NPI – The aftermath

The NPI deadline has come and gone. Whats the verdict?
Well, the insurance companies seemed to have their shit together (for once). I expected the same shit as when Medicrap part D hit the fan but only encountered minor bugs and glitches.
Doctors however need to get their heads out of their asses. Either that, or inform their front staff what the hell an NPI number is.
You have no idea how many times I heard “All the pharmacies are calling me for this NPI number! I don’t know what it is, and I don’t have it!” from doctors offices. Yeah honey, I realize your high school education didn’t prepare you for “real life”, but when everyone and their brother are calling you for something, don’t you think you should ASK someone else in the office so you don’t sound like a total ditz on the phone? Oh, I’m sorry, I didn’t realize you’re the doctors daughter, now you really have no excuse.
Also, if you are in hospital administration, and I’m calling you asking for a list of all the doctors in the hospital and their NPI numbers, don’t give me some bullshit excuse on why you cant fax me the list. Unlike you, I don’t like to sit on the phone (among my other pharmacy breatheren) and waste time calling your fat lazy ass 10 times a day for something on a list that would take you 2 seconds to fax to me. Seriously, its not a HIPAA violation to send me the list. You’re a friggin idiot for even thinking so. So I’m going to call you, 20 times a day, and every time I’m going to YELL at you for not sending me the list.
However many hospitals were on the ball, and immediately said “Whats your fax/email, i’ll send you the whole list”. To them, I (and the rest of the pharmacies in town) are grateful.
The best nut-kicker of this whole ordeal, is that to bill for Medicare part B stuff (and State Medicaide) we do NOT use the NPI numbers. Thats right folks, the feds make us switch to this new number, but they themselves dont use it. Why am I not surprised.
Oh, and have any of you seen how to calculate the checksum digit for the NPI number (to see if its valid). My small pharmacist brain cant handle that much mathmagic voodoo. Go look it up. Why cant it be as easy as the DEA checksum?

Avandia – Oh why are people so stupid.

**WARNING! Avandia and other prescriptions are hazardous to your health, and only should be prescribed and dispensed under the supervision of people who went to a collective of 15+ years of college and who KNOWS what the hell they are doing. This is because Rx drugs are DANGEROUS and require KNOWLEDGE to use effectively****
Duh right? Obviously not.
So Avandia is being tied to causing MI’s and related deaths in their patients. Lets look at some facts shall we. I bet the media isnt picking up on these:

  • Look who funded this “Study” (from http://content.nejm.org/cgi/content/full/NEJMoa072761) Dr. Nissen reports receiving research support to perform clinical trials through the Cleveland Clinic Cardiovascular Coordinating Center from Pfizer, AstraZeneca, Daiichi Sankyo, Roche, Takeda, Sanofi-Aventis, and Eli Lilly. Dr. Nissen consults for many pharmaceutical companies but requires them to donate all honoraria or consulting fees directly to charity so that he receives neither income nor a tax deduction. No other potential conflict of interest relevant to this article was reported.
    Yeah, does anyone else see something wrong with believing a study that was funded by the COMPETITORS of GSK? Im sure Dr. Nissen doesnt get ANYTHING from these companies. No sir. He probably doesnt get to use their houses in the Bahamas on their corporate jets and eat with the offical Pfizer credit card. Charity my ass.

  • Amazing how they didnt include trials that showed no deaths: Six of the 48 trials did not report any myocardial infarctions or deaths from cardiovascular causes and therefore were not included in the analysis because the effect measure could not be calculated. You think maybe that skewed the data a bit? Lets not include the studies that showed no risk, just the ones that did. Way to go douches.
  • The population this is being tested against is already at risk for having a heart attack. Its very well knows that Diabetics are at risk for stroke, Heart attack, Renal Failure, blah blah blah. Water is wet, the sun rises in the morning. Why is this such a big issue?
  • These risks are included in the package insert of Avandia, and are KNOWN risks, and have been known since the drug came out.
  • http://content.nejm.org/cgi/content-nw/full/NEJMoa072761v1/T3 Nice chart of all of the results. Notice the differences between placebo and Avandia? See how they are almost identical? So if you have say a p value of 0.05, and your study has 200 people in it, that 5% error margin is a lot of people. See where this is going?
  • The Lawsuits are already gearing up. AMERICA! WAKE UP! THIS IS WHY YOUR MEDICATION COSTS SO MUCH! SO DRUG COMPANIES CAN SURIVIVE BULLSHIT LAWSUITS BASED UPON ‘STUDIES’ BY BULLSHIT DOCTORS WHO SPEND MORE TIME GETTING KICKBACKSINCENTIVES BY THE DRUG COMPANIES AND STROKING THEIR OWN EGOS THAN ACTUALLY PRACTICING MEDICINE.
    Yes, Dr. Nissen, I’m talking about you. You and your flawed ‘study’ is causing me, my colleagues, and the doctors (who actually work and see patients) hours upon hours of time explaining to people why your study is no cause for alarm and they should NOT stop their Avandia without talking with someone with a clue (their doctor). You should be ashamed for causing so much useless and pointless panic over something that is (in the scope of things) retarded and unwarranted. I hope someone tears your ‘study’ a new asshole and points out the glaring flaws. I know you probably dont work for a living actually helping people, so i’ll give you a little pointer: Prescription drugs are dangerous, henceforth why doctors can only write them, and I can only dispense them. I know this is a foreign concept to you, but think about it next time you’re on that jet getting lapdances from the Lilly reps.
    In short, Americans want to listen to the media, who obviously know a lot more about medicine than their Pharmacist, their Doctor, or Nurse. I say if they dont want to take Avandia, thats fine, they can die an early death. Thin the herd a bit. Sometimes we need to take the warning stickers off of things and let nature run its course.
    Sorry this isnt more rantilicious. I’m gearing up for the NPI cutover clusterfuck that I know is going to drive me to an early grave tomorrow.

  • RN’s vs NA/MA

    I know I’m going to get some hatemail with this one, but this topic really bugs the hell out of me.
    I get this call today from the hospital (as if the gods themselves read my blog and graced me with discharge orders) from a self identified “Nurse” from the “floor” who could barely speak english. I asked her “Oh? You’re a nurse? Where did you go to nursing school?” She gave me some junior college somewhere I had never heard of. I then asked her “Are you an RN?” She said “No, i’m just a nursing assistant”.
    Why are Nursing Assistants and Medical Assistants and other NON REGISTERED NURSES calling themselves NURSES? Why?! Do pharm techs call themselves pharmacists? I dont see why they cant by their standards, they go to school, and do 3/4th of the work a pharmacist does.. Why doesnt a PA or an NP call themselves a doctor? They do basically the same job dont they? Do security guards call themselves policemen? NO!@#!
    I’ll tell you why, because ITS FUCKING WRONG. Thats right, MA’s and NA calling themselves nurses is WRONG. Why haven’t the tried and true RN’s of the world put the backhand of justice down on the ignorant fools who are calling themselves something that they aren’t. Here you have the title “Nurse” splattered around any half-witted moron who completes a 4 month course at some shitty junior college only to throw “Nurse” around and ruin it for the people who went to an actual college, actually have a BS in Nursing, and actually KNOW something about medicine. It’s shitty I tell you. If I were an RN I’d be mad as hell and backhanding mofo’s left and right!
    Now once in a while I’ll get someone who identified themselves as an “MA”, but with the accent it sounds like “PA” so I get confused for a second before I realize whats going on. But the majority of the grunt hospital “Nurses” really arent nurses at all, but go around using that title. Its a conspiracy, and I’m the first to report it.
    Now I also get down on pharmacist who go around waving their PharmD penises in the air and demand people off the street call them “Doctor”. I can see using the “Doctor” title while you’re working on the floors in the hospital (sorta), but with the common folk? Gimme a break. Put your tiny penis away and just face the fact that you’re just a pharmacist like me, the drugnazi, and all other retail folk. Hell, I have a PharmD, didnt realize that did you? Its because I DONT FUCKING FLAUNT IT. Doctor only in title, not in spirit is what I always say.
    I still havent gotten an email from DrugNazi about PharmBoozeFest’07

    The fun of Discharge Medication

    Whats more fun than a kick in the balls? More exciting than seeing plastic bags full of random pill bottles plunk on your counter? More uplifting than seeing that 65 year old who cant tie her own shoes walk in the front door with yet another barrage of same questions she asked yesterday? More hilarious than watching an Alzheimer’s patient go greeting card shopping?
    DISCHARGE ORDERS!
    Thats right! Pages upon pages of fun!
    Let me explain why they frustrate the hell out of us:
    If they are phoned in, they are usually called in by a nurse (i use that term VERY VERY loosely) who cannot speak english. They usually involve 20 some-odd drugs, and the nurse cant figure out how to fax them over, and demands to just verbally give them. After 20 mins of ‘eye tink dats hydoxyzyzine (?!?!?)’ sort of mayhem, they want you to READ back to them all of the medications they called in, upon which they somehow get really confused and make you start over not once, not twice, but three times. Did I mention that she cannot read the doctors handwriting, so shes GUESSING at most of these? Yanno, people really throw the term ‘Nurse’ around like it means something now days.. You a MA? You’re a NURSE! You’re a Nursing Assistant? NURSE FOR YOU! You clean the floors? NURSE! If I were a ‘real’ RN-type nurse, and associated with these types of ‘nurses’, i’d be pissed. Of course I’m in the camp that gets pissed when PharmD’s call themselves “Doctor”. Anyhoo, I digress, back on track.
    When you are fortunate enough to get a REAL nurse who calls you and spends all of 30 seconds getting your fax number and saying “i’ll send it over” (thank you, we love you). One of the following will (not maybe, will) happen:

  • The page will fax so horribly, it looks like a 2 year old took a dump on a piece of paper and then scribbled with it.
  • The doctor will sign but not print his name, so these drugs are written by Rsquiggle Mcsqiggle
  • The hospitals letterhead will be written or scribbled over so you have no idea where to call for clarification
  • The patients name wont fax, or better yet, you get just random letters in the persons name (Vanna, can I buy a vowel?)
  • The fax goes to the wrong pharmacy
  • The order finally comes in.. 10 min before closing.. Before a 3 day weekend…
    Now all of these are really that bad, so why do we hate discharge orders?
    Because the patient picked up all of his medication from your store…. Last week…. And they’re all on this discharge sheet… All changed…. I can hear the collective sigh from pharmacists across the nation. Here is why we’re screwed in this case:

  • Insurance is going to balk at filling the same medication with a different strength and sig. Their systems are going to show it filled 3 days ago, so its going to reject.
  • The patient is 99% of the time not mentally able to comprehend taking 1/2 of this drug, while taking 2 of these. Even if you make them bring in all of the bottles and stick new labels on them, they are going to take them the way they have been taking them for the last 5 years.
  • The doctor is going to see his patient in 2 weeks, freak out at what the dipshit resident did while he/she was in the hospital, and change things yet again.
    So yeah, for pharmacists, its a lose-lose situation. You’re getting screwed by the insurance company; you’re getting screwed by the patient who has the understanding of a turd when it comes to what medication does what and changes; and you’re just bending yourself over to just have this all happen again in 2 weeks when he has an appointment with his primary care doctor.
    DrugNazi/Monkey – Lets go out drinking. Seriously. I dont care where you are, I will drive, fly, hitchhike, etc to you. We need to meet up, plunk down a few hundred on a nice bottle of expensive scotch, and see who’s store is more hellish. email me: druglord@theangrypharmacist.com
    Oh, and the rest of the internet is posting these wierd numbers on their webpage, so I will too dammit! I’m internet hip! Maybe i’ll win a prize or something.
    09-f9-11-02-9d-74-e3-5b-d8-41-56-c5-63-56-88-c0