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News & Press: Industry News

Crises, Compliance, and the Orthopaedic Practice

Tuesday, April 10, 2018   (0 Comments)
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Written for AAOE by Barbara Mullarky, Director of Product Management, SRS Health

It’s not news that America is facing a crisis with opioids and narcotic abuse—public service announcements are running on every network; the president has declared it a health emergency; and an increasing number of Americans have had personal experiences with a family member or friend who has become addicted.

Laws have been put in place or are being considered at every level of the government to help address the problem. One approach to helping doctors continue to care for their legitimate patient requests while identifying drug seekers or “doctor shoppers” is the PDMP, or Prescription Drug Monitoring Program. PDMPs are state-run databases containing patients’ prescription histories. PDMPs now exist in all states, and more than 35 states have laws making it mandatory to check the PDMP before prescribing a narcotic. Some states require documentation that the doctor not only checked the PDMP, but also counseled the patient. And some states are starting to identify doctors who prescribe high numbers of narcotics, and are putting programs in place to counsel those providers. The College of Healthcare Information Management Executives (CHIME), a branch of HIMSS, recently met and recommended that the Center for Medicare and Medicaid Services (CMS) include the use of Electronic Prescribing of Controlled Substances (EPCS) as part of the MIPS portion of the Quality Payment Program (QPP) in 2019. They also recommended that CMS and Office of the National Coordinator (ONC) focus on interoperability and removing the burden for clinicians.

Another method to help control the crisis is the use of EPCS. Unfortunately only 17 percent of physicians in the US are EPCS enabled. While 90 percent of standard prescriptions are processed electronically, only 14 percent of controlled substance prescriptions are electronically delivered (Surescripts CEO Tom Skelton, at HIMSS March 2018).

Does your EHR offer PDMP connectivity? Does it allow for EPCS? The technology to automatically complete PDMP checking and documentation does exist—today—providing physicians with the option of making their prescribing and compliance workflows seamless. Providers who use EPCS with PDMP should automatically be presented with the patient’s prescription history any time they prescribe a narcotic. The system should also automatically connect to the state database, retrieve the history, display it to the physician, and record that the physician checked the PDMP. This can be up to a 67 percent time savings over the current process of logging into the PDMP directly (DrFirst case study, 2018).

 

Appropriate Use Criteria

A lesser-known government law is called the Appropriate Use Criteria (AUC). It’s an ambiguous name for a law that will affect everyone who orders advanced imaging procedures—a staple of orthopaedic practices. AUC is part of the Medicare Physician Fee Schedule regulations.

The law will impact the ordering, performing, and payment for advanced imaging procedures beginning January 1, 2019. The initial year (2019) will be an educational and testing year that will not affect payment.

Included in the advanced imaging procedure category are MRI, CT, PET, and nuclear studies. While orthopaedists may not order many PET or nuclear studies, MRI and CT are staples in the diagnostic pathway and help determine care.

How does the law work? The government is mandating that any time an advanced imaging procedure is ordered, the ordering provider must consult an approved Clinical Decision Support Mechanism (CDSM). The CDSM will look at multiple factors on the patient and come back with a recommendation as to whether or not the ordered procedure is appropriate or whether something else would be better. At this point, providers have the choice to continue with the original order or to follow the CDSM recommendations and change the order. Information is returned from the CDSM that must be provided to the furnishing provider (imaging facility). The imaging facility must include this information on the claim to the payer. Data on the choices made by the ordering provider will be stored in the CDSM for future auditing purposes.

Those who do their own imaging in house will be impacted on the ordering and furnishing side. Your EHR, Radiology Information System (RIS), and claims management system will all need to be updated with new software to manage this.

In both cases, we encourage you to speak with your EHR vendor to make this process as seamless, and minimally invasive as possible for meeting the requirements to remain compliant.

 


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