Iowa
Board Offers New Agreement for Physicians Who Prescribe to Patients with Chronic Pain
The Iowa Board of Medicine has created a new sample “pain management agreement” physicians can use when prescribing controlled substances to patients with long-term chronic pain. The agreement is offered as a tool to help physicians strengthen their chronic pain management practice.
The model agreement for use between physicians and patients spells out specifics in the use of the pain control medications and the consequences for their misuse. It is intended to prevent misunderstandings about high-strength opioid painkillers, which can be highly addictive if they are not managed properly.
The Iowa Board encourages physicians to use pain management agreements if they believe a patient is at risk of abusing or diverting medications. The sample agreement is now available on the Board's website, www.medicalboard.iowa.gov.
In a news release, the Board said that “physicians should not fear Board action for treating pain with controlled substances as long as the physicians' prescribing is consistent with appropriate pain management practices. These practices, which are delineated in administrative rules, include a comprehensive examination of the patient, a treatment plan, and a periodic review of the drug therapy.”
“In addition, if the physician believes the patient is at risk of drug abuse or diversion, then there should be a pain management agreement and periodic drug-testing to ensure the patient is receiving appropriate levels of the prescribed medications,” the Board said.
The Board is also encouraging physicians to use to the Iowa Prescription Monitoring Program database, which contains a patient's controlled substance prescription history.
The Iowa Department of Public Health's Bureau of Vital Statistics reports the drug overdose death of at least 130 Iowans over the past three years due to prescription pain relievers such as oxycodone, hydrocodone and methadone.
Source: Iowa Board of Medicine news release, July 9, 2012
Maryland
Maryland Board of Physicians Appoints Catalfo As New Executive Director
The Maryland Board of Physicians (MBP) has appointed Carole J. Catalfo, Esq., as its new Executive Director.
Catalfo, a member of the Kentucky and District of Columbia Bar Associations, is a former prosecutor and government trial attorney. She has a long history of public service in compliance and regulation, including leadership positions with Daymar College in Louisville, Ky., and the Commonwealth of Kentucky on behalf of the Educational Professional Standards Board and Cabinet for Families and Children. She most recently served as an Education Program Specialist in teacher licensure with the Maryland State Department of Education.
In a statement about her appointment, the MBP said Catalfo “has participated in all phases of the institutional licensure and regulatory process, and has extensive experience in program administration, complex litigation management, quality assurance initiatives, and strategic operations planning.”
She earned her bachelor's degree in Animal Science (Bioscience & Technology) from the University of New Hampshire, and her J.D. from the University of Louisville School of Law.
Source: Maryland Board of Physicians newsletter, Spring 2012
Nevada
Nevada State Board of Medical Examiners Releases 2011 Highlights and Statistics
The Nevada State Board of Medical Examiners recently released highlights and summaries of its activities in 2011, detailing a year in which the Board successfully advanced several legislative initiatives that enhanced and streamlined its work.
Among the initiatives that moved forward in 2011, the Board reduced from 30 to five the number of days a medical facility has to report to the Board on a physician's loss of privileges for specific behavioral and competency issues; established a 14-day sentinel event reporting timeline; and established, at five days, the time allowed a health care provider to produce in-state medical records upon request. The Board also successfully advanced legislation that allows it to process applicants for unrestricted licensure (of residents) at 24 months, with provisions to safeguard the public. Previously, the Board was allowed to process resident applications for full licensure at the end of the third year of post-graduate training only. The Board reports that this step will make Nevada more competitive in its attempts to attract new physicians to the state. An upward trend in complaints processed by the Board continued in 2011, with 828 investigations opened, 687 investigations closed, and 46 disciplinary actions imposed in 45 matters. The Board reports that the number of disciplinary matters it resolves has continued to increase over the last seven years.
The Board took an average of 7.2 disciplinary actions per 1,000 active-status licensed physicians in 2011, compared with 5.7 actions in 2010 and 5.3 actions in 2009.
The Board issued licenses to 477 physicians, 79 physician assistants, 172 respiratory therapists, and three perfusionists.
In 2011, the ratio of physicians to 100,000 in population increased only slightly over the previous year, reaching 171 per 100,000. From 1980 to 1992, the ratio of physicians to 100,000 population was relatively static, staying between 140 and 151 physicians per 100,000 population. From 1993 through 2007, the ratio increased, averaging between 153 and 161 physicians per 100,000. In 2008, the ratio increased to 164; in 2009 it increased to 166; and in 2010, the ratio increased to 170. The Board also reported that the number of physician assistants in the state increased by 2.5 percent in 2011. The number of respiratory therapists in the state increased by 4.6 percent and the number of perfusionists decreased by 3.8 percent.
Source: Nevada State Board of Medical Examiners Annual Report, 2011
North Carolina
North Carolina Medical Board Introduces Online Reentry Center
The North Carolina Medical Board (NCMB) has established a new online resource to provide licensees and others with information and tools related to the NCMB's physician and physician assistant reentry requirements. The state's reentry programs are designed for professionals who return to medical practice after a significant period of inactivity.
The NCMB has created a special section at its website that offers a variety of resources on reentry, ranging from sample reentry plans and form letters to details of the NCMB's reentry requirements. Licensees who have been out of clinical practice for two or more years are required to complete an approved program of reentry before returning to unrestricted practice in North Carolina. In a story about its new online resource in its newsletter, Forum, the NCMB said it views its reentry program as “a cost-effective alternative to other ways of demonstrating clinical competence before reentering active clinical practice, such as completing a mini-residency program or a formal personalized education program.”
The NCMB established formal standards for reentry in 2011 with the implementation of administrative rules that list specific factors that affect the terms of an individual's reentry program. These factors include the length of time out of practice, the prior intensity of practice, the skills needed for the intended area of practice, the reason for the interruption in practice, and the licensee's activities during the interruption in practice, including the amount of practice-relevant CME completed.
The NCMB's standards call for a “multiphase period of mentoring under a physician approved by the Board.” Phases of the program include an observation phase, during which the reentry candidate observes his or her mentor in practice; a phase during which the reentry candidate practices under their mentor's direct supervision; and a final phase during which the reentry candidate practices under the mentor's indirect supervision.
More than 150 physicians and physician assistants have successfully completed reentry programs to date, according to the NCMB.
To see the NCMB's online reentry resources, visit www.ncmedboard.org/professional_resources and click on “Special Topics.”
Source: North Carolina Medical Board Forum, 2012, Vol. 1
Ohio
State Medical Board of Ohio Adopts Position Statement on Telemedicine
The State Medical Board of Ohio has adopted a position statement on telemedicine in response to increased inquiries from providers, patients, and businesses related to the status of telemedicine and telehealth in Ohio.
The Board formally adopted its statement in May after meeting with a variety of interested parties in what it called a “concerted effort to ensure a viable framework for telemedicine moving forward.”
In its statement, the Board said it “recognizes that technological advances have made it possible for licensees to provide medical care to patients in ways that were not feasible in the past. As a result, telemedicine is a potentially useful tool that, if employed appropriately, can provide important benefits to patients, including increased access to health care, expanded utilization of specialty expertise, rapid availability of patient records, and potential reductions in the cost of patient care.”
The Medical Board cautions in the statement, however, that “licensees practicing via telemedicine will be held to the same standards of care as licensees employing more traditional in-person medical care. A failure to conform to appropriate standards of care whether that care is rendered in person or via telemedicine may subject the licensee to potential discipline by the Medical Board.”
In its statement the Board provided guidelines and definitions as clarification for physicians who hold a full medical license or telemedicine certificate in Ohio and provide medical services via oral, written or electronic communication.
Telemedicine is defined in Ohio as “the practice of medicine in this state through the use of any communication, including oral, written or electronic communication, by a physician located outside this state.”
The Board's statement stipulates that staff involved in a telemedicine visit should be trained in the use of the telemedicine equipment and competent in its operation.
The statement sets forth a definition of what the Board calls a “Licensee–Patient Relationship,” stating that “a licensee using telemedicine should have some means of verifying that the patient seeking treatment is in fact who they claim to be. A diagnosis should be established through the use of accepted medical practices, i.e., a patient history, mental status examination, physical examination, and any appropriate diagnostic and laboratory testing. Licensees using telemedicine should also ensure the availability for appropriate follow-up care and maintain a complete medical record that is available to the patient and other treating health care providers.”
The statement also sets forth definitions and expectations for examinations, which must be conducted before diagnosis or treatment, but “need not be in person if the technology is sufficient to provide the same information to the licensee as if the exam had been performed face-to-face.”
Other parameters for telemedicine practice defined in the statement cover prescribing, the use of medical records, and the use of licensure requirements.
To read the statement in full, visit the State Medical Board of Ohio website at www.med.ohio.gov.
Source: State Medical Board of Ohio website, August 2012
