Don asked us to post this string of comments he, Dr. Stephen Nelson, Rep. Daw, Rachel, and Kye had regarding prescriber licensing. I posted them as one large comment. Click on "comments" link to see the entire sequence of email comments.SMART Management.
3 comments:
9/14/09
That’s the essence of it in my opinion. There are other questions which I think need to be included as well.
Kim Bateman and Lynn Webster are both very knowledgeable medical educators and are heavily invested in this subject.
To my knowledge, Lynn Webster is as on top of the subject of narcotic prescriber CME as anyone in the state. I believe we need his expertise/support in order to succeed with UMA. I’ve tried to contact Lynn but have not heard back from him. Do any of you know him?
Is it too late to invite Lynn and perhaps Kim to the retreat?
Steve
Stephen Nelson, MD
Intermountain WorkMed Springville
385 S 400 E
Springville, UT 84663
(801) 491-6400 phone
(801) 491-6449 fax
9/14/09
Hey y’all,
Steve and I both feel that the number of CME hours and maybe even the idea of CME hours is foreboding. Steve let me know if I’m off base, but the idea is to incorporate a 1-2 hour educational webcast or test questions that 1) informs docs that CSDB is out there and very useful, 2) designated people in the office can actually do the CSDB search, 3) CSDB reports can be printed and placed in patients chart, 4)the problem w/ prescription narcotic abuse and misuse is causing an unacceptable number of problems and death and that a multifaceted, multi-group effort is being employed to control the problem, one approach happens to be targeted at the supply and hence the prescribing body in the state of Utah, ie docs, dentists, PA’s, NP’s.
What do ya think?
Don
9/14/09
That should have been a reply-all. The number came from DOPL and I'm certainly open to negotiation on that point.
Brad
9/14/09
My question is: how big should the stick be?
Somebody please tell me where Brad came up with the 20 hour CME requirement. I think it is excessive.
Steve
Stephen Nelson, MD
Intermountain WorkMed Springville
385 S 400 E
Springville, UT 84663
(801) 491-6400 phone
(801) 491-6449 fax
9/14/09
Sounds interesting.
As for working with these other groups, I think it is important to know what Rep Beck, Rep Ray, Senator Jones and the AG's Office has in mind, Maybe Rep Daw has some insight there.
As to Michelle's comments, where is her stick? I can see the carrot, but not the stick. Unless we change some laws and require change . . . nothing will change. Think of reductions in tobacco smoking, the reductions came after policy change (e.g. tax increases, restrictions on use in public places).
Sounds to me like the community is screaming for change or else legislators and community groups would not be working to make change. We are on the right side of this issue.
Don, you ask what AG is, I believe she is referring to the Attorney General.
Should we be publishing these comments on the blog so we have a continuos record?
Kye
9/14/09
I really wish Michelle would get back to me on this. She's had plenty of time to bring these concerns to me. FYI AG is Attorney General. That would be Mark Shurtleff. If that many people are teeing up this kind of legislation, Michelle would be well advised to pick the easiest person to work with and try to get something that UMA could live with. Anyway this is very good information.
Brad Daw
9/11/09
Steve, Kye, Rep Daw,
I talked with Michelle McOmber the new UMA Exec VP, this is the long term work horse of the UMA. She advised me that the meeting today is not for the likes of us. In fact, neither is the monthly Board Member meetings. Apparently what she has done in the past is meet w/ Rep Daw and discuss his bills. Apparently, he has met a number of times w/ Michelle. Anyway, her stance is that the UMA prefers to not legislate but rather encourage doctors to write more responsibly. She mentioned a carrot and stick approach rather than a stick only approach. She also does not like to have assigned number of CME hours prescribed particularly in the face of a void of available CME in narcotic prescribing.
Another thorn in her side is that there are at least three other congressmen pushing related legislation: Rep Beck, Rep Ray and Senator Jones, not to mention the AG's Office (no, I don't know what that is exactly, Adjugent General?) and several SPF organizations, ie state and county health department. Perhaps we should meet w/ them and coordinate our efforts or not.
Let me know when is a good time to try to meet w/ Michelle McOmber, Rep Daw and each of you and I'll try to coordinate an meeting.
Warmly,
Don
9/9/09
I am definitely interested.
I don't know how Brad came up with the 20-hour CME requirement for his draft. I am inclined toward a simpler, much shorter approach using a webinar-type online test--part of the renewal itself--in which you can keep answering questions until you get them right. Kim Bateman was also sympathetic towards this approach.
If designed well, this method truly instructs and evaluates at the same time. I believe it could be effective and meet with far less resistance.
Steve
Stephen Nelson, MD
Intermountain WorkMed Springville
385 S 400 E
Springville, UT 84663
(801) 491-6400 phone
(801) 491-6449 fax
9/9/09
Steve, Rep Daw, Kye,
I talked w/ the UMA secretary Paul Winterton, MD about Friday's meeting. Although initially he suggested that I attend that meeting, after talking with him in more detail he suggested that a better approach to finding the UMA's stance on this issue is to get on the UMA Board of Directors Meeting agenda. Meetings are held monthly and he suggested I contact Michelle McOmber, the Exec VP elect who will take office in one week. So, I will contact Michelle McOmber and talk to whomever I need to in order to get on the agenda. I'll let you know the details. I sure would like for you and me to go to that meeting if you can make yourself available. I'll check w/ Kye also.
Fraternally,
Don Fairbanks
9/3/09
Since finishing my residency in 1980, I have been required, as a diplomate of the American Board of Family Practice, to take a daylong recertification exam every 7 years. There are other specialties (but not all) which have taken similar initiatives. State medical boards, health care organizations, and third party payors have always accepted passage of the AAFP recertification exam as evidence of general competency.
I recall very little emphasis on prescription drug abuse in those exams.
The FSMB Maintenance of Licensure website provides ample precedent for addressing general medical competency at the time of license renewal. But there is nothing specific to controlled substance licensure.
Every prescriber of controlled substances in the state of Utah must have two licenses--a DEA license from the federal government, and a Controlled Substances license from the state of Utah. At present, the DEA does not have a requirement for examination at the time of license renewal (?every 3 years). Any change nationwide would have to come from the DEA.
FSMB's Frances Cain indicated in her reply to Rachel that it is up to each individual state to develop and implement its own competency requirements for its Controlled Substances license.
Perhaps the DEA has something in the works at the national level. Perhaps other states with controlled substances licenses mentioned by Frances have competency requirements for renewal. Can you check into these two things, Rachel?
Steve
Stephen Nelson, MD
Intermountain WorkMed Springville
385 S 400 E
Springville, UT 84663
(801) 491-6400 phone
(801) 491-6449 fax
September 03, 2009 12:13 PM
-----Original Message-----
From: Rachel Moulton [mailto:rachelm.ucadm@state.ut.us]
Sent: Thursday, September 03, 2009 12:13 PM
To: don_fairbanks@byu.edu; braddaw@gmail.com; Stephen Nelson
Cc: Kye Nordfelt
Subject: Physician Licensing
Dr. Fairbanks, Dr. Nelson, and Representative Daw,
I've been doing some research on the physician licensing process (revising, updating, and requiring more frequent license renewals). It looks like someone is way ahead of us...
http://www.fsmb.org/m_mol.html . This is the Federation of State Medical Boards (FSMB) and the model they are working on called Maintenance of Licensure (MOL). Check out the FAQ's. I will attach it to this email as well.
To me it looks like they are trying to implement everything we want to do regarding the physician license already. I'm not sure if this model will eventually become a requirement of just be handed to DOPL as a recommendation. I'm working on getting more details.
Have any of you heard about this already? If so, I'm sorry to bother you, as I know you are all very busy. Under the research tab on the web page it looks like they at least have some good evidence we could take advantage of.
I hope this is helpful!
Rachel Moulton
Utah County Health Department
Division of Substance Abuse Prevention
RachelM.UCADM@state.ut.us
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