Gov. Baker Releases Budget; Board of Registration in Medicine and Mass Health Affected

Posted in Board of Medicine, Uncategorized on March 6th, 2015 by Erica Noonan – Be the first to comment

 

BY WILLIAM RYDER, ESQ

MMS LEGISLATIVE COUNSEL

Governor Charlie Baker released his first budget this week. Saddled by deficits from the previous administration, particularly in MassHealth spending due to well-documented problems with the Connector, Gov. Baker was faced with significant challenges.

Overall spending is up in MassHealth for Fiscal Year 2016. This is led by managed care line item increases with fee-for-service appropriations slightly down. Both these amounts are based on anticipated demand and projected to maintain access to covered services and maintain current rates. Chiropractic coverage is eliminated for a projected $300,000 saving.

Gov. Baker’s stated commitment to rein in MassHealth spending by confirming eligibility, rather than through across-the-board cuts to providers and legitimate patients, is a reasonable and fair approach that is also federally mandated. Some physicians have expressed concern about reports  that the state could carry over some payments from this fiscal year in FY16. This is often done in state government late in the fiscal year. It does not mean that there will be no payments until July. The governor’s budget proposal is a proposal which must be acted on by the legislature to become law. Usually final passage occurs in June.  Massachusetts State House

Also in the budget is the prescription monitoring program, funded at approximately $1.2 million, a reduction of about $45,000 from last year. It has only six employees to register prescribers, pharmacists, and delegates. As we try to evolve a better PMP, perhaps more resources should be provided to improve the system, provide support staff to participants with concerns, and strengthen the database.

The governor’s proposed budget also included outside sections that would directly impact the Board of Registration in Medicine by placing it within the Mass. DPH and under the authority of the commissioner. The MMS has always supported a fully funded, independent medical board with oversight by the Division of Administrative Law Appeals, the Supreme Judicial Court and the Commissioner of Public Health with some oversight on new regulations. This change was offered by former Senator Richard Moore and rejected in last year’s budget.  MMS will work to maintain the medical board’s independence.

Physician Focus for March: The Measles Outbreak and The Value of Vaccines

Posted in Physician Focus, Public Health on February 27th, 2015 by MMS Communications – Be the first to comment

The current measles outbreak, which began last December in Disney World and has since led to more than 150 cases in 17 states, is a stark reminder that diseases once declared eliminated can, without vigilance, return easily and spread quickly.

To remind patients about the benefits of immunization, the March episode of Physician Focus examines the current outbreak, how it came about, and why vaccines merit its place on the list of the top ten greatest public health achievements of the 20th century.

Guests are George Abraham, M.D., (photo, center) a board-certified infectious disease specialist, Associate Chief of Medicine at Saint Vincent Hospital in Worcester, Professor of Medicine at UMass Medical School, and Governor of the Massachusetts Chapter of the American College of Physicians, and Sean Palfrey, M.D., (right) a pediatrician at Boston Medical Center, Clinical Professor of Pediatrics and Public Health at Boston University School of Medicine and the founder and director of the Immunization Initiative of the Massachusetts Chapter of the American Academy of Pediatrics. Hosting this edition is primary care physician Bruce Karlin, M.D. (left).

Among the topics of discussion are how once-eradicated diseases like measles can return and spread, how dangerous childhood diseases can be and why people tend to discount their severity, the risks of not getting vaccinated, how herd immunity to protect the public’s health is determined, how misinformation about medicines can spread quickly, how physicians may deal with patients and their parents who have questions or reservations about vaccines, and the importance of immunization for adults as well as children.

Physician Focus, now in its 11th consecutive year of production, is available for viewing on public access television stations throughout Massachusetts. It is also available online at www.physicianfocus.org, www.massmed.org/physicianfocus, and on YouTube.

The President’s Podium: Reducing Opiate Abuse

Posted in Department of Public Health, Health Policy, Medicine, opioids on February 18th, 2015 by MMS Communications – Be the first to comment

By Richard Pieters, M.D., President, Massachusetts Medical Society

Governor Charlie Baker and Attorney General Maura Healey have each made opiate abuse one of their top priorities, and this week they will announce steps they will take to fight this public health crisis. That the state’s top elected official and top law enforcement officer have put this issue at the forefront of their agendas is good news, because even as Massachusetts ranks as one of the top four states in adopting strategies to curb prescription drug abuse by the Trust for America’s Health, prescription and opiate abuse remains a crisis in the Commonwealth.

MMS has reached out to both the Governor and Attorney General to offer our assistance as they address the problem. Their initial responses have been encouraging, and we look forward to hearing the specifics of their plans and working with them.

One of the keys to reducing the abuse, however, is a sustained effort in raising public awareness about the issue, and the Massachusetts Medical Society has long recognized the importance of communicating to both physicians and patients about prescription drug abuse.

We highlighted the topic in 2011 with our patient education television program that reaches communities across the state, and in subsequent shows addressed the topic of substance abuse in young people and how they can be treated.

Our current program revisits the subject of prescription abuse with experts in addiction medicine. Additionally, we have distributed articles to local media, to outline what both physicians and patients can do to prevent prescription abuse. This is especially important, as more than three out of four people who misuse prescription pain medicines use drugs prescribed to someone else.

My predecessor Dr. Ronald Dunlap last year outlined the physician’s perspective on prescription drug abuse and recommended additional steps that can be taken to reduce the abuse.

I have since provided my views and recommended improvements in the state’s prescription monitoring program, which the Society helped to create more than 20 years ago. We believe a well-run, real-time, robust monitoring program is a key element in the fight against prescription abuse and one in which every physician should participate.

MMS will continue its educational effort on opioids and prescription abuse on April 8 with our Annual Public Health Leadership Forum for physicians and health care providers. The Opioid Epidemic: Policy and Public Health, featuring local and national leaders in substance abuse and addiction medicine, will discuss a range of issues, including the basics of pain management, alternatives to opioids, communicating with patients about pain management and treatment, and advocacy for treatment programs for those with addictions. This forum will offer important information for those who prescribed opioids and treat pain and addiction, and I urge those who do so to attend.  Also, the MMS Ethics Forum at our annual meeting in May will explore the ethical and legal considerations in pain management by physicians.

As government and public health officials seek remedies to the opiate crisis, we urge them to recognize that physicians and their patients – the ones who treat the pain and take the medicines – can play critical roles in reducing the abuse.

The President’s Podium appears periodically on the MMS Blog, offering Dr. Pieters’ commentary on a range of issues in health and medicine.

Interoperability is New Focus for Health IT

Posted in Electronic health records, Electronic Medical Records, meaningful use on February 13th, 2015 by Erica Noonan – Be the first to comment

By Leon Barzin

MMS Director of Health Information Technologykeyboard 1

Barriers to interoperability continue to be main challenges to moving the nation’s health care system beyond simply making electronic silos of information from paper ones, according to experts at the recent annual meeting of the eHealth Initiative.

The recent Meaningful Use Program started with three goals for the identified stages: Stage 1: data capture and sharing; Stage 2: advance clinical processes; and Stage 3: improve outcomes.

Stage 1 of Meaningful Use, as painful as it has been to some independent practices, is generally considered quite successful in fostering electronic data capture.  It has moved the use of electronic medical records from single digits in the pre-Meaningful Use period to an estimated 70 percent nationwide today.

Unfortunately, it appears that both Stages 1 and 2 have largely failed in the primary objective of “sharing,” moving health data security to the right place at the right time – especially among dissimilar systems.

In January 2015, the U.S. Department of Health and Human Services released the document, A 10-Year Vision to Achieve an Interoperable Health IT Infrastructure.

If improved interoperability can be achieved via this federal roadmap, such a system would support more efficient and effective healthcare and lead to a continuously improving health system that empowers individuals, customizes treatment, and accelerates cure of disease.

On the heels of the release of the government’s document, the eHealth Initiative held its yearly meeting last week, bringing together physicians, administrators and other national experts to focus on how this plan could be implemented in real clinical environments.

Several consensus items among attendees were clear:

  • EHR vendors and providers can no longer ignore interoperability.
  • New secure interoperability software is on the near horizon and mobile devices will be the focus.
  • Patients will soon be included as active partners in their healthcare and possess some or all of their records on their smartphones.
  • Wearable sensor devices like Fitbit will become more clinically connected and able to provide useful clinical information.
  • Early pilots in telemedicine are moving toward standard operation, especially chronic disease management, benefiting from advances in sharing technology.

Although there seems to be little impetus for additional “checkbox” Meaningful Use requirements, it appears efforts will shift throughout the industry, within provider communities, and at CMS to push forward with interoperability improvements.

MMS Building Status for Tuesday, Feb. 10

Posted in MMS Building Information, Weather Alert on February 9th, 2015 by MMS – Be the first to comment

Because of the winter weather, MMS facilities will be operating at reduced levels on Tuesday, Feb. 10.

Some meetings are still being held as scheduled. If you have an event scheduled at an MMS facility, please check with your meeting or event coordinator for the status of your event.

February Physician Focus: The Physician’s Perspective on Prescription Drug Abuse

Posted in Drug Abuse, Health, opioids, Physician Focus, Public Health on January 30th, 2015 by MMS Communications – Comments Off

Health and governmental officials at all levels are struggling with solutions to what has become one of the nation’s most pressing public health problems: prescription drug and opiate abuse.

Addiction experts, public officials, and even some physicians, have pointed to the medical profession as one cause of the problem. Physicians write too many prescriptions, they say.  But the fact that more than three out of four people who misuse prescription pain medicines use drugs that are prescribed to someone else is one indication that the problem arises from more than a single cause.

The February edition of Physician Focus, with a discussion among three physicians knowledgeable about the treatment of pain, pain medications, and opioid abuse, offers the perspectives of physicians on prescription drug and opioid abuse.

Participating in this conversation are Richard Pieters, M.D., (center, photo) President of the Massachusetts Medical Society and Professor of Radiation Oncology and Pediatrics at the University of Massachusetts Memorial Medical Center in Worcester; Daniel Alford, M.D., (right) Director of the Safe and Competent Opioid Prescribing Education program at Boston University School of Medicine and the Director of the Clinical Addiction Research and Education Unit at Boston Medical Center; and Barbara Herbert, M.D., (left) Medical Director of Addiction Service at Commonwealth Care Alliance and President-Elect of the Massachusetts Chapter of the American Society of Addiction Medicine, who serves as host for this program.

All three physicians bring their personal experiences in treating patients with pain to the discussion. Among the topics they address are the physicians’ viewpoints on the causes of opiate abuse; the prevalence of pain as a medical condition; the elements of effective and safe pain management; the distinctions among different kinds of pain; what steps physicians and patients can take, both individually and collectively, to reduce the abuse of pain medicines; and how physicians view the use of the prescription drug Narcan to prevent deaths from overdoses.

Physician Focus, now in its 11th consecutive year of production, is available for viewing on public access television stations throughout Massachusetts. It is also available online at www.physicianfocus.org, www.massmed.org/physicianfocus, and on  YouTube.

New Medical Marijuana Registration Rules Take Effect Feb. 1

Posted in Department of Public Health, Medical Marijuana on January 30th, 2015 by MMS – Comments Off

marijuanaEffective February 1, 2015, patient certifications from physicians for the medical use of marijuana must be submitted electronically. Paper certifications are no longer sufficient to comply with state law or regulations.

Patients must now obtain their certifications electronically and be registered with the Medical Use of Marijuana Program to possess marijuana for medical use. Paper certifications will no longer be valid. Patients who previously had a paper certification must get a new electronic certification from their physician.

Physicians who wish to certify patients for medical marijuana must now do so electronically. Paper certifications will no longer be valid. Before certifying patients electronically, physicians must register with the state, after earning at least 2 CME credits relating to medical marijuana.

 Additional Resources

What Mattered Most to Physicians Last Year? Top MMS Website Content in 2014

Posted in website on January 2nd, 2015 by MMS – Comments Off

What mattered most to Massachusetts physicians in 2014? The most heavily visited pages on the MMS website may offer some hints.

This list is not a complete traffic report; it covers only individual articles. It doesn’t include transaction pages, or the pages that list individual article pages.

The top 25 are listed here, ranked by the number of page views. Perhaps you will find it of some interest.

  1. Health Care Proxy Information and Forms
  2. Continuing Medical Education Requirements for Physician License Renewal in Massachusetts
  3. Choosing a Specialty
  4. Find a Physician
  5. MMS Careers
  6. End-of-Life Care Series (Online CME course)
  7. MMS Leadership
  8. Health Care Proxies and End of Life Care
  9. Opioid Prescribing Series (Online CME course)
  10. Physician Health Services
  11. Medical Marijuana
  12. Important Differences Between Health Care Proxies and Living Wills
  13. Managing Risk When Prescribing Narcotics Painkillers (Online CME course)
  14. House of Delegates
  15. Legal Advisor: Advance Directives (Online CME course)
  16. The Importance of Discussing End of Life Care (Online CME course)
  17. Medical Price Transparency Law Rolls Out: Physicians Must Help Patients Estimate Costs
  18. MMS Study Shows Patient Wait Times for Primary Care Still Long
  19. Proposed EHR/Meaningful Use Regulations
  20. Medical Marijuana CME (Online CME course)
  21. Physician Health Services: Success Story – An Amazing Journey to Sobriety
  22. Avoiding Failure-to-Diagnose Suits (Online CME course)
  23. Legal Advisor: Identifying Drug Dependence (Online CME course)
  24. Medical Mistakes: Learning to Steer Clear of the Common Ones (Online CME course)
  25. Massachusetts Medical Marijuana Law: Considerations for Physicians

January Physician Focus: Chronic Kidney Disease

Posted in Health, Medicine, Physician Focus, Public Health on December 31st, 2014 by MMS Communications – Comments Off

The kidneys are vital organs in the human body, performing such critical functions as cleaning blood, removing waste, and controlling blood pressure. Yet more than 20 million Americans have chronic kidney disease, a serious condition that raises the risks of heart attack, stroke, and end-stage kidney disease.

To create awareness among patients about the condition, Physician Focus begins 2015 with a guest appearance by Martin Gelman, M.D., (photo, right) a board-certified internist and nephrologist who practices at Milford Regional Medical Center and St. Elizabeth’s Medical Center in Boston. He joins program host Bruce Karlin, M.D., (photo, left) a primary care physician in Worcester, in conversation about various aspects of the disease.

Among the topics discussed are the functions of the kidney in the human body, the major causes and effects of chronic kidney disease, who is most at risk for the condition, kidney dialysis and transplants, and a look at what the future might hold in renal replacement therapy with a bio-implantable artificial kidney that has just been approved for clinical trials.

Physician Focus, now in its 11th consecutive year of production, is available for viewing on public access television stations throughout Massachusetts. It is also available online at  www.massmed.org/physicianfocus, www.physicianfocus.org, and on YouTube.

Walgreens Expands Its “Good Faith Dispensing” Policy

Posted in Drug Abuse, opioids on December 22nd, 2014 by MMS – Comments Off

Presciption drugs and stethoscopeIn April 2013, Walgreens Pharmacy notified health care providers across the country of its revised policy for the dispensing of controlled substances.

The letter cited every pharmacist’s corresponding responsibility, along with physicians, to ensure that every prescription for a controlled substance “must be issued for a legitimate medical purpose.”

The letter said Walgreen’s pharmacists would start taking additional steps when verifying certain prescriptions for controlled substances. MMS has heard from several physicians inquiring about this policy.

Walgreens’ policy states: “Our pharmacists are required to take additional steps when verifying certain prescriptions for controlled substances. This verification process may, at times, require the pharmacist to contact you … information requested may vary, potential questions could include information about the diagnosis, ICD-9 code, expected length of therapy and previous medications/therapies tried and failed.”

According to an FAQ provided to the New Hampshire State Medical Society, Walgreens has emphasized that this new policy should not mean calls to prescribers on every, or even most, prescriptions for controlled substances.

Why did this happen?

Over the past few years, the Drug Enforcement Agency (DEA) has increasingly been looking at the problem of narcotics abuse in this country. While the DEA has investigated and prosecuted individual prescribers of prescription narcotics and synthetic opiates, the DEA is also looking at the distributors and dispensers of these prescription drugs.

The DEA has also been visiting states nationwide and presenting an intense power point lecture to help train pharmacists and remind them of their corresponding duty under federal regulations to ensure that each prescription for a controlled substance is issued for a legitimate medical purpose by each individual prescriber.

In response, Walgreens revised its policy on good faith dispensing of controlled substances, using in part “red flags” as determined by the DEA. Walgreens wants its pharmacists to be comfortable when they fill a prescription for controlled substances and the policy lays out suggestions on how to assure that the prescription is legitimate.

Where do things stand?

MMS has worked closely with the AMA in sharing information and gaining a perspective of this problem on the national scale.  The AMA, along with the national medical societies for family physicians, emergency physicians, anesthesiologists, and osteopathic physicians have been part of broad medicine-pharmacy meetings convened by the National Association of Boards of Pharmacy, with Walgreens, CVS, the National Association of Chain Drug Stores, National Community Pharmacy Association, PhRMA, DEA and other groups to identify “red flags” that stakeholders agree would warrant some sort of further review.  It is anticipated that this set will be reviewed by the stakeholders in Spring 2015.

Red Flags of Illicit Use, Doctor Shopping, and Diversion of Controlled Substances

For Physicians

  • Symptoms incompatible with reported injury
  • History of problems with no medical records
  • Patient reports being from out of town
  • Multiple accidents
  • Insistence on drug of choice
  • Requests drugs by their street names, e.g. “blues” “Ms”
  • Loss of prescription or medications
  • Failure to provide or go for medical testing
  • Taking more medicine than directed
  • Requests medicine refills early
  • Use medicines from multiple physicians or filled at multiple pharmacies (as seen on the Prescription Monitoring Program)
  • Use of medicines prescribed for others
  • Use medicines in combination with alcohol
  • Paying in cash or sometimes uses insurance and other times cash

For Pharmacists

  • Prescriptions for large quantities of a “cocktail” or “holy trinity” of opioids, benzodiazepines, and carisoprodol
  • Diagnosis of lower lumbar pain. DEA testified that 90 percent of the pill mill doctors use lower lumbar pain as a diagnosis code
  • Pattern prescribing. Prescriptions for the same drugs, the same quantities, coming in from the same doctor
  • Shared addresses by customers presenting prescriptions on the same day
  • Customers going to the pharmacy counter with dilated pupils and difficulty concentrating
  • Unusual physical distance between the doctor, the patient, and the pharmacy
  • Patients paying in cash or sometimes uses insurance and other times cash
  • Prescriptions done in a “factory-like” manner – no reason to prescribe 15mg and 30 mg oxycodone because 30mg tablets are scored down the middle
  • Use medicines from multiple physicians or filled at multiple pharmacies (as seen on the Prescription Monitoring Program)
  • Inordinately large quantity of controlled substance prescribed
  • Prescriptions refilled at inconsistent intervals based on quantity
  • Use of street drug name by either the patient or the prescriber
  • Suspicion of forged or altered prescription
  • Suspicion of forged or altered identification or refusal to provide

What should you, the prescriber do?

If you or your patients have difficulties filling prescriptions for controlled substances at any pharmacy please contact the MMS Physician Practice Resource Center at (781)434-7702 or pprc@mms.org.