Saturday, March 24, 2018


Prescription Drug Abuse – What to Look For

By Ann Whitehead, JD, RN
Vice President of Risk Management & Patient Safety Cooperative of American Physicians, Inc.

The Centers for Disease Control and Prevention (CDC) has classified prescription drug abuse as an epidemic. A staggering statistic from the National Drug Abuse Institute reveals prescription drugs are the second most abused drug, behind marijuana, by seniors in high school. The CDC finds overdoses from prescription painkillers resulted in more deaths in 2010 than heroin and cocaine combined.1

Prescription drug abuse affects all age, race, gender, and socioeconomic classes. Here are two examples: the patient on an antidepressant prescribed by his psychiatrist was also taking a narcotic prescribed by an orthopedist. In a drug-induced haze, the man threw himself down a flight of stairs, breaking his neck; or the 83-year-old patient who recently came to the office for morphine who later tested positive for cocaine. Both patients create liability and treatment issues for their physicians. 

Although many types of prescription drugs are abused, there is currently a growing, deadly epidemic of prescription painkiller abuse. Nearly three out of four prescription drug overdoses are caused by prescription opioid painkillers. The U.S. Drug Enforcement Administration (DEA) and the California Department of Justice are aggressively prosecuting individuals who prescribe opioids illegally and those who operate “pill mills.” Physicians face challenges when trying to spot the patient who may be abusing prescription drugs or possibly improperly sharing them with others. The following are some suspicious behaviors that may raise the red flag. 

The patient may:

• Refuse to grant permission to obtain old records or communicate with previous physicians.
• Demonstrate reluctance to undergo comprehensive histories, physical examinations, or diagnostic testing, especially urine drug screenings.
• Request specific drugs (often because of the higher resale value of brand names).
• Profess multiple allergies to recommended medications.
• Resist certain treatment options.
• Threaten doctors or display anger during visits.
• Consistently target appointments at the end of the day or during off hours.
• Repeatedly lose prescriptions.
• Request escalation in dosages.
• Demonstrate noncompliance with prescription instructions.

A helpful tool for physicians is the “Opioid Overdose Toolkit: Information for Prescribers” recently released by the Substance Abuse and Mental Health Services Administration (SAMHSA).2 This guide offers tips on safe prescribing and preventing opioid overdose including: assessment, state drug monitoring programs, medication selection, prescription writing tips, use of naloxone, and deciding when to stop opioid.

Lastly, if you get a call from the DEA or local law enforcement, contact the CAP Hotline for assistance.

For more information about CAP, or to request additional information or risk management publications, please contact us at:, or call 800-356-5672. You can also visit our website at:

1 Centers for Disease Control and Prevention (CDC). CDC grand rounds: Prescription drug overdoses – A U.S. epidemic. MMWR Morb Mortal Wkly Rep.2012; 61(1):10-13.
2 Substance Abuse and Mental Health Services Administration. SAMHSA Opioid Overdose Toolkit” Information for Prescribers. HHS Publication No. (SMA) 13-4742. Rockville, MD: Substance Abuse and Mental Health Administration, 2013.

CMA launches Covered California Provider Education Program

The California Medical Association (CMA) and the CMA Foundation have been awarded a $1.5 million grant from Covered California, the state's new health benefit exchange. The grant application was submitted in partnership with the Latino Physicians of California, the American Academy of Pediatrics and a number of CMA's component medical societies.
The grant is being used to establish the CMA's "California Health Benefit Exchange Outreach and Education Program." The goal is to help medical professionals across the state and their health care teams to educate their patients about the new coverage options available through Covered California and the financial assistance available to help pay for them. The program will focus more intensive outreach to physicians working in communities with a large number of consumers eligible for Covered California.
Physicians are powerful and effective messengers to deliver information to patients. We will be working to educate not only physicians, but also the office and health care teams that support physician practices. We will work with registered nurses, medical assistants, nurse practitioners, physician assistants, office managers and other physician practice staff in the targeted geographic areas that have the highest number of newly eligible exchange enrollees. All staff working in a practice or clinic will have an opportunity to learn more about Covered California insurance plans to fully utilize their skills and potential in educating patients about exchange eligibility and enrollment.

Regional Outreach

The California Health Benefit Exchange Outreach and Education Program will have four regional Provider Educators, with one assigned to each of the following regions: 1) Fresno, Kern, Tulare and Kings Counties; 2) San Diego, Riverside and San Bernardino Counties; 3) Los Angeles and Orange Counties; and 4) San Joaquin, Santa Clara, Alameda and Contra Costa Counties. For those practices in regions not listed, CMA Foundation staff will provide outreach and education. 

Educational Strategy

The educational strategy will be a multifaceted approach that factors in the different physician practice environments and incorporates multiple strategies to communicate with the physicians and their health care teams. The approach will incorporate group learning sessions, focus groups, educational print medium and one-on-one "touches" supported by newsletters, webinars and e-communication.
We will develop learning communities of grantees, sub-grantees and other interested partners to share challenges and best practices and to help us use resources as effectively as possible.
Our strategy will also include the following: 

  • Identify the gaps in physician knowledge about the exchange and design educational messaging to address those gaps.
  • Create a master list of existing regularly held meetings of the association members and partners so that we can utilize the already built network and standing meeting schedule
  • Establish lesson plans to ensure consistency in presentations.
  • Identify physician champions to be trained to educate their peers and other health care professionals and staff.
  • Establish a Physician/Health Care Worker Subcommittee to provide message testing, guidance and input on presentations and one-on-one education.
  • Make resources available through the physician practice to patients, helping them understand Covered California.
  • Develop a physician toolkit comprised of essential outreach materials for physician champions and their health care teams to give to patients.
  • Work with hospitals and health plans to book training and education sessions in hospital grand rounds, regularly scheduled patient-support focused meetings and medical staff meetings.


For the full Covered California Grant Newsletter, click here.

For a list of Health Benefit Exchange resources available to physicians, click here.

All resources are available on the CMA website at

OCMA members may contact Physician Advocate Mitzi Young with questions about Covered California and the Health Benefits Exchange at (888) 236-0267 or

OCMA Internist and Addiction Specialist Receives Gary Nye, MD Award

Max A. Schneider, M.D., an Orange County internist and addiction specialist, was given the Dr. Gary Nye Award at the 2013 at the California Medical Association (CMA) House of Delegates held this weekend in Anaheim. The award is given annually to a CMA member physician who has made significant contributions toward improving physician health and wellness.

Dr. Schneider for over 40 years has helped educate medical students, residents and physicians on addiction as a disease and the specific risks it poses for physicians. 

He was instrumental in establishing addiction medicine as part of the medical school curriculum at University of California, Irvine School of Medicine.

Dr. Schneider helped establish the concept of physician well-being committees and has served on the well-being committees for the Orange County Medical Association, St. Joseph’s Hospital, Children’s Hospital of Orange County and Chapman Hospital.

A fellow and past president of the American Society of Addiction Medicine, he also is past chairman of the Board of Directors of the National Council on Alcoholism and Drug Dependence and has served as a consultant to the Drug and Alcohol Advisory Committee of the U.S. Food and Drug Administration.

Dr. Schneider graduated from the University of Buffalo, School of Medicine in 1949. He practiced internal medicine in his native Buffalo for 11 years until 1964 and since 1964 has practiced in Orange County.

Your Participation is Requested - 2013 Employee Salary Survey

The California Medical Group Management Association (CAMGMA) is coordinating their 2013 salary survey. They are using a dynamic new instrument which provides real-time results back to the participants, along with customized reports.
Data entry and support is being coordinated for OCMA members by Jay Wikum, CPA (Business Partner - HMWC CPAs and Business Advisors).
The link to the online instrument can be found at:  The data entry period is scheduled to run through September 30, 2013
If you have any questions on the survey or the instrument, feel free to contact Jay Wikum at (714) 505-9000.
Click here to access the form directly.

Upcoming CalOptima Provider Forum on Duals Demonstration

On July 10, the OCMA, CalOptima and the Health Networks in the CalOptima health care delivery system co-hosted a forum for physicians to learn about the contracting options for the upcoming "duals demonstration."  The demonstration will entail enrolling the dual-eligible (Medicare/Medi-Cal) beneficiaries in Orange County into CalOptima. OCMA has been advocating that physicians and their dual-eligible patients have multiple options for participating in the demonstration, including an option that allows physicians to contract directly with CalOptima. 


On Wednesday, August 14, CalOptima will host another forum which will include the Health Networks to once again reach out to physicians and educate them on the various contracting options the CalOptima board of directors will consider at their next board meeting.  If you missed the July 10th forum, OCMA strongly encourages you to attend the forum on August 14.  It is imperative that CalOptima and the Health Networks hear from the physicians that are caring for the dual-eligible patients in Orange County. The invitation to the August 14 forum is attached.


Note: this forum will be held at CalOptima. See invitation for full details.


Thank you for your attention to this matter.

Resources to Assist Physicians with the Medicare Contractor Transition

Goal:   Provide members with information and resources to prepare their practices for the transition of Medicare contractors from Palmetto to Noridian on September 16 (Part B).


Current CMA Resources


1. CMA’s Medicare Transition webpage – CMA has created a dedicated Medicare transition webpage,, offering practices the ability to access updates and important information regarding the transition in one easy-to-access to location. All resources related to the Medicare transition will be accessible through this site.

2. CMA’s Medicare Transition Guide: What physicians need to knowThis guide, which members can download free from the CMA website, includes an FAQ that includes information on the transition dates, what will remain the same with the transition and what will change, Noridian’s online provider portal, what practices can do to prepare for the transition, and links to additional resources and way to stay apprised of new information on the transition.

3. CMA Practice Resources (CPR)CMA Practice Resources is a free monthly newsletter from CMA’s practice management experts that focuses on critical payor and health care industry issues, including the Medicare transition, and how these issues directly impact the business of a physician practice. To sign up, visit the CMA website or contact CMA Member Services at (800) 786-4262.

4. CMA webinarAt the request of CMA, Noridian has agreed to conduct a webinar for CMA members on August 7 from 12:15-1:30pm.  The other webinars Noridian is offering is open to all provider types in California, Nevada, Hawaii, and the U.S. territories of American Samoa, Guam and the Northern Mariana Islands. However, the August 7 webinar will be limited to CMA members and will give attendees an opportunity to ask their specific questions. This webinar will be held at the OCMA Conference Center during a "Lunch & Learn." 
During the gathering, we will participate in the "live" CMA Medicare Transition webinar and then discuss any questions. To register for the Lunch & Learn, click here.

For those who miss the live webinar, it will be available on-demand via the CMA website.


5. Content alert updates - The CMA website allows registered users to create custom content alerts on the top­ics that are of interest to you. Once signed up, you will be notified any time there is new content posted in one of your interested areas, including Medicare issues. To sign up, users should visit their account dashboard on the CMA website and click on “my alerts,” then select “Insurance Reimbursement -> Medicare.”


CMA Resource in Development


  • Practice preparation checklist indicating all of the steps practices should take to prepare for the transition to Noridian. This document will be added to the Medicare Transition Guide.


MEC Engagement


The Priority Assistance Committee recommends that MEC proactively educate members about the resource available from CMA to help navigate contracting with the exchange.

  • Promote CMA Medicare transition website
  • Promote CMA’s Medicare transition guide
  • Promote Aug 7 Medicare transition webinar (promo from CMSS coming)
  • Include articles and announcements in CMS publications and communications
  • Alert CMA’s Michele Kelly 213/226-0338 of any issues related to the transition. 

Additional Resources

  • Noridian’s transition website: The Noridian transition website includes information on what’s new/changing and what will remain the same during and after the transition.
  • Paul O’Donnell, Noridian (701) 277-2401.  NOTE: MEC are welcome to contact Mr. O’Donnell directly; however, it is important to keep CMA/Michele Kelly in the loop so that she is aware of issues as they arise.


Additional Medicare-related Resources


1.      Medicare Enrollment Guide for Physicians - This document guides  physicians through the enrollment process and assists enrolled physicians who are making changes or who must revalidate their enrollment.

2.      Getting Started with the Medicare Physician Quality Reporting System (PQRS) – this guide assists physicians with understanding and complying with PQRS.

3.      Medicare Electronic Prescribing Overview: Payment Incentives and Payment Reductions – Overview of electronic prescribing (eRX) program, including incentive payments for physicians who e-prescribe and payment penalties for physicians who do not.

4.      Medicare Part B Important Changes: What they mean to your practice

5.     Medicare Audit Guide for Physicians – Guide for preparing and responding to a Medicare audit.

6.      Various Medicare webinars available on demand at

7.      Numerous Medicare-related CMA On-Call documents can be downloaded at

Announcement: Medicare SGR and GPCI Bill Clears Committee

On Wednesday, July 31, the House Energy & Commerce Committee voted UNANIMOUSLY to approve H.R. 2810, the bill to repeal and replace the Medicare SGR. Included in that bill is a California Medicare locality reform (known as the "California GPCI Fix") which will update payments for the urban physicians in Locality 99 and Locality 3 while holding the rural physicians in these localities harmless from payment cuts. 


OCMA and CMA are pleased with this herculean effort to move Medicare SGR legislation on a bipartisan basis as well as update the outdated Medicare physician payment localities.  CMA physicians have cleared the first hurdle in a long legislative process. The Medicare SGR and GPCI Locality  issues will now be taken up by the House Ways & Means Committee as well as the Senate Finance Committee.   


While there are several aspects of the bill that concern CMA, including the downside penalties and lack of adequate updates, the bill meets many of the goals that CMA advocated to Congress to eliminate the annual threat of nearly 30% SGR payment cuts, 5 years of stable updates, a continuation of the Fee-for-Service (FFS) program with opportunities for updates, and incentives to help physicians transition to new payment and delivery models. There is still much work to be done on the entire bill and Congress recognizes that.  


If you would like further details on this matter, please contact OCMA.

Physician Financial Transparency Reports (Sunshine Act) Begins August 1, 2013

Tracking of Industry Gifts to Physicians Begins in August

Don't miss your chance to challenge false or misleading data before it goes public!

Beginning August 1, 2013, manufacturers of drugs, medical devices and biologics that participate in federal health care programs must begin tracking and reporting certain payments and items of value—including consulting fees, travel reimbursements, research grants and other gifts—given to physicians and teaching hospitals. The new law, known as the Sunshine Act, also requires manufacturers and group purchasing organizations (GPOs) to report certain ownership interests held by physicians and their close family members.

The intention of the law is to increase transparency and reduce the potential for conflicts of interest that can influence research, education and clinical decision making.

The reports will be submitted to the Centers for Medicare and Medicaid Services (CMS) on an annual basis. The majority of the information contained in the reports will be made available on a public, searchable website beginning in September 2014. Physicians will, however, have the right to review their reports and to challenge any information that is false, inaccurate or misleading. By statute, physicians are provided, at a minimum, 45 days to review the transparency reports and make corrections before they are made public.

“Data accuracy is the number one goal of our program,’’ said Anita Griner, CMS’s deputy director for the Data Sharing and Partnership Group, speaking to the American Medical Association's House of Delegates in June. “We do not want to perpetuate any false information about a physician or teaching hospital…. And that will come from you tracking your own transfers and checking the website before it goes public.’’



The Sunshine Act covers all physicians who have an active state license, even if they do not participate in federal health care programs, but excludes residents and medical students.

Payments of less than $10 do not need to be reported unless the aggregate amount exceeds $100 annually. The $10 threshold will increase every year, based on the Consumer Price Index.

How to challenge false, inaccurate or misleading reports

Physicians will have 45 days after the annual reports are completed to challenge the data before it is made public. The reports will be available to physicians for their review via an online portal sometime after the close of the calendar year. The portal will also facilitate contact between a physician with a dispute and the manufacturer/GPO that submitted the disputed information.


Manufacturers then have 15 days to correct any misinformation. If a resolution is not reached within the allotted time period, the disputed information will be flagged, but the report will be posted on a public webpage. Physicians will, however, have two full years to contest or seek corrections to data contained in the reports, even after it has been made public.


Physicians are encouraged to proactively check with any manufacturer from which they have received payments or any items of value to see what information they are tracking and intend to report. If you hold any ownership interests, you should also check to ascertain what they intend to report. (Ownership or investment interests in publicly traded securities and mutual funds are excluded from reporting.)

What you can do now to prepare for the Sunshine Act

Update your disclosures regularly. Ensure that all financial disclosures and conflict of interest disclosures required by employers, advisory bodies and entities funding research, for example, are current and updated regularly.

If you have an NPI, update the information and ensure your specialty is correctly designated. Physicians who have a National Provider Identifier (NPI) should ensure all information in the NPI enumerator database is current and regularly updated as needed. This information will be used by industry reporters, among other unique identifiers, to ensure that they have accurately identified you.

Inform your industry contacts that you want ongoing notice of what they report to the government. Ask all manufacturer and GPO representatives with whom you interact to provide you with notice and an opportunity to review and, if necessary, correct all information that they intend to report before it is submitted to the federal government.

For more information


Physicians are encouraged to register for the CMS Open Payments listserv to receive periodic email updates about the program. To register, visit Questions about the program can be sent to

Some information in this article was republished with permission from the American Medical Association. For more information, visit



Key Dates

August 1, 2013: Manufacturers begin collecting and tracking payment, transfer and ownership information.

January 1, 2014: CMS is expected to launch the physician portal that allows physicians to sign up to receive notice when their individual consolidated report is available for review. This portal will also allow physicians to dispute the accuracy of a report.

March 31, 2014: Manufacturers/GPOs report 2013 data to CMS.

June 2014: CMS is expected to provide physicians with access to their individualized consolidated reports for the prior calendar year. Physicians will be able to access the reports online and will be able to seek correction or modification by contacting the manufacturer/GPO via the web portal.

September 30, 2014: CMS will release most of the data on a public website.


The Sunshine Act includes a number of exemptions from the reporting requirements; among them are:

  • Samples intended for patient use, including coupons and coupons to obtain samples
  • Certified and accredited continuing medical education activities funded by manufacturers
  • Educational materials ultimately intended to be used with patients (for example, wall models or anatomical models)
  • Buffet meals, snacks, soft drinks, or coffee generally available to all participants of large-scale conference or similar large-scale events
  • The loan of a medical device for a short-term trial period
  • Discounts (including rebates)
  • In-kind items used for the provision of charity care
  • A dividend or other profit distribution from a publicly traded security or mutual fund

ACA Self Attestation Form Now Available

July 22, 2013

The ACA Self Attestation Form is now available on the ACA Increased Medicaid Payment for Primary Care Physicians page of the Medi-Cal website. Providers must use this form to self-attest that they are eligible for the increased payment available under the Affordable Care Act (ACA). Providers can reference the Primary Care Physician Self Attestation Form Completion Instructions for step-by-step instructions and additional information about the form.


The Patient Protection and Affordable Care Act (PPACA), as amended by the H.R. 4872-24 Health Care and Education Reconciliation Act of 2010, Section 1202, requires payments to be increased to the Medicare equivalent for certain primary care services. The increased payments are retroactive for dates of service on or after January 1, 2013, for both fee-for-service and managed care programs.

 According to the final rule, physicians must meet the following criteria to be eligible for increased payments:

  • A physician as defined in 42 Code of Federal Regulations (CFR) 440.50, with a specialty designation of family medicine, general internal medicine, pediatric medicine or a subspecialty within one of the listed specialties.


  • Meeting at least one of the following qualifications:

o    Board certified in a specialty or subspecialty as recognized by the American Board of Medical Specialties, the American Osteopathic Association and the American Board of Physician Specialties.


o    At least 60 percent of the services billed to Medi-Cal for the most recently completed calendar year fall within the Evaluation and Management (E&M) or vaccine administration codes covered by the regulation.

Services provided at Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) are not eligible and will continue to receive their prospective payment system (PPS) rate. Physicians must attest online to be eligible for the increased payments.

The Department of Health Care Services (DHCS) is working with Xerox State Healthcare, LLC, (Xerox) the DHCS Fiscal Intermediary (FI), to make the necessary system changes. Upon complete implementation of the system, DHCS will initiate payment corrections for eligible services provided on or after January 1, 2013. Eligible providers will receive the increased payments for future claims as defined in the Centers for Medicare & Medicaid Services (CMS) Final Rule.

State Offering Webinar on Coordinated Care Initiative

The California Department of Health Services is offering two more educational webinars on the Coordinated Care Initiative (CCI) in July. It is important to note that these webinars will NOT be recorded or available for on-demand playback.

Physicians and their staff in affected counties are encouraged to participate in one of the live webinars, Tuesday, July 23 or Tuesday, July 30.


The initiative, also known as "CalMediConnect," was authorized by the Assembly in July 2012 in an effort to save money and better coordinate care for the state's low-income seniors and persons with disabilities. The program begins with a three-year demonstration project that will transition more than 450,000 of the state's dual eligible beneficiaries - those eligible for both Medicare and Medi-Cal - into managed care plans.


Enrollment begins no sooner than January 2014 in 8 counties (Alameda, San Mateo, Santa Clara, Los Angeles, Orange, San Diego, Riverside and San Bernardino).


Physicians, other providers and their staff are invited to participate in one of the July webinars:

  • Tuesday, July 23 at 6:00pm (Click here to register)
  • Tuesday, July 30 at 5:00pm (Click here to register)

Each webinar will include a 30 minute overview of the program, including continuity of care provisions, and 30 minutes of Q&A. Note that the content of the overview will be the same on both dates. Additional webinars will be scheduled as enrollment nears.

For more information on the initiative, please visit

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