Physician Edition

03-31-2017


March 31, 2017

Volume 5-Issue 6


PDMP Prescribing Requirement and Other Changes Take Effect April 1

DSPS sets out process for reporting technological failures preventing access to the PDMP

Physicians and other prescribers are reminded that on Saturday, April 1, Act 266 will require a practitioner to review a patient’s records under the Prescription Drug Monitoring Program (PDMP) before issuing a prescription order for a monitored drug. Under the statute, there are exceptions to the mandate:

The patient is receiving hospice care, as defined in s. 50.94 (1) (a).
The prescription order is for a number of doses that is intended to last the patient three days or less and is not subject to refill.
The monitored prescription drug is lawfully administered to the patient. For example, a drug that is both prescribed and administered to a patient on an inpatient unit is exempted.
Due to emergency, it is not possible for the practitioner to review the patient’s records under the program before the practitioner issues a prescription order for the patient.
The practitioner is unable to review the patient’s records under the program because the digital platform for the program is not operational or due to other technological failure if the practitioner reports that failure to the Board.
On March 30, the Department of Safety and Professional Services (DSPS) sent an email providing a procedure for implementing the exception for inability to review PDMP records due to PDMP technological or operational failure. It states:

"As you may be aware, Wis. Stat. ch. § 961.385(2)(cs)2.e. offers an exception to the ePDMP requirement should the ePDMP not be operational or if there is a technological failure if the practitioner reports that failure to the board. Under this section, "board" is defined as the Controlled Substances Board (Wis. Stat. ch. §961.385(1)(ac), and notifications should be provided following the below procedure:

To report a technological failure preventing you from accessing the WI ePDMP, send an email to PDMP@wisconsin.gov with the subject line "WI ePDMP Tech Failure."

WHA has been receiving reports and notices of both planned and unplanned outages of the ePDMP in the days leading up to April 1. If your organization’s prescribers are having difficulty with outages, unreasonably slow response times, or other technological failures, you should contact DSPS, including through the process set forth above.

As reported in previous Valued Voice stories, WHA continues to work with DSPS and its boards to provide additional clarity around the new mandate and to expedite efforts by DSPS’s vendor to implement cost and time effective options to enable federally certified EHRs to present PDMP data.

Training materials, FAQs, and additional contact information are available on the PDMP website. To view that information, go to: https://pdmp.wi.gov/training-materials.

In addition, other changes to the PDMP take effect April 1. One change shortens the time period in which applicable dispensers must submit data to the PDMP to no later than 11:59 p.m. of the next business day after the monitored prescription drug is dispensed.

Another change taking effect April 1 permits individuals who "medically coordinate, direct, supervise, or establish standard operating procedures" to receive certain PDMP data to help such individuals evaluate practitioners’ job performance or perform quality assessment or improvement activities.

Additional information about these additional changes, along with a summary of the Act’s PDMP mandate can be found in a "WHA Act Summary of Act 266, 267, and 268: Changes to Wisconsin’s Prescription Drug Monitoring Program (PDMP)" in the WHA members-only portal under the "Legal Resources – Wis. Legislative Summaries" tab. If you do not have a member account in the WHA members-only portal, go to members.wha.org and click on "Register" to create an account. If you have questions about how to register, contact Tammy Hribar at thribar@wha.org or 608-274-1820.

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PDMP Intent and Compliance Discussed by State Boards

Follows WHA Physician Leaders Council call for additional regulatory clarity

The Controlled Substances Board met on short notice March 13 to review and discuss the need for additional clarity on its intent regarding enforcement of the upcoming April 1 requirement created in 2015 Act 266 for a prescriber to review Prescription Drug Monitoring Program (PDMP) records before prescribing certain controlled substances. Under statute, the Controlled Substances Board has rulemaking authority over the PDMP.

Department of Safety and Professional Services (DSPS) staff to the Controlled Substances Board said the meeting was called to address concerns raised by health systems and others seeking clarification regarding the Board’s role. Tim Westlake, MD, chair of the Controlled Substances Board and vice chair of the Medical Examining Board, said there are some real and significant questions and concerns being raised regarding technical compliance.

"We don’t want systems implementing procedures that get in the way of patient care and don’t add benefit," said Westlake. He further said he believed the Controlled Substances Board would be wise to recognize these issues and use some discretion in its enforcement of the PDMP mandate.

To help provide some clarity to practitioners, the Controlled Substances Board adopted the following resolution: "The Board, with the assistance of the Department, recognizes that the priority will be to continue promoting, educating and training practitioners about the benefits of the PDMP and the requirements in 2015 Act 266 regarding a practitioner’s review of PDMP data. Further, the Board recognizes it has discretion in its authority for non-compliance of its rules that implement 2015 Act 266 to refer non-compliant practitioners to the regulatory authority that regulates the profession of the non-compliant practitioner."

DSPS staff also shared with the Controlled Substances Board that Rep. John Nygren is drafting a letter regarding the legislative intent regarding the PDMP mandate that staff believed would further help give clarity to prescribers. Staff indicated the letter has not yet been finalized, but the Controlled Substances Board discussed and made a motion that the letter should be posted on the ePDMP website for prescribers to see when it is received by DSPS.

These actions follow a letter sent by the WHA Physician Leaders Council to the Medical Examining Board (MEB) asking for it to consider providing additional clarity to physicians regarding the MEB’s intent regarding physician discipline and the upcoming PDMP prescriber mandate. As reported in the March 10 edition of The Valued Voice, the letter signed by the chair of the WHA Physician Leaders Council, Steve Kulick, MD, chief medical officer, ProHealth Care, was the result of discussions at the March 2 WHA Physician Leaders Council meeting. A copy of the letter can be found at: www.wha.org/pdf/WHALettertoMEB3-9-17.pdf.

"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 Medical Examining Board also discussed the PDMP mandate at its March 15 meeting, and its members had a similar discussion as the Controlled Substances Board regarding interpreting the statutory mandate and technical compliance. Consistent with the February Medical Examining Board meeting and the Controlled Substances Board resolution, individual members indicated that their intent is to focus on advancing use of the PDMP by physicians and not to focus on "technical" compliance with the statute. One apparent difficulty the Medical Examining Board faces is a "catch-22" where the Board is being advised that it is not authorized to generally comment on what review is under the statutory mandate.

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