STATE MEMBER BOARD BRIEFS

Colorado Becomes Latest State to Enact Interstate Medical Licensure Compact

Colorado became the 17th state to enact the Interstate Medical Licensure Compact recently when legislation was signed into law by Governor John Hickenlooper. With the addition of Colorado, five states enacted legislation in May and June to expand access to health care by expediting medical licensure.

In addition to Colorado, other states that have enacted the Compact include Alabama, Arizona, Idaho, Illinois, Iowa, Kansas, Minnesota, Mississippi, Montana, Nevada, New Hampshire, South Dakota, Utah, West Virginia, Wisconsin and Wyoming.

The Compact offers an expedited licensing process for physicians interested in practicing medicine in multiple states. The Compact is expected to expand access to health care, especially to those in rural and underserved areas of the country, and facilitate the use of telemedicine technologies in the delivery of health care.

“It is encouraging to see Colorado join the Compact, along with a growing number of states, as this will improve and increase health care access in the Rocky Mountain region and beyond, while still ensuring that we protect patient safety and quality,” said Joan Bothner, MD, Chief Medical Officer of Children's Hospital Colorado.

For more information about the Interstate Medical Licensure Compact, please visit http://licenseportability.org.

Source: FSMB news release, June 9, 2016

Florida Board of Medicine Publishes Position Statement on Disruptive Behavior

The Florida Board of Medicine has published a position statement that offers background and guidance to health care facilities, physicians and other health care professionals in dealing with the issue of disruptive behavior in health care settings.

The American Medical Association (AMA) defines disruptive behavior as physical or verbal personal conduct that has a negative effect or potentially has a negative effect on patient care. According to statistics, an estimated 3% to 5% of all physicians fall into this category of behavior.

The Board's position statement notes that disruptive behavior can arise from a variety of factors, such as “impairment issues, personal and professional stressors and specific personality traits,” and inappropriate behaviors among physicians and health care professionals “present potential threats to the health and safety of patients, the health care team and the environment of care.”

IN ITS POSITION STATEMENT, THE BOARD ACKNOWLEDGES THAT ‘THERE IS NO EASY SOLUTION TO THIS ISSUE.’

In its position statement, the Board recommends health care facilities and health organizations should consider taking several steps to address disruptive and inappropriate behavior:

• Health care facilities should establish a code of conduct that defines acceptable behavior, and behavioral policies and procedures that can be reviewed and signed by physicians during their initial credentialing and during subsequent re-credentialing cycles.

• On the first reported occurrence of disruptive behavior, a health care facility's chief of staff, chief of service or chief medical officer can speak with the physician engaging in such behavior.

• On the next reported occurrence of disruptive behavior, the physician can be asked to appear before the health care facility's wellness committee or other appropriate committee.

• If the disruptive behavior continues, the physician can be asked to voluntarily submit to an evaluation by PRN to exclude impairment.

• As a final step, the health care facility can mandate the referral of the physician for evaluation by a third-party program that specializes in treating impaired physicians.

In its position statement, the Board acknowledges that “there is no easy solution to this issue.” The position statement may be viewed at http://fiboardofmedicine.gov/latest-news/position-statement-on-disruptive-behavior/

Source: Florida Board of Medicine website announcement, June 14, 2016

First Non-Physician Leads Medical Board in Iowa

The Iowa Board of Medicine has installed the first non-physician to chair the Board in its 130-year history. Diane Clark was elected chair at the Board's organizational meeting in April. Iowa Governor Terry Branstad appointed Clark to the Board in 2011 and reappointed her in 2014. For the past three years, she has served on the Board's executive committee and was chair of the licensure committee.

ONE OF THREE PUBLIC MEMBERS ON THE 10-MEMBER BOARD, CLARK WAS TRAINED AS A REGISTERED NURSE AND HELD SEVERAL KEY ADMINISTRATIVE POSITIONS IN HEALTH CARE SETTINGS.

One of three public members on the 10-member board, Clark was trained as a registered nurse and held several key administrative positions in health care settings. She has a master's degree in organizational management and was the primary recruiter for physician staff members of the Mayo Health System's Albert Lea, Minnesota, Medical Center, for several years until retiring in 2013.

Source: Des Moines Register, June 30, 2016

Louisiana Reports Significant Increase in PMP Usage

Use of the Louisiana Prescription Monitoring Program (PMP) rose sharply between 2014 and 2015, according to the Louisiana Board of Pharmacy. The program, which monitors the prescribing of controlled substances in the state, logged 1,447,593 prescriber and prescriber-delegate searches in 2015, an increase of 49% over 2014. Pharmacist and pharmacist-delegate searches in the PMP grew by 132% over the same period, from 460,522 in 2014 to 1,066,781 in 2015. According to the Board, prescribers, pharmacists, and their delegates are currently averaging more than 7,330 searches of the PMP per day.

Source: Louisiana State Board of Medical Examiners Newsletter, April 2016

Maine Physicians Now May Work with Pharmacists on Collaborative Drug Therapy Management

The Maine Board of Licensure in Medicine has adopted a joint rule with Maine's Board of Pharmacy that sets out the requirements for collaborative drug therapy for patients by medical practitioners and pharmacists. Requirements include continuing education for pharmacists, a collaborative practice agreement, a treatment protocol, and standards for notifications and record-keeping.

The new rule will allow medical practitioners to work collaboratively with pharmacists in out-patient settings to manage chronic medical conditions such as asthma, diabetes, hypertension, infectious disease, cancer, thyroid disorders and coagulation disorders.

Source: Maine Board of Licensure in Medicine Newsletter, March 2016

Consultative Telemedicine Registration Paves the Way for Out of State Physicians to Provide Advice

The Maine Board of Licensure in Medicine has developed an application process for a new category of licensure called Consultative Telemedicine Registration. The registration allows physicians not located or practicing within Maine and not providing direct care to Maine patients to provide expert consultation on a regular basis at the request of a Maine physician, physician assistant, or advanced practice registered nurse.

The registration does not permit the physician to open an office in Maine, meet with patients in Maine, or receive calls in Maine from patients. In addition, the physician, physician assistant, or advanced practice registered nurse who requests the consultation retains ultimate responsibility over the care, diagnosis and treatment of the patient. To learn more about Maine's new licensure category, visit www.maine.gov/md/index.html.

Source: Maine Board of Licensure in Medicine Newsletter, March 2016

State Lifts Cap on Number of DOs Serving on Medical Board

Following two years of statewide discussion, Minnesota recently passed an update to the Minnesota Medical Practice Act bill that grants osteopathic physicians (DOs) equal opportunity, with their allopathic physician (MD) counterparts to serve on the state medical board. Eleven physicians serve on the Minnesota Board of Medical Practice; previously, only one could be a DO, but now there's no cap on how many DOs may serve.

ELEVEN PHYSICIANS SERVE ON THE MINNESOTA BOARD OF MEDICAL PRACTICE; PREVIOUSLY, ONLY ONE COULD BE A DO, BUT NOW THERE'S NO CAP ON HOW MANY DOS MAY SERVE.

In an article in The DO, a publication of the American Osteopathic Association, Minnesota DO Joe Willett said that in the past, the Minnesota Board “sometimes had very qualified DOs who wanted to serve, but weren't able to because the one DO slot was already taken.”

“Now if a DO wants to serve on the Minnesota State Medical Board, he or she has an equal chance,” added Willett, who serves on the Minnesota Board.

In the same article, Ruth Martinez, Executive Director of the Minnesota Board, echoed support for the change. “Minnesota recognizes the equivalent training and examination standards of osteopathic and allopathic physicians and advocates for a practice act that fairly and accurately reflects these equivalencies,” she said. “The Board believes these changes provide the equal recognition in statute of MDs and DOs as is found in the health care delivery system across Minnesota and throughout the nation.”

Source: American Osteopathic Association, The DO, June 1, 2016

NCMB Safe Opioid Prescribing Initiative Now Includes ‘Safe Opiods’ Web Page

The North Carolina Medical Board's comprehensive Safe Opioid Prescribing Initiative, which includes stepped-up investigation and enforcement, policy development and education and outreach efforts, now offers an enhanced web page with a variety of resources for physicians and other health professionals.

The web page includes news, information about Medical Board programs, prescribing resources, online CME opportunities and other tools.

In recent years, as patient deaths from opioid poisoning have continued to rise, the Board has intensified its effort to ensure appropriate prescribing of opioids. According to the Board, the Safe Opioid Prescribing Initiative is “an attempt to reduce patient harm from misuse and abuse of prescription opioids by identifying and, where necessary, intervening to prevent excessive and/or inappropriate prescribing.”

In April 2016, the Board emailed its licensees, providing information about its new efforts to address the opioid crisis, informing them of the measures it is taking, including clarification on prescriber investigations.

As a part of its initiative, the Board will investigate prescribers who meet one or more of the several criteria:

• The prescriber falls within the top 1% of those prescribing 100 milligrams of morphine equivalents (MME) per patient per day.

• The prescriber falls within the top 1% of those prescribing 100 MMEs per patient per day in combination with any benzodiazepine and is within the top 1% of all controlled substance prescribers by volume.

• The prescriber has prescribed to two or more patients who died in the preceding twelve months due to opioid poisoning.

Source: North Carolina Medical Board Forum, Spring 2016

North Carolina Year-In-Review Shows Downward Trend in Complaints

Medical complaints registered with the North Carolina Medical Board have dropped in each of the past several years, according to a report from the Board titled “Year in Review: A look back at data from 2015.”

Complaints to the Board decreased from 1,416 in 2012 to 1,343 in 2013, decreasing again to 1,256 in 2014 and 1,196 in 2015.

The top five causes of public action against licensees in 2015 were quality of care issues (55 cases), alcohol or substance abuse (32 cases), prescribing issues (24 cases), action by another licensing authority (15 cases), and other unprofessional or unethical conduct (14 cases).

The Board issued new licenses to 2,156 allopathic physicians (MDs), 929 resident trainees, 609 physician assistants, 245 osteopathic physicians (DOs), 24 licensed perfusionists, and 10 anesthesiology assistants in 2015.

Total licensee population in the state was 45,107, in the following categories: MD, 34,248; physician assistant, 5,880; resident trainee, 2,702; DO, 1,931; clinical pharmacist practitioner, 170; licensed perfusionist, 151; anesthesiology assistant, 25.

Source: North Carolina Medical Board Forum, Spring 2016

Medical Board Plans to Cut Initial Licensure Fee

The State Medical Board of Ohio is looking to create financial incentives to encourage new physicians to stay in Ohio. In June 2016 it informed licensees that although Ohio's initial physician licensing fee is already among the least expensive in the country, it has approved a further reduction from $335 to $305. It is now awaiting legislative approval to implement the change.

Source: State Medical Board of Ohio Med Bd E-News, June 3, 2016

Medical Quality Assurance Commission Staffer Receives AIM National Award for Medical Care Investigators

Renee Bruess, an investigator for the Washington State Medical Quality Assurance Commission, has been selected by the Administrators in Medicine (AIM) as the recipient of the Ronald K. Williamson Memorial Award for Board Investigators.

AIM, a national organization for state medical and osteopathic board executives, recognized Bruess for her work in a case that spanned three years, encompassing 23 complaints against the same practitioner. Bruess completed 24 separate investigations concerning 52 patients and reviewed more than 6,800 pages of medical records and other evidence regarding standard of care.

Bruess, a registered nurse with a master's degree in Health Law, conducts complex standard-of-care investigations for the Commission.

Source: Washington State Medical Commission Newsletter, Summer 2016

New Laws Passed in Wisconsin Take Aim at Pain Management and Safe Prescribing

Several new laws related to pain management, opioid prescribing and reporting were recently passed by Wisconsin's state legislature and signed into law by Governor Scott Walker.:

• 2015 Wisconsin Act 266 requires practitioners to review a patient's state Prescription Drug Monitoring Program (PDMP) records before the practitioner issues a prescription order for that patient for a monitored drug.

• 2015 Wisconsin Act 267 creates reporting requirements for the PDMP to determine the program's effectiveness.

• 2015 Wisconsin Act 268 requires law enforcement to report instances of inappropriate use of opioids to the PDMP.

• 2015 Wisconsin Act 269 allows the state's Medical Examining Board, Podiatry Affiliated Credentialing Board, Board of Nursing, Dentistry Examining Board, and Optometry Examining Board to issue guidelines regarding best practices in prescribing controlled substances, as defined in § 961.01, for persons credentialed by that Board who are authorized to prescribe controlled substances.

The Medical Examining Board is currently drafting guidelines, in addition to a continuing medical education (CME) rule that would require CME in safe-and-responsible controlled substances prescribing.

Comprehensive information about Wisconsin's new legislation is available at “2015–16 Session Acts,” found at http://legis.wisconsin.gov/2015/related/acts.

Source: Wisconsin Medical Examining Board Med Board Newsletter, June 2016