In a WHA letter to the Medical Examining Board (MEB) sent March 9, the WHA Physician Leaders Council asked the MEB to consider providing via MEB resolution additional clarity to physicians regarding the MEB’s intent regarding physician discipline and the upcoming Prescription Drug Monitoring Program (PDMP) prescriber mandate. The letter, signed by the chair of the WHA Physician Leaders Council, Steve Kulick, MD, CMO ProHealth Care, was the result of discussions at the March 2 WHA Physician Leaders Council meeting. A copy of the letter can be found here.
“Physicians greatly appreciate the information contained in the PDMP and have significant interest in utilizing the PDMP to enable physicians to make more informed decisions,” wrote Kulick. “However, the Council has also been concerned that a well-intentioned mandate for use of a PDMP system has the potential to introduce additional, unintended regulatory complexity for physicians, particularly if the PDMP system is not optimally designed to be integrated into existing physician practice patterns and EHR resources.”
“It is clear that physicians across the state have many questions regarding multiple technical compliance questions regarding the new PDMP mandate and how the Medical Examining Board will be approaching physician discipline related to the April 1 mandate,” wrote Kulick. “By articulating a clear and common sense approach that aligns with the intent of the PDMP prescriber mandate, the Medical Examining Board can help physicians focus on the benefits of the PDMP and remove technical compliance concerns of physicians intending to make good faith use of the PDMP tool.”
The letter was one outcome of a detailed discussion by the WHA Physician Leaders Council at its March 2 meeting of a growing list of PDMP implementation concerns being identified by physicians and physician leaders in health systems across Wisconsin. Discussions were consistent with the concerns discussed at a WHA-organized February 28 meeting of multiple health systems with the Department of Safety and Professional Services (DSPS) including:
- The critical importance for DSPS to expedite the implementation of an interoperable/integrated EHR solution for accessing the PDMP database.
- The lack of progress by the PDMP vendor to have a widely available interoperable/integrated EHR solution before April 1.
- Multiple, ongoing functionality problems with the new web-based PDMP.
- Timeliness of response to questions and multiple organizations asking the same questions.
Staff also reported that following the February 28 meeting, DSPS indicated they would be taking additional steps recommended by WHA to help advance a successful full implementation of the PDMP including:
- Create a PDMP user group to help formally inform DSPS and its vendor as they continue to implement the new PDMP.
- Add new FAQs and resources to the PDMP website to address questions and concerns that are brought to DSPS’s attention, including information about how the MEB will interpret compliance requirements.
- Add to the PDMP website a list of “known issues” that DSPS is working on, what the solution will be and the timeline for the solution.
WHA also offered to DSPS to help host or promote any additional educational webinars DSPS is planning regarding PDMP usage and implementation before April 1.
“The burden of regulatory complexity, intended or not, on physicians is a significant concern to physicians and their hospitals and health systems,” said WHA Chief Medical Officer Chuck Shabino, MD.
“Regulatory complexity adds to physician frustrations and professional dissatisfaction as even well intentioned regulations such as the PDMP mandate can erode trust in physicians’ professional judgement and negatively impact their ability to meet the public’s expectations to provide efficient, high-quality patient care. When regulations are added, government has an obligation to make sure that it is taking all steps possible to minimize the burden of those regulations. ”
2017 Physician Leaders Council Plans and Goals
As has been the case in prior years’ WHA goals, WHA’s 2017 goals includes a section addressing physician engagement in the integrated health care enterprise. At its March 2 meeting, the Council discussed WHA’s past and present integrated physician engagement and advocacy efforts, and potential topics and efforts the Council would like to focus on in 2017.
“As WHA’s members’ focus has evolved beyond the traditional ‘walls’ of the hospital to a presence as local and regional integrated health systems, WHA’s focus has similarly evolved,” said Shabino. “The physician component of our members’ enterprise is significantly larger, and WHA has been evolving to respond to those changes by enhancing WHA activities to incorporate, from the system prospective, physician issues, opportunities and initiatives.”
Legislative and Regulatory Input
Matthew Stanford, WHA general counsel, provided an overview of the Governor’s proposed state budget and other WHA advocacy efforts to the Council. As part of that overview, staff asked the Council for input on three policy items: A state budget proposal to permit licensing boards such as the Medical Examining Board to impose fines on licensees, the pros and cons of gathering workforce data as part of physician license renewal, and potential federal Stark/Anti-kickback reform.
The Council was particularly concerned with the state budget proposal that would authorize licensing boards to impose fines on licensees. The Council said the licensing boards already have broad authority to take a wide range of actions against licensees, each of which can impose significant financial costs on licensees. Council members did not see how imposing forfeitures would improve patient safety and would instead add another layer of regulatory subjectivity on physicians.
ACA Repeal and Replace
Joanne Alig, WHA senior vice president, policy and research, shared with the Council the latest developments related to the ACA. Her presentation discussed WHA’s policy priorities and advocacy strategies both in Washington, D.C. and Madison.
Alig said WHA has been fully engaged in the federal reform issue, making several trips to Washington to meet with Wisconsin’s congressional delegation. WHA staff has also delivered several letters and white papers to the congressional and state delegation along with state agency leaders to keep them fully informed on the impact reforms would have on their constituents. In addition, WHA Board Chair Cathy Jacobson recently appointed a subcommittee on health care reform to help WHA proactively engage and react to health care reforms as Congress and the President move toward repealing and replacing the ACA.
The next meeting of the WHA Physician Leaders Council is May 11.