Idaho Medical Association IMAges Inside this issue Volume XXV No. 9, S EPTEMBER 15, 2014 Updates from the DEA The Drug Enforcement Agency (DEA) has recently published several important rule changes. Tramadol a Schedule IV Controlled Substance On July 2, the Drug Enforcement Administration (DEA) published its Final Rule in the Federal Register placing tramadol into Schedule IV effective August 18, 2014. (Tramadol is a centrally acting opioid analgesic first approved for use in the U.S. in 1995 under the name “Ultram”. Since then, the Food and Drug Administration (FDA) has approved for marketing generic, combination and extended release versions.) The DEA follows in the path of a number of states that have already taken this step such as Arkansas, Mississippi, and New York. By making tramadol a Schedule IV controlled substance, the DEA makes it easier for the pharmaceutical industry to develop consistent policies and procedures nationwide for how this drug is handled. It is important to note that as of August 18, 2014, manufacturers are required to print the designation “C-IV” onto every bottle and it is unlawful for commercial containers of tramadol to be distributed without that designation. Also on August 18 every DEA registrant possessing tramadol was required to take an inventory of all tramadol stock in compliance with 21 C.F.R. § 1304.11(d). Because the Idaho Board of Pharmacy did not object, tramadol- containing products are also now scheduled in Idaho. Confirmation of this change will be codified in statute by the 2015 legislature. Federal regulation and Board rule require all DEA registrants to treat all subsequent tramadol records and inventories as Schedule IV. Rescheduling of Hydrocodone Combination Products The DEA also recently reclassified medications containing the painkiller hydrocodone from Schedule III to the much more restrictive Schedule II effective October 6, 2014. This will have a big impact on patients, prescribers and pharmacies because under DEA Schedule II these prescriptions can no longer be called in by phone, faxed to the pharmacy or transmitted as electronic (Continued on Page 2) Susie Pouliot Chief Executive Officer Margy Leach Communications and Membership Director Teresa Cirelli, CPC, CPMA Reimbursement Director Kathrine Forstie, CPC, CPMA Reimbursement Specialist The IMA accepts limited advertisements and announcements in this publication, but does not endorse them. Consent to Care of a Pregnant Minor 4 New IMA Members 6 IMA Foundation Charitable Status 6 Take Action Now to Avoid Penalty 6 More CMS Penalties 8 Online Ethics Course 8 MPO Ads 11
Transcript
Idaho Medical Association
IMAges
Inside this issue
Volume XXV No. 9 , SEPTEMBER 15, 2014
Updates from the DEA The Drug Enforcement Agency (DEA) has recently published several important rule changes. Tramadol a Schedule IV Controlled Substance On July 2, the Drug Enforcement Administration (DEA) published its Final Rule in the Federal Register placing tramadol into Schedule IV effective August 18, 2014. (Tramadol is a centrally acting opioid analgesic first approved for use in the U.S. in 1995 under the name “Ultram”. Since then, the Food and Drug Administration (FDA) has approved for marketing generic, combination and extended release versions.) The DEA follows in the path of a number of states that have already taken this step such as Arkansas, Mississippi, and New York. By making tramadol a Schedule IV controlled substance, the DEA makes it easier for the pharmaceutical industry to develop consistent policies and procedures nationwide for how this drug is handled. It is important to note that as of August 18, 2014, manufacturers are required to print the designation “C-IV” onto every bottle and it is unlawful for commercial containers of tramadol to be distributed without that designation. Also on August 18 every DEA registrant possessing tramadol was required to take an inventory of all tramadol stock in compliance with 21 C.F.R. § 1304.11(d). Because the Idaho Board of Pharmacy did not object, tramadol-containing products are also now scheduled in Idaho. Confirmation of this change will be codified in statute by the 2015 legislature. Federal regulation and Board rule require all DEA registrants to treat all subsequent tramadol records and inventories as Schedule IV. Rescheduling of Hydrocodone Combination Products The DEA also recently reclassified medications containing the painkiller hydrocodone from Schedule III to the much more restrictive Schedule II effective October 6, 2014. This will have a big impact on patients, prescribers and pharmacies because under DEA Schedule II these prescriptions can no longer be called in by phone, faxed to the pharmacy or transmitted as electronic
(Continued on Page 2)
Susie Pouliot Chief Executive Officer Margy Leach Communications and Membership Director Teresa Cirelli, CPC, CPMA Reimbursement Director Kathrine Forstie, CPC, CPMA Reimbursement Specialist The IMA accepts limited advertisements and announcements in this publication, but does not endorse them.
Consent to Care of a Pregnant Minor
4
New IMA Members 6
IMA Foundation Charitable Status
6
Take Action Now to Avoid Penalty
6
More CMS Penalties 8
Online Ethics Course 8
MPO Ads 11
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DEA Updates (Continued from Page 1) prescriptions. Also, prescriptions for any product containing hydrocodone (Norco, Hydromet, Lorcet, Lortab, Tussionex, Vicodin, Vicoprofen, etc.) written on or after October 6, 2014 may not contain refills; this means patients will need to obtain a handwritten prescription from their provider for each medication treatment. Some of the impacts of moving the drugs to Schedule II include: Prescribing
Prescribers will not be allowed to authorize refills for hydrocodone combination products (HCPs), though they will be allowed to issue multiple prescriptions for up to a 90-day supply.
Note: DEA will permit pharmacies to dispense HCP refills after the effective date of the rescheduling if the prescription was issued before the effective date and the dispensing occurs before April 8, 2015. However, insurance limitations and some pharmacy quality and safety operations and processes may not allow for these prescriptions to be refilled.
Prescribers will not be able to fax or phone in prescriptions for HCPs, though verbal prescriptions will be allowed in emergency situations.
Dispensing In some states, pharmacists will have to
count the prescriptions themselves because pharmacy technicians are not allowed to do so.
Ordering Registrants will have to use official DEA
Forms 222 to transfer HCPs, rather than simple invoices or packing slips.
Security Manufacturers and wholesale distributors
will have to store HCPs in vaults, rather than cages.
Labeling and Packaging Manufacturers will be required to label
every commercial container of HCPs, including all bottles, with a “C-II” designation.
DEA noted that the packaging and labeling requirements for manufacturers and distributors do not apply to dispensers. Thus, dispensers with HCPs in commercial containers labeled as Schedule III can continue to dispense them after the rescheduling takes effect.
DEA to Allow Pharmacies to Take Back Unused Drugs On September 8, the DEA released its Final Rule for the Disposal of Controlled Substances, which implements the Secure and Responsible Drug Disposal Act of 2010. The Act, in an effort to curtail the prescription drug abuse epidemic, authorized DEA to develop and implement regulations that outline methods of transfer of unused or unwanted pharmaceutical controlled substances to authorized collectors for the purpose of disposal. The Act also permits long-term-care facilities to so the same on behalf of residents or former residents of their facilities. Previously, the Controlled Substances Act made no legal provisions for patients to rid themselves of unwanted pharmaceutical controlled substances except to give them to law enforcement. Most people flushed their unused drugs down the toilet, threw them in the trash or kept them in the household medicine cabinet. Unused medications in homes create a public health and safety concern, because they are highly susceptible to accidental ingestion, theft, misuse, and abuse. More than two-thirds (70 percent) of people who misuse prescription painkillers for the first time report obtaining the drugs form friends or relatives, including from the home medicine cabinet. The new programs will be voluntary. Pharmacies may choose to register with the drug agency to take back controlled substances or to receive leftovers through the mail. While pharmacies haven't generally wanted the hassle of being responsible for old pills, some are expected to heed the government's call, in part to show they are making a good-faith effort to keep drugs out of the wrong hands.
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Consent to Care of a Pregnant Minor By: Emily McClure, JD, Givens Pursley, LLP
A pregnant patient under the age of eighteen comes to you seeking care. Who can consent to her treatment? The following are guidelines a physician can rely on under most circumstances.* Follow this Rule Most of the Time: The laws governing consent for treatment of a pregnant minor are generally the same as for a non-pregnant minor. Idaho Code § 39-4504 sets out a list of people who can consent or refuse consent for the treatment of minors, in descending order of authority:
A minor’s court-appointed guardian; A minor’s parent; The person to whom a minor’s parent or guardian delegated authority via a lawful power of attorney; Any relative who purports to be an appropriate person to act under the circumstances; Any other competent person purporting to be responsible for the minor’s health care; A healthcare provider, in an emergency (details below).
Under some circumstances, a minor may consent to her own care. For example, a patient fourteen or older may consent to her own diagnosis and treatment of certain sexually transmitted diseases. I.C. § 39-3801. If the Patient Might be the Victim of Abuse: If a physician has reason to believe a minor has been abused, abandoned or neglected, or is subject to conditions which would reasonably result in such, he or she must report it to law enforcement or the Department of Health and Welfare within 24 hours. I.C. § 16-1605. The physician will be immune from liability, so long as the report was made in good faith. A patient who is already in foster care will have a court-appointed guardian or be under the guardianship of the Department. Her guardian may provide consent for “ordinary medical, dental, psychiatric, psychological, or other remedial care and treatment” and to surgery, if the surgery is deemed necessary by two physicians.* I.C. §§ 16-1602(26)(d), 39-4504. Concerns regarding consent or care for the patient may be directed to the child’s Department case worker. If Consent is Refused or Unavailable: If a physician believes a patient’s life will be greatly endangered without certain treatment, but her parent, guardian or other custodian is unavailable or refuses to consent, the physician should act according to the urgency of the patient’s need. Immediate Emergency If a patient presents with a medical emergency, or there is a substantial likelihood that her life or health will be seriously endangered if care is withheld or delayed, and there is no time to secure consent from a parent, guardian or court, a physician may authorize care. I.C. § 39-4504. Care Required Within a Day or Two If a patient’s life will be greatly endangered without certain treatment, but that treatment can be delayed for a few hours or a day or two, the physician should contact law enforcement and the child may be declared in imminent danger.
(Continued on Page 6) * This does not pertain to abortion or contraceptives, which will be the subject of a later article.
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Pregnant Minor (Continued from Page 4) Care Required, but Can Wait a Few Days If the patient’s life will be greatly endangered without certain treatment, but that treatment can be safely delayed for a few days or longer, the physician may seek a court order authorizing care by calling the child abuse and neglect reporting hotline at 1-855-552-KIDS (5437). I.C. § 16-1627. The Bottom Line: It is safest to proceed as though a pregnant minor does not have legal authority to consent to her own treatment. Instead, rely on the consent of parents or others according to the list above. If a patient is in foster care, her guardian may have authority to consent, but if uncertain, contact her Department case worker. If consent is refused or unavailable, proceed according to the degree of the emergency. The Idaho Medical Association Welcomes New Members A warm welcome to these physicians who have recently joined the IMA:
Alan Bean, MD, Emergency Medicine, Eagle Jonathan Calder, MD, Emergency Medicine,
Meridian James Earl, MD, Ophthalmology, Boise Gregory M. Ford, MD, Orthopedic Surgery,
Pocatello Richard Hetherington, DO, Anesthesiology,
Reston, VA Morton Hyson, MD, Neurology, Las Vegas, NV Jennifer J. King, MD, Pediatrics, Boise Frank D. MacDonald, MD, Family Medicine,
Boise Jonathan D. Miller, MD, Emergency Medicine,
Meridian David G. Riss, DO, Emergency Medicine,
Meridian Lindsay M. Winans, MD, Internal Medicine,
Boise
IMA Foundation Receives Charitable Status Notification Good news! The Idaho Medical Association Foundation has received the long-awaited tax-exempt, charitable status notification from the Internal Revenue Service. Contributions to the IMA Foundation are deductible under the Internal Revenue Code.
The IMA Foundation is the arm of the Idaho Medical Association that was formed to continue and expand on the long held goals of the IMA’s Medical Education Scholarship Trust. The Foundation’s goals are to:
Support Idaho medical education and residency training through individual scholarships and organizational contributions
Support loan repayment and other activities to recruit and encourage physicians to practice in Idaho
Support and provide resources for practicing physicians to improve the quality and accessibility of healthcare for Idaho patients
An opportunity to make a tax-deductible contribution supporting the practice of medicine in Idaho will be included on your 2015 IMA Membership Notice which you will receive in the next few weeks. Thank you for your support! Groups of Ten or More Eligible Professionals Must Take Action Now to Avoid Value-Based Modifier Penalty In calendar year (CY) 2016, the Centers for Medicare and Medicaid Services (CMS) will apply the Value-Based Payment Modifier (Value Modifier) to physician payments under the Medicare Physician Fee Schedule for physicians in groups with ten or more eligible professionals (EPs). EPs consist of physicians, mid-levels, physical or occupational therapists, qualified speech-language pathologists, and qualified audiologists. A group of physicians is defined by its Medicare-enrolled Taxpayer Identification Number (TIN). This does not apply to providers who practice in Federally Qualified Health Centers or Rural Health Clinics. CY 2014 is the performance period for the Value Modifier that will be applied in CY 2016. In order to avoid an automatic Value Modifier penalty of two percent, EPs in groups of ten or more must participate in and satisfy the Physician Quality Reporting System (PQRS) requirements as a group or as individuals in CY 2014.
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CY 2016 Penalty (Continued from Page 6) Groups can avoid the automatic penalty by participating in the PQRS Group Practice Reporting Option (GPRO) in CY 2014. If groups choose to participate in PQRS GPRO, an authorized representative from the group must have an Individuals Authorized Access to the CMS Computer Services (IACS) account and register to participate in GPRO by September 30, 2014. A quick reference guide for registering for the 2014 PQRS GPRO is available on the CMS website at http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Self-Nomination-Registration.html. Alternately, groups can choose to participate in PQRS as individuals. At least 50 percent of the EPs in the group must meet the satisfactory reporting criteria as individuals. The IMA has obtained a discounted rate of $195 (normally $299) to report PQRS data through a qualified PQRS registry - Covisint - in 2014. If you would like additional information on utilizing Covisint for PQRS reporting,
please visit their website, http://www.covisint.com/healthcare-pqrs, or contact IMA Reimbursement Director Teresa Cirelli, CPC, CPMA at [email protected] or IMA Reimbursement Specialist Kathrine Forstie, CPC, CPMA at [email protected] or 208-344-7888. For questions about the Value Modifier, the IACS sign up process or participating in the 2014 PQRS as a group or individual, please contact the QualityNet Help Desk at 1-866-288-8912 or via email at [email protected]. Additional CMS Penalties to Avoid in 2016 As previously reported in the August 1 IMA Wire, the Centers of Medicare and Medicaid Services (CMS) has other “payment adjustments” or penalties in place for 2016. All eligible providers (EPs) will be subject to a two percent penalty in 2016 if they do not participate in and satisfy the Physician Quality Reporting System
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Ethics in Prevention Online Course for Idaho
The Substance Abuse and Mental Health Services Administration (SAMHSA) Center for Substance Abuse Prevention's (CSAP) Center for the Application of Prevention Technologies (CAPT) West Resource Team invites you to participate in:
Ethics in Prevention: A Guide for Substance Abuse Prevention Practitioners
Dates: September 22-October 3, 2014 This web-based learning event offers substance abuse prevention professionals - both experienced and new to the field - an opportunity to explore the role of ethics in their work. Over a two-week period, participants in this moderated online course will examine the Prevention Code of Ethics’ six key principles and explore a four-step decision-making model for assessing, addressing, and evaluating a variety of ethical issues. Course participants are expected to review course materials and complete a range of interactive learning activities, including a series of brief online assignments. These activities are critical to learning, offering participants a chance to discuss course content with fellow participants, share experiences, and apply new skills. Participants should plan on spending approximately six hours completing course assignments. This is an asynchronous course, meaning that participants can log on to the course when it is most convenient for them. However, it is important that participants begin and end the course together, and move through the course materials at roughly the same pace. To facilitate this process, participants are expected to complete five course assignments according to a schedule. The course is limited to the first twenty-five registrants. Remaining registrants will be put on a wait list and will be notified of the next available training. Additional information and online registration is available on the Idaho Office of Drug Policy website at http://www.odp.idaho.gov/.
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CMS Penalties (Continued from Page 8)
(PQRS) requirements as a group or as individuals in 2014. For groups of ten or more, both the PQRS non-participating penalty (two percent) and the Value Modifier penalty (two percent) will apply. In 2017, all EPs will be subject to the Value Modifier penalty. Also in 2016, EPs who do not demonstrate meaningful use in CMS’ Electronic Health Records (EHR) incentive program in 2014 will receive an additional two percent penalty. CMS has produced three web-based training courses on their quality reporting programs. The CMS Physician Quality Reporting System
(PQRS) Program: What Medicare Eligible Professionals Need to Know in 2014
The CMS Value-Based Payment Modifier: What Medicare Eligible Professionals Need to Know in 2014
The Medicare and Medicaid EHR Incentive Programs: What Medicare and Medicaid Providers Need to Know in 2014
These courses are free and offer continuing education credits. To access the courses, go to http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/index.html?redirect=/MLNProducts and click on “Web-Based Training Courses” under “Related Links” at the bottom of the web page. As you can see, it is crucial to take steps now to avoid these penalties associated with the various CMS Medicare quality reporting programs. Contact IMA Reimbursement Director Teresa Cirelli, CPC, CPMA at [email protected] or IMA Reimbursement Specialist Kathrine Forstie, CPC, CPMA at [email protected] or 208-344-7888, if you have questions on getting started or how to follow current reporting requirements.
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Medical Practice Opportunities
Full Time MD and NP or PA
Hagerman, Wendell, Gooding Family Practice or Internal Medicine
Associates in Family Practice
425 Idaho St, Gooding, ID Phone: 208-934-5900 Email: [email protected]
To place a Medical Practice Opportunities Classified Advertisement, please contact:
Margy Leach, Director of Communications at 208-344-7888 or by email [email protected].
Are You a Certified DOT Medical Examiner?
As of May 21, 2014, Commercial Motor Vehicle (CMV) drivers must have medical exams performed by a certified medical examiner listed on the National Registry of Certified Medical Examiners (NRCME). The Idaho Medical Association (IMA) is prepared to assist you in the certification process. We are a registered NRCME training provider for health care professionals seeking to be listed on the National Registry website. IMA’s online training course is designed to meet the core curriculum requirements for medical examiners according to the Federal Motor Carrier Safety Administration (FMCSA). Did you know? This training can be completed with no travel, no classroom time, and no time away from work or home. Designed for busy health care professionals, our course is 100 percent online and available to you for six months from the date of registration. In addition, this training, through the use of a pre-test, post-test and case scenarios, will prepare and qualify the medical examiner to take the NRCME certification exam.
This training has a 99% Pass Rate for the National Exam
To register or learn more go to http://ima.essentialeducationwebinarnetwork.com/
To make the process easier we have created a step-by-step checklist and FAQs to assist you in the certification process. You can print a PDF of the checklist and FAQs at the links below: Step by Step Checklist: http://essentialeducationwebinarnetwork.com/cdl/StepByStep.pdf FAQs: http://essentialeducationwebinarnetwork.com/cdl/FAQs.pdf
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Calendar of Upcoming Events September 17 - 19, 2014 IMGMA Conference: Become a Medical Management Superhero Boise State University, Boise October 8, 2014 IMA Brown Bag in the Boardroom Webinar 12:15 - 1:30 pm (MT) Idaho Regulations Affecting Idaho Practices: Fraud & Abuse Issues Guest Speaker: Kim Stanger, Holland & Hart October 17, 2014 IMA Board of Trustees Meeting Hampton Inn, Boise November 5, 2014 IMA Brown Bag in the Boardroom Webinar 12:15 - 1:30 pm (MT) Idaho Regulations Affecting Idaho Practices: Patient Relations Guest Speaker: Kim Stanger, Holland & Hart
Additional information and registration forms for seminars are available at www.idmed.org.
