FSIPP ALERTS

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October 24, 2011

Millennium Invitation to FREE one-day CME conference

Millennium Research Institute invites you to attend one of three, FREE one-day CME conferences in Florida on chronic pain management, risk management, and the new Florida regulations,

Expanding the Conversations Encompassing Pain Management.

This conference, offers an opportunity to dialogue around the clinical and regulatory issues facing practicing physicians. Joining the dialogue is Dave Aronberg, the “Florida Drug Czar”, Howard Heit, MD and Doug Gourlay, MD, who will lead clinical case studies and other great speakers who will focus on the regulatory changes related to pain care and walk participants through a practice self-audit.

Seating is limited for each of these events so register now if you wish to attend. Attached is a PDF of the conference information and you can register at www.millenniumresearchinstitute.org/florida .

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October 20, 2011

TV - 60 Minutes - Feature on Prescription Epidemic in Florida

FSIPP Membership:

This past Sunday, CBS ran an 8 minute feature on the prescription drug epidemic in Florida and across the country. The youtube link to this report is below. The report features law enforcement in Palm Beach and Pinellas Counties.

Nation's Overdose by Tracy Smith 10-16-11 CBS Sunday Morning
http://www.youtube.com/watch?v=3QUPmD5Sa8U

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October 19, 2011

CPT Coding Changes for 2012 for Interventional Pain

FSIPP Membership:

The new AMA 2012 CPT® code books are now available. The CPT® code changes that will impact interventional pain physicians (IPM) are provided in this link. Please look over these carefully and consult your billing department to inform them of these changes. Please read each description carefully as descriptions have been revised and the text in red represents new text.

• New codes for radiofrequency have been assigned with fluoroscopy bundled.
• For disc decompression, discography, epidural and fluoroscopy is bundled.
• Fluoroscopy is bundled for SI joints
  

Only the pertinent changes for interventional pain management are described in the following information. Click here for the 2012 IPM coding changes.

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October 17, 2011

Reminder: The Deadline to request a Medicare eRx incentive program hardship exemption for the 2012 eRx payment adjustment is November 1, 2011.

FSIPP Membership;

The Centers for Medicare & Medicaid Services (CMS) would like to remind eligible professionals and group practices participating in the Medicare electronic prescribing (eRx) incentive program that the deadline to request a hardship exemption for the 2012 eRx payment adjustment is November 1, 2011.

Eligible professionals and group practices should determine if they are subject to the 2012 eRx payment adjustment by reviewing the MLN Article SE1107 , “2011 Electronic Prescribing Incentive Program Update – Future Payment Adjustments.” If you believe that you may be subject to the 2012 eRx payment adjustment, you should determine if you meet any of the hardship exemption categories specified by CMS in the 2011 Medicare electronic prescribing (eRx) incentive program final rule.

Avoiding the 2012 eRx Payment Adjustment:
An eligible professional can avoid the 2012 eRx Payment Adjustment if he or she:

• Is not a physician (MD, DO, or podiatrist), Nurse Practitioner, or Physician Assistant as of June 30, 2011, based on primary taxonomy code in the National Plan and Provider Enumeration System (NPPES);
• Does not have prescribing privileges and reports G-code G8644 (defined as not having prescribing privileges) at least one time on an eligible claim prior to June 30, 2011;
• Does not have at least 100 cases containing an encounter code in the measure’s denominator;
• Becomes a successful electronic prescriber (submits required number of electronic prescriptions (10 for individual) via claims and reports this to CMS before June 30, 2011

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October 12, 2011

OIG 2012 Work-Plan

FSIPP Membership;

Attached is the OIG 2012 Work-Plan. We have extracted below a few key areas of focus. We recommend you scan this document.

Physicians and Suppliers: Compliance With Assignment Rules
We will review the extent to which providers comply with assignment rules and determine to what extent beneficiaries are inappropriately billed in excess of amounts allowed by Medicare. We will also assess beneficiaries’ awareness of their rights and responsibilities regarding potential billing violations and Medicare coverage guidelines. Physicians participating in Medicare agree to accept payment on an “assignment” for all items and services furnished to individuals enrolled in Medicare. (Social Security Act, § 1842(h)(1).) CMS defines “assignment” as a written agreement between beneficiaries, their physicians or other suppliers, and Medicare. The beneficiary agrees to allow the physician or other supplier to request direct payment from Medicare for covered Part B services, equipment, and supplies by assigning the claim to the physician or supplier. The physician or other supplier in return agrees to accept the Medicare-allowed amount indicated by the carrier as the full charge for the items or services provided. (OEI; 00-00-00000; expected issue date: FY 2013; new start)

Physicians and Other Suppliers: High Cumulative Part B Payments (New)
We will review payment systems controls that identify high cumulative Medicare Part B payments to physicians and suppliers. We will determine whether payment system controls are in place to identify such payments and assess the effectiveness of those controls. Medicare Part B services must be reasonable and necessary (Social Security Act, § 1862(a)(1)(A)), adequately documented (§ 1833(e)), and provided consistent with Federal regulations (42 CFR, § 410). A high cumulative payment is an unusually high payment made to an individual physician or supplier, or on behalf of an individual beneficiary, over a specified period. Prior OIG work has shown that unusually high Medicare payments may indicate incorrect billing or fraud and abuse. (OAS; W-00-12-35605; various reviews; expected issue date: FY 2012; new start)

Physician-Owned Distributors of Spinal Implants (New)
We will determine the extent to which physician-owned distributors (POD) provide spinal implants purchased by hospitals. We will also analyze Medicare claims data to determine whether PODs we identify in our review are associated with high use of spinal implants. PODs are business arrangements involving physician ownership of medical device companies and distributorships. PODs are focused primarily in the surgical arena and are currently primarily involve orthopedic implants such as spine and total joints. However, PODs appear to be quickly growing into other areas such as cardiac implants. (HHS OIG Work Plan | FY 2012 Part I: Medicare Part A and Part B Page I-18) Congress has expressed concern that PODs could create conflicts of interest and safety concerns for patients. (OEI; 01-11-00660; expected issue date: FY 2012; work in progress)

Physicians: Place-of-Service Errors
We will review physicians’ coding on Medicare Part B claims for services performed in ambulatory surgical centers and hospital outpatient departments to determine whether they properly coded the places of service. Federal regulations provide for different levels of payments to physicians depending on where services are performed. (42 CFR § 414.32.) Medicare pays a physician a higher amount when a service is performed in a nonfacility setting, such as a physician’s office, than it does when the service is performed in a hospital outpatient department or, with certain exceptions, in an ambulatory surgical center. (OAS; W-00-10-35113; W-00-11-35113; various reviews; expected issue date: FY 2012; work in progress)

Physicians: Incident-To Services (New)
We will review physician billing for “incident-to” services to determine whether payment for such services had a higher error rate than that for non-incident-to services. We will also assess CMS’s ability to monitor services billed as “incident-to.” Medicare Part B pays for certain services billed by physicians that are performed by nonphysicians incident to a physician office visit. A 2009 OIG review found that when Medicare allowed physicians’ billings for more than 24 hours of services in a day, half of the services were not performed by a physician. We also found that unqualified nonphysicians performed 21 percent of the services that physicians did not perform personally. Incident-to services represent a program vulnerability in that they do not appear in claims data and can be identified only by reviewing the medical record. They may also be vulnerable to overutilization and expose Medicare beneficiaries to care that does not meet professional standards of quality. Medicare’s Part B coverage of services and supplies that are performed incident to the professional services of a physician is in the Social Security Act, § 1861(s)(2)(A). Medicare requires providers to furnish such information as may be necessary to determine the amounts due to receive payment. (Social Security Act, § 1833(e).) (OEI; 00-00-00000; expected issue date: FY 2013; new start)

Physicians: Impact of Opting Out of Medicare (New)
We will review the extent to which physicians are opting out of Medicare and determine whether physicians who have opted out of Medicare are submitting claims to Medicare. We will also examine whether specific areas of the country have seen higher numbers of physicians opting out and its potential impact on beneficiaries. Physicians are permitted to enter into private contracts with Medicare beneficiaries. (Social Security Act, § 1802(b).) As a result of entering into private contracts, physicians must commit that they will not submit a claim to Medicare for any Medicare beneficiary.
(OEI; 07-11-00340; expected issue date: FY 2012; work in progress)

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October 5, 2011

Practitioner Profile Registration for Prescribing Controlled Substances for Chronic Pain

FSIPP Membership;

Effective January 1, 2012 in accordance with s. 456.44(2), Florida Statutes, an allopathic physician licensed under chapter 458, an osteopathic physician licensed under chapter 459, a podiatric physician licensed under chapter 461 or a dentist licensed under chapter 466 who prescribes any controlled substance as defined in s. 893.03, for the treatment of chronic nonmalignant pain, must designate himself or herself as a controlled substance prescribing practitioner on the practitioner profile.

You must register as a prescriber even if you are exempt:
To Register Go To: http://www.doh.state.fl.us/mqa/ControlledSubstance_RxReg.html

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October 5, 2011

Attorney Allen Grossman Update on Department of Health Activities Regarding Pain Clinic Laws

FSIPP Membership:

Please see below the recent update from Attorney Grossman regarding the BOM, BOOM and DOH activities in interpreting and enforcing the new prescribing and pain clinic laws.

I attended the Board of Medicine meetings this past weekend, including the Rules and Legislative Committee.  I am providing this report addressing the various aspects of the pain management law and rule as they were relevant during the meeting. 

As has previously been discussed, §458.3265(1)(a)1.b., Florida Statutes*, defines the term “pain management clinic” as any publicly or privately owned facility that advertises in any medium for any type of pain-management services; or where in any month a majority of patients are prescribed opioids, benzodiazipines, barbiturates, or carisoprodol for the treatment of chronic nonmalignant pain.  Section 458.3265(1)(a)2., Florida Statutes, requires such clinics to register with the Department of Health unless such clinic meets one of the eight identified exceptions to the registration requirement.  (Some of you have determined that you meet one or more of those specific exceptions and therefore have not registered with the Department of Health even though your activities meet the definition of a pain management clinic.

Section 458.3265(2)(a), Florida Statutes, prohibits a physician from practicing in a pain management clinic that is required to be registered unless it is actually registered.  Furthermore, any physician who qualifies to practice medicine in a pain-management clinic pursuant to rules adopted by the Board of Medicine as of July 1, 2012, may continue to practice medicine in a pain-management clinic as long as the physician  continues to meet the qualifications  set forth in the board rules. 

The Board of Medicine adopted its rule on the qualifications of physicians to practice in pain management clinics with an effective date of May 17, 2011.  (The Board of Osteopathic Medicine adopted a very similar rule [64B15-14.0051, Florida Administrative Code] with an effective date of March 16, 2011.)  The Board of Medicine’s rule, 64B8-9.0131, Florida Administrative Code, requires that any physician prescribing or dispensing  controlled substance medications in registered pain management clinics must meet one or more of the following qualifications:

(1)  Board certification by a specialty board recognized by the American Board of Medical Specialties (ABMS) and holds a sub-specialty certification in pain medicine;

(2)  Board certification in pain medicine by the American Board of Pain Management (ABPM);

(3)  Successful completion of a  pain medicine fellowship or residency accredited by  the ACGME;

(4)  Successful completion of a residency program in physical medicine and rehabilitation, anesthesiology, neurology, neurosurgery, family practice, internal medicine, orthopedics or psychiatry approved by the ACGME or hold a sub-specialty certification in hospice and palliative medicine or geriatric medicine recognized by the ABMS;

(5)  Hold current staff privileges at a Florida-licensed hospital to practice pain medicine or perform pain medicine procedures; or

(6)  Have 3 years of documented full-time practice, which is defined as an average of 20 hours per week each year, in pain-management and within six months  of the effective date of this rule, attendance and successful completion of 40 hours of in-person, live-participatory AMA Category I CME courses in pain management that address all the following subject areas:

(a)  The goals of treating both short term and ongoing pain treatment;

(b)  Controlled substance prescribing rules, including controlled substances agreements;

(c)  Drug screening or testing, including usefulness and limitations;

(d)  The use of controlled substances in treating short-term and ongoing pain syndromes, including usefulness and limitations;

(e)  Evidenced-based non-controlled pharmacological pain treatments;

(f)  Evidenced-based non-pharmacological pain treatments;

(g)  A complete pain medicine history and a physical examination;

(h)  Appropriate progress note keeping;

(i)  Comorbidities with pain disorders, including psychiatric and addictive disorders;

(j)  Drug abuse and diversion, and prevention of same;

(k)  Risk management; and

(l)  Medical ethics.

In addition, if a physician utilizes option (6) he or she must also document hospital privileges at a Florida-licensed hospital; practice under the direct supervision of a physician who is qualified under options (1)-(4); or have the practice reviewed by a  Florida-licensed risk manager and document compliance with all recommendations of the risk management review.

In spite of its acknowledgement that there do not appear to be any specific courses that provided the requirements, at its meeting last weekend, the Florida Board of Medicine decided once again not to amend its rule regarding the date by which a physician qualifying pursuant to option (6) must complete the 40 hour CME requirement.  As of right now, in spite of the fact that he statute provides for compliance by July 1, 2012, the Board of Medicine’s rule requires that the 40 hours of CME be completed by November 17, 2011.  The biggest problem in meeting that deadline is that no such single course has been identified.  The only course provider who has requested approval of a course, Dannemiller, was told that they had not provided enough information for the Board to grant approval.  For now, licensees are required to piece together 40 hours of individual courses that might reasonably be considered to include all of the required elements set forth in the rule.  It should be noted that nothing in the rule sets up a time-frame in which the CME hours could have been completed prior to the date set forth in the rule.  It might be possible to select various courses from a physician’s completed CME hours in prior years.  Most importantly, if any of your members are or employ physicians who will want to qualify to work in a registered pain management clinic on or after July 1, 2012, they need to make sure that the 40 hour CME requirement is fulfilled by the time set forth in the Boards’ rules.  It is likely that the Board will have to do some rulemaking because the current rule references dispensing of controlled substances, which is no longer permitted as a matter of law.  If such rulemaking is initiated, there may be another opportunity to ask the Board to address the issue of when the coursework must be completed for option 6.

*Each of the herein referenced statutory provisions has an identical provision in the Osteopathic Medicine Practice Act (Ch. 459, Florida Statutes.)

It appears that he Department of Health has activated the section in the on-line practitioner profiles for physicians to add their self-designation as a prescriber of controlled substances.  Section 456.44(2), Florida Statutes requires that before January 1, 2012, physicians who prescribe controlled substances for the treatment of chronic nonmalignant pain register as a controlled substance prescribing physician on their practitioner profile maintained by the Department of Health.  During the Board of Medicine meeting this past weekend, the Board finalized its Declaratory Statement to the Hospice physicians that asked the Board to confirm that they are not prescribing controlled substances for the “treatment of chronic nonmalignant pain” when they prescribe controlled substance pain medications for hospice patients who will need pain medication until they die.  (Draft copy attached)  However, a similar question asked by a group of physicians  who primarily perform interventional pain and other surgical procedures did not receive a response from the Board of Medicine.  The physicians provided a specific list of diseases and conditions that routinely require extended use of controlled substances for pain relief and asked whether because the pain was the result of an injury or disease that was within its reasonably expected duration (sometimes lifelong) their prescribing would be considered as being for the treatment of chronic nonmalignant pain, which is defined as being pain that persists beyond the usual course of disease or injury causing the pain.  Although the Board of Medicine ultimately declined to answer the question, during the course of their discussion, it was repeatedly acknowledged that the law clearly defines chronic nonmalignant pain as being outside the usual course of a disease or injury.  Logically then, a physician prescribing a controlled substance for pain that is existing during the reasonably defined “usual course” of the disease or injury causing the pain would not be prescribing controlled substances for the treatment of chronic nonmalignant pain.  We can expect to see more issues in this regard as the Department of Health and State Attorneys’ offices  attempt to prosecute physicians.

The Department of Health has taken the position in regard to the quarterly reporting of patient data by registered pain management clinics that follow-up patient visits should only be reported once each quarter.  Therefore, a continuing patient who returns to a clinic for prescriptions throughout the quarter should only be included once in the returning patient data, even if that patient had multiple follow-up visits during the quarter.   The Department only wants the number of patients not the actual number of visits at which prescriptions for controlled substances were provided.  This may be a bit confusing to anyone who read the reporting requirement and recommended reporting form to require identification of each returning patient encounter.

There was a rally against the Board of Medicine that was held during the Friday morning portion of the Board of Medicine’s meeting in Tampa.  The rally group was reportedly comprised of family  members who had lost young adults to drug overdoses.  They remained outside the hotel for the most part and did not disrupt the meeting in any way.  Their position appeared to be that the Board is not being hard enough on physicians who prescribe pain medications and that all production of Oxycontin should be halted.

For those of you who may be interested, I have attached a copy of the Department of Health’s recent Declaratory Statement on the issue of registering a pain management clinic.  In the reported case, the physician was operating a clinic with the word pain in the name of the clinic and wishes to advertise the clinic on the internet.  However, the physician held board certification by the American Board of Anesthesiology and the American Board of Pain Medicine (and others) and the physicians at the clinic did not prescribe controlled substances for the treatment of chronic nonmalignant pain for the majority of its patients.  Based on the owner physician’s specialty certification and the  fact that less than 50% of the clinic’s patients received controlled substance prescriptions for the treatment of chronic nonmalignant pain, the Department of Health opined that the clinic is not required to be registered.

Allen R. Grossman

 

 

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September 7, 2011

REGARDING; TRAINING REQUIRMENTS FOR PRACTICING IN A PAIN CLINIC, CMEs

NOTE: If you have given up your pain management clinic registration or have not been required to have your clinic registered, the following message is not necessarily applicable to you. However, this information and the regulatory “glitch” created by the rule may be significant enough for you to at least be aware of it, even if you do not currently hold a pain management clinic registration.

The Board of Medicine adopted rule 64B8-9.0131, Florida Administrative Code which became effective on May 17, 2011. This rule sets forth the training requirements that every physician who is prescribing or dispensing controlled substance medications in a registered pain management clinic must meet as of July 1, 2012. We previously provided you with the attached copy of the Board’s notice of this rule on May 6, 2011.

Although there are five other options:

1. ABMS specialty board certification with a sub-specialty certification in pain medicine;

2. American Board of Pain Medicine (ABPM) specialty certification;

3. Successful completion of an ACGME accredited fellowship or residency in pain medicine;

4. Successful completion of an ACGME accredited residency in physical medicine and rehabilitation, anesthesiology, neurology, neurosurgery, family practice, internal medicine, orthopedics or psychiatry or hold sub-specialty certification from an ABMS specialty board in hospice and palliative medicine or geriatric medicine;

5. Hold current staff privileges at a Florida licensed hospital to practice pain medicine or perform pain medicine procedures.

If any physician practicing in a registered pain management clinic does not meet one of these requirements by July 1, 2012 then that physician must be able to document 3 years of full time practice (average of 20 hours per week for each year) in pain management AND, within six months of the effective date of the rule (no later than November 17, 2011) have attended and successfully completed 40 hours of in-person, live, participatory AMA Category I CME in pain management that address the 12 specific areas set forth in the rule. In addition, physicians meeting the 40-hour CME option must also document either hospital privileges, or practice under the direct supervision (on premises) of a physician who qualifies through one of the first 4 options in the rule, or have the practice reviewed by a Florida licensed risk manager and document compliance with all recommendations. In addition, any physician qualifying by this final option must also document annual completion of 15 hours of live lecture format AMA Category I CME in pain management every year that the physician is practicing pain management.

Although these requirements do not become effective until July 1, 2012, on that date each physician will need to show that the requirements were met by November 17, 2011. (The Board of Osteopathic Medicine’s rule on training requirements, although very similar, became effective on November 8, 2010 and therefore, the date for completion of CME for the 6th option in their rule was May 8, 2011.) If the 40 hours of CME were not completed within the appropriate 6 month period, then technically the physician will not be in compliance with the July 1, 2012 requirements.

Should you have a physician working in your registered pain management clinic that needs to meet the 6th option, but is going to have a problem with the completion date, unless the Board’s choose to amend their rules before July 1, 2012, it may be necessary to seek a Waiver or Variance of the appropriate Board’s administrative rule either to seek an extension of time or to seek approval of CME completed outside of the required time frame.

Allen R. Grossman

September 16, 2011

Important Information about Your Rights to Practice Pain

Dear ABPM Diplomate,

As a Diplomate of the American Board of Pain Medicine (ABPM), I would like to share some important information regarding recent developments in Florida law, and request that you pass this information along to your colleagues.

Since 1999 the Florida Board of Medicine (FBM) has recognized the American Board of Pain Medicine (ABPM) as a legitimate non-ABMS Board recognized as equivalent for advertising purposes. This has not changed.

During the past several years Florida has seen a crisis involving the sale, administration, dispensing and prescribing of controlled substances. The State reacted to this illegal and abusive practice by passing a series of statutes and regulations attempting to curtail such practice. The laws, being amended and modified on numerous occasions have led to marked confusion among the medical profession.

Current laws, HB 7059, enacting legislation effective July 1, 2011, and 64B8-9.0131, FBM regulations effective July 1, 2011, are the only binding laws that address this issue. The Florida Medical Practice Act is being revised to bring it in conformity.

Accordingly, most physicians prescribing controlled substances for chronic non-malignant pain and practicing in a registered pain clinic must have completed at least 12 months of an ACGME Accredited fellowship training program in pain medicine. There are a number of qualifications and exceptions.

Any physicians certified as Diplomates by the ABPM as of July 1, 2012, are exempt from the training requirements. This exemption is in perpetuity under a grandfather clause, as long as the physician holds a valid ABPM Diplomate certificate.

This advice is based on legal opinions coming from highly regarded attorneys practicing in Florida. In as much as the enabling laws are ambiguous and complex, it is prudent and advisable, as always, to seek the legal opinion of your own attorney.

Those Diplomates who are scheduled to recertify in the next few years should keep this change in mind, and also consider the right to retake a failed exam prior to the expiration of certification when deciding whether or not to test early in 2012.

I also ask that you forward this email along to fellow Pain Medicine physicians in Florida that you feel may be qualified to take the 2012 Examination. Don't let them miss the opportunity to retain their rights as pain specialists. Please do encourage your colleagues to view the 2012 Certification requirements to determine if they meet current eligibility criteria.

There is still time to apply. The deadline for submitting an application to the American Board of Pain Medicine is September 30, 2011. The 2012 Certification examination and American Board of Pain Medicine MOC® examination will both be administered during the 3-week window of Saturday, April 7, 2011 through Saturday, April 28, 2011 at ACT testing centers nationwide.

For more information and to obtain the 2012 Bulletin of Information and all application materials, please visit www.abpm.org, or contact the ABPM office to request a copy of the Examination packet at (847)375-4726 or info@abpm.org.

ABPM believes that an ongoing commitment to the specialty of Pain Medicine is critical. I hope you will choose to encourage qualified individuals to apply for the 2012 Certification Examination.

Sincerely,
Michel Y. Dubois, MD
President, American Board of Pain Medicine

 

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September 7, 2011

REGARDING; TRAINING REQUIRMENTS FOR PRACTICING IN A PAIN CLINIC, CMEs

NOTE: If you have given up your pain management clinic registration or have not been required to have your clinic registered, the following message is not necessarily applicable to you. However, this information and the regulatory “glitch” created by the rule may be significant enough for you to at least be aware of it, even if you do not currently hold a pain management clinic registration.

The Board of Medicine adopted rule 64B8-9.0131, Florida Administrative Code which became effective on May 17, 2011. This rule sets forth the training requirements that every physician who is prescribing or dispensing controlled substance medications in a registered pain management clinic must meet as of July 1, 2012. We previously provided you with the attached copy of the Board’s notice of this rule on May 6, 2011.

Although there are five other options:

1. ABMS specialty board certification with a sub-specialty certification in pain medicine;

2. American Board of Pain Medicine (ABPM) specialty certification;

3. Successful completion of an ACGME accredited fellowship or residency in pain medicine;

4. Successful completion of an ACGME accredited residency in physical medicine and rehabilitation, anesthesiology, neurology, neurosurgery, family practice, internal medicine, orthopedics or psychiatry or hold sub-specialty certification from an ABMS specialty board in hospice and palliative medicine or geriatric medicine;

5. Hold current staff privileges at a Florida licensed hospital to practice pain medicine or perform pain medicine procedures.

If any physician practicing in a registered pain management clinic does not meet one of these requirements by July 1, 2012 then that physician must be able to document 3 years of full time practice (average of 20 hours per week for each year) in pain management AND, within six months of the effective date of the rule (no later than November 17, 2011) have attended and successfully completed 40 hours of in-person, live, participatory AMA Category I CME in pain management that address the 12 specific areas set forth in the rule. In addition, physicians meeting the 40-hour CME option must also document either hospital privileges, or practice under the direct supervision (on premises) of a physician who qualifies through one of the first 4 options in the rule, or have the practice reviewed by a Florida licensed risk manager and document compliance with all recommendations. In addition, any physician qualifying by this final option must also document annual completion of 15 hours of live lecture format AMA Category I CME in pain management every year that the physician is practicing pain management.

Although these requirements do not become effective until July 1, 2012, on that date each physician will need to show that the requirements were met by November 17, 2011. (The Board of Osteopathic Medicine’s rule on training requirements, although very similar, became effective on November 8, 2010 and therefore, the date for completion of CME for the 6th option in their rule was May 8, 2011.) If the 40 hours of CME were not completed within the appropriate 6 month period, then technically the physician will not be in compliance with the July 1, 2012 requirements.

Should you have a physician working in your registered pain management clinic that needs to meet the 6th option, but is going to have a problem with the completion date, unless the Board’s choose to amend their rules before July 1, 2012, it may be necessary to seek a Waiver or Variance of the appropriate Board’s administrative rule either to seek an extension of time or to seek approval of CME completed outside of the required time frame.

Allen R. Grossman

August 30, 2011

REMINDER: The Use of Mandatory Counterfeit-Proof Prescriptions Effective Aug 30

The new law requiring the use of counterfeit-proof prescription pads or printer paper when prescribing controlled substance(s) will be enforced effective Tuesday, August 30. You may recall the original effective date of July 1 was delayed by the State Surgeon General, Dr. Frank Farmer, for 60 days. The appropriate pads or printer paper must be purchased from a vendor approved by the Department of Health (DOH). The state approved vendor list includes 360 vendors from around the state and a list of frequently asked questions and answers. Both the vendor list and the frequently asked questions can be found at: http://doh.state.fl.us/mqa/counterfeit-proof.html.

Key Dates for Implementation of Prescription Drug Monitoring Program:

*Indicates projected date as released by the Department of Health and dates are subject to change.

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August 15, 2011

Dear FSIPP Membership;

Please see below Attorney Grossman’s summary.

The Board of Medicine at its meeting last week discussed matters that may have some relevance to your practice in and operation of a pain management clinic.

The Board decided to leave its current rule on the training requirements for physicians practicing in pain management clinics as it currently reads. The rule, 64B8-9.0131, Florida Administrative Code, which became effective May 17, 2011, provides the CME requirements that must be met by any physician who does not qualify through the other options set forth in the rule. (Three years of documented full-time practice in pain management and completion of 40 hours of in-person CME in specific topics set forth in the rule.) I provided a copy and some discussion of the rule back in early May before it became effective. Last week I tried to convince the Board that their language requiring that the CME course be completed within 6-months of the effective date of the rule will probably end up being problematic, but they declined to amend the language. Therefore, in order to practice in a registered pain management clinic after July 1, 2012, every physician must meet one of the qualifications listed in the rule:

ABMS board certification and a subspecialty certification in pain medicine or

Certification by the American Board of Pain Medicine (ABPM) or

Successful completion of a pain medicine fellowship or residency accredited by the ACGME or

Successful completion of an ACGME accredited residency in (1) physical medicine and rehabilitation, (2) anesthesiology, (3) neurology, (4) neurosurgery, (5) family practice, (6) internal medicine, (7) orthopedics, or (8) psychiatry or

Subspecialty certification recognized by the ABMS in hospice and palliative medicine or geriatric medicine or

Hold current staff privileges at a Florida licensed hospital to practice pain medicine or perform pain medicine procedures or

Complete the required CME by October 17, 2011 (as discussed above).


In response to a request by a CME provider for approval of a proposed course intended to provide the specific CME required for physicians practicing in pain management clinics after July 1, 2012, the Board appointed a board member to review the course and determine if it qualifies. The Board’s attorney announced a presumption that appropriate courses are out there, but the Board does not appear to have any knowledge of specific courses.

The director of the PDMP (Prescription Drug Monitoring Program) spoke to the Board and advised that they were going to be initiating rulemaking workshops to address issues for the PDMP. Under the new law, prescribing physicians are not required to query the program or enter information in the data bank. However, you should be aware that some local governments are including such requirements in local ordinances. (This goes hand in hand with those counties that are also requiring registration with DOH even if a pain management clinic is exempt from registration under the state law.) Please be sure that you have reviewed local city and county ordinances as they may apply to your practice. Some of them are specifically overriding the various exemptions from registration and compliance in the state law.

Throughout the meeting there were comments made by the Surgeon General, representatives of the Department of Health, and Board members, indicating their intention to be aggressive in matters related to pain management and protecting the public from the dangers of pain pill mills. The Surgeon General specifically announced his aggressive use of Emergency Suspension Orders that have and will continue to result from joint enforcement efforts between DOH and local law enforcement, federal agencies, and other state agencies. It appears that the DOH intends to shoot first and ask questions later.

Allen R. Grossman
Grossman, Furlow & Bayó, L.L.C.

 

July 21, 2011

CMS Specialty Medical Review Transforaminal Epidurals

FSIPP Membership:

CMS has initiated an interventional pain “Specialty Medical Review” of transforaminal epidurals. They have contracted with Strategic Health Solutions, LLC, the auditing entity. The reason for these audits is that a number of transforaminal epidurals do not meet the LCD requirements of Medicare contractors. Responses to audit requests should contain: H&P and/or progress note documenting the medical necessity, rationale for initiating TF injections and follow-up notes showing the efficacy of the injection.

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July 11, 2011

Pain Clinic Exemptions

FSIPP Membership;

I have received inquiries from a few of your FSIPP board members asking about the exemptions from clinic registration provided in §458.3265(1)(a)2.g. and h., Florida Statutes and §459.0137(1)(a)2.g. and h., Florida Statutes. Both of these exemptions require that the clinic be wholly owned by the specified specialists. For purposes of subparagraph g., that would mean all of the owners are either anesthesiologists, physiatrists or neurologists. For purposes of subparagraph h., that would mean that all of the owners are board certified physicians who have completed accredited fellowships in pain medicine OR who are board certified in pain medicine by an ABMS or AOA and perform interventional pain procedures of the type routinely billed using surgical codes. Although , I believe that it would be okay for all of the owners to meet any of the three options, all of the owners must fall into at least one of the identified groups or the exemptions cannot apply to the practice.

I am providing this statement to you because of the general applicability to your board and membership. If any of them are unsure of the application of this general statement to their specific practice or believe that there may be another exemption for which their practice might qualify and they care to retain my firm to review their specific circumstances, they are welcome to contact me about establishing a separate engagement agreement for our legal services.

Allen R. Grossman
Grossman, Furlow & Bayó, L.L.C.
2022-2 Raymond Diehl Road
Tallahassee, FL 32308
(850)385-1314
(850)385-4240 (fax)
www.gfblawfirm.com

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July 8, 2011

E-FORCSE website, PDMP use

FSIPP Membership:

The link below is available to the E-FORCSE website. The information at this link has been put together by the Department of Health to address issues likely to be of interest to physicians in regard to the new PDMP and its use.

http://www.eforcse.com/docs/Fact_Sheet_Health_Care_Practitioners.pdf

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July 7, 2011

DOH Order Suspends Required Counterfeit-Proof Rx Pads

FOR IMMEDIATE RELEASE

July 7, 2011

Contact: DOH Office of Communications
Nancy Blum, (850) 245-4111

STATE SURGEON GENERAL ISSUES A SUPPLEMENTAL ORDER TO PUBLIC HEALTH EMERGENCY DECLARATION

- Supplemental language suspends requirement for practitioners to use counterfeit proof prescription pads for 60 days -

TALLAHASSEE – In order to minimize unintended consequences of House Bill 7095, State Health Officer and Surgeon General, Dr. Frank Farmer today issued a supplemental order to his previously issued statewide public health emergency declaration. The supplemental order suspends the requirement for health care practitioners to use the Florida Department of Health (DOH) approved counterfeit proof prescription pads for any controlled substance as defined in Chapter 893 of the Florida Statutes, to run concurrent with the July 1, 2011 declaration.

Over the last several days, DOH has received phone calls from practitioners and patients stating that pharmacies have refused to fill otherwise-legitimate prescriptions for controlled substances because the prescriptions were not written on the approved counterfeit proof prescription pads. Currently, as many as 50,000 Florida-licensed physicians prescribe controlled substances to treat their patients’ medical needs.

“Once we began learning of the unintended consequences to law-abiding doctors and patients with legitimate health care needs, we knew we needed to take action to prevent substantial injury or harm to patients,” said Dr. Frank Farmer. “Issuing the supplemental order, provides practitioners the time needed to order the necessary prescription pads to ensure public safety over the long term.”

On June 15, 2011, DOH’s Division of Medical Quality Assurance published, on its website, a list of approved vendors from which practitioners can purchase the prescription pads. As of today, there are 91 DOH approved vendors on the website. The Division is actively working with the printing industry to increase the vendor list, to make certain each region of the state has an adequate number of participating printers. Any printer interested in becoming an approved vendor can download the application on DOH’s website.

“As a licensed practitioner myself, I understand the complexities of running a medical practice,” Dr. Farmer added. “But in the interest of public health and safety to stop the abuse of prescription drugs, I urge all of Florida’s licensed health care practitioners to visit DOH’s website and order the counterfeit proof prescription pads.”

Visit DOH’s website at http://www.doh.state.fl.us/mqa/counterfeit-proof.html for a listing of approved vendors, instructions on becoming a vendor, and answers to frequently asked questions regarding counterfeit-proof prescription pads. View the supplemental order. Practitioners with additional questions can call DOH’s Division of Medical Quality Assurance Customer Contact Center at (850) 488-0595 or email MQAOperations@doh.state.fl.us.

 

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July 6, 2011

PDMP Information

From FSIPP Counsel:HB7095 left the Prescription Drug Monitoring Program in place, but pushed back its starting point to later this year. Although physicians are not required under the new law to report to or inquire of the controlled substance prescription data base (PDMP or E-FORCSE [interesting name]) unless they are still dispensing controlled substances for one of the limited reasons permitted by statute, others such as pharmacies and wholesalers are required to fully participate. Physicians are however, permitted to obtain advisories from the databank or inquire of the databank if they desire.

For your information, attached is an update on the Department of Health’s progress in regard to the development and operation of the new databank. The link on the update provides additional information.

Allen R. Grossman

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July 1, 2011

BOM Pain Clinic Regulation July 1 Effective Date!

Good afternoon:

It has been brought to our attention that many of you have not received a letter our office sent out dated June 14, 2011 regarding important legislation going into effect as a result of the recent legislative session. A link to an electronic copy of this letter is included in the June Edition of the Message from the Chair, which we sent out yesterday. However, due to the potential impact of this on your medical practice as soon as July 1st, we thought it prudent to provide this information to you directly.

A copy of the letter is available on our website here: ftp://ftppub.doh.state.fl.us/pub/medicine/Special/Letter-JuneMessage.pdf. Depending on your computer and Internet settings, you may find that saving the file directly to your computer (right-click on the link and choose "Save As," tell it where to save the file, then double-click the file on your computer to open) works better than simply clicking the link above.

Thank you for the good work that you do. Feel free to contact our office with any questions or concerns.

____________________________

The Florida Board of Medicine
E-mail: mqa_medicine@doh.state.fl.us
Phone: 850-245-4131

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HB 7095 Changes in Effect Today

FSIPP Membership:

Our legal Counsel has advised us of the changes that will take place today as a result of HB 7095. Please see the attachment.

Deborah H. Tracy MD, MBA
FSIPP President

June 23, 2011

Deregister as a Pain Clinic

Dear FSIPP Membership:

We expect that most of the FSIPP membership will be exempt from Florida DOH Pain Clinic Registration, when the new law contained in HB 7095 goes into effect on July 1, 2011. If you are exempt by the new law you must deregister as a pain clinic with the DOH or you will still be subject to the Department requirements as a pain clinic. Write a letter to the DOH including your contact information and registration number to deregister.

If you need help with this task please contact Lorry Davis, director@flsipp.org, and
she will provide you with the names of Attorneys to assist you.

EXEMPTIONS
• Licensed as Chapter 395
• Majority of physicians provide surgical services
• Publicly owned and assets per quarter > $50 million
• Affiliated with Medical School (TO BE DEFINED)
• No CS prescribed
• Non-profit, 501 (c) 3
• Owned and operated by one or more
    - Board-certified Anesthesiologist, Physiatrist, Neurologist
    - Board-certified Medical Specialists
• Fellowship in pain medicine (ACGME approved)
• Board Certified in Pain Medicine (ABMS) and perform procedures routinely billed
as surgical codes.

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June 21, 2011

Medicare 5010 Conversion

Dear Membership:

FCSO, Medicare has advised the Society that it remains very concerned about the implementation of the 5010 version to HIPPA electronic transactions standards. Of the 600 clearing houses for electronic transmittal only about 30 are in active testing. The deadline for conversion is January 1, 2012. Please see the attachment for steps you can take to protect your practice against an interruption in cash flow. Those who have not converted to 5010 in January will NOT get paid.

 

May 31, 2011

FSIPP CORRECTION! Undispensed CS II & III Public Health Emergency

Dear FSIPP Membership:

• As you know HB7095 will take effect July 1, 2011 (not 2012 as we stated in error in our previous eblast - very sorry).
• Within 10 days of the effective date dispensing physicians (DEA) must return all undispensed CS II & III to distributor from which it was purchased in accordance with contract, or to law enforcement.
• The DOH declares this as a Public Health Emergency. Please find attached the Declaration of Public Health Emergency.