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.

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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.

How To Respond To 2 Common Patient Fears

While it may not be visible, nervous patients walk into healthcare organizations every day.  Although each patient is unique, most share two common fears. First, they fear that they won’t be listened to.  Second, they fear that their care will be too expensive.  Here are some ideas about how to respond to these two widespread patient fears.   Community Health Doctor
No one will listen to me
There are two popular views of doctors.  Some patients consider doctors as trusted partners in their medical care.  Others feel like the doctors will judge them.  Regardless of a person’s specific beliefs, patients and providers can work collaboratively to ensure that the appointment goes smoothly.
Steps For Patients: Prior to the appointment, write down your concerns.  Practice explaining these concerns in the simplest way possible. When patients complete these steps, they often feel more confident—and prepared—during the appointment.
Steps For Providers: During the appointment, remember that everyone communicates differently. Ask questions and listen to answers. Summarize what the patient said, and repeat it back to them.  When possible, allow the patient to finish answering before asking another question.
I won’t be able to afford it
High medical bills are a barrier to care for many people.  Finances impact each patient differently, and clinics should have a variety of resources to help.
Steps For Patients:  If possible, enroll in health insurance.  Once enrolled, read plan documents carefully.  Learn what your insurance policy includes and excludes.  Note any additional requirements (like prior authorization) to ensure coverage. Often, patients with active health insurance have an easier time establishing care with providers.
If unable to enroll in health insurance, you should begin researching.  Ask your providers if they offer financial assistance programs or discounts for cash payments.  If the clinic does not offer it, consider calling other local healthcare organizations to ask the same question.  Healthcare social workers also may be able to connect you with community resources to further assist you.
Steps For Providers:  Clinics should always be transparent about their financial policies and resources.  Offer copies of these policies to patients.  Train staff to explain the organizational billing system in an understandable manner. Implement tools that estimate the costs of office visits or medical procedures.  When possible, offer alternatives to the recommended treatment plan—particularly when there are concerns about if the patient’s insurance will cover it.

8 Simple Ways To Recognize Your Employees

Employee recognition programs are designed to make it easier for managers to acknowledge staff successes. By praising accomplishments, these programs aim to retain employees. When someone leaves a job, it costs the business between 16-200% of the employee’s salary to fill the vacancy.  These replacement costs are tied to the employee’s salary, which means that the highest earners are harder to replace.  Since recognition is a helpful way to minimize turnover, here are some ideas to help managers recognize their employees.

  1. Ask new employees how they prefer to be recognized and what they like to do outside of work. Record this information in their employee file.When it is time to recognize this employee, choose a method that’s consistent with what they originally told you.Other options—while appreciated—may be less impactful.
  2. Verbal recognition:  Simply saying thank you is a great start.  Then take the time to specifically describe the positive impact of their work.
  3. Verbal recognition with an audience:  If an employee’s actions positively impacted the larger organization, announce their success at a meeting.
  4. Written recognition:  Writing a card or email to an employee gives them the opportunity to revisit the kind words later.
  5. Gift:  There are a lot of possibilities here.  Some managers have gift cards and movie tickets.  Other organizations offer branded items (like reusable shopping bags and water bottles) for managers to give away for recognition reasons. If recognition items are not provided by an employee recognition program, there may be room in the budget to purchase items to have on hand.
  6. Time off: People love getting extra time off, whether it’s the day or simply the afternoon.
  7. Free meal:  Everyone loves a free meal.  Before offering this option, determine the employee has any dietary restrictions.  Pick an appropriate place and take your employee to lunch.
  8. Meetings with executive level managers: This option can only be offered if the organization’s highest leaders are dedicated to spending time with employees.  Since this is not true for many leaders, it is important to determine this prior to offering to an employee.

Recognition programs were created to foster an appreciative workplace that celebrates successes.  After all, retaining employees is easier than replacing them.  There are countless ways to recognize employees.  Use these 8 ideas as inspiration.  Take what works, and feel free to leave disregard the rest.

Merhar, Christina.  Employee Retention: The Real Cost of Losing An Employee. Zane Benefits, 2016 February 4, Accessed March 25, 2017.
Recognizing And Rewarding Your Staff. Harvard University Faculty of Arts & Sciences Human Resources Department, Accessed March 25, 2017.

Should My Clinic Have A Social Media Account?

In today’s world, it seems that everyone is on social media.  The potential audience is gigantic, and many organizations consider joining social media as a way to expand their reach.  Unfortunately, many do not realize that simply creating an account isn’t enough.
Instead, social media requires commitment. People are more likely to “follow” pages that have consistent posts with helpful information.  In your organization, someone will need to regularly manage and post to the account.  If the organization’s social media page looks incomplete or abandoned, visitors will move on.  Before committing to a clinic social media account, take time to identify the desired goals are.

How do your current patients find information?

Ultimately, you want to be active in spots where your patients are.  If your target patient population does not use social media to find their information, it may not be the right primary channel to invest in.  Instead, social media efforts could come secondary to other marketing efforts.

Who will follow your social media account?

Answer this question with as many specific as possible.  Healthcare organizations usually target their social media content either to patients or caregivers. It’s possible to have a successful social media account that targets patients or caregivers.  An internal medicine clinic may target patients directly.  A geriatric medicine clinic may target its social media content to appeal to the patient’s family, instead of directly to the patient.

How will this account benefit your practice?

Connecting with current and potential patients should always be the primary goal of clinic outreach efforts.  Social media could be the best channel to help accomplish that. Write down your specific goals for social media.  Are these realistic?  Do these make sense? Before creating an account, you should ensure that your organization is comfortable with the potential return on investment.

How will this account benefit your (potential and current) patients?

When done strategically, social media accounts have incredible power to connect and share information.  Describe what information your organization would share on its social media account.  Write down a list of subjects that you’d cover.  List how frequently your organization would post.

For people, businesses, and healthcare organizations, social media is a powerful tool that hold the promise of expanded reach and influence among target audiences.  Yet social media accounts take time and energy to maintain.  If you’re struggling to answer the questions listed above, it may be a sign to postpone creating an account.

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 Reasons Why You Should Share Financial Goals with Staff

There are two sides to the American healthcare system: financial and patient care. While most staff recognize the existence of both, few are aware of their organizations financial goals.  In almost all offices, there are at least two people—the clinic manager and the medical director—who know the organization’s patient-care and financial goals. Smart healthcare leaders share financial information with their clinic staff.  Failing to share this information is a mistake.FL83630

After all, it’s difficult to expect a clinic team to collectively work to accomplish goals when they aren’t aware of them.  Here are responses to some common objections to sharing financial goals with clinic staff.

Objection: What are financial goals?

Response:  Financial goals are the targets that your clinic is reaching toward. Is it a decrease in the no show rate?  Is it an increase in payments from providers?  The specifics vary between organizations.  Summarizing information on financial goals should be easy.  If it cannot be described in a few sentences, continue simplifying until it can.

Objection:  My staff don’t need to know about the organization’s financial goals.

Response:  Many medical directors assume that their staff are uninterested in the larger goals of the organization. That’s not true. Since staff receive paychecks, they already have a vested interest in the financial success of the organization.

Objection:  It doesn’t benefit the organization to share the financial goals.

Response: When managers don’t share information on goals, they actively prevent their staff from assisting.  Since goals cannot always be easily achieved, smart managers recruit their staff to help reach them. Staff suggestions won’t always work.  Frequently, a staff member offers a solution that the managers hadn’t considered.

Objection:  Our first priority is patient care.

Response: Perfect.  Healthcare organizations should focus on providing high-quality patient care first.  The two goals are not mutually exclusive.  Staff can provide high-quality patient care and also be aware of the financial goals of the organization.

Finances and patient care make up the two sides to the American healthcare system. One cannot exist without the other.  Staff realize this, yet many managers still fail to share financial goal information with staff.  Reaching goals takes concentrated effort.  Smart healthcare leaders will share this information with staff to ensure that there is as much brainpower as possible working to achieve goals. Managers who fail to share the information intentionally limit their chances of success.

Nurses Needed In These 5 Health Care Settings


Employment for these nursing roles is projected to grow much faster than average until the mid-2020s. In addition to inpatient roles, nurses can work in outpatient clinics, schools, community health centers, nursing homes, home health options, palliative care, and correctional centers.

Outpatient clinics allow nurses to work deeply in a specific specialty.  Nurses who already have (or who want to build) in-depth knowledge about medical specialty will be attracted to these roles.

Schools also need nurses to care for ill students. Job requirements will vary.  Some school nurses work full time; some work part time.  They may work in one location or rotate between neighboring schools.  In these environments, nurses will typically work with pediatric or adolescent patients.

Nursing homes offer the opportunity to work with patients who need varying levels of care.  Some patients may be long-term residents who need assistance with all of their activities of daily living.  Others may be short-term residents who are recovering from an injury or illness.  Since many patients are elderly, nurses interested in geriatric care may gravitate toward these roles.

Home health nurses travel to patient’s homes to assist them on a temporary or permanent basis. Some patients may need short-term care while recovering from an injury or acute illness.  Others may need ongoing care to help with chronic conditions or disabilities.  Since they visit patient’s homes, palliative care nurses are also considered home health nurses.

Correctional center nurses are responsible for intake screenings and medical care for inmates.  Within correctional centers, nurses see patients who have acute and chronic medical conditions.  Due to the close proximity of inmates, outbreaks of disease are common.  On a daily basis, nurses may also be responsible for administering medications as needed.  Care coordination between providers is another part of the nursing role, particularly when someone is being released.

Nurses fill a range of roles in any setting.  Inpatient nurses help patients who are currently admitted to the hospital.  Outpatient nurses get to work in-depth within a particular medical specialty.  School nurses typically work with pediatric populations in one or more locations.  Nursing home nurses care for patients who need varying levels of assistance.  Home health nurses visit patients in their homes on a temporary or ongoing basis.  Correctional center nurses care for incarcerated patients and help coordinate their care. Each setting offers a different set of challenges for nurses to conquer as they care for specific patient populations.

Correctional Facility Nursing. Minority Nurse, 7 February 2016, Accessed January 31, 2017.
Giang, Vivian. Jailhouse Doctor Shares What It’s Like To Care For The Most Dangerous People In the World. Business Insider, 20 March 2013, Accessed January 31, 2017.
Registered Nurses. United States Department of Labor. Bureau of Labor Statistics. Occupational Outlook Handbook, 17 December 2015, Accessed January 31, 2017.

What Sets Correctional Medicine Apart?

Staff working in correctional medicine provide health care to almost 2 million Americans who are currently incarcerated in jails, prisons, and detention centers. There are differences between correctional and traditional medicine environments.

Different Environment
Correctional medicine has rules to protect the safety and privacy. For example, staff need to routinely assess what items they leave out in an unattended exam room. As a safety precaution, certain items should never be left unattended. There may also be restrictions on items (like cell phones) that can be brought into the care environment. On a broader scale, staff may be asked to limit their sharing personal experiences with patients. These restrictions are meant to help maintain a safe health care environment. Despite the restrictions, workers in correctional medicine benefit from its unique environment.

Staff in traditional health care settings spend a chunk of time worrying about health insurances, contracts, and billing. Different doctors accept separate insurances. Some patients who lack (or have undesirable) insurances are barred from seeking care at certain offices. In correctional medicine, staff do not worry about billing or insurances. Instead, providers in correctional medicine are bound to provide medically necessary care to their entire patient population.

Better Follow-Up Care and Routine Screenings
In traditional health care environments, patients go home. In correctional medicine environments, patients do not leave. The patients are always nearby, which simplifies follow up care. Additionally, many correctional medical facilities have higher percentages of compliance with recommended screenings than their traditional medicine counterparts. Again, this is because the patient population is always nearby.

Treating Chronic and Acute Conditions
Similar to the larger population, patients have chronic medical conditions that need care. While some medications can be given to the patient. Guards or correctional medicine staff need to distribute other prescriptions. Due to the close living quarters, acute infections (if not caught quickly) can spread throughout the entire population. If an infection spreads, providers often work with epidemiologists to determine cause and next steps. Due to changing needs, most correctional medicine providers are generalists who can quickly respond to a patient’s needs.

Partnership with Other Staff
Security guards help maintain a safe environment. Sometimes guards provide extra support when a provider needs help with an escalated patient. Often, security guards recognize and report unusual appearance or behavior to correctional medicine providers. This early recognition helps providers to begin early treatment—if necessary.


Correctional medicine has different restrictions and freedoms than traditional health care environments. While the work is challenging, it is worth considering for those health care staff who want the opportunity to stop worrying about insurance and treat their patients.

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Correctional medicine. Wikipedia, 2 June 2016, Accessed February 7, 2017.
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Keller, Jeffrey. Correctional Medicine is Different: Our Patients Don’t Go Home!, Accessed February 7, 2017.
Keller, Jeffrey. Correctional Medicine: The Principles of Fairness., Accessed February 7, 2017.
Keller, Jeffrey. Correctional Medicine is Different: All Clinical Encounters are Discussed in the Dorm., Accessed February 7, 2017.
Keller, Jeffrey. Correctional Medicine is Different: We Can’t Fire Our Patients-and They Can’t Fire Us!, Accessed February 7, 2017.

Healthcare Systems Around the World

There are no easy answers in the debate about reforming the American health care system.  Any proposed solution needs provide better patient care and affordability than the current system does.  With a population of 324 million, finding these solutions is difficult.  Over the years, health care reform has come in different pieces of legislation. For President Johnson, it was the creation of the Medicare and Medicaid programs. Under President Clinton’s administration, HIPAA strengthened protections for patients.  In 2010, President Obama signed the Affordable Care Act that took steps to curb rising costs while expanding coverage to twenty million people.  With a new presidential administration, the debate about the future of the American healthcare system continues.  Given that, it is important for all Americans to understand different options for health care delivery systems.

American Health Care System—or the Fee-For-Service Model  

All health care services have fees associated with them.  When possible, those fees are first charged to the patient’s health insurance company.  After the insurance company processes and pays their part of the claim, the patient is responsible for the remaining balance.  If a patient lacks insurance, the entire bill goes to the patient. Every year, almost 2 million people declare bankruptcy due to medical costs.

The American government provides a variety of different insurance systems that provide different coverage levels to distinct groups of people, ranging from veterans to the elderly to children.  Yet, people are still stunned that the United States is the only wealthy country that doesn’t provide universal health coverage.

A National Health Service

In the United Kingdom, the government provides health care like all other public services (i.e. emergency responders and trash collection.)  Taxes pay for the government to operate medical facilities and pay doctors. Privately owned clinics and independent medical providers are allowed, but face restrictions.

National Health Insurance Plans—also called Single Payer System

In Canada, patients seek care from private sector doctors.  Their bills are paid by a government fund that everyone pays into.  Single payer systems have a strong negotiating position, and often pay lower prices for pharmaceuticals and services.

Since any solution needs to work better than the current system, debates about the American health care system will continue long into the future.  As Americans, it is important to remain educated about the options available.  Each health care delivery system faces a unique combination of strengths and weaknesses.  Ultimately, it will be up to the American people to decide how to shape the system as we move into the future.

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How To Quickly Capture Health Insurance Changes

Jobs change; marriages happen; children are born; open enrollment starts. Throughout the year, a patient’s health insurance coverage can change via these four options or many more. Although most organizations focus on updating insurance information each January, it’s important to do it year round. Capturing accurate insurance information ensures smooth clinical operations and medical billing. Use these five resources to prioritize catching health insurance changes as they happen.

Image by Wellness Corporate Solutions ( line staff: Staff the front desk with smart, well-trained healthcare administrative employees.  Since they frequently talk with patients, these staff members play a vital role in capturing a patient’s insurance. Instruct these staff to ask the patient to confirm their insurance when scheduling appointments and at check-in.  Train these staff members on how to properly update a patient’s insurance, either in the patient’s file or in the electronic medical record.  Also teach these staff members how to use resources to

The patient: Most patients come to the doctor’s office prepared.  They should be able to tell you which insurance they have, and what their identification numbers are.  If they are unable to provide proof of active insurance (i.e. a health insurance card), front line staff should be aware of the preferred course of action.  For example, some organizations will allow the patient to check in with the promise that the patient will update it later.  Other organizations will instruct staff not to check in the patient without proof of insurance.

The patient’s insurance card: Although they like to change things all of the time, there is one thing that healthcare organizations can count on.  And that is the fact that a patient’s health insurance card will be a treasure trove of information.  Typically, this is where you can find information about a patient’s member and group identification numbers as well as the billing address to send the bills to the insurance company for processing.

An updated list of health insurance changes:  Create a list (or another tool) that captures the insurances that an organization is contracted with and the ones that the organization is not contracted with. This tool should be available to all staff members who update or work with a patient’s insurance.  Since changes frequently happen, regular updates to this tool are required.

Access to an eligibility portal: Investigate if there are online eligibility portals that staff can use to confirm eligibility or referral authorization.  These are time saving tools, because it minimizes the number of times that staff have to call a patient’s insurance.

Regardless of size, it is important for all organizations to quickly capture any insurance changes for a patient.  After reading the list, take a moment to consider what is working well and what could be better.  Adjust as needed.