Illinois Prescription Monitoring Program

One of our RN Managers attended the 17th Annual SafeWorks Illinois Work Injury Prevention and Control Strategies conference held in Champaign, IL on October 29, 2009 and brought back information about an exciting new program to help manage chronic pain patients.

Dr. David Fletcher presented on the new Illinois Prescription Monitoring Program (PMP). This program allows any licensed physician or pharmacist to determine if a patient is obtaining narcotic prescriptions from multiple physicians, and can also determine if they were receiving narcotics pain medicine prior to a work injury.

This program is only open to licensed pharmacists and physicians in the state of Illinois.

This program is authorized by 710 ILCS 570/321, known as the Illinois Controlled Substances Act and applies to Schedule II, III, IV and V medications, and contains all Schedule drugs listed above, dispensed by Illinois retail pharmacies. All pharmacies must report this data on a weekly basis, and the database is updated every Friday.

In an effort to maximize the benefit of the IME process, S&H will be requesting IME physicians include the data base search results as a part of their report.

Other applications suggested by Gene Keefe in his weekly newsletter:
1. As part of fitness for duty evaluations, the database can be checked to clarify the completeness of information provided by the new hire, during the post job offer physical examination. It makes sense to review the patient’s use of scheduled drugs for the previous six months.
2. If a pattern of excessive use of controlled substances is detected, the physician can alert other providers also.
3. To clarify if the patient is “doctor shopping”.

Considerations:
1. Remember to use a HIPAA compliant release. The information in this database is covered by HIPAA and all confidentiality and disclosure provisions of Illinois law. S&H utilizes this type of release when working with your injured worker.
2. A doctor may also want to review what scripts have been filled for a specific patient, clarifying who wrote each script, if they suspect a patient has obtained one of their prescription pads fraudulently.

The goal for obtaining this information is two-fold. S&H wants to help bring to light inappropriate narcotic usage by the injured worker, hoping to prevent or address narcotic addiction much earlier in a case. Also to put unscrupulous physicians on notice that they are being closely monitored.

For more information on the IL PMP contact: Stan Tylman, 401 North Fourth Street, Springfield, IL, 62702 Phone: 217-524-9074.

Dr. Fletcher can be contacted via http://www.safeworksillinois.com/contact-safeworks.html

Thanks to Gene Keefe and his most recent Newsletter dated 11/1/09. Some of the information in this article was excerpted from this recent newsletter. Gene’s newsletters are stored on his blog. www.keefe-law.com/blog

Gene’s blog just won an award as one of the top 25 W/C blogs http://law.lexisnexis.com/practiceareas/Workers-Compensation-Law-Blog/Workers-Compensation/LexisNexis-Top-25-Blogs-for-Workers-Compensation-and-Workplace-Issues—2009-Honorees

Nurse Licensure Compact Considerations – Are the nurses you work with licensed in the states for which you refer files?

S&H has recently become aware (at the time we have hired RNs from other case management companies) that many RNs are not licensed in the states for which they practice case management.

When asked why the RN is not licensed (and many of these RNs were most recently employed by national or large regional case management companies) they have uniformly responded, our most recent company told us they are “covering our licenses” in our other states. Every one of these RNs told us their company did research and found they did not need to be licensed except for their “home state”.

In the past (over 15 – 20 years ago), some states did not specifically address case managment when discussing the need for out of state licensure. Many companies gambled on this technicality when deciding to or not to license their RN staff. Later, many states tightened up the in-person case management, but left the telephonic requirements vague. All of this has changed.

I have looked at the state board of nursing for each state in which S&H practices, and there are no remaining “loopholes”. In addition, when I attended the National Case Management Society Conference (CMSA) in Phoenix, AZ, in 2009, I attended a seminar on legal issues in nursing. I specifically addressed this with the RN, JD that taught the seminar.

This is how it was explained to me: If the RN Case Manager is providing field-based (in person) case management, there is NO EXCEPTION! All RNs are to be licensed in the state (and all states) in which they practice.

Further, If the RN is performing telephonic case management and is only contacting the physician or physical therapist, or other treatment provider and is basing her recommendations on analysis of this information, then (s)he does not require a nursing license in that state. HOWEVER, if the RN is also speaking with the injured worker or recipient of health care, then she does require a nursing license to make this assessment.

Why would a company not get the proper licensures for their staff? Because it is expensive and time consuming! There are also continuing education requirements in some states. S&H has always insisted upon proper state licensure for all RNs providing field and telephonic case management.

So what does this mean to you, the adjuster or plan administrator? Would you use a physician that is not licensed in the state in which your plan recipient or injured worker is receiving treatment? Would you use an attorney that is not licensed in the state in which they are practicing? Why not? The same reasons apply for the RN.

If the RN is practicing outside of the scope of the Nurse Practice Act (and she is, if she is not licensed) then her company’s liability insurance does not cover her. If there is any type of untoward result as a consequence of recommendations made by the RN and it comes to light that you hired this consultant but did not make sure they were properly licensed, do you think your company will share in the liability?

So how do you safeguard against this? You can ask to see copies of all licenses for all states in which the RN practices. Another safeguard: Use a URAC accredited company. As part of the accreditation, URAC does spot checks for licensure. However, in some of our most recent hires from national companies that are URAC accredited, we found the RN did not have the proper licensure.

S&H was also informed at this recent conference many states are now making it their business to aggessively seek out and prosecute any company and/or RN working in their state, but working without a license in their state.

One solution that is helping with some of the licensure issues is a concept called State Licensure Compact. S&H communicated with the Missouri State Legislature as this issue was being considered in 2009. We are happy to report that as of this date, Missouri is in process to consider joining the compact!

More information on RN Multi-State Licensure Compact: https://www.ncsbn.org/158.htm

Medication and Treatment Non-Adherence

As noted on the Case Management Society of America (CMSA) website, The World Health Organization estimates that only one-half of the patients in the US take their medications as prescribed! Studies show that 10 percent of all hospital admissions and 23 to 40 percent of all nursing home admissions are the result of non-adherence. The cost adds up to an estimated $100 billion a year!

Even a 1% reduction in non-adherence would save the health care system $1 billion, not to mention the benefits to patients. The consequences of non-adherence include a decrease in quality-of-life and increase in avoidable healthcare costs. Studies cited in CMSA’s Case Management Adherence Guidelines (CMAG) show the magnitude.

S&H has developed a Medication Adherence Assessment tool, integrated into our Care Management services, based on the CMSA Case Management Adherence Guidelines (CMAG).

The CMSA recently added tools for addressing issues related to adherence to the chronic conditions of Diabetes, Deep Vein Thrombosis (DVT) and Depression.

S&H is currently working on developing a Pilot Project for one of our clients, incorporating these guidelines. We will keep you posted!

http://www.sandhmms.com/pay.asp

Adopt Tony’s Platoon

What started out as a plan to send one naval airman a Christmas package from S&H has snowballed into our year long project for 2009. We have made the decision to adopt the entire platoon, 64 men and women.

This platoon of naval airmen is currently serving in Kuwait at the Iraqi border. This is the fourth tour of duty for these sixty four dedicated men and women! S&H became acquainted with this fine group by way of Petty Officer, Second Class, Tony Stephens, serving with this platoon. Tony’s mom, Vanessa works at S&H Medical Management. S&H Medical Management has decided to adopt this deserving platoon for the next year.

However, today’s tough economic conditions make it difficult for S&H Medical Management Services to meet those needs without help from people like you. S&H invites your business to donate an item or gift certificate for our next shipment. Our employees were able to supply each airman one of each item on their wish list in December, but we need help to keep the momentum going! Please contact us for a list of appropriate items.

All sponsors will be listed here on our company website in this special section devoted to the Adopt a Platoon project. All items will be donated by businesses like yours – as well as by members of S&H Medical Management Services, Inc., and other community members.