| IN THE NEWS | Brief Medicare Pay Fix May Mean Showdown In Lame-Duck Congress
Washington -- For Leah McCormack, MD, the modest Medicare raise she started receiving in late June to replace a double-digit cut might be the last adjustment the government makes to her pay. After the first half of a particularly tumultuous year for Medicare physicians, she has decided to drop out of the program.
Dr. McCormack, who has operated a solo, private dermatology practice for 25 years in Forest Hills, N.Y., decided in July to terminate all of her contracts with Medicare and managed care companies as soon as she is able.
"The failure of the government to permanently fix the long-promised physician reimbursement rate factored greatly into this decision," she said.
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ABOUT HARTLEY MEDICAL | The national leader in intra-spinal therapy, Hartley Medical specializes in the compounding of quality sterile pharmaceuticals for infusion therapy clients throughout the United States.
Owned and directed
by William A. Stuart - R Ph, acknowledged pioneer in the field of pharmaceutical sterile compounding - Hartley, prior to its national expansion, established itself as the one of the most successful and professionally distinguished pharmacies in the state of California. We now serve over 400 leading pain physicians and premier health care institutions across the nation.
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 Welcome
Three glorious, growth-infused days in the heart of wine country - an awesome setting for a truly bountiful meeting of minds. As a sharing of knowledge, experience and effective strategies for pain management, the 2010 Napa Pain Conference was without peer - cutting-edge, in-depth, inspirational - with internationally known faculty top-of-the-top of their field in neuro-modulation and pain management.
The Napa Pain Conference is a MUST for 2011 attendance.
I was proud to be a part of it . . . and I am anxious to share all of it with all with you in next month's Hartley Standard.
All the best, 
P.S. We want to hear your comments and feedback. Send us an e-mail and let us know what you think - and what you'd like to see in future issues. |
Pharmacology Review:
INTRATHECAL FENTANYL | |
Patented by Janssen Pharmaceuticals in 1963, fentanyl is a potent narcotic analgesic primarily used for spinal analgesia. The drug possesses a high solubility, with a maximum concentration of 25,000 mcg per milliliter. Fentanyl is extremely lipophilic when administered intraspinally. This limits its spinal distribution, a factor which must be considered in the treatment of pain at the site of nocioception. It must also be noted that fentanyl is 100 times more potent than morphine sulfate for acute pain and 40 to 50 times more potent in chronic pain.
Conversion from Morphine/Dosing Considerations
Often when a physician contacts Hartley Medical for drug conversion assistance, we discuss pertinent literature and then employ mathematical calculations to derive a beginning intraspinal fentanyl dose. When considering the conversion of patients from morphine to fentanyl for intrathecal treatment of chronic pain, we frequently modify our specific calculation of the dosage based on my experience with patients treated with fentanyl. In my many personal conversations with physicians having extensive experience in fentanyl, these practitioners favored converting patients from morphine to fentanyl utilizing smaller ratios, such as 1/10 to 1/25 of the daily morphine sulfate dose.
With such a broad conversion range, clinicians unfamiliar with intraspinal administration of fentanyl should seek consultation prior to drug conversion. With regard to dosing, the spectrum is also wide for pain providers. Some physicians have reported dosing as low as 4 mcg per day and others, approximately 5,000 mcg per day. Read more - Maintaining Stability
Hartley Medical's staff of expert pharmacists are always available for clinical consultations. Please don't hesitate to contact us. |
SPEAKING OF STANDARDS:
MEDIA FILL | |
"Media fill" can be defined as a procedure in which a pharmacist or technician involved with sterile compounding simulates the production of a sterile product in order to directly assess the effectiveness of employed aseptic compounding technique. At Hartley, we believe in the importance (and the necessity) of the media fill process.
Proper simulation requires the similar to activities that I would use to make an intrathecal preparation.
Instead of using the actual drug, we typically substitute diluence and growth media. I would use sterile water for injection, plus a large volume of prepared sterile growth media suitable for the promotion of bacterial growth. I would finish making the preparation and then seal the container and label it in such a fashion. Then we would incubate.
The industry standard for performing this simulation is twice a year. The Hartley Standard? Once a month. Our media fill testing standards and the frequency of their application are representative of the guiding, growing force that lies at the heart and core of Hartley Medical: continuous quality improvement. It is a principle that is self-generating ... a concept of "evergreen" if you will ... an ongoing, etched-in-our-DNA commitment to the belief that what we do today is the foundation for tomorrow's insights, improvement, and excellence.
Continuous quality improvement has been a key ingredient to the Hartley Medical mix since its inception. In 1996, CQI achieved added significance with our decision to focus on pain management ... and it continues today as a result of our conscious efforts to build on the acquiring of instruments and adoption of procedures that perpetually assess and elevate the quality of our product, the performance of our staff, and the impeccable functionality of our clean room and preparation facilities.
As a result, the staffing and conduct of the organization has evolved with the focus on providing nothing less than the best. Today builds for tomorrow ...ever-evolving to achieve optimal results. |
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Disclaimer. The information contained in this publication is provided "as is" and without warranty, express or implied. Hartley Medical assumes no responsibility for any damages of any kind resulting from the procedures contained herein.
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