Category Archives: Regulation

A Brief History of the Opioid Epidemic

America’s relationship with opioid medications has grown and changed over the past 100 years. Today, the medications are connected to a national public health epidemic.  The statistics are alarming, and getting worse.  Since the situation is complicated, everyone—from providers to patients to politicians—needs to be part of the solution.

Opioids include opium derived drugs (i.e. morphine and heroin) and synthetic drugs (i.e. hydrocodone, oxycodone, and fentanyl.)

A Brief History
Use of opioid medications began before the Civil War.  In 1898, Bayer Pharmaceuticals introduced heroin into the commercial marketplace. Opioid medications (including heroin) were widely available to treat a variety of conditions for the next twenty years.  During the 1920s, doctors recognized the addictive nature of these medications.  Heroin was outlawed in 1924.
For the next 50 years, doctors avoided prescribing opioid medications to minimize the risks of addiction. Popular belief began to change in the 1970s.  A few studies came out that questioned the widespread beliefs about the true addictive risks of opioid medications.  Over the next 30 years, three new opioid medications came out.
Percocet, Vicodin, and OxyContin brought the debate around opioid medications back into the forefront.  During the 1990s, doctors wrote millions of additional prescriptions for opioid medications annually.  Year over year, the total numbers increased throughout the decade.  Although as availability increased, more people became addicted or accidentally overdosed.  Once again, people began to question the safety of these medications.
Today, steps are being taken at local, state, and federal levels to combat the overuse of opioid medications and heroin.  Although illegal, heroin plays a role in the epidemic. Due to increasing restrictions on prescriptions, some patients find it easier to use heroin instead.  The opioid epidemic is a complex problem that needs a comprehensive approach to begin to reverse it.

Current Statistics

  • According to the American Public Health Association, prescription drug abuse has been the top public health concern since 1999.  Since that point, the rate has doubled in 29 states, tripled in 10 states, and quadrupled in 4 states.
  • Someone dies every 19 minutes from an unintentional overdose.
  • Drug overdoses are part of the reason that American life expectancy has declined.
  • In 2015, more than 52,000 people died from drug overdoses.  Two thirds were linked to opioids.
  • Deaths from drug overdoses are still on the rise.

According to the Department of Health and Human Services, 20 billion dollars is spent on emergency department and inpatient care for opioid poisonings.  Health and social costs related to prescription opioid abuse are closer to 55 billion dollars.

Health Crisis. Wikipedia, 17 April 2017, Accessed April 25, 2017.
Lopez, German and Sarah Frostman. How The Opioid Epidemic Became America’s Worst Drug Crisis Ever, in 15 Maps And Charts. Vox. 29 March 2017. Accessed April 25, 2017.
Meldrum, Marcia. The Ongoing Opioid Prescription Epidemic: Historical Context. American Journal of Public Health, 2016 August, Accessed April 25, 2017.
Moghe, Sonia. Opioid History: From ‘Wonder Drug’ To Abuse Epidemic. CNN, 14 October 2016, Accessed April 25, 2017
Opioid. Wikipedia, 2 April 2017, Accessed April 25, 2017.
Opioids: The Prescription Drug & Heroin Overdose Epidemic.  United States Department of Health and Human Services, 24 March 2016, Accessed April 25, 2017
Opioid Overdose. United States Centers for Disease Control and Prevention, 16 December 2016. Accessed April 25, 2017.
The Opioid Epidemic By the Numbers.  United States Department of Health and Human Services, June 2016,  Accessed April 25, 2017
Prevention and Intervention Strategies to Decrease Misuse of Prescription Pain Medication.  American Public Health Association, 3 November 2015, Accessed April 25, 2016.
Understanding the Epidemic. United States Center for Disease Control, 16 December 2016,  Accessed April 25, 2017
Inside a Killer Drug Epidemic: A Look at America’s Opioid Crisis. New York Times, 6 January 2017, Accessed April 16, 2017.
Opioid Epidemic. Wikipedia, 13 April 2017, Accessed April 16, 2017.

5 Questions about the American Healthcare System

Healthcare reform is a contentious issue in American politics.  While a few presidents—Lyndon Johnson, Bill Clinton, and Barack Obama—have signed laws that changed the American healthcare landscape, the system is still imperfect.  With the new Trump administration, the future of healthcare policy remains unclear.  Some of the changes (i.e. Medicare and the Affordable Care Act) may be in jeopardy.Picture-1000words(442x400)

Below are answers to some important questions about the American healthcare system.  In order to play a part in the continuing conversation about healthcare reform, it’s important to understand the current status of the American healthcare system.

Question: What makes the American healthcare system different than other healthcare systems?
Answer: The American healthcare systems offers a lot of choice for potential insurance coverage, private plans, and public plans including Medicare, Medicaid, Veterans benefits, and the Children’s Health Insurance Program.  Despite all of those choices, America is the only wealthy country without universal coverage.   Additionally, the American healthcare system has higher usage of expensive medical technologies—like MRI machines.

Question: Where does the American healthcare system rank on the list of world healthcare systems?
Answer: The World Health Organization’s 2000 report ranks the American healthcare system as 37th in the world—behind every other wealthy country.

Question: How much does the United States spend on healthcare every year?
Answer: In 2013, the United States spent approximately $9,000 per resident (or 17.1% of the gross domestic product) on healthcare costs.  France spent the second highest amount of money on healthcare, approximately $4,300 per resident and 11.6% of its GDP.  With the lowest healthcare spending levels, the United Kingdom spent 8.8% of its GDP or approximately $3,300 per resident.

Question:  Doesn’t higher spending means that Americans get better healthcare?
Answer:  Not necessarily.  The American healthcare systems provides quality care that is similar to the care provided by other wealthy countries.

Question: If the care is comparable, what are the higher costs for?
Answer:  There isn’t one answer to this question.  There are a range of contributing factors including: widespread use of expensive medical technology, the fee for service model, and higher volumes of patients.

Healthcare policy continues to be a contentious issue in American politics.  Citizens, experts, and politicians have spent decades debating what changes will reform the system.  Yet this is not simply an issue for the politicians.  Stay informed about the discussion surrounding healthcare reform.  These changes will eventually impact the lives (and futures) of many Americans.

Baribault, Maryann and Casey Cloyd. Health Care Systems: Three International Comparisons. EDGE: Ethics of Development in a Global Environment, 26 July 1999, Accessed January 22, 2017.
Comparing International Health Care Systems. PBS News Hour, 26 October 2009, Accessed January 22, 2017.
Murray, Christoper J.L., D Phil, and Julio Frank. Ranking 37th—Measuring the Performance of the U.S, Health Care System. The New England Journal of Medicine, 14 January 2010, Accessed January 22, 2017.
The U.S. Health Care System: An International Perspective. Fact Sheet 2016. DPE. Department for Professional Employees. AFL-CIO,, Accessed January 22, 2017.
U.S. Health Care from a Global Perspective: Spending, Use of Services, Prices, and Health in 13 Countries.  The Commonwealth Fund, Accessed January 22, 2017.
World Health Organization’s Ranking of the World’s Health Systems. The Patient Factor: Your Voice in the Health Care Equation, Accessed January 22, 2017.

4 Important Provisions of the Affordable Care Act

The 2010 passage of the Affordable Care Act changed the landscape of American healthcare. On a large scale, it addressed longstanding systemic concerns while also attempting to bring down costs.  Nearly everyone has an opinion on the bill, yet few people really understand some of the significant changes that it ushered in.  Since 2010, much of the media coverage of the bill and the associated outcry has been reduced to 140 character summaries and soundbites.  Before forming an opinion, take time to learn about some of the things the bill did.

Young Adult Coverage: Before the Affordable Care Act, health insurance companies could remove enrolled children when they turned 19.  Some insurance plans allowed for enrolled children to stay on the insurance plan while they were enrolled as a full time student.  Under the Affordable Care Act, children can remain on a parent’s insurance plan until they turn 26.

Pre-existing Conditions: Prior to the Affordable Care Act, health insurers could deny (or charge more for) coverage because of a pre-existing condition.  Often this meant that people with chronic health conditions, like cancer, had significant trouble getting new health insurance coverage.  Some insurers even classified pregnancy as a pre-existing medical condition and would refuse to pay for related care.  Under the Affordable Care Act, health insurers can no longer charge more for or deny coverage for pre-existing health conditions.

Annual and Lifetime Limits: Health insurance plans used to be able to set annual and lifetime limits for coverage as long as someone was enrolled in the plan.  If a participant exceeded the limit, they would be responsible for all charges.  Under the Affordable Care Act, health insurance plans can no longer place limits on medically necessary care.  Limits on “non-essential” health benefits are still allowed.

Plain Language Benefits Information: Details about health insurance plans used to be hidden behind small fonts and legal language.  For many people, it was tough to understand and even tougher to compare plans side-by-side. The Affordable Care Act requires that health insurers provide participants with an easy-to-understand summary.  This mandatory standardization now allows people to easily compare the benefits and costs of medical plans.

Without realizing it, all Americans already know someone who has benefited from these four changes made by the Affordable Care Act.  Teenagers can now keep health insurance until age 26.  People with chronic conditions no longer fear being denied health insurance—or the associated extra costs of medically necessary treatment that isn’t covered.  Annual and lifetime limits are gone.  Insurances now explain their benefits and costs in an easily understandable format.  The Affordable Care Act has changed the American healthcare system in ways that have already benefited all Americans, regardless of political opinion.

U.S. Department of Health and Human Services. “Lifetime & Annual Limits.” December 5, 2014. (
U.S. Department of Health and Human Services. “Plain Language Benefits Information.” September 8, 2014. (
U.S. Department of Health and Human Services. “Pre-Existing Conditions.” November 18, 2014. (
U.S. Department of Health and Human Services. “Young Adult Coverage.” March 12, 2013 (

Health Insurance 101: Introduction to Healthcare Insurance

By Emily Manahan

It’s important for all people who work in healthcare to be familiar with the different types of health insurance.  Even if your position doesn’t routinely deal with it, all staff—particularly those in clinical settings—will encounter health care questions, concerns, and challenges.  To build your knowledge, use this list of common health insurance categories.

Types of Insurance Plans

Health Maintenance Organization (HMO)  Patients with these types of insurance plans have to see their primary care doctor to get a referral.  Unlike their PPO counterparts, these people would not be able to go straight to see a specialist.  Instead, they would have to be examined by their PCP first.  Then they could be referred, if deemed appropriate.

Medicare is a federal insurance program that covers people 65 years and older.  It also covers people with specific disabilities.

Medicaid offers insurance to people who meet certain income requirements.  Medicaid programs are jointly operated by the state and federal governments.

Motor Vehicle Claims are selected as insurances for patients who have been injured in a motor vehicle accident.  Typically the clinic will require written or verbal confirmation that the particular claim is still open and billable.

Preferred Provider Organizations (PPO).  Patients with these type of plans usually have more flexibility.   Unless required by a particular office, this patient can typically go to any provider in their preferred insurance network without a referral.

Self pay patients pay the entire cost of their medical care out of pocket.

Veterans Administration and Tricare are health insurance plans offered to active and retired military and their families.  If a patient is seeking care outside of the VA system, their health insurance plan will often require a written authorization.  Different requirements vary.

Worker’s Compensation comes in a variety of forms including private, state, or federal claims.  These plans cover patients who had a job related injury or accident.
Within these eight categories of health insurance, there are many different plans.  Each individual plan has different requirements.  If patients have specific questions about their type of health insurance, please encourage them to call their company directly.

Blue Cross. Blue Shield. Blue Care Network of Michigan “What’s the Difference between HMO, PPO, and EPO Plans? “Medicaid
Social Security Administration. “Medicare” October 2015
US Department of Veterans Affairs. “I am an Active Duty Servicemember.”  November 10, 2014. (

An Introduction to the Health Insurance Portability and Accountability Act

HIPAA – The Basics

Most people are already aware of HIPAA because of the annual privacy consent forms. HIPAA changed more than privacy consent forms. In the twenty years since it was signed, the Healthcare Health Insurance Portability and Accountability Act has changed how healthcare organizations operate. Here’s what you need to know.

Was It Always Called HIPAA?
No. The bill was originally named the Kennedy-Kassebaum bill after its two authors, Senator Edward Kennedy of Massachussets and Senator Nancy Kassebaum of Kansas. It is now known as the Healthcare Insurance Portability and Accountability Act, or HIPAA for short.

When Was It Passed?
President Bill Clinton signed this bill in 1996. Major provisions of the bill were implemented between 1999 and 2006.

Why Was It Written?
In the mid-1990s, it became clear that the healthcare industry needed to modernize and standardize how they kept records. The authors also included provisions to make it easier for employees to keep health insurance after leaving a job. The original intent of the bill was to address these concerns.

What Did People Think?
Three years earlier, a comprehensive healthcare reform bill failed.
When this bill passed, opinions were split. Although it wasn’t exactly what they wanted, proponents felt that this bill was still a win. Opponents were skeptical of the need for the bill. Many felt like it set new standards for the healthcare industry that were too high.

How Many Components Are There?
There were four sets of rules included in the original HIPAA regulations: The Privacy Rule; The Transaction and Code Sets Rule; The Security Rule and The National Provider Identifier, or Unique Identifiers, Rule; and the Enforcement Rule.

What Did That Mean For Healthcare Organizations?
Here are some of the major structural changes that healthcare organizations had to make to comply with HIPAA. Please note that this simply an overview and not a complete list.
An organization must have a trained HIPAA Compliance Officer who is aware of all regulations and ensures that the company is following all HIPAA requirements.
Organizations must teach and train employees about HIPAA and the pertinent policies. Usually, organizations make an annual commitment to training their staff.
Organizations must safeguard patient health information against unauthorized access and disclosure. If there is a security breach, organizations are required to report the incident and inform the patients who may have been affected.

The Healthcare Insurance Portability and Accountability Act of 1996 massively changed the healthcare industry and will always be remembered as a turning point. It will be exciting to see what changes the future has in store for healthcare.

• Department of Health and Human Services. Centers for Medicare and Medicaid Services, “HIPAA Basics for Providers: Privacy, Security, and Breach Notification Rules.” May 2015 (
• Indian Health Service: The Federal Health Program for American Indians and Alaskan Natives, “Healthcare Insurance Portability and Accountability Act.” (
• Paul Starr, “The Signing of the Kennedy-Kassebaum Bill,” August 22, 1996 (
•, “Congressional Concealer. Rumor: HIPAA Laws started because a senator wanted to cover up his wife’s plastic surgery.’” April 3, 2015. (
• “History and Background of HIPAA.” (

June 3rd Weekly Healthcare News Roundup

OPEN ACT Could Encourage Pharmaceutical Innovation at Reduced R&D Costs

Drs. Klane White and David Fajgenbaum wrote in the opinion section of The Seattle Times that “There are 30 million Americans affected by 7,000 rare diseases, and, of those, only 5 percent have Food and Drug Administration-approved therapies.” The article calls for congress to pass the OPEN ACT, encouraging pharmaceutical companies to study the benefits of modifying existing drugs to be used for rare medical conditions.

Tacoma Hospital Alliance Seeks Additional Funds for Psychiatric Facility

MultiCare Health System and CHI Franciscan Health are planning a new psychiatric hospital in Tacoma. The $41 million project would create a 120-bed hospital in Pierce County, and the Alliance for South Sound Health is seeking funding from the Tacoma City Council and Pierce County to help with construction costs. The hospitals have requested $1.5 million from both municipal governments, and they’ve been pledged an additional $400,000 from the city of Auburn.

American Death Rate Has Increased for the First Time in a Decade

According to preliminary numbers from the National Center for Health Statistics, the death rate in the United States has increased for the first time since 2005. Some causes of death which have increased include Alzheimer’s disease, stroke, suicides, drug overdoses, accidents, and firearm deaths. The rate of death in 2014 was 723.2 deaths per 100,000 people, and it increased to 729.5 in 2015.

Olympic Medical Center Hires New Medical Oncologist

The Olympic Medical Center has found a replacement for their outgoing medical oncologist, Dr. Tom Kummet, MD. Dr. Rachna Anand, DO, who trained in oncology at Hahnemann University Hospital in Philadelphia, will take up the mantel. In addition to Dr. Anand, Olympic Medical Center has expanded their medical oncology department by bringing on nurse practitioner Tamara Montgomery, MSN, NPC-C, OCN.

National Physician Shortage Projected

On April 5th 2016, IHS Inc. released a  2016 update to their report on behalf of the Association of American Medical Colleges about the projected supply and demand for physicians in American from 2014 – 2025.1


The updated report comes in at around 40 pages, and contains projections for many different scenarios that have an effect on demand for physicians services such as demographic changes like the aging of the baby boomer generation, or the ability of non-physician healthcare providers like ARNPs to provide services presently offered by physicians. The report also discusses the supply of physician services, which is impacted by the number of physicians retiring in the next decade and the number of physicians graduating from medical school who are expected to enter the workforce. The report is very detailed, and it is worth a read to anyone who faces the difficult task of recruiting physicians over the coming decades.

 Empty Waiting Room

The key findings of the report are:


1. Even under the “brightest” of assumptions, there will be a physician shortfall in 2025, it’s just a matter of how large that shortfall is. The report projects there will be between 61K-94K fewer physicians than needed by 2025. For comparison, the US had about 1 million physicians in 2012.2


2. There will be a shortfall in both primary care physicians and non-primary care physicians by 2025.


3. The largest impact on supply will be the retirement of currently practicing physicians. Just as the aging of the baby boomers will have a drastic effect of the age diagram of the American population over the coming decade, many physicians are members of the baby boom generation, so we will see a similar demographic trends. Today 11% of the physician workforce is age 65-75. That fraction will increase to one-third by 2025. The exact percentage that will retire as they age is unknown, but the aggregate effect will push down the total supply of physicians.


4. The aging of the American population will be the primary cause of increased demand for physician services. The population under 18 is expected to grow by 5% and the population over 65 will grow by 41% – a factor of 8X.


5. The expansion of coverage under the Affordable Care Act (ACA) will push up demand for physicians. Depending on how many states expand medicaid, the ACA could contribute to the shortfall by 10,000 to 17,000 physicians.

What does this all mean for physician jobs in Washington state?


It’s good news for physicians. The shortfall should push up wages for physicians as employers compete to hire the best talent. This is also good news for non-physician providers who may be able to perform services once restricted to physicians as states change their regulations in order to help address this shortfall. The labor market for physicians is national and many physicians practicing in Washington state attended medical school in other states. Fortunately the opening of Washington State University’s medical school in Spokane and its inaugural class in 2017 will lead to a direct increase in the supply of physicians coming out eastern Washington. Whether or not those new WSU medical graduates will remain in Washington for their residency is difficult to know.


All signs indicate that physician recruiters will have an increasingly challenging task ahead in the coming decade. While the exact magnitude of the shortfall is unknown, its impending presence is rather certain according to this report. Employers will need to continue to innovate and improve their recruiting practices to stay competitive with the hospital down the road.

Replace ObamaCare With BernieCare?


Bernie Sanders makes a strong case that healthcare should be a right.

Eliminating health insurance companies sounds good to me. The expense for our Obamacare ‘affordable healthcare’ insurance plan for my small company with older employees was very high, and that was WITH a $7,000 per year per person deductible – aka, a ‘catastrophic’ plan. Can’t live with it. Can’t live without it.

We all know people who are working for their insurance. Or looking for a job that provides insurance. Imagine the freedom to choose a cup-filling job, or simply leave a lousy employer, rather than staying based on your insurance.

So what would that mean to our hospitals and clinics? Many (most?) are already using Medicare rates as the plumb line for managing their expenses. Many private providers refuse to process insurance forms, offering discounted fees in their place. Can you imagine the impact eliminating insurance processing?! That alone could make #BernieCare a net gain for hospitals.   

As for all the laid-off employees? Let’s offer training for a career in healthcare! I hear it’s a growing field with a decreasing supply and increasing demand.   

What do you think? If Obamacare is the Galactic Empire, is BernieCare the Resistance, or the First Order?


Mental Health: The Next ‘Inconvenient Truth’


Could be a friend, relative, or another shooting. Might be hereditary, or from disease, substance abuse, head trauma, PTSD, or some other cause. Regardless of the who and the why, mental health care can no longer be pushed aside. [It reminds me of the debates around the impact of second hand smoke and dental health.]

The financial impact is huge, requiring both new facilities and staffing, so the need to legislate mental health treatment is not a surprise. The #Affordable Care Act was instrumental in legislating insurance coverage. State laws are inconsistent, but most have three forms of court-ordered treatment: (CLICK HERE for state specific info):

    1. Emergency hospitalization for evaluation (aka “psychiatric hold” or “pick-up”)
    2. Civil commitment – inpatient
    3. Civil commitment – outpatient

#Healthcare employment is already stretched thin from decreasing supply (retiring professionals) and increasing demand (aging population). Adding Mental Health positions will exacerbate the problem as employers seek #Registered Nurses, psychologists and clinicians specializing in psychiatric, mental health, behavioral health, chemical dependency, and addiction, as well as counselors, social workers, chaplains and parish nurses. Proving once again that healthcare is #1 for people seeking a long term career with growth opportunities and variety.

To learn more, check out these national professional associations (and Washington State chapters):

To see current job openings in Washington state:


ACA: 2015 Trends and 2016 Questions


ACA Trends (positive):

  1. In just two years the percent of uninsured adults fell from 18% (2013) to 11.9% (Apr, 2015 Gallup Poll)
  2. Medicare patient readmissions fell 8% between Jan, 2012 and Dec, 2013
  3. Many say these trends validate the ACA’s worth

ACA Trends (negative):

  1. 25% of U.S. employers offer only high-deducible health plans to employees, double the number from 2012 (2015 PricewaterhouseCoopers survey)
  2. It’s getting more difficult to sign up the remaining uninsured who tend to be young, without funds for insurance, and unaware they can qualify for subsidies (per HHS, 2015)
  3. Only a slight overall increase in enrollment is expected in the 2016 open enrollment (Obama administration, Oct, 2015)
  4. 2016 will see big cost increases for uninsured individuals, employers and insurers.
  5. 45 states and Washington D.C. are requesting premium increases insurers in for 2016 (federal government, Jun, 2015). Many increases exceed 20%, with some topping more than 50% (Washington Examiner).
  6. “If enrollment plateaus, we may see a growing discussion of whether the law is fulfilling expectations in covering the uninsured and whether subsidies for low-and-middle-income people are sufficient to make coverage truly affordable.” (Kaiser Family Foundation)
  7. Many say these trends validate the ACA’s failure

Presidential Election:

  1. There seems to be plenty of reasons to support or vilify the ACA in 2016.
  2. What’s the fulcrum for the election? ISIS? Immigration? Wall Street? ACA?
  3. Is the ACA so entrenched that it can never be repealed?

ACA Won’t Help or Harm Our Healthcare Employment Problems:

  1. Scarcity of healthcare professionals will continue, as will the aging population
  2. What do you envision? Telemedicine? More PAs and NPs? More ADNs and LPNs? Return to Masters level #PTs?
  3. One thing’s for sure: Healthcare is and will continue to be an excellent profession!