ER doc, golf addict, UTMB + TAMU, life member #NRA, #RuleofLaw
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Mar 15, 2022 • 4 tweets • 1 min read
"Rain Like Hell" show: The weather that night is what really made it incredible. The entire show, up through midway through the 2nd half of the set, we could see the thunderstorms and lightning off in the distance, getting closer throughout. reddit.com/r/pinkfloyd/co…
What was amazing it almost seemed the thunder clashes and lightening were almost choreographed to the music, really enhancing it. After a while, the rain started just pouring down hard, peaking during "Another Brick in the Wall (Pt.2)"...seriously an amazing climax to the show.
Jan 29, 2022 • 5 tweets • 1 min read
I thought it would be a good idea to keep my CT scanner and employ a CT tech in my urgent care facility. More information is good, right? And by offering cheaper CT scans than the ER, I thought both patients and insurers would appreciate this plan.
I just learned yesterday that one very large insurer with whom I am in network pays me $89 for a CT scan of the abdomen and $30 for a CT scan of the brain. They also pay me $6 for a common blood test that costs me $11. These are all lower than Medicare rates.
Jan 22, 2022 • 12 tweets • 2 min read
I have a secret theory about the Sotrovimab (SOT) shortage I haven't seen discussed. A thread.
Before September 2021, we could order (and receive) as much REGEN-COV (REG) as we wanted straight from the manufacturer at no charge. We charged a nominal price for the medication and were paid around $100 per dose from most insurers.
Since November 28 only 55,000 doses of Sotrovimab have been distributed throughout the country. 1/5 phe.gov/emergency/even…
Per the Texas DSHS:
The supply of COVID-19 therapeutics remains low throughout the state relative to the demand. Ensure that you use all therapeutics available at your facility before requesting any new therapeutics. 2/5
Oct 24, 2021 • 10 tweets • 3 min read
Interesting topic with many angry replies. Things to keep in mind - parents can always request Plastics, but 1) they don't have to come 2) they can charge A LOT more and may be out of network and 3) the ER doc and facility will still bill you anyway. ncbi.nlm.nih.gov/pmc/articles/P…
If it is a simple repair that is considered part of a typical ER doc's skill set, EMTALA doesn't require the Plastics specialist to come in. Hospital policy might, but probably won't. If they do come in, expect to be charged a lot more.
Oct 7, 2021 • 4 tweets • 1 min read
I'm gonna retweet it again because it's so shocking. In this 80% vaccinated over-65 population, an estimated 60% of hospitalizations were of fully vaccinated individuals in the week ending Aug 7. In a group of 5.4 million Medicare beneficiaries. In a study conducted by the govt.
71% of the total COVID cases were vaccinated in this age group.
Sep 13, 2021 • 5 tweets • 1 min read
I don't know how all the "free" COVID tests work. In particular, the insurers have made it VERY clear to us that they will not pay for COVID testing when required for work, school, or travel. They review our charts and deny every visit where such a reason is mentioned.
The tests we bill for have to be "medically necessary." They will even take back money they previously paid us when they find out it was done for one of those reasons. But these "free" testing sites are billing insurance too, they just don't generate a medical chart.
Sep 12, 2021 • 8 tweets • 2 min read
The word equitable made it so. I don't think it's "equitable" to withhold medication from the areas that need it most. I don't believe that there is a shortage. I believe that this action was politically motivated to further the political agenda of the current administration.
The order to the HHS to ration this medication came from high level politicians, not from physicians. I do not believe the manufacturer or the distributor was involved in the decision, but their hands are tied because it is the government who bought all of the medication.
Sep 11, 2021 • 4 tweets • 1 min read
Now the freestanding ER we were referring patients to get the monoclonal antibody infusions called us and told us to stop sending them patients. Apparently they only have one monitor and can only do one infusion at a time. So I have more capability than the ER does.
We are going to ask them if they will give us some of their medication if they aren't going to use it.
Sep 11, 2021 • 4 tweets • 1 min read
Still no antibodies today. It seems that they won't be sending more. I've referred several patients elsewhere but it's very frustrating not being able to offer the most effective COVID treatment to them. I reached out to the distributor but haven't gotten a response.
So the manufacturer cancelled my order of monoclonal antibodies. I have one day supply remaining. I placed an order via the appropriate link two days ago but didn't get a response, so yesterday I tried to order directly from the manuracturer and today I got this:
"Hello –
You’re receiving this email because your facility recently placed an order for C19 Therapies via the AB order platform. Please note that HHS is now reviewing every mAb order submitted and has advised that all mAb orders must be placed via the direct order link below"
Sep 8, 2021 • 13 tweets • 3 min read
I see that there is a lot of interest in monoclonal antibody infusions, so I will discuss our process for administering them. I think it is a great treatment with very little downside.
We are giving the infusions to patients diagnosed with COVID and to high risk patients with exposure (spouses mainly). Here is a fact sheet from the FDA discussing the treatment and the qualifications for receiving it. We generally follow these guidelines. fda.gov/media/143894/d…
Sep 7, 2021 • 7 tweets • 2 min read
The reporting process required to obtain monoclonal antibody is extremely tedious. They don't just want to know how many doses per week we are using or how many we have on hand. They ask dozens of questions about our other supplies, and they require weekly updates.
They require submission of a CSV file with these data, most of which would only apply to hospitals. But they want to know how many gloves and masks and goggles we have on hand and how many days each supply is expected to last.
Sep 4, 2021 • 6 tweets • 1 min read
So now the government is getting involved in (read: restricting) monoclonal antibody distribution. Before I could just order as much as we needed and they shipped it next day air. Now a govt. commission will decide when, if, and how much I will be able to get for my pts.
"Should you have any questions regarding this update in ordering and distribution procedures, please email the Federal COVID-19 Response Team."
Wonderful.
Sep 1, 2021 • 5 tweets • 1 min read
A month ago I thought 25 patients a day was a lot. Then I thought 35 was a lot. Then I though 45 was a lot. Now we're seeing over 50, and we're talking about creating hallway stations so I think we could see 80.
It's really more of a flow dynamics problem than a medical problem.
Sep 4, 2020 • 5 tweets • 1 min read
Fascinating study. The virus does what it does, regardless of human interventions.
"...human interaction does not conform to simple epidemiological models. In the real world human social networks overlap in such a way that a virus can spread rapidly for a short period of time, as some people contact more networks than others, but reaches natural dead-ends..."
Jul 18, 2019 • 27 tweets • 5 min read
Today I’m going to discuss an important and frequently misunderstood topic among physicians of all specialties, that of narcotic tolerance. A thread. #pain#chronicpain#tolerance 1/x
If someone is on chronic opioid therapy, they may present with conditions that require additional therapy. Whether it is a recent surgery, a flareup of their chronic condition, or a new injury, you should realize that despite their current medication regimen, 2/x
