DPH Proposes New Regulations for Prescription Monitoring Program

Rules May Apply to All Physicians and Prescribers

The Department of Public Health this week presented draft regulations to the Public Health Council to implement changes to the state Prescription Drug Monitoring Program (PMP).

The draft regulations spell out the requirements for review of 12 months of prescribing history in the PMP database by all fully licensed physicians and other professionals for new patients and those who have not been seen in the past 12 months. This requirement appears to be proposed for any patient encounter, regardless of the likelihood of prescribing being indicated.

While there are some exceptions to the requirement listed and more possible in future guidelines, the MMS had hoped the proposed regulations would be more reflective of the demands of clinical practice than the initial draft has proven.

The MMS has engaged the DPH in discussions around the proposed regulations and on recent changes to the drug control registration program done without regulations or public comment and which require submission of email addresses and certification of compliance with the PMP requirements as a condition of receiving a state registration.

The MMS recognizes that limitations of the state database system and federal grant requirements for adherence to specific patient privacy protections have probably had an impact on the DPH in its decisions.

Physicians who cannot meet the new requirements are urged to contact the Department for a waiver of the email requirement. MMS government relations staff is interested in your experiences if you have been subject to a registration recall in 2013. We are also interested in your experiences with the PMP database .

A meeting with DPH staff on the proposed regulations and MMS’s concerns with changes to the drug registration process is scheduled for early March. The MMS continues to investigate options in responding to these initiatives.

There will be a public hearing on the regulations March 22. A final vote is likely at the April Public Health Council meeting.

Physicians are urged to review the proposed regulations and the DPH vision for the PMP program. Future MMS communications will provide more details.

– William Ryder, Esq.

  1. T K says:

    I haven’t read through the entire document in careful detail, but one thing that I would like to see addressed is outpatient procedures done by a consulting service.

    As a resident with a future in interventional procedures, there are many procedures I will perform on an outpatient setting and one time only (hopefully).

    I may only see the patient a maximun of 3 times (pre, procedure, post). Some of our procedures cause a lot of pain and we may need to write a short term prescription for pain meds.

    I feel that 105 CMR 700.012(H)(2)(f) should be amended to include outpatient consulting services.

  2. I am baffled that as physicians we are told how to practice medicine by law makers.
    I have never prescribed a pain killer for two reasons: one I was told that if I get the license to prescribe suboxone then I should never prescribe a pain killer, the second reason is that I refer patients to their PCP and orthopedic physicians to do so: this way the pain treatment is done by one doctor.

    I am practicing as a psychiatrist and was told by BCBS of MA that I was the only doctor who was not using EMR in 2008. In 2009 I designed my own EMR using filemaker pro and was told again by BCBS that I was the only psychiatrist in private practice not using EMR used by everyone.
    In January 2012 I opted for EMR called Practice Fusion and when I tried to show BCBS of MA all the changes I implemented I was told they did not need to see and 2 weeks later they send me a letter stating that I did not write my notes in accordance to the majority of psychiatrists:

    Are any psychiatrist here using EMR ? and on BCBS of MA ?
    are you able to send me a letter stating how you wite your notes?

    Thank you

    Dr. Nouvellon

  3. Lawrence F. Berley, M.D. says:

    I had sent in my application for renewing the controlled substances registration on 1/24/13. The application asks for email but does not specify that it is required. Because I do not have a computer in my private office and did not want DPH sending me emails with patient information on my home computer which is potentially accessible to other family members, I wrote in the email box that I do not use email for office work. I do not prescribe narcotics in my private office as a psychiatrist and thought it would be very unlikely that I would be needing to check the DPH records to see if a patient was getting multiple narcotic prescriptions. In my role as a moonlighter at McLean Hospital Southeast, I very much liked the idea of being able to check the DPH database for a newly admitted patient’s prescription history (proovided the patient gives written consent to do so). I had thought this would be done on a computer from the hospital location, not involving my email address. About a week ago, I received my application and check with the email answer highlighted in pink and a form stating the applicatioon was incomplete. I called the DPH and was referred to someone with whom I explained my dilemma. I was told the reason my email was being requested was for the DPH to contact me; I said they could contact me by the phone number I had listed. I was referred to another person who told me the DPH needed my email to send me introductory information by emai. I said that such information could be sent to me by U.S. mail. I was told that DPH could not do that. I reviewed again that I did not want to be receiving DPH patient information on my home computer because I would then be required to protect that information according to HIPAA regulations which would mean preventing other family members from using my home computer. The staff person replied that patient infomation avilable only by opening up the program website and searching it. The implication was that they were not sending me information about patients by email. I asked the staff member if there was a computer designated for doctors at the DPH itself where I could come and do that search; she laughed and said they didn’t have any plans to provide such a convenience and told me I could go to any library and use a public computer there to do a search or even on my smart phone; Clearly, the staff person had no idea of the problems of protecting patient privacy using electronic devices. I ended the conversation asking the staff member to send me information by U.S. mail about the program so I could decide whether to give my email address on the renewal application. I am between a rock and a hard place in that my registration must be renewed before 3/3/13. It would be especially burdensome to have to review all prescriptions for a year for each new patient as the DPH is proposing. Because this represents a breach of confidentiality, the only way I could envision such access being done is by the patient signing a consent form allowing such a search. For my private office, it would mean having a computer or electronic device there dedicated to that task. Larry Berley

  4. Albert Alexander MD says:

    The DPH has done a poor job of educating physicians about the database and how to use it for those patients where we might have a suspicion that this might be worth checking. For the vast majority of patients where there is no medication prescribed, this makes no sense. It also fails to recognize that if a known drug-abusing doctor shopping patients sees us with, say, a new Colle’s fracture, they still need some pain medication. Another unfunded mandate which goes way overboard.

  5. Julian Melamed MD says:

    Applying this to all non narcotic prescriptions is draconian and totally counter productive.
    In addition this may be a blatant HIPAA violation in that patients records will be reviewed without their consent , that may be not pertinent to their care by a specialist.

  6. Robert D'Agostino, MD says:

    Another misguided regulation pushing doctors closer to retirement. If I wanted to perform law enforcement, I would have gone to the Police Academy.

  7. the database was supposed to be a place physicians could check when there were concerns about controlled substance inappropriate usage. this is a major hoop to add to a doctor’s day with very low yield.

    Im not sure that this law addresses a concern appropriately.

  8. Alice Ling, M.D. says:

    Please do not make me do one more thing to take care of my patients.
    What are you supposed o do if your internet access is down? Their website is down? Plus the information is months old and there is no recent information .
    To get around the system all the patient has to do is use a different name, or misspell it by 1 letter and then pay in cash at the pharmacy.

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