Working on a camera setup...and...
...then the lights went out...
I think it was a bad circuit breaker...
Our Mission: "Tighter sphincters in 30 days, or we'll EAT OUR LUNCH!"
Saturday, May 11, 2013
Thursday, May 02, 2013
Bragging up the dog
OK, so it's the animating apothecary site, and I really do try to make things apply to animation or pharmacy...but dawgunnit, this little puppy of mine is so CUTE!!!
Wednesday, April 17, 2013
A Cursory Analysis of a Blue Cross Audit
One of the most dreaded notifications a pharmacy can receive is the prospect of an insurance company audit. Pharmacy Benefit Managers (PBMs) are notorious for trumped up reasons to refuse claims on the most ridiculous of reasons; auditors even get a percentage of the 'disputed claim' paybacks, so you know where their interests will lie. But the standard audits from typical insurers can be - well - let's call their mathematical algorithms poetic.
For example, here is the breakdown on how Blue Cross of Michigan determines its disputed claim payback. This was all carefully written down during the 'debriefing' phase of a recent audit, as the auditor would not leave a copy of the formula with the pharmacy.
175 prescriptions were chosen from 2012, 'at random' prior to the audit, with the instructions that the original prescription, signature logs, and dispensing history were to be made available to the auditor. A 'small number' of additional prescriptions were to be requested, with a dispensing history, at the start of the audit. This 'small number' turned out to be 20, or 11.4% of the initial number. This brought the number of prescriptions to 195 for this particular audit. It was explained that this represented one prescription for each day the pharmacy was open and doing business with Blue Cross of Michigan.
The trouble is, however, that the pharmacy was open 294 days in 2012. The ratio 195/294 is 0.663. This becomes important when considering the rest of their analytical algorithm.
The prescriptions that were found to be 'payable' mainly amounted to electronic prescriptions that were handed in to the pharmacy without a physical handwritten signature from the physician. In this case, three were noted (however, the three were true electronic prescriptions, but for purposes of argument, we'll let it ride).
These three prescriptions represented a total of $140 in payments from Blue Cross that they wanted back. That is fine, one could argue, but it doesn't end there. They EXTRAPOLATE this $140 in this manner:
1. Blue Cross adds up the dollar amount of all prescriptions in the audit. Here, those 195 prescriptions amounted to $45,000
2. They then take the disputed prescription value of $140 and divide that by $45,000. This yields 0.003111. Seems like a pretty small number, to most eyes, BUT...
3. They THEN take the dollar value of the ENTIRE YEAR'S BUSINESS with Blue Cross - here it was $6,600,000 - and multiply THAT by 0.003111. That number becomes .... 20,533.26
4. They then put a dollar sign in front of that number and say THAT is your payback bill to Blue Cross for the audit. Yes, you read it right - $140 is inflated to $20,533.26.
Now, back to the numbers themselves. First of all, the number 195 somehow representing the days a pharmacy is open. Again, this particular pharmacy was actually open 294 days in that year. This means the results are OVERestimated, even by their peculiar method of statistical analysis, by 32.7%. That alone would make the 20K damages more like 13.6K, still a hyperinflationary amount.
And then to examine the 'randomness' of the audit. Of the 195 prescriptions chosen, 155 were for those where the drug cost in the prescription was over $150. There were many ways to manipulate that total cost of $45,000. In addition, carefully choosing which prescriptions to require a payback upon has a significant impact on that minute figure used in the final calculation - each 0.0001 represents $660 in the end. One could eye the term 'random' with suspicion.
This is why pharmacies go out of business. This is why pharmacies who deal with insurances (and that is all of them with the possible exception of two nationwide) cannot just fill prescriptions, they have to micromanage each of these scraps of paper. It doesn't matter if the drug is right, that the dose is right, that an interaction is uncovered or a life helped or saved. Place an initial in the wrong place, and this is the consequence. And Blue Cross is one of the 'better ones'...
Blue Cross of Michigan is currently regulated under the State of Michigan. This year, the State congress and Governor Snyder pushed through a series of their notion of reforms, under the guidance of Blue Cross, to convert it from its current form to one of less regulation and oversight by 2014.. the conversion will make Blue Cross a 'non-profit.' (an oxymoron in the insurance industry) The reason cited is to increase 'competitiveness' of Blue Cross. I doubt this sort of creative mathematics will be improved in such an environment, just as I suspect more and more will be done by Blue Cross to maintain its CEO's $3.4 million salary.
For example, here is the breakdown on how Blue Cross of Michigan determines its disputed claim payback. This was all carefully written down during the 'debriefing' phase of a recent audit, as the auditor would not leave a copy of the formula with the pharmacy.
175 prescriptions were chosen from 2012, 'at random' prior to the audit, with the instructions that the original prescription, signature logs, and dispensing history were to be made available to the auditor. A 'small number' of additional prescriptions were to be requested, with a dispensing history, at the start of the audit. This 'small number' turned out to be 20, or 11.4% of the initial number. This brought the number of prescriptions to 195 for this particular audit. It was explained that this represented one prescription for each day the pharmacy was open and doing business with Blue Cross of Michigan.
The trouble is, however, that the pharmacy was open 294 days in 2012. The ratio 195/294 is 0.663. This becomes important when considering the rest of their analytical algorithm.
The prescriptions that were found to be 'payable' mainly amounted to electronic prescriptions that were handed in to the pharmacy without a physical handwritten signature from the physician. In this case, three were noted (however, the three were true electronic prescriptions, but for purposes of argument, we'll let it ride).
These three prescriptions represented a total of $140 in payments from Blue Cross that they wanted back. That is fine, one could argue, but it doesn't end there. They EXTRAPOLATE this $140 in this manner:
1. Blue Cross adds up the dollar amount of all prescriptions in the audit. Here, those 195 prescriptions amounted to $45,000
2. They then take the disputed prescription value of $140 and divide that by $45,000. This yields 0.003111. Seems like a pretty small number, to most eyes, BUT...
3. They THEN take the dollar value of the ENTIRE YEAR'S BUSINESS with Blue Cross - here it was $6,600,000 - and multiply THAT by 0.003111. That number becomes .... 20,533.26
4. They then put a dollar sign in front of that number and say THAT is your payback bill to Blue Cross for the audit. Yes, you read it right - $140 is inflated to $20,533.26.
Now, back to the numbers themselves. First of all, the number 195 somehow representing the days a pharmacy is open. Again, this particular pharmacy was actually open 294 days in that year. This means the results are OVERestimated, even by their peculiar method of statistical analysis, by 32.7%. That alone would make the 20K damages more like 13.6K, still a hyperinflationary amount.
And then to examine the 'randomness' of the audit. Of the 195 prescriptions chosen, 155 were for those where the drug cost in the prescription was over $150. There were many ways to manipulate that total cost of $45,000. In addition, carefully choosing which prescriptions to require a payback upon has a significant impact on that minute figure used in the final calculation - each 0.0001 represents $660 in the end. One could eye the term 'random' with suspicion.
This is why pharmacies go out of business. This is why pharmacies who deal with insurances (and that is all of them with the possible exception of two nationwide) cannot just fill prescriptions, they have to micromanage each of these scraps of paper. It doesn't matter if the drug is right, that the dose is right, that an interaction is uncovered or a life helped or saved. Place an initial in the wrong place, and this is the consequence. And Blue Cross is one of the 'better ones'...
Blue Cross of Michigan is currently regulated under the State of Michigan. This year, the State congress and Governor Snyder pushed through a series of their notion of reforms, under the guidance of Blue Cross, to convert it from its current form to one of less regulation and oversight by 2014.. the conversion will make Blue Cross a 'non-profit.' (an oxymoron in the insurance industry) The reason cited is to increase 'competitiveness' of Blue Cross. I doubt this sort of creative mathematics will be improved in such an environment, just as I suspect more and more will be done by Blue Cross to maintain its CEO's $3.4 million salary.
Monday, March 25, 2013
The Wandering Mind of the Animating Apothecary
On a lecture-bus trip to Chicago...the mind began to wander as notes were presented....
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| Reading "The Story of Pi" - and for some reason, was compelled to square a rectangle... |
...and then the paper ran out...or the bus arrived in Chicago...or both...
Sunday, February 24, 2013
Mug Design #1 - Mr Caffeine for President
Everyone else is getting ready for 2016, so why not Mr. Caffeine?
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| (c) 1988, 2013 The Animating Apothecary |
Coming soon from cafepress....maybe too soon...
In the meantime...
See the first volume of sketches at http://www.lulu.com/shop/jim-middleton/uncle-stans-profusely-illustrated-world-no-1/paperback/product-20701680.html
Friday, February 22, 2013
A blast from 1974
Ev Nienhouse was among the finest instructors to stimulate a frontal cortex - and in the 1970s, when the concept of college video production was something other folks did, he and Gary Nash created a series of instructional tapes that were meant to run in tandem with the Morrison and Boyd textbook in use at Ferris State College. With laboratory work being somewhat dry (or somewhat explosive, depending on the reagents used), they enlisted some student help to create 'commercials' for the course. Here is one, back when we all had more hair, and it was mostly one color....
Tuesday, February 19, 2013
James B. Turner, WGADOSA (1927-2013)
From the Big Rapids Pioneer:
BIG RAPIDS James Bevier Turner, 85, passed away peacefully at home on Sunday, Feb. 17, 2013, supported by his family's presence and gentle care. Jim was born on May 26, 1927, in Flint, the second son of William H. and Geneva Postal Turner, who preceded him in death. His older brother, William Postal Turner, passed away in 1949.
In 1948, after serving in the U.S. Army during World War II and continuing his studies in pharmacy, Jim married Helen Joan Moore; together they had two children, Nancy E. (Ed Andres) Turner, of Traverse City, and James J. (Denise Sloan) Turner, of Lansing.
In 1988, he married the former Wanda V. Johnson and enjoyed that nearly 25-year union until his death. They enjoyed many years together and especially enjoyed spending time each summer at Sturgeon Bay. Surviving are his wife, Wanda; his two children, Nancy and James; and two grandchildren, Erin (Ben Scott) Sloan-Turner, of Macomb, Ill., and Patrick Sloan-Turner, of Burbank, Calif.
He will be remembered by two beloved local families, Curtis Erb and his son, Jaden, and Lois and George Helbert, as well as Wanda Johnson family living in Virginia, North Carolina and Ohio. Among others are the cronies who were regulars with him on the golf course, those who fly-fished with him on the Au Sable and the guys who swapped lies at the early morning gatherings at Currie's.
Under the mentorship of his maternal grandfather, Jim became captivated with fly-fishing at a very early age. He learned all about fly-fishing, including how to tie his own flies, thanks to his beloved grandfather. As well, he was introduced to golf at age 8; that avocation became another passion for life. He was especially proud of winning the club championship in 1980 at the (former) Meceola Golf and Country Club where he was a member since 1961.
Jim also had a love of music, inheriting that love from his mother who taught piano in the West Michigan area for decades. He especially loved to sing, starting as a member of the boy's choir at St. Mark's Episcopal Church in Grand Rapids with his older brother and then continued singing throughout much of his life, most recently under the direction of Bill Donahue in various locations around the area. He also was a very fine cook, especially enjoying preparing breakfast for his grandchildren and wife Wanda.
Jim was an active volunteer in the area as well, chairing the Survivor's Walk for the American Cancer Society's Relay for Life in Mecosta County for 10 years. Additionally, he enjoyed being involved with the Meals on Wheels delivery in Big Rapids; he not only delivered nutritious meals but also provided an essential connection to the outside world and a social respite for those who received the meals.
Professionally, Jim was singularly involved in the practice and teaching of pharmacy and administration of the student academic affairs function at Ferris State University. He graduated from the Ferris State University College of Pharmacy in 1949. He then practiced as a pharmacist in Alpena, Hastings and Cadillac before purchasing the former Fairman Drug Store in Big Rapids in 1960. He operated the store as Turner Pharmacy until 1975, when the store was sold but still functioned as the Turner Pharmacy. Shortly thereafter, he joined the faculty of the College of Pharmacy at Ferris State University as a teacher of pharmacy practice. He quickly moved into administration in the area of student academic affairs, retiring in 1994 as Associate Dean of Student Academic Affairs. He was awarded the Clark A. Andreson Alumni Recognition Award shortly after his retirement.
During his career at Ferris, Jim was a member of the American Pharmacists Association, Michigan Pharmacists Association and the American Association of Colleges of Pharmacy. He also met and collaborated with his cohorts in student academic affairs across the nation on a regular basis. He continued his education, earning a Master of Science degree from Central Michigan University and a Ph.D. from the University of Michigan.
Cremation has taken place. In lieu of a traditional funeral, the family will greet friends from 2 to 4 p.m. on March 2, 2013, at the Holiday Inn to celebrate Jim's life.
Memorial contributions may be made to the James B. Turner Memorial Scholarship Fund for the Ferris State University College of Pharmacy. Alternatively, Jim asked that memorial contributions be made to the Mecosta County Habitat for Humanity, Women's Information Services (WISE), the Big Rapids Community Library or the Mecosta County Senior Center (Meals on Wheels and/or Medical Transportation). Hospice of Michigan also is suggested by his family. (end of Pioneer article)
That's the official line. When growing up in Big Rapids, the Turner Pharmacy was the alternative to the old Martz and Shapley's on the main street, and both places smelled of Robitussin and witch hazel. Later, as I found myself awash in the often frustrating curriculum of pharmacy at Ferris, Jim Turner was one of those too-rare bright spots in the education sphere there. His sense of humor was dry and deliciously scewed - and with little provocation he could launch into a Great Carsoni routine or extrapolate from dialogue by Bob and Ray. He related to me his shock on learning, during his last minute decision to get a retirement physical ("Hey, it was still on the college insurance at that point."), that prostate cancer was a new visitor in his life. Certainly his bright outlook gave him more time than any physician could have predicted. "Guess all I have to do now is grow a beard," he said of his retirement in that conversation. And while his photo above is how many saw him for the past several years, here is the image I recall when thinking of one James B. Turner, The World's Greatest Associate Dean of Student Affairs:
BIG RAPIDS James Bevier Turner, 85, passed away peacefully at home on Sunday, Feb. 17, 2013, supported by his family's presence and gentle care. Jim was born on May 26, 1927, in Flint, the second son of William H. and Geneva Postal Turner, who preceded him in death. His older brother, William Postal Turner, passed away in 1949.
 James Turner, WGADOSA |
In 1988, he married the former Wanda V. Johnson and enjoyed that nearly 25-year union until his death. They enjoyed many years together and especially enjoyed spending time each summer at Sturgeon Bay. Surviving are his wife, Wanda; his two children, Nancy and James; and two grandchildren, Erin (Ben Scott) Sloan-Turner, of Macomb, Ill., and Patrick Sloan-Turner, of Burbank, Calif.
He will be remembered by two beloved local families, Curtis Erb and his son, Jaden, and Lois and George Helbert, as well as Wanda Johnson family living in Virginia, North Carolina and Ohio. Among others are the cronies who were regulars with him on the golf course, those who fly-fished with him on the Au Sable and the guys who swapped lies at the early morning gatherings at Currie's.
Under the mentorship of his maternal grandfather, Jim became captivated with fly-fishing at a very early age. He learned all about fly-fishing, including how to tie his own flies, thanks to his beloved grandfather. As well, he was introduced to golf at age 8; that avocation became another passion for life. He was especially proud of winning the club championship in 1980 at the (former) Meceola Golf and Country Club where he was a member since 1961.
Jim also had a love of music, inheriting that love from his mother who taught piano in the West Michigan area for decades. He especially loved to sing, starting as a member of the boy's choir at St. Mark's Episcopal Church in Grand Rapids with his older brother and then continued singing throughout much of his life, most recently under the direction of Bill Donahue in various locations around the area. He also was a very fine cook, especially enjoying preparing breakfast for his grandchildren and wife Wanda.
Jim was an active volunteer in the area as well, chairing the Survivor's Walk for the American Cancer Society's Relay for Life in Mecosta County for 10 years. Additionally, he enjoyed being involved with the Meals on Wheels delivery in Big Rapids; he not only delivered nutritious meals but also provided an essential connection to the outside world and a social respite for those who received the meals.
Professionally, Jim was singularly involved in the practice and teaching of pharmacy and administration of the student academic affairs function at Ferris State University. He graduated from the Ferris State University College of Pharmacy in 1949. He then practiced as a pharmacist in Alpena, Hastings and Cadillac before purchasing the former Fairman Drug Store in Big Rapids in 1960. He operated the store as Turner Pharmacy until 1975, when the store was sold but still functioned as the Turner Pharmacy. Shortly thereafter, he joined the faculty of the College of Pharmacy at Ferris State University as a teacher of pharmacy practice. He quickly moved into administration in the area of student academic affairs, retiring in 1994 as Associate Dean of Student Academic Affairs. He was awarded the Clark A. Andreson Alumni Recognition Award shortly after his retirement.
During his career at Ferris, Jim was a member of the American Pharmacists Association, Michigan Pharmacists Association and the American Association of Colleges of Pharmacy. He also met and collaborated with his cohorts in student academic affairs across the nation on a regular basis. He continued his education, earning a Master of Science degree from Central Michigan University and a Ph.D. from the University of Michigan.
Cremation has taken place. In lieu of a traditional funeral, the family will greet friends from 2 to 4 p.m. on March 2, 2013, at the Holiday Inn to celebrate Jim's life.
Memorial contributions may be made to the James B. Turner Memorial Scholarship Fund for the Ferris State University College of Pharmacy. Alternatively, Jim asked that memorial contributions be made to the Mecosta County Habitat for Humanity, Women's Information Services (WISE), the Big Rapids Community Library or the Mecosta County Senior Center (Meals on Wheels and/or Medical Transportation). Hospice of Michigan also is suggested by his family. (end of Pioneer article)
That's the official line. When growing up in Big Rapids, the Turner Pharmacy was the alternative to the old Martz and Shapley's on the main street, and both places smelled of Robitussin and witch hazel. Later, as I found myself awash in the often frustrating curriculum of pharmacy at Ferris, Jim Turner was one of those too-rare bright spots in the education sphere there. His sense of humor was dry and deliciously scewed - and with little provocation he could launch into a Great Carsoni routine or extrapolate from dialogue by Bob and Ray. He related to me his shock on learning, during his last minute decision to get a retirement physical ("Hey, it was still on the college insurance at that point."), that prostate cancer was a new visitor in his life. Certainly his bright outlook gave him more time than any physician could have predicted. "Guess all I have to do now is grow a beard," he said of his retirement in that conversation. And while his photo above is how many saw him for the past several years, here is the image I recall when thinking of one James B. Turner, The World's Greatest Associate Dean of Student Affairs:
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