Giving patients written instructions on the proper use of blood thinning medication reduces the risk of life threatening complications such as gastrointestinal bleeding and hemorrhagic stroke, according to the results of a study published in the Journal of General Internal Medicine.

Dr. Joshua P. Metlay and his team at the University of Pennsylvania reached this conclusion after studying 2,346 elderly patients that took Coumadin for various reasons.

The scientists found that only 55% of patients in the study recalled getting medication instructions of any type from nurses or physicians.

Patients that did recall receiving instructions from a nurse or a doctor plus a pharmacist were 60% less likely to incur a serious bleeding complication in the ensuing 2 years. This benefit was independent of cognitive function, patient age, living arrangements and the number of co-administered medications.

Only written instructions seemed to make a difference. Verbal instructions did not reduce the risk of bleeding complications.

“While we do not know the specific mechanism linking the medication instructions to reduced bleeding risk, it is likely that improved communication about medications leads to increased drug adherence and earlier recognition of medication side effects,” Dr. Metlay said in a press release picked up by the Washington Post.

The results of the study support the FDA’s 2006 mandate that a medication guide be distributed to patients taking Coumadin. The study design used here did not allow scientists to determine the optimal format for written instructions or to evaluate the instructions put forward by Bristol-Meyers, the makers of Coumadin, in response to the FDA mandate.

No one needs to hear more bad news about the economy, but it keeps coming anyway.

Last week Circuit City, the nation’s second largest electronics retailer filed for Chapter 11 bankruptcy protection. 8,000 jobs will be lost.  It’s the latest of 14 major retail chains, including Steve & Barry’s, Mervyn’s and Linens ‘n Things to file for bankruptcy protection in the last 12 months.

And since most can’t line up financing to reorganize and come out swinging, they simply liquidate and disappear.

A tenth of the American workforce works in retail, but in the last year a quarter of all US job losses—320,000 according to the Wall Street Journal—have been in this sector. This doesn’t include another 200,000 workers whose employment has been switched from full- to part-time.

The pummeling of retail speaks volumes about the severity of the Great Economic Crisis of 2008. In mild recessions such as the one linked to the dot com collapse and the terrorist attacks of 2001, retail employment hangs in there for a long time because consumers continue to spend, maybe not as much but at least some.

Not so this time. Job losses in retail are already more severe than in financial services, automotive manufacturing and hospitality, and experts think the worst is yet to come.

Now for the bad news. Retail jobs have traditionally served as an economic safety net for Americans. If we needed a second job to make ends meet, we found it in retail. If we got laid off from a manufacturing job, we ended up in retail. If we were fresh out of college and couldn’t get a dream job, we headed for retail. Same thing if we didn’t go to college in the first place.

Forget that.

Medicare owes tens of millions of dollars to physicians in California, Nevada and Hawaii. The delinquent payments are in some cases so large and so late that physicians have been forced to turn away beneficiaries, lay off staff and default on rent.

Medicare owes Tim Ganey and his oncology practice $750,000 for example, and as a consequence the practice doesn’t have cash to purchase chemotherapy drugs for its patients. So it either needs to take out a loan, cajole the drug companies, or admit patients to hospitals which are inconvenient and inefficient places for cancer therapy.

Things have gotten so bad for Walnut Creek cardiologist Sally Davis that she’s taken to doing the office laundry to save money. Davis told the Los Angeles Times that Medicare owes her practice $700,000.

The payment delays result from Rube Goldberg-like process complexity in 2 organizations.

Earlier this year, the Centers for Medicare and Medicaid Services began assigning new ID numbers to physicians as part of its plan to expedite Medicare payment. ID assignments were supposed to be complete by May but physicians in some western states had not received their numbers by September.

That was when CMS switched Medicare claims processors for those western states, and the handoff didn’t go well. The new vendor, Palmetto GBA of South Carolina had to contend with unstable CMS databases arising from the ID project. It may not have received properly formatted information from CMS or the previous vendor. And it managed to botch a host of mundane administrative tasks like processing address change requests.

Then, when Palmetto went live it was not staffed to handle the flood of calls from irate physicians. Palmetto’s call center received 45,000 calls that first day. It was staffed for 2,500. Three months after start-up, 90% of calls to Palmetto were still greeted by a busy signal.

But CMS officials have defended Palmetto. Torris Smith, an associate regional administrator pointed to Palmetto’s 40 years of experience as a Medicare contractor and asserted the organization was selected using a “full and open competition.”

“There are always going to be general transition issues,” Smith told the Times. He added that the backlog of applications for the ID numbers should be cleared out by the end of the year.

No word though on when the docs actually get paid.