pharmacists

CA low-income medical providers denied payments

Sterling Meyers — Thu, 24 Jul 2008 12:32:25 -0400

Payments from Medi-Cal's insurance program for the poor will cease today, rattling healthcare facilities across California. Until a budget is approved, Medi-Cal payments for low-income patients will not be paid because lawmakers failed to pass a budget, causing the state to prohibit payments.

CA law requires payment for private doctors and pharmacists treating Medi-Cal patients, but healthcare "institutions," as the state calls them, will no longer be funded. These medical businesses and organizations, including 1,200 homes for the developmentally disabled--which have previously relied on funding from Medi-Cal entirely--will be cut off immediately. While most facilities don't plan on turning Medi-Cal patients away, healthcare institutions are racing to find funding from foundations, banks and their own reserves--the emergency funding that state officials had set aside in case of a budget delay is spent.

In 2007, a similar budget freeze occurred, but this year brings a tighter budget for struggling banks that are less willing to offer bridge loans. Some managers of healthcare institutions that previously received payments from Medi-Cal are paying premiums for their secured loans, and are facing a dwindling amount of cash because of today's news from state officials.

To learn more about the freeze:
- read this LA Times article

DEA wants tough rules for e-prescribing controlled drugs

Anne Zieger — Mon, 14 Jul 2008 12:09:23 -0400

For a long time, government officials, health plans and IT vendors have been trying to get doctors to write prescriptions electronically. Many doctors have held back, though, because at least 10 percent of their scripts were for controlled substances like OxyContin and Vicodin, which can't legally be e-prescribed--and who wants to switch back and forth from paper to computer? Things may change soon, as the DEA has proposed a rule that would allow physicians to write e-scripts for controlled drugs. That being said, however, it still won't be easy to do. In fact, everyone involved will be required to comply with a boatload of regulations if they want to participate.

The controlled-substances e-prescribing rules impose a range of new regulations on doctors, hospitals and pharmacies that want to participate. Not only would doctors have to register in person with law-enforcement officials, but they'd also have to allow routine audits of their prescription records. Pharmacists, meanwhile, would have to verify weekly that doctors doing the prescribing remain licensed and in good standing, keep digital records of the controlled drug e-prescriptions and notify the DEA within 24 hours in the case of a security violation.

To learn more about the rules:
- read this Modern Healthcare article (reg. req.)

Related Articles:
DEA eases painkiller prescription rules
DEA may allow e-prescribing of controlled substances
DEA allows e-prescriptions for controlled drugs

NH considers database tracking frequently-abused drugs

Anne Zieger — Mon, 30 Jun 2008 22:57:27 -0400

New Hampshire's attorney general has started to push the state to develop a centralized database tracking frequently-abused prescription medications such as painkillers and stimulants. Attorney General Kelly Ayotte is calling for the database to be developed, in part, because over the past two years, drug abuse deaths have exceeded traffic deaths in the state. Ayotte would like to establish the database to allow physicians and pharmacists to see whether patients have already gotten a prescription for these abused drugs elsewhere, a practice commonly known as "doctor shopping." To date, legislators in the state have rejected this notion. However, officials in other states have already established similar databases. For example, one Wisconsin county has worked to establish a database allowing area doctors to track painkiller scripts.

To learn more about the NH initiative:
- read this Modern Healthcare article (reg. req.)

Heparin scare leads to new dosing issue

Fri, 16 May 2008 06:59:55 -0400

While efforts to make dosing safer in the wake of recent heparin-related deaths make sense, such efforts have created a fresh set of safety concerns for providers who use it, observers say. For one thing, with providers turning to new suppliers, the drug is arriving in different quantities and strengths than many medical staffs are used to administering, raising the risk that the drug will be dosed incorrectly. Specifically, new packaging isn't coming in the single-dose form typically distributed by Baxter; instead, many vials contain larger or more potent quantities of the drug.

Heparin already is one of the five "high-alert" drugs most commonly associated with medication errors in hospitals, and this only raises the ante. As a result, some medical centers are having to establish extra precautions. For example, in some hospitals, pharmacists are reminding nurses to draw the drug from a vial instead of using a pre-filled syringe, and have asked the hospitals to remove the syringes so nurses won't make a mistake while switching between products.

To learn more about this issue:
- read this article from the Baltimore Sun

Related Articles:
Number of heparin-related deaths reported triples
Baxter provides update on heparin reactions
Post-heparin, no oversight excuses

OH pharmacists lobby health plans to expand patient care role

Mon, 12 May 2008 06:59:56 -0400

Fresh from the success of a 10-year demonstration in Asheville, North Carolina, Ohio pharmacists are lobbying insurers to convince them to pay for care coordination services. The pharmacists contend that they're among the only ones in a position to know all of the drugs patients are taking, particularly those with complex, chronic conditions such as diabetes or asthma.

The pharmacists are taking their cue from the "Asheville Model," under which the city of Asheville and another local employer paid a fee to pharmacists to consult with patients. The program also gave employees an incentive to see the pharmacists, such as waived co-pays. The program has produced positive health results, including improvements in patient blood pressure and cholesterol levels, researchers have found.

To learn more about this initiative:
- read this Cleveland Plain Dealer piece

Related Articles:
Pharmacists a valuable asset in the ER
Errors encouraged by fast pharmacy pace
Study: Pharmacist oversight improves cardiac outcomes

Case study: WI system creates new care model

Tue, 08 Apr 2008 06:59:54 -0400

When it kicked off its patient care revamp, executives with Wisconsin health system ThedaCare had two broad objects: finding waste and identifying risk. Its new healthcare model, Collaborative Care, is designed to do just that. Drawing manufacturing techniques, the system has redesigned every task from restocking supplies to physician rounds. The results: The general medicine unit has reduced patient stays by 20 percent.

The biggest changes resulting from the model involve tighter collaboration and redefined roles for doctors, pharmacists, nurses and other caregivers. For example, doctors make rounds with the pharmacists and nurse, and sometimes a care manager as well. These teams help each other, on the spot, as needed. For example, pharmacists give immediate advice on dosing or ask questions about why the doctor ordered what he or she did. Meanwhile, nurses focus on coordinating care, while LPNs or nurse assistants do many tasks the RNs used to do.

Other changes include physical, practical care process helpers, such as colored lights outside the rooms to indicate when a doctor has written an order or medication has been developed, and magnets on the door for when a patient needs a specimen taken or test.

To learn more about these changes:
- read this Milwaukee Journal-Sentinel piece

Related Articles:
HIMSS: Patient safety top reason for IT investment. Report
Case study: Hospital takes lessons from Toyota. Report
BIDMC uses lean production approach. Report
Memorial Hospital-South Bend--Hospital Innovators 2007. Report

SPOTLIGHT: Pharma can't meet CA tracking deadline

Tue, 25 Mar 2008 07:59:52 -0400

It's a case pitting grand intentions against market realities. California wanted to become the first state to require all prescription drugs to be tracked from factory to patient. The aim: prevent counterfeiting and allow any tainted meds to be traced to their source. But drug makers, wholesalers, and pharmacists in California aren't ready. They can't afford the cost of tracking equipment, they say, and haven't settled on which of several tracking technologies to use. Report

CA auditing drug programs for health professionals

Tue, 11 Mar 2008 07:59:54 -0400

Last year, the Medical Board of California shut down its confidential addiction treatment program for doctors after a series of audits concluded that the program wasn't working. The program, which let drug- and alcohol-abusing healthcare providers avoid public discipline by getting treatment and agreeing to random drug tests, wasn't doing enough to protect the public from harm caused by impaired doctors, the board concluded. Now, the state is taking a hard look at similar "diversion" programs for nurses, pharmacists and other health professionals. Currently seven other healthcare boards offer such programs. Advocates for health professionals, for their part, were disappointed by the Medical Board's decision to drop the diversion program, and hope the legislature will step in and create an alternative option. Otherwise, they suggest, impaired professionals will be more likely to cause harm, since they'll hide their condition as long as possible.

To learn more about this issue:
- read this Los Angeles Times piece

Related Articles:
CA plan to kill addicted-doctor program sparks controversy. Report
NC law makes medical board info public. Report
Virginia's medical board tightens discipline process. Report
Study: Medical board discipline varies widely. Report

ALSO NOTED: Health data sharing groups in trouble; Pharmacists ranked highly for ethics; and much more...

Tue, 18 Dec 2007 06:59:50 -0500

> A new study suggests that regional health information organizations may face a cloudier future than expected. FierceHealthIT

> It looks like pharmacists are getting some good press. A new study suggests that almost three-quarters of Americans see them as having high honesty and ethical standards. Article

> HHS has approved a Medicaid waiver in Indiana which will let Medicaid beneficiaries enroll in a state-subsidized high-deductible plan. Article

> CMS and NCQA are asking for public comments on proposed quality measures for Medicare special needs plans. Article

And Finally... Here's a look at how hospitals and health systems are using social media to get their message out and build relationships with patients. Blog

Trend: Physicians dispensing drugs in offices

Tue, 30 Oct 2007 07:59:54 -0400

While it's far from an established practice, physicians are increasingly beginning to sell prescription drugs in their offices. Right now, only 10 percent of U.S. physicians do so, but the number could increase to 25 percent over the next five to 10 years, according to research by analyst firm Manhattan Research.

Pharmacists have raised questions about the practice, with some arguing that the arrangement gives doctors an incentive to overcharge. Pharmacists also contend that if patients get drugs from physicians, they might not get the proper counseling on drug interactions. However, some physicians say that it's one of the only ways they can fight back against falling reimbursement rates and rising costs.

To learn more about this trend:
- read this Kaiser Daily Health Policy Report piece