CDC ANNOUNCES ACTIVE POST-ARRIVAL MONITORING FOR TRAVELERS FROM IMPACTED COUNTRIES: The Centers for Disease Control and Prevention (CDC) announced that public health authorities will begin active post-arrival monitoring of travelers whose travel originates in Liberia, Sierra Leone, or Guinea. These travelers are now arriving to the United States at one of five airports where entry screening is being conducted by Customs and Border Protection and CDC. Active post-arrival monitoring means that travelers without febrile illness or symptoms consistent with Ebola will be followed up daily by state and local health departments for 21 days from the date of their departure from West Africa. Six states (New York, Pennsylvania, Maryland, Virginia, New Jersey, and Georgia), where approximately 70% of incoming travelers are headed, have already taken steps to plan and implement active post-arrival monitoring which will begin on Monday, October 27. Active post-arrival monitoring will begin in the remaining states in the days following. CDC is providing assistance with active post-arrival monitoring to state and local health departments, including information on travelers arriving in their states, and upon request, technical support, consultation and funding.
Active post-arrival monitoring is an approach in which state and local health officials maintain daily contact with all travelers from the three affected countries for the entire 21 days following their last possible date of exposure to Ebola virus. Twenty-one days is the longest time it can take from the time a person is infected with Ebola until that person has symptoms of Ebola.
Specifically, state and local authorities will require travelers to report the following information daily: their temperature and the presence or absence of other Ebola symptoms such as headache, joint and muscle aches, weakness, diarrhea, vomiting, stomach pain, lack of appetite, or abnormal bleeding; and their intent to travel in-state or out-of-state. In the event a traveler does not report in, state or local public health officials will take immediate steps to locate the individual to ensure that active monitoring continues on a daily basis.
In addition, travelers will receive a CARE (Check And Report Ebola) kit at the airport that contains a tracking log and pictorial description of symptoms, a thermometer, guidance for how to monitor with thermometer, a wallet card on who to contact if they have symptoms and that they can present to a health care provider, and a health advisory infographic on monitoring health for three weeks.
Active monitoring establishes daily contact between public health officials and travelers from the affected region. In the event a traveler begins to show symptoms, public health officials will implement an isolation and evaluation plan following appropriate protocols to limit exposure, and direct the individual to a local hospital that has been trained to receive potential Ebola patients.
Post arrival monitoring is an added safeguard that complements the existing exit screening protocols, which require all outbound passengers from the affected West African countries to be screened for fever, Ebola symptoms, and contact with Ebola and enhanced screening protocols at the five U.S. airports that will now receive all travelers from the affected countries. All three of these nations have asked for, and continue to receive, CDC assistance implementing exit screening.
All the latest information on Ebola is here: http://www.cdc.gov/vhf/ebola/
ADHS URGES HEALTHCARE FACILITIES DEVELOP AN EBOLA PREPARTION AND RESPONSE PLAN: Ebola has arrived in the United States. It is imperative that every practitioner, infection preventionist, clinic and health department is prepared to identify, isolate and manage suspected and confirmed cases of Ebola.
To assist with outpatient clinic preparation, the Arizona Department of Health Services has created an Ebola Outpatient Clinic Toolkit. This toolkit provides concise checklists, planning templates, screening guidelines and posters for clinics to use in building a practical and feasible Ebola Preparation and Response Plan.
The Arizona Department of Health Services strongly urges every healthcare facility to develop an Ebola Preparation and Response Plan. The key to Ebola control in Arizona relies on the training and response of each and every facility.
To begin, the following actions can be performed immediately.
- Appoint 1-2 individuals to be responsible for receiving and distributing Arizona Ebola communications
- Complete the Outpatient Clinic Checklist for Ebola Preparedness to assess readiness.
- Implement a facility specific screening protocol for Ebola virus.
- Schedule a tabletop exercise or drill for the management of an Ebola patient.
As the situation is continually evolving, Arizona's Ebola toolkits and website will be updated frequently. Interim questions should be directed to local health departments or to the Office of Infectious Disease Services at the Arizona Department of Health Services at (602) 364-3676.
LICENSING OF NEW ARIZONA PHYSICIANS RESUMES: Last week, the Arizona Medical Board (AMB) approved a motion to resume issuing new licenses, effective immediately.
As reported the issue was an opinion issued by the Attorney General (AG) interpreting the fingerprinting law in such a way that effectively brought the issuance of new licenses to a complete halt.
ArMA, working with the support of PCMS and Maricopa County Medical Society and with the backing of the Arizona Hospital and Healthcare Association (AzHHA), took the leadership position remedying the situation. ArMA’s attorneys did extensive legal research and analysis in a short timeframe to issue what became a compelling legal opinion countering that of the AG. Efforts received strong support from the State Senate and State House leadership, and active and strong support from the Governor's office.
The AMB's action today applies to the issuing of new licenses. Renewal licenses were not impacted by this specific issue. Please be certain to closely follow the instructions of the AMB for renewing your licenses.
For those of you directly involved with any of the applicants, who have been impacted, the licensing board has posted the following language on their website. It’s based on the adopted motion proposed by PCMS and AMB board member Dr. Screven Farmer.
"The Arizona Medical Board met today and voted to resume processing and issuing initial licenses effective immediately to applicants meeting all statutory requirements for licensure, with the exception of the FBI criminal background check. These applicants will be issued an Arizona medical license on a provisional basis with the following stipulations: requiring applicants to sign a notarized attestation that there are no undisclosed criminal convictions in other states or countries; requiring applicants to submit a signed statement acknowledging that failure to disclose such information will result in discipline and/or revocation of licensure; additionally, requiring applicants to undergo a third party background check by an entity other than the FBI. The board staff is in the process of investigating and determining the entity that will conduct the criminal background check. Applicants granted a license under these terms and conditions are subject to additional processing once the Board receives approval to obtain criminal background checks from the FBI."
Advice when renewing a license:
1) In its first renewal notice following implementation of the requirement, the AMB mistakenly informed renewal licensees that they must complete their fingerprinting at the local police or sheriff's office. Fingerprinting at a law enforcement agency is NOT required by law, and many local police departments no longer offer this as a public service. PCMS has compiled a list of fingerprinting services in the city. A mobile service is also available.
2) The AMB has issued specific instructions for submitting their pre-printed fingerprint card sent with your renewal packet. If you adhere to the instructions issued, and submit your renewal packet on time, you will be deemed in compliance. AMB has posted the instructions on their website.
3) We have been asked if physicians might complete the fingerprinting process before their renewal packet arrives, and we advise against doing so. The AMB is issuing their own pre-printed fingerprint cards, and are not accepting any FD-258 cards in advance of license renewal notices. Additionally, there are specific instructions that must be followed by your fingerprinting technician, and finally, keeping a fingerprint card on file prior to submission could expose individuals to potential fraud breaches.
MEANINGFUL USE HARDSHIPS EXTENDED: CMS announced its intent to reopen the submission period for hardship exception applications for eligible professionals and eligible hospitals to avoid the 2015 Medicare payment adjustments for not demonstrating Meaningful Use of Certified Electronic Health Record Technology (CEHRT). The new deadline will be November 30, 2014. Previously, the hardship exception application deadline was April 1, 2014 for eligible hospitals and July 1, 2014 for eligible professionals. This reopened hardship exception application submission period is for eligible professionals and eligible hospitals that:
- Have been unable to fully implement 2014 Edition CEHRT due to delays in 2014 Edition CEHRT availability; AND
- Eligible professionals who were unable to attest by October 1, 2014 and eligible hospitals that were unable to attest by July 1, 2014 using the flexibility options provided in the CMS 2014 CEHRT Flexibility Rule.
These are the only circumstances that will be considered for this reopened hardship exception application submission period. Applications must be submitted by 11:59 PM EST November 30, 2014. More information about the application process will be shared as it becomes available. Visit the Payment Adjustments and Hardship Exceptions webpage for more information about Medicare EHR Incentive Program payment adjustments.
AZ COURTS DO NOT SEE TREATING PHYSICIANS AS EXPERTS: ArMA, PCMS and MCMS all have been involved in numerous defenses of attempts by plaintiffs' personal injury attorneys to dismantle our legislative tort success. We report on this periodically as we have had numerous important successes, including a decision at the State Supreme Court keeping in place our qualifications of expert witness statute. Most recently, we petitioned to reverse a court rule that has more practical financial implications. In summary, the Court of Appeals ruled in Sanchez v. Gama that treating physicians are not considered experts and thus are only entitled to $12.00 per day for providing a deposition or testifying at trial, plus $.20 per mile for travel, one way. Accordingly, if a doctor receives a subpoena for a deposition or to testify at trial and is the treating physician in the suit, under the Court of Appeals' decision, they are not entitled to compensation for time out of the office. However, if the doctor has been retained as an expert witness in the suit, pursuant to Rule 26(b)(4)(C) of the Arizona Rules of Civil Procedure, the party noticing the deposition must pay the doctor "a reasonable fee." Because the Arizona Supreme Court denied the rule change petition to provide compensation for treating physicians, and because the Arizona Supreme Court denied the Petition for Review of the Sanchez decision, the Arizona Court of Appeals' decision in Sanchez still governs this issue. This is unfortunate news for those called into the Arizona court system as treating physicians.
HYDROCODONE RECLASSIFICATION: If you prescribe hydrocodone combination products, prescribing these medications to the patients who need them to alleviate pain just became more complicated. A new rule from the Drug Enforcement Administration (DEA) taking effect Oct. 6 reclassifies hydrocodone combination products as Schedule II controlled substances, prohibiting refills and establishing other restrictions that will require major changes to prescribing practices. Here are six key points you need to know so you can take appropriate action over the next few weeks:
1. Refills aren't allowed for prescriptions that are written beginning Oct. 6. Be prepared to issue new hard-copy or electronic prescriptions for patients. Note that eScripts can only be used if state law permits and the prescriber is certified to ePrescribe Schedule II substances. Pharmacies also must be certified to accept eScripts for controlled substances.
2. Prescriptions issued before Oct. 6 won't necessarily qualify for refills; plan to issue new ones. Although the DEA rule allows refills of prescriptions issued before Oct. 6 until April 8, 2015, other factors could prevent patients from getting those refills. Several states have published notices that they will treat hydrocodone combination product prescriptions issued before Oct. 6 in the same way they will handle prescriptions issued after the rule's implementation date. In addition, any state laws that are more stringent than the DEA rule will govern refills. Meanwhile, some pharmacy quality and safety processes may not allow refills for prescriptions issued before Oct. 6, and some health insurers will not pay for those refills.
3. Prescriptions can't be called in or faxed. Make sure to plan ahead for any patients who may need refills. The new rule prohibits pharmacies from filling prescriptions delivered over the phone or via fax, so you'll need to issue written scripts. The only exception to this rule is emergency treatment, which would allow physicians to call in a limited quantity of the medication to cover the emergency period only. Pharmacies are required to report prescribers to the DEA if they make such a request and do not give the pharmacy a written prescription within seven days.
4. Allied health professionals might not be able to write prescriptions for these drugs going forward. Check your state's restrictions around Schedule II substances to confirm whether any non-physician members of your team who have prescriptive authority will be able to continue issuing prescriptions for hydrocodone combination products. You may need to modify your collaborative practice agreements accordingly.
5. Multiple prescriptions may be issued at one time under certain circumstances. The new rule does allow a patient to receive prescriptions that would total a 90-day supply, if the prescriber has determined it is appropriate to see the patient only once every 90 days. Each prescription must include written instructions that specify the earliest date it may be filled. In addition to sound medical judgment and established medical standards, make sure to base your practice's policy on issuing multiple prescriptions on relevant federal and state laws.
6. Patients should be notified of the new requirements and processes. Make sure your patients understand that their new prescriptions will not be refilled and are aware of the procedures they will need to follow going forward.
We have warned the DEA about the potential unintended consequences of reclassifying hydrocodone combination products since the agency made the proposal early last year. Eliminating phoned-in prescriptions and refills could make it difficult for some patients to get the pain relief they need, especially patients in nursing homes and those with persistent pain and disabilities. The rule is published in the Federal Register.
ADHS HEALTH NOTICE / ENTEROVIRUS D68 ASSOCIATED WITH SEVERE RESPIRATORY ILLNESS IN CHILDREN: In late August, the Centers for Disease Control and Prevention (CDC) was notified by two states of an increase in children hospitalized with severe respiratory illness. Enterovirus D68 (EV-D68) was identified in many of these patients. There are now several other states reporting increases in admissions for severe respiratory illness. It is possible that these are also associated with EV-D68. EV-D68 appears to spread via close contact (e.g., saliva, sputum, feces) with infected individuals. Currently, there is no vaccine to prevent EV-D68 and no specific antiviral treatment recommended. However, patients can help protect themselves and others from respiratory illnesses by:
- avoiding close contact with people who are sick;
- avoiding touching eyes, nose, and mouth with unwashed hands;
- washing hands often with soap and water, especially after changing diapers;
- cleaning/disinfecting frequently touched surfaces, such as toys and doorknobs, especially if someone is sick;
- ensuring vaccinations, including the influenza vaccine, are up to date.
Clinicians should be aware of EV-D68 as one of many causes of viral respiratory disease and should report clusters of unexplained respiratory illness to the Pima County Health Department. Please refer to this MMWR for more detailed information.
FSMB RELEASES MODEL LEGISLATION FOR CREATING MULTISTATE COMPACT SYSTEM: In a move to facilitate the growth of telemedicine and speed increased healthcare access to residents in rural areas, the Federation of State Medical Boards has released model legislation that could be used to create a multistate agreement, or "compact" system, under which physicians who are licensed in one state can use a streamlined process to be quickly licensed in another. The Wyoming State Board of Medicine spearheaded the effort; Executive Director Kevin Bohnenblust said states like his are accustomed to interstate compacts. The model legislation calls for at least seven states to participate in the compact and with participating states to have representatives on a governing commission. Once enough states have joined the effort, participating states would share credential and disciplinary information on physicians licensed by their states with other states so they could quickly issue their own licenses without collecting the usual load of paperwork normally required. Read more at Modern Healthcare.
DEA TO ALLOW RETURN OF UNUSED PRESCRIPTIONS TO PHARMACIES AND HOSPITALS: The abuse of prescription medications has been termed a "public health crisis." In an effort to address the nation's growing prescription drug abuse problem, the U.S. Drug Enforcement Administration (DEA) announced this week that it will allow hospitals, clinics and pharmacies to collect unused prescription drugs. Effective next month, the DEA's new regulation will also provide residents at long-term health facilities with the option of turning in unused prescription drugs on-site. Under the new regulation, patients and their relatives will also be allowed to mail unused prescription drugs to an authorized collector using packages to be made available at pharmacies and other locations, like libraries and senior centers. Read more here. Further information on drug disposal as well as the final published rule is available at the DEA website.
HEALTHCARE DATA BREACHES INCREASING: The recent theft of 4.5 million medical records by hackers highlights one undeniable truth about healthcare data: it's valuable, and people want it. Identity thieves can sell patient information to be used for obtaining free medical care or to file bogus insurance claims. Since federal reporting requirements kicked in, the U.S.
Department of Health and Human Services' (HHS) database of major breach reports (those affecting 500 people or more) has tracked 944 incidents affecting personal information from about 30.1 million people. A majority of those records are tied to theft (17.4 million people), followed by data loss (7.2 million people), hacking (3.6 million), and unauthorized access accounts (1.9 million people). There are also many more incidents of smaller-scale breaches. In 2012, HHS received 21,194 reports of smaller breaches affecting 165,135 people, according to the department's most recent report to Congress. Healthcare data has seemingly become increasingly targeted, accounting for 43% of major data breaches reported in 2013, according to the Identity Theft Resource Center. That's the first time the healthcare sector topped the group's annual list, and it's on the same pace for 2014. Read more here: https://www.magnetmail.net/actions/email_web_version.cfm?recipient_id=1450658731&message_id=5994069&user_id=PIAA&group_id=1210335&jobid=21166378
AHCCCS CLARIFIES NEW REQUIREMENT FOR SAM COVERAGE: Physicians have asked AHCCCS to offer clarification of their new requirement regarding insurance coverage for Sexual Abuse and Molestation (SAM). According officials, SAM is discretionary.
MICA-insureds can find a newsbrief that notes, subject to the terms of the policy, MICA’s medical professional liability insurance policy provides for defense of an insured when faced with these kinds of claims. For non-MICA policy holders, check with your carrier about coverage but don’t be pressured into purchasing coverage that you already have, or may not need.
SYPHILIS CASES ON THE RISE IN PIMA COUNTY: The Pima County Health Department (PCHD) is reporting that as of July 31, seventy-eight (78) primary and secondary cases of Syphilis have been confirmed. The dramatic increase, as compared to recent years, has prompted PCHD to issue a “Public Health Alert.”
Dr. Francisco Garcia, director & chief medical officer for PCHD, is calling for all providers to heighten their index of suspicion for the disease and get informed about reporting, diagnostic and treatment recommendations by clicking on the “Provider Resources” tab at http://webcms.pima.gov/cms/One.aspx?portalId=169&pageId=136859. Clinicians may also receive assistance by calling 724-3916.
ADHS RELEASES INFECTIOUS DISEASES MANAUAL: The Arizona Department of Health Services recently released “An Introduction to Arizona’s Infectious Diseases” manual. To view the new guide click here: http://www.scribd.com/doc/236048552/Arizona-Dept-of-Health-Physician-Manual?secret_password=J281p3z1rxz2HUEL24tS
IOM REPORT STIRS GME FUNDING CONTROVERSY: The federal government, mostly via the Medicare program, currently provides more than $11 billion per year in payments to support graduate medical education (GME), the training of doctors who have graduated medical school. Most of these funds go to the hospitals that sponsor interns and residents. States, through the Medicaid program, contribute nearly another $4 billion annually. But there is little data on how those funds are spent and how well they contribute to the preparation of a medical workforce needed for the 21st century. This week saw the release of a report from an expert panel by the Institutes of Medicine (IOM) that recommended a complete overhaul of the way government pays for the training of physicians. The five major recommendations the committee made were:
- Medicare should maintain its GME support but should be replaced in phases by a new payment system.
- A GME policy council should be created in the Office of the Secretary of Health and Human Services, as well as a GME Center within the Centers for Medicare and Medicaid Services.
- The single Medicare GME fund should be divided into two parts: an Operational Fund to support residency training positions that are currently approved and a Transformation Fund to develop and test new GME programs.
- Medicare should make a single payment to GME programs based on a national, geographically adjusted, per-resident amount.
- Medicaid funding for GME should remain at the discretion of individual states.
The Association of American Medical Colleges issued sharp criticism of the report, stating that the recommendations threaten the viability of excellent training programs. The panel did not recommend lifting the current cap on residency slots currently supported by Medicare which were established with the 1997 Balanced Budget Act.
PHYSICIANS SHIFTING TO EMPLOYMENT RATHER THAN PRIVATE PRACTICE: Jackson Healthcare this week released the findings of a survey on physician practice environment, workload and patient access. A total of 1,527 physicians across the nation completed the survey this spring. When comparing previous survey results, this year's findings noted that the percentage of hospital-employed primary care physicians doubled from 10 percent in 2012 to 20 percent in 2014. The number of primary care physicians with an ownership stake in a single-specialty practice decreased from 12 percent in 2012 to 7 percent in 2014. When responding to why they chose employment, overall, the lifestyle that employment offers is the underlying factor driving physician preference. The number of physicians taking call in 2012 (77 percent) dropped to 57 percent in 2014. Eighty-five percent of physician practices reported accepting new Medicare patients. Sixty percent reported accepting new Medicaid patients. Survey details here: http://www.jacksonhealthcare.com/media-room/articles/physician-trends/physician-data-on-practice-environment-workload-and-patient-access.aspx
PHYSICIANS CHALLENGED BY ACA PLANS: A new study released by the Medical Group Management Association (MGMA) surveyed 728 practices representing 40,000 physicians in 46 states during April 2014. Almost 80% of the medical groups reported their practice is participating with new health insurance products sold on the ACA exchanges, and over 90% of these practices have already seen patients with this coverage. These practices report that verification processes were more difficult and lengthy than with commercial plans. Nearly 60% of respondents indicated that it is more difficult to verify patient eligibility, obtain cost-sharing or network information, or get information about the plan's provider network, in order to facilitate referrals. For practices not participating with ACA insurance exchange product, 48.1% cited concerns about assuming financial liability during a 90-day grace period for ACA exchange enrollees. For practices that chose to participate with ACA insurance exchange products, 57.6% cited remaining competitive in the local market as the reason for doing so. Almost half of respondents reported they have been unable to provide covered services to exchange patients because their practice is out of the patient's network. About 36.6% of respondents indicated that average payment rates for ACA exchange insurers were equal to payment rates from traditional commercial and traditional Medicare contracts; 32% indicated that average payment rates were somewhat lower. The American Medical Association (AMA) has created a physician practice resource page for grace period information. Resources include model language and sample letter forms for notifying patients.
WEBSITE OFFERS ACCESS TO CLINICAL TRIALS: Participating in vital health-related research to help improve or saves lives has gotten easier, thanks to a new website that features the clinical trials at the Arizona Health Sciences Center. The new Clinical Research Studies website facilitates access to research studies at the University of Arizona for the general public and for researchers recruiting people to their studies. The UA Clinical Research Studies website is searchable by health topic and makes access to information about the studies easy to find. The studies are listed by disease area and in laymen's terms for ease of navigation and understanding, and more in-depth medical information also is included for both UA and community health-care providers. Currently, there are over 100 UA studies focusing on a variety of diseases. The studies are led by nationally renowned researchers who are working to identify new cancer therapies, treatments for heart disease, asthma and lung disease, depression, Alzheimer's disease, Parkinson's disease, diabetes, and to find innovative uses for technology in health care.
ICD-10 CODING: The requirement to use the ICD-10 coding system has been extended to Oct. 1, 2015, however if your practice hasn’t developed an implementation plan these resource sites can assist.
Online ICD-10 Guide: http://www.cms.gov/Medicare/Coding/ICD10/ICD-10ImplementationTimelines.html
Introduction to ICD-10: http://www.cms.gov/Medicare/Coding/ICD10/ProviderResources.html
Basics for Small and Rural Practices: http://www.cms.gov/Medicare/Coding/ICD10/Medicare-Fee-for-Service-Provider-Resources.html
AMA’s What You Need to Know for the Upcoming Transition to ICD-10: http://www.azmed.org/ckfinder/userfiles/files/icd-10-transition.pdf
AMA’s Your 12-Step Transition Plan for ICD-10: http://www.azmed.org/ckfinder/userfiles/files/AMA_icd-10-action-plan-12-step-transition.pdf
PCMS / FAVORITE STAFFING SERVICE: If you need staffing, contact Favorite our affiliate medical staffing service. Favorite provides a full range of services including direct hire, contract, temp- to-perm, permanent placement and “just –in-time” per diem. Special rates are given to member physicians. Call Amy Erbe at 319-5766. She is anxious to assist.
WALK-WITH-A-DOC: The Society is teaming with the Arizona Chapter of the American College of Physicians (ACP) to host and provide physician leaders for the monthly Walk-With-A-Doc outings. Walkers sign in at the ramada east of Swan Bridge on the south bank.PCMS physicians are encouraged to urge patients to participate in the program. Each walk begins with a brief discussion on a health topic and includes a one- or two-mile walk on level ground. Please contact Dennis Carey at 795-7985 or email@example.com with questions. There is one more walk scheduled for 2013. It's on December 14. In 2014 walks will be held on January 11, February 8, March 8, April 12, September 13, October 11, November 8 and December 13. They begin at 8 a.m.