Misuse of Vitamin K

[Guest]

I just added the following to my website.

Wu et al report on a study of reversing warfarin for patients with INRs between 3 and 20 conducted at a teaching hospital affiliated with a world-renowned medical school. Fresh frozen plasma (FFP) was used in 22 patients. According to the guidelines published with the article, this was the correct agent to use in 21 of those patients. However, only 5 (23.8%) of the patients received the correct dose of FFP. There were an 21 patients who should have been given vitamin K according to the guidelines. Of these, only 14 were given vitamin K. Of those 14, none (0%) received the correct dose. Editor's Note: Not only is vitamin K being misused, the doctors in training are being taught to misuse it.

This is why I don't put much faith in doctors who recommend INR ranges that are outside the guidelines. Often they are not tailor making them to the individual, they simply do not know what the guidelines say.

 

[Ross]

Do you think that these Doctors may get it together any time soon or even in my lifetime? I mean this is ridiculous. They have to prescribe something that they don't even understand.

 

[RCB]

So sad, but true

 

[Nancy]

In Joe's long career in Coumadin (26 years), we can count on the fingers of one hand the number of doctors who fully understand Coumadin management.

Do you think it's because there's some minor math attached to the figuring of the dosages? I know that the younger generation and the older generation is math deprived. But then they could get a chart if need be, and I think there is a computer program the figures it all out.

The most basic error we find is that the ones "not in the know", don't know how to figure out the INR ranges for different individuals.

OK, OK, so I have come right around to what Al said above, "they simply do not know what the guidelines say".

 

[Marty]

I was surprised too. Neither my cardiologists or surgeons had much interest in managing coumadin. We are not fortunate in this area to have private clinics managed by pharmacists like Al. When I went back to work for Kaiser , an HMO ,I found they have 2 PhD pharmacists manging their clinic but you need to be a Kaiser patient to use it and Alice and I have Medicare and stuck with our regular doctors.. Roche( I was consulting for them) sent me to a big international "thrombosis" meeting when I was about 6 months postop and still not managing well. I was doing the yoyo most of the time. At this meeting I met a hematologist from Vienna, Austria who told me I would do best if I did my own dosing with the Coaguchek as a guide and used the 10% solution when out of range. He said he liked his patients in Austria to do this and most of them could handle it. It has worked for me. I have not used the central lab or bothered my doctors about dose change for over four years. I did E-mail Prof. Jack Ansell in Boston with a few questions and always received a prompt reply.
Jack has been an advocate for patient self management for years.
You can check with him too after first checking with Al and getting his opinion.

 

[LUVMyBirman]

Have had a few lab draws in the past week (at a local hospital) to satisfy my carido after my run in with a medication that caused an INR of 8.1.

My Coaguchek is right in line with the lab so that is good news.

Make a long story short. Both times I went in for testing...... there were so many individuals having a protime drawn. Finally asked someone it they planned on opening a Coumadin clinc. Another patient quickly chimed in and a said she has been writing the hospital admistrator for such. Coumadin nurse proceeded to tell us that they need a bigger lab for the clinic.. ..they are out of space. Normally this would not be an issue....but she shared that Medicare is not interested in such a venue and would only pay $9 per draw.

Should be interesting to see what they are charging now for a protime. She said one fee goes to the hospital...one to the lab. Now isn't that crazy? If these insurance companies would just approve such testing (in home, etc) they would save so much.

Prior to my Coaguchek.....my testing at a local Dr. office was billed $90. $15 co-pay for myself. I can get 10 tests or so out of my Coaguchek for the same amount! Lets not mention the time spent sitting in the lab 3 times in the past week! Why are some doctors so leary of home unit accuracy? After all, it was my Coaguchek that saved the day and raised the red flag!

 

[Lisa in Katy]

When I get my EOB for the INR, there is a code for "surgery" and another for the test. I don't pay attention to the charge because I have a $10 copay. I think they charge something like $45.

 

[Ross]

Also bare in mind folks, that is the "Billed amount" not what the insurance companies "Actually Pay". What is billed and what is payed is a big difference. Usually it gets paid at about 1/3 of the billed amount.

 

[Guest]

I think that a lot of places would be happy with 1/3. I think that we bill $45 and get $9 from Medicare. Do not ask why!!! I do not ask why!! Medicare is so complicated that I think that every hospital, doctor's office, therapy center etc could be charged with fraud. Medicare is so complicated that most of the same people charged with fraud could point out that were doing exactly what is allowed under the law.

 

[RickKiem]

My clinic uses a Coaguchek and bills United Healthcare $16.00 and receives @ $4.00 per visit. I do not have to pay a copay for this. I do not see how they even break even.

Rick

 

[Guest]

We do not come close to breaking even. This is why, as Marty as written, they do not have the clinics in his area. We function as a public service. My departments runs on grants, insurance billings, and other services that we provide. Also there are only two hospitals in the area and the other hospital has one. So we cannot fall away and let all of the people go there.

 

[RCB]

Echo everyone above

Echo everyone above

My cardiologist follows my protime like a hawk and I try to make his life easy. Appointments are made by secretary,
when I come to his office a receptionist takes my name and let
the lab know I'm there, the lab picks up my chart and calls me
from the waiting area, she checks my DOB and my dosage, draws
the blood- bandages me, then spins it and does the protime,
then she shows the dr. the results, he makes a decision and relays
that to the secretary and she calls me with the results. All that
and medicare pay a total of $9 bucks! If that isn't charity, I don't
know what is.

 

[LUVMyBirman]

The $90 charge I mentioned above was reduced to $65 by my insurance carrier. The same carrier that refused to pay $72 for a box of strips that would allow me to preform 10 tests or so depending upon my control method.

It is my understanding that these home units are not approved by the FDA? At least I was once given this information. If you think about it.......there is no way to classify an "non-approved" medication or proceedure. That may be the key here. Also the reluctancy that most doctors hold on home testing.

Ps.......I found supporting documentation that these units are approved by the FDA. So.....what's the problem "insurance carriers"?????

Coumadin is a very powerful medication that can be dangerous if not monitored properly. Last week my Coaguchek caught a seriously high INR that would have gone undetected if I were using a lab just once a month! Do they hand out licenses to drive to individuals that have not passed the test? This is shameful practice if you ask me!

 

[catwoman]

Gina:

Have you thought about sending a printout of your problems with Monistat to your insurance carrier, along with your comments in this thread? I'd go up the food chain on that one.