Minnesota Physician cover stories

July 2017

Past cover stories

The value of Medicaid

A safety net for children

 

By Kelly Wolfe

 

Imagine you’re pregnant and you unexpectedly go into premature labor, delivering your baby two months early. While you have health care coverage through your employer, you discover upon discharge from the hospital that your insurance won’t cover the 24-hour nursing care your baby will require, nor does it cover the equipment or medications your infant will need to survive. Thankfully, your child is eligible for Medicaid and you can now access these services.

 

Opioid Prescribing Improvement Project

A safety net for children

 

By Kelly Wolfe

 

Imagine you’re pregnant and you unexpectedly go into premature labor, delivering your baby two months early. While you have health care coverage through your employer, you discover upon discharge from the hospital that your insurance won’t cover the 24-hour nursing care your baby will require, nor does it cover the equipment or medications your infant will need to survive. Thankfully, your child is eligible for Medicaid and you can now access these services.

 

Quality reporting

The importance of accounting for social conditions

 

By Paul Kleeberg, MD, and Phil Deering, BA

 

Like many Minnesota physicians, Dr. Lynne Ogawa first saw her Minnesota Statewide Quality Reporting and Measurement System (SQRMS) outcomes toward the end of the last decade. At the time, the family practice doctor saw patients at the Fremont Clinic, located in the heart of North Minneapolis.

 

Why just retire?

Consider physician emeritus

 

By Michael J. Weber, JD, and Nancy Lee Nelson, JD, MPH, RN

 

If you are like many other Minnesota-licensed physicians, you might be unaware of the option to retire as a “physician emeritus.” To retire as a physician emeritus, a physician has to complete a short application with the Minnesota Board of Medical Practice.

 

Regenerative Medicine Minnesota

Transforming the future of health care

 

By Jakub Tolar, MD, PhD, and Andre Terzic, MD, PhD, FAHA

 

We have grown accustomed to the medical miracles—antibiotics to combat infection; transplantation to replace failed organs; and biologics to control high cholesterol, rheumatoid arthritis, or psoriasis—that have transformed patient care. Despite remarkable advances, many serious health problems resist conventional medicine and surgery, causing suffering and shortening lives.

 

The Minnesota Adult Abuse Reporting Center

Protecting the vulnerable

 

By Commissioner Emily Piper, JD

 

An older adult woman living in northern Minnesota was at her most vulnerable—recovering from surgery after a stroke—when she became the victim of financial exploitation by her own daughter.

 

The CARES Model

A way to engage your patients

 

By Archelle Georgiou, MD

 

Sixty-two percent of Americans say they want to deliberate with their physician about their treatment options. And, to help make the right choices, consumers have been armed with an array of health information sites, symptom checkers, cost calculators, and provider quality scores and report cards.

 

Minnesota Prescription Monitoring Program

Important updates responding to an epidemic

 

By Barbara A. Carter

 

In a recent survey conducted by the American Medical Association, in which 44 of the 49 state prescription drug monitoring programs (PDMP/PMP) responded there was a 180 percent increase, between 2014 and 2016, in the number of physicians’ and other health care professionals that had registered for an account with a PDMP/PMP.

 

Regenerative Medicine:

Efficacy, Economics, and Evolution

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Minnesota Prescription Monitoring Program

Important updates responding to an epidemic

 

By Barbara A. Carter

 

In a recent survey conducted by the American Medical Association, in which 44 of the 49 state prescription drug monitoring programs (PDMP/PMP) responded there was a 180 percent increase, between 2014 and 2016, in the number of physicians’ and other health care professionals that had registered for an account with a PDMP/PMP. During that same time there was also a 121 percent increase in the number of times physicians and other health care professionals used a state’s PDMP/PMP. In 2016 alone, there were more than 136.1 million queries of those 44 state’s databases.

 

Mandated registration

Although the numbers continue to increase, a bill passed during the 2016 Minnesota legislative session requires all Minnesota licensed prescribers, who practice in this state, and who hold a valid DEA prescriber registration to prescribe to humans, to register for and maintain an account with the Minnesota Prescription Monitoring Program (MN PMP). Such prescribers must register and activate their account no later than July 1, 2017.

 

Minnesota is one of 49 states that currently have an operational PMP. The Minnesota PMP, which is administered by the Minnesota Board of Pharmacy, has been operational since January 2010 and continues to collect an average of 8 million controlled substance (Schedules II-V), gabapentin and butalbital prescription records annually. In 2016 alone, more than 1.2 million queries of patient profiles were requested by more than 16,000 prescribers who had been granted direct access to the PMP database.

 

A critical tool for battling addiction

While more than 30 states have mandated the use of the PMP under certain circumstances and with the hopes of increasing use of the database, the MN PMP is hoping that the requirement to register for and maintain a PMP account will bring to the prescriber’s attention the availability of this critical information to assist in saving lives. PMPs have been identified as a critical tool in assisting prescribers and dispensers in identifying patients who may be at risk for overdose, addiction, or who may be visiting multiple providers and multiple dispensers seeking controlled substances for non-medical purposes.

 

Prescribers who are authorized to prescribe controlled substances may apply for access to the database by completing an online access request form during their annual professional license renewal, or at one of the many educational events the PMP staff attend throughout the state. Information collected during the registration process includes name, practice name and address, professional license number, DEA registration number, and email address. Once the information has been submitted electronically, the credentials provided will be verified and notifications regarding the status of the account request followed by a temporary password will be sent via email, normally within 15 minutes of application. The account holder must immediately access their account and establish a unique, secure password. Failure to reset the temporary password will reflect the account’s status as inactive or “not maintained.”

 

Maintaining your PMP account

The MN PMP staff is currently developing a new mechanism to notify account holders when their passwords will expire. Account passwords are set to expire after 180 days and when the new process is implemented, an email will be generated by the system 10 days prior to the password expiration, and again three days prior if no action was taken. If the password does expire, the account will be locked. The account holder can conveniently use a self-service button to retrieve a new password by answering a security question.

 

Additionally, another new mechanism to notify account holders when it is time for their annual account profile update is in development. Similar to the notifications received for password expirations, the result in failure to take action will be deactivation of the account. Account deactivation will require a phone call to the help desk for credential verification and reactivation.

Monthly, the MN PMP staff will provide a list of all active accounts to the Minnesota Board of Medical Practice, in addition to the other Boards that license permissible users of the MN PMP data. The MN PMP has no jurisdiction over these health care professionals; therefore, it is entirely up to the Boards to decide what actions will be taken when one of their licensees does not hold an active MN PMP account. For information regarding the requirement to register for a MN PMP account, please contact the appropriate health licensing board.

 

The Minnesota Board of Pharmacy has worked with the boards that license prescribers to integrate registration into online renewal processes. However, prescribers can also register on the MN PMP website.

 

Access Request Forms can be found at www.pmp.pharmacy.state.mn.us on the “PMP User Registration and Resources” page. Registration and access are free!

In addition to registration during annual license renewal and directly on the MN PMP website, the MN Board of Pharmacy, through a Harold Rogers Prescription Drug Monitoring Program grant is providing funds to the Minnesota Board of Medical Practice to incorporate the ability to apply for a MN PMP account directly from their Board’s website. This new functionality is in development as of this writing and is scheduled to be deployed before the end of 2017. This will make it more convenient for newly licensed physicians to register for an account.

 

Use of the MN PMP RxSentry

Prescribers may access the MN PMP database 24 hours a day, seven days a week. Prescribers themselves or their employers may decide how often and when they will request patient profiles. Some may decide to do so for all patients for whom the prescribing of a controlled substance is being considered. Others may do so only when they suspect potential abuse, misuse, or diversion. The reports can be used to determine appropriate medical treatment such as referral to a pain-management specialist as well as to identify “doctor-shopping” behaviors. The MN PMP encourages prescribers to assist individuals tentatively identified as having an issue of concern regarding controlled substances in finding the help they need. Recent improvements to the MN PMP website include a resource section for prescribers with links to prescribing and screening tools as well as treatment resource information.

 

In addition to checking on a patient’s controlled substance prescription history in the state of Minnesota, an authorized practitioner with an active MN PMP user account has the ability to view their patient’s history in other states. Through the “Multiple State Query” function, a prescriber, after selecting from a list of states currently participating in the interstate data exchange, can locate additional patient information. Minnesota is now actively participating with 31 states with additional states coming on board in the near future.

A prescriber with an active MN PMP account may also use the system to access a report of the controlled substance prescriptions dispensed using their DEA registration number. This functionality enables prescribers to monitor use of their DEA registration number and potentially detect fraudulent use.

 

Prescribers must respect confidentiality, and may only access data on those patients for whom they are directly providing care, in accordance with Minnesota Statutes Section 152.126. Patient profile reports from the Minnesota PMP database are designated as private data and can be used to supplement an evaluation of a patient, confirm a patient’s drug history, or document compliance with a therapeutic regimen. However, the Minnesota Board of Pharmacy can’t guarantee that any patient profile is accurate or complete. Dispensers have an obligation to accurately report all controlled substance prescriptions that they have dispensed to the MN PMP database. However, they do not always do so—despite the efforts of the MN PMP staff to monitor the reporting of prescriptions and to work with dispensers to correct inaccurate or incomplete data.

 

For more information or to inquire about the registration process for the MN PMP, please contact the MN PMP office via email at minnesota.pmp@state.mn.us or at 651-201-2836.

 

Barbara A. Carter manages the MN PMP, along with Katrina Howard, PharmD and Shannon Whitman, program administrator, and continues to advance the program by ensuring the incoming data is timely, complete, and accurate and that permissible users of the data have continuous access. Barbara currently serves as vice president of the National Association of State Controlled Substances Authorities (NASCSA) and co-chairs its PMP Committee. Additionally, she serves on the National Alliance for Model State Drug Laws (NAMSDL) PMP Resource Group and the National Association of Boards of Pharmacy (NABP) PMP InterConnect Steering Committee.

 

How to Apply:

Access Request Forms can be found on the MN PMP website at

www.pmp.pharmacy.state.mn.us  on the “PMP User Registration and Resources” page.

Minnesota Physician Publishing Inc. © 2017