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Published: Friday, November 10, 2017 @ 10:46 AM
— A private school in South Florida is offering bulletproof armor that students can use to protect themselves from gunfire.
Florida Christian School in Miami-Dade County, which has students ranging from preschool to high school, is offering parents the ability to buy a piece of ballistic armor that can be placed in their child’s backpack, according to the Miami Herald.
“It’s just a tool,” George Gulla, the school’s head of security, told the Miami Herald. “I’d rather be prepared for the worst than be stuck after saying ‘Wow, I wish we would’ve done that.’”
Gulla, who has 27 years of law enforcement experience, was running through safety drills with parents at the school when Alex Cejas, founder of the body armor company Applied Fiber Concepts, suggested the idea.
Cejas created binder-sized armor that can protect students from some bullets, but not bullets from a rifle.
The pieces of armor can be bought by parents at the school for $120.
Published: Sunday, March 18, 2018 @ 5:00 AM
Updated: Sunday, March 18, 2018 @ 4:45 PM
— A quiet night is expected with temperatures overnight dropping into the lower 30s, Storm Center 7 Meteorologist Brett Collar said.
Monday: Clouds will increase through the day with highs in the lower to middle 50s. The chance for rain returns in the evening, and with temperatures falling past sunset, a few wet flakes may mix in as well.
Tuesday: A few lingering snow showers or a wintry mix will be possible early, then more snow is possible later in the day. Mostly cloudy skies are expected with highs in the lower to middle 40s.
Wednesday: It’ll be a cold day with highs in the upper 30s. The chance for snow continues, but some weather models keep the snow to the south. We will keep a close eye on the track of this system.
Thursday: Partly sunny skies are expected with highs in the lower 40s.
Friday: A dry start is expected, but the chance for rain returns at night. Highs will be in the middle 40s.
Published: Sunday, March 18, 2018 @ 10:10 AM
— As the cost of health care continues to rise, large employers seeking to hold down health care costs are starting to negotiate fixed-price deals for common surgeries.
Companies that self fund their health insurance benefits can pay as much for health care as they pay some of their large suppliers. But with suppliers, employers can compare costs and look for lower cost options that are still high quality. With health care, that’s hard to do.
Fixed price deals can help fix this problem by bundling all the costs associated with a common surgery into one sticker price instead of an unpredictable list of line-item bills. Kroger became the latest major employer to negotiate a bundled payment deal when it struck an agreement with The Christ Hospital Health Network for a fixed price for spine surgery and total hip or knee replacements for its employees with health benefits.
Bryan Bucklew, CEO of the Greater Dayton Area Hospital Association, said deals haven’t caught on around Dayton like they have in other regions that have large enough employers to negotiate for set prices.
But their effect can still be felt when employers like Kroger strike deals that could lure some of their Dayton-area employees into other cities.
Medicare and Medicaid first led the push for bundled payments, and now large employers like General Electric, Walmart and Boeing are increasingly looking at fixed price deals as an option for controlling the high cost of health care. In 2014, Lowe’s even struck a deal to fly employees for free to the Cleveland Clinic for a fixed price surgery deal, rather than pay unbundled costs at other hospitals.
When the deal works, all parties get what they want. The employer that self funds its health insurance gets controlled costs and high quality. The employee gets less bills — sometimes no out-of-pocket bills — and more coordinated care.
“What the hospital gets is, quite honestly, it directs more business to you,” Chris Bergman, Dayton Children’s Hospital’s chief financial officer.
Bergman was one the architects of one of the first bundled payment deals in the area — a deal with GE employees when he worked as CFO at Christ Hospital — and he’s now looking for ways to bring bundling to Children’s.
“Most of the problem with health care is the numbers bounce around. That drives companies crazy that they don’t have predictability,” Bergman said.
Scott McGohan, CEO of employee benefits firm McGohan Brabender, said these deals are a way to control costs without making employees feel like they are being told what to do.
Employees might resent being told they can only go to one place for health care, even if that place is both cheaper and higher quality. But McGohan said employees tend to like programs that let them shop and then reward them with the employer covering the whole surgery if they opt for the provider with a fixed price.
These deals aren’t right for every employer and they aren’t right for every procedure, McGohan said. A company with mostly employees under 40 years old wouldn’t get much savings from a fixed price deal for hip replacements.
But for self-insurance employers with large employee counts, McGohan said the savings can add up fast if employees are being steered toward a $15,000 knee replacement verses a $42,000 knee replacement, and the employer is given data that show the cheaper procedure gets the same quality outcomes.
“And then it forces all the other health systems to get really competitive in pricing, and it forces them to be very transparent in quality,” McGohan said.
These bundled deals are part of a broader push in health care to pay for results, not pay for layers of fees that incentive providers to do additional services and that pay hospitals more fees for follow up care for complications.
“Under the current system no one gets paid unless they do something. So the economics of health care is to do something. To do a procedure. To do a diagnosis. Now what CMS (Centers for Medicare and Medicaid) is trying to do and commercial payers are tying to do is pay for value,” Bucklew said.
Bergman said these deals also push hospitals to review how they do procedures and get more cost effective.
Two physicians practicing at the same hospital might have learned two different ways to do a procedure and charge two different prices. But to guarantee a price to an employer, the hospital has to evaluate whether one procedure costs less but has just as high of quality outcomes, and then the hospital has to get all physicians who do that type of surgery to agree to one single way to do it.
There aren’t many examples of bundled payments in pediatrics to look to as examples, but Bergman said Dayton Children’s is considering options for procedures that are high volume enough to negotiate a fixed price on, like maybe ear tubes or tonsillectomies.
Published: Sunday, March 18, 2018 @ 9:38 AM
— Almost daily, Dr. Gogi Kumar is questioned at Dayton Children’s Hospital about medical marijuana by concerned parents of children who suffer from seizures.
Kumar is not alone in the curiosity she receives from patients about Ohio’s confusing medical marijuana program that is expected to begin in September.
Doctors told this newspaper they are bombarded with questions about medical marijuana and are concerned because they don’t have all the answers. There is an information gap on questions such as how effective marijuana is for specific disorders, how the compounds affect children and how it interacts with other medications, doctors said.
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Kumar, the hospital’s neurology medical director, said parents have seen examples of children who are helped by cannabis-based treatment and want that same relief for their kids.
“I’m not resistant to (recommending) medical marijuana, but I need data,” Kumar said. “Although it’s natural, marijuana is not like a vitamin. I have to be careful as to what I’m giving the patient.”
Ohio’s medical marijuana program is set to start Sept. 8, but patients who are hoping to take medical marijuana may still face another obstacle: physicians wrestling with issues of data gaps and ethical questions when it comes to recommending a substance that was approved for treating 21 disorders by a legislative vote, not the FDA.
There’s a lack of large, double-blind studies in the U.S. on the effects of medical marijuana on specific conditions. And with the studies that are out there, said Dr. Glen Solomon, it’s hard to control whether the exact strain and dosage studied is what his patient ends up taking.
With other medications, said Solomon, who practices internal medicine with Wright State Physicians, research has shown the substance to be safe and effective.
“And that let’s you sleep well at night when you’re a doctor,” he said. “Medical marijuana never went through that process. This is a substance that basically the state legislature decided is now a medicine.”
Solomon is part of a task force at Wright State University’s Boonshoft School of Medicine that wants to serve as a resource for students, residents and local doctors to learn the information that’s available about marijuana.
The task force is still early in formation; Solomon said the goal is also to create an online database of what research is available about marijuana and to provide educational programs for doctors and residents.
Tessie Pollock, spokeswoman for the State Medical Board of Ohio, said the state marijuana program “is fortunate that we had a lot of other states to look at when establishing these rules” and was able to garner best practices, what worked and what didn’t work and how those states developed education for their physicians.
The medical board hasn’t started certifying doctors yet to recommend marijuana but will do so this spring.
Physicians will also need to complete two hours of continuing medical education to get certified to recommend marijuana and those renewals.
The refusal of the U.S. DEA to move marijuana from a Schedule 1 drug — considered to have to no acceptable medical use — to a Schedule 2 drug is in part responsible for the state legislature legalizing medical marijuana, said State Rep. Steve Huffman, who is also an emergency physician.
If the DEA changed how it classified marijuana, then there could have been research and federal approval for certain disorders like with other medicines, but without that change, it’s been approved instead by state votes.
One of the results of research not keeping up with patient demand has been patients going out on their own to treat their symptoms with marijuana. And that can leave physicians in the dark on what is the real reason that their patients’ symptoms are improving.
Since the state approved starting a medical marijuana program, Dr. Cleanne Cass, who is a Dayton area hospice and palliative care physician, said her patients have been less likely to try to hide that they’ve been using marijuana to help with their symptoms.
“Since the state referendum, patients are more open to telling me that they are using marijuana,” she said.
Cass said she plans to attend “as many conferences as I can” to learn about medical marijuana, which is going to be a hot topic in hospice care.
Kumar said while she doesn’t encourage her patients’ parents to do things like order cannabis oil on the internet, they still do and she tells them to be honest with her what they are doing at home so she can sort out what is working and what’s not.
“I always encourage them to please tell me,” she said.
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There are also recent clinical trials that provide evidence that a cannabis based medication, Epidolex, is effective in some patients with intractable epilepsy, but this medication is not yet approved by the FDA.
“We already have a drug that’s on the way to being approved by the FDA so why not wait for it because then you know exactly what you’re doing,” Kumar said.
With a shortage of robust studies on how marijuana could be used medically, it raises a bigger question of whether states should be allowed to approve these type of issues with a vote, said Marc Sweeney, dean of Cedarville University School of Pharmacy.
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“The challenge is when you put any type of pharmacologic therapy on a ballet, unlike the FDA process, the general public is making a decision whether a quote unquote drug should be used,” Sweeney said.
A review published in 2015 in The Journal of the American Medical Association looked at all randomized controlled trials of cannabis or cannabinoids to treat medical conditions and found 79 trials involving more than 6,400 participants. Most did not achieve statistical significance. Some did though, like a study that associated marijuana with improvements in resolution of nausea and vomiting due to chemotherapy, with 47 percent of those using it finding relief versus 20 percent of the control group.
Hufffman said he would advocate for federally reclassifying marijuana to allow more U.S. research, because if federal restrictions weren’t in the way there could be more scientific information to guide these debates.
“But we’re ham-stringed by not moving it to Schedule 2 so we could have that data,” he said.
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What can you get medical marijuana for?
Under Ohio law, the 21 qualifying medical conditions:
AIDS, amyotrophic lateral sclerosis, Alzheimer’s disease, cancer, chronic traumatic, encephalopathy, Crohn’s disease;
Epilepsy or another seizure disorder, fibromyalgia, glaucoma, hepatitis C, inflammatory bowel disease, multiple sclerosis, pain that is either chronic and severe or intractable, Parkinson’s disease;
Positive status for HIV, post-traumatic stress disorder, sickle cell anemia, spinal cord disease or injury, Tourette’s syndrome, traumatic brain injury, and ulcerative colitis.
Medical marijuana facts
1. It’s still illegal under federal law for doctors to prescribe marijuana. In Ohio, patients will get what is classified as a physician recommendation, which is filled at a dispensary and not a pharmacy. Physicians have to be certified by the State Medical Board of Ohio to recommend marijuana.
2. All medical marijuana patients and their caregivers have to register with the State Board of Pharmacy. The registration expires in a year, or if the patient is terminally ill, it expires after six months.
3. Ohio’s medical marijuana program is scheduled to start Sept. 8. The state already awarded licenses to grow marijuana and still needs to award licenses for dispensaries.
Published: Sunday, March 18, 2018 @ 5:03 PM
— A vessel in the Gateway Clipper fleet hosted an unexpected furry passenger on Sunday.
Pittsburgh animal control officers safely captured the wild cat and plan to release it in a wildlife center in Verona.