss!

Here is a clip from an investigative story by CNN, soon after the hearing, where Seth Rogen is interviewed and they discuss the empty seats — at the end of this video please note that AD is now the 3rd leading cause of death, not the 6th:

If you’re interested in learning more and want to watch the full hearing, go to this site:

ACA Attempts Mental Health Parity But Where Are The Providers?



A good article by Ben Hartman, MD published in The Gupta Guide about lack of providers in mental health.

Telepsychiatry is discussed here in the article. It’s being used partly because of the lack of clinicians willing to specialize in psychiatry. It’s a Band-aid and ought to stay that way otherwise it will take the place of face-to-face encounters in this challenging field, and that will be a dangerous thing. We don’t want this to become “treatment as usual”.

Primary care providers are continuing to be the mainstay for providing mental health but they lack the training (not required) and the time.

I’ll go back and say again that every PCP office ought to have a mental health RN in place to assist the PCPs. When clients are identified as needing further screening, they simply go to the RN’s office for further triage.

“The Waiting Room” : 24 hours in the ED

This award-winning 2012 documentary (currently available via Netflix streaming) explores the difficulties faced by Americans who lack health insurance or other means to pay for care when they are forced to access the US healthcare system via an emergency department.

Watch the enormous frustration felt by patients, their caregivers and medical team at a public hospital’s emergency department as they go through the ordeal of obtaining and providing treatment for everything from gunshot wounds to strep throat at this public hospital in California.

Anyone that’s worked in healthcare in the US, or been a patient in the system, can identify with the heroes in this film — and they’re all heroes.

“The Waiting Room” tells it like it really is.

Nurses Step Out to Help with ACA Enrollment

Nurses Step Out to Help with ACA Enrollment – NurseZone.

“Nurses play a critical and important role in these efforts,” said Secretary of Health and Human Services Kathleen Sebelius on a recent national conference call with nurses. “You know from your first-hand experience how important health coverage can be.”